Does physiotherapy management of low back pain change as a result of an evidence-based educational programme? Do physiotherapists' attitudes towards evidence-based practice change as a result of an evidence-based educational programme? Effectiveness of workplace interventions in rehabilitating musculoskeletal disorders and preventing its consequences among workers with physical and sedentary employment: systematic review protocol Evaluating two implementation strategies for whiplash guidelines in physiotherapy: a cluster randomised trial. Testing the feasibility of a knowledge translation intervention designed to improve chiropractic care for adults with neck pain disorders: study protocol for a pilot cluster-randomized controlled trial Implementation of a protocol facilitates evidence-based physiotherapy practice in intensive care units. Ten years of evidence to guide physiotherapy interventions: Physiotherapy Evidence Database (PEDro) Randomised trial of a brief physiotherapy intervention compared with usual physiotherapy for neck pain patients: outcomes and patients' preference A Description of the Trials, Reviews, and Practice Guidelines Indexed in the PEDro Database Perceptions of health professionals towards the management of back pain in the context of work: a qualitative study Review article: Methodology for the ‘rapid review’ series on musculoskeletal injuries in the emergency department Testing the effectiveness of an innovative information package on practitioner reported behaviour and beliefs: The UK Chiropractors, Osteopaths and Musculoskeletal Physiotherapists Low back pain ManagemENT (COMPLeMENT) trial [ISRCTN77245761] Effectiveness of an interactive postgraduate educational intervention with patient participation on the adherence to a physiotherapy guideline for hip and knee osteoarthritis: a randomised controlled trial Knowledge transfer in family physicians managing patients with acute low back pain: a prospective randomized control trial. Synthesising ‘best evidence’ in systematic reviews when randomised controlled trials are absent: three tips for authors to add value for clinician readers Perspectives of health care professionals on the facilitators and barriers to the implementation of a stroke rehabilitation guidelines cluster randomized controlled trial 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
RATIONALE The concept of evidence -based medicine is important in providing efficient health care . The process uses research findings as the basis for clinical decision making . Evidence -based practice helps optimize current health care and enables the practitioners to be suitably accountable for the interventions they provide . Little work has been undertaken to examine how allied health professionals change their clinical practice in light of the latest evidence . The use of opinion leaders to disseminate new evidence around the management of low back pain into practice has been proposed . AIMS The aim of this study was to investigate if physiotherapists ' clinical management of patients with low back pain would change following an evidence -based education package , which utilized local opinion leaders and delivered the best evidence . METHOD Thirty musculoskeletal physiotherapists from a Community Trust in North Staffordshire were cluster r and omized by location of work , to two groups . The intervention group received an evidence -based programme on the management of low back pain , including advice regarding increasing activity levels and return to normal activity and challenging patients ' fears and beliefs about their pain . The control group received a st and ard in-service training package on the management of common knee pathologies . The physiotherapists ' clinical management of patients with low back pain was measured prior to training and 6 months post training . Outcome measures were based on physiotherapists completing ' discharge summary ' question naires , which included information relating to the use and importance of therapies for treating their low back pain patients . RESULTS There were few significant differences in treatment options between the intervention and control groups post training . Whilst there was some indication that physiotherapists were already utilizing aspects of psychosocial management for patients with low back pain , there was little change in what physiotherapists perceived to be important to patient recovery and actual clinical practice following the intervention . CONCLUSIONS Psychosocial factors have been identified as an important factor in the recovery of patients with low back pain . This project incorporated the latest evidence on the management of low back pain and utilized the theory of opinion leaders to disseminate this evidence into clinical practice . Whilst there were some limitations in the overall size of the study , the results help to give an insight into the challenges faced by the health care system and research ers alike to ensure quality evidence is actually utilized by practitioners for the benefits of patient care RATIONALE The concept of evidence -based practice ( EBP ) encourages health care professionals to provide the most effective health care , and to be accountable for the interventions they provide . Little work has been undertaken to examine how practically allied health