Evaluating two implementation strategies for whiplash guidelines in physiotherapy: a cluster randomised trial. Testing the effectiveness of an innovative information package on practitioner reported behaviour and beliefs: The UK Chiropractors, Osteopaths and Musculoskeletal Physiotherapists Low back pain ManagemENT (COMPLeMENT) trial [ISRCTN77245761] The implementation of a community-based aerobic walking program for mild to moderate knee osteoarthritis (OA): a knowledge translation (KT) randomized controlled trial (RCT): Part I: The Uptake of the Ottawa Panel clinical practice guidelines (CPGs) Adherence to physiotherapy clinical guideline acute ankle injury and determinants of adherence: a cohort study Physiotherapy screening of patients referred for orthopaedic consultation in primary healthcare - a randomised controlled trial. Implementation of the Swedish Guideline for Prevention of Mental ill-health at the Workplace: study protocol of a cluster randomized controlled trial, using multifaceted implementation strategies in schools Perspectives of health care professionals on the facilitators and barriers to the implementation of a stroke rehabilitation guidelines cluster randomized controlled trial Effectiveness of workplace interventions in rehabilitating musculoskeletal disorders and preventing its consequences among workers with physical and sedentary employment: systematic review protocol Effect on the process of care of an active strategy to implement clinical guidelines on physiotherapy for low back pain: a cluster randomised controlled trial The emergency department community-acquired pneumonia trial: Methodology of a quality improvement intervention. The Effectiveness of a Posted Information Package on the Beliefs and Behavior of Musculoskeletal Practitioners: The UK Chiropractors, Osteopaths, and Musculoskeletal Physiotherapists Low Back Pain ManagemENT (COMPLeMENT) Randomized Trial Implementation of a new clinical practice guideline regarding pain management during childhood vaccine injections. Evaluation of a tailored, multi-component intervention for implementation of evidence-based clinical practice guidelines in primary care physical therapy: a non-randomized controlled trial Does physiotherapy management of low back pain change as a result of an evidence-based educational programme? Do physiotherapists' attitudes towards evidence-based practice change as a result of an evidence-based educational programme? Information system support as a critical success factor for chronic disease management: Necessary but not sufficient Testing the feasibility of a knowledge translation intervention designed to improve chiropractic care for adults with neck pain disorders: study protocol for a pilot cluster-randomized controlled trial Effectiveness of implementation strategies in improving physician adherence to guideline recommendations in heart failure: a systematic review protocol Implementation of multidimensional knowledge translation strategies to improve procedural pain in hospitalized children The study design and rationale of the randomized controlled trial: translating COPD guidelines into primary care practice Randomized Controlled Trials in Music Therapy: Guidelines for Design and Implementation. The BLISS cluster randomised controlled trial of the effect of 'active dissemination of information' on standards of care for premature babies in England (BEADI) study protocol [ISRCTN89683698] Improving the care for people with acute low-back pain by allied health professionals (the ALIGN trial): A cluster randomised trial protocol
QUESTION Are implementation strategies involving education any more effective than mere dissemination of clinical practice guidelines in changing physiotherapy practice and reducing patient disability after acute whiplash ? DESIGN Cluster-r and omised trial . PARTICIPANTS Twenty-seven physiotherapists from different private physiotherapy clinics and the 103 patients ( 4 dropouts ) who presented to them with acute whiplash . INTERVENTION The implementation group of physiotherapists underwent education by opinion leaders about whiplash guidelines and the dissemination group had the guidelines mailed to them . OUTCOME MEASURES The primary outcome was patient disability , measured using the Functional Rating Index , collected on admission to the trial and at 1.5 , 3 , 6 and 12 months . Physiotherapist knowledge about the guidelines was measured using a custom-made question naire . Physiotherapist practice and cost of care were measured by audit of patient notes . RESULTS There were no significant differences between groups for any of the patient outcomes at any time . The implementation patients had 0.6 points ( 95 % CI -7.8 to 6.6 ) less disability than the dissemination patients at 12 months ; 44 % more physiotherapists in the implementation group reported that they prescribed two out of the five guideline -recommended treatments ; and 32 % more physiotherapists actually prescribed them . The cost of care for patients in the implementation group was $ 255 ( 95 % CI -1505 to 996 ) less than for patients in the dissemination group . CONCLUSION Although the active implementation program increased guideline -consistent practice , patient outcomes and cost of care were not affected Background Low back pain ( LBP ) is a common and costly problem . Initiatives design ed to assist practitioner and patient decisions about appropriate healthcare for LBP include printed evidence -based clinical guidelines . The three professional groups of chiropractic , osteopathy and musculoskeletal physiotherapy in the UK share common ground with their approaches to managing LBP and are amongst those targeted by LBP guidelines . Even so , many seem unaware that such guidelines exist . Furthermore , the behaviour of at least some of these practitioners differs from that recommended in these guidelines .Few r and omised controlled trials evaluating printed information as an intervention to change practitioner behaviour have utilised a no-intervention control . All these trials have used a cluster design and most have method ological flaws . None specifically focus upon practitioner behaviour towards LBP patients . Studies that have investigated other strategies to change practitioner behaviour with LBP patients have produced conflicting results . Although numerous LBP guidelines have been developed worldwide , there is a paucity of data on whether their dissemination actually changes practitioner behaviour . Primarily because of its low unit cost , sending printed information to large numbers of practitioners is an attractive dissemination and implementation strategy . The effect size of such a strategy , at an individual practitioner level , is likely to be small . However , if large numbers of practitioners are targeted , this strategy might achieve meaningful changes at a population level . Methods The primary aim of this prospect i ve , pragmatic r and omised controlled trial is to test the short-term effectiveness ( six-months following intervention ) of