Improved adherence to clinical guidelines for low back pain after implementation of the BetterBack model of care: A stepped cluster randomized controlled trial within a hybrid type 2 trial

Schröder, Karin; Öberg, Birgitta; Enthoven, Paul; Hedevik, Henrik; Abbott, Allan

doi:10.1080/09593985.2022.2040669

Cited by 6 publications

(11 citation statements)

References 60 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The conflicting findings on HCP outcomes might be explained by significant methodological concerns such as the possibility of selection bias. It is likely that the HCPs who agreed to participate in the studies had extensive experience, continued education and were more inclined to be adherent with high quality of treatment and high baseline measurements, leaving less potential for improvement (31,32,38,39,48,49,51,52,59,61,63,66,67). Furthermore, the participating HCPs may have been more motivated with a positive attitude towards the implemented intervention implying a readiness to change (40,43,48–50,58,59).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Implementation Interventions in Musculoskeletal Healthcare: A Systematic Review

Hansen,

Bahnsen,

Nørgaard

et al. 2023

Preprint

View full text Add to dashboard Cite

BackgroundImplementing new knowledge into clinical practice is a challenge, but nonetheless crucial to improve our healthcare system related to the management of musculoskeletal pain. This systematic review aimed to assess the effectiveness of implementation interventions within musculoskeletal healthcare.MethodsWe searched Medline, Embase, Cochrane Central Register of Controlled Trials, and Scopus. Any type of randomised controlled trials investigating implementation strategies or interventions in relation to musculoskeletal pain conditions were included. Risk of bias were assessed using the Cochrane Risk of Bias 2 tool. Data analysis was done using frameworks from Powell et al. 2015, and Waltz et al. 2015 and outcomes were identified by Thompson et al. 2022 or self-made outcome domains were established.ResultsThe literature search yielded 14,265 original studies, of which 38 studies from 31 trials, with 13,203 participating healthcare professionals and 30,320 participating patients were included in the final synthesis. Nineteen studies had a high risk of bias, sixteen had a moderate risk of bias, and three had a low risk of bias. Twenty distinct implementation interventions were identified. A significant heterogeneity in the utilised outcome measurements was observed, thereby rendering a meta-analysis infeasible; consequently, all outcomes were classified into six outcome domains for healthcare professionals, seven for patients and one for cost-effectiveness.ConclusionsOur findings suggest that some implementation interventions may have a tendency towards a statistically significant positive effect in favour of the intervention group on the outcome domain “Adherence to the implemented interventions” for healthcare professionals in the included studies. The remaining outcome domains yielded varying results; therefore, these findings should be interpreted with caution. Future high-quality trials with clear reporting and rationale of implementation strategies and interventions utilising standardised nomenclature are needed to further advance our understanding of this area.Trial registrationOpen Science Framework, DOI:10.17605/OSF.IO/SRMP2

show abstract

Section: Discussionmentioning

confidence: 99%

Effectiveness of Implementation Interventions in Musculoskeletal Healthcare: A Systematic Review

Hansen,

Bahnsen,

Nørgaard

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…The 11 MoCs implemented in primary healthcare for the management of LBP patients are the STarT Back, 34 35 46 56-58 SCOPiC, [59][60][61] MATCH, 36 62 TARGET, [37][38][39] BetterBack☺ MoC, [40][41][42][43] Low Back and Radicular Pain Pathway, 44 45 47-49 Beating Back Pain Service (BBPS), 50 North East Essex Primary Care Trust (PCT) manual therapy service, 51 Interprofessional Spine Assessment and Education Clinics (ISAEC), 52 Saskatchewan Spine Pathway (SSP) 53 54 and Back Pain Assessment Clinic (BAC). 55 All MoCs were implemented in high-income countries from Europe, North America and Australia (figure 2).…”

Section: General Descriptionmentioning

confidence: 99%

“…However, adaptations of this MoC, with significant adjustments to its core characteristics, were also implemented in the USA (MATCH and TARGET) 36-39 62 and Sweden (BetterBack☺). [40][41][42][43] The target population of the MoCs involved adults with LBP, with or without radicular pain, or radiculopathy. North East Essex PCT manual therapy service 51 and BAC 55 also included patients with neck pain.…”

Section: General Descriptionmentioning

confidence: 99%

Low back pain management in primary healthcare: findings from a scoping review on models of care

