Clinician Education Unlikely Effective for Guideline-adherent Medication Prescription in Low Back Pain: Systematic Review and Meta-analysis of RCTs

Overview

Journal EClinicalMedicine

Specialty General Medicine

Date 2022 Jan 14

PMID 35028542

Authors

Daniel L Belavy

Scott D Tagliaferri

Paul Buntine

Tobias Saueressig

Kate Sadler

Christy Ko

Clint T Miller

Patrick J Owen

Affiliations

Soon will be listed here.

Abstract

Background: Effectiveness of implementing interventions to optimise guideline-recommended medical prescription in low back pain is not well established.

Methods: A systematic review and random-effects meta-analyses for dichotomous outcomes with a Paule-Mandel estimator. Five databases and reference lists were searched from inception to 4 August 2021. Randomised controlled/clinical trials in adults with low back pain to optimise medication prescription were included. Cochrane Risk of Bias 2 tool and GRADE were implemented. The review was registered prospectively with PROSPERO (CRD42020219767).

Findings: Of 3352 unique records identified in the search, seven studies were included and five were eligible for meta-analysis (N=11339 participants). Six of seven studies incorporated clinician education, three studies included audit/feedback components and one study implemented changes in medical records systems. Via meta-analysis, we estimated a non-significant odds-ratio of 0·94 (95% CI (0·77; 1.16), I² = 0%; n=5 studies, GRADE: low) in favour of the intervention group. The main finding was robust to sensitivity analyses.

Interpretation: There is low quality evidence that existing interventions to optimise medication prescription or usage in back pain had no impact. Peer-to-peer education alone does not appear to lead to behaviour change. Organisational and policy interventions may be more effective.

Funding: This work was supported by internal institutional funding only.

Citing Articles

Understanding general practitioners' prescribing choices to patients with chronic low back pain: a discrete choice experiment.

Hamilton M, Lin C, Arora S, Harrison M, Tracy M, Nickel B Int J Clin Pharm. 2023; 46(1):111-121.

PMID: 37882955 PMC: 10831024. DOI: 10.1007/s11096-023-01649-y.

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