Observational studyEuropean journal of pain (London, England)2023
The slow de-implementation of non-evidence-based treatments in low back pain hospital care-Trends in treatments using Dutch hospital register data from 1991 to 2018.
Observational study in European journal of pain (London, England), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it, 29 citations in OpenAlex.
- Global prevalence of hospital admissions for low back pain: a systematic review with meta-analysis.BMJ open · 2023Pooled it
- Key Conditions for Successful Implementation of the Manchester Procedure as Primary Surgical Treatment for Mild to Moderate Uterine Prolapse: A Qualitative Study Among Dutch Gynecologists.International urogynecology journal · 2026Article
- Nationwide guideline implementation: a qualitative study of barriers and facilitators from the perspective of guideline organizations.BMC health services research · 2025Article
- The role of guideline organizations in nationwide guideline implementation: a qualitative study.Health research policy and systems · 2024Article
- A descriptive evaluation of a job analysis survey in the chiropractic profession in Switzerland - an update after more than 10 years.Chiropractic & manual therapies · 2024Article
- Relevance and use of health policy, health systems and health services research for strengthening rehabilitation in real-life settings: methodological considerations.European journal of physical and rehabilitation medicine · 2024Article
- Is the use of diagnostic imaging and the self-reported clinical management of low back pain patients influenced by the attitudes and beliefs of chiropractors? A survey of chiropractors in the Netherlands and Belgium.Chiropractic & manual therapies · 2024Article
- Rehabilitation after Hip Fracture Surgery: A Survey on Italian Physiotherapists' Knowledge and Adherence to Evidence-Based Practice.Healthcare (Basel, Switzerland) · 2023Article
- The slow de-implementation of non-evidence-based treatments in low back pain hospital care-Trends in treatments using Dutch hospital register data from 1991 to 2018.European journal of pain (London, England) · 2023Observational
Corrections and comments
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Authors and funding
8 authors at 4 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundLow back pain (LBP) is the leading cause of disability worldwide and has an excessive societal burden. Accumulating evidence has shown that some medical approaches such as imaging in absence of clear indications, medication and some invasive treatments may contribute to the problem rather than alleviating it.
objectivesTo determine the extent of de-implementation of non-evidence-based hospital treatments for LBP care in the Netherlands in the last three decades.
methodsUsing a register-based population-level observational study with Dutch hospital data, providing a nearly complete coverage of hospital admissions in the Netherlands in 1991-2018, we assessed five frequently applied non-evidence-based hospital treatments for LBP. Time trends in treatment use (absolute and per 100,000 inhabitants) were plotted and analysed using Poisson regression.
resultsThe use of bed rest for non-specific LBP and hernia nuclei pulposi, and discectomy for spinal stenosis decreased 91%, 81% and 86% since the availability of evidence/guidelines, respectively. De-implementation, beyond 84%, was reached after 18 and 17 years for bed rest for non-specific LBP and discectomy respectively, while it was not reached after 28 years for bed rest for hernia nuclei pulposi. For spinal fusion and invasive pain treatment, there was an initial increase followed by a reduction. Overall, these treatments reduced by 85% and 75%, respectively.
conclusionsIn the Netherlands, de-implementation of five non-recommended hospital LBP treatments, if at all, took several decades. Although de-implementation was substantial, slow de-implementation has likely resulted in considerable waste of resources and avoidable harm to many patients in Dutch hospitals. SIGNIFICANCE: Medically intensive approaches to low-back pain care contribute to the high societal burden of this disease. There have been calls to avoid such care. Using Dutch hospital data, we showed that de-implementation of five non-recommended hospital low-back pain treatments, if at all, took several decades (i.e. ≥17 years) after availability of evidence and guidelines. Slow de-implementation has likely resulted in considerable waste of resources and avoidable harm to hospital patients; better ways for de-implementation of non-evidence-based care are needed.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.