Effect on the process of care of an active strategy to implement clinical guidelines on physiotherapy for low back pain: a cluster randomised controlled trial
Effect on the process of care of an active strategy to implement clinical guidelines on physiotherapy for low back pain: a cluster randomised controlled trial
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DOI：
10.1136/qshc.2003.009357
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发表时间：
2005-04-01
影响因子：
--
通讯作者：
Bouter, LM
中科院分区：
文献类型：
--
作者：
Bekkering, GE;Hendriks, HJM;Bouter, LM
目的：评估实施腰痛物理治疗临床指南的积极策略对护理过程的影响。设计：一项比较积极策略与标准传播的整群随机对照试验。背景：初级保健物理治疗实践。参与者：113 名物理治疗师被随机分配以通过邮件接收指南（对照组）或接受额外的积极策略（干预组），该策略由多方面的计划组成，包括教育、讨论、角色扮演、反馈和提醒。主要结果指标：通过记录物理治疗师完成的治疗的个体患者表格来衡量对指南的遵守情况。使用基于治疗次数、治疗目标、干预措施和患者教育的算法对表格进行评估。结果：干预组中的物理治疗师更经常正确地限制正常背痛病程患者的治疗次数（OR 2.39；95% CI 1.12 至 5.12），更经常设定功能性治疗目标（OR 1.99；95% CI 1.06 至 3.72），更常用主要是积极干预（OR 2.79；95% CI 1.19 至 6.55），并且更经常给予患者足够的教育（OR 3.59；95% CI 1.35 至 9.55）。他们还更加遵守所有四项标准（OR 2.05；95% CI 1.15 至 3.65）。结论：积极策略适度提高了对指南的遵守程度。建议采取积极的策略来实施腰痛物理治疗的临床指南。
Objectives: To evaluate the effect on the process of care of an active strategy to implement clinical guidelines on physiotherapy for low back pain.Design: A cluster randomised controlled trial comparing an active strategy with standard dissemination.Setting: Primary care physiotherapy practices.Participants: 113 physiotherapists were randomly allocated to receive the guidelines by mail (control group) or to receive an additional active strategy (intervention group) which consisted of a multifaceted programme including education, discussion, role playing, feedback, and reminders.Main outcome measures: Adherence to the guidelines was measured by means of individual patients' forms recording the treatment completed by the physiotherapist. The forms were assessed using an algorithm based on the number of treatment sessions, treatment goals, interventions, and patient education.Results: Physiotherapists in the intervention group more often correctly limited the number of treatment sessions for patients with a normal course of back pain (OR 2.39; 95% CI 1.12 to 5.12), more often set functional treatment goals (OR 1.99; 95% CI 1.06 to 3.72), more often used mainly active interventions (OR 2.79; 95% CI 1.19 to 6.55), and more often gave adequate patient education (OR 3.59; 95% CI 1.35 to 9.55). They also adhered more to all four criteria (OR 2.05; 95% CI 1.15 to 3.65).Conclusions: The active strategy moderately improved adherence to the guidelines. Active strategies are recommended to implement the clinical guidelines on physiotherapy for low back pain.