professionals ' encompass EBP and how they perceptive and underst and the concept of EBP . The use of opinion leaders to disseminate new evidence into practice , and thereby encourage the behaviour of health care professionals has been proposed . AIMS The aims of this study were to investigate physiotherapists ' attitudes towards EBP and to examine change in their attitudes following an education package , which utilized local opinion leaders . METHOD Thirty musculoskeletal physiotherapists from a Community Trust in North Staffordshire were cluster r and omized by location of work to two groups . The intervention group received an evidence -based programme on aspects of EBP including literature search ing and critical appraisal . The attention control group received a st and ard in-service training package on the management of common knee pathologies . The physiotherapists ' attitudes towards EBP were measured at baseline ( before r and omization ) and at 3 and 6 months follow-up . RESULTS Physiotherapists reported that they primarily relied on ' courses ' and ' in-service training ' for informing their clinical practice . Most agreed that clinical practice should be based on the best available evidence and that they would change their clinical practice if evidence suggested they should do so . However , many of the physiotherapists reported difficulty in reading journals and could not identify opinion leaders in key areas . In terms of clinical practice , literature , journals and research were ascribed low priority throughout . Differences in attitudes between the intervention and control groups were observed in relation to management support for EBP at 3 and 6 months follow-up . CONCLUSIONS In this study , physiotherapists appeared to be in favour of the idea of EBP , yet they remained reluctant to change their practice . Opinion leaders were not easily identifiable by physiotherapists , suggesting that this method alone may not be an effective method of changing attitudes in clinical practice . The process of changing attitudes in the clinical environment is a complex issue worthy of further research Background Musculoskeletal disorders ( MSDs ) are the leading cause of work disability and sickness absence worldwide . The prevalence of MSDs increases with age , consequently challenging sustainable employability among the growing ageing workforce . Knowledge of feasible and efficient workplace-based interventions to rehabilitate MSD or prevent its consequences is therefore warranted . This systematic review will evaluate the effectiveness of workplace-based interventions on MSDs and its consequences among adult workers with physical and sedentary work tasks , respectively . Methods We will search the following bibliographic data bases : PubMed ( including the data base ‘ MEDLINE ’ ) and Web of Science Core Collection ( including the data bases ‘ Science Citation Index Exp and ed ’ , ‘ Social Sciences Citation Index ’ and ‘ Arts & Humanities Citation Index ’ ) . Manual search es will also be performed . We will include r and omised controlled trials ( RCTs ) and non- RCTs reported in English in which ( 1 ) participants are adult workers with MSD , ( 2 ) interventions are aim ing at rehabilitating pain symptoms of MSD or preventing the consequences of MSD and ( 3 ) interventions are initiated and /or carried out at the workplace . The review will adhere to the ‘ Preferred Reporting Items for Systematic review s and Meta-Analyses ’ ( PRISMA ) guidelines for reporting systematic review s and the Institute for Work and Health ( IWH ) guidelines for workplace-based interventions . For the primary evaluation of the review , the quality assessment and evidence synthesis will conform to the IWH guidelines . Secondary evaluation will include a meta- analysis ( unless the included studies do not allow this due to heterogeneity ) and employ the risk of bias domains recommended by Cochrane along with the Grading of Recommendations , Assessment , Development and Evaluations ( GRADE ) approach on the studies with pain intensity as an outcome . Discussion This systematic review will provide knowledge on effective workplace-based interventions among physical and sedentary workers with MSD . RCTs are considered the most powerful experimental design in clinical trials , but solely including these may be too restrictive to underst and effective workplace-based interventions where r and omised and carefully controlled trials ( RCTs ) are not always possible . In order to maximize practical relevance , the selection process will , therefore , include both RCTs and non- RCTs and the quality assessment and evidence synthesis will conform to IWH guidelines focusing on developing practical guidelines for stakeholders . The result of this work will form the basis for industry-specific evidence -based recommendations on effective workplace-based interventions for rehabilitation of MSDs and its consequences that will later be operationalised into concrete and user-friendly practical tools for workplaces . Systematic review registration International Prospect i ve Register of Systematic Review s ( PROSPERO ) number CRD42018116752 QUESTION Are implementation strategies involving education any more effective than mere dissemination of clinical practice guidelines in changing physiotherapy practice and reducing