Abstract
BackgroundFor the optimal use of clinical guidelines in daily practice, mere distribution of guidelines and materials is not enough, and active implementation is needed. This review investigated the effectiveness of multifaceted implementation strategies compared to minimal, single, or no implementation strategy for the implementation of non-specific low back and/or neck pain guidelines in health care.MethodsThe following electronic databases were searched from inception to June 1, 2015: MEDLINE, Embase, PsycInfo, the Cochrane Library, and CINAHL. The search strategy was restricted to low back pain, neck pain, and implementation research. Studies were included if their design was a randomized controlled trial, reporting on patients (age ≥18 years) with non-specific low back pain or neck pain (with or without radiating pain). Trials were eligible if they reported patient outcomes, measures of healthcare professional behaviour, and/or outcomes on healthcare level. The primary outcome was professional behaviour. Guidelines that were evaluated in the studies had to be implemented in a healthcare setting. No language restrictions were applied, and studies had to be published full-text in peer-reviewed journals, thus excluding abstract only publications, conference abstracts, and dissertation articles. Two researchers independently screened titles and abstract, extracted data from included studies, and performed risk of bias assessments.ResultsAfter removal of duplicates, the search resulted in 4750 abstracts to be screened. Of 43 full-text articles assessed for eligibility, 12 were included in this review, reporting on 9 individual studies, and separate cost-effectiveness analyses of 3 included studies. Implementation strategies varied between studies. Meta-analyses did not reveal any differences in effect between multifaceted strategies and controls.ConclusionThis review showed that multifaceted strategies for the implementation of neck and/or back pain guidelines in health care do not significantly improve professional behaviour outcomes. No effects on patient outcomes or cost of care could be found. More research is necessary to determine whether multifaceted implementation strategies are conducted as planned and whether these strategies are effective in changing professional behaviour and thereby clinical practice.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0482-7) contains supplementary material, which is available to authorized users.
Highlights
This review showed that multifaceted strategies for the implementation of neck and/or back pain guidelines in health care do not significantly improve professional behaviour outcomes
More research is necessary to determine whether multifaceted implementation strategies are conducted as planned and whether these strategies are effective in changing professional behaviour and thereby clinical practice
The recent Global Burden of Disease Study showed that low back pain (LBP), with 83 million years lived with disability, is the leading cause of disability worldwide, while neck pain (NP) is ranked 4th with 33.6 million years lived with disability [1,2,3]
Summary
The recent Global Burden of Disease Study showed that low back pain (LBP), with 83 million years lived with disability, is the leading cause of disability worldwide, while neck pain (NP) is ranked 4th with 33.6 million years lived with disability [1,2,3]. Most of the guidelines for LBP/NP are developed for multidisciplinary use in primary care and are mainly national professional guidelines. The contents of these guidelines are similar. The guidelines encourage similar diagnostic triages and discourage the use of diagnostic imaging, bed rest, and referrals to specialist care unless neurological or pathological causes are suspected [4]. The use of these guidelines might improve the quality of care for patients with LBP/NP and reduce the financial and societal burden of these disorders. This review investigated the effectiveness of multifaceted implementation strategies compared to minimal, single, or no implementation strategy for the implementation of non-specific low back and/or neck pain guidelines in health care
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