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FOTO Rehab Outcomes Blog

Guidelines... Do They Impact Physiotherapy Practice?

As I read the title of the abstract, I thought the findings would be a no-brainer. As I read the abstract, I learned my initial gut thought was wrong.


More and more studies indicate the value of guidelines to improve clinical practice, reduce cost and improve outcomes. It would seem that guidelines should make an impact on practice.

In this particular case, I forgot about common sense. 

Before implementing  guidelines within an organization, it is probably wise to first know current practice patterns. Even better than that, it might was wise to actually know your organization's outcomes. If your clinicians are already knocking their performance out of the park and providing fantastic service with outstanding outcomes, it's probably a waste of time. From a psychological perspective it probably feels clinically demeaning to your stellar clinicians. 

There is definite value in guidelines - the actual act of implementing guidelines is fully dependent upon how a clinician is currently practicing.

You'll find the abstract to the recent study below.

Does a tailored guideline implementation strategy have an impact on clinical physiotherapy practice? A nonrandomized controlled study.




Clinical practice guidelines are a common strategy for implementing research findings into practice and facilitating evidence-based practice in health care settings. There is a paucity of knowledge about the impact of different guideline implementation strategies on clinical practice in a physiotherapy context. The study aimed to assess the impact of a guideline implementation intervention on clinical physiotherapy practice.


A tailored, multicomponent guideline implementation was compared with usual practice. Clinical practice was evaluated in physiotherapy treatment methods used for 3 common musculoskeletal disorders. Data were collected with a validated web-based questionnaire.


Postimplementation data were collected from 168 physiotherapists in the intervention group and 88 in the control group. The most frequently reported treatment methods for low back pain were advice on posture (reported by 95% in the intervention group vs 90% in the control group), advice to stay active (93% vs 90%), and stabilization exercise (88% vs 80%). Differences between groups were not significant. Reported use of body awareness training (23% vs 6%, P = .023) and spinal manipulation (9% vs 23%, P = .044) differed between the groups. The most frequently used treatment methods for neck pain were advice on posture (95% vs 92%), advice to stay active (89% vs 87%), and ROM exercise (85% vs 71%) (no significant differences between groups). Reported use of body awareness training (24% vs 7%, P = .023) differed between the groups. The most frequently used treatment methods for subacromial pain were range of motion exercises (reported by 93% in both groups), advice on posture (90% vs 87%), home exercise (77% vs 74%), and stabilization exercise (69% vs 66%) (no significant difference between groups).


Treatment methods used were largely in line with evidence already before the guideline implementation, which may explain why the guideline implementation had only little impact on clinical practice.

 2018 May 28. doi: 10.1111/jep.12958. [Epub ahead of print]

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