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Do evidence-based guidelines have an impact in primary care?: A cross-sectional study of Swedish physicians and physiotherapists
Örebro University, School of Health and Medical Sciences.
Örebro University, Department of Behavioural, Social and Legal Sciences.ORCID iD: 0000-0001-5359-0452
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2005 (English)In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 30, no 1, 146-151 p.Article in journal (Refereed) Published
Abstract [en]

Study Design. A cross-sectional study of physicians and physiotherapists in primary care.

Objectives. To survey how familiar clinicians were with evidence-based guidelines for back pain and their opinion about their clinical usefulness and to compare self-reported practice behavior with the guidelines.

Summary of Background Data. Guidelines, based on empirical evidence, are meant to ensure that patients get the most effective treatment. These evidence-based guidelines should steer clinical praxis, but clinicians may not read, let alone heed, them.

Methods. Using a questionnaire, the authors surveyed all physicians and physiotherapists in primary health care in Örebro County, Sweden (N = 235).

Results. Forty-two percent of the physicians and 37% of the physiotherapists were unfamiliar with the content of the guidelines, and 40% of the physicians and 25% of the physiotherapists were unfamiliar with the concept of 'red flags.' Less than half of the clinicians, 47%, were familiar both with the content of the guidelines and the concept of red flags. Their opinion about the guidelines showed that 54% of the physicians and 56% of the physiotherapists agreed that the guidelines were useful in clinical praxis. Concerning the self-reported practice behavior, the majority indicated that they followed the key points in the guidelines.

Conclusions. A relatively large proportion of clinicians were unfamiliar with the content of evidence-based guidelines and/or with the concept of red flags. The process of implementing research into clinical practice is in need of an overhaul, and the impact of guidelines on clinical practice may be questioned.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins , 2005. Vol. 30, no 1, 146-151 p.
Keyword [en]
Back pain, primary health care, implementation, evidence-based medicine
National Category
Family Medicine
Research subject
Rehabilitation Medicine
Identifiers
URN: urn:nbn:se:oru:diva-10396OAI: oai:DiVA.org:oru-10396DiVA: diva2:311062
Available from: 2010-04-20 Created: 2010-04-20 Last updated: 2015-03-10Bibliographically approved
In thesis
1. Implementing psychosocial factors in physical therapy treatment for patients with musculoskeletal pain in primary care
Open this publication in new window or tab >>Implementing psychosocial factors in physical therapy treatment for patients with musculoskeletal pain in primary care
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This dissertation focuses on 2 parts: 1) Whether evidence-based guidelines are recognized and integrated into clinical practice in primary care and 2) Whether a university course aimed at teaching physical therapists to identify and address evidence-based psychosocial factors in primary care might change practice behaviour and patient outcome. To this end practising clinicians were surveyed and a course for physical therapists was developed.Concerning the first part, we showed that a relatively large proportion of clinicians in primary care were unfamiliar with the content of evidence-based guidelines and/or with the concept of “Red flags”. Yet, concerning the self-reported practice behaviour, the majority indicated they followed the key points in the guidelines. To enhance the impact of guidelines, interventions or tactics for teaching and implementing guidelines should include interactive education,discussion, feedback, and reminders which in research have shown to enhance knowledge,skills and change behaviour. Furthermore, the clinical applicability of the guidelines needs to be further developed. We could also show that psychosocial factors were integrated up to a certain point and that physical therapists in primary care were well aware of the importance of psychosocial risk factors, but it seemed physical therapists lack specificity about which factors are important. Physical therapists may have heard about risk factors but probably did not have a clear model or structure about how these factors work.Concerning the second part, the results showed that we, by means of a university course, managed to change attitudes and beliefs, increase knowledge, skills and competencies towards a more biopsychosocial standpoint. But despite these changes, the results did not show a behavioural change on behalf of the physical therapists or a better outcome for patients at risk of longterm pain and disability. Several possible explanations for this are discussed. First, the content of the course should be changed so it focuses more on behavioural change on behalf of the physical therapists. This would facilitate implementation of new behaviour in clinical practice and increase the likelihood that the new behaviour is maintained and thereby the possibility of improved patient outcome. Second, treating patients at risk for long-term pain and disability may also be too difficult for a single physical therapist in a clinical setting. This would imply large changes in the way patients are directed through the health care system compared to now. The main tasks of the physical therapists in primary care would then be to select patients at risk for long-term pain and disability. They would then treat the patients not at risk and refer the patients at risk for long-term pain and disability to more suitable treatment, for example CBT treatment delivered by a psychologist or multimodal treatment delivered by a team of experts.Since risk patients experience most suffering and are the most costly for the health care system, it is important they get the appropriate treatment at the earliest possible opportunity.In summary, this dissertation shows that integrating psychosocial factors in physical therapy is not an easy task.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2010. 69 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 44
Keyword
Physical therapy, musculoskeletal pain, psychosocial factors, dissimilation, evidence based, education, primary health care
National Category
Family Medicine
Research subject
Rehabilitation Medicine
Identifiers
urn:nbn:se:oru:diva-10426 (URN)978-91-7668-727-7 (ISBN)
Public defence
2010-05-28, Bomanssonsalen, Universitetssjukhuset Örebro, Örebro, 13:00 (English)
Opponent
Supervisors
Available from: 2010-04-21 Created: 2010-04-21 Last updated: 2011-04-26Bibliographically approved

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