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BMC Health Services Research

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Open Access 01-12-2018 | Research article

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

Authors: Fadi M. AL Zoubi, Anita Menon, Nancy E. Mayo, André E. Bussières

Published in: BMC Health Services Research | Issue 1/2018

Abstract

Background

The 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.

Methods

A 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.

Results

A 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.

Conclusions

The 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.

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Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380(9859):2197–223. https://doi.org/10.1016/S0140-6736(12)61689-4.CrossRefPubMed

Smith E, Hoy DG, Cross M, Vos T, Naghavi M, Buchbinder R, et al. The global burden of other musculoskeletal disorders: estimates from the global burden of disease 2010 study. Ann Rheum Dis. 2014;73(8):1462–9. https://doi.org/10.1136/annrheumdis-2013-204680.CrossRefPubMed

March L, Smith EU, Hoy DG, Cross MJ, Sanchez-Riera L, Blyth F, et al. Burden of disability due to musculoskeletal (MSK) disorders. Best Pract Res Clin Rheumatol. 2014;28(3):353–66. https://doi.org/10.1016/j.berh.2014.08.002.CrossRefPubMed

Bove SE, Flatters SJ, Inglis JJ, Mantyh PW. New advances in musculoskeletal pain. Brain Res Rev. 2009;60(1):187–201. https://doi.org/10.1016/j.brainresrev.2008.12.012. Epub Dec 25.CrossRefPubMed

Das SK, Farooqi A. Osteoarthritis. Best Pract Res Clin Rheumatol. 2008;22(4):657–75. https://doi.org/10.1016/j.berh.2008.07.002.CrossRefPubMed

Breivik H, Borchgrevink PC, Allen SM, Rosseland LA, Romundstad L, Hals EK, et al. Assessment of pain. Br J Anaesth. 2008;101(1):17–24. https://doi.org/10.1093/bja/aen103. Epub 2008 May 16CrossRefPubMed

McBeth J, Jones K. Epidemiology of chronic musculoskeletal pain. Best Pract Res Clin Rheumatol. 2007;21(3):403–25. https://doi.org/10.1016/j.berh.2007.03.003.CrossRefPubMed

Asche CV, Kirkness CS, McAdam-Marx C, Fritz JM. The societal costs of low back pain: data published between 2001 and 2007. J Pain Palliat Care Pharmacother. 2007;21(4):25–33.PubMed

Luo X, Pietrobon R, Sun SX, Liu GG, Hey L. Estimates and patterns of direct health care expenditures among individuals with back pain in the United States. Spine (Phila Pa 1976). 2004;29(1):79–86. https://doi.org/10.1097/01.BRS.0000105527.13866.0F.CrossRef

10.

Holm LW, Carroll LJ, Cassidy JD, Hogg-Johnson S, Cote P, Guzman J, et al. The burden and determinants of neck pain in whiplash-associated disorders after traffic collisions: results of the bone and joint decade 2000-2010 task force on neck pain and its associated disorders. Spine (Phila Pa 1976). 2008;33(4 Suppl):S52–9. https://doi.org/10.1097/BRS.0b013e3181643ece.CrossRef

11.

Makela M, Heliovaara M, Sievers K, Knekt P, Maatela J, Aromaa A. Musculoskeletal disorders as determinants of disability in Finns aged 30 years or more. J Clin Epidemiol. 1993;46(6):549–59.CrossRefPubMed

12.

Dagenais S, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J. 2008;8(1):8–20. https://doi.org/10.1016/j.spinee.2007.10.005.CrossRefPubMed

13.

Koes BW, van Tulder M, Lin CW, Macedo LG, McAuley J, Maher C. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010;19(12):2075–94. https://doi.org/10.1007/s00586-010-1502-y.CrossRefPubMedPubMedCentral

14.

Pillastrini P, Gardenghi I, Bonetti F, Capra F, Guccione A, Mugnai R, et al. An updated overview of clinical guidelines for chronic low back pain management in primary care. Joint Bone Spine. 2012;79(2):176–85. https://doi.org/10.1016/j.jbspin.2011.03.019.CrossRefPubMed

15.

Delitto A, George SZ, Van Dillen LR, Whitman JM, Sowa G, Shekelle P, et al. Low back pain. J Orthop Sports Phys Ther. 2012;42(4):A1–57. https://doi.org/10.2519/jospt.2012.0301.CrossRefPubMedPubMedCentral

16.

Wallace J, Nwosu B, Clarke M. Barriers to the uptake of evidence from systematic reviews and meta-analyses: a systematic review of decision makers’ perceptions. BMJ Open. 2012;2:e001220. https://doi.org/10.1136/bmjopen-2012-001220.

17.

