Meta-analyses did not reveal any differences in effect between multifaceted strategies and controls .
Conclusion 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 .
Background For the optimal use of clinical guidelines in daily practice , mere distribution of guidelines and material s 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 .
Implementation of a Guideline for Low Back Pain Management in Primary Care: A Cost-Effectiveness Analysis
Study Design . Cost-effectiveness analysis alongside a cluster r and omized controlled trial . Objective . To study the cost-effectiveness of 2 low back pain guideline implementation ( GI ) strategies . Summary of Background Data . Several evidence -based guidelines on management of low back pain have been published . However , there is still no consensus on the effective implementation strategy . Especially studies on the economic impact of different implementation strategies are lacking . Methods . This analysis was performed alongside a cluster r and omized controlled trial on the effectiveness of 2 GI strategies ( physician education alone [ GI ] or physician education in combination with motivational counseling [ MC ] by practice nurses)-–both compared with the postal dissemination of the guideline ( control group , C ) . Sociodemographic data , pain characteristics , and cost data were collected by interview at baseline and after 6 and 12 months . low back pain – related health care costs were valued for 2004 from the societal perspective . Results . For the cost analysis , 1322 patients from 126 general practice s were included . Both interventions showed lower direct and indirect costs as well as better patient outcomes during follow-up compared with controls . In addition , both intervention arms showed superiority of cost-effectiveness to C. The effects attenuated when adjusting for differences of health care utilization prior to patient recruitment and for clustering of data . Conclusion . Trends in cost-effectiveness are visible but need to be confirmed in future studies . Research ers performing cost-evaluation studies should test for baseline imbalances of health care utilization data instead of judging on the r and omization success by review ing non-cost parameters like clinical data alone
Meta-analyses did not reveal any differences in effect between multifaceted strategies and controls .
Conclusion 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 .
Background For the optimal use of clinical guidelines in daily practice , mere distribution of guidelines and material s 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 .