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BMC Health Services Research
Published in: BMC Health Services Research 1/2014

Open Access 01-12-2014 | Research article

Evaluation of a tailored, multi-component intervention for implementation of evidence-based clinical practice guidelines in primary care physical therapy: a non-randomized controlled trial

Authors: Susanne Bernhardsson, Maria EH Larsson, Robert Eggertsen, Monika Fagevik Olsén, Kajsa Johansson, Per Nilsen, Lena Nordeman, Maurits van Tulder, Birgitta Öberg

Published in: BMC Health Services Research | Issue 1/2014

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Abstract

Background

Clinical practice guidelines are important for transmitting research findings into practice and facilitating the application of evidence-based practice (EBP). There is a paucity of knowledge about the impact of guideline implementation strategies in primary care physical therapy. The aim of this study was to evaluate the effect of a guideline implementation intervention in primary care physical therapy in western Sweden.

Methods

An implementation strategy based on theory and current evidence was developed. A tailored, multi-component implementation intervention, addressing earlier identified determinants, was carried out in three areas comprising 28 physical therapy practices including 277 physical therapists (PTs) (intervention group). In two adjacent areas, 171 PTs at 32 practices received no intervention (control group). The core component of the intervention was an implementation seminar with group discussions. Among other components were a website and email reminders. Data were collected at baseline and follow-up with a web-based questionnaire. Primary outcomes were the self-reported awareness of, knowledge of, access to, and use of guidelines. Secondary outcomes were self-reported attitudes toward EBP and guidelines. Analyses were performed using Pearson’s χ2 test and approximative z-test.

Results

168 PTs (60.6%) in the intervention group and 88 PTs (51.5%) in the control group responded to the follow-up questionnaire. 186/277 PTs (67.1%) participated in the implementation seminars, of which 97 (52.2%) responded. The proportions of PTs reporting awareness of (absolute difference in change 20.6%, p = 0.023), knowledge where to find (20.4%, p = 0.007), access to (21.7%, p < 0.001), and frequent use of (9.5%, NS) guidelines increased more in the intervention group than in the control group. The proportion of PTs reporting frequent guideline use after participation in the implementation seminar was 15.2% (p = 0.043) higher than the proportion in the control group. A higher proportion considered EBP helpful in decision making (p = 0.018). There were no other significant differences in secondary outcomes.

