A Cochrane review [Abstract] 1 included 28 studies; 16 studies were cluster RCTs, 6 were individual RCTs, 1 was a non-randomised controlled clinical trial (CCT) and 5 were interrupted time series (ITS) studies. Twenty three studies evaluated professional interventions alone, 2 studies evaluated organisational interventions alone, 2 studies evaluated a combination of professional and organisational interventions and one study evaluated a professional intervention in combination with an organisational and a financial intervention. Fifteen studies involved the management of osteoporosis, 6 studies the management of low back pain, 2 studies the management of low back pain and knee pain, and 5 studies involved the management of multiple conditions, including various musculoskeletal conditions.
To improve the use of imaging in the management of osteoporosis, the effect of any type of intervention compared to no-intervention controls was modest (absolute improvement in bone mineral density test ordering +10%, interquartile range IQR 0.0 to +27.7). Patient mediated, reminder, and organisational interventions appeared to have most potential for improving imaging use in osteoporosis. For low back pain studies, the most common intervention evaluated was distribution of educational materials and this showed varying effects. Other interventions in low back pain studies also showed variable effects. For other musculoskeletal conditions, distribution of educational materials, educational meetings and audit and feedback were not shown to be effective for changing imaging ordering behaviour. Across all conditions, increasing the number of intervention components did not increase effect.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment ) and by inconsistency (heterogeneity in interventions and outcomes).
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