patient disability after acute whiplash ? DESIGN Cluster-r and omised trial . PARTICIPANTS Twenty-seven physiotherapists from different private physiotherapy clinics and the 103 patients ( 4 dropouts ) who presented to them with acute whiplash . INTERVENTION The implementation group of physiotherapists underwent education by opinion leaders about whiplash guidelines and the dissemination group had the guidelines mailed to them . OUTCOME MEASURES The primary outcome was patient disability , measured using the Functional Rating Index , collected on admission to the trial and at 1.5 , 3 , 6 and 12 months . Physiotherapist knowledge about the guidelines was measured using a custom-made question naire . Physiotherapist practice and cost of care were measured by audit of patient notes . RESULTS There were no significant differences between groups for any of the patient outcomes at any time . The implementation patients had 0.6 points ( 95 % CI -7.8 to 6.6 ) less disability than the dissemination patients at 12 months ; 44 % more physiotherapists in the implementation group reported that they prescribed two out of the five guideline -recommended treatments ; and 32 % more physiotherapists actually prescribed them . The cost of care for patients in the implementation group was $ 255 ( 95 % CI -1505 to 996 ) less than for patients in the dissemination group . CONCLUSION Although the active implementation program increased guideline -consistent practice , patient outcomes and cost of care were not affected Background Neck pain in adults is common and a leading cause of physical disability . Recently , a guideline was developed for the management of non-specific neck pain ( NSNP ) with an aim to improve the quality of the delivery of chiropractic care . One key guideline recommendation is to undertake multimodal care for patients with NSNP . The aim of this pilot study is to determine the feasibility of implementing a multifaceted knowledge translation intervention by promoting the use of multimodal care by chiropractors managing patients with NSNP . Methods / design The design is a cluster-r and omized controlled pilot and feasibility trial . Chiropractors in private practice in Canada will be approached to participate in the study . Thirty consenting chiropractors will be r and omized to receive either a theory-based educational intervention in the experimental group or simply a printed copy of the guideline in the control group .  Each chiropractor will recruit five neck pain patients ( a total of 150 patients ) into the study . Development of the multifaceted intervention was informed by the results of a related qualitative study based on the Theoretical Domains Framework and consists of a series of three webinars , two online case scenarios , a self-management video on Brief Action Planning , and a printed copy of the practice guideline . Primary feasibility outcomes for both chiropractors and patients include rates of ( 1 ) recruitment , ( 2 ) retention , and ( 3 ) adherence to the intervention . A checklist of proxy measures embedded within patient encounter forms will be used to assess chiropractors ’ compliance with guideline recommendations ( e.g. exercise and self-care prescriptions ) at study onset and at 3 months . Secondary outcomes include scores of behavioural constructs ( level of knowledge and self-efficacy ) for recommended multimodal care . Clinical outcomes include pain intensity and neck pain-specific disability . Analyses from this study will focus on generating point estimates and corresponding 95 % confidence intervals for parameters of a priori interest ( recruitment , retention , adherence , pain intensity , Neck Disability Index ) . Discussion Results of this study will inform the design of a larger cluster-r and omized controlled trial aim ed at evaluating the effectiveness of the theory-based tailored intervention and increasing the use of multimodal care by chiropractors managing patients with NSNP.Trial registration https:// clinical trials.gov/ , OBJECTIVES To compare the physiotherapy service provided when therapists ' decisions are guided by an evidence -based protocol with usual care ( i.e. patient management based on therapists ' clinical decisions ) . DESIGN Exploratory , controlled , pragmatic sequential time block clinical trial . SETTING Level 3 surgical unit in a tertiary hospital in South Africa . PARTICIPANTS All patients admitted consecutively to the surgical unit over a 3-month period were allocated to usual or protocol care based on date of admission . INTERVENTIONS Usual care was provided by clinicians from the hospital department , and non-specialised physiotherapists were appointed as locum tenens to provide evidence -based protocol care . MAIN OUTCOME MEASURES Patient waiting time , frequency of treatment sessions , tasks performed and adverse events . RESULTS During protocol -care periods , treatment sessions were provided more frequently ( P<0.001 ) and with a shorter waiting period ( P<0.001 ) . It was more likely for a rehabilitation management option to be included in a treatment session during protocol -care periods ( odds ratio 2.34 , 95 % confidence interval 1.66 to 3.43 ; P<0.001 ) . No difference in the risk of an adverse event was found between protocol -care and usual-care periods ( P=0.34 ) . CONCLUSIONS Physiotherapy services