Table 1 Characteristics and results of included systematic reviews

Educational strategies

Grudniewicz A. et al. What is the effectiveness of printed educational materials on primary care physician knowledge, behaviour, and patient outcomes: a systematic review and meta-analyses (2015)

7

40

Setting: High income countries (HIC)

Effectiveness: No significant effect was found on clinically important patient outcomes, physician behaviour, or physician cognition when printed educational materials (PEMs) were compared to usual care.

Target population: primary care physicians (PCPs)

Scope of impact: PEMs were not effective at improving patient outcomes, knowledge, or behaviour of PCPs.

Quality of individual studies: The reported quality of evidence ranged from low to high and many studies were unclear on important methodological factors. Using the Cochrane Effective Practice and Organization of Care (EPOC) risk of bias assessment tool, 33 Randomised Controlled Trials (RCTs) had unclear or high risk of bias for at least two criteria. Two RCTs were appraised as low risk of bias on eight of nine criteria, and only two RCTs were appraised as having low risk of bias on all nine criteria. The ITS studies had at least two unclear risk of bias out of seven criteria.

Educational strategies

Koota E., Kääriäinen M. & Melender H-L. Educational interventions promoting evidence-based practice among emergency nurses: A systematic review (2018)

7

10

Setting: unclear/not specified

Effectiveness: Interventions involving face-to-face contact led to significant or highly significant effects on patient benefits and emergency nurses’ knowledge, skills, and behavior. Interventions using written self-directed learning material led to significant improvements in nurses’ knowledge of evidence based practice (EBP).

Target population: emergency nurses

Scope of impact: Most of the studied interventions had promising effects on emergency nurses’ EBP. The review primarily included small studies with low response rates, and many of them relied on self-assessed outcomes. The strength of the evidence for these outcomes is modest.

Quality of individual studies: Three of the ten original studies were considered to be of excellent quality.

Educational strategies

Wu Y. et al. Do educational interventions aimed at nurses to support the implementation of evidence-based practice improve patient outcomes? A systematic review (2018)

7

18

Setting: HIC

Effectiveness: Although based on evaluation projects and qualitative data, the results suggest that positive changes on patient outcomes can be made following the implementation of specific evidence-based approaches (or projects). Four studies stated that conducting EBP projects in clinical practice improved patient outcomes but did not report specific details. Furthermore, one study reported mixed results regarding patient outcomes.

Target population: nurses

Scope of impact: This review provided evidence that conducting EBP educational interventions on nurses in clinical practice can have a positive impact on patient outcomes, which can demonstrate the usefulness and importance of such programmes.

Quality of individual studies: The quality of the 18 studies was assessed using the HCPRDU (Health Care Practice R&D Unit) evaluation tools and the scoring system developed for the purpose of this review. Five of the studies were assessed as excellent, seven studies could be classified as having some limitations, and six as having many limitations.

Local opinion leaders

Flodgren G. et al. Local opinion leaders: effects on professional practice and healthcare outcomes (2019)

7

24

Setting: HIC

Effectiveness: Local opinion leaders alone, or in combination with other interventions, can be effective in promoting evidence‐based practice, but the effectiveness varies both within and between studies. The effect on patient outcomes is uncertain. The review found that, overall, any intervention involving opinion leaders (OLs) probably improves healthcare professionals' compliance with evidence-based practice. The effect, however, varies within and across studies.

Target population: health care professionals

Scope of impact: The use of OLs probably improves the ability of healthcare professionals to follow evidence-based guidelines, but we do not know if patient outcomes are improved.

Quality of individual studies: All included studies were randomised and were initially considered to have a high certainty of evidence (before assessment of quality). The certainty of evidence for the main outcome (compliance with evidence-based practice) was downgraded from high to moderate certainty of evidence due to high risk of bias.

