Implementation interventions to improve the management of non-specific low back pain: a systematic review.
Recommendations in clinical practice guidelines for non-specific low back pain (NSLBP) are not necessarily translated into practice. Multiple studies have investigated different interventions to implement best evidence into clinical practice yet no synthesis of these studies has been carried out to date. The aim of this study was to systematically review available studies to determine whether implementation interventions in this field have been effective and to identify which strategies have been most successful in changing healthcare practitioner behaviours and improving patient outcomes.



A systematic review was undertaken, searching electronic databases until end of December 2012 plus hand searching, writing to key authors and using prior knowledge of the field to identify papers. Included studies evaluated an implementation intervention to improve the management of NSLBP in clinical practice, measured key outcomes regarding change in practitioner behaviour and/or patient outcomes and subjected their data to statistical analysis. The Cochrane Effective Practice and Organisation of Care (EPOC) recommendations about systematic review conduct were followed. Study inclusion, data extraction and study risk of bias assessments were conducted independently by two review authors.



Of 7654 potentially eligible citations, 17 papers reporting on 14 studies were included. Risk of bias of included studies was highly variable with 7 of 17 papers rated at high risk. Single intervention or one-off implementation efforts were consistently ineffective in changing clinical practice. Increasing the frequency and duration of implementation interventions led to greater success with those continuously ongoing over time the most successful in improving clinical practice in line with best evidence recommendations.



Single intervention or one-off implementation interventions may seem attractive but are largely unsuccessful in effecting meaningful change in clinical practice for NSLBP. Increasing frequency and duration of implementation interventions seems to lead to greater success and the most successful implementation interventions used consistently sustained strategies.
, 502, Caspian, Apartments, 5, Salton Square, London, England, E14 7GJ. simonmesner@gmail.com.
Simon Alexander
SA
Mesner
NIHR Musculoskeletal Health in Primary Care, Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, England, ST5 5BG.
Nadine E
NE
Foster
Canadian Chiropractic Research Foundation Professorship in Rehabilitation Therapy, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada; Senior Research Fellow, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.
Simon David
SD
French
D001291:Attitude of Health Personnel; D019317:Evidence-Based Medicine / Q000379:methods*; D058005:General Practitioners / Q000523:psychology; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D059408:Pain Management / Q000379:methods / Q000592:standards*; D058007:Physicians, Primary Care / Q000523:psychology; D017410:Practice Guidelines as Topic
Best practice guidelines; Implementation; Non-specific low back pain