clinical practice guidelines low back pain apta

These clinical practice guidelines are thought to affect patient outcomes by standardizing care and decreasing use of inappropriate treatments, which ultimately assists in controlling overall health care expenses of LBP management.6 Referring to a set of guidelines can aid clinicians in choosing the most appropriate treatments for their patients, while allowing patients to remain as active as tolerated throughout the course of treatment.7 Using clinical practice guidelines in the treatment of acute, nonspecific LBP in the field of physical therapy has shown improved patient outcomes, specifically increased patient satisfaction scores, higher adherence rates, lower costs of treatments, and measurable changes in pain and disability before and after treatment.8 However, the reported evidence supporting the use of clinical practice guidelines must be interpreted with caution, as the methodology of many of the studies may be of concern. Phys Ther. A systematic review of the use of theory in the design of guideline dissemination and implementation strategies and interpretation of the results of rigorous evaluations. 2021;126:511342. However, most CPGs now recommend patient-centered care and shared decision-making (SDM) as an important component of care, thus placing greater emphasis on patient preference [51]. As noted above, delineating chronicity of pain may also be of use in future studies. This program was established to increase dissemination and implementation of AOPT's CPGs into real-world clinics. Fillipo, R., Pruka, K., Carvalho, M. et al. Four studies [23, 25, 29, 34] utilized published implementation frameworks. Implementation Science Communications Target Patient Population Two points were awarded if a study reported any possible confounders (eg, sex ratios, age, comorbidities, and severity of injury) that might account for differences between groups clearly in table format. Clinical practice guidelines are developed with the best available evidence; however, they generally fail to identify specific interventions that physical therapists may have utilized in clinical practice. We utilized Powell et al. Methods. Are the Roland Morris Disability Questionnaire and Oswestry Disability Index interchangeable in patients after lumbar spinal fusion? PubMed Were study subjects in different intervention groups (trials and cohort studies) or were the cases and controls (case-control studies) recruited over the same period of time? 2019;61(6):44552. A point was not awarded if the study made no mention of the presence or absence of adverse events. It is considered to be one of the most common disabilities in American adults younger than 45 years of age.1 Estimates suggest that up to 84% of adults may be affected by LBP at some point during their lifetime.2 According to the Institute of Medicine, LBP is among the top 15 priority conditions, further signifying its increasing incidence in health care.3 LBP is of significance not only for patient disability but also for escalating health care costs. One such approach that has been proposed in the management of acute, nonspecific LBP is the use of clinical practice guidelines that suggest a more active lifestyle that incorporates exercise and physical activity. Two studies [30, 32] did not assess statistical significance across groups. the purpose of these low back pain clinical practice guidelines, in particular, is to describe the peer-reviewed literature and make recommendations related to (1) treatment matched to low back pain subgroup responder categories, (2) treatments that have evidence to prevent recurrence of low back pain, and (3) treatments that have evidence to Of the six studies assessing visits relative to guideline adherence, four [17,18,19, 35] found significantly decreased visits for guideline adherent care. RF, KP, MC, DC, and MH contributed significantly to the writing of the manuscript. Patient Outcomes (Select a Field (optional)) AND Low Back Pain Treatment (Select a Field (optional)) AND Physical Therapy (Select a Field (optional)) AND Clinical Practice Guidelines (Select a Field (optional)), Patient outcomes (Select a Field (optional)) AND low back pain treatment (Select a Field (optional)) AND physical therapy (Select a Field (optional)) AND clinical practice guidelines (Select a Field (optional)), Patient Outcomes AND Low Back Pain Treatment AND Physical Therapy AND Clinical Practice Guidelines, Clinical outcomes recorded by physical therapists in 325 practices in the Netherlands, KNGF Clinical Practice Guideline for Physical Therapy in patients with low back pain, # of sessions in normal course low back pain, Quebec Back Pain and Disability Score (QBPDS), QBPDS scores lowered, meaning patients had less disability, Clinical outcomes maintained by Employee Health Services Outpatient Clinics at the University of Pittsburgh Medical Center, Active within limitations of pain, within 4 weeks of pain onset, Modified Oswestry Disability Questionnaire, Both classification-based groups, and guideline adherent groups had better pain and disability scores after treatment; classification-based group scored better, Clinical outcomes maintained by the Rehabilitation Agency of Intermountain Health Care, Active