Physician-reported barriers to using evidence-based recommendations for low back pain in clinical practice: a systematic review and synthesis of qualitative studies using the Theoretical Domains Framework

IntroductionSurgical rates for low back pain (LBP) have been increasing in Europe, North America and Asia. Many patients treated surgically will require postsurgical rehabilitation. Little is known about the effectiveness of postsurgical rehabilitation interventions on health outcomes or about patients’ experiences with these interventions.ObjectivesTo conduct a mixed studies systematic review of quantitative and qualitative studies regarding: (1) the effectiveness and safety of postsurgical rehabilitation interventions for adults with LBP treated surgically and (2) the experiences of patients, healthcare providers, caregivers or others involved with the rehabilitation.Methods and analysisWe will search MEDLINE, Embase, PsycINFO, CINAHL, the Index to Chiropractic Literature, the Cochrane Controlled Register of Trials and the Rehabilitation & Sports Medicine Source for peer-reviewed empirical studies published from inception in any language. Studies using quantitative, qualitative and mixed methodologies will be included. We will also search reference lists of all eligible articles. Data extraction will include type of presurgical pathology, indication for surgery, surgical procedure, how the intervention was delivered and by whom, context and setting. We will conduct a quality assessment of each study and consider study quality in our evidence synthesis. We will use a sequential approach at the review level to synthesise and integrate data. First, we will synthesise the quantitative and qualitative studies independently, conducting a meta-analysis of the quantitative studies if appropriate and thematic synthesis of the qualitative studies. Then, we will integrate the quantitative and qualitative evidence by juxtaposing the findings in a matrix.Ethics and disseminationEthical approval is not required for this knowledge synthesis. Findings will be disseminated through knowledge translation activities including: (1) presentations at national and international conferences and scientific meetings; (2) presentations to local and international stakeholders; (3) publications in peer-reviewed journals and (4) posts on organisational websites.PROSPERO registration numberCRD42019134607.

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Barriers to primary care clinician adherence to clinical guidelines for the management of low back pain: protocol of a systematic review and meta-synthesis of qualitative studies

BMJ Open ◽

10.1136/bmjopen-2014-007265 ◽

2015 ◽

Vol 5 (4) ◽

pp. e007265-e007265 ◽

Cited By ~ 14

Author(s):

S. C. Slade ◽

P. Kent ◽

T. Bucknall ◽

E. Molloy ◽

S. Patel ◽

...

Keyword(s):

Systematic Review ◽

Primary Care ◽

Low Back Pain ◽

Back Pain ◽

Clinical Guidelines ◽

Qualitative Studies ◽

Low Back ◽

Primary Care Clinician

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Applying psychological theories to evidence-based clinical practice: identifying factors predictive of lumbar spine x-ray for low back pain in UK primary care practice

Implementation Science ◽

10.1186/1748-5908-6-55 ◽

2011 ◽

Vol 6 (1) ◽

Cited By ~ 25

Author(s):

Jeremy M Grimshaw ◽

Martin P Eccles ◽

Nick Steen ◽

Marie Johnston ◽

Nigel B Pitts ◽

...

Keyword(s):

Primary Care ◽

Low Back Pain ◽

Back Pain ◽

Clinical Practice ◽

Primary Care Practice ◽

Care Practice ◽

Evidence Based ◽

Low Back ◽

X Ray ◽

Psychological Theories

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Ottawa Panel evidence-based clinical practice guidelines on therapeutic massage for low back pain

Journal of Bodywork and Movement Therapies ◽

10.1016/j.jbmt.2012.04.002 ◽

2012 ◽

Vol 16 (4) ◽

pp. 424-455 ◽

Cited By ~ 32

Author(s):

Lucie Brosseau ◽

George A. Wells ◽

Stéphane Poitras ◽

Peter Tugwell ◽

Lynn Casimiro ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Evidence Based ◽

Low Back ◽

Therapeutic Massage

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Are Clinical Practice Guidelines for Low Back Pain interventions of high quality and updated? A systematic review using the AGREE II instrument

10.21203/rs.3.rs-42082/v2 ◽

2020 ◽

Author(s):

Greta Castellini ◽

Valerio Iannicelli ◽

Matteo Briguglio ◽

Davide Corbetta ◽

Luca Maria Sconfienza ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Grey Literature ◽

Pharmacological Intervention ◽

Low Back ◽

Agree Ii

Abstract BACKGROUND: Clinical practice guidelines (CPGs) provide recommendations for practice, but the proliferation of CPGs issued by multiple organisations in recent years has raised concern about their quality. The aim of this study was to systematically appraise CPGs quality for low back pain (LBP) interventions and to explore inter-rater reliability (IRR) between quality appraisers. The time between systematic review search and publication of CPGs was recorded.METHODS: Electronic databases (PubMed, Embase, PEDro, TRIP), guideline organisation databases, websites, and grey literature were searched from January 2016 to January 2020 to identify GPCs on rehabilitative, pharmacological or surgical intervention for LBP management. Four independent reviewers used the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool to evaluate CPGs quality and record the year the CPGs were published and the year the search strategies were conducted. RESULTS: A total of 21 CPGs met the inclusion criteria and were appraised. Seven (33%) were broad in scope and involved surgery, rehabilitation or pharmacological intervention. The score for each AGREE II item was: Editorial Independence (median 67%, interquartile range [IQR] 31 – 84%), Scope and Purpose (median 64%, IQR 22 – 83%), Rigour of Development (median 50%, IQR 21 – 72%), Clarity and Presentation (median 50%, IQR 28 – 79%), Stakeholder Involvement (median 36%, IQR 10 – 74%), and Applicability (median 11%, IQR 0 – 46%). The IRR between the assessors was nearly perfect (interclass correlation 0.90; 95% confidence interval 0.88 – 0.91). The median time span was 2 years (range, 1-4), however, 38% of the CPGs did not report the coverage dates for systematic searches.CONCLUSIONS: We found methodological limitations that affect CPGs quality. A universal database is needed in which guidelines can be registered and recommendations dynamically developed through a living systematic reviews approach to ensure that guidelines are based on updated evidence. LEVEL OF EVIDENCE: 1REGISTRATION PROSPERO DETAILS: CRD42019127619.

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