Professional interventions for general practitioners on the management of musculoskeletal conditions

Victoria Tzortziou Brown; Martin Underwood; Noman Mohamed; Olwyn Westwood; Dylan Morrissey

doi:10.1002/14651858.CD007495.pub2

مداخلات حرفه‌ای برای پزشکان عمومی به منظور مدیریت بالینی بیماری‌های عضلانی‌اسکلتی

Appendices

Appendix 1. Search strategies

MEDLINE OVID

Search date: October 24, 2013

1 exp musculoskeletal diseases/ or rheumatology/ or exp orthopedics/ or orthopedic procedures/ (857643)
2 (musculoskeletal or arthriti$ or orthop?edic? or osteo$ or polymyalg$ or periarthrit$).ti. (249636)
3 (arthritis or back pain or chondrocalcinosis or dermatomyositis or dupuytren? contracture or fibromyal$ or Fibrositis or Fibrositides or gout or hyperostos$ or low$ back or lupus or osteitis or osteoarthrit$ or osteoarthrop$ or osteochondr$ or Osteonecros$ or osteoporos$ or periarthriti$ or polymyalgia? or raynaud disease? or rheumatism or rheumatic disease? or sciatica or scleroderma$ or Spondylarthrit$).ti,ab. (352214)
4 (((cartiledge or connective tissue? or joint? or ligament? or muscula$ or myofascial or neck or soft tissue? or spine or spinal) adj2 (damage? or disease? or disorder? or injury or injuries or pain? or strain?)) and (care or treatment)).ti. (2884)
5 ((caplan? or felty's or Sjogren's or still's or wissler's) adj (disease? or syndrome?)).ti,ab. (11736)
6 ((elbow or hand? or knee or knees or leg or muscle or muscular$ or orthop?edic? or shoulder? or wrist?) adj2 (care or treatment? or injury or injuries or pain? or strain?)).ti,ab. (38503)
7 (athletic? adj2 (strain? or injury or injuries)).ti. (451)
8 Dermatomyositis/ or Dupuytren's Contracture/ or Lupus Erythematosus, Cutaneous/ or Lupus Erythematosus, Systemic/ or exp back pain/ or neck pain/ or sciatica/ or exp Raynaud Disease/ or exp Scleroderma, Systemic/ or exp arm injuries/ or athletic injuries/ or exp back injuries/ or exp dislocations/ or exp fractures bone/ or fractures cartilage/ or exp hand injuries/ or exp hip injuries/ or exp leg injuries/ or multiple trauma/ or exp neck injuries/ or soft tissue injuries/ or exp spinal cord injuries/ or exp spinal injuries/ or exp "sprains and strains"/ or exp tendon injuries/ or exp musculoskeletal system/ (1447111)
9 or/1‐8 [MSK Rev] (2072899)
10 general practice/ or physicians, primary care/ [Terms added August 2012] (4535)
11 family practice/ or physicians, family/ or primary health care/ (122879)
12 ((family or general) adj2 (doctor? or medicine or medical practitioner? or medical practice? or practice? or practitioner? or physician$)).ti,ab. [Increased adj Aug 2012] (101849)
13 (primary adj2 (care or health care or healthcare or medical care or patient care)).ti,ab. (89077)
14 or/10‐13 [Primary Care Rev ML] (217520)
15 (randomized controlled trial or controlled clinical trial).pt. or randomized.ab. or placebo.ab. or clinical trials as topic.sh. or randomly.ab. or trial.ti. (930250)
16 exp animals/ not humans.sh. (4051829)
17 15 not 16 [Cochrane RCT Filter 6.4.d Sens/Precision Maximizing] (859939)
18 intervention?.ti. or (intervention? adj6 (clinician? or collaborat$ or community or complex or DESIGN$ or doctor? or educational or family doctor? or family physician? or family practitioner? or financial or GP or general practice? or hospital? or impact? or improv$ or individuali?e? or individuali?ing or interdisciplin$ or multicomponent or multi‐component or multidisciplin$ or multi‐disciplin$ or multifacet$ or multi‐facet$ or multimodal$ or multi‐modal$ or personali?e? or personali?ing or pharmacies or pharmacist? or pharmacy or physician? or practitioner? or prescrib$ or prescription? or primary care or professional$ or provider? or regulatory or regulatory or tailor$ or target$ or team$ or usual care)).ab. (165998)
