Effectiveness of strategies for implementing guideline-concordant care in low back pain: a systematic review and meta-analysis of randomised controlled trials

International low back pain guidelines recommend providing education/advice to patients, discouraging routine imaging use, and encouraging judicious prescribing of analgesics. However, practice variation occurs and the effectiveness of implementation strategies to promote guideline-concordant care i...

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Published in:EClinicalMedicine 2024-12, Vol.78, p.102916, Article 102916
Main Authors: Zhao, Siya, Langford, Aili V., Chen, Qiuzhe, Lyu, Meng, Yang, Zhiwei, French, Simon D., Williams, Christopher M., Lin, Chung-Wei Christine
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Guideline-concordant care
Implementation strategy
Low back pain
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container_title EClinicalMedicine
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Chen, Qiuzhe
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French, Simon D.
Williams, Christopher M.
Lin, Chung-Wei Christine
description International low back pain guidelines recommend providing education/advice to patients, discouraging routine imaging use, and encouraging judicious prescribing of analgesics. However, practice variation occurs and the effectiveness of implementation strategies to promote guideline-concordant care is unclear. This review aims to comprehensively evaluate the effectiveness of implementation strategies to promote guideline-concordant care for low back pain. Five databases (including MEDLINE, Embase, CINAHL, CENTRAL and PEDro were searched from inception until 22nd August 2024. Randomised controlled trials (RCTs) that evaluated strategies to promote guideline-concordant care (providing education/advice, discouraging routine imaging use, and/or reducing analgesic use) among healthcare professionals or organisations were included. Two reviewers independently conducted screening, data extraction, and risk of bias assessments. The primary outcome was guideline-concordant care in the medium-term (>3 months but
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However, practice variation occurs and the effectiveness of implementation strategies to promote guideline-concordant care is unclear. This review aims to comprehensively evaluate the effectiveness of implementation strategies to promote guideline-concordant care for low back pain. Five databases (including MEDLINE, Embase, CINAHL, CENTRAL and PEDro were searched from inception until 22nd August 2024. Randomised controlled trials (RCTs) that evaluated strategies to promote guideline-concordant care (providing education/advice, discouraging routine imaging use, and/or reducing analgesic use) among healthcare professionals or organisations were included. Two reviewers independently conducted screening, data extraction, and risk of bias assessments. The primary outcome was guideline-concordant care in the medium-term (&gt;3 months but &lt;12 months). The taxonomy recommended by the Cochrane Effective Practice and Organisation of Care (EPOC) group was used to categorise implementation strategies. Meta-analysis with a random-effects model was conducted where possible. This systematic review was prospectively registered in PROSPERO (registration number: CRD42023452969). Twenty-seven RCTs with 32 reports were included. All strategies targeted healthcare professionals (7796 health professionals overseeing 34,890 patients with low back pain), and none targeted organisations. The most commonly used implementation strategies were educational materials (15/27) and educational meetings (14/27), although most studies (24/27) used more than one strategy (‘multifaceted strategies’). In the medium-term, compared to no implementation, implementation strategies probably reduced the use of routine imaging (number of studies [N] = 7, odds ratio [OR] = 1.26, 95% confidence interval [CI]: 1.01–1.58, I2 = 50%, moderate certainty evidence), but made no difference in reducing analgesic use (N = 4, OR = 1.05, 95% CI: 0.96–1.14, I2 = 0%, high certainty evidence). Further, implementation strategies may make no difference to improve the rate of providing education/advice (N = 3, OR = 1.83, 95% CI: 0.87–3.87, I2 = 95%, low certainty evidence), but this finding should be interpreted with caution because the sensitivity analysis showed a weak positive finding indicating unstable results that are likely to change with future research (N = 2, OR = 1.18, 95% CI: 1.04–1.35, I2 = 0%, moderate certainty evidence). No difference was found when comparing one implementation strategy to another in the medium-term. 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subjects Guideline-concordant care
Implementation strategy
Low back pain
title Effectiveness of strategies for implementing guideline-concordant care in low back pain: a systematic review and meta-analysis of randomised controlled trials
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