TABLE 3.
Characteristics of intervention groups and knowledge translation (KT) effectiveness outcomes according to target population evaluated in individual studies
| Author (ref), year; type of study; country | KT intervention, comparison groups (n allocated) | Unit of allocation, target, clinical topic | Unit of analysis, numbers analyzed per group, primary outcome and results | Statistically significant result | ||||
|---|---|---|---|---|---|---|---|---|
| KT interventions targeting health professionals | ||||||||
| Becker et al (43), 2008; cRCT; Germany | Multifaceted intervention G1: Multifaceted CPG implementation (n=37) G2: CPG implementation + motivational counselling (n=38) G3: Postal dissemination of CPG (n=43) |
Practice; GPs; chronic LBP | Unit of analysis: Patient | Yes | ||||
| Function (Hannover Functional Ability Questionnaire for Measuring Back Pain-related Functional Limitations [12 items]) (mean, 95% CI) | ||||||||
| TOA | G1 (n=NR) | G2 (n=NR) | G3 (n=NR) | |||||
| Baseline | 67.5 (21.4) | 68.7 (20.9) | 65.8 (21.9) | |||||
| 6 months | 72.9 (70.6 to 75.2) | 73.9 (71.6 to 76.2)* | 70.2 (68.8 to 72.7) | |||||
| 12 months | 72.9 (70.4 to 75.4) | 74.6 (72.2 to 77.1) | 71.5 (68.9 to 74.1) | |||||
| *P between groups = 0.032 | ||||||||
| Bekkering et al (44), 2005; cRCT; Netherlands | Single intervention G1: Active CPG dissemination (n=52) G2: Standard passive CPG dissemination (n=61) |
Practice; PTs; chronic LBP | Unit of analysis: Patient | Yes | ||||
| Physical functioning (Quebec Back Pain Disability Scale [(0 to 100 max]) (median score [IQR]) | ||||||||
| TOA | G1 (n=48) | G2 (n=59) | MD (95% CI) | |||||
| Baseline | 38 (26.5, 50.5) | 40.5 (26.3, 55.8) | ||||||
| 6 weeks | 24 (13, 40) | 17 (4.6, 32) | 1.9 (−1.4 to −5.3)* | |||||
| 12 weeks | 20 (7, 32.8) | 17 (4.6, 32) | 2.8 (−0.6 to 6.3) | |||||
| 26 weeks | 20 (7, 32.8) | 11 (4, 29) | 4 (0.6 to 7.3) | |||||
| 52 weeks | 17 (4.6, 32) | 11 (4, 29) | 3.5 (−0.2 to 7.3) | |||||
| *P=0.05; overall effect = 4.88 (P>0.05) | ||||||||
| Derebery et al (49), 2002; CCT; USA | Single intervention G1: Active evidence-based educational package (n=61) G2: Usual pasive training (n=151) |
Health provider; OPs; LBP | Unit of analysis: Patient | Unable to tell | ||||
| Patients’ restricted work duty (rate) | ||||||||
| TOA | G1 (n=NR) | G2 (n=NR) | ||||||
| 1 year | 66.3 | 85 | ||||||
| P between groups=NR | ||||||||
| Figueiras et al (45), 2001; cRCT; Spain | Single intervention G1: One-to-one education (n=98) G2: By-group education (n=98) |
Geographical area; GPs, FPs; chronic pain | Unit of analysis: Health provider | Yes | ||||
| Average prescribing behaviour improvement (prescription records review) (%) | ||||||||
| TOA | G1 (n=94) | G2 (n=59) | ||||||
| 9 months | 6.5* | 2.4 | ||||||
| P between groups <0.05* | ||||||||
| Geraud et al (38), 2009; RCT; France | Single intervention G1: E-learning education based on CPG (n=NR) G2: Live interactive workshop (n=NR) |
Health provider; GPs; migraine | Unit of analysis: Health provider | No | ||||
| Percentage of GP changing from a low or medium recommendation assimilation score (%; recommendation assimilation score [1 to 10]) | ||||||||
| TOA | G1 (n=198) | G2 (n=283) | ||||||
| 1 month | 13 | 38.5 | ||||||
| P between groups for equivalence test >0.0001 | ||||||||
| Harris et al (39), 2008; RCT; USA | Single intervention G1: Online CME pain program (n=49) G2: Live lectures (n=50) G3: Control lecture (n=55) |
Health provider; GPs, FPs; non-malignant chronic pain | Unit of analysis: Health provider | No | ||||
| Physicians’ knowledge about pain management (KnowPain-50 score) (mean ± SD) | ||||||||