a directly-posted information package on the reported clinical behaviour ( primary outcome ) , attitudes and beliefs of UK chiropractors , osteopaths and musculoskeletal physiotherapists . We sought to r and omly allocate a combined sample of 1,800 consenting practitioners to receive either the information package ( intervention arm ) or no information above that gained during normal practice ( control arm ) . We collected question naire data at baseline and six-months post-intervention . The analysis of the primary outcome will assess between-arm differences of proportions of responses to questions on recommendations about activity , work and bed-rest , that fall within categories previously defined by an expert consensus exercise as either ' guideline -consistent ' and ' guideline -inconsistent ' Background The implementation of evidence based clinical practice guidelines on self-management interventions to patients with chronic diseases is a complex process . A multifaceted strategy may offer an effective knowledge translation ( KT ) intervention to promote knowledge uptake and improve adherence in an effective walking program based on the Ottawa Panel Evidence Based Clinical Practice Guidelines among individuals with moderate osteoarthritis ( OA ) . Methods A single-blind , r and omized control trial was conducted . Patients with mild to moderate ( OA ) of the knee ( n=222 ) were r and omized to one of three KT groups : 1 ) Walking and Behavioural intervention ( WB )  ( 18 males , 57 females ) which included the supervised community-based aerobic walking program combined with a behavioural intervention and an educational pamphlet on the benefits of walking for OA ; 2 ) Walking intervention ( W )  ( 24 males , 57 females ) wherein participants only received the supervised community-based aerobic walking program intervention and the educational pamphlet ; 3 )  Self-directed control ( C ) ( 32 males , 52 females ) wherein participants only received the educational pamphlet . One-way analyses of variance were used to test for differences in quality of life , adherence , confidence , and clinical outcomes among the study groups at each 3 month assessment during the 12-month intervention period and 6-month follow-up period . Results Short-term program adherence was greater in WB compared to C ( p<0.012 ) after 3 months . No statistical significance ( p > 0.05 ) was observed for long-term adherence ( 6 to 12 months ) , and total adherence between the three groups . The three knowledge translation strategies demonstrated equivalent long-term results for the implementation of a walking program for older individuals with moderate OA .  Lower dropout rates as well as higher retention rates were observed for WB at 12 and 18 months . Conclusion The additional knowledge translation behavioural component facilitated the implementation of clinical practice guidelines on walking over a short-term period . More studies are needed to improve the long-term walking adherence or longer guidelines uptake on walking among participants with OA . Particular attention should be taken into account related to patient ’s characteristic and preference . OA can be managed through the implementation of a walking program based on clinical practice guidelines in existing community-based walking clubs as well as at home with the minimal support of an exercise therapist or a trained volunteer . Trial Registration Current Controlled Trials Background Clinical guidelines are considered important instruments to improve quality in health care . In physiotherapy , insight in adherence to guidelines is limited . Knowledge of adherence is important to identify barriers and to enhance implementation . Purpose of this study is to investigate the ability to adherence to recommendations of the guideline Acute ankle injury , and to identify patient characteristics that determine adherence to the guideline . Methods Twenty-two physiotherapists collected data of 174 patients in a prospect i ve cohort study , in which the course of treatment was systematic ally registered . Indicators were used to investigate adherence to recommendations . Patient characteristics were used to identify prognostic factors that may determine adherence to the guideline . Correlation between patient characteristics and adherence to outcome -indicators ( treatment sessions , functioning of patient , accomplished goals ) was calculated using univariate logistic regression . To calculate explained variance of combined patient characteristics , multivariate analysis was performed . Results Adherence to individual recommendations varied from 71 % to 100 % . In 99 patients ( 57 % ) the physiotherapists showed adherence to all indicators . Adherence to preset maximum of six treatment sessions for patients with severe ankle injury was 81 % ( 132 patients ) .The odds to receive more than six sessions were statistically significant for three patient characteristics : females ( OR:3.89 ; 95%CI : 1.41–10.72 ) , recurrent sprain ( OR : 6.90 ; 95%CI : 2.34 – 20.37 ) , co-morbidity ( OR : 25.92 ; 95 % CI : 6.79 – 98.93 ) . All factors together explained 40 % of the variance . Inclusion of physiotherapist characteristics in the regression model showed that work-experience reduced the odds to receive more than six sessions ( OR : 0.2 ; 95%CI : 0.06 – 0.77 ) , and increased explained variance to 45 % . Conclusion Adherence to the clinical guideline Acute ankle sprain showed that the guideline is applicable in daily practice . Adherence to the guideline , even in a group of physiotherapists familiar with the guideline , showed possibilities for improvement . The necessity to exceed the expected number of treatment sessions may be explained by co-morbidity and recurrent sprains . It is not clear why female patients were treated with more sessions . Experience of the physiotherapist reduced the number of treatment sessions . Quality indicators may be used for audit and feedback as part of the implementation strategy A large proportion of patients who consult primary healthcare for musculoskeletal pain are referred for orthopaedic consultation , but only a small number of these patients are appropriate for orthopaedic intervention . Experienced physiotherapists have the appropriate knowledge to manage musculoskeletal disorders . The primary aim of this r and omised study was therefore to evaluate a screening by a physiotherapist of patients referred for orthopaedic consultation compared to st and ard practice in primary care . Patients referred for orthopaedic consultation ( n=203 ) were r and omised to physiotherapy screening or st and ard practice .  