Effectiveness of Implementation Strategies to Improve Adherence of Physical Therapist Treatment Choices to Clinical Practice Guidelines for Musculoskeletal Conditions: Systematic Review

2020 ◽  
Vol 100 (9) ◽  
pp. 1516-1541
Author(s):  
Joshua R Zadro ◽  
Mary O’Keeffe ◽  
Jodie L Allison ◽  
Kirsty A Lembke ◽  
Joanna L Forbes ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Physical Therapists ◽  
Care Delivery ◽  
Peer Assessment ◽  
Implementation Strategies ◽  
Educational Outreach ◽  
Treatment Choices ◽  
Musculoskeletal Conditions

Abstract Objective The objective of this study was to evaluate the effectiveness of implementation strategies aimed at improving the adherence of physical therapists’ treatment choices to clinical practice guidelines for a range of musculoskeletal conditions. Methods For this review, searches were performed in several databases combining terms synonymous with “practice patterns” and “physical therapy” until August 2019. The review included randomized controlled trials that investigated any intervention to improve the adherence of physical therapists’ treatment choices to clinical practice guidelines or research evidence. Treatment choices assessed by surveys, audits of clinical notes, and treatment recording forms were the primary measures of adherence. Self-reported guideline adherence was the secondary measure. Three reviewers independently assessed risk of bias. Because of heterogeneity across studies, only a narrative synthesis of the results was performed. Results Nine studies were included. Four demonstrated a positive effect on at least 1 measure of treatment choices for low back pain and acute whiplash. One involved a comparison with no intervention, and 3 involved a comparison with another active intervention. The interventions that demonstrated a positive effect included dissemination of clinical practice guidelines, with additional elements including interactive educational meetings (3 studies), tailored interventions and monitoring of the performance of health care delivery (1 study), peer assessment (1 study), and local opinion leaders plus educational outreach visits (1 study). Conclusions Although this review revealed limited trials evaluating interventions to increase physical therapists’ use of evidence-based treatments for musculoskeletal conditions compared with no intervention, it highlighted some interventions that may be effective. Impact Dissemination of clinical practice guidelines, interactive educational meetings, tailored interventions and monitoring the performance of health care delivery, peer assessment, and use of local opinion leaders plus educational outreach visits should be implemented to improve physical therapists’ adherence to clinical practice guidelines for a range of musculoskeletal conditions.

Educational Interventions for Implementation of Arthritis Clinical Practice Guidelines in Primary Care: Effects on Health Professional Behavior

2010 ◽  
Vol 37 (8) ◽  
pp. 1562-1569 ◽  
Author(s):  
SYDNEY C. LINEKER ◽  
JANICE A. HUSTED
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Care Delivery ◽  
Statistical Significance ◽  
Educational Interventions ◽  
Educational Programs ◽  
Educational Outreach ◽  
System Level

Objective.The dissemination and adoption of clinical practice guidelines (CPG) has been suggested as one method for improving arthritis care delivery. This article provides a review and synthesis of studies evaluating the influence of educational programs designed to implement CPG for osteoarthritis (OA) and rheumatoid arthritis (RA) in primary care.Methods.A systematic literature search was conducted to identify relevant educational interventions that reported behavioral outcomes that ensured actual knowledge utilization in primary care. A standardized approach was used to assess the quality of the individual studies and a modified version of the Philadelphia Panel methodology allowed for grading of studies based on strength of design, clinical relevance, and statistical significance.Results.The search identified 485 articles; 7 studies were selected for review. In OA, peer facilitated workshops with nurse case-management support for patients decreased the number of referrals to orthopedics by 23%, and educational outreach by trained physicians improved prescribing of analgesics. Interprofessional peer facilitated workshops were successful in increasing referrals to rehabilitation services for people with OA and RA.Conclusion.There was sparse literature on educational programs for the implementation of arthritis CPG in the primary care environment. Future studies are needed to evaluate which specific organizational, provider, patient, and system level factors influence the uptake of arthritis CPG in primary care.

scholarly journals A Critical Approach to Clinical Practice Guidelines

2000 ◽  
Vol 14 (6) ◽  
pp. 505-509 ◽  
Author(s):  
John K Marshall
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Patient Outcomes ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Care Delivery ◽  
Critical Approach ◽  
High Quality ◽  
Number Of Publications ◽  
Improve Patient

