为了在日常实践中最佳使用临床指南,仅仅分发指导方针和材料是不够的,需要积极实施。这篇综述调查了多方面实施策略的有效性,单身,或没有实施策略在医疗保健中实施非特异性腰痛和/或颈痛指南。
从开始到2015年6月1日搜索了以下电子数据库:MEDLINE,Embase,PsycInfo,Cochrane图书馆,和CINAHL。搜索策略仅限于腰痛,颈部疼痛,和实施研究。如果他们的设计是一项随机对照试验,报告患有非特异性下腰痛或颈部疼痛(伴有或不伴有放射痛)的患者(年龄≥18岁)。如果他们报告患者结果,试验是合格的,医疗保健专业行为的衡量标准,和/或医疗保健水平的结果。主要结果是职业行为。研究中评估的指南必须在医疗保健环境中实施。没有应用语言限制,研究必须全文发表在同行评审的期刊上,因此,只排除抽象出版物,会议摘要,和论文文章。两名研究人员独立筛选标题和摘要,从纳入的研究中提取数据,并进行偏见风险评估。
删除重复项后,搜索结果筛选了4750篇摘要.在接受资格评估的43篇全文文章中,这次审查包括12个,报告9项单独研究,以及3项纳入研究的单独成本效益分析。不同研究的实施策略各不相同。荟萃分析没有发现多方面策略和控制之间的效果差异。
这篇综述显示,在医疗保健中实施颈部和/或背部疼痛指南的多方面策略并不能显著改善职业行为结果。没有发现对患者预后或护理成本的影响。需要进行更多的研究,以确定是否按计划进行了多方面的实施策略,以及这些策略是否有效地改变了专业行为,从而改变了临床实践。
For the optimal use of clinical guidelines in daily practice, mere distribution of guidelines and materials is not enough, and active implementation is needed. This
review investigated the effectiveness of multifaceted implementation strategies compared to minimal, single, or no implementation strategy for the implementation of non-specific low back and/or neck pain guidelines in health care.
The following electronic databases were searched from inception to June 1, 2015: MEDLINE, Embase, PsycInfo, the Cochrane Library, and CINAHL. The search strategy was restricted to low back pain, neck pain, and implementation research. Studies were included if their design was a randomized controlled trial, reporting on patients (age ≥18 years) with non-specific low back pain or neck pain (with or without radiating pain). Trials were eligible if they reported patient outcomes, measures of healthcare professional behaviour, and/or outcomes on healthcare level. The primary outcome was professional behaviour. Guidelines that were evaluated in the studies had to be implemented in a healthcare setting. No language restrictions were applied, and studies had to be published full-text in peer-reviewed journals, thus excluding abstract only publications, conference abstracts, and dissertation articles. Two researchers independently screened titles and abstract, extracted data from included studies, and performed risk of bias assessments.
After removal of duplicates, the search resulted in 4750 abstracts to be screened. Of 43 full-text articles assessed for eligibility, 12 were included in this
review, reporting on 9 individual studies, and separate cost-effectiveness analyses of 3 included studies. Implementation strategies varied between studies. Meta-analyses did not reveal any differences in effect between multifaceted strategies and controls.
This
review showed that multifaceted strategies for the implementation of neck and/or back pain guidelines in health care do not significantly improve professional behaviour outcomes. No effects on patient outcomes or cost of care could be found. More research is necessary to determine whether multifaceted implementation strategies are conducted as planned and whether these strategies are effective in changing professional behaviour and thereby clinical practice.