Does the implementation of clinical practice guidelines for low back and neck pain by physical therapists improve patient outcomes? A systematic review

Abstract

Background Physical therapy for neck and low back pain is highly variable despite the availability of clinical practice guidelines (CPG). This review aimed to determine the impact of CPG implementation on patient-level outcomes for spinal pain. Implementation strategies were also examined to determine prevalence and potential impact. Methods Multiple databases were searched through April 2021 for studies assessing CPG implementation in physical therapy for neck and low back pain. Articles were screened for eligibility. The Modified Downs and Black checklist was utilized to determine study quality. Due to the heterogeneity between studies, a meta-analysis was not performed. Results Twenty-one studies were included in this review. Implementation strategies were significantly varied between studies. Outcomes pertaining to healthcare utilization, pain, and physical functioning were assessed in relation to the implementation of CPGs. Multiple implementation strategies were identified, with Managing Quality as the most frequently utilized key implementation process. Findings indicate CPG implementation decreased healthcare utilization, but inconsistent results were found with physical functioning and pain outcomes. Conclusions CPG implementation appears to have a beneficial effect on healthcare utilization outcomes, but may not impact pain and physical functioning outcomes. Effective CPG implementation strategies remain unknown, though utilizing implementation framework may improve outcomes. More research is needed to determine the most effective implementation strategies and effects on pain and physical function outcomes.

Developing a low back pain guideline implementation programme in collaboration with physiotherapists and chiropractors using the Behaviour Change Wheel: a theory-driven design study

“…Several studies have evaluated the effect of implementation strategies for implementing LBP guidelines among HCPs on patients [ 6 , 33 , 56 , 57 ] and HCPs [ 32 , 33 , 36 , 56 – 58 ]. However, to our knowledge, only four studies have described the development process of their implementation programmes [ 59 – 62 ], suggesting that these development studies are needed in the field of implementation programme evaluation.…”

“…LBP is associated with a significant burden to patients, reporting that LBP has adverse effects on their social lives, emotional state, and ability to work [ 3 ]. Simultaneously, LBP is the condition for which the most significant number of people may benefit from evidence-based rehabilitation [ 4 ], a claim supported by a significant body of literature showing that the provision of evidence-based rehabilitation for patients with LBP leads to a decrease in healthcare utilisation compared to non-evidence-based care [ 5 , 6 ]. To support healthcare professionals (HCPs) in providing evidence-based care, health authorities in most countries continuously produce and update clinical practice guidelines [ 7 ].…”

Adherencia a recomendaciones basadas en evidencia para enfermedades crónicas no transmisibles: estudio de corte transversal multicéntrico en médicos de Bogotá

“…The objective of CPGs, as compiled from evidence-based recommendations, is to improve clinical outcomes, avoid unjustified variability in clinical practice, implement health resources more efficiently, and reduce inequity gaps (9,11). Consistently, greater adherence of users to CPG has improved clinical outcomes and reduced health costs in CNCD patients (12)(13)(14)(15)(16).…”