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

Susanne Bernhardsson,Birgitta Öberg,Per Nilsen,Monika Fagevik Olsén,Maria Eh Larsson,Kajsa Johansson,Lena Nordeman,Robert Eggertsen,Maurits Van Tulder

doi:10.1186/1472-6963-14-105

Abstract

BackgroundClinical 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.MethodsAn 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.Results168 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.ConclusionsA 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.

Highlights

Clinical practice guidelines are important for transmitting research findings into practice and facilitating the application of evidence-based practice (EBP)
One hundred and eighty-six Physical therapists (PTs) participated in the implementation seminars, of which 97 (52.2%) responded (Figure 1)
Respondent and workplace characteristics in the two groups were comparable, both at baseline and follow-up, with the exception of workplace size; fewer PTs in the intervention group worked at clinics with 6−10 PTs and more worked at clinics with 11−15 PTs (Table 1)

Summary

Introduction

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. To bridge the gap between research and practice and facilitate the uptake of research findings in physical therapy practice, evidence-based clinical practice guidelines are increasingly being produced. The use of physical therapy guidelines has been shown to contribute to EBP, improve the quality of care, and decrease costs [2,8,11]. In Sweden, few guidelines for physical therapy treatments are available and less than half of the PTs in a recent survey stated that they use guidelines on a regular basis [5]

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