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Open Access Highly Accessed Research article

Evaluation of a tailored, multi-component intervention for implementation of evidence-based clinical practice guidelines in primary care physical therapy: a non-randomized controlled trial

Susanne Bernhardsson12*, Maria EH Larsson34, Robert Eggertsen56, Monika Fagevik Olsén47, Kajsa Johansson2, Per Nilsen8, Lena Nordeman9, Maurits van Tulder10 and Birgitta Öberg2

Author Affiliations

1 Närhälsan Öckerö Rehabilitation, Region Västra Götaland, Hönö, Sweden

2 Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden

3 Närhälsan, Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden

4 The Sahlgrenska Academy, Institute of Neuroscience and Physiology/Physiotherapy, University of Gothenburg, Gothenburg, Sweden

5 Närhälsan Mölnlycke Health Care Centre, Mölnlycke, Sweden

6 The Sahlgrenska Academy, Institute of Medicine/Department of Public Health and Community Medicine/Primary Health Care, University of Gothenburg, Gothenburg, Sweden

7 Department of physical therapy and occupational therapy, Sahlgrenska University Hospital, Gothenburg, Sweden

8 Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, Sweden

9 Närhälsan, Research and Development Primary Health Care, Region Västra Götaland, Borås, Sweden

10 Department of Health Sciences & EMGO + Institute for Health and Care Research, VU University, Amsterdam, The Netherlands

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BMC Health Services Research 2014, 14:105  doi:10.1186/1472-6963-14-105

Published: 4 March 2014

Abstract

Background

Clinical practice guidelines are important for transmitting research findings into practice and facilitating the application of evidence-based practice (EBP). There is a paucity of knowledge about the impact of guideline implementation strategies in primary care physical therapy. The aim of this study was to evaluate the effect of a guideline implementation intervention in primary care physical therapy in western Sweden.

Methods

An implementation strategy based on theory and current evidence was developed. A tailored, multi-component implementation intervention, addressing earlier identified determinants, was carried out in three areas comprising 28 physical therapy practices including 277 physical therapists (PTs) (intervention group). In two adjacent areas, 171 PTs at 32 practices received no intervention (control group). The core component of the intervention was an implementation seminar with group discussions. Among other components were a website and email reminders. Data were collected at baseline and follow-up with a web-based questionnaire. Primary outcomes were the self-reported awareness of, knowledge of, access to, and use of guidelines. Secondary outcomes were self-reported attitudes toward EBP and guidelines. Analyses were performed using Pearson’s χ2 test and approximative z-test.

Results

168 PTs (60.6%) in the intervention group and 88 PTs (51.5%) in the control group responded to the follow-up questionnaire. 186/277 PTs (67.1%) participated in the implementation seminars, of which 97 (52.2%) responded. The proportions of PTs reporting awareness of (absolute difference in change 20.6%, p = 0.023), knowledge where to find (20.4%, p = 0.007), access to (21.7%, p < 0.001), and frequent use of (9.5%, NS) guidelines increased more in the intervention group than in the control group. The proportion of PTs reporting frequent guideline use after participation in the implementation seminar was 15.2% (p = 0.043) higher than the proportion in the control group. A higher proportion considered EBP helpful in decision making (p = 0.018). There were no other significant differences in secondary outcomes.

Conclusions

A tailored, theory- and evidence-informed, multi-component intervention for the implementation of clinical practice guidelines had a modest, positive effect on awareness of, knowledge of, access to, and use of guidelines, among PTs in primary care in western Sweden. In general, attitudes to EBP and guidelines were not affected.

Keywords:
Implementation; Physical therapy; Evidence-based practice; Practice guidelines