Reminders

Arditi C. et al. Computer-generated reminders delivered on paper to healthcare professionals: effects on professional practice and healthcare outcomes (2017)

7

34

Setting: HIC/low and middle income countries (LMIC)

Effectiveness: There is moderate-certainty evidence that computer-generated reminders delivered on paper to healthcare professionals probably slightly improves quality of care, in terms of compliance with preventive guidelines and compliance with disease management guidelines. It is uncertain whether reminders improve patient outcomes because the certainty of the evidence is very low. The heterogeneity of the reminder interventions included in this review also suggests that reminders can probably improve quality of care in various settings under various conditions. The authors are uncertain whether reminders, alone or in addition to co-intervention(s), improve patient outcomes as the certainty of the evidence is very low.

Target population: healthcare professionals

Scope of impact: Providing reminders to doctors probably improves slightly the quality of care patients receive. However, because the certainty of the evidence is moderate, more high-quality studies on the effectiveness of reminders are needed to confirm to findings of this review.

Quality of individual studies: The quality of the studies was fairly low. One reason for the low quality of studies was that reporting of earlier studies was very poor, thus making it difficult to assess whether appropriate measures were taken to reduce bias.

Reminders

Pantoja T. et al. Manually-generated reminders delivered on paper: effects on professional practice and patient outcomes (2019)

7

63

Setting: HIC/LMIC

Effectiveness: Manually-generated reminders delivered on paper as a single intervention probably lead from small to moderate increases in outcomes related to adherence to clinical recommendations, and they could be used as a single quality improvement (QI) intervention.

Target population: health care professionals

Scope of impact: Forty-eight studies reported changes in professional practice measured as dichotomous process adherence outcomes (e.g., compliance with guidelines recommendations), 16 reported those changes measured as continuous process-of-care outcomes (e.g., number of days with catheters), eight reported dichotomous patient outcomes (e.g., mortality rates) and five reported continuous patient outcomes (e.g., mean systolic blood pressure).

Quality of individual studies: Only one study was judged to be at high risk of reporting bias, with 41 studies assessed as low risk. The remaining 21 Studies were rated at unclear risk of selective reporting.

ICT focused approaches

De Angelis G. et al. Information and communication technologies for the dissemination of clinical practice guidelines to health professionals: a systematic review (2016)

6

21

Setting: unclear/not specified

Effectiveness: Website studies demonstrated significant improvements in perceived usefulness and perceived ease of use, but not for knowledge, reducing barriers, and intention to use clinical practice guidelines. Computer software studies demonstrated significant improvements in perceived usefulness, but not for knowledge and skills. Web-based workshop and email studies demonstrated significant improvements in knowledge, perceived usefulness, and skills. An electronic educational game intervention demonstrated a significant improvement from baseline in knowledge after 12 and 24 weeks. Computerized decision support system studies demonstrated variable findings for improvement in skills. Multifaceted interventions demonstrated significant improvements in beliefs about capabilities, perceived usefulness, and intention to use clinical practice guidelines, but variable findings for improvements in skills.

Target population: health professionals (eg, physicians including medical residents, nurses, and physiotherapists)

Scope of impact: While the evidence is limited, studies of information and communication technologies (ICTs) included in this review have shown promising findings. ICTs are novel ways of disseminating clinical practice guidelines (CPGs), compared with more traditional methods. This review highlights which ICTs have been successfully used as a dissemination strategy for CPGs; however, it remains unclear whether one ICT is more effective than another. It is also unclear whether other ICTs not captured in this review, such as social media, can be used as effective dissemination strategies for CPGs.

Quality of individual studies: The overall methodological quality of included studies was strong for the website studies, while it was uncertain for the electronic education game, email, and multifaceted studies.

ICT focused approaches

Brown A. et al. Effectiveness of technology-enabled knowledge translation strategies in improving the use of research in public health: systematic review (2020)

7

8

Setting: HIC

Effectiveness: Digital technology-enabled knowledge translation (TEKT) interventions may be effective at improving public health professionals’ knowledge, and may be as effective at improving knowledge as a face-to-face knowledge translation (KT) approach. The findings suggest that although a digital TEKT intervention may improve knowledge, the effects of such interventions on other outcomes are equivocal.

