title: 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.
abstract: BACKGROUND
  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.
  
  
  METHODS
  An 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.
  
  
  RESULTS
  168 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.
  
  
  CONCLUSIONS
  A 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.
authors.affiliation: Närhälsan Öckerö Rehabilitation, Region Västra Götaland, Hönö, Sweden. susanne.bernhardsson@vgregion.se.
authors.forename: Susanne
authors.initials: S
authors.lastname: Bernhardsson
authors.forename: Maria E H
authors.initials: ME
authors.lastname: Larsson
authors.forename: Robert
authors.initials: R
authors.lastname: Eggertsen
authors.forename: Monika Fagevik
authors.initials: MF
authors.lastname: Olsén
authors.forename: Kajsa
authors.initials: K
authors.lastname: Johansson
authors.forename: Per
authors.initials: P
authors.lastname: Nilsen
authors.forename: Lena
authors.initials: L
authors.lastname: Nordeman
authors.forename: Maurits
authors.initials: M
authors.lastname: van Tulder
authors.forename: Birgitta
authors.initials: B
authors.lastname: Öberg
mesh_terms: D000328:Adult; D019317:Evidence-Based Medicine / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000628:therapy; D026741:Physical Therapy Modalities / Q000592:standards / Q000706:statistics & numerical data; D026761:Physical Therapy Specialty / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult