The 12 remaining studies across all musculoskeletal conditions showed little or no improvement in GP behaviour and patient outcomes .The direction of the targeted behaviour ( i.e. increasing or decreasing a behaviour ) does not seem to affect the effectiveness of an intervention .
There is good- quality evidence that a GP alerting system with or without patient-directed education on osteoporosis improves guideline -consistent GP behaviour , result ing in better diagnosis and treatment rates .
Interventions such as GP reminder messages and GP feedback on performance combined with guideline dissemination may lead to small improvements in guideline -consistent GP behaviour with regard to low back pain , while GP education on osteoarthritis pain and the use of educationally influential physicians may lead to slight improvement in patient outcomes and guideline -consistent behaviour respectively .
BACKGROUND Musculoskeletal conditions require particular management skills .
Identification of interventions which are effective in equipping general practitioners ( GPs ) with such necessary skills could translate to improved health outcomes for patients and reduced healthcare and societal costs .
OBJECTIVES To determine the effectiveness of professional interventions for GPs  that aim to improve the management of musculoskeletal conditions in primary care .
We investigated whether the direction of the targeted behavioural change affects the effectiveness of interventions .
Case management of arthritis patients in primary care: a cluster-randomized controlled trial.
OBJECTIVE To assess whether providing information on arthritis self-management through general practitioners ( GPs ) increases the quality of life in patients with osteoarthritis and whether additional case management provided by practice nurses shows better results . METHODS We conducted a pragmatic , cluster-r and omized , controlled , 3-arm trial that included 1,021 patients from 75 primary care practice s in Germany . GPs were r and omized to intervention group I , group II , or a control group . GPs of both intervention groups participated in 2 peer group meetings . In intervention group II , additional case management was conducted via telephone by a practice nurse . The primary outcome was change in quality of life , assessed by the German version of the Arthritis Impact Measurement Scales Short Form ( AIMS 2-SF ) . Secondary outcomes were health service utilization , prescriptions , and physical activity . Data were controlled for depression using the Patient Health Question naire 9 as a potential confounder . RESULTS Of 1,125 administered question naires , 1,021 were analyzed . Compared with the control group , no significant changes occurred in intervention group I with respect to the primary outcome . Performed radiographs decreased significantly ( P = 0.050 ) , whereas prescriptions of  acetaminophen  increased significantly ( P < 0.001 ) . In intervention group II , significant changes in the AIMS 2-SF dimensions social ( P < 0.001 ) , symptom ( P = 0.048 ) , and lower body ( P = 0.049 ) were identified . Radiographs ( P = 0.031 ) and orthopedic referrals ( P = 0.044 ) decreased whereas prescriptions of pain relievers increased significantly . CONCLUSION Improving the quality of life in patients with arthritis using arthritis self-management seems challenging . Simply providing this information through GPs is not sufficient but combining it with case management seems to be a promising approach
The 12 remaining studies across all musculoskeletal conditions showed little or no improvement in GP behaviour and patient outcomes .The direction of the targeted behaviour ( i.e. increasing or decreasing a behaviour ) does not seem to affect the effectiveness of an intervention .
There is good- quality evidence that a GP alerting system with or without patient-directed education on osteoporosis improves guideline -consistent GP behaviour , result ing in better diagnosis and treatment rates .
Interventions such as GP reminder messages and GP feedback on performance combined with guideline dissemination may lead to small improvements in guideline -consistent GP behaviour with regard to low back pain , while GP education on osteoarthritis pain and the use of educationally influential physicians may lead to slight improvement in patient outcomes and guideline -consistent behaviour respectively .
BACKGROUND Musculoskeletal conditions require particular management skills .
Identification of interventions which are effective in equipping general practitioners ( GPs ) with such necessary skills could translate to improved health outcomes for patients and reduced healthcare and societal costs .
OBJECTIVES To determine the effectiveness of professional interventions for GPs  that aim to improve the management of musculoskeletal conditions in primary care .
We investigated whether the direction of the targeted behavioural change affects the effectiveness of interventions .