Target population: health professionals, including nurses, child care health consultants, physiotherapists, primary health care workers, and public health practitioners

Scope of impact: The effectiveness of digital TEKT strategies relative to control or other KT interventions for self-efficacy or behavioral intention outcomes and changes to health policy or practice were mixed. Such findings offer little guidance for those interested in utilizing digital TEKT strategies to promote the transfer of knowledge to improve public health and demonstrate a considerable need for further research in this field.

Quality of individual studies: Of the 8 studies, 7 were assessed as having an overall high risk of bias. All 8 studies were classified as having some concerns in relation to the selection of the reported results.

ICT focused approaches

Jamal A., McKenzie K. & Clark M. The impact of health information technology on the quality of medical and health care: a systematic review (2009)

3

23

Setting: HIC

Effectiveness: A positive improvement, in relation to their compliance with evidence-based guidelines, was seen in 14 studies. Studies that included an assessment of patient outcomes, however, showed insufficient evidence of either clinically or statistically important improvements

Target population: clinicians

Scope of impact: In the current review, 14 out of 17 studies that assessed the impact of health information technology (HIT)/health information systems (HIS) on health care practitioners’ performance, revealed a positive improvement in relation to their compliance with evidence-based guidelines. The impact of HIS/HIT on the patient’s outcomes however inconsistent as only a small proportion of studies found benefits.

Quality of individual studies: Owing to the fact that these study designs are prone to bias, the studies’ methodological quality was assessed with caution. For this purpose, a standardised quality assessment checklist for non-randomised studies was used, obtained from the Joanna-Briggs Institute. Therefore, only studies that met the minimum criteria as outlined in the quality assessment checklist were included for final review.

Audit & feedback

Sykes M.J., McAnuff J. & Kolehmainen N. When is audit and feedback effective in dementia care? A systematic review (2018)

4

13

Setting: unclear/not specified

Effectiveness: Included studies demonstrated large variation in the effectiveness of audit and feedback.

Target population: health professionals

Scope of impact: All studies sought change in structures and processes; however, only one also sought change in outcome.

Quality of individual studies: Methodological and reporting limitations in the included studies hinder the ability to draw strong conclusions on the effectiveness of audit and feedback in dementia care.

Non-EPOC listed strategies: Social media

Bhatt N.R. et al. A systematic review of the use of social media for dissemination of clinical practice guidelines (2021)

7

5

Setting: HIC

Effectiveness: The development of CPGs was driven by the principles of evidenced-based medicine, and that social media has the potential to improve CPGs dissemination. The papers shows that social media impact on CPG dissemination, knowledge and implementation. Methods of dissemination were highly variable. Two studies reported statistically significant improvement in knowledge, awareness, compliance, and positive behavior with respect to CPGs.

Target population: clinicians

Scope of impact: The qualitative synthesis of the data and outcomes reported revealed a significant improvement in knowledge, aware- ness, compliance, and positive behavior with respect to CPGs with the use of social media dissemination compared with traditional methods of dissemination.

Quality of individual studies: Overall, the studies were of average quality, considering the limitation of the lack of a comparison arm.

Non-EPOC listed strategies: Toolkits

Yamada J. et al. The effectiveness of toolkits as knowledge translation strategies for integrating evidence into clinical care: a systematic review (2015)

7

39

Setting: unclear/not specified

Effectiveness: Toolkits, either alone or as part of a multi-strategy intervention, hold promise as an effective approach for facilitating evidence use in practice and improving outcomes across a variety of disease states and healthcare settings. Six of the eight toolkits were partially or mostly effective in changing clinical outcomes and six studies reported on implementation outcomes. The types of resources embedded within toolkits varied but included predominantly educational materials.

