UZH-Logo

Maintenance Infos

Effekte einer richtlinienorientierten Behandlung bei Rückenbeschwerden und Wege der Richtlinienimplementierung: Systematischer Review


Christen, G; Mäder, U; Uebelhart, D; de Bruin, E D (2007). Effekte einer richtlinienorientierten Behandlung bei Rückenbeschwerden und Wege der Richtlinienimplementierung: Systematischer Review. Physioscience, 3(4):151-160.

Abstract

Background: Development and implementation of evidence-based guidelines appear to be two of the most promising and effective tools for improving the quality of care. New multifaceted strategies have been developed to prove perceived barriers and discrepancies between current practice and the guidelines' recommendations.
Objective: This systematic review compared the effectiveness of guideline-oriented treatments for LBP with non-guideline oriented treatments and determined which implementation strategies for clinical practitioners had been used to ensure the acceptance and application of successful guidelines in clinical practice settings.
Method: A computer-aided sensitive search was performed in multiple databases. Randomised controlled trials were included if they dealt with the clinical management of LBP.
Results: There was limited evidence that both a guideline-oriented patient treatment using a “personal active implementation program” or an “early multifaceted implementation program” have better effect on pain (VAS) and functional disability in LBP. Effect sizes for pain outcome ranged between d = 0.14 and d = 0.36, for functional disability, assessed by questionnaires, ranged between d = 0.5 (CI 0.08 / 0.91) and d = 0.58 (CI 0.16 / 1.0). Reported findings showed at best a moderate effect of the “guideline” treatment in comparison to non-guideline treatments. There was no evidence that an education- and feedback-supported, multifaceted implementation program decreases the application of radiology and speciality services. There was conflicting evidence that a multifaceted implementation program changes the referral to physiotherapy.
Conclusion: Further research should address the underlying causes for these disturbing findings. It should particularly include cost-effectiveness, the same main outcomes and should be adapted to the Swiss health system.

Background: Development and implementation of evidence-based guidelines appear to be two of the most promising and effective tools for improving the quality of care. New multifaceted strategies have been developed to prove perceived barriers and discrepancies between current practice and the guidelines' recommendations.
Objective: This systematic review compared the effectiveness of guideline-oriented treatments for LBP with non-guideline oriented treatments and determined which implementation strategies for clinical practitioners had been used to ensure the acceptance and application of successful guidelines in clinical practice settings.
Method: A computer-aided sensitive search was performed in multiple databases. Randomised controlled trials were included if they dealt with the clinical management of LBP.
Results: There was limited evidence that both a guideline-oriented patient treatment using a “personal active implementation program” or an “early multifaceted implementation program” have better effect on pain (VAS) and functional disability in LBP. Effect sizes for pain outcome ranged between d = 0.14 and d = 0.36, for functional disability, assessed by questionnaires, ranged between d = 0.5 (CI 0.08 / 0.91) and d = 0.58 (CI 0.16 / 1.0). Reported findings showed at best a moderate effect of the “guideline” treatment in comparison to non-guideline treatments. There was no evidence that an education- and feedback-supported, multifaceted implementation program decreases the application of radiology and speciality services. There was conflicting evidence that a multifaceted implementation program changes the referral to physiotherapy.
Conclusion: Further research should address the underlying causes for these disturbing findings. It should particularly include cost-effectiveness, the same main outcomes and should be adapted to the Swiss health system.

Altmetrics

Downloads

3 downloads since deposited on 18 Mar 2009
0 downloads since 12 months
Detailed statistics

Additional indexing

Other titles:Effects of guideline-oriented treatment for low back pain and ways to implement guidelines: systematic review
Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Rheumatology Clinic and Institute of Physical Medicine
Dewey Decimal Classification:610 Medicine & health
Language:German
Date:2007
Deposited On:18 Mar 2009 12:22
Last Modified:05 Apr 2016 12:35
Publisher:Thieme
ISSN:1860-3092
Publisher DOI:10.1055/s-2007-963656
Permanent URL: http://doi.org/10.5167/uzh-6028

Download

[img]
Filetype: PDF - Registered users only
Size: 306kB
View at publisher

TrendTerms

TrendTerms displays relevant terms of the abstract of this publication and related documents on a map. The terms and their relations were extracted from ZORA using word statistics. Their timelines are taken from ZORA as well. The bubble size of a term is proportional to the number of documents where the term occurs. Red, orange, yellow and green colors are used for terms that occur in the current document; red indicates high interlinkedness of a term with other terms, orange, yellow and green decreasing interlinkedness. Blue is used for terms that have a relation with the terms in this document, but occur in other documents.
You can navigate and zoom the map. Mouse-hovering a term displays its timeline, clicking it yields the associated documents.

Author Collaborations