Determinants of clinical practice guidelines’ utilization for the management of musculoskeletal disorders: a scoping review

Abstract

Context Many clinical practice guidelines have been developed for the management of musculoskeletal disorders (MSDs). However, there is a gap between evidence-based knowledge and clinical practice, and reasons are poorly understood. Understanding why healthcare providers use clinical practice guidelines is essential to improve their implementation, dissemination, and adherence. Aim To identify determinants of clinical practice guidelines’ utilization by health care providers involved in the assessment and management of MSDs. Method A scoping review of the literature was conducted. Three databases were searched from inception to March 2021. Article identification, study design, methodological quality, type of healthcare providers, MSDs, barriers and facilitators associated with guidelines’ utilization were extracted from selected articles. RESULTS: 8671 citations were retrieved, and 43 articles were selected. 51% of studies were from Europe, and most were quantitative studies (64%) following a cross-sectional design (88%). Almost 80% of articles dealt with low back pain guidelines, and the most studied healthcare providers were general practitioners or physiotherapists. Five main barriers to guideline utilization were expressed by providers: 1) disagreement between recommendations and patient expectations; 2) guidelines not specific to individual patients; 3) unfamiliarity with “non-specific” term, or with the bio psychosocial model of MSDs; 4) time consuming; and 5) heterogeneity in guideline methods. Four main facilitators to guideline utilization were cited: 1) clinician’s interest in evidence-based practice; 2) perception from clinicians that the guideline will improve triage, diagnosis and management; 3) time efficiency; and 4) standardized language. Conclusion Identifying modifiable determinants is the first step in developing implementation strategies to improve guideline utilization in clinical practice.

Learning from the past to plan for the future: A scoping review of musculoskeletal clinical research in Sweden 2010–2020

“…MSK disorders are one of most common reasons for accessing primary health care in Sweden (5,6). Many clinicians in primary care do not feel confident to diagnose and manage patients with MSK disorders, unnecessarily refer to secondary healthcare services, are not aware of recent evidence for effectiveness of different treatments, rely on shared beliefs and personal opinion rather than research evidence, or poorly adhere to existing guidelines (7)(8)(9). The result is a discordance between what is known to be effective from clinical research and what is done in clinical practice, i.e.…”

Does the implementation of clinical practice guidelines for low back and neck pain by physical therapists improve patient outcomes? A systematic review

“…Providers report numerous barriers to guideline adherence including patient preference [ 50 ]. However, most CPGs now recommend patient-centered care and shared decision-making (SDM) as an important component of care, thus placing greater emphasis on patient preference [ 51 ].…”

Do chiropractic interns use clinical practice guidelines when managing patients with neck pain in France? A feasibility study

“…This feasibility study has also strengths. First, the content of the questionnaire the was informed by our scoping review of the literature [ 14 ]. Although, a theoretical underpinning and potentially missing questions to uncover pertinent barriers/facilitators to guideline use could be two major weaknesses of this work.…”

“…Questions about barriers and facilitators of guideline utilization were based on our scoping review [ 14 ] (Additional file 2 written in French). The Theory of planned behavior [ 22 ] was the most commonly used framework to report determinants following 4 categories: (1) Behavioral Intention, (2) Attitudes toward behavior, (3) Subjective Norm and (4) Perceived behavioral control [ 23 ].…”

“…As reported in our recent coping review of the literature, any determinants influence the use of clinical practice guidelines by healthcare providers [ 14 ]. The review identified few patients’ determinants, highlighting that literature on guideline use primarily focuses on clinicians.…”