Selection accuracy for orthopaedic intervention and other referrals were analysed with proportion analysis . Patient views of the quality of care were analysed with Mann-Whitney U-test , waiting time with Independent t-test . There was higher selection accuracy for orthopaedic intervention in the physiotherapy screening group ( p=0.002 ) . A smaller proportion of patients in the screening group were referred back to their general practitioner ( GP ) ( p<0.001 ) and a larger proportion to the physiotherapy clinic ( p<0.001 ) compared to st and ard practice . The proportion of patients referred for further investigations was significantly lower in the physiotherapy screening group ( p<0.039 ) . Waiting time was shorter in the screening group ( p<0.001 ) . A large proportion of the patients reported no hesitation to attend the clinic for future care , no difference between the groups ( p<0.95 ) . The findings in this study suggest that an experienced physiotherapist effectively can screen patients referred for orthopaedic consultation in primary healthcare Given today ’s high prevalence of common mental disorders and related sick leave among teachers , an urgent need exists for a more systematic approach to the management of social and organizational risk factors within schools . In 2015 , we launched the first Swedish occupational health guideline to support a structured prevention of these risks at the workplace . The existence of guidelines does however not guarantee their usage , as studies show that guidelines are often underused . Knowledge is therefore needed on effective implementation strategies that can facilitate the translation of guidelines into practice . The primary aim of the r and omized waiting list-controlled trial described in this study protocol is to compare the effectiveness of a multifaceted implementation strategy versus a single implementation strategy for implementing the Guideline for the prevention of mental ill-health at the workplace within schools . The effectiveness will be compared regarding the extent to which the recommendations are implemented ( implementation effectiveness ) and with regard to social and organisational risk factors for mental ill-health , absenteeism and presenteeism ( intervention effectiveness ) . The trial is conducted among primary schools of two municipalities in Sweden . The single implementation strategy is an educational strategy ( an educational meeting ) . The multifaceted strategy consists of the educational meeting , an implementation team and a series of workshops . The outcome measure of implementation effectiveness is  guideline adherence . The primary outcome of intervention effectiveness is exhaustion . Secondary outcomes include dem and s at work , work organization and job contents , interpersonal relations and leadership , presenteeism , work performance , recovery , work-life balance , work-engagement , self-reported stress , self-perceived health , sickness absence and psychosocial safety climate . Process outcomes as well as barriers and facilitators influencing the implementation process are assessed . Data will be collected at baseline , 6 , 12 , 18 and 24 months by mixed methods ( i.e. survey , focus-group interviews , observation ) . The study described in this protocol will provide valuable knowledge on the effectiveness of implementation strategies for implementing a guideline for the prevention of common mental disorders within schools . We hypothesize that successful implementation will result in reductions in school personnel ’s  perceived social and organizational risk factors , mental ill-health and sick-leave . Clinical Trials.gov ID : NCT03322839 ( trial registration : 09/19/2017 ) Background The Stroke Canada Optimization of Rehabilitation by Evidence Implementation Trial ( SCORE-IT ) was a cluster r and omized controlled trial that evaluated two knowledge translation ( KT ) interventions for the promotion of the uptake of best practice recommendations for interventions targeting upper and lower extremity function , postural control , and mobility . Twenty rehabilitation centers across Canada were r and omly assigned to either the facilitated or passive KT intervention . The objective of the current study was to underst and the factors influencing the implementation of the recommended treatments and KT interventions from the perspective of nurses , occupational therapists and physical therapists , and clinical managers following completion of the trial . Methods A qualitative descriptive approach involving focus groups was used . Thematic analysis was used to underst and the factors influencing the implementation of the recommended treatments and KT interventions . The Clinical Practice Guidelines Framework for Improvement guided the analysis . Results Thirty-three participants were interviewed from 11 of the 20 study sites ( 6 sites from the facilitated KT arm and 5 sites from the passive KT arm ) . The following factors influencing the implementation of the recommended treatments and KT interventions emerged : facilitation , agreement with the intervention – practical , familiarity with the recommended treatments , and environmental factors , including time and re sources . Each of these themes includes the sub-themes of facilitator and /or barrier . Improved team communication and interdisciplinary collaboration emerged as an unintended outcome of the trial across both arms in addition to a facilitator to the implementation of the treatment recommendations . Facilitation was identified as a facilitator to implementation of the KT interventions in the passive KT intervention arm despite the lack of formally instituted facilitators in this arm of the trial . Conclusions This is one of the first studies to examine the factors influencing the implementation of stroke recommendations and associated KT interventions within the context of a trial . Findings highlight the important role of self-selected facilitators to implementation efforts . Future research should seek to better underst and the specific characteristics of facilitators that are associated with successful implementation and clinical outcomes , especially within the context of stroke rehabilitation Background Musculoskeletal disorders ( MSDs ) are the leading cause of work disability and sickness absence worldwide . The prevalence of MSDs increases with age , consequently challenging sustainable employability among the growing ageing workforce . Knowledge of feasible and efficient workplace-based interventions to rehabilitate MSD or prevent its consequences is therefore warranted . This systematic review will evaluate the effectiveness of workplace-based interventions on MSDs and its consequences among adult workers with physical and sedentary work tasks , respectively . Methods We will search the following bibliographic data bases : PubMed ( including the data base ‘ MEDLINE ’ ) and Web of Science Core Collection ( including the data bases ‘ Science Citation Index Exp and ed ’ , ‘ Social Sciences Citation Index ’ and ‘ Arts & Humanities Citation Index ’ ) . Manual search es will also be performed . We will include r and omised controlled trials ( RCTs ) and non- RCTs reported in English in which ( 1 ) participants are adult workers with MSD , ( 2 ) interventions are aim ing at rehabilitating pain symptoms of MSD or preventing the consequences of MSD and ( 3 ) interventions are initiated and /or carried out at the