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

Abstract

Background and Purpose. An active strategy was developed for the implementation of the clinical guidelines on physical therapy for patients with low back pain. The effect of this strategy on patients' physical functioning, coping strategy, and beliefs regarding their low back pain was studied. Subjects. One hundred thirteen primary care physical therapists treated a total of 500 patients. Methods. The physical therapists were randomly assigned to 1 of 2 groups. The control group received the guidelines by mail (standard passive method of dissemination). The intervention group, in contrast, received an additional active training strategy consisting of 2 sessions with education, group discussion, role playing, feedback, and reminders. Patients with low back pain, treated by the participating therapists, completed questionnaires on physical functioning, pain, sick leave, coping, and beliefs. Results. Physical functioning and pain in the 2 groups improved substantially in the first 12 weeks. Multilevel longitudinal analysis showed no differences between the 2 groups on any outcome measure during follow-up. Discussion and Conclusion. The authors found no additional benefit to applying an active strategy to implement the physical therapy guidelines for patients with low back pain. Active implementation strategies are not recommended if patient outcomes are to be improved.

Psychologists’ Application of Clinical Guidelines and Recommended Protocols and Procedures within State Insurance Regulatory Authority Insurance Frameworks: Outcomes for Injured Patients with Musculoskeletal Injuries

“…Stephens and Gross () found that EBP protocol adherence improved RTW outcomes for injured patients with musculoskeletal injuries and resulted in a savings of approximately $21.5 million for the Workers Compensation Board of Alberta (Canada). Conversely, guideline adherence by Dutch physiotherapists did not improve patient outcomes or reduce costs (Bekkering et al, ). Another study argued that for positive health‐related outcomes, the guideline adherence has to be at least 75%, which may explain why the anticipated outcomes in Bekkering et al () did not emerge (Fritz, Cleland, & Brennan, ).…”

“…Conversely, guideline adherence by Dutch physiotherapists did not improve patient outcomes or reduce costs (Bekkering et al, ). Another study argued that for positive health‐related outcomes, the guideline adherence has to be at least 75%, which may explain why the anticipated outcomes in Bekkering et al () did not emerge (Fritz, Cleland, & Brennan, ). The findings in Phase 2 (analysis of the WCI cases) revealed that the highest claim costs and poorest injured patient outcomes occurred when there was no adherence to the treatment guidelines.…”

Minimally important change determined by a visual method integrating an anchor-based and a distribution-based approach

“…From May 2001 until December 2002 patients with non-specific LBP who were referred for physiotherapy were recruited for a randomised controlled trial, comparing an active strategy for the implementation of clinical guidelines on physiotherapy for LBP with the standard method of implementation [ 17 ]. In total, 500 patients were included.…”

The effectiveness of implementation strategies for promoting evidence informed interventions in allied healthcare: A Systematic Review

“…One study described educational meetings, [18] one study described local opinion leaders, [19] one study described patient mediated intervention [14] and three studies described multi-faceted components. [21], [22], [23] Four studies involved physiotherapists, [19], [21], [22], [23] one with paramedics [20] and one with speech language therapists. [18] Three studies were from the UK, [18], [19], [20] two from the Netherlands [22], [23] and one from Australia.…”