Target population: healthcare providers

Scope of impact: There was significant variation in the combination and type of KT strategies contained within the toolkits, a range of diseases for which they were developed, and a variety of intended knowledge users (e.g., health professionals or patients/caregivers), all of which contributed to key knowledge gaps.

Quality of individual studies: The majority of studies (n=26) were rated as methodologically weak on the EPHPP tool (i.e., in terms of study design, selection bias, confounders, blinding, data collection methods and withdrawals and drop-outs); with 8 studies rated as moderate; and 5 as strong.

Multi-faceted Interventions (MFIs)

Afari-Asiedu S. et al. Interventions to improve dispensing of antibiotics at the community level in low and middle income countries: a systematic review (2022)

6

13

Setting: LMICs

Effectiveness: Educational meetings were the most frequently applied interventions and were effective in improving appropriate antibiotics dispensing. No evidence suggesting that multiple interventions were more effective than single interventions.

Target population: community health posts (CHPs), over-the-counter medicine sellers (OTCMSs) and community pharmacies

Scope of impact: All studies reported positive effects following interventions to improve dispensing of medicines including antibiotics at the community level. Both providers and patient outcomes reported.

Quality of individual studies: Trials/studies were generally rated as good quality and largely reported low risk of bias. Some observational studies were rated as poor-quality studies with high risk of bias.

Multi-faceted Interventions (MFIs)

Boonacker C.W.B. et al. Interventions in health care professionals to improve treatment in children with upper respiratory tract infections (2010)

6

10

Setting: unclear/not specified

Effectiveness: All strategies used (i.e., computer interventions, educational sessions with or without education materials, collaborative development of guidelines and a training video in combination with a risk factor checklist) were effective in changing health care professionals practice regarding children with URTIs. Multifaceted and computer strategies work best.

Target population: health care professionals’ behavior in the management of children with upper respiratory tract infections (URTIs).

Scope of impact: Most strategies were aimed at changing antibiotic prescribing behavior in children with acute otitis media.

Quality of individual studies: 17% of the quality criteria were judged as unclear since many studies provided not enough information to judge the risk of bias as no risk or high risk. Contamination may have played a role in three studies, which may have caused an underestimation of the effect of the interventions.

Multi-faceted Interventions (MFIs)

Al Zoubi F.M. et al. The effectiveness of interventions designed to increase the uptake of clinical practice guidelines and best practices among musculoskeletal professionals: a systematic review (2018)

7

11

Setting: HIC

Effectiveness: Findings suggest that for professional outcomes, single-component KT interventions are more effective than no intervention, and multifaceted interventions are more effective than single-component interventions. Single-component KT interventions such as interactive educational meetings and educational materials were found to have a small effect on enhancing professional adherence to clinical practice guidelines. Some studies that assessed multifaceted interventions reported mixed results.

Target population: musculoskeletal professionals

Scope of impact: The findings suggested that multifaceted educational KT interventions appear to be effective for improving professional outcomes, although effects were inconsistent. The KT strategies were generally not effective on patient outcomes.

Quality of individual studies: The majority of the included studies were considered to have moderate-to-high risk of bias. In general, studies were of low quality.

Multi-faceted Interventions (MFIs)

Ariyo P. et al. Implementation strategies to reduce surgical site infections: a systematic review (2019)

5

8

Setting: LMIC

Effectiveness: Multifaceted implementation strategies represent the most common approach to facilitating the adoption of evidence-based practices.

Target population: health professionals

Scope of impact: Implementation strategies to improve adherence with evidence-based SSI-prevention interventions.

Quality of individual studies: Study quality was appraised

with the EPOC criteria. Only 8 studies met the EPOC criteria of an acceptable-quality study design.

Multi-faceted Interventions (MFIs)

Borgert M.J., Goossens A. & Dongelmans D.A. What are effective strategies for the implementation of care bundles on ICUs: a systematic review (2015)

7

47

Setting: unclear/not specified

Effectiveness: The three most frequently used strategies were education, reminders and audit and feedback. The authors could not identify the most effective implementation strategy that resulted in the highest levels of compliance.

