Bishop Paul B, Wing Peter C
Combined Neurosurgical and Orthopaedic Spine Program, Vancouver General Hospital/University of British Columbia, 2733 Heather Street, Vancouver, BC, Canada V5Z 3J5.
Spine J. 2006 May-Jun;6(3):282-8. doi: 10.1016/j.spinee.2005.10.008.
The process through which new scientific developments are incorporated into clinical practice is referred to as "knowledge transfer" and is currently the subject of great interest in many areas of clinical medicine. Family physicians managing patients with acute low back pain have been shown to have a poor overall rate of concordance with clinical practice guideline-recommended treatments. New methods need to be developed to help physicians bridge the guideline implementation gap.
To determine the efficacy of a knowledge transfer method that communicates clinical practice guidelines to family physicians and their patients using patient-specific, physician-to-physician communications.
A prospective randomized controlled study.
428 patients with acute mechanical low back pain and accepted Workers' Compensation Board claims were studied.
Concordance with specific clinical practice guideline-derived history taking items, physical examination procedures and treatment recommendations was determined.
Patients with acute mechanical back pain of less than 4 weeks duration and accepted Workers' Compensation Board claims were randomly assigned to one of three groups. In Group 1 (control group) neither the patients nor their family physicians received any information concerning the guidelines. In Group 2, family physicians alone or as well as their patients (Group 3) received a summary of clinical practice guidelines at approximately 2 weeks postinjury. In addition, both Groups 2 and 3 received reminders summarizing the recommended guidelines for patients at three specific stages of their clinical course. All guideline correspondence was addressed to a specific family physician or patient, signed by the study physician-investigators, and specified the patient by name.
Family physicians in the control and intervention groups demonstrated a high degree of concordance with the guideline-recommended history taking and physical examination procedures, but were generally highly discordant with guideline-recommended treatments. Significant improvement in guideline-concordant treatments was seen only with diminished recommendations of prolonged bed rest and passive therapies and an increase in recommended aerobic exercise. Concordance with guideline recommendations relating to the use of spinal manipulative therapy was poor in all study groups.
A knowledge transfer method that involved patient-specific, physician-to-physician communication to family physicians or their patients at three stages of the patient's clinical course was largely unsuccessful in improving concordance with guideline treatment recommendations.
新科学进展融入临床实践的过程被称为“知识转移”，目前是临床医学许多领域的热门话题。研究表明，管理急性下腰痛患者的家庭医生总体上与临床实践指南推荐的治疗方法的一致性较差。需要开发新方法来帮助医生缩小指南实施差距。
确定一种知识转移方法的疗效，该方法通过针对患者个体的医生对医生沟通，将临床实践指南传达给家庭医生及其患者。
一项前瞻性随机对照研究。
对428例急性机械性下腰痛且已被工人赔偿委员会受理索赔的患者进行研究。
确定与特定临床实践指南衍生的病史采集项目、体格检查程序和治疗建议的一致性。
将病程少于4周且已被工人赔偿委员会受理索赔的急性机械性背痛患者随机分为三组。第1组（对照组）患者及其家庭医生均未收到任何有关指南的信息。第2组，家庭医生单独或与患者一起（第3组）在受伤后约2周收到临床实践指南摘要。此外，第2组和第3组在患者临床病程的三个特定阶段都收到了总结推荐指南的提醒。所有指南通信均寄给特定的家庭医生或患者，由研究医师-调查员签名，并注明患者姓名。
对照组和干预组的家庭医生在指南推荐的病史采集和体格检查程序方面表现出高度一致性，但在指南推荐的治疗方法上普遍存在高度不一致。仅在减少长期卧床休息和被动治疗的建议以及增加有氧运动建议方面，与指南一致的治疗有显著改善。所有研究组在与脊柱手法治疗使用相关的指南建议方面的一致性都很差。
一种在患者临床病程的三个阶段通过针对患者个体的医生对医生沟通向家庭医生或其患者进行知识转移的方法，在提高与指南治疗建议的一致性方面基本未成功。
