Lighting Talk Sydney Spinal Symposium 2024

Effectiveness of strategies for implementing guideline-concordant care in low back pain: a systematic review and meta-analysis (#16)

Siya Zhao 1 2 , Aili Langford 1 3 , Qiuzhe Chen 1 2 , Meng Lv 4 , Zhiwei Yang 1 2 , Simon French 5 , Christopher Williams 6 7 , Chung-Wei Christine Lin 1 2
  1. Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia
  2. Sydney School of Public Health, The University of Sydney,, Sydney, NSW, Australia
  3. Sydney School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
  4. School of Public Health, Lanzhou University, Lanzhou, Gansu, China
  5. Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
  6. University Centre for Rural Health, School of Health Sciences, University of Sydney, Lismore, NSW, Australia
  7. Research and Knowledge Translation Directorate, Mid North Coast Local Health District, Port Macquarie, NSW, Australia

Background International low back pain guidelines recommend providing education/advice to patients, discouraging routine imaging use, and encouraging judicious prescribing of analgesics. However, practice variation occurs and the effectiveness of implementation strategies to promote guideline-concordant care is unclear. This review aims to comprehensively evaluate the effectiveness of implementation strategies to promote guideline-concordant care for low back pain.

Methods We searched five databases from inception until 1st September 2023. Randomised controlled trials that evaluated strategies to promote guideline-concordant care (providing education/advice, discouraging routine imaging use, and/or reducing analgesic use) among healthcare professionals or organisations were included. Two reviewers independently conducted screening, data extraction, and risk of bias assessments. The primary outcome was guideline-concordant care in the medium-term (> 3 months but < 12 months). We used the taxonomy recommended by the Cochrane Effective Practice and Organisation of Care (EPOC) group to categorise implementation strategies. Meta-analysis with a random effects model was conducted where possible.

Findings Twenty-seven studies were included. All strategies targeted healthcare professionals (7,796 health professionals overseeing 34,890 patients with low back pain), and none targeted organisations. The most commonly used implementation strategies were educational materials (15/27) and educational meetings (14/27), although most studies (24/27) used more than one strategy (‘multifaceted strategies’). In the medium-term, compared to no implementation, implementation strategies effectively reduced use of routine imaging (number of studies [N]=7, odds ratio [OR]=1.26, 95% confidence interval [CI]: 1.01 to 1.58, I2=50%, moderate certainty evidence), but did not improve the rate of providing education/advice (N=3, OR=1.83, 95% CI: 0.87 to 3.87, I2=95%, low certainty evidence) or reduce analgesic use (N=4, OR=1.05, 95% CI: 0.96 to 1.14, I2=0%, high certainty evidence). No difference was found when comparing one implementation strategy to another in the medium-term.

Interpretation There is some evidence that implementation strategies targeting healthcare professionals promote guideline concordant care in the management of low back pain, but the effects are inconsistent.