Target population: health providers in adult intensive care

Scope of impact: Care bundles have already proven to be effective in reducing negative clinical outcomes. It is important to mention that the authors focused on finding the best implementation strategy to achieve high levels of bundle compliance and not on the outcome of care processes.

Quality of individual studies: 77% of the studies scored between 15 and 19 points on the Downs and Black quality assessment scale and were classified as fair. 13% of the studies scored 20 points or more and were classified as good. 11% of the studies were classified as poor. The authors assessed reporting bias of the included studies, and no studies were found reporting negative results.

Multi-faceted Interventions (MFIs)

Cahill L. et al. Implementation interventions to promote the uptake of evidence- based practices in stroke rehabilitation (Review) (2020)

7

9

Setting: HIC

Effectiveness: The authors could not obtain a reliable estimate of the effect of stroke rehabilitation implementation interventions on healthcare professional adherence to evidence-based practice compared with no intervention as the certainty of the evidence is very low.

Target population: healthcare professionals in stroke rehabilitation

Scope of impact: Main outcomes were healthcare professional adherence to recommended treatment, patient adherence to recommended treatment, patient health status and well-being, healthcare professional intention and satisfaction, resource use outcomes and adverse effects.

Quality of individual studies: The certainty of the evidence was considered very low.

Multi-faceted Interventions (MFIs)

Pedersen E.R. et al. Elusive search for effective provider interventions: a systematic review of provider interventions to increase adherence to evidence-based treatment for depression (2018)

7

22

Setting: unclear/not specified

Effectiveness: Findings provide little support for the effectiveness of currently tested provider education or dissemination interventions on provider adherence to depression treatment guidelines; however, there was some evidence that provider interventions improved the outcomes of medication prescribing and patient depression treatment response. Results also suggested that some interventions that were tailored to providers’ needs and that went beyond simply distributing guidelines to providers may improve provider behavior and promote guideline adherence.

Target population: healthcare providers responsible for patient care in the outpatient setting

Scope of impact: Results were heterogeneous and analyses comparing provider interventions with usual clinical practice did not indicate a statistically significant difference in guideline adherence across studies. There was some evidence that provider interventions improved individual outcomes such as medication prescribing and indirect comparisons indicated more complex provider interventions may be associated with more favorable outcomes.

Quality of individual studies: The methodological rigor of the included studies was variable; however, all studies were rated high risk of performance bias related to the lack of blinding of intervention providers.

Multi-faceted Interventions (MFIs)

Jenkins H.J. et al. Effectiveness of interventions designed to reduce the use of imaging for low-back pain: a systematic review (2015)

6

7

Setting: unclear/not specified

Effectiveness: Clinical decision support in a hospital setting and targeted reminders to pri­mary care doctors were effective interventions in reducing the use of imaging for low-back pain.

Target population: healthcare professionals

Scope of impact: Clinical decision support involving a modified referral form in a hospital setting and targeted reminders to primary care doctors of appropriate indications for imaging were interventions that significantly decreased the use of imaging for low-back pain by 36.8% and 22.5%, respectively. These strategies are potentially low-cost interventions that would substantially decrease medical expenditures associated with the management of low-back pain.

Quality of individual studies: All of the RCTs reported using adequate randomization and allocation procedures and objective outcome measures. However, they were unable to blind the practitioners involved in the study.

Multi-faceted Interventions (MFIs)

Bennett S. et al. Implementation of evidence-based, non-pharmacological interventions addressing behavior and psychological symptoms of dementia: a systematic review focused on implementation strategies (2021)

6

12

Setting: HIC

Effectiveness: Multiple implementation strategies to increase the use of nonpharmacological interventions have demonstrated clinical improvements when provided by clinicians as part of their everyday work routines.