to Passive codes 75% and each visit included at least 1 active code, Adherent group60.5% decrease in pain rating, and also had better health outcomes; nonadherent group had only a 38.0% decrease in pain rating, Clinical outcomes maintained by the CZ, health insurance company in New Zealand, Dutch Physical and Manual Therapy Guidelines, Subjects reported scores of 40.5 for baseline and 21.3 for posttreatment, indicative of a decrease in pain and improvement in function following adherent care. Clinical practice guidelines (CPGs) also called 'clinical guidelines' can improve healthcare by promoting best practice, reducing the use of lowvalue interventions and unwarranted. Improved Clinical Effectiveness through Behavioural Research G. Designing theoretically-informed implementation interventions. Google Scholar. The precise method of randomization need not be specified. OVID and PubMed exist as interfaces for the same database, MEDLINE; thus, only one interface needs to be searched in order to capture MEDLINE content. Meet the Speaker: Brandon I. Peterson, DPT, MDT. A consensus meeting between the 2 reviewers was held to determine whether the study met the required criteria. [14], which details six key implementation processes and 68 discrete, or individual, implementation strategies. Liu X, Hanney WJ, Masaracchio M, Kolber MJ. CPGs provide evidence-based recommendations to assist decision-making about health interventions [4]. Article Upper body push and pull strength ratio in recreationally active adults, Spinal conditioning for athletes with lumbar spondylolysis and spondylolisthesis. Pilot Feasibility Stud. One study [46] utilizing an implementation framework by Grol et al. Physical therapists use of interventions with high evidence of effectiveness in the management of a hypothetical typical patient with acute low back pain. Two of the studies [17, 18] found a statistically significant difference favoring adherent care. Mayo Clin Proc. Childs JD, Fritz JM, Wu SS, Flynn TW, Wainner RS, Robertson EK, et al. A point was given if the inclusion or exclusion criteria, or both, were indicated. The addition of an intensive training protocol to guideline-based care did not significantly impact imaging utilization [24]. Does adherence to the guideline recommendation for active treatments improve the quality of care for patients with acute low back pain delivered by physical therapists? A systematic review highlights the need to investigate the content validity of patient-reported outcome measures for physical functioning in patients with low back pain. See Additional file 1. Therefore, the purpose of this systematic literature review is to analyze previous studies that have examined patient outcomes when adhering to clinical practice guidelines in the physical therapy setting that recommend an active treatment approach for nonspecific LBP. Our search strategy was thorough and able to capture as many eligible studies as possible. 2014;9:3. Phys Ther. . Multifaceted strategies may increase implementation of physiotherapy clinical guidelines: a systematic review. Patients were then further categorized into the type of nonspecific LBP based on duration: acute, subacute, and chronic.17 Overall, higher adherence rates led to fewer functional limitations posttreatment.17 Further analysis of the 3 categories of nonspecific LBP found the most significant negative correlations between guideline adherence and functional limitations in patients with chronic LBP.17 The patients experiencing acute LBP experience a medium negative correlation and no significant correlation was found in patient with acute and subacute LBP.17 In this review, negative correlations suggest that higher percentages of adherence are associated with fewer functional limitations, less pain, and fewer treatment visits.17. H:\QI\Clinical Practice Guidelines\2020\Completed\Final Word Documents\Low Back Pain CPG.docxx Page 1 of 9 CLINICAL PRACTICE GUIDELINES FOR MANAGEMENT OF LOW BACK PAIN Low back pain is very common, up to 90+% of people are affected by back pain at some time in their lives. <p>Listen as chiropractor and founder of the Cox Technic, Dr. James Cox explains what Cox Technic is and why it is so effective for treating back pain.</p><p>James M. Cox, DC, DACBR, FICC, Hon.D.Litt., FACO(H)</p><p>Dr. Cox is the developer of Cox Technic Flexion Distraction Manipulation and the proud participant in the on-going federal research projects involving the Keiser University . The rising prevalence of chronic low back pain, The Saskatchewan Health and Back Pain Survey. Conclusion. All contents 2020 American Physical Therapy Association. Introduction. Article [26] reported that the addition of pain education to guideline-based care resulted in significantly less pain compared to guideline-based care alone. Spine J. Low Back Pain: Clinical Practice Guidelines | april 2012 | volume 42 | number 4 | journal of orthopaedic & sports physical therapy . Singh V, Singh P, Karmakar M, et al. Otherwise, a point was not awarded (eg, a point was not awarded when all participants from the adherence group received care at clinic A and all participants in the nonadherence group received care at clinic B, because they could have represented 2 distinct populations). These documents, developed by expert panels, are normally updated every 3 to 5 years or when the available evidence suggests a reformulation of the previous document is necessary [5]. Despite this lack of statistical significance, the trend toward improved patient outcomes with the use of clinical practice guidelines for acute, nonspecific LBP treatment remain consistent in the literature. The outcome variables on guideline adherence and the other primary outcome variables listed in the study selection section were extracted by one primary author (EGL) and inputted in Table 2. Implement Sci. Implement Sci Commun. 