The aim of the study was to investigate the adoption of key recommendations from the LBP guidelines by Danish physiotherapists and chiropractors working in primary care using a tailored implementation programme.
The study was conducted as a 'pre-post' implementation study using self-reported questionnaires, with follow-up at 16 weeks (after programme completion).
The implementation object was the two key guideline recommendations: 1) screening of psychosocial risk factors and 2) patient education. 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 a change in self-reported behaviour and perception of professional identity and culture from baseline to follow-up at 16 weeks.
Eighty clinicians from 15 private clinics were included in the study. Overall, there was an even gender distribution (53 % males). Most were physiotherapists (93 %), self-employed (49 %), and had an average of 14,5 years of clinical experience. From before to after participating in the implementation programme, 45% of participants reported increased adherence to the recommendation to screen patients' psychosocial risk factors, and 37% reported increased adherence to providing patient education. Also, the programme enhanced the adoption of a biopsychosocial professional identity in 50-69% of participants, particularly participants' feeling of being skilled and confident in having a biopsychosocial approach improved. Likewise, the programme increased the adoption of a biopsychosocial culture in 40-41% of the participants.
Adopting the two key recommendations, 1) screening of psychosocial risk factors and 2) offering patient education, could be improved using a tailored implementation programme. Also, the programme enhanced the participants' biopsychosocial professional identity and culture.
This PhD project shows that an active implementation effort using a tailored implementation program can increase the use of the guidelines in practice. The results show that a different approach to implementation is needed than the usual passive strategy. Implementing a biopsychosocial approach is a collective endeavour. Physiotherapists are encouraged to dedicate an hour weekly to working on behaviour change with colleagues. Together, they can systemise the process of addressing patients' psychosocial factors and practice using this information to provide personalised patient education.
Clinical practice guidelines
Biopsychosocial approach
