Effectiveness of Implementation Interventions in Musculoskeletal Healthcare: A Systematic Review

BackgroundImplementing new knowledge into clinical practice is a challenge, but nonetheless crucial to improve our healthcare system related to the management of musculoskeletal pain. This systematic review aimed to assess the effectiveness of implementation interventions within musculoskeletal healthcare. MethodsWe searched Medline, Embase, Cochrane Central Register of Controlled Trials, and Scopus. Any type of randomised controlled trials investigating implementation strategies or interventions in relation to musculoskeletal pain conditions were included. Risk of bias were assessed using the Cochrane Risk of Bias 2 tool. Data analysis was done using frameworks from Powell et al. 2015, and Waltz et al. 2015 and outcomes were identified by Thompson et al. 2022 or self-made outcome domains were established. ResultsThe literature search yielded 14,265 original studies, of which 38 studies from 31 trials, with 13,203 participating healthcare professionals and 30,320 participating patients were included in the final synthesis. Nineteen studies had a high risk of bias, sixteen had a moderate risk of bias, and three had a low risk of bias. Twenty distinct implementation interventions were identified. A significant heterogeneity in the utilised outcome measurements was observed, thereby rendering a meta-analysis infeasible; consequently, all outcomes were classified into six outcome domains for healthcare professionals, seven for patients and one for cost-effectiveness. ConclusionsOur findings suggest that some implementation interventions may have a tendency towards a statistically significant positive effect in favour of the intervention group on the outcome domain "Adherence to the implemented interventions" for healthcare professionals in the included studies. The remaining outcome domains yielded varying results; therefore, these findings should be interpreted with caution. Future high-quality trials with clear reporting and rationale of implementation strategies and interventions utilising standardised nomenclature are needed to further advance our understanding of this area. Trial registrationOpen Science Framework, DOI: 10.17605/OSF.IO/SRMP2