workplace . The review will adhere to the ‘ Preferred Reporting Items for Systematic review s and Meta-Analyses ’ ( PRISMA ) guidelines for reporting systematic review s and the Institute for Work and Health ( IWH ) guidelines for workplace-based interventions . For the primary evaluation of the review , the quality assessment and evidence synthesis will conform to the IWH guidelines . Secondary evaluation will include a meta- analysis ( unless the included studies do not allow this due to heterogeneity ) and employ the risk of bias domains recommended by Cochrane along with the Grading of Recommendations , Assessment , Development and Evaluations ( GRADE ) approach on the studies with pain intensity as an outcome . Discussion This systematic review will provide knowledge on effective workplace-based interventions among physical and sedentary workers with MSD . RCTs are considered the most powerful experimental design in clinical trials , but solely including these may be too restrictive to underst and effective workplace-based interventions where r and omised and carefully controlled trials ( RCTs ) are not always possible . In order to maximize practical relevance , the selection process will , therefore , include both RCTs and non- RCTs and the quality assessment and evidence synthesis will conform to IWH guidelines focusing on developing practical guidelines for stakeholders . The result of this work will form the basis for industry-specific evidence -based recommendations on effective workplace-based interventions for rehabilitation of MSDs and its consequences that will later be operationalised into concrete and user-friendly practical tools for workplaces . Systematic review registration International Prospect i ve Register of Systematic Review s ( PROSPERO ) number CRD42018116752 Objectives : To evaluate the effect on the process of care of an active strategy to implement clinical guidelines on physiotherapy for low back pain . Design : A cluster r and omised controlled trial comparing an active strategy with st and ard dissemination . Setting : Primary care physiotherapy practice s. Participants : 113 physiotherapists were r and omly allocated to receive the guidelines by mail ( control group ) or to receive an additional active strategy ( intervention group ) which consisted of a multifaceted programme including education , discussion , role playing , feedback , and reminders . Main outcome measures : Adherence to the guidelines was measured by means of individual patients ’ forms recording the treatment completed by the physiotherapist . The forms were assessed using an algorithm based on the number of treatment sessions , treatment goals , interventions , and patient education . Results : Physiotherapists in the intervention group more often correctly limited the number of treatment sessions for patients with a normal course of back pain ( OR 2.39 ; 95 % CI 1.12 to 5.12 ) , more often set functional treatment goals ( OR 1.99 ; 95 % CI 1.06 to 3.72 ) , more often used mainly active interventions ( OR 2.79 ; 95 % CI 1.19 to 6.55 ) , and more often gave adequate patient education ( OR 3.59 ; 95 % CI 1.35 to 9.55 ) . They also adhered more to all four criteria ( OR 2.05 ; 95 % CI 1.15 to 3.65 ) . Conclusions : The active strategy moderately improved adherence to the guidelines . Active strategies are recommended to implement the clinical guidelines on physiotherapy for low back pain Community-acquired pneumonia causes more than 4 million episodes of illness each year and has high morbidity , mortality , and total cost of care . Nationwide , nearly 75 % of community-acquired pneumonia patients are initially evaluated and treated in hospital-based emergency departments ( EDs ) . Substantial variation exists in illness severity assessment , hospital admission decisions , and performance of recommended processes of care . We design ed an ED-based quality improvement trial focused on the initial care of patients with community-acquired pneumonia . We used the  Pneumonia Severity Index and level of arterial oxygenation  to identify patients at low risk for 30-day mortality and to guide admission decisionmaking . We assessed the performance of recommended " best practice s , " consisting of assessment of arterial oxygenation , the collection of blood cultures for in patients , and the timely initiation of appropriate empiric antibiotic therapy for in patients and out patients . We conducted a 32-site , cluster-r and omized trial in Pennsylvania and Connecticut , comparing the effectiveness and safety of 3 guideline implementation strategies of increasing intensity . The multifaceted implementation plans were carried out in conjunction with each state 's quality improvement organization . This article describes the background , objectives , and methodology of this trial to translate evidence -based knowledge on the quality and efficiency of care for community-acquired pneumonia into clinical practice Study Design . R and omized controlled trial . Objective . To investigate the effect of a printed information package on the low back pain (LBP)-related beliefs and reported behavior of musculoskeletal practitioners ( chiropractors , osteopaths , and musculoskeletal physiotherapists ) across the United Kingdom . Summary of Background Data . A substantial proportion of musculoskeletal practitioners in United Kingdom does not follow current LBP guideline recommendations . Methods . In total , 1758 practitioners were r and omly allocated to either of the 2 study arms . One arm was posted a printed information package containing guideline recommendations for the management of LBP ( n = 876 ) and the other received no intervention ( n = 882 ) . The primary outcome measure consisted of 3 “ quality indicators ” ( activity , work , and bed-rest ) relating to a vignette of a patient with LBP , in which responses were dichotomized into either “ guideline -inconsistent ” or “ guideline -consistent . ” The secondary outcome was the practitioners ' LBP-related beliefs , measured using the Health Care Providers Pain and Impairment Relationship Scale . Outcomes were measured at baseline and at 6 months . Results . Follow-up at 6 months was 89 % . The changes in reported behavior on the quality indicators were as follows : activity , odds ratio ( OR ) 1.29 ( 95 % confidence interval , 1.03–1.61 ) and number needed to be treated ( NNT ) , 19 ( 15–28 ) ; work , OR 1.35 ( 1.07–1.70 ) and NNT 19 ( 14–29 ) ; and bed-rest , OR 1.31 ( 0.97–1.76 ) and NNT 47 ( 33–103 ) . The composite NNT for a change from guideline -inconsistent to guideline -consistent behavior on at least 1 of the 3 quality indicators was 10 ( 9–14 ) . LBP-related beliefs were significantly improved in those who were sent the information package ( P = 0.002 ) , but only to a small degree ( mean difference , 0.884 scale points ; 95 % confidence interval , 0.319–1.448 ) . Conclusion . Printed educational material can shift LBP-related beliefs and reported behaviors of musculoskeletal practitioners , toward practice that is more