Can a tailored implementation programme enhance the adoption of guideline-adherent behaviour in physiotherapists and chiropractors managing patients with low back pain? An implementation study.

Abstract

Background: Low back pain (LBP) is the primary contributor to disability worldwide, leading to a significant healthcare burden. Implementing evidence-based practice (EBP) can reduce this burden, as healthcare professionals (HCPs) working evidence-based reduce the number of treatments, the use of imaging and medication compared to HCPs not working evidence-based. Clinical practice guidelines have been published to help HCPs implement research evidence into practice. Unfortunately, studies have consistently shown a lack of adherence to guidelines in LBP care. This study aimed to investigate the implementation outcomes of a tailored programme for implementing key recommendations from LBP guidelines among Danish physiotherapists and chiropractors working in primary care.

Methods: This study was conducted as a 'pre-post' implementation study among 80 physiotherapists and chiropractors from 15 primary care clinics. The implementation object was the two key guideline recommendations: 1) screening of psychosocial risk factors and 2) patient education, including reassuring information. The programme comprised multipronged strategies and was designed as a step-by-step implementation process comprising 16 hours of activities distributed over 16 weeks. Adoption was measured as changes in self-reported behaviour and perceptions of the professional role and culture from baseline to follow-up at 16 weeks. Acceptability and appropriateness of the programme were measured weekly using a four-point Likert scale. Feasibility was measured at 16-week follow-up using a five-point Likert scale. Fidelity was measured as the number of strategies and implementation support delivered as planned and registered by the research team.

Results: An increase in the adoption of screening of psychosocial factors and offering patient education, including reassuring information, was seen in 38% and 33% of participants, respectively. Most participants reported that the programme was partly or overall acceptable and appropriate. The feasibility of the implementation programme was assessed as moderate to high, and the fidelity of the implementation programme was determined as high.

Conclusion: The tailored implementation programme enhanced the adoption of the guidelines and changed the participants' professional identity and culture. Most participants found the programme partly or overall acceptable and appropriate. The programme was feasible, but the perspective requires refinements, as most participants rated it moderately feasible.