2021;22(1):507. One study assessed chronic neck pain [19], and one assessed WAD [28]. Multiple implementation strategies were identified, with Managing Quality as the most frequently utilized key implementation process. Therefore, the purpose of this systematic review is to evaluate the reported efficacy of active treatment approaches as recommended by clinical practice guidelines on LBP treatment on patient outcomes. The following keywords were used in combination: clinical practice guidelines, patient outcomes, low back pain, treatment, and physical therapy. 2021;10(6):1230. van der Roer N, van Tulder M, van Mechelen W, de Vet H. Economic evaluation of an intensive group training protocol compared with usual care physiotherapy in patients with chronic low back pain. Implementation strategies were also examined to determine prevalence and potential impact. One point was awarded if the study indicated that groups were matched for any such demographical variables or if potential confounders were mentioned in the text of the article but not clearly listed in table format. Studies identified in this review indicate that adherence to an active treatment approach as recommended by clinical practice guidelines may result in improved patient outcomes. William J. Hanney, DPT, PhD, Department of Health Professions, University of Central Florida, Health & Public Affairs I, 12805 Pegasus Drive #262, Orlando, FL 32816-2205; e-mail: Received 2016 Sep 30; Revised 2017 Feb 9; Accepted 2017 Feb 10. A point was given if the criteria for guideline adherence were described in detail. Utilizing a theory-informed implementation strategy is proposed to improve implementation outcomes [42] but often explanations for the theoretical basis are lacking [43]. Effectiveness of multifaceted implementation strategies for the implementation of back and neck pain guidelines in health care: a systematic review. Comprehensive, blended strategies, including barrier assessment, may be beneficial as these may more efficiently address the obstacles and needs of the involved stakeholders and should be further investigated. Other authors [49] suggest that the duration of the implementation strategy may be insufficient to produce long-term changes in practice and patient outcomes. Hanney WJ, Masaracchio M, Liu X, Kolber MJ. The results of this review suggest guideline implementation and adherence may decrease HCU, but the results are inconclusive when comparing pain and physical function outcomes. Terms and Conditions, The article states that "higher percentage of adherence to the Dutch guidelines for low back pain is associated with better clinical outcomes."1(p1119) This statement . Were the staff, places, and facilities where the patients were treated representative of the treatment the majority of patients receive? Eighteen studies [16,17,18,19,20,21,22,23,24,25,26,27,28, 31, 33,34,35,36] assessed HCU as an outcome. The functionality is limited to basic scrolling. These outcome variables were the most common variables that were reported between each of the articles and were the variables most agreed upon by the 2 primary authors (EGL and WJH) that would demonstrate patient outcomes. A medical librarian was not consulted however, the authors (WJH and MJK) have considerable experience with systematic literature reviews and were in agreement with the search methods used. No points were awarded if the study did not report any confounders. While there are no specific cut points to define favoring guideline treatment, we utilized information gleaned from a previously published systematic review.15 While it appears this criterion can be subjective, further criteria should be considered in order to be more specific. Guideline adherence did not significantly impact function in one study that included patients with neck pain [19]. Physical therapy for neck and low back pain is highly variable despite the availability of clinical practice guidelines (CPG). Lemieux J, Kawchuk G, Kongsted A, Hartvigsen J, Abdollah V, Jones A. The studies analyzed in this review showed a general trend of reduced disability and improved patient outcomes when adhering to an active approach practice guideline. 2009;19(1):94105. The search was restricted to articles that were published in a peer-reviewed journal, published in the English language, examined patient outcomes with a determined scale, determined the usage of an established clinical practice guideline for LBP treatment, reported at least one outcome measure, and specified either nonspecific or acute LBP. 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, Direct access compared with referred physical therapy episodes of care: a systematic review. 