Evidence map›Paper›PMID 41497504›Full record

ArticleEClinicalMedicine2025

Effectiveness of strategies for implementing guideline-concordant care in low back pain: a systematic review and meta-analysis of randomised controlled trials.

Siya Zhao, Aili V Langford, Qiuzhe Chen, Meng Lyu, Zhiwei Yang, Simon D French, Christopher M Williams, Chung-Wei Christine Lin

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in EClinicalMedicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Review
  2. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors.

Siya ZhaoInstitute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia.
Aili V LangfordSydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
Qiuzhe ChenInstitute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia.
Meng LyuInstitute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia.
Zhiwei YangInstitute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia.
Simon D FrenchDepartment of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia.
Christopher M WilliamsUniversity Centre for Rural Health, School of Health Sciences, University of Sydney, Lismore, NSW, Australia.
Chung-Wei Christine LinInstitute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: International low back pain guidelines recommend providing education/advice to patients, discouraging routine imaging use, and encouraging judicious prescribing of analgesics. However, practice variation occurs and the effectiveness of implementation strategies to promote guideline-concordant care is unclear. This review aims to comprehensively evaluate the effectiveness of implementation strategies to promote guideline-concordant care for low back pain. Methods: Five databases (including MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL) and Physiotherapy Evidence Database (PEDro) were searched from inception until 22nd August 2024. Randomised controlled trials (RCTs) that evaluated strategies to promote guideline-concordant care (providing education/advice, discouraging routine imaging use, and/or reducing analgesic use) among healthcare professionals or organisations were included. Two reviewers independently conducted screening, data extraction, and risk of bias assessments. The primary outcome was guideline-concordant care in the medium-term (>3 months but <12 months), measured by the rate of patients receiving such care. The taxonomy recommended by the Cochrane Effective Practice and Organisation of Care (EPOC) group was used to categorise implementation strategies. Meta-analysis with a random effects model was conducted where possible. This systematic review was prospectively registered in PROSPERO (registration number: CRD42023452969). Findings: Twenty-seven RCTs with 32 reports were included. All strategies targeted healthcare professionals (7796 health professionals overseeing 34,890 patients with low back pain), and none targeted organisations. The most commonly used implementation strategies were educational materials (15/27) and educational meetings (14/27), although most studies (24/27) used more than one strategy ('multifaceted strategies'). In the medium-term, compared to no implementation, implementation strategies probably reduced analgesic use (number of studies [N] = 4, odds ratio [OR] = 1.21, 95% confidence interval [CI]: 1.05-1.40, Interpretation: Implementing guideline recommendations delivered mixed effects in promoting guideline-concordant care for low back pain management. Further research is needed to establish the effectiveness of implementation strategies for specific guideline-concordant care practices in low back pain. Funding: There was no funding source for this review.

Indexed as

Guideline-concordant careImplementation strategyLow back pain

Identifiers

PMID41497504
PMCPMC12766490

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

None linked

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.