UMR1295, Toulouse III University, Inserm, Equipe EQUITY, Equipe constitutive du CERPOP, Toulouse, France.
Institut Franco-Européen de Chiropraxie, 72 chemin de la Flambère-31,300, Toulouse, France.
BMC Musculoskelet Disord. 2021 Jun 1;22(1):507. doi: 10.1186/s12891-021-04204-w.
Many clinical practice guidelines have been developed for the management of musculoskeletal disorders (MSDs). However, there is a gap between evidence-based knowledge and clinical practice, and reasons are poorly understood. Understanding why healthcare providers use clinical practice guidelines is essential to improve their implementation, dissemination, and adherence.
To identify determinants of clinical practice guidelines' utilization by health care providers involved in the assessment and management of MSDs.
A scoping review of the literature was conducted. Three databases were searched from inception to March 2021. Article identification, study design, methodological quality, type of healthcare providers, MSDs, barriers and facilitators associated with guidelines' utilization were extracted from selected articles.
8671 citations were retrieved, and 43 articles were selected. 51% of studies were from Europe, and most were quantitative studies (64%) following a cross-sectional design (88%). Almost 80% of articles dealt with low back pain guidelines, and the most studied healthcare providers were general practitioners or physiotherapists. Five main barriers to guideline utilization were expressed by providers: 1) disagreement between recommendations and patient expectations; 2) guidelines not specific to individual patients; 3) unfamiliarity with "non-specific" term, or with the bio psychosocial model of MSDs; 4) time consuming; and 5) heterogeneity in guideline methods. Four main facilitators to guideline utilization were cited: 1) clinician's interest in evidence-based practice; 2) perception from clinicians that the guideline will improve triage, diagnosis and management; 3) time efficiency; and 4) standardized language.
Identifying modifiable determinants is the first step in developing implementation strategies to improve guideline utilization in clinical practice.
许多针对肌肉骨骼疾病（MSD）管理的临床实践指南已经制定。然而，基于证据的知识与临床实践之间存在差距，其原因尚不清楚。了解医疗保健提供者为何使用临床实践指南对于改善其实施、传播和依从性至关重要。
确定参与 MSD 评估和管理的医疗保健提供者使用临床实践指南的决定因素。
对文献进行了范围综述。从成立到 2021 年 3 月，在三个数据库中进行了搜索。从选定的文章中提取了文章识别、研究设计、方法学质量、医疗保健提供者类型、与指南使用相关的障碍和促进因素、MSD。
共检索到 8671 条引文，选择了 43 篇文章。51%的研究来自欧洲，并且大多数是采用横断面设计（88%）的定量研究（64%）。几乎 80%的文章涉及腰痛指南，研究最多的医疗保健提供者是全科医生或物理治疗师。提供者表达了五个主要的指南使用障碍：1）建议与患者期望不一致；2）指南不适用于个别患者；3）对“非特异性”术语或 MSD 生物心理社会模型不熟悉；4）耗时；5）指南方法的异质性。引用了四个主要的指南使用促进因素：1）临床医生对循证实践的兴趣；2）临床医生认为该指南将改善分诊、诊断和管理；3）时间效率；4）标准化语言。
确定可修改的决定因素是制定实施策略以改善临床实践中指南使用的第一步。