19 (pre‐intervention? or preintervention? or "pre intervention?" or post‐intervention? or postintervention? or "post intervention?").ti,ab. [added 2.4] (10262)
20 (hospital$ or patient?).hw. and (study or studies or care or health$ or practitioner? or provider? or physician? or nurse? or nursing or doctor?).ti,hw. (720981)
21 demonstration project?.ti,ab. (1984)
22 (pre‐post or "pre test$" or pretest$ or posttest$ or "post test$" or (pre adj5 post)).ti,ab. (65680)
23 (pre‐workshop or post‐workshop or (before adj3 workshop) or (after adj3 workshop)).ti,ab. (610)
24 trial.ti. or ((study adj3 aim?) or "our study").ab. (632839)
25 (before adj10 (after or during)).ti,ab. (362830)
26 ("quasi‐experiment$" or quasiexperiment$ or "quasi random$" or quasirandom$ or "quasi control$" or quasicontrol$ or ((quasi$ or experimental) adj3 (method$ or study or trial or design$))).ti,ab,hw. [ML] (104437)
27 ("time series" adj2 interrupt$).ti,ab,hw. [ML] (1184)
28 (time points adj3 (over or multiple or three or four or five or six or seven or eight or nine or ten or eleven or twelve or month$ or hour? or day? or "more than")).ab. (9391)
29 pilot.ti. (39876)
30 Pilot projects/ [ML] (84019)
31 (clinical trial or controlled clinical trial or multicenter study).pt. [ML] (649874)
32 (multicentre or multicenter or multi‐centre or multi‐center).ti. (29829)
33 random$.ti,ab. or controlled.ti. (779263)
34 (control adj3 (area or cohort? or compare? or condition or design or group? or intervention? or participant? or study)).ab. not (controlled clinical trial or randomized controlled trial).pt. [ML] (412256)
35 "comment on".cm. or review.ti,pt. or randomized controlled trial.pt. [ML] (2959592)
36 review.ti. [EM] (255522)
37 (rat or rats or cow or cows or chicken? or horse or horses or mice or mouse or bovine or animal?).ti. (1368734)
38 exp animals/ not humans.sh. [ML] (4051829)
39 (animal$ not human$).sh,hw. [EM] (3956028)
40 *experimental design/ or *pilot study/ or quasi experimental study/ [EM] (24261)
41 ("quasi‐experiment$" or quasiexperiment$ or "quasi random$" or quasirandom$ or "quasi control$" or quasicontrol$ or ((quasi$ or experimental) adj3 (method$ or study or trial or design$))).ti,ab. [EM] (104437)
42 ("time series" adj2 interrupt$).ti,ab. [EM] (1184)
43 (or/18‐29,32‐34) or experimental design/ or between groups design/ or quantitative methods/ or quasi experimental methods/ [PsycInfo] (2839256)
44 exp animals/ or animal?.ti,id,hw. [PsycInfo] (17706941)
45 (or/18‐34) not (or/35,37‐38) [EPOC Methods Filter 2.4 Medline] (2151565)
46 (or/18‐25,28‐29,32‐33,40‐42) not (or/36,39) [EPOC Methods Filter 2.4 EMBASE] (2199704)
47 43 not (or/36‐37,44) [EPOC Methods Filter 2.4 PsycInfo] (339055)
48 9 and 14 [MSK & PC] (11460)
49 9 and 14 and 17 [MSK & PC & RCT FILTER] (1584)
50 (9 and 14 and 45) not 49 [MSK & PC & EPOC FILTER 2.4] (2810)
51 (201208$ or 201209$ or 201210$ or 201211$ or 201212$ or 2013$).ed,ep,yr. (1796601)
52 49 and 51 [rct] (167)
53 remove duplicates from 52 [RCT to export Oct 24‐2013] (129)
54 50 and 51 [EPOC] (292)
55 remove duplicates from 54 [EPOC to export Oct 2013]

EMBASE OVID

Embase Classic+Embase <1947 to 2013 October 23>

1 exp *musculoskeletal disease/ or rheumatology/ or *orthopedics/ or *orthopedic surgery/ (1190591)
2 (arthrit$ or back pain or fibromyalg$ or gout or low$ back or musculoskeletal or orthop?edic? or lupus or osteitis or osteoarthrit$ or osteoarthrop$ or osteochondr$ or Osteonecros$ or osteoporos$ or periarthriti$ or polymyalgia? or rheumatism or rheumatic disease? or sciatica or scleroderma$ or Spondylarthrit$).ti. (311875)
3 ((arthritis or