Shirazi KK, Wallace LM, Niknami S, Hidarnia A, Torkaman G, Gilchrist M, et al. A home-based, transtheoretical change model designed strength training intervention to increase exercise to prevent osteoporosis in Iranian women aged 40-65 years: a randomized controlled trial. Health Educ Res. 2007;22(3):305–17.CrossRefPubMed

18.

Graham ID, Tetroe JM. Getting evidence into policy and practice: perspective of a health research funder. J Can Acad Child Adolesc Psychiatry. 2009;18(1):46–50.PubMedPubMedCentral

19.

Scott SD, Albrecht L, O’Leary K, Ball GD, Hartling L, Hofmeyer A, et al. Systematic review of knowledge translation strategies in the allied health professions. Implement Sci. 2012;7:70. https://doi.org/10.1186/1748-5908-7-70.CrossRefPubMedPubMedCentral

20.

Flodgren G, Eccles MP, Shepperd S, Scott A, Parmelli E, Beyer FR. An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes. Cochrane Database Syst Rev. 2011;7:CD009255. https://doi.org/10.1002/14651858.CD009255.CrossRef

21.

Vergouwen AC, Bakker A, Katon WJ, Verheij TJ, Koerselman F. Improving adherence to antidepressants: a systematic review of interventions. J Clin Psychiatry. 2003;64(12):1415–20.CrossRefPubMed

22.

Williams JW Jr, Gerrity M, Holsinger T, Dobscha S, Gaynes B, Dietrich A. Systematic review of multifaceted interventions to improve depression care. Gen Hosp Psychiatry. 2007;29(2):91–116. https://doi.org/10.1016/j.genhosppsych.2006.12.003.CrossRefPubMed

23.

Kawamoto K, Lobach DF. Clinical decision support provided within physician order entry systems: a systematic review of features effective for changing clinician behavior. AMIA Annu Symp Proc. 2003;2003:361–5.PubMedCentral

24.

Siddiqui MR, Sajid MS, Khatri K, Kanri B, Cheek E, Baig MK. The role of physician reminders in faecal occult blood testing for colorectal cancer screening. Eur J Gen Pract. 2011;17(4):221–8. https://doi.org/10.3109/13814788.2011.601412.CrossRefPubMed

25.

Randell R, Mitchell N, Dowding D, Cullum N, Thompson C. Effects of computerized decision support systems on nursing performance and patient outcomes: a systematic review. J Health Serv Res Policy. 2007;12(4):242–9. https://doi.org/10.1258/135581907782101543.CrossRefPubMed

26.

Thompson DS, Estabrooks CA, Scott-Findlay S, Moore K, Wallin L. Interventions aimed at increasing research use in nursing: a systematic review. Implement Sci. 2007;2:15. https://doi.org/10.1186/1748-5908-2-15.CrossRefPubMedPubMedCentral

27.

Thompson C, Stapley S. Do educational interventions improve nurses’ clinical decision making and judgement? A systematic review. Int J Nurs Stud. 2011;48(7):881–93. https://doi.org/10.1016/j.ijnurstu.2010.12.005.CrossRefPubMed

28.

Foxcroft DR, Cole N. Organisational infrastructures to promote evidence based nursing practice. Cochrane Database Syst Rev. 2003;4:CD002212. https://doi.org/10.1002/14651858.CD002212.CrossRef

29.

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(13):1024–32. https://doi.org/10.2340/16501977-0451.CrossRefPubMed

30.

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(4):233–41. https://doi.org/10.1016/S0004-9514(08)70002-3CrossRefPubMed

31.

Jones CA, Roop SC, Pohar SL, Albrecht L, Scott SD. Translating knowledge in rehabilitation: systematic review. Phys Ther. 2015;95(4):663–77. https://doi.org/10.2522/ptj.20130512.CrossRefPubMed

32.

Bérubé M-È, Poitras S, Bastien M, Laliberté L-A, Lacharité A, Douglas PG. Strategies to translate knowledge related to common musculoskeletal conditions into physiotherapy practice: a systematic review. Physiotherapy. 2018;104(1):1–8. https://doi.org/10.1016/j.physio.2017.05.002.CrossRefPubMed

33.

Higgins JPT, Green S, (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from http://handbook-5-1.cochrane.org/.

34.

Search Strategies Rx for Change. Professional. In: Organisational and Consumer Interventions; 2014. https://www.cadth.ca/media/media/Search%20Strategies%20Rx%20for%20Change%20April%202014.pdf.

35.

Hennekens CH, DeMets D. Statistical association and causation: contributions of different types of evidence. JAMA. 2011;305(11):1134–5. https://doi.org/10.1001/jama.2011.322.CrossRefPubMed

36.

Chalmers I. Unbiased, relevant, and reliable assessments in health care: important progress during the past century, but plenty of scope for doing better. BMJ. 1998;317(7167):1167–8.CrossRefPubMedPubMedCentral

37.