2017;47(7):A1A83. Findings indicate CPG implementation decreased healthcare utilization, but inconsistent results were found with physical functioning and pain outcomes. Numerous CPGs have been published on the management of LBP, both interdisciplinary and specific to physical therapy, though fewer have been published on the management of neck pain [6, 7]. Two did not report a country as they were conducted in global military health systems [16, 33]. CAS Magel et al. For studies where the effect of any nonadherence was likely to bias any association to the null, the study was not awarded a point. Implementation of guidelines does not guarantee provider adherence to guidelines or a change in provider practice. and (2) Does the implementation strategy of CPGs impact outcomes? Were losses of patients to follow-up taken into account? In conclusion, guideline implementation in physical therapy treatment of low back and neck pain has a positive effect on HCU, but more research is needed to determine the effect on pain and function. Horn ME, Brennan GP, George SZ, Harman JS, Bishop MD. 2018;18(1):435. However, it has been established that there is significant variability in the care provided to patients with low back and neck pain by physical therapists despite the existence of clinical practice guidelines (CPGs) to treat these conditions [3]. Davies P, Walker AE, Grimshaw JM. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Hence, patients with higher function may be more likely to demonstrate reduced pain and disability scores, improved adherence, and greater satisfaction within their treatment course. 2006;1:4. BMC Health Serv Res. J Orthop Sports Phys Ther. Studies have examined the use of LBP guidelines and have evaluated their effectiveness with measures including pain and disability scores, perceived patient outcomes, adherence rates, and the total amount of treatment. ;=S4w^au*}3z9?gdPOVs5TKRjf05iZ}TUgj~U jOX}4/}&_=w>A3,6y3W{=7hH>u6iLWAWpTTa}:: Costa LD, Maher CG, Hancock MJ, McAuley JH, Herbert RD, Costa LO. The ability to compare functional outcomes across studies is limited due to the lack of consistent outcome measures utilized. We would like to thank Stephanie Hendren for completing our database searches. There was no significant difference between groups when compared to guideline-based care alone. the first difference is that the labels in this clinical practice guideline incorporate the following icf impairments of body functions terminology: low back pain with mobility deficits, low back pain with movement coordination impairments, low back pain with related (referred) lower extremity pain, low back pain with radiating pain, and low back Can upper extremity functional tests predict the softball throw for distance: a predictive validity investigation. The purpose of this clinical practice guideline is to provide evidence-based recommendations for physical therapist management of PGP in the postpartum population. Magel J, Hansen P, Meier W, Cohee K, Thackeray A, Hiush M, et al. PubMed Central Implementation strategies for CPGs were also examined to determine the variance in the focus of implementation strategies on success of the implementation. The authors of this tool indicated that this question should be answered yes when clear reasons for exclusion were described. Several included studies utilized published implementation frameworks to guide their intervention, while others utilized theories such as the behavior change theory, learning theory, and change management theory to structure their intervention. APTA's Passport to Learning provides a world of learning at your fingertips! The variance of treatments for LBP may lead to selection of inappropriate interventions and overuse of ineffective therapies.8 The various treatment options used by the clinician may further affect the course of treatment for LBP. The primary outcome measure was the numeric pain rating scale (NPRS) or numeric rating scale (NRS), utilized in all but one study [35]. Five studies were conducted in private practice clinics [16, 18, 21, 29, 35], two studies were conducted in military treatment centers [16, 33], and one study was conducted based on a review of workers compensation [20]. Eight studies [17, 18, 23, 24, 26, 27, 30, 33] assessed the total number of healthcare visits, fifteen studies [16,17,18,19, 21,22,23,24,25,26,27,28, 34,35,36] assessed the number of PT visits, and four studies [17, 18, 23, 34] assessed the duration of PT care. BMC Health Serv Res. Two additional studies [33, 36] used psychological and educational theories to guide implementation interventions. Salamh PA, Corrao M, Hanney WJ, Kolber MJ. BMC Musculoskelet Disord. Longtin C, Decary S, Cook CE, Tousignant-Laflamme Y. One study [19] found that the group that received nonadherent care had greater improvements in pain, but no difference in functional outcomes. The method of data analysis was based on a previous systematic literature review published by Hanney et al15 that used a modified Downs and Black checklist to score article quality. 2017;17(3):34659. Are the main outcomes to be measured clearly described in the Introduction or Methods section?

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