Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden.
Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Unit of Physiotherapy, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
J Eval Clin Pract. 2019 Aug;25(4):575-584. doi: 10.1111/jep.12958. Epub 2018 May 28.
RATIONALE, AIMS, AND OBJECTIVES: Clinical practice guidelines are a common strategy for implementing research findings into practice and facilitating evidence-based practice in health care settings. There is a paucity of knowledge about the impact of different guideline implementation strategies on clinical practice in a physiotherapy context. The study aimed to assess the impact of a guideline implementation intervention on clinical physiotherapy practice.
A tailored, multicomponent guideline implementation was compared with usual practice. Clinical practice was evaluated in physiotherapy treatment methods used for 3 common musculoskeletal disorders. Data were collected with a validated web-based questionnaire.
Postimplementation data were collected from 168 physiotherapists in the intervention group and 88 in the control group. The most frequently reported treatment methods for low back pain were advice on posture (reported by 95% in the intervention group vs 90% in the control group), advice to stay active (93% vs 90%), and stabilization exercise (88% vs 80%). Differences between groups were not significant. Reported use of body awareness training (23% vs 6%, P = .023) and spinal manipulation (9% vs 23%, P = .044) differed between the groups. The most frequently used treatment methods for neck pain were advice on posture (95% vs 92%), advice to stay active (89% vs 87%), and ROM exercise (85% vs 71%) (no significant differences between groups). Reported use of body awareness training (24% vs 7%, P = .023) differed between the groups. The most frequently used treatment methods for subacromial pain were range of motion exercises (reported by 93% in both groups), advice on posture (90% vs 87%), home exercise (77% vs 74%), and stabilization exercise (69% vs 66%) (no significant difference between groups).
Treatment methods used were largely in line with evidence already before the guideline implementation, which may explain why the guideline implementation had only little impact on clinical practice.
背景、目的和目标：临床实践指南是将研究结果应用于实践并促进医疗保健环境中循证实践的常用策略。在物理治疗背景下，不同指南实施策略对临床实践的影响知之甚少。本研究旨在评估指南实施干预对临床物理治疗实践的影响。
将定制的多组分指南实施与常规实践进行比较。使用经过验证的基于网络的问卷评估了物理治疗治疗三种常见肌肉骨骼疾病的方法。
在干预组中从 168 名物理治疗师和对照组中 88 名收集了实施后数据。对于腰痛，最常报告的治疗方法是关于姿势的建议（干预组报告 95%，对照组报告 90%），建议保持活跃（93%对 90%）和稳定运动（88%对 80%）。组间差异不显著。报告使用身体意识训练（23%对 6%，P =.023）和脊柱手法治疗（9%对 23%，P =.044）之间存在差异。对于颈部疼痛，最常报告的治疗方法是关于姿势的建议（95%对 92%），建议保持活跃（89%对 87%）和 ROM 运动（85%对 71%）（组间无显著差异）。报告使用身体意识训练（24%对 7%，P =.023）之间存在差异。对于肩峰下疼痛，最常报告的治疗方法是运动范围练习（两组均报告 93%），关于姿势的建议（90%对 87%），家庭运动（77%对 74%）和稳定运动（69%对 66%）（组间无显著差异）。
在指南实施之前，使用的治疗方法在很大程度上与证据相符，这可能解释了为什么指南实施对临床实践的影响很小。
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