Implementation: the need for a contextual approach to the implementation of musculoskeletal guidelines

Abstract

This chapter focuses on how strategies to reduce the burden of musculoskeletal disease might be used to inform the development of best clinical practice, public behaviour and health policy. We review what is known about how to modify clinical practice and public behaviour and the effectiveness of a range of interventions that seek to achieve change. From a health policy perspective we examine how those who produce evidence can be linked with decision-makers and how evidence can be used to answer key questions that are pertinent to policy-makers. We argue that implementation strategies need to be targeted to meet the particular contextual constraints and opportunities found within the specific clinical field, policy domain or public setting, but that research is needed to establish the cost and clinical effectiveness of more complex implementation strategies and the financial impact of changing public policy.