Poster Presentation Sydney Spinal Symposium 2026

Effectiveness of strategies for implementing guideline-concordant care in low back pain: a systematic review and meta-analysis of randomised controlled trials (#117)

Siya Zhao 1 , Aili V. Langford 2 , Qiuzhe Chen 1 , Meng Lyu 1 , Zhiwei Yang 1 , Simon D. French 3 , Christopher M. Williamse 4 , Chung-Wei Christine Lin 1
  1. Institute for Musculoskeletal Health, the University of Sydney, Croydon, NSW, Australia
  2. Sydney School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
  3. Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
  4. University Centre for Rural Health, School of Health Sciences, University of Sydney, Lismore, NSW, Australia

Background

This review aims to comprehensively evaluate the effectiveness of implementation strategies to promote guideline-concordant care for low back pain.

Methods

Five databases were searched. 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. 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.

Findings

Twenty-seven RCTs were included. All strategies targeted healthcare professionals, 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, I2 = 0%, moderate certainty evidence), but probably made little to no difference in reducing the use of routine imaging (N = 5, OR = 1.16, 95% CI: 0.95–1.41, I2 = 41%, moderate certainty evidence). Further, implementation strategies may make little to no difference in improving the rate of providing education/advice (N = 3, OR = 2.40, 95% CI: 0.89–6.49, I2 = 95%, low certainty evidence). However, this should be interpreted with caution as the sensitivity analysis indicated a positive effect, albeit with low certainty evidence, suggesting that the results are unstable and may change with future research (N = 2, OR = 3.59, 95% CI: 1.68–7.69, I2 = 75%).

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.