Effectiveness of multifaceted implementation strategies for the implementation of back and neck pain guidelines in health care: a systematic review

Abstract

BackgroundFor the optimal use of clinical guidelines in daily practice, mere distribution of guidelines and materials is not enough, and active implementation is needed. This review investigated the effectiveness of multifaceted implementation strategies compared to minimal, single, or no implementation strategy for the implementation of non-specific low back and/or neck pain guidelines in health care.MethodsThe following electronic databases were searched from inception to June 1, 2015: MEDLINE, Embase, PsycInfo, the Cochrane Library, and CINAHL. The search strategy was restricted to low back pain, neck pain, and implementation research. Studies were included if their design was a randomized controlled trial, reporting on patients (age ≥18 years) with non-specific low back pain or neck pain (with or without radiating pain). Trials were eligible if they reported patient outcomes, measures of healthcare professional behaviour, and/or outcomes on healthcare level. The primary outcome was professional behaviour. Guidelines that were evaluated in the studies had to be implemented in a healthcare setting. No language restrictions were applied, and studies had to be published full-text in peer-reviewed journals, thus excluding abstract only publications, conference abstracts, and dissertation articles. Two researchers independently screened titles and abstract, extracted data from included studies, and performed risk of bias assessments.ResultsAfter removal of duplicates, the search resulted in 4750 abstracts to be screened. Of 43 full-text articles assessed for eligibility, 12 were included in this review, reporting on 9 individual studies, and separate cost-effectiveness analyses of 3 included studies. Implementation strategies varied between studies. Meta-analyses did not reveal any differences in effect between multifaceted strategies and controls.ConclusionThis review showed that multifaceted strategies for the implementation of neck and/or back pain guidelines in health care do not significantly improve professional behaviour outcomes. No effects on patient outcomes or cost of care could be found. More research is necessary to determine whether multifaceted implementation strategies are conducted as planned and whether these strategies are effective in changing professional behaviour and thereby clinical practice.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0482-7) contains supplementary material, which is available to authorized users.

Clinical guidelines for low back pain: A critical review of consensus and inconsistencies across three major guidelines

“…In a systematic review of the implementation interventions designed to improve clinical practice for the management of LBP in low back pain Mesner et al [33] found that a range of interventions had been applied but that single, one-off strategies were consistently unsuccessful and there was no consistent pattern with regards the differential effectiveness of the different types of implementation events utilised. Suman et al [34] systematically reviewed the evidence of the effectiveness of multifaceted guideline implementation strategies for back and neck pain and did not find consistent benefits when they were compared to either usual or minimal intervention. Mesner et al [33] concluded that frequency of messaging may be important as ongoing and regular interventions demonstrated greater success in changing practice and sustaining those changes, but advise caution on the basis of between study heterogeneity and risk of bias in the included literature.…”

Protocol for the development of guidance for stakeholder engagement in health and healthcare guideline development and implementation

“…Many guideline groups that have sought to involve stakeholders have utilized limited numbers of participants or utilized slow and labor-intensive processes (e.g., time and resources needed to administer, collate, and respond to over 200 stakeholder views and comments) [12]. It is recognized that successful guideline development and implementation requires the engagement of multiple stakeholders [24] and "shared solutions" (input from patients, clinicians, and policymakers) improve health outcomes [24][25][26]. Patient/public stakeholders may potentially feel intimidated to contribute if they are only one voice among many.…”

Effectiveness and cost-utility of a multifaceted eHealth strategy to improve back pain beliefs of patients with non-specific low back pain: a cluster randomised trial

“…The results of the current study are in line with other studies that have attempted to improve patient outcomes and costs in LBP by using multifaceted strategies. A systematic review of the effectiveness of multifaceted strategies for guideline implementation in LBP and neck pain did not find that multifaceted strategies changed patient outcomes or costs of care 45. However, the majority of the studies included in the review did not provide insight into the implementation process, raising the question whether the lack of effectiveness is caused by the failure of the theory (multifaceted strategy) or by failure of the implementation process, making it difficult to compare the current study to others.…”