provided in intensive care units ( ICUs ) when the decisions of non-specialised therapists are guided by an evidence -based protocol are safe , differ from usual care , and reflect international consensus on current best evidence for physiotherapy in ICUs . Non-specialised therapists can use this protocol to provide evidence -based physiotherapy services to their patients . Future trials are needed to establish whether or not this will improve patient outcome Clinicians are increasingly using evidence from high- quality clinical research to guide clinical decision making . Recent articles in this journal have examined research evidence to assist in clinical decisions as diverse as the prescription of running shoes,1 exercise therapy in the treatment of chronic disease2 and the use of protective equipment to prevent concussion.3 The most valid information about the effectiveness of healthcare interventions is provided by r and omised controlled trials and systematic review s of r and omised controlled trials.4 The Physiotherapy Evidence Data base ( PEDro ; http://www.pedro.org.au ) provides easy access to r and omised controlled trials and systematic review s of physiotherapy interventions . PEDro also includes links to evidence -based clinical practice guidelines . October 2009 marked the 10th anniversary of the launch of PEDro . PEDro is freely available on the internet . The data base indexes citation details , author abstract s and , where available , links to full text for r and omised controlled trials , systematic review s and practice guidelines in physiotherapy . Although the PEDro data base is design ed primarily for health professionals , a subsite , called Physiotherapy Choices ( http://www.physiotherapychoices.org.au ) , provides information in lay terms directly to consumers of physiotherapy services . As of August 2009 , more than 15 000 records ( 12 408 trials , 2060 review s and 603 guidelines ) have been indexed on PEDro . Each record is coded according to the subdiscipline(s ) of physiotherapy it addresses . PEDro now includes 615 r and omised controlled trials and 102 Abstract Objectives Firstly , to compare the effectiveness of a brief physiotherapy intervention with “ usual ” physiotherapy for patients with neck pain . Secondly , to evaluate the effect of patients ' preferences on outcome . Design Non-inferiority r and omised controlled trial eliciting preferences independently of r and omisation . Setting Physiotherapy departments in a community setting in Yorkshire and north Lincolnshire . Participants 268 patients ( mean age 48 years ) with subacute and chronic neck pain , who were referred by their general practitioner and r and omly assigned to a brief physiotherapy intervention ( one to three sessions ) using cognitive behaviour principles to encourage self management and return to normal function or usual physiotherapy , at the discretion of the physiotherapist concerned . Main outcome measures The Northwick Park neck pain question naire ( NPQ ) , a specific measure of functional disability result ing from neck pain . Also , the short form 36 ( SF-36 ) question naire , a generic , health related , quality of life measure ; and the Tampa scale for kinesophobia , a measure of fear and avoidance of movement . Results At 12 months , patients allocated to usual physiotherapy had a small but significant improvement in NPQ scores compared with patients in the brief intervention group ( mean difference 1.99 , 95 % confidence interval 0.45 to 3.52 ; P = 0.01 ) . Although the result shows a significant inferiority of the intervention , the confidence interval shows that the effect could be in the non-inferiority range for the brief intervention ( below 1.2 points of NPQ score ) . Patients who preferred the brief intervention and received this treatment had similar outcomes to patients receiving usual physiotherapy . Conclusions Usual physiotherapy may be only marginally better than a brief physiotherapy intervention for neck pain . Patients with a preference for the brief intervention may do at least as well with this approach . Additional training for the physiotherapists in cognitive behaviour techniques might improve this approach further This perspective provides an overview of the r and omized controlled trials , systematic review s , and evidence -based clinical practice guidelines in physical therapy . Data from the Physiotherapy Evidence Data base ( PEDro ) are used to describe key events in the history of physical therapy research and the growth of evidence of effects of interventions used in the various subdisciplines of physical therapy . The 11,494 records that were identified reveal a rich history of physical therapy research dating back to the first trial in 1929 . Most of the r and omized controlled trials , systematic review s , and evidence -based clinical practice guidelines in physical therapy have been published since the year 2000 . This rapid growth presents a challenge for physical therapists who want to keep up to date in clinical practice Background Musculoskeletal complaints have a significant impact on work in terms of reduced productivity , sickness absence and long term incapacity for work . This study sought to explore GPs ’ and physiotherapists ’ perceptions of  sickness certification in patients with musculoskeletal problems . Methods Eleven ( 11 ) GPs were sample d from an existing general practice survey , and six ( 6 ) physiotherapists were selected r and omly using ‘ snowball ’ sampling techniques , through established contacts in local physiotherapy departments .  