Juni P, Holenstein F, Sterne J, Bartlett C, Egger M. Direction and impact of language bias in meta-analyses of controlled trials: empirical study. Int J Epidemiol. 2002;31(1):115–23.CrossRefPubMed

38.

Moher D, Fortin P, Jadad AR, Juni P, Klassen T, Le Lorier J, et al. Completeness of reporting of trials published in languages other than English: implications for conduct and reporting of systematic reviews. Lancet. 1996;347(8998):363–6.CrossRefPubMed

39.

Moher D, Pham B, Lawson ML, Klassen TP. The inclusion of reports of randomised trials published in languages other than English in systematic reviews. Health Technol Assess. 2003;7(41):1–90.CrossRefPubMed

40.

Morrison A, Polisena J, Husereau D, Moulton K, Clark M, Fiander M, et al. The effect of English-language restriction on systematic review-based meta-analyses: a systematic review of empirical studies. Int J Technol Assess Health Care. 2012;28(2):138–44. https://doi.org/10.1017/S0266462312000086.CrossRefPubMed

41.

Sutton AJ, Duval SJ, Tweedie RL, Abrams KR, Jones DR. Empirical assessment of effect of publication bias on meta-analyses. BMJ. 2000;320(7249):1574–7.CrossRefPubMedPubMedCentral

42.

Cochrane Effective Practice and Organisation of Care Review Group. Data collection checklist. Available from <http://epoc.cochrane.org/sites/epoc.cochrane.org/files/uploads/datacollectionchecklist.pdf> (Accessed February 6, 2015).

43.

Samuel BG. How many subjects does it take to do a regression analysis? Multivar Behav Res. 1991;26:499–510.CrossRef

44.

Durlak JA. How to select, calculate, and interpret effect sizes. J Pediatr Psychol. 2009;34(9):917–28. https://doi.org/10.1093/jpepsy/jsp004.CrossRefPubMed

45.

Cohen J. Statistical power analysis for the behavioral sciences. Routledge Academic: New York, NY; 1988.

46.

Cleland JA, Fritz JM, Brennan GP, Magel J. Does continuing education improve physical therapists’ effectiveness in treating neck pain? A randomized clinical trial. Phys Ther. 2009;89(1):38–47.CrossRefPubMed

47.

Bussières A, Laurencelle L, Peterson C. Diagnostic imaging guidelines implementation study for spinal disorders: a randomized trial with postal follow-ups. Journal of Chiropractic Education (Association of Chiropractic Colleges). 2010;24(1):2–18.CrossRef

48.

Evans DW, Breen AC, Pincus T, Sim J, Underwood M, Vogel S, et al. 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(8):858–66. https://doi.org/10.1097/BRS.0b013e3181d4e04b. CrossRef

49.

Peter WF, van der Wees PJ, Verhoef J, de Jong Z, van Bodegom-Vos L, Hilberdink WK, et al. Postgraduate education to increase adherence to a Dutch physiotherapy practice guideline for hip and knee OA: a randomized controlled trial. Rheumatology. 2013;52(2):368–75.CrossRefPubMed

50.

Peter W, van der Wees PJ, Verhoef J, de Jong Z, van Bodegom-Vos L, Hilberdink WK, et al. Effectiveness of an interactive postgraduate educational intervention with patient participation on the adherence to a physiotherapy guideline for hip and knee osteoarthritis: a randomised controlled trial. Disability & Rehabilitation. 2015;37(3):274–82.CrossRef

51.

Chipchase LS, Cavaleri R, Jull G. Can a professional development workshop with follow-up alter practitioner behaviour and outcomes for neck pain patients? A randomised controlled trial. Man Ther. 2016;25:87–93.CrossRefPubMed

52.

Bekkering GE, van Tulder MW, Hendriks EJ, Koopmanschap MA, Knol DL, Bouter LM, et al. 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. Phys Ther. 2005;85(6):544–55.PubMed

53.

Stevenson K, Lewis M, Hay E. Does physiotherapy management of low back pain change as a result of an evidence-based educational programme? J Eval Clin Pract. 2006;12(3):365–75.CrossRefPubMed

54.

Rebbeck T, Maher CG, Refshauge KM. Evaluating two implementation strategies for whiplash guidelines in physiotherapy: a cluster randomised trial. Australian Journal of Physiotherapy. 2006;52(3):165–74.CrossRefPubMed

55.

van Dulmen SA, Maas M, Staal JB, Rutten G, Kiers H, Nijhuis-van der Sanden M, et al. Effectiveness of peer assessment for implementing a Dutch physical therapy low back pain guideline: cluster randomized controlled trial. Phys Ther. 2014;94(10):1396–409. https://doi.org/10.2522/ptj.20130286.CrossRefPubMed

56.

