Duke University School of Medicine, Durham, North Carolina.
University of North Carolina at Chapel Hill, and Durham VA Health Care Center, Durham, North Carolina.
Arthritis Care Res (Hoboken). 2024 Sep;76(9):1246-1259. doi: 10.1002/acr.25353. Epub 2024 May 28.
Translation of knee osteoarthritis (KOA) clinical practice guidelines (CPGs) to practice remains suboptimal. The primary purpose of this systematic review was to describe the use of implementation strategies to promote KOA CPG-recommended care.
Medline (via PubMed), Embase, CINAHL, and Web of Science were searched from inception to February 23, 2023, and the search was subsequently updated and expanded on January 16, 2024. Implementation strategies were mapped per the Expert Recommendations for Implementing Change taxonomy. Risk of bias (RoB) was assessed using the Cochrane Effective Practice and Organisation of Care criteria. The review was registered prospectively (PROSPERO identifier: CRD42023402383).
Nineteen studies were included in the final review. All (100% [n = 4]) studies that included the domains of "provide interactive assistance," "train and educate stakeholders" (89% [n = 16]), "engage consumers" (87% [n = 13]), and "support clinicians" (79% [n = 11]) showed a change to provider adherence. Studies that showed a change to disability included the domains of "train and educate stakeholders," "engage consumers," and "adapt and tailor to context." Studies that used the domains "train and educate stakeholders," "engage consumers," and "support clinicians" showed a change in pain and quality of life. Most studies had a low to moderate RoB.
Implementation strategies have the potential to impact clinician uptake of CPGs and patient-reported outcomes. The implementation context, using an active learning strategy with a patient partner, restructuring funding models, and integrating taxonomies to tailor multifaceted strategies should be prioritized. Further experimental research is recommended to determine which implementation strategies are most effective.
膝关节骨关节炎（KOA）临床实践指南（CPG）的转化实施仍不理想。本系统评价的主要目的是描述使用实施策略来促进 KOA CPG 推荐的护理。
从建库到 2023 年 2 月 23 日，在 Medline（通过 PubMed）、Embase、CINAHL 和 Web of Science 中进行检索，随后于 2024 年 1 月 16 日进行了更新和扩展。根据实施策略专家建议实施变革分类法对实施策略进行映射。使用 Cochrane 有效实践和组织护理标准评估偏倚风险（RoB）。该综述进行了前瞻性注册（PROSPERO 标识符：CRD42023402383）。
最终综述纳入了 19 项研究。所有（100%[n=4]）包含“提供互动协助”、“培训和教育利益相关者”（89%[n=16]）、“让消费者参与”（87%[n=13]）和“支持临床医生”（79%[n=11]）领域的研究都显示出提供者遵医行为的改变。显示残疾变化的研究包括“培训和教育利益相关者”、“让消费者参与”和“适应和调整以适应背景”等领域。使用“培训和教育利益相关者”、“让消费者参与”和“支持临床医生”等领域的研究显示疼痛和生活质量的变化。大多数研究的 RoB 为低到中度。
实施策略有可能影响临床医生对 CPG 和患者报告结果的采纳。应优先考虑实施背景，使用具有患者伙伴的主动学习策略、重构资金模式以及整合分类法以定制多方面的策略。建议进一步进行实验研究以确定哪些实施策略最有效。
