Implementation of a Multidisciplinary Guideline for Low Back Pain: Process-Evaluation Among Health Care Professionals.
Arnela Suman, Frederieke G Schaafsma, Rachelle Buchbinder and 2 others
PMID 27699618WHAT IT FOUND
A guideline implementation strategy including training, take-home materials, rules of conduct, contact details, quarterly reminders, monthly newsletters and website/social media was mostly delivered and well liked.
Participants reported guideline awareness, but time, payment, privacy and distrust remained barriers.
Key findings
01The multifaceted implementation strategy was delivered at 89% of the planned dose overall.
02Of 91 attendees who completed the satisfaction questionnaire, most rated the implementation components good; the video and expected effectiveness were rated lower.
03Interviews found that time constraints reduced use of website, social media and take-home materials, and lack of reimbursement for collaboration was seen as a major barrier.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This is a process evaluation, not a patient-outcome trial, so it cannot show that the strategy changed patient care or patient outcomes. Participants were professionals who chose to take part and attended training, so they may have been more motivated to change than average clinicians. The satisfaction results come from self-report immediately after training and may overestimate positive experiences. Interviews were with only 20 of the attendees, and some were limited to about 10 minutes. Dose-delivered scores were simple points and may overestimate how much of the complex strategy was actually delivered. The study was in Dutch primary care, where payment, referral and privacy rules are specific, so results may not transfer.
Declared interests
The paper names ZonMw as funder. No author conflicts of interest are reported in the supplied text.
The easy way to misread this
Do not conclude that this strategy improved guideline adherence or patient care. It evaluated delivery and professionals' experiences, not patient outcomes, and the authors say actual adherence may still not be achieved because barriers remain.