Murray A, Hall AM, Williams GC, McDonough SM, Ntoumanis N, Taylor IM, et al. Effect of a self-determination theory–based communication skills training program on Physiotherapists’ psychological support for their patients with chronic low back pain: a randomized controlled trial. Archives of Physical Medicine & Rehabilitation. 2015;96(5):809–16. https://doi.org/10.1016/j.apmr.2014.11.007.CrossRef

57.

Ospina MB, Taenzer P, Rashiq S, MacDermid JC, Carr E, Chojecki D, et al. A systematic review of the effectiveness of knowledge translation interventions for chronic noncancer pain management. Pain Res Manag. 2013;18(6):e129–41.CrossRefPubMedPubMedCentral

58.

Jones CA, Roop SC, Pohar SL, Albrecht L, Scott SD. Translating knowledge in rehabilitation: a systematic review. Phys Ther. 2014;95(4) https://doi.org/10.2522/ptj.20130512.

59.

Grimshaw JM, Shirran L, Thomas R, Mowatt G, Fraser C, Bero L, et al. Changing provider behavior: an overview of systematic reviews of interventions. Med Care. 2001;39(8 Suppl 2):Ii2–45.PubMed

60.

Davis DA, Thomson MA, Oxman AD, Haynes RB. Changing physician performance. A systematic review of the effect of continuing medical education strategies. JAMA. 1995;274(9):700–5.CrossRefPubMed

61.

Wensing M, Grol R. Single and combined strategies for implementing changes in primary care: a literature review. Int J Qual Health Care. 1994;6(2):115–32.CrossRefPubMed

62.

Squires JE, Sullivan K, Eccles MP, Worswick J, Grimshaw JM. Are multifaceted interventions more effective than single-component interventions in changing health-care professionals’ behaviours? An overview of systematic reviews. Implement Sci. 2014;9:152. https://doi.org/10.1186/s13012-014-0152-6.CrossRefPubMedPubMedCentral

63.

Albada A, Ausems MG, Bensing JM, van Dulmen S. Tailored information about cancer risk and screening: a systematic review. Patient Educ Couns. 2009;77(2):155–71. https://doi.org/10.1016/j.pec.2009.03.005.CrossRefPubMed

64.

Glanz K, Bishop DB. The role of behavioral science theory in development and implementation of public health interventions. Annu Rev Public Health. 2010;31:399–418. https://doi.org/10.1146/annurev.publhealth.012809.103604.CrossRefPubMed

65.

Evans C, Gilbert JR, Taylor W, Hildebrand A. A randomized controlled trial of flexion exercises, education, and bed rest for patients with acute low back pain. Physiother Can. 1987;39(2):96–101.CrossRef

66.

Webb TL, Joseph J, Yardley L, Michie S. Using the internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. J Med Internet Res. 2010;12(1):e4. https://doi.org/10.2196/jmir.1376.CrossRefPubMedPubMedCentral

67.

Easterbrook PJ, Berlin JA, Gopalan R, Matthews DR. Publication bias in clinical research. Lancet. 1991;337(8746):867–72.CrossRefPubMed

68.

Tramer MR, Reynolds DJ, Moore RA, McQuay HJ. Impact of covert duplicate publication on meta-analysis: a case study. BMJ. 1997;315(7109):635–40.CrossRefPubMedPubMedCentral

69.

Huston P, Moher D. Redundancy, disaggregation, and the integrity of medical research. Lancet. 1996;347(9007):1024–6.CrossRefPubMed

70.

Sanson-Fisher RW, Bonevski B, Green LW, D’Este C. Limitations of the randomized controlled trial in evaluating population-based health interventions. Am J Prev Med. 2007;33(2):155–61. https://doi.org/10.1016/j.amepre.2007.04.007.CrossRefPubMed

71.

Peinemann F, Tushabe DA, Kleijnen J. Using multiple types of studies in systematic reviews of health care interventions – a systematic review. PLoS One. 2013;8(12):e85035. https://doi.org/10.1371/journal.pone.0085035.CrossRefPubMedPubMedCentral

72.

Calvert M, Kyte D, Mercieca-Bebber R, Slade A, Chan AW, King MT, et al. Guidelines for inclusion of patient-reported outcomes in clinical trial protocols: the SPIRIT-PRO extension. JAMA. 2018;319(5):483–94. https://doi.org/10.1001/jama.2017.21903.CrossRefPubMed

Title: The effectiveness of interventions designed to increase the uptake of clinical practice guidelines and best practices among musculoskeletal professionals: a systematic review
Authors: Fadi M. AL Zoubi
Anita Menon
Nancy E. Mayo
André E. Bussières
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-018-3253-0

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Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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