| TOA | G1 (n=30) | G2 (n=32) | G3 (n=33) | |||||
| Baseline | 143.6±19.7 | 138.0±17.5 | 139.2±18.7 | |||||
| 3 months | 149.5±21.4 | 151.0±19.4 | 144.8±22.0 | |||||
| P between groups = 0.448 | ||||||||
| Jones et al (54), 1992; CBA; USA | Multifaceted intervention G1: Interactive educational program (n=88) G2: Usual care (n=87) |
Practice; nurses; chronic pain | Unit of analysis: Health provider | No | ||||
| Nurses’ knowledge about pain (36 knowledge items [true/false]) (% mean score) | ||||||||
| TOA | G1 (n=74) | G2 (n=75) | ||||||
| Baseline | 69 | 68 | ||||||
| NR | 71 | 67 | ||||||
| P between groups: NR | ||||||||
| Keijsers et al (40), 1992; RCT; Netherlands | Single intervention G1: Provision of written empirical evidence (n=103) G2: No intervention (n=100) |
Health provider; GPs, PTs; chronic LBP | Unit of analysis: Health provider | Yes | ||||
| Reduction in confidence in back schools (VAS scale [5% to 95%; maximum: very effective]) (baseline to end point mean change, %) | ||||||||
| TOA | G1 (n=82) | G2 (n=88) | ||||||
| 10 weeks | −10%* | 1.6% | ||||||
| *P between groups <0.05. | ||||||||
| Rahme et al (46), 2005; cRCT; Canada | Multifaceted intervention G1: Workshop and decision tree (n=84) G2: Workshop alone (n=29) G3: Decision tree alone (n=54) G4: No intervention (n=82) |
Town; GPs; osteoarthritis | Unit of analysis: Prescriptions | No | ||||
| Number of adequate prescriptions (prescription score) (%) | ||||||||
| TOA | G1 | G2 | G3 | G4 | ||||
| Baseline | 58 | 51 | 51 | 47 | ||||
| 5 months | 62 | 56 | 54 | 49 | ||||
| G1 versus G4 OR (95% CI): 1.9 (0.9 to 3.8); G2 versus G4 OR (95% CI): 5.7 (0.4 to 26.9); G3 versus G4 OR (95% CI): 1.0 (0.6 to 1.7) | ||||||||
| Smelt et al (47), 2010; cRCT; Netherlands | Single intervention G1: Proactive education intervention (n=NR) G2: Usual care (n=NR) |
Health provider; GPs; migraine | Unit of analysis: Patient | No | ||||
| Headache complaints (Headache Impact Test) (mean change score between groups) | ||||||||
| TOA | G1 (n=NR) | G2 (n=NR) | ||||||
| 6 months | 0.05 points | |||||||
| P between groups = 0.083 | ||||||||
| Smits et al (51), 2000; CCT; Netherlands | Single intervention G1: Posgraduate educational program based on CPG (n=25) G2: No intervention (n=20) |
Health provider; OPs; LBP | Unit of analysis: Health provider | Yes | ||||
| Percentage correct answers in knowledge test (45 true/false questions) (mean ±SD) | ||||||||
| TOA | G1 (n=18) | G2 (n=20) | MD (95% CI) | |||||
| Baseline | 70±11.7 | 67±10.4 | ||||||
| NR | 85±6.8 | 73±6.7 | 9 (95% CI 0.4 to 16)* | |||||
| *P between groups <0.05 | ||||||||
| Stevenson et al (48), 2006; cRCT; United Kingdom | Single intervention G1: Educational package (n=17) G2: Usual in-service training (n=13) | Practice; PTs; LBP | Unit of analysis: Health provider | No | ||||
| Change in clinical management | ||||||||
| Time spent providing advice about work situation (discharge summary questionnaire) (%) | ||||||||
| TOA | G1 (n=16) | G2 (n=11) | OR (95% CI) | |||||
| 6 months | 37% | 35% | 1.1 (0.05 to 2.5) | |||||
| Ferguson et al (53), 2010; CBA; Scotland | Single intervention G1: Quality improvement and audit (n=NR) G2: Pre-intervention period (n=NR) |
Practice; PTs; chronic LBP | Unit of analysis: Process measure | Unable to tell | ||||
| Case notes with LBP factor documented (%) (medical record audit) | ||||||||
| TOA | G1 (n=NR) | G2 (n=NR) | ||||||
| 7 months | 79 | 54 | ||||||
| P between groups = NR | ||||||||
| KT interventions targeting chronic noncancer pain patients | ||||||||
| Coudeyre et al (37), 2006; RCT; France | Single intervention G1: The Back Book (n=72) G2: Usual care (n=70) |
