The effectiveness of interventions designed to increase the uptake of clinical practice guidelines and best practices among musculoskeletal professionals: a systematic review

Abstract

BackgroundThe objective of this systematic review was to summarize and evaluate evidence about the effectiveness of knowledge translation (KT) interventions to improve the uptake and application of clinical practice guidelines and best practices for a wide range of musculoskeletal (MSK) disorders and health care professionals.MethodsA search for relevant randomized controlled trials (RCTs) published in English was conducted in MEDLINE (Ovid interface), EMBASE, CINAHL, and CENTRAL (Cochrane library). Two independent reviewers selected studies, assessed risk of bias, and extracted data. All MSK disorders were included except MSK injuries, fractures, trauma, or inflammatory disorders.ResultsA total of 7904 citations yielded 11 eligible RCTs. The targeted MSK disorders included: low back pain (n = 5), neck pain (n = 2), whiplash (1), spinal disorders (n = 1), and osteoarthritis of the hip and knee (n = 2). Studies primarily involved physiotherapists, chiropractors, and a mix of physiotherapists, chiropractors and osteopaths. Results were reported using effect sizes (Cohen’s d). Interactive educational meetings were the most commonly used KT strategy. For professional outcomes, 3 studies using single-component interventions had a small effect (d ranges from 0.14 to 0.28) and 7 studies used multifaceted interventions (3 were effective (d ranges from 0.824 to 2.27). For patient outcomes, 4 studies were ineffective (d ranges from 0.06 to 0.31). The majority of the included RCTs had moderate-to-high risk of bias. About half of the studies used theory-based interventions, but the elements of the interventions and theoretical frameworks were often poorly described. Furthermore, there were no comparable outcome measures to evaluate the impact of the interventions on a similar scale.ConclusionsThe findings suggested that multifaceted educational KT interventions appear to be effective for improving professional outcomes, although effects were inconsistent. The KT strategies were generally not effective on patient outcomes. In general, studies were of low quality, interventions were poorly described, and only half had theoretical underpinning. Researchers are encouraged to use validated professional and patient outcomes.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3253-0) contains supplementary material, which is available to authorized users.

Non-Surgical Interventions for Lumbar Spinal Stenosis Leading To Neurogenic Claudication: A Clinical Practice Guideline

“…Methods for updating these guidelines are as reported in our prior guidelines 23 and others 97,123 . The Canadian Chiropractic Guideline Initiative will follow the following process: (1) monitoring changes in evidence, available interventions, importance and value of outcomes, resources available, and relevance of the recommendations to clinicians (limited systematic literature searches each year for 3-5 years and survey to experts in the field annually); (2) assessing the need to full or partial update (relevance of the new evidence or other changes, type and scope of the update); and (3) communicating the process, resources, and timeline to the Guideline Advisory Committee of the CCGI, who will submit a recommendation to the Guideline Steering Committee to make a decision to update and schedule the process. Further, a recently developed checklist (CheckUp) will be used to improve the reporting of the updated guideline.…”

Effectiveness and Quality of Implementing a Best Practice Model of Care for Low Back Pain (BetterBack) Compared with Routine Care in Physiotherapy: A Hybrid Type 2 Trial

“…Bamm et al [50] suggest that although change in the way we organize and provide treatment might not lead to significant changes in patients' function and activity, clinicians can potentially affect patient's perception of LBP and improve their coping with illness. Difficulties in showing between-group differences in PROMs is in line with the few existing studies evaluating patient outcomes after implementation of LBP guidelines [18,51]. A recent systematic review by Bérubé et al [13] found only eight studies evaluating patient outcomes after various implementation strategies in LBP physiotherapy contexts.…”

Using technology-based educational interventions to improve knowledge about clinical practice guidelines:

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