Background/Purpose: Despite the development of care models and practice guidelines the translation of knee osteoarthritis guidelines to practice remains suboptimal. Theoretically informed implementation strategies may facilitate the translation of guidelines to practice however their selection and use present challenges for clinicians and health systems aiming to improve patient quality of care for patients with knee osteoarthritis. Therefore, the purpose of this systematic review was to describe the use of implementation strategies to promote knee osteoarthritis guideline recommendations and evaluate their impact on guideline adherent care and patient-reported outcomes.

Methods: An electronic search was performed using MEDLINE (via PubMed), Embase (Elsevier), CINAHL(EBSCO), and Web of Science (Clarivate) databases to identify studies that included the use implementation strategies to improve knee osteoarthritis guideline recommendations and or patient reported outcomes. Implementation strategies were categorized based on the nine implementation domains and 73 implementation strategies as described by the Expert Recommendations for Implementing change (ERIC) taxonomy. Risk of bias was assessed using the Cochrane Effective Practice and Organization of Care(EPOC) criteria.

Results: Twenty-one studies were included in the final review. Eight implementation domains and 36 implementation strategies were represented within the twenty one studies with six strategies represented in ten or more studies. Seventy-one percent of implementation interventions were theoretical informed with an average of ten strategies used per study. “Develop educational materials”, “Conduct educational meetings”, “Make training dynamic”, “Distribute educational material” and “Prepare patients/consumers to be active participants” were the top represented strategies. “Utilize financial strategies” and “Provide interactive assistance” domains were the least represented of the included studies. Eight implementation domains demonstrated a positive effect on clinician adherence to knee osteoarthritis guidelines, quality of life(3 domains), disability(8 domains), and reduction of pain intensity(3 domains). “Train and educate stakeholders” and “Engage consumers” had positive effects on both clinician adherence to guidelines and patient reported outcomes. The majority of studies had a low to moderate risk of bias.

Conclusion: This review highlights the use of strategies to improve the quality of care and outcomes for patients with knee osteoarthritis. The findings suggests that using multifaceted implementation strategies appear to be effective for improving knee osteoarthritis clinical practice guideline adherence and patient-reported outcomes. The findings also suggest only 50% of the 73 strategies recommended by the ERIC taxonomy have been used in improving guideline adherence and outcomes in the context of knee osteoarthritis care management, demonstrating a need for further research. In general, the use of implementation strategies in the context of knee osteoarthritis management, may guide future initiatives to improve quality of care and patient outcomes.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/use-of-implementation-strategies-to-promote-adherence-of-knee-osteoarthritis-guidelines-and-improve-patient-outcomes-a-systematic-review/