Duarte,

Moniz,

Costa

et al. 2024

BMJ Open

View full text Add to dashboard Cite

IntroductionModels of care (MoCs) describe evidence-informed healthcare that should be delivered to patients. Several MoCs have been implemented for low back pain (LBP) to reduce evidence-to-practice gaps and increase the effectiveness and sustainability of healthcare services.ObjectiveTo synthesise research evidence regarding core characteristics and key common elements of MoCs implemented in primary healthcare for the management of LBP.DesignScoping review.Data sourcesSearches on MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials, PEDro, Scopus, Web of Science and grey literature databases were conducted.Eligibility criteriaEligible records included MoCs implemented for adult LBP patients in primary healthcare settings.Data extraction and synthesisData extraction was carried out independently by two researchers and included a summary of the studies, the identification of the MoCs and respective key elements, concerning levels of care, settings, health professionals involved, type of care delivered and core components of the interventions. Findings were investigated through a descriptive qualitative content analysis using a deductive approach.Results29 studies reporting 11 MoCs were included. All MoCs were implemented in high-income countries and had clear objectives. Ten MoCs included a stratified care approach. The assessment of LBP patients typically occurred in primary healthcare while care delivery usually took place in community-based settings or outpatient clinics. Care provided by general practitioners and physiotherapists was reported in all MoCs. Education (n=10) and exercise (n=9) were the most common health interventions. However, intervention content, follow-ups and discharge criteria were not fully reported.ConclusionsThis study examines the features of MoCs for LBP, highlighting that research is in its early stages and stressing the need for better reporting to fill gaps in care delivery and implementation. This knowledge is crucial for researchers, clinicians and decision-makers in assessing the applicability and transferability of MoCs to primary healthcare settings.

show abstract

“…Adherence to clinical guidelines has been shown to reduce complications and improve patient care 4–6 . Despite a large amount of evidence available, varied practice is still commonly observed worldwide with an average guideline adherence rate of only 34% 7 .…”

Section: Introductionmentioning

confidence: 99%

“…In response to procedural complexity and negative consumer feedback surrounding peripheral intravenous catheter (PIVC) performance, 1 3 Adherence to clinical guidelines has been shown to reduce complications and improve patient care. [4][5][6] Despite a large amount of evidence available, varied practice is still commonly observed worldwide with an average guideline adherence rate of only 34%. 7 Numerous studies have suggested a wide range of concerns regarding PIVC insertion and management in EDs, where nearly onethird of PIVCs (26-32%) are inserted.…”

Section: Introductionmentioning

confidence: 99%

Exploring Australian emergency department clinicians' knowledge, attitudes and adherence to the national peripheral intravenous catheter clinical care standard: A cross‐sectional national survey

Rickard

Takashima

et al. 2023

Emerg Medicine Australasia

View full text Add to dashboard Cite

ObjectiveThis study aimed to (i) capture clinicians' knowledge, attitude and adherence to the first Australian national peripheral intravenous catheter (PIVC) Clinical Care Standard, (ii) examine the instrument performance of the knowledge related questions and (iii) explore the educational needs for, and barriers to, Standard adherence among Australian ED clinicians.MethodsA cross‐sectional national online survey was conducted from March to June 2022, using a snowball sampling method. The survey used 5‐point Likert scales and multiple‐choice questions to capture respondents' knowledge, attitude and adherence to the Standard as well as the educational needs for, and barriers to, Standard adherence.ResultsIn total, 433 ED nurses and doctors responded. Although nearly half (n = 206, 47.6%; 95% confidence interval [CI] 55.5–65.8) of respondents claimed that they were unfamiliar with the Standard, questions on PIVC knowledge yielded that most respondents had adequate knowledge of most of the key standards. Respondents' attitudes towards multiple intravenous insertion attempts and ongoing PIVC competency monitoring are not in agreement with the Standard. Self‐reported practices regarding routine insertion of idle catheters (55%; 95% CI 49.9–59.9), using antecubital fossa as the first insertion site (84%; 95% CI 80–87), insertion without confidence (46%; 95% CI 41.2–51.1) and lack of routine reviewing the ongoing needs of PIVC (40%; 95% CI 35.3–45.1) were not aligned with the Standard. Unawareness of the Standard and non‐practical recommendations were rated as the top barriers to Standard adherence.ConclusionThe findings of the survey suggest that the Standard may need modification to align with the needs of ED clinicians. Future studies need to explore the applicability and relevancy of some recommendations in the ED settings as they may cause low adherence to the Standard.

show abstract

Improved adherence to clinical guidelines for low back pain after implementation of the BetterBack model of care: A stepped cluster randomized controlled trial within a hybrid type 2 trial

Cited by 6 publications

References 60 publications

Effectiveness of Implementation Interventions in Musculoskeletal Healthcare: A Systematic Review

Effectiveness of Implementation Interventions in Musculoskeletal Healthcare: A Systematic Review

Low back pain management in primary healthcare: findings from a scoping review on models of care

Exploring Australian emergency department clinicians' knowledge, attitudes and adherence to the national peripheral intravenous catheter clinical care standard: A cross‐sectional national survey

Contact Info

Product

Resources

About