Conclusions

A tailored, theory- and evidence-informed, multi-component intervention for the implementation of clinical practice guidelines had a modest, positive effect on awareness of, knowledge of, access to, and use of guidelines, among PTs in primary care in western Sweden. In general, attitudes to EBP and guidelines were not affected.
Appendix
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Literature
1.
Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS: Evidence based medicine: what it is and what it isn't. BMJ. 1996, 312: 71-72. 10.1136/bmj.312.7023.71.CrossRefPubMedPubMedCentral
2.
Fritz J, Cleland JA, Brennan GP: Does adherence to the guideline recommendation for active treatments improve the quality of care for patients with acute low back pain delivered by physical therapists?. Med Care. 2007, 45: 973-980. 10.1097/MLR.0b013e318070c6cd.CrossRefPubMed
3.
Jette DU, Bacon K, Batty C, Carlson M, Ferland A, Hemingway RD, Hill JC, Ogilvie L, Volk D: Evidence-based practice: beliefs, attitudes, knowledge, and behaviors of physical therapists. Phys Ther. 2003, 83: 786-805.PubMed
4.
Turner P, Whitfield TW: Physiotherapists' use of evidence based practice: a cross-national study. Physiother Res Int. 1997, 2: 17-29. 10.1002/pri.76.CrossRefPubMed
5.
Bernhardsson S, Johansson K, Nilsen P, Oberg B, Larsson ME: Determinants of guideline use in primary care physical therapy: a cross-sectional survey of attitudes, knowledge, and behavior. Phys Ther. 2013 Oct 31, [Epub ahead of print]
6.
Holden MA, Nicholls EE, Hay EM, Foster NE: Physical therapists' use of therapeutic exercise for patients with clinical knee osteoarthritis in the United Kingdom: in line with current recommendations?. Phys Ther. 2008, 88: 1109-1121. 10.2522/ptj.20080077.CrossRefPubMedPubMedCentral
7.
Walsh NE, Hurley MV: Evidence based guidelines and current practice for physiotherapy management of knee osteoarthritis. Musculoskeletal Care. 2009, 7: 45-56. 10.1002/msc.144.CrossRefPubMed
8.
Liddle SD, Baxter GD, Gracey JH: Physiotherapists' use of advice and exercise for the management of chronic low back pain: a national survey. Man Ther. 2009, 14: 189-196. 10.1016/j.math.2008.01.012.CrossRefPubMed
9.
Mikhail C, Korner-Bitensky N, Rossignol M, Dumas JP: Physical therapists' use of interventions with high evidence of effectiveness in the management of a hypothetical typical patient with acute low back pain. Phys Ther. 2005, 85: 1151-1167.PubMed
10.
Maher CG, Moseley AM, Sherrington C, Elkins MR, Herbert RD: A description of the trials, reviews, and practice guidelines indexed in the PEDro database. Phys Ther. 2008, 88: 1068-1077. 10.2522/ptj.20080002.CrossRefPubMed
11.
Overmeer T, Linton SJ, Holmquist L, Eriksson M, Engfeldt P: Do evidence-based guidelines have an impact in primary care? A cross-sectional study of Swedish physicians and physiotherapists. Spine (Phila Pa 1976). 2005, 30: 146-151.CrossRef
12.
Iles R, Davidson M: Evidence based practice: a survey of physiotherapists' current practice. Physiother Res Int. 2006, 11: 93-103. 10.1002/pri.328.CrossRefPubMed
13.
Nilsagård Y, Lohse G: Evidence-based physiotherapy: a survey of knowledge, behaviour, attitudes and prerequisites. Adv Physiother. 2010, 12: 179-186. 10.3109/14038196.2010.503812.CrossRef
14.
Heiwe S, Kajermo KN, Tyni-Lenne R, Guidetti S, Samuelsson M, Andersson IL, Wengstrom Y: Evidence-based practice: attitudes, knowledge and behaviour among allied health care professionals. Int J Qual Health Care. 2011, 23: 198-209. 10.1093/intqhc/mzq083.CrossRefPubMed
15.
Grol R: Successes and failures in the implementation of evidence-based guidelines for clinical practice. Med Care. 2001, 39: II46-54.CrossRefPubMed
16.
Grol R, Grimshaw J: From best evidence to best practice: effective implementation of change in patients' care. Lancet. 2003, 362: 1225-1230. 10.1016/S0140-6736(03)14546-1.CrossRefPubMed
17.
Grol R, Wensing M, Eccles M: Improving Patient Care; The implementation of change in clinical practice. 2005, Edinburgh, Scotland: Elsevier Butterworth Heineman
18.