Semi-structured qualitative interviews were conducted with respondents lasting up to 30 minutes . The interviews were audio recorded and transcribed verbatim , following which they were coded using N-Vivo qualitative software and analysed thematically using the constant comparative methodology , where themes were identified and contrasted between and within both groups of respondents . Results Three themes were identified from the analysis : 1 ) Approaches to evaluating patients ’ work problems 2 ) Perceived ability to manage ‘ work and pain ’ , and 3 ) Policies and penalties in the work-place . First , physiotherapists routinely asked patients about their job and work difficulties using a structured ( protocol -driven ) approach , whilst GPs rarely used such structured measures and were less likely to enquire about patients ’ work situation . Second , return to work assessment s revealed a tension between GPs ’ gatekeeper and patient advocacy roles , often resolved in favour of patients ’ concerns and needs . Some physiotherapists perceived that GPs ’ decisions could be influenced by patients ’ dem and for a sick certificate and their close relationship with patients made them vulnerable to manipulation . Third , the workplace was considered to be a specific source of strain for patients acting as a barrier to work resumption , and over which GPs and physiotherapists could exercise only limited control . Conclusion We conclude that healthcare professionals need to take account of patients ’ work difficulties , their own perceived ability to offer effective guidance , and consider the ‘ receptivity ’ of employment context s to patients ’ work problems , in order to ensure a smooth transition back to work Musculoskeletal injuries are a common presentation to the ED , with significant costs involved in the management of these injuries , variances in care within the ED and associated morbidity . A series of rapid review papers were completed to guide best practice for the assessment and management of common musculoskeletal injuries presenting to the ED . This paper presents the methodology used across the rapid review s. PubMed , CINAHL , EMBASE , TRIP and the grey literature , including relevant organisational websites , were search ed in 2015 . The search was repeated consistently for each topic area ( injuries of the foot and ankle , knee , h and and wrist , elbow , shoulder , lumbar spine and cervical spine ) . English- language primary studies , systematic review s and guidelines that were published in the last 10 years and addressed acute musculoskeletal injury management were considered for inclusion . Data extraction of each included article was conducted , followed by a quality appraisal . The extracted data from each article was synthesis ed to group similar evidence together . For each rapid review , the evidence has been organised in a way that a clinician can direct their attention to a specific component of the clinical cycle of care in the ED , such as the assessment , diagnostic tests , management and follow-up considerations from ED . The series of rapid review s are design ed to foster evidence -based practice within the ED , targeting the injuries most commonly presenting . The review s provide clinicians in EDs with rapid access to the best current evidence , which has been synthesis ed and organised to assist decision-making Background Low back pain ( LBP ) is a common and costly problem . Initiatives design ed to assist practitioner and patient decisions about appropriate healthcare for LBP include printed evidence -based clinical guidelines . The three professional groups of chiropractic , osteopathy and musculoskeletal physiotherapy in the UK share common ground with their approaches to managing LBP and are amongst those targeted by LBP guidelines . Even so , many seem unaware that such guidelines exist . Furthermore , the behaviour of at least some of these practitioners differs from that recommended in these guidelines .Few r and omised controlled trials evaluating printed information as an intervention to change practitioner behaviour have utilised a no-intervention control . All these trials have used a cluster design and most have method ological flaws . None specifically focus upon practitioner behaviour towards LBP patients . Studies that have investigated other strategies to change practitioner behaviour with LBP patients have produced conflicting results . Although numerous LBP guidelines have been developed worldwide , there is a paucity of data on whether their dissemination actually changes practitioner behaviour . Primarily because of its low unit cost , sending printed information to large numbers of practitioners is an attractive dissemination and implementation strategy . The effect size of such a strategy , at an individual practitioner level , is likely to be small . However , if large numbers of practitioners are targeted , this strategy might achieve meaningful changes at a population level . Methods The primary aim of this prospect i ve , pragmatic r and omised controlled trial is to test the short-term