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 the Canadian C-Spine Rule: prospective 12 centre cluster randomised trial
Objective To evaluate the effectiveness of an active strategy to implement the vali date d Canadian C-Spine Rule into multiple emergency departments . Design Matched pair cluster r and omised trial . Setting University and community emergency departments in Canada . Participants 11 824 alert and stable adults presenting with blunt trauma to the head or neck at one of 12 hospitals . Interventions Six hospitals were r and omly allocated to the intervention and six to the control . At the intervention sites , active strategies were used to implement the Canadian C-Spine Rule , including education , policy , and real time reminders on radiology requisitions . No specific intervention was introduced to alter the behaviour of doctors requesting cervical spine imaging at the control sites . Main outcome measure Diagnostic imaging rate of the cervical spine during two 12 month before and after periods . Results Patients were balanced between control and intervention sites . From the before to the after periods , the intervention group showed a relative reduction in cervical spine imaging of 12.8 % ( 95 % confidence interval 9 % to 16 % ; 61.7 % v 53.3 % ; P=0.01 ) and the control group a relative increase of 12.5 % ( 7 % to 18 % ; 52.8 % v 58.9 % ; P=0.03 ) . These changes were significant when both groups were compared ( P<0.001 ) . No fractures were missed and no adverse outcomes occurred . Conclusions Implementation of the Canadian C-Spine Rule led to a significant decrease in imaging without injuries being missed or patient morbidity . Final imaging rates were much lower at intervention sites than at most US hospitals . Widespread implementation of this rule could lead to reduced healthcare costs and more efficient patient flow in busy emergency departments worldwide . Trial registration Clinical trials NCT00290875
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 .