in line with guideline recommendations OBJECTIVE To determine the impact of a multifaceted knowledge translation strategy for a new vaccination pain management guideline on public health immunizers ' attitudes , beliefs and use of pain-relieving strategies during childhood vaccination . METHOD Using a r and omized controlled pre-post study design , public health nurses ( PHNs ) at intervention sites received a multifaceted knowledge translation intervention about new pain management guidelines incorporated in the British Columbia Immunization Program Manual , including education , supplies and online support . Attitudes and beliefs of PHNs toward immunization pain and pain management , and use of pain-relieving strategies were compared for the intervention sites between the pre- and postimplementation phases . RESULTS A total of 516 children were immunized by 31 PHNs pre- and postimplementation in the intervention sites . Postimplementation , satisfaction and confidence with ability to manage pain and willingness to use newly recommended strategies were significantly more positive ( P<0.05 ) in the intervention sites , and overall use of at least one newly recommended strategy increased from 49.8 % preintervention to 77.6 % postimplementation ( P<0.001 ) . CONCLUSION The knowledge translation intervention improved PHN immunizers ' attitudes , beliefs and practice s regarding paediatric vaccination pain management . Reducing pain may result in a better immunization experience for children , caregivers and immunizers Background Clinical practice guidelines are important for transmitting research findings into practice and facilitating the application of evidence -based practice ( EBP ) . There is a paucity of knowledge about the impact of guideline implementation strategies in primary care physical therapy . The aim of this study was to evaluate the effect of a guideline implementation intervention in primary care physical therapy in western Sweden . Methods An implementation strategy based on theory and current evidence was developed . A tailored , multi-component implementation intervention , addressing earlier identified determinants , was carried out in three areas comprising 28 physical therapy practice s including 277 physical therapists ( PTs ) ( intervention group ) . In two adjacent areas , 171 PTs at 32 practice s received no intervention ( control group ) . The core component of the intervention was an implementation seminar with group discussion s. Among other components were a website and email reminders . Data were collected at baseline and follow-up with a web-based question naire . Primary outcomes were the self-reported awareness of , knowledge of , access to , and use of guidelines . Secondary outcomes were self-reported attitudes toward EBP and guidelines . Analyses were performed using Pearson ’s χ2 test and approximative z-test . Results 168 PTs ( 60.6 % ) in the intervention group and 88 PTs ( 51.5 % ) in the control group responded to the follow-up question naire . 186/277 PTs ( 67.1 % ) participated in the implementation seminars , of which 97 ( 52.2 % ) responded . The proportions of PTs reporting awareness of ( absolute difference in change 20.6 % , p = 0.023 ) , knowledge where to find ( 20.4 % , p = 0.007 ) , access to ( 21.7 % , p < 0.001 ) , and frequent use of ( 9.5 % , NS ) guidelines increased more in the intervention group than in the control group . The proportion of PTs reporting frequent guideline use after participation in the implementation seminar was 15.2 % ( p = 0.043 ) higher than the proportion in the control group . A higher proportion considered EBP helpful in decision making ( p = 0.018 ) . There were no other significant differences in secondary outcomes . Conclusions A tailored , theory- and evidence -informed , multi-component intervention for the implementation of clinical practice guidelines had a modest , positive effect on awareness of , knowledge of , access to , and use of guidelines , among PTs in primary care in western Sweden . In general , attitudes to EBP and guidelines were not affected RATIONALE The concept of evidence -based medicine is important in providing efficient health care . The process uses research findings as the basis for clinical decision making . Evidence -based practice helps optimize current health care and enables the practitioners to be suitably accountable for the interventions they provide . Little work has been undertaken to examine how allied health professionals change their clinical practice in light of the latest evidence . The use of opinion leaders to disseminate new evidence around the management of low back pain into practice has been proposed . AIMS The aim of this study was to investigate if physiotherapists ' clinical management of patients with low back pain would change following an evidence -based education package , which utilized local opinion leaders and delivered the best evidence . METHOD Thirty musculoskeletal physiotherapists from a Community Trust in North Staffordshire were cluster r and omized by location of work , to two groups . The intervention group received an evidence -based programme on the management of low back pain , including advice regarding increasing activity levels and return to normal activity and challenging patients ' fears and beliefs about their pain . The control group received a st and ard in-service training package on the management of common knee pathologies . The physiotherapists ' clinical management of patients with low back pain was measured prior to training and 6 months post training . Outcome measures were based on physiotherapists completing ' discharge summary ' question naires , which included information relating to the use and importance of therapies for treating their low back pain patients . RESULTS There were few significant differences in treatment options between the intervention and control groups post training . Whilst there was some indication that physiotherapists were already utilizing aspects of psychosocial management for patients with low back pain , there was little change in what physiotherapists perceived to be important to patient recovery and actual clinical practice following the intervention . CONCLUSIONS Psychosocial factors have been identified as an important factor in the recovery of patients with low back pain . This project incorporated the latest evidence on the management of low back pain and utilized the theory of opinion leaders to disseminate this evidence into clinical practice . Whilst there were some limitations in the overall size of the study , the results help to give an insight into the challenges faced by the health care system and research ers alike to ensure quality evidence is actually utilized by practitioners for the benefits of patient care RATIONALE The concept of evidence -based practice ( EBP ) encourages health care professionals to provide the most effective health care , and to be accountable for the interventions they provide . Little work has been undertaken to examine