effectiveness ( six-months following intervention ) of a directly-posted information package on the reported clinical behaviour ( primary outcome ) , attitudes and beliefs of UK chiropractors , osteopaths and musculoskeletal physiotherapists . We sought to r and omly allocate a combined sample of 1,800 consenting practitioners to receive either the information package ( intervention arm ) or no information above that gained during normal practice ( control arm ) . We collected question naire data at baseline and six-months post-intervention . The analysis of the primary outcome will assess between-arm differences of proportions of responses to questions on recommendations about activity , work and bed-rest , that fall within categories previously defined by an expert consensus exercise as either ' guideline -consistent ' and ' guideline -inconsistent ' Abstract Purpose : To determine the effectiveness of an interactive educational intervention on a physiotherapy guideline for hip and knee osteoarthritis . Method : Physiotherapists were r and omly allocated to a 3-h interactive educational course with the collaboration of three patient partners or no intervention . Assessment s comprised question naires on adherence ( score range 0–24 ) , knowledge ( score range 0–76 ) , and barriers to use the guideline ( score range 0–80 ) . Assessment s were conducted 1 week before the interactive course ( T0 ) immediately after ( T1 ) , and 3 months thereafter ( T2 ) . Change scores were compared between the groups by means of Mann – Whitney U tests and linear mixed models . Results : 284 of 4328 eligible PTs ( 7 % ) were included . The intervention ( n = 133 ) was significantly more effective than no intervention ( n = 151 ) concerning self-reported adherence and knowledge with mean differences in change scores ( 95 % CI ) at T1 and T2 being 1.4 ( 0.7–2.0 ) and 0.9 ( 0.2–1.7 ) for adherence and 6.8 ( 4.5–9.1 ) and 3.9 ( 1.7–6.2 ) for knowledge , ( all p values < 0.005 ) . In both groups the barrier score increased at T1 and decreased at T2 , with a significantly larger increase at T1 and decrease at T2 in the intervention group ( mean differences 3.1 ( 1.8–4.4 ) and 3.3 ( 0.5–6.1 ) , respectively . Conclusions : A short interactive educational course with patient participation on a PT guideline on hip and knee osteoarthritis showed a small to moderate positive effect on self-reported guideline adherence and knowledge , whereas for perceived barriers an advantage was only seen on the longer term . Implication s for Rehabilitation Continuing professional development is important and effective , it works very well when patients are engaged in the process , and hence it is supportive overall of enhancing clinical practice . Interactive education can reduce barriers in guideline usage in daily practice BACKGROUND CONTEXT The process through which new scientific developments are incorporated into clinical practice is referred to as " knowledge transfer " and is currently the subject of great interest in many areas of clinical medicine . Family physicians managing patients with acute low back pain have been shown to have a poor overall rate of concordance with clinical practice guideline -recommended treatments . New methods need to be developed to help physicians bridge the guideline implementation gap . PURPOSE To determine the efficacy of a knowledge transfer method that communicates clinical practice guidelines to family physicians and their patients using patient-specific , physician-to-physician communications . STUDY DESIGN A prospect i ve r and omized controlled study . PATIENT SAMPLE 428 patients with acute mechanical low back pain and accepted Workers ' Compensation Board cl aims were studied . OUTCOME MEASURES Concordance with specific clinical practice guideline -derived history taking items , physical examination procedures and treatment recommendations was determined . METHODS Patients with acute mechanical back pain of less than 4 weeks duration and accepted Workers ' Compensation Board cl aims were r and omly assigned to one of three groups . In Group 1 ( control group ) neither the patients nor their family physicians received any information concerning the guidelines . In Group 2 , family physicians alone or as well as their patients ( Group 3 ) received a summary of clinical practice guidelines at approximately 2 weeks postinjury . In addition , both Groups 2 and 3 received reminders summarizing the recommended guidelines for patients at three specific stages of their clinical course . All guideline correspondence was addressed to a specific family physician or patient , signed by the study physician-investigators , and specified the patient by name . RESULTS Family physicians in the control and intervention groups demonstrated a high degree of concordance with the guideline -recommended history taking and physical examination procedures , but were generally highly discordant with guideline -recommended treatments . Significant improvement in guideline -concordant treatments was seen only with diminished recommendations of prolonged bed rest and passive therapies and an increase in recommended aerobic exercise . Concordance with guideline recommendations relating to the use of spinal manipulative therapy was poor in all study groups . CONCLUSIONS A knowledge transfer method that