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 .
Shoulder acute pain in primary healthcare: is retraining effective for GP principals? SAPPHIRE--a randomized controlled trial.
OBJECTIVE To address the question whether general practitioners ( GPs ) should receive practical training in shoulder problems and to test whether cortisone injections are better than anaesthetic injections for rotator cuff problems . METHODS A pragmatic split-plot , r and omized trial with a cluster factorial design , conducted in general practice s across five centres across the United Kingdom . Ninety-one practice s were r and omized to receive additional training in diagnosing and injecting rotator cuff problems or no additional training .  Two hundred patients consulting their general practice s with shoulder pain were then r and omized to receive either a corticosteroid or lignocaine injection . The main outcome was score on the British Shoulder Disability Question naire ( BSDQ ) . The Short-Form 36-item Health Survey and EuroQol at 12 months from entry to the trial were also scored . RESULTS Over the course of the trial there was a mean difference of 0.94 ( s.e . = 1.01 ) on the BSDQ score between the groups , with patients treated by the untrained group having a mean of 9.46 ( s.e . = 0.82 ) and those by the trained group having a mean of 8.51 ( s.e . = 0.60 ) . There were no statistically significant differences between the groups . Analysing by substance injected , there was a mean difference of 0.15 ( s.e . = 0.48 ) throughout the trial between the groups , with patients given the cortisone having a mean BSDQ of 9.67 ( s.e . = 0.39 ) and those given lignocaine , 9.82 ( s.e . = 0.39 ) . This was not statistically significantly different . CONCLUSIONS Training GPs in the diagnosis and treatment of shoulder disorders does not make any difference to the outcome , in terms of pain and disability , 1 yr later . Further , there is no advantage to injecting steroid in a group with predominant rotator cuff disorder . Trial registration . International St and ard R and omized Controlled Trial Number 58537244 . Trial steering committee comprised Prof. Paul Dieppe , Prof. Elaine Hay , Dr Brian Hazleman and Dr Kerenza Hood
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 .