The rate of publication of clinical practice guidelines for the management of common medical illnesses continues to accelerate. The appropriate dissemination and uptake of high quality practice guidelines can synthesize evidence, improve patient outcomes and enhance the efficiency of health care delivery. However, the methodological rigour and relevance of the growing number of publications labelled ’clinical practice guidelines’ vary widely. Health care payers, providers and advocates must learn to appraise and interpret guideline recommendations critically. A simple and practical nine-question approach to evaluating the quality, relevance and effectiveness of clinical practice guidelines is presented.

scholarly journals Adherence to clinical practice guidelines (CPGs) for the treatment of cancers in Australia and the factors associated with adherence: a systematic review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e050912
Author(s):  
Mia Bierbaum ◽  
Frances Rapport ◽  
Gaston Arnolda ◽  
Yvonne Tran ◽  
Bróna Nic Giolla Easpaig ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Cancer Treatment ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Data Extraction ◽  
Meta Analysis ◽  
Survival Rates ◽  
Implementation Strategies ◽  
Factors Associated

IntroductionClinical practice guidelines (CPGs) synthesise the latest evidence to support clinical and patient decision-making. CPG adherent care is associated with improved patient survival outcomes; however, adherence rates are low across some cancer streams in Australia. Greater understanding of specific barriers to cancer treatment CPG adherence is warranted to inform future implementation strategies.This paper presents the protocol for a systematic review that aims to determine cancer treatment CPG adherence rates in Australia across a variety of common cancers, and to identify any factors associated with adherence to those CPGs, as well as any associations between CPG adherence and patient outcomes.Methods and analysisFive databases will be searched, Ovid Medline, PsychInfo, Embase, Scopus and Web of Science, for eligible studies evaluating adherence rates to cancer treatment CPGs in Australia. A team of reviewers will screen the abstracts in pairs according to predetermined inclusion criteria and then review the full text of eligible studies. All included studies will be assessed for quality and risk of bias. Data will be extracted using a predefined data extraction template. The frequency or rate of adherence to CPGs, factors associated with adherence to those CPGs and any reported patient outcome rates (eg, relative risk ratios or 5-year survival rates) associated with adherence to CPGs will be described. If applicable, a pooled estimate of the rate of adherence will be calculated by conducting a random-effects meta-analysis. The systematic review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Ethics and disseminationEthics approval will not be required, as this review will present anonymised data from other published studies. Results from this study will form part of a doctoral dissertation (MB), will be published in a journal, presented at conferences, and other academic presentations.PROSPERO registration numberCRD42020222962.

scholarly journals Clinical Update for Physical Therapists: Coagulopathy and COVID-19

2020 ◽  
Vol 100 (12) ◽  
pp. 2127-2133
Author(s):  
Kathleen Lukaszewicz ◽  
Ellen Hillegass ◽  
Michael L Puthoff ◽  
A Kate MacPhedran
Keyword(s):  
Physical Activity ◽  
Clinical Practice ◽  
Venous Thromboembolism ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Signs And Symptoms ◽  
Early Mobility ◽  
Unique Role

Abstract Physical therapists have a unique role in both prevention of venous thromboembolism (VTE) through the promotion of early mobility and physical activity and diagnosis through discovery of signs and symptoms of VTE. This Perspective updates clinicians on the latest information regarding pathophysiology of coagulopathy associated with COVID-19 and applies VTE clinical practice guidelines to COVID-19 in order to provide guidance on physical therapist management.

scholarly journals Clinicians’ attitudes to oncology clinical practice guidelines and the barriers and facilitators to adherence: a mixed methods study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e035448 ◽  
Author(s):  
Mia Bierbaum ◽  
Jeffrey Braithwaite ◽  
Gaston Arnolda ◽  
Geoffrey P Delaney ◽  
Winston Liauw ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Mixed Methods ◽  
Cancer Treatment ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Sample ◽  
Phase 1 ◽  
Implementation Strategies ◽  
Mixed Methods Study ◽  
Barriers And Facilitators