Target population: health professionals/care staff

Scope of impact: One of the key messages from this review is that implementation studies were able to demonstrate clinical improvements, despite substantial changes to original clinical interventions introduced to accommodate the constraints of clinical practice. Seven implementation studies reported positive (small, beneficial effects) outcomes for clients on some aspect of behavior or depression for the person with dementia. The majority of studies also reported some improvement in carers’ ability to respond to behavioral and psychological symptoms of dementia. However, this review did not set out to identify studies implementing interventions that had focused on carer outcomes.

Quality of individual studies: Overall, methods and results were clearly reported.

Multi-faceted Interventions (MFIs)

Noonan V.K. et al. Knowledge translation and implementation in spinal cord injury: a systematic review (2014)

7

13

Setting: HIC

Effectiveness: All studies used multiple implementation drivers. KT interventions included developing and implementing patient care protocols, providing clinician education and incorporating outcome measures into clinical practice. The methods (or drivers) to facilitate the implementation included organizing training sessions for clinical staff, introducing computerized reminders and involving organizational leaders.

Target population: clinicians

Scope of impact: There is some evidence that KT interventions may change clinician behavior and improve patient outcomes. 3 studies reported significant behavior change. Out of the 10 studies, 6 evaluated the effect of the implementation on patient outcomes using statistical analyses, with 4 reporting significant improvements.

Quality of individual studies: The majority of the articles were considered to be poor, suggesting the need for more rigorous study methodology.

Multi-faceted Interventions (MFIs)

Yost J. et al. The effectiveness of knowledge translation interventions for promoting evidence-informed decision-making among nurses in tertiary care: a systematic review and meta-analysis (2015)

7

30

Setting: HIC

Effectiveness: Recommendations cannot be drawn about the relative effectiveness of single or multifaceted KT interventions or components of these interventions. No studies evaluated the impact on knowledge and skills; they primarily investigated the effectiveness of multifaceted KT strategies for promoting evidence informed decision-making (EIDM) behaviours and improving client outcomes. Almost all studies included an educational component. A meta-analysis of two studies determined that a multifaceted intervention (educational meetings and use of a mentor) did not increase engagement in a range of EIDM behaviours. Among the remaining studies, no definitive conclusions could be made about the relative effectiveness of the KT interventions due to variation of interventions and outcomes, as well as study limitations.

Target population: nurses

Scope of impact: KT interventions are being implemented and evaluated on nurses’ behaviour and client outcomes. Implementing single-component educational interventions and multifaceted interventions with an educational component appear to have value for promoting nurses’ EIDM behaviours, while multifaceted interventions with an educational component were shown to contribute to improvements in client outcomes.

Quality of individual studies: Most studies reporting quantitative data were at high risk of bias. Criteria judged across studies to be high risk of bias were primarily blinding of participants/personnel and other bias. Overall, the quality of the evidence ranged from very low to high. Most studies reporting qualitative information met the quality criteria.

Multi-faceted Interventions (MFIs)

Albreacht L. et al. Systematic review of knowledge translation strategies to promote research uptake in child health settings (2016)

7

21

Setting: HIC

Effectiveness: More than half of the included studies displayed mixed effects on primary outcome measures. Of the studies with moderate to strong methodological quality ratings, three demonstrated consistent, positive effect(s) on the primary outcome(s); effective knowledge translation interventions were two single, non-educational interventions and one multiple, educational intervention.

Target population: health professional groups and settings

Scope of impact: Of the 21 included studies, the primary outcomes were professional/process outcomes (n = 14), patient outcomes (n = 1), and economic outcomes (n = 2). One study identified both professional/process and patient outcomes as primary outcomes and three studies did not clearly identify the primary outcome from multiple outcomes identified and measured.

Quality of individual studies: The methodological quality of the included studies was largely moderate (n = 8) or weak (n = 11). Both studies rated as strong were RCTs. Six RCTs and two controlled before-after studies (CBAs) were rated as moderate. Five RCTs, two controlled clinical trials (CCTs), and four CBAs were classified as weak.

