Abstract
Background
Recommendations in clinical practice guidelines for non-specific low back pain (NSLBP) are not necessarily translated into practice. Multiple research studies have investigated different strategies to implement best evidence into practice yet no synthesis of these studies is available.
Objectives
To systematically review available studies to determine whether implementation efforts in this field have been successful; to identify which strategies have been most successful in changing healthcare practitioner behaviours and patient outcomes.
Methods
A systematic review was undertaken, searching electronic databases, hand searching, writing to key authors and using prior knowledge of the field to identify papers. Included papers evaluated a strategy to implement best evidence about management of NSLBP into practice; measured key outcomes regarding change in practitioner behaviour/patient outcomes and subjected their data to statistical analysis. The Cochrane Effective Practice and Organisation of Care (EPOC) recommendations about data extraction and synthesis were followed. Study inclusion, data extraction and study risk of bias assessments were conducted independently.
Results
Of 7654 potentially eligible citations, 17 papers reporting on 14 studies were included. Single/one-off implementation efforts were consistently unsuccessful. Increasing the frequency and duration of strategies led to greater success with those continuously ongoing over time the most successful. Risk of bias was highly variable with 7 of 17 papers rated at high risk.
Conclusions
One-off implementation strategies may seem attractive but are largely unsuccessful in effecting meaningful change in practice. Increasing frequency and duration of strategies results in greater success and the most successful implementation strategies use consistently sustained interventions.
