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

ContextMany 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.AimTo identify determinants of clinical practice guidelines' utilization by health care providers involved in the assessment and management of MSDs.MethodA 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.ConclusionIdentifying modifiable determinants is the first step in developing implementation strategies to improve guideline utilization in clinical practice.

Automated summary

The study found barriers and facilitators to the utilization of clinical practice guidelines by healthcare providers involved in the assessment and management of musculoskeletal disorders. The main barriers included disagreement between recommendations and patient expectations, guidelines not being specific to individual patients, lack of familiarity with certain terms or models, time-consuming processes, and variations in guideline methods. The main facilitators included clinicians' interest in evidence-based practice, perception that guidelines improve triage, diagnosis, and management, time efficiency, and standardized language.