Implementation Initiatives to Improve Low Back Pain Care in Australia: A Scoping Review

Nathalia Costa; Fiona M Blyth; Anita B Amorim; Sarika Parambath; Selvanaayagam Shanmuganathan; Carmen Huckel Schneider

doi:10.1093/pm/pnac102

Implementation Initiatives to Improve Low Back Pain Care in Australia: A Scoping Review

Pain Med. 2022 Dec 1;23(12):1979-2009. doi: 10.1093/pm/pnac102.

Authors

Nathalia Costa^{1

2}, Fiona M Blyth¹, Anita B Amorim³, Sarika Parambath¹, Selvanaayagam Shanmuganathan¹, Carmen Huckel Schneider¹

Affiliations

¹ Faculty of Medicine and Health, The University of Sydney, Sydney School of Public Health, Menzies Centre for Health Policy and Economics, Sydney, New South Wales, Australia.
² School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
³ Faculty of Medicine and Health, The University of Sydney, School of Health Sciences, Sydney, New South Wales, Australia.

Abstract

Objective: This scoping review aimed to comprehensively review strategies for implementation of low back pain (LBP) guidelines, policies, and models of care in the Australian health care system.

Methods: A literature search was conducted in MEDLINE, EMBASE, CINAHL, Allied and Complementary Medicine Database, and Web of Science to identify studies that aimed to implement or integrate evidence-based interventions or practices to improve LBP care within Australian settings.

Results: Twenty-five studies met the inclusion criteria. Most studies targeted primary care settings (n = 13). Other settings included tertiary care (n = 4), community (n = 4), and pharmacies (n = 3). One study targeted both primary and tertiary care settings (n = 1). Only 40% of the included studies reported an underpinning framework, model, or theory. The implementation strategies most frequently used were evaluative and iterative strategies (n = 14, 56%) and train and educate stakeholders (n = 13, 52%), followed by engage consumers (n = 6, 24%), develop stakeholder relationships (n = 4, 16%), change in infrastructure (n = 4, 16%), and support clinicians (n = 3, 12%). The most common implementation outcomes considered were acceptability (n = 11, 44%) and adoption (n = 10, 40%), followed by appropriateness (n = 7, 28%), cost (n = 3, 12%), feasibility (n = 1, 4%), and fidelity (n = 1, 4%). Barriers included time constraints, funding, and teamwork availability. Facilitators included funding and collaboration between stakeholders.

Conclusions: Implementation research targeting LBP appears to be a young field, mostly focusing on training and educating stakeholders in primary care. Outcomes on sustainability and penetration of evidence-based interventions are lacking. There is a need for implementation research guided by established frameworks that consider interrelationships between organizational and system contexts beyond the clinician-patient dyad.

Keywords: Guidelines; Health Care System; Implementation; Low Back Pain; Models of Care; Policy.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Australia
Databases, Factual
Humans
Low Back Pain* / therapy