how practically allied health professionals ' encompass EBP and how they perceptive and underst and the concept of EBP . The use of opinion leaders to disseminate new evidence into practice , and thereby encourage the behaviour of health care professionals has been proposed . AIMS The aims of this study were to investigate physiotherapists ' attitudes towards EBP and to examine change in their attitudes following an education package , which utilized local opinion leaders . METHOD Thirty musculoskeletal physiotherapists from a Community Trust in North Staffordshire were cluster r and omized by location of work to two groups . The intervention group received an evidence -based programme on aspects of EBP including literature search ing and critical appraisal . The attention control group received a st and ard in-service training package on the management of common knee pathologies . The physiotherapists ' attitudes towards EBP were measured at baseline ( before r and omization ) and at 3 and 6 months follow-up . RESULTS Physiotherapists reported that they primarily relied on ' courses ' and ' in-service training ' for informing their clinical practice . Most agreed that clinical practice should be based on the best available evidence and that they would change their clinical practice if evidence suggested they should do so . However , many of the physiotherapists reported difficulty in reading journals and could not identify opinion leaders in key areas . In terms of clinical practice , literature , journals and research were ascribed low priority throughout . Differences in attitudes between the intervention and control groups were observed in relation to management support for EBP at 3 and 6 months follow-up . CONCLUSIONS In this study , physiotherapists appeared to be in favour of the idea of EBP , yet they remained reluctant to change their practice . Opinion leaders were not easily identifiable by physiotherapists , suggesting that this method alone may not be an effective method of changing attitudes in clinical practice . The process of changing attitudes in the clinical environment is a complex issue worthy of further research UNLABELLED Improvement of chronic disease management in primary care entails monitoring indicators of quality over time and across patients and practice s. Informatics tools are needed , yet implementing them remains challenging . OBJECTIVE To identify critical success factors enabling the translation of clinical and operational knowledge about effective and efficient chronic care management into primary care practice . DESIGN A prospect i ve case study of positive deviants using key informant interviews , process observation , and document review . SETTING A chronic disease management ( CDM ) collaborative of primary care physicians with documented improvement in adherence to clinical practice guidelines using a web-based patient registry system with CDM guideline -based flow sheet . PARTICIPANTS Thirty community-based physician participants using predominantly paper records , plus a project management team including the physician lead , project manager , evaluator and support team . ANALYSIS A critical success factor ( CSF ) analysis of necessary and sufficient pathways to the translation of knowledge into clinical practice . RESULTS A web-based CDM ' toolkit ' was found to be a direct CSF that allowed this group of physicians to improve their practice by tracking patient care processes using evidence -based clinical practice guideline -based flow sheets . Moreover , the information and communication technology ' factor ' was sufficient for success only as part of a set of seven direct CSF components including : health delivery system enhancements , organizational partnerships , funding mechanisms , project management , practice models , and formal knowledge translation practice s. Indirect factors that orchestrated success through the direct factor components were also identified . A central insight of this analysis is that a comprehensive quality improvement model was the CSF that drew this set of factors into a functional framework for successful knowledge translation . CONCLUSIONS In complex primary care setting s environment where physicians have low adoption rates of electronic tools to support the care of patients with chronic conditions , successful implementation may require a set of interrelated system and technology factors Background Neck pain in adults is common and a leading cause of physical disability . Recently , a guideline was developed for the management of non-specific neck pain ( NSNP ) with an aim to improve the quality of the delivery of chiropractic care . One key guideline recommendation is to undertake multimodal care for patients with NSNP . The aim of this pilot study is to determine the feasibility of implementing a multifaceted knowledge translation intervention by promoting the use of multimodal care by chiropractors managing patients with NSNP . Methods / design The design is a cluster-r and omized controlled pilot and feasibility trial . Chiropractors in private practice in Canada will be approached to participate in the study . Thirty consenting chiropractors will be r and omized to receive either a theory-based educational intervention in the experimental group or simply a printed copy of the guideline in the control group .  Each chiropractor will recruit five neck pain patients ( a total of 150 patients ) into the study . Development of the multifaceted intervention was informed by the results of a related qualitative study based on the Theoretical Domains Framework and consists of a series of three webinars , two online case scenarios , a self-management video on Brief Action Planning , and a printed copy of the practice guideline . Primary feasibility outcomes for both chiropractors and patients include rates of ( 1 ) recruitment , ( 2 ) retention , and ( 3 ) adherence to the intervention . A checklist of proxy measures embedded within patient encounter forms will be used to assess chiropractors ’ compliance with guideline recommendations ( e.g. exercise and self-care prescriptions ) at study onset and at 3 months . Secondary outcomes include scores of behavioural constructs ( level of knowledge and self-efficacy ) for recommended multimodal care . Clinical outcomes include pain intensity and neck pain-specific disability . Analyses from this study will focus on generating point estimates and corresponding 95 % confidence intervals for parameters of a priori interest ( recruitment , retention , adherence , pain intensity , Neck Disability Index ) . Discussion Results of this study will inform the design of a larger cluster-r and omized controlled trial aim ed at evaluating the effectiveness of the theory-based tailored intervention and increasing the use of multimodal care by chiropractors managing patients with NSNP.Trial registration https:// clinical trials.gov/ , Introduction The uptake of Clinical Practice Guideline ( CPG ) recommendations that improve outcomes in heart failure ( HF ) remains