IntroductionClinical practice guidelines (CPGs) are designed to reduce inappropriate clinical variation and improve the quality of care. Barriers to CPGs include a lack of awareness of CPGs, access to them, time pressures and concerns regarding the evidence underpinning CPG development, implementation and dissemination. The objectives of this study are to assess clinicians’ attitudes to CPGs for cancer treatment and the perceived barriers to and facilitators of CPG adherence in order to inform the implementation of cancer treatment CPGs.Methods and analysisA mixed methods study will be conducted using a three-phase, sequential design, with each phase informing the next. In phase 1, a qualitative study using recorded interviews will investigate clinicians’ attitudes to CPGs for cancer treatment and perceptions of barriers and facilitators to CPG adherence (n=30); interview transcripts will be analysed thematically. In phase 2, a survey will quantify the frequency of attitudes, barriers and facilitators identified in phase 1, in a broader clinical sample (n=200). In phase 3, a workshop forum will be held to facilitate discussions examining the implications of phase 1 and 2 findings for cancer CPG implementation strategies (n=40) leading to recommendations for improvements to practice. The workshop discussion will be recorded, and the transcript will be analysed thematically.Ethics and disseminationThis study has received ethics approval in New South Wales, Australia (2019/ETH11722, #52019568810127). Study findings will be published in peer-reviewed journals and will form part of a doctoral thesis and be presented at national and international conferences.

scholarly journals Mobilization and Exercise Intervention for Patients With Multiple Myeloma: Clinical Practice Guidelines Endorsed by the Canadian Physiotherapy Association

2020 ◽  
Vol 101 (1) ◽  
Author(s):  
Deepa Jeevanantham ◽  
Venkadesan Rajendran ◽  
Zachary McGillis ◽  
Line Tremblay ◽  
Céline Larivière ◽  
...  
Keyword(s):  
Systematic Review ◽  
Multiple Myeloma ◽  
Clinical Practice ◽  
Physical Therapy ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Exercise Intervention ◽  
Physical Therapists ◽  
Evidence Based ◽  
Consensus Process

Abstract Objective Individuals with multiple myeloma (MM) often have reduced functional performance due to the cancer itself or as a direct side effect of cancer treatments. Physical therapy is a part of cancer rehabilitation; however, no guidelines are available to provide information and direction for physical therapists managing patients with MM. The goal of this guideline is to provide recommendations based on a systematic review and consensus process that physical therapists can use to manage patients with MM. Methods A systematic review of the literature published until August 2018 was performed in 8 databases with 2 independent reviewers assessing quality. Seventeen articles were identified as relevant, and a draft guideline was developed in the form of action statements. A total of 10 physical therapists with hematology experience and 10 patients with MM were recruited for consensus process. A priori threshold of 80% agreement was used to establish a consensus for each statement. The draft guidelines were reviewed externally by 4 methodologists using the AGREE II tool and a stakeholder representing OH (Cancer Care Ontario) Program in Evidence Based Care, McMaster University. The final guideline was reviewed and officially endorsed by the Canadian Physiotherapy Association. Results A total of 30 action statements were developed that achieved consensus, indicating physical therapy recommendations based on physiological markers (ie, hemoglobin, platelet count), complete patient presentation, and the stage of medical treatment. Conclusion These clinical practice guidelines were developed to aid physical therapists in implementing evidence-based and best-practice care for patients with MM to optimize rehabilitation outcomes. Impact These guidelines fill an important knowledge gap and are the first to provide information specifically for physical therapist management of patients with MM.

Clinical Practice Guidelines: The Need for Improved Implementation Strategies

2000 ◽  
Vol 13 (1) ◽  
pp. 36-42 ◽  
Author(s):  
Glen Randall ◽  
D. Wayne Taylor
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Positive Impact ◽  
Implementation Strategies ◽  
Successful Implementation ◽  
Minimal Impact ◽  
Effective Implementation ◽  
Clinical Behaviour

Although substantial resources have been spent developing clinical practice guidelines, little effort has been made to evaluate the effectiveness of their implementation. In the absence of effective implementation, CPGs will have minimal impact on changing behaviours. This article critically reviews the literature and identifies a number of reasons why these guidelines have not been implemented successfully. If CPGs are to have a positive impact upon clinical behaviour and practice, then more aggressive and positive implementation strategies are indicated. Five key ingredients for successful implementation of quality CPGs are identified and recommended.

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