Prior M, Guerin M, Grimmer-Somers K: The effectiveness of clinical guideline implementation strategies–a synthesis of systematic review findings. J Eval Clin Pract. 2008, 14: 888-897. 10.1111/j.1365-2753.2008.01014.x.CrossRefPubMed
19.
Francke AL, Smit MC, de Veer AJ, Mistiaen P: Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review. BMC Med Inform Dec Mak. 2008, 8: 38-10.1186/1472-6947-8-38.CrossRef
20.
Boaz A, Baeza J, Fraser A, European Implementation Score Collaborative G: Effective implementation of research into practice: an overview of systematic reviews of the health literature. BMC Res Notes. 2011, 4: 212-10.1186/1756-0500-4-212.CrossRefPubMedPubMedCentral
21.
22.
Giguere A, Legare F, Grimshaw J, Turcotte S, Fiander M, Grudniewicz A, Makosso-Kallyth S, Wolf FM, Farmer AP, Gagnon MP: Printed educational materials: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012, 10: CD004398
23.
Forsetlund L, Bjorndal A, Rashidian A, Jamtvedt G, O'Brien MA, Wolf F, Davis D, Odgaard-Jensen J, Oxman AD: Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2009, 2: CD003030.PubMed
24.
Cheung A, Weir M, Mayhew A, Kozloff N, Brown K, Grimshaw J: Overview of systematic reviews of the effectiveness of reminders in improving healthcare professional behavior. Syst Rev. 2012, 1: 36-10.1186/2046-4053-1-36.CrossRefPubMedPubMedCentral
25.
Baker R, Camosso-Stefinovic J, Gillies C, Shaw EJ, Cheater F, Flottorp S, Robertson N: Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2010, 3: CD005470.PubMed
26.
Grimshaw JM, Shirran L, Thomas R, Mowatt G, Fraser C, Bero L, Grilli R, Harvey E, Oxman A, O'Brien MA: Changing provider behavior: an overview of systematic reviews of interventions. Med Care. 2001, 39: II2-II45.CrossRefPubMed
27.
Bosch M, van der Weijden T, Wensing M, Grol R: Tailoring quality improvement interventions to identified barriers: a multiple case analysis. J Eval Clin Pract. 2007, 13: 161-168. 10.1111/j.1365-2753.2006.00660.x.CrossRefPubMed
28.
Michie S, Johnston M, Francis J, Hardeman W, Eccles M: From theory to intervention: mapping theoretically derived behavioural determinants to behaviour change techniques. Applied Psychol Int Rev. 2008, 57: 660-680. 10.1111/j.1464-0597.2008.00341.x.CrossRef
29.
Oxman AD, Fretheim A, Flottorp S: The OFF theory of research utilization. J Clin Epidemiol. 2005, 58: 113-116. 10.1016/j.jclinepi.2004.10.002. discussion 117–120CrossRefPubMed
30.
Bhattacharyya O, Reeves S, Garfinkel S, Zwarenstein M: Designing theoretically-informed implementation interventions: fine in theory, but evidence of effectiveness in practice is needed. Implement Sci. 2006, 1: 5-10.1186/1748-5908-1-5.CrossRefPubMedPubMedCentral
31.
Eccles M, Grimshaw J, Walker A, Johnston M, Pitts N: Changing the behaviour of healthcare professionals: the use of theory in promoting the uptake of research findings. J Clin Epidemiol. 2005, 58: 107-112. 10.1016/j.jclinepi.2004.09.002.CrossRefPubMed
32.
Rycroft-Malone J, Bucknall T: Using theory and frameworks to facilitate the implementation of evidence into practice. Worldwide Evid Based Nurs. 2010, 7: 57-58.
33.
Davies P, Walker AE, Grimshaw JM: A systematic review of the use of theory in the design of guideline dissemination and implementation strategies and interpretation of the results of rigorous evaluations. Implement Sci. 2010, 5: 14-10.1186/1748-5908-5-14.CrossRefPubMedPubMedCentral
34.
Improved Clinical Effectiveness through Behavioural Research Group (ICEBeRG): Designing theoretically-informed implementation interventions. Implement Sci. 2006, 1: 4.CrossRef
35.
Abraham C, Kelly MP, West R, Michie S: The UK National Institute for Health and Clinical Excellence public health guidance on behaviour change: a brief introduction. Psychol, Health Med. 2009, 14: 1-8. 10.1080/13548500802537903.CrossRef
36.
Zidarov D, Thomas A, Poissant L: Knowledge translation in physical therapy: from theory to practice. Disabil Rehabil. 2013, 35: 1571-1577. 10.3109/09638288.2012.748841.CrossRefPubMed
37.
Hakkennes S, Dodd K: Guideline implementation in allied health professions: a systematic review of the literature. Qual Saf Health Care. 2008, 17: 296-300. 10.1136/qshc.2007.023804.CrossRefPubMed