suboptimal . We will conduct a systematic review to identify implementation strategies that improve physician adherence to class I recommendations , those with clear evidence that benefits outweigh the risks . We will use American , Canadian and European HF guidelines as our reference . Methods and analysis We will conduct a literature search in the data bases of MEDLINE , EMBASE , HEALTHSTAR , CINAHL , Cochrane Library , Campbell Collaboration , Joanna Briggs Institute Evidence Based Practice , Centre for Review s and Dissemination and Evidence Based Practice Centres . We will include prospect i ve studies evaluating implementation interventions aim ed at improving uptake of class I CPG recommendations in HF . We will extract data in duplicate . We will classify interventions according to their level of application ( ie , provider , organisation , systems level ) and common underlying characteristics ( eg , education , decision-support , financial incentives ) using the Cochrane Effective Practice and Organisation of Care Taxonomy . We will assess the impact of the intervention on adherence to the CPGs . Outcomes will include proportion of eligible patients who were : prescribed a CPG-recommended pharmacological treatment ; referred for device consideration ; provided self-care education at discharge ; and provided left ventricular function assessment . We will include clinical outcomes such as hospitalisations , readmissions and mortality , if data is available . We will identify the common elements of successful and failing interventions , and examine the context in which they were applied , using the Process Re design context ual framework . We will synthesis e the results narratively and , if appropriate , will pool results for meta- analysis . Discussion and dissemination In this review , we will assess the impact of implementation strategies and context ual factors on physician adherence to HF CPGs . We will explore why some interventions may succeed in one setting and fail in another . We will disseminate our findings through briefing reports , publications and presentations . Trial registration number CRD42015017155 Background Despite extensive research , institutional policies , and practice guidelines , procedural pain remains undertreated in hospitalized children .  Knowledge translation ( KT ) strategies have been employed to bridge the research to practice gap with varying success . The most effective single or combination of KT strategies has not been found . A multifaceted KT intervention , Evidence -based Practice for Improving Quality ( EPIQ ) , that included tailored KT strategies was effective in improving pain practice s and clinical outcomes at the unit level in a prospect i ve comparative cohort study in 32 hospital units ( 16 EPIQ intervention and 16 St and ard Care ) , in eight pediatric hospitals in Canada . In a study of the 16 EPIQ units ( two at each hospital ) only , the objectives were to : determine the effectiveness of evidence -based KT strategies implemented to achieve unit aims ; describe the KT strategies implemented and their influence on pain assessment and management across unit types ; and identify facilitators and barriers to their implementation . Methods Data were collected from each  EPIQ intervention unit on targeted pain practice s and KT strategies implemented , through chart review and a process evaluation checklist , following four intervention cycles over a 15-month period . Results Following the completion of the four cycle intervention , 78 % of 23 targeted pain practice aims across units were achieved within 80 % of the stated aims . A statistically significant improvement was found in the proportion of children receiving pain assessment and management , regardless of pre-determined aims ( p < 0.001 ) . The median number of KT strategies  implemented was 35 and included reminders , educational outreach and material s , and audit and feedback . Units successful in achieving their aims implemented more KT strategies than units that did not . No specific type of single or combination of KT strategies was more effective in improving pain assessment and management outcomes . Tailoring KT strategies to unit context , support from unit leadership , staff engagement , and dedicated time and re sources were identified as facilitating effective implementation of the strategies . Conclusions Further research is required to better underst and implementation outcomes , such as feasibility and fidelity , how context influences the effectiveness of multifaceted KT strategies , and the sustainability of improved pain practice s and outcomes over time Background Chronic obstructive pulmonary disease ( COPD ) is a progressive , debilitating disease associated with significant clinical burden and is estimated to affect 15 million individuals in the US . Although a large number of individuals are diagnosed with COPD , many individuals still remain undiagnosed due to the slow progression of the disorder and lack of recognition of early symptoms . Not only is there under-diagnosis but there is also evidence of sub-optimal evidence -based treatment of those who have COPD . Despite the development of international COPD guidelines , many primary care physicians who care for the majority of patients with COPD are not translating this evidence into effective clinical practice . Method / Design This paper describes the design and rationale for a r and omized , cluster design trial ( RCT ) aim ed at translating the COPD evidence -based guidelines into clinical care in primary care practice s. During Phase 1 , a needs assessment evaluated barriers and facilitators to implementation of COPD guidelines into clinical practice through focus groups of primary care patients and providers . Using formative evaluation and feedback from focus groups , three tools were developed . These include a computerized patient activation tool ( an interactive iPad with wireless data transfer to the spirometer ) ; a web-based COPD guideline tool to be used by primary care providers as a decision support tool ; and a COPD patient education toolkit to be used by the practice team . During phase II , an RCT will be performed with one year of intervention within 30 primary care practice s. The effectiveness of the material s developed in Phase I are being tested in Phase II regarding physician performance of COPD guideline implementation and the improvement in the clinical ly relevant outcomes ( appropriate diagnosis and management of COPD ) compared to usual care . We will also examine the use of a patient activation tool - ‘ MyLungAge ’ - to prompt patients at risk for or who have COPD to request spirometry confirmation and to request support for smoking cessation if a smoker . Discussion Using a multi-modal intervention of patient activation and a technology-supported health care provider team , we are testing the effectiveness of this intervention in activating patients and improving physician performance around COPD guideline implementation . Trial registration