involved patient-specific , physician-to-physician communication to family physicians or their patients at three stages of the patient 's clinical course was largely unsuccessful in improving concordance with guideline treatment recommendations ‘ More research is needed ’ is a most unhelpful conclusion for the clinician reader of a systematic review . Clinicians look to research ers for the ‘ research evidence ’ part of Professor Sackett ’s ‘ three circles ’ of evidence -based practice .1 The clinician can not ignore the patient in front of him or her just because there is no evidence from systematic review s or r and omised controlled trials ( RCTs ): ‘ Kindly forget about your shoulder problem , until we have better research to tell me what to do ’ ? This will not do ! In this editorial , we share three practical tips for authors synthesis ing lower level evidence in systematic review s , when high- quality RCTs are absent . Our goal is to help authors help clinicians help patients . Consider the patient who plays tennis and presents with shoulder pain . Right now , the clinician who is seeking RCT evidence on how to progress from impairment-focused tasks in neutral shoulder positions to high-level , sport-specific tasks will be disappointed . Being able to function in shoulder elevation positions above Background The Stroke Canada Optimization of Rehabilitation by Evidence Implementation Trial ( SCORE-IT ) was a cluster r and omized controlled trial that evaluated two knowledge translation ( KT ) interventions for the promotion of the uptake of best practice recommendations for interventions targeting upper and lower extremity function , postural control , and mobility . Twenty rehabilitation centers across Canada were r and omly assigned to either the facilitated or passive KT intervention . The objective of the current study was to underst and the factors influencing the implementation of the recommended treatments and KT interventions from the perspective of nurses , occupational therapists and physical therapists , and clinical managers following completion of the trial . Methods A qualitative descriptive approach involving focus groups was used . Thematic analysis was used to underst and the factors influencing the implementation of the recommended treatments and KT interventions . The Clinical Practice Guidelines Framework for Improvement guided the analysis . Results Thirty-three participants were interviewed from 11 of the 20 study sites ( 6 sites from the facilitated KT arm and 5 sites from the passive KT arm ) . The following factors influencing the implementation of the recommended treatments and KT interventions emerged : facilitation , agreement with the intervention – practical , familiarity with the recommended treatments , and environmental factors , including time and re sources . Each of these themes includes the sub-themes of facilitator and /or barrier . Improved team communication and interdisciplinary collaboration emerged as an unintended outcome of the trial across both arms in addition to a facilitator to the implementation of the treatment recommendations . Facilitation was identified as a facilitator to implementation of the KT interventions in the passive KT intervention arm despite the lack of formally instituted facilitators in this arm of the trial . Conclusions This is one of the first studies to examine the factors influencing the implementation of stroke recommendations and associated KT interventions within the context of a trial . Findings highlight the important role of self-selected facilitators to implementation efforts . Future research should seek to better underst and the specific characteristics of facilitators that are associated with successful implementation and clinical outcomes , especially within the context of stroke rehabilitation 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 practice s including 277 physical therapists ( PTs ) ( intervention group ) . In two adjacent areas , 171 PTs at 32 practice s received no intervention ( control group ) . The core component of the intervention was an implementation seminar with group discussion s. Among other components were a website and email reminders . Data were collected at baseline and follow-up with a web-based question naire . 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 question naire . 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
RESULTS Knowledge translation interventions appear to have result ed in a positive change in physiotherapist beliefs , attitudes , skills and guideline awareness .
However , no consistent improvement in clinical practice , patient and economic outcomes were observed .
AND IMPLICATION OF KEY FINDINGS The intensity and type of knowledge translation intervention seem to have an effect on practice change .
BACKGROUND Many physiotherapists underuse evidence -based practice guidelines or recommendations when treating patients with musculoskeletal disorders , yet synthesis of knowledge translation interventions used within the field of physiotherapy fails to offer clear conclusions to guide the implementation of clinical practice guidelines .
OBJECTIVES To evaluate the effectiveness of various  knowledge translation interventions used to implement changes in the practice of current physiotherapists treating common musculoskeletal issues .