Multi-faceted Interventions (MFIs)

Scott D. et al. Systematic review of knowledge translation strategies in the allied health professions (2012)

7

32

Setting: HIC

Effectiveness: Education was the main approach for KT interventions. In the majority of studies, the interventions demonstrated mixed effects on primary outcomes, and only four studies demonstrated statistically significant, positive effects on primary outcomes.

Target population: allied health professions

Scope of impact: The majority of primary outcomes were identified as professional/process outcomes (n = 25), but impact was limited. Patient outcomes (n = 4), economic outcomes (n = 2), and multiple primary outcomes (n = 1) were also represented.

Quality of individual studies: Generally, the studies were of low methodological quality.

Multi-faceted Interventions (MFIs)

Campbell A. et al. Knowledge translation strategies used by healthcare professionals in child health settings: an updated systematic review (2019)

7

48

Setting: HIC

Effectiveness: Effective KT strategies used by health care professionals in child health settings were found to be online education curriculums and computerized decision supports or reminders. Findings of the review in conjunction with other knowledge syntheses examining multi versus single component KT interventions indicate that single KT interventions may be as effective or more effective than multicomponent interventions.

Target population: health care professionals

Scope of impact: The most common primary outcomes were healthcare professional/process outcomes (n=32). Seven studies reported patient outcomes as the primary outcome and one study reported economic. Four studies reported healthcare professional/process and patient outcomes both as primary outcomes, one study reported healthcare professional/process, patient and economic outcomes as primary outcomes and three study's primary outcomes were unclear.

Quality of individual studies: The methodological quality of studies was moderate (n=18), strong (n=16) and weak(n=14).

Multi-faceted Interventions (MFIs)

Bird M.L. et al. Moving stroke rehabilitation evidence into practice: a systematic review of randomized controlled trials (2019)

7

17

Setting: unclear/not specified

Effectiveness: Multicomponent multidisciplinary interventions that include site facilitation and consideration of local settings can change clinical practice. Also, education and training interventions should form part of multi-component interventions and not be used in isolation. Education is commonly used, but in isolation is not effective. Multicomponent interventions including facilitation and tailoring to local settings can change clinical practice and are more effective when targeting fewer changes.

Target population: clinicians

Scope of impact: Implementing a small number of practice changes at a time produces more effective results.

Quality of individual studies: Risk of bias was generally low. Overall, the GRADE (Grading of Recommendations assessment, Development and Evaluation) criteria indicated that this body of literature was of low quality.

Multi-faceted Interventions (MFIs)

Goorts K., Dizon J. & Milanese S. The effectiveness of implementation strategies for promoting evidence informed interventions in allied healthcare: a systematic review (2021)

7

6

Setting: HIC

Effectiveness: The review found moderate evidence for educational meetings, local opinion leaders and patient mediated interventions. The authors found stronger evidence for multifaceted components strategies. Few studies describe the effectiveness of implementation strategies for allied healthcare, but evidence was found for multi-faceted components for implementing research in an allied health therapy group population. When considering implementation of evidence informed interventions in allied health a multi-pronged approach appears to be more successful.

Target population: allied health therapy group

Scope of impact: Multi-faceted strategies appear to remain the most effective in improving knowledge and adherence to guidelines and evidence (professional outcomes) but none of the strategies were found to improve patient outcomes.

Quality of individual studies: The six studies included in this review were of sound methodologic quality with SIGN (Scottish Intercollegiate Guidelines Network) scores ranging from adequate to high quality.

Multi-faceted Interventions (MFIs)

Zadro J.R. et al. Effectiveness of implementation strategies to improve adherence of physical therapist treatment choices to clinical practice guidelines for musculoskeletal conditions: systematic review (2020)

7

9

Setting: HIC

Effectiveness: Four studies (out of 6 examining our primary outcome) identified implementation strategies that can increase physical therapists’ use of some evidence-based treatments.