Clinical Trials.gov , BACKGROUND Evidence from r and omized controlled trials ( RCTs ) plays a powerful role in today 's healthcare industry . At the same time , it is important that multiple types of evidence contribute to music therapy 's knowledge base and that the dialogue of clinical effectiveness in music therapy is not dominated by the biomedical hierarchical model of evidence -based practice . Whether or not one agrees with the hierarchical model of evidence in the current healthcare climate , RCTs can contribute important knowledge to our field . Therefore , it is important that music therapists are prepared to design trials that meet current method ological st and ards and , equally important , are able to respond appropriately to those design aspects that may not be feasible in music therapy research . OBJECTIVE To provide practical guidelines to music therapy research ers for the design and implementation of RCTs as well as to enable music therapists to be well-informed consumers of RCT evidence . METHODS This article review s key design aspects of RCTs and discusses how to best implement these st and ards in music therapy trials . A systematic presentation of basic r and omization methods , allocation concealment strategies , issues related to blinding in music therapy trials and strategies for implementation , the use of treatment manuals , types of control groups , outcome selection , and sample size computation is provided . CONCLUSIONS Despite the challenges of meeting all key design dem and s typical of an RCT , it is possible to design rigorous music therapy RCTs that accurately estimate music therapy treatment benefits Background Gaps between research knowledge and practice have been consistently reported . Traditional ways of communicating information have limited impact on practice changes . Strategies to disseminate information need to be more interactive and based on techniques reported in systematic review s of implementation of changes . There is a need for clarification as to which dissemination strategies work best to translate evidence into practice in neonatal units across Engl and . The objective of this trial is to assess whether an innovative active strategy for the dissemination of neonatal research findings , recommendations , and national neonatal guidelines is more likely to lead to changes in policy and practice than the traditional ( more passive ) forms of dissemination in Engl and . Methods / design Cluster r and omised controlled trial of all neonatal units in Engl and ( r and omised by hospital , n = 182 and stratified by neonatal regional networks and neonatal units level of care ) to assess the relative effectiveness of  active dissemination strategies  on changes in local policies and practice s. Participants will be mainly consultant lead clinicians in each unit . The intervention will be multifaceted using : audit and feedback ; educational meetings for local staff ( evidence -based lectures on selected topics , interactive workshop to examine current practice and draw up plans for change ) ; and  quality improvement and organisational changes  methods . Policies and practice outcomes for the babies involved will be collected before and after the intervention . Outcomes will assess  all premature babies born in Engl and during a three month period for timing of surfactant administration at birth , temperature control at birth , and resuscitation team ( qualification and numbers ) present at birth . Trial registration Current controlled trials IS RCT Background Variability between clinical practice guideline recommendations and actual clinical practice exists in many areas of health care . A 2004 systematic review examining the effectiveness of guideline implementation interventions concluded there was a lack of evidence to support decisions about effective interventions to promote the uptake of guidelines . Further , the review recommended the use of theory in the development of implementation interventions . A clinical practice guideline for the management of acute low-back pain has been developed in Australia ( 2003 ) . Acute low-back pain is a common condition , has a high burden , and there is some indication of an evidence - practice gap in the allied health setting . This provides an opportunity to develop and test a theory-based implementation intervention which , if effective , may provide benefits for patients with this condition . Aims This study aims to estimate the effectiveness of a theory-based intervention  to increase allied health practitioners ' ( physiotherapists and chiropractors in Victoria , Australia ) compliance with a clinical practice guideline for acute non-specific low back pain ( LBP ) , compared with providing practitioners with a printed copy of the guideline . Specifically , our primary objectives are to establish if the intervention is effective in reducing the percentage of acute non-specific LBP patients who are either referred for or receive an x-ray  , and improving mean level of disability for patients three months post-onset of acute LBP . Methods The design of the study is a cluster r and omised trial . Restricted r and omisation was used to r and omise 210 practice s ( clusters ) to an intervention or control group . Practitioners in the control group received a printed copy of the guideline . Practitioners in the intervention group received a theory-based intervention developed to address prospect ively identified barriers to practitioner compliance with the guideline . The intervention primarily consisted of an educational symposium .  Patients aged 18 years or older who visit a participating practitioner for acute non-specific LBP of less than three months duration over a two-week data collection period , three months post the intervention symposia , are eligible for inclusion . Sample size calculations are based on recruiting between 15 to 40 patients per practice . Outcome assessors will be blinded to group allocation . Trial registration Australian New Zeal and Clinical Trials Registry ACTRN12609001022257 ( date registered 25th November 2009
RESULTS Knowledge translation interventions appear to have result ed in a positive change in physiotherapist beliefs , attitudes , skills and guideline awareness .
However , no consistent improvement in clinical practice , patient and economic outcomes were observed .
AND IMPLICATION OF KEY FINDINGS The intensity and type of knowledge translation intervention seem to have an effect on practice change .
BACKGROUND Many physiotherapists underuse evidence -based practice guidelines or recommendations when treating patients with musculoskeletal disorders , yet synthesis of knowledge translation interventions used within the field of physiotherapy fails to offer clear conclusions to guide the implementation of clinical practice guidelines .
OBJECTIVES To evaluate the effectiveness of various  knowledge translation interventions used to implement changes in the practice of current physiotherapists treating common musculoskeletal issues .