Multifaceted strategies may increase implementation of physiotherapy clinical guidelines: A systematic review

Abstract

Question: What is the effectiveness of strategies to increase the implementation of physiotherapy clinical guidelines? Design: Systematic review. Participants: Physiotherapists treating any type of patients. Intervention: Single or multiple strategies to increase the implementation of physiotherapy clinical guidelines. Outcome measures: Professional practice, patient health, and cost of care. Results: Five papers reporting three cluster-randomised trials evaluated whether multifaceted strategies based on educational meetings increased the implementation of low back pain guidelines (2 trials) or whiplash guidelines (1 trial). Educational meetings were effective in increasing adherence to the following recommendations of low back pain guidelines: limiting the number of sessions (RD 0.13, 95% CI 0.03 to 0.23), using active intervention (RD 0.13, 95% CI 0.05 to 0.21), giving adequate information (RD 0.05, 95% CI 0.00 to 0.11), increasing activity level (RD 0.16, 95% CI 0.02 to 0.30), changing attitudes/beliefs about pain (RD 0.13, 95% CI 0.01 to 0.24). Educational meetings were effective in increasing adherence to the following recommendations of whiplash guidelines: reassuring the patient (RD 0.40, 95% CI 0.07 to 0.74), advising the patient to act as usual (RD 0.48, 95% CI 0.15 to 0.80), using functional outcome measures (RD 0.62, 95% CI 0.32 to 0.92). There was no evidence that patient health was improved or that the cost of care was reduced. Conclusion: This review shows that multifaceted interventions based on educational meetings to increase implementation of clinical guidelines may improve some outcomes of professional practice but do not improve patient health or reduce cost of care. These findings are comparable with results among other health professions. © Australian Physiotherapy Association 2008.