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Effectiveness of strategies for implementing guideline-concordant care in low back pain: a systematic review and meta-analysis of randomised controlled trials

Sat, 01 Nov 2025 00:00:00 GMT

Title: Effectiveness of strategies for implementing guideline-concordant care in low back pain: a systematic review and meta-analysis of randomised controlled trials Authors: Zhao, S.; Langford, A. V.; Chen, Q.; Lyu, M.; Yang, Z.; French, S. D.; Williams, C. M.; Lin, C-W. C. Abstract: Background: International low back pain guidelines recommend providing education/advice to patients, discouraging routine imaging use, and encouraging judicious prescribing of analgesics. However, practice variation occurs and the effectiveness of implementation strategies to promote guideline-concordant care is unclear. This review aims to comprehensively evaluate the effectiveness of implementation strategies to promote guideline-concordant care for low back pain. Methods: Five databases (including MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL) and Physiotherapy Evidence Database (PEDro) were searched from inception until 22nd August 2024. Randomised controlled trials (RCTs) that evaluated strategies to promote guideline-concordant care (providing education/advice, discouraging routine imaging use, and/or reducing analgesic use) among healthcare professionals or organisations were included. Two reviewers independently conducted screening, data extraction, and risk of bias assessments. The primary outcome was guideline-concordant care in the medium-term (>3 months but <12 months), measured by the rate of patients receiving such care. The taxonomy recommended by the Cochrane Effective Practice and Organisation of Care (EPOC) group was used to categorise implementation strategies. Meta-analysis with a random effects model was conducted where possible. This systematic review was prospectively registered in PROSPERO (registration number: CRD42023452969). Findings: Twenty-seven RCTs with 32 reports were included. All strategies targeted healthcare professionals (7796 health professionals overseeing 34,890 patients with low back pain), and none targeted organisations. The most commonly used implementation strategies were educational materials (15/27) and educational meetings (14/27), although most studies (24/27) used more than one strategy ('multifaceted strategies'). In the medium-term, compared to no implementation, implementation strategies probably reduced analgesic use (number of studies [N] = 4, odds ratio [OR] = 1.21, 95% confidence interval [CI]: 1.05-1.40, I 2 = 0%, moderate certainty evidence), but probably made little to no difference in reducing the use of routine imaging (N = 5, OR = 1.16, 95% CI: 0.95-1.41, I 2 = 41%, moderate certainty evidence). Further, implementation strategies may make little to no difference in improving the rate of providing education/advice (N = 3, OR = 2.40, 95% CI: 0.89-6.49, I 2 = 95%, low certainty evidence). However, this should be interpreted with caution as the sensitivity analysis indicated a positive effect, albeit with low certainty evidence, suggesting that the results are unstable and may change with future research (N = 2, OR = 3.59, 95% CI: 1.68-7.69, I 2 = 75%). There was insufficient evidence to indicate one implementation strategy was superior to another in the medium-term. Interpretation: Implementing guideline recommendations delivered mixed effects in promoting guideline-concordant care for low back pain management. Further research is needed to establish the effectiveness of implementation strategies for specific guideline-concordant care practices in low back pain.

Retraction notice to "Effectiveness of strategies for implementing guideline-concordant care in low back pain: a systematic review and meta-analysis of randomised controlled trials" [eClinicalMedicine 78 (2024) 102916]

Sat, 01 Nov 2025 00:00:00 GMT

Title: Retraction notice to "Effectiveness of strategies for implementing guideline-concordant care in low back pain: a systematic review and meta-analysis of randomised controlled trials" [eClinicalMedicine 78 (2024) 102916] Authors: Zhao, S.; Langford, A. V.; Chen, Q.; Lyu, M.; Yang, Z.; French, S. D.; Williams, C. M.; Lin, C-W. Abstract: Retraction notice.

Does routine estimated glomerular filtration rate reporting adversely affect medication dosing in an older population?

Thu, 01 Jan 2026 00:00:00 GMT

Title: Does routine estimated glomerular filtration rate reporting adversely affect medication dosing in an older population? Authors: Davis, G.; Smyth, B.; Kinchington, M.; Brown, M. Abstract: Historically, Cockcroft-Gault (CG) estimated creatinine clearance (eCrCl) was recommended for drug dosing in the presence of kidney disease, but standard pathology reports only include estimated glomerular filtration rate (eGFR). This single-centre retrospective cohort study of 162 patients ≥65 years old examined whether drug dosing errors occurred more commonly when using eGFR versus eCrCl. Of just over 200 medications requiring dose adjustment for GFR, one in eight had a potential prescribing error regardless of the method of estimating GFR. Use of CKD-EPI eGFR rather than CG eCrCl explained only a minority of potential prescribing errors, with no observed clinical consequences.

The Long-Term Impact of Delirium: An Integrative Review of Patient Experiences

Wed, 22 Oct 2025 00:00:00 GMT

Title: The Long-Term Impact of Delirium: An Integrative Review of Patient Experiences Authors: Steffen, J.; Aggar, C.; Hutchinson, C. Abstract: Objectives This integrative review explores patients' recall of delirium post-discharge and synthesises existing research on the long-term impact of delirium from the patients' perspective. The findings will inform post-discharge strategies, offering healthcare professionals valuable insights to support patient recovery. Methods An integrative review of the literature was utilised following the Whittemore and Knafl methodology. Six electronic databases were searched to identify relevant studies. Studies that met inclusion criteria were appraised using the Mixed Methods Appraisal Tool (MMAT) and then analysed using thematic analysis to identify key themes across all articles. The PRISMA checklist was used to evaluate the current research. Results Fifteen studies were included in the review. Following thematic analysis, two primary themes emerged: (1) Emotional and psychological burden, including anxiety, flashbacks, vivid hallucinations, and chronic sleep disturbances, and (2) Memories of care and connection, emphasising the role of healthcare professionals and social support in recovery. Patients reported feelings of shame, guilt and embarrassment related to delirium-associated memories, particularly their interactions with staff and loved ones. The attitudes and communication styles of healthcare professionals significantly influenced participants' outcomes, with supportive and empathetic care alleviating distress. Family, friends and fellow patients played a crucial role in reassuring participants and reducing feelings of isolation. Conclusions Effective post-discharge strategies are essential to support patients' long-term recovery and minimise the lasting impact of delirium. Future research should focus on developing interventions to support patients during the post-discharge phase of their delirium.