Although this review revealed limited trials evaluating interventions to increase physical therapists’ use of evidence-based treatments for musculoskeletal conditions compared with no intervention, it highlighted some interventions that may be effective.

Target population: physical therapists

Scope of impact: There are examples where implementation strategies improved physical therapists’ use of evidence-based treatments despite most of the sample treating according to guidelines at baseline and where implementation strategies did not improve physical therapists’ use of evidence-based treatments despite most of the sample not following guidelines at baseline.

Quality of individual studies: From the 9 studies, 2 studies were at low risk of bias for all EPOC domains. For random sequence generation, 2 were at unclear risk of bias and 7 were at low risk. For allocation concealment, 1 was at unclear risk of bias and 8 were at low risk. All studies were at low risk of bias for “baseline characteristics similar” and “selective outcome reporting,” whereas only 2 studies were at high risk of bias, and 1 had an unclear risk for baseline outcome measurements similar.” Six studies were at high risk of bias for “incomplete outcome data,” whereas 3 were at low risk. Eight studies ensured that knowledge of the allocated interventions were adequately prevented during the study (i.e., were at low risk of bias); 1 study was at high risk. Eight studies were at low risk of bias for protection against contamination, whereas only 1 was at high risk. One study assessed treatment choices using audits of clinical notes and was at low risk of “other bias”; the remaining 8 studies were at high risk of “other bias”.

Multi-faceted Interventions (MFIs)

Menon A. et al. Strategies for rehabilitation professionals to move evidence-based knowledge into practice: a systematic review (2009)

7

12

Setting: unclear/not specified

Effectiveness: Findings from this systematic review suggest that participation in an active multi-component KT intervention results in improved self-perceived knowledge, as well as positive changes in actual and self-perceived practice behaviors of physical therapists.

Target population: rehabilitation clinicians

Scope of impact: These gains did not translate into change in physical therapists’ attitude towards best practices. While this review found no studies examining the use of active multi-component interventions with occupational therapists specifically, limited evidence suggests that single active KT interventions may improve knowledge, attitudes and practice behaviors of this professional group. It is not clear from this review which KT strategy can effectively change clinicians’ attitudes towards the use of EBP.

Quality of individual studies: The most important limitation of this systematic review was the reported quality of the studies included, some of which had methodological weaknesses that may have reduced the validity of our conclusions for each PICO (population, intervention, control, outcomes) question.

Multi-faceted Interventions (MFIs)

Jones C.A. et al. Translating knowledge in rehabilitation: systematic review (2015)

7

26

Setting: HIC

Effectiveness: This systematic review showed that educational meetings were commonly used KT strategies specifically directed at translating research into practice and enhancing research uptake in rehabilitation disciplines. Active multicomponent KT strategies were effective in physical therapy knowledge and practice behaviors. Overall, the effectiveness of the KT strategies was not significant.

Target population: rehabilitation professions

Scope of impact: No clear delineation of the effect on KT strategies was seen.

Quality of individual studies: Based on the Quality Assessment Tool for Quantitative Studies, none of the quantitative studies received a strong rating, although 3 studies received a moderate rating and the remaining studies received weak ratings. The methodological rigor of most studies was weak.

Multi-faceted Interventions (MFIs)

Van Der Veer S.N. et al. Translating knowledge on best practice into improving quality of RRT care: A systematic review of implementation strategies (2011)

6

96

Setting: HIC

Effectiveness: Results tend to support previous findings that multifaceted strategies are more effective than single strategies.

Target population: renal replacement therapy (RRT) providers

Scope of impact: The authors’ ability to draw firm conclusions on the relationship between the implementation strategies and specific QI techniques used and the outcomes achieved was limited.

Quality of individual studies: Only a small number of studies were of sufficient methodological quality.

TOTAL

747