Patient; chronic LBP | Unit of analysis: Patient | Yes | ||||
| Functional capacity (Quebec Back Pain Disability Scale [0 to 100 max]) (mean ± SD) | ||||||||
| TOA | G1 (n=63) | G2 (n=62) | ||||||
| Baseline | 48.4±14.5 | 52.1±16.8 | ||||||
| 3 months | 34.5±18.4 | 42.4±14.9 | ||||||
| *P between groups = 0.03 | ||||||||
| Meng et al (41), 2011; RCT; Germany | Single intervention G1: Back school progam based on evidence and practice guidelines (n=197) G2: Usual care (Traditional back school program) (n=185) |
Patient; chronic LBP | Unit of analysis: Patient | Yes | ||||
| Patients’ LBP knowledge acquisition (mean effect size; rating scale [0 to 45]) | ||||||||
| TOA | G1 (n=181) | G2 (n=163) | ||||||
| 6 months | eta2=0.056* | |||||||
| 12 months | eta2=0.026* | |||||||
| *P between groups <0.001 | ||||||||
| Sciamanna et al (42), 2006; RCT; USA | Single intervention G1: Internet-based computer program (n=NR) G2: No intervention (n=NR) |
Patient; migraine | Unit of analysis: Clinical encounter | No | ||||
| Number of migraine-related topics discussed during the visit (single score from survey) (mean number) | ||||||||
| TOA | G1 (n=28) | G2 (n=22) | ||||||
| NR | 5.5 | 4.3 | ||||||
| P between groups = NR | ||||||||
| Rossignol et al (22), 2000; RCT;Canada | Multifaceted intervention G1: Coordination of primary care program (n=54) G2: Usual care (n=56) |
Patient; chronic LBP | Unit of analysis: Patient | No | ||||
| Return to work (medical record audit) (%) | ||||||||
| TOA | G1 (n=48) | G2 (n=48) | ||||||
| 6 months | 77.8 | 73.2 | ||||||
| P between groups = 0.1 | ||||||||
| Combined target groups | ||||||||
| Doubova et al (50), 2010; CCT; Mexico | Multifaceted intervention G1: Interactive educational programme (patients, n=282; health providers, n=58) G2: Passive educational programme (patients, n=291; health providers, n=58) |
Health provider; patients, FPs; nonmalignant pain syndrome | Unit of analysis: Health provider | Yes | ||||
| Proportion of appropriately prescribed NOAs (medical record audit) (% [95% CI]) | ||||||||
| TOA | G1 (n=58) | G2 (n=52) | ||||||
| Baseline | 65.2 (59.5 to 71.0) | 62 (56.1 to 67.9); | ||||||
| 6 months | 82.6 (78 to 87.2) | 68 (62.8 to 73.2) | ||||||
| MD between groups: 15.0 (95% CI 14.4 to 16.3)* | ||||||||
| Buchbinder et al (52), 2005; CBA; Australia | Multifaceted intervention G1: Victorian Work Cover Authority back campaign (patients, n=1185; health providers, n=691) G2: No intervention (patients, n=1185; health providers n=691) |
Geographical area; GPs; back pain | Unit of analysis: Patient | Yes | ||||
| Patients’ beliefs about back pain (Back Beliefs Questionnaire [9 to 45, more positive]) (mean score, 95% CI) | ||||||||
| TOA | G1 (n=900) | G2 (n=600) | MD (95% CI) | |||||
| Baseline | 26.5 (26.1 to 26.8) | 26.3 (25.9 to 26.6) | 0.2 (0.3 to −0.8)* | |||||
| Survey 2 | 28.4 (27.9 to 28.8) | 26.2 (25.7 to 26.7) | 2.1 (1.4 to 2.8)* | |||||
| Survey 3 | 29.7 (29.2 to 30.3) | 26.3 (25.7 to 26.8) | 3.5 (2.7 to 4.2)* | |||||
| 3 years | 28.8 (28.4 to 29.2) | 26.1 (25.5 to 26.6) | 2.7 (2.1 to 3.4)* | |||||
| *P between groups <0.05 | ||||||||
*
Statistically significant difference between groups. CBA Controlled before-and-after study; CCT Controlled clinical trial; CME Continuing medical education; CPG Clinical practice guideline; cRCT Cluster randomized controlled trial; G Group; GP General physician; FP Family physician; IQR Interquartile range; LBP Low-back pain; MD Mean difference; NOA Nonopioid analgesic; NR Not reported; OP Occupational physician; PT Physical therapist; RCT Randomized controlled trial; ref Reference; TOA Time of outcome assessment; VAS Visual analogue scale