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What behaviour change techniques have been used to improve adherence to evidence-based low back pain imaging?

BACKGROUND: Despite international guideline recommendations, low back pain (LBP) imaging rates have been increasing over the last 20 years. Previous systematic reviews report limited effectiveness of implementation interventions aimed at reducing unnecessary LBP imaging. No previous reviews have ana...

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Autores principales: Hall, Amanda, Richmond, Helen, Pike, Andrea, Lawrence, Rebecca, Etchegary, Holly, Swab, Michelle, Thompson, Jacqueline Y., Albury, Charlotte, Hayden, Jill, Patey, Andrea M., Matthews, James
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8254222/
https://www.ncbi.nlm.nih.gov/pubmed/34215284
http://dx.doi.org/10.1186/s13012-021-01136-w
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author Hall, Amanda
Richmond, Helen
Pike, Andrea
Lawrence, Rebecca
Etchegary, Holly
Swab, Michelle
Thompson, Jacqueline Y.
Albury, Charlotte
Hayden, Jill
Patey, Andrea M.
Matthews, James
author_facet Hall, Amanda
Richmond, Helen
Pike, Andrea
Lawrence, Rebecca
Etchegary, Holly
Swab, Michelle
Thompson, Jacqueline Y.
Albury, Charlotte
Hayden, Jill
Patey, Andrea M.
Matthews, James
author_sort Hall, Amanda
collection PubMed
description BACKGROUND: Despite international guideline recommendations, low back pain (LBP) imaging rates have been increasing over the last 20 years. Previous systematic reviews report limited effectiveness of implementation interventions aimed at reducing unnecessary LBP imaging. No previous reviews have analysed these implementation interventions to ascertain what behaviour change techniques (BCTs) have been used in this field. Understanding what techniques have been implemented in this field is an essential first step before exploring intervention effectiveness. METHODS: We searched EMBASE, Ovid (Medline), CINAHL and Cochrane CENTRAL from inception to February 1, 2021, as well as and hand-searched 6 relevant systematic reviews and conducted citation tracking of included studies. Two authors independently screened titles, abstracts, and full texts for eligibility and extracted data on study and intervention characteristics. Study interventions were qualitatively analysed by three coders to identify BCTs, which were mapped to mechanisms of action from the theoretical domains framework (TDF) using the Theory and Techniques Tool. RESULTS: We identified 36 eligible studies from 1984 citations in our electronic search and a further 2 studies from hand-searching resulting in 38 studies that targeted physician behaviour to reduce unnecessary LBP imaging. The studies were conducted in 6 countries in primary (n = 31) or emergency care (n = 7) settings. Thirty-four studies were included in our BCT synthesis which found the most frequently used BCTs were ‘4.1 instruction on how to perform the behaviour’ (e.g. Active/passive guideline dissemination and/or educational seminars/workshops), followed by ‘9.1 credible source’, ‘2.2 feedback on behaviour’ (e.g. electronic feedback reports on physicians’ image ordering) and 7.1 prompts and cues (electronic decision support or hard-copy posters/booklets for the office). This review highlighted that the majority of studies used education and/or feedback on behaviour to target the domains of knowledge and in some cases also skills and beliefs about capabilities to bring about a change in LBP imaging behaviour. Additionally, we found there to be a growing use of electronic or hard copy reminders to target the domains of memory and environmental context and resources. CONCLUSIONS: This is the first study to identify what BCTs have been used to target a reduction in physician image ordering behaviour. The majority of included studies lacked the use of theory to inform their intervention design and failed to target known physician-reported barriers to following LBP imaging guidelines. PROTOCOL REGISTATION: PROSPERO CRD42017072518 SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13012-021-01136-w.
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spelling pubmed-82542222021-07-06 What behaviour change techniques have been used to improve adherence to evidence-based low back pain imaging? Hall, Amanda Richmond, Helen Pike, Andrea Lawrence, Rebecca Etchegary, Holly Swab, Michelle Thompson, Jacqueline Y. Albury, Charlotte Hayden, Jill Patey, Andrea M. Matthews, James Implement Sci Systematic Review BACKGROUND: Despite international guideline recommendations, low back pain (LBP) imaging rates have been increasing over the last 20 years. Previous systematic reviews report limited effectiveness of implementation interventions aimed at reducing unnecessary LBP imaging. No previous reviews have analysed these implementation interventions to ascertain what behaviour change techniques (BCTs) have been used in this field. Understanding what techniques have been implemented in this field is an essential first step before exploring intervention effectiveness. METHODS: We searched EMBASE, Ovid (Medline), CINAHL and Cochrane CENTRAL from inception to February 1, 2021, as well as and hand-searched 6 relevant systematic reviews and conducted citation tracking of included studies. Two authors independently screened titles, abstracts, and full texts for eligibility and extracted data on study and intervention characteristics. Study interventions were qualitatively analysed by three coders to identify BCTs, which were mapped to mechanisms of action from the theoretical domains framework (TDF) using the Theory and Techniques Tool. RESULTS: We identified 36 eligible studies from 1984 citations in our electronic search and a further 2 studies from hand-searching resulting in 38 studies that targeted physician behaviour to reduce unnecessary LBP imaging. The studies were conducted in 6 countries in primary (n = 31) or emergency care (n = 7) settings. Thirty-four studies were included in our BCT synthesis which found the most frequently used BCTs were ‘4.1 instruction on how to perform the behaviour’ (e.g. Active/passive guideline dissemination and/or educational seminars/workshops), followed by ‘9.1 credible source’, ‘2.2 feedback on behaviour’ (e.g. electronic feedback reports on physicians’ image ordering) and 7.1 prompts and cues (electronic decision support or hard-copy posters/booklets for the office). This review highlighted that the majority of studies used education and/or feedback on behaviour to target the domains of knowledge and in some cases also skills and beliefs about capabilities to bring about a change in LBP imaging behaviour. Additionally, we found there to be a growing use of electronic or hard copy reminders to target the domains of memory and environmental context and resources. CONCLUSIONS: This is the first study to identify what BCTs have been used to target a reduction in physician image ordering behaviour. The majority of included studies lacked the use of theory to inform their intervention design and failed to target known physician-reported barriers to following LBP imaging guidelines. PROTOCOL REGISTATION: PROSPERO CRD42017072518 SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13012-021-01136-w. BioMed Central 2021-07-02 /pmc/articles/PMC8254222/ /pubmed/34215284 http://dx.doi.org/10.1186/s13012-021-01136-w Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Systematic Review
Hall, Amanda
Richmond, Helen
Pike, Andrea
Lawrence, Rebecca
Etchegary, Holly
Swab, Michelle
Thompson, Jacqueline Y.
Albury, Charlotte
Hayden, Jill
Patey, Andrea M.
Matthews, James
What behaviour change techniques have been used to improve adherence to evidence-based low back pain imaging?
title What behaviour change techniques have been used to improve adherence to evidence-based low back pain imaging?
title_full What behaviour change techniques have been used to improve adherence to evidence-based low back pain imaging?
title_fullStr What behaviour change techniques have been used to improve adherence to evidence-based low back pain imaging?
title_full_unstemmed What behaviour change techniques have been used to improve adherence to evidence-based low back pain imaging?
title_short What behaviour change techniques have been used to improve adherence to evidence-based low back pain imaging?
title_sort what behaviour change techniques have been used to improve adherence to evidence-based low back pain imaging?
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8254222/
https://www.ncbi.nlm.nih.gov/pubmed/34215284
http://dx.doi.org/10.1186/s13012-021-01136-w
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