Development of an implementation strategy for physiotherapy guidelines on low back pain

Abstract

In the Netherlands, clinical practice physiotherapy guidelines are mainly implemented by using passive implementation strategies. It is well known that these strategies are not effective in establishing changes in behaviour of health care professionals. Therefore, a new implementation strategy was developed for the physiotherapy guidelines on low back pain. This paper describes the method for the design of this strategy. A survey was conducted of 100 physiotherapy practices to identify perceived barriers to implementation of the guidelines and the most important discrepancies between current practice and recommendations of the guidelines. The strategy was further developed using a model for changing professionals' behaviour and systematic reviews on the effectiveness of implementation interventions. The most frequently reported barriers for implementation of the guidelines are related to a lack of knowledge or skills of physiotherapists. The most frequently reported discrepancies between physiotherapy practice and guidelines recommendations were related to the focus of the diagnostic process on impairments, the common use of passive physiotherapeutic interventions, the frequent use of a pain-contingent approach, and the expectations of the patient. The new implementation strategy consisted of multiple interventions, namely education, discussion, role-playing, feedback and reminders. The strategy addressed perceived barriers and discrepancies between current practice and the recommendations of the guidelines.

Implementation of Clinical Guidelines on Physical Therapy for Patients With Low Back Pain: Randomized Trial Comparing Patient Outcomes After a Standard and Active Implementation Strategy

“…The strategy consisted of 2 training sessions, each lasting 2.5 hours with groups of 8 to 12 physical therapists. 17 For each session, a preparation time of 2 hours was recommended. The aim of the strategy was to improve the knowledge and skills of physical therapists with regard to evidence-based physical therapy for patients with low back pain.…”

“…Each item is scored on a 4-point scale ranging from 1 ("seldom or never") to 4 ("very often"). Reversed items were recoded and separate sum scores were calculated for 3 active coping strategy subscales (transforming [4 -16], relaxation [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], and lowering demands [3][4][5][6][7][8][9][10][11][12]) and for 3 passive coping strategy subscales (withdrawing , catastrophizing [9 -36], and resting [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]). A higher score refers to the use of more active and passive coping strategies for active and passive subscales, respectively.…”

“…The active strategy was further developed using a model for changing behavior of professionals and systematic reviews on the effectiveness of implementation interventions. 17 In this article, we describe the effects of this active implementation strategy for the Dutch guidelines for patients with low back pain, with specific attention to patient outcomes. This article accompanies an article published in the Journal of Quality and Safety of Health Care 18 that describes positive effects of the active implementation strategy on adherence of the physical therapists to the guidelines.…”

Are physiotherapy guidelines for the management of osteoporosis being implemented? A UK-wide survey

“…Optimal strategies include the involvement of a local opinion leader, interaction between researchers and research users, reminders to care providers, and facilitating change through increased resources and training. [16][17] [28] [29] In the current study it was evident that some of the implementation strategies thought to be most effective were not used very often. This may be responsible for under-use of the guideline, as passive dissemination may not be sufficient to address barriers to guideline use.…”

“…[18] A Dutch survey of physiotherapists achieved a 76% response rate, with no documented incentive. [28] In the UK however, a lower response rate of 54% resulted in a survey of GPs. [23] All of these studies attracted higher response rates than the present study.…”