Can a tailored implementation programme enhance the adoption of guideline-adherent behaviour in physiotherapists and chiropractors managing patients with low back pain? An implementation study

TL;DR

A tailored program helped physiotherapists and chiropractors adopt evidence-based practices for treating low back pain, improving patient care and professional culture.

Contribution

The study introduces a tailored implementation program that successfully increased guideline adherence in primary care professionals for low back pain management.

Findings

38% of participants increased screening for psychosocial risk factors after the program.

33% of participants improved patient education and reassurance practices.

Most participants found the program acceptable and appropriate, with moderate to high feasibility.

Abstract

Low back pain (LBP) is the primary contributor to disability worldwide, leading to a significant healthcare burden. Implementing evidence-based practice (EBP) can reduce this burden, as healthcare professionals (HCPs) working evidence-based reduce the number of treatments, the use of imaging and medication compared to HCPs not working evidence-based. Clinical practice guidelines have been published to help HCPs implement research evidence into practice. Unfortunately, studies have consistently shown a lack of adherence to guidelines in LBP care. This study aimed to investigate the implementation outcomes of a tailored programme for implementing key recommendations from LBP guidelines among Danish physiotherapists and chiropractors working in primary care.

This study was conducted as a 'pre-post' implementation study among 80 physiotherapists and chiropractors from 15 primary care clinics. The implementation object was the two key guideline recommendations: 1) screening of psychosocial risk factors and 2) patient education, including reassuring information. The programme comprised multipronged strategies and was designed as a step-by-step implementation process comprising 16 hours of activities distributed over 16 weeks. Adoption was measured as changes in self-reported behaviour and perceptions of the professional role and culture from baseline to follow-up at 16 weeks. Acceptability and appropriateness of the programme were measured weekly using a four-point Likert scale. Feasibility was measured at 16-week follow-up using a five-point Likert scale. Fidelity was measured as the number of strategies and implementation support delivered as planned and registered by the research team.

An increase in the adoption of screening of psychosocial factors and offering patient education, including reassuring information, was seen in 38% and 33% of participants, respectively. Most participants reported that the programme was partly or overall acceptable and appropriate. The feasibility of the implementation programme was assessed as moderate to high, and the fidelity of the implementation programme was determined as high.

The tailored implementation programme enhanced the adoption of the guidelines and changed the participants’ professional identity and culture. Most participants found the programme partly or overall acceptable and appropriate. The programme was feasible, but the perspective requires refinements, as most participants rated it moderately feasible.

Central Denmark Region, Registered November 11, 2021, act no. 1–16-02–93-19.

The online version contains supplementary material available at 10.1186/s43058-025-00820-y.

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