38.
Menon A, Korner-Bitensky N, Kastner M, McKibbon KA, Straus S: Strategies for rehabilitation professionals to move evidence-based knowledge into practice: a systematic review. J Rehabil Med. 2009, 41: 1024-1032. 10.2340/16501977-0451.CrossRefPubMed
39.
van der Wees PJ, Jamtvedt G, Rebbeck T, de Bie RA, Dekker J, Hendriks EJM: Multifaceted strategies may increase implementation of physiotherapy clinical guidelines. a systematic review. Aust J Physiother. 2008, 54: 233-241. 10.1016/S0004-9514(08)70002-3.CrossRefPubMed
40.
Bekkering GE, Hendriks HJM, van Tulder MW, Knol DL, Hoijenboes M, Oostendorp RA, Bouter LM: Effect on the process of care of an active strategy to impement clinical guidelines on physiotherapy for low back pain: a cluster randomised controlled trial. Qual Saf Health Care. 2005, 14: 107-112. 10.1136/qshc.2003.009357.CrossRefPubMedPubMedCentral
41.
Rebbeck T, Maher CG, Refshauge KM: Evaluating two implementation strategies for whiplash guidelines in physiotherapy: a cluster-randomised trial. Aust J Physiother. 2006, 52: 165-174. 10.1016/S0004-9514(06)70025-3.CrossRefPubMed
42.
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schunemann HJ, Group GW: GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008, 336: 924-926. 10.1136/bmj.39489.470347.AD.CrossRefPubMedPubMedCentral
43.
Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, Fervers B, Graham ID, Grimshaw J, Hanna SE, Littlejohns P, Makarski J, Zitselberger L, AGREE Next Steps Consortium: AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ. 2010, 182: E839-E842. 10.1503/cmaj.090449.CrossRefPubMedPubMedCentral
44.
Grol RP, Bosch MC, Hulscher ME, Eccles MP, Wensing M: Planning and studying improvement in patient care: the use of theoretical perspectives. Milbank Q. 2007, 85: 93-138. 10.1111/j.1468-0009.2007.00478.x.CrossRefPubMedPubMedCentral
45.
Green S, Buchbinder R, Hetrick S: Physiotherapy interventions for shoulder pain. Cochrane Database Syst Rev. 2003, 2: CD004258.PubMed
46.
Bernhardsson S, Larsson ME: Measuring evidence-based practice in physical therapy: Translation, adaptation, further development, validation, and reliability test of a questionnaire. Phys Ther. 2013, 93: 819-832. 10.2522/ptj.20120270.CrossRefPubMed
47.
Pathman DE, Konrad TR, Freed GL, Freeman VA, Koch GG: The awareness-to-adherence model of the steps to clinical guideline compliance. The case of pediatric vaccine recommendations. Med Care. 1996, 34: 873-889. 10.1097/00005650-199609000-00002.CrossRefPubMed
48.
Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, Rubin HR: Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999, 282: 1458-1465. 10.1001/jama.282.15.1458.CrossRefPubMed
49.
Scott SD, Albrecht L, O'Leary K, Ball GD, Hartling L, Hofmeyer A, Jones CA, Klassen TP, Kovacs Burns K, Newton AS, Thompson D, Dryden DM: Systematic review of knowledge translation strategies in the allied health professions. Implement Sci. 2012, 7: 70-10.1186/1748-5908-7-70.CrossRefPubMedPubMedCentral
50.
Nilsen P, Roback K, Brostrom A, Ellstrom PE: Creatures of habit: accounting for the role of habit in implementation research on clinical behaviour change. Implement Sci. 2012, 7: 53-10.1186/1748-5908-7-53.CrossRefPubMedPubMedCentral
51.
Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A, Psychological Theory G: Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005, 14: 26-33. 10.1136/qshc.2004.011155.CrossRefPubMedPubMedCentral
52.
Evans DW, Breen AC, Pincus T, Sim J, Underwood M, Vogel S, Foster NE: The effectiveness of a posted information package on the beliefs and behavior of musculoskeletal practitioners: the UK Chiropractors, Osteopaths, and Musculoskeletal Physiotherapists Low Back Pain ManagemENT (COMPLeMENT) randomized trial. Spine (Phila Pa 1976). 2010, 35: 858-866. 10.1097/BRS.0b013e3181d4e04b.CrossRef
53.
Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, Whitty P, Eccles MP, Matowe L, Shirran L, Wensing M, Dijkstra R, Donaldson C: Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 2004, 8: iii-iv. 1–72CrossRefPubMed
54.
Grol R: Improving the quality of medical care. Building bridges among professional pride, payer profit, and patient satisfaction. JAMA. 2001, 286: 2578-2585. 10.1001/jama.286.20.2578.CrossRefPubMed
55.
Rutten G, Kremers S, Rutten S, Harting J: A theory-based cross-sectional survey demonstrated the important role of awareness in guideline implementation. J Clin Epidemiol. 2009, 62: 167-176. 10.1016/j.jclinepi.2008.04.004. e161CrossRefPubMed
56.
Rogers EM: Diffusion of innovations. 2003, New York: Free Press, 5
57.
Grilli R, Lomas J: Evaluating the message: the relationship between compliance rate and the subject of a practice guideline. Med Care. 1994, 32: 202-213. 10.1097/00005650-199403000-00002.CrossRefPubMed
58.
Foy R, MacLennan G, Grimshaw J, Penney G, Campbell M, Grol R: Attributes of clinical recommendations that influence change in practice following audit and feedback. J Clin Epidemiol. 2002, 55: 717-722. 10.1016/S0895-4356(02)00403-1.CrossRefPubMed
59.
Bhattacharyya OK, Estey EA, Zwarenstein M: Methodologies to evaluate the effectiveness of knowledge translation interventions: a primer for researchers and health care managers. J Clin Epidemiol. 2011, 64: 32-40. 10.1016/j.jclinepi.2010.02.022.CrossRefPubMed
60.
Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, Eccles MP, Cane J, Wood CE: The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013, 46: 81-95. 10.1007/s12160-013-9486-6.CrossRefPubMed
61.
Gagliardi AR: Tailoring interventions: examining the evidence and identifying gaps. J Cont Educ Health Prof. 2011, 31: 276-282. 10.1002/chp.20141.CrossRef
62.
Stevens A, Beurskens AJMH: Implementation of measurement instruments in physical therapist pratice: development of a tailored strategy. Phys Ther. 2010, 90: 953-961. 10.2522/ptj.20090105.CrossRefPubMed
63.
Flottorp S, Oxman AD: Identifying barriers and tailoring interventions to improve the management of urinary tract infections and sore throat: a pragmatic study using qualitative methods. BMC Health Serv Res. 2003, 3: 3-10.1186/1472-6963-3-3.CrossRefPubMedPubMedCentral
64.
Godin G, Bélanger-Gravel A, Eccles M, Grimshaw J: Healthcare professionals' intentions and behaviours: a systematic review of studies based on social cognitive theories. Implement Sci. 2008, 3: 36-10.1186/1748-5908-3-36.CrossRefPubMedPubMedCentral
65.
Lizarondo L, Grimmer-Somers K, Kumar S: A systematic review of the individual determinants of research evidence use in allied health. J Multidiscip Healthc. 2011, 4: 261-272.CrossRefPubMedPubMedCentral
66.
Streiner DL, Norman GR: Health measurement scales: a practical guide to their development and use. 2008, Oxford, New York: Oxford University Press, 4CrossRef
67.
Grimshaw J, Campbell M, Eccles M, Steen N: Experimental and quasi-experimental designs for evaluating guideline implementation strategies. Fam Pract. 2000, 17: S11-S16. 10.1093/fampra/17.suppl_1.S11.CrossRefPubMed
68.
McCluskey A, Cusick A: Strategies for introducing evidence-based practice and changing clinician behaviour: a manager’s toolbox. Aust Occup Ther J. 2002, 49: 63-70. 10.1046/j.1440-1630.2002.00272.x.CrossRef
69.
Marinopoulos SS, Dorman T, Ratanawongsa N, Wilson LM, Ashar BH, Magaziner JL, Miller RG, Thomas PA, Prokopowicz GP, Qayyum R, Bass EB: Effectiveness of continuing medical education. Evid Rep Technol Assess. 2007, 149: 1-69.
70.
Birken SA, Lee SY, Weiner BJ, Chin MH, Schaefer CT: Improving the effectiveness of health care innovation implementation: middle managers as change agents. Med Care Res Rev. 70: 29-45.
Metadata
Title
Evaluation of a tailored, multi-component intervention for implementation of evidence-based clinical practice guidelines in primary care physical therapy: a non-randomized controlled trial
Authors
Susanne Bernhardsson
Maria EH Larsson
Robert Eggertsen
Monika Fagevik Olsén
Kajsa Johansson
Per Nilsen
Lena Nordeman
Maurits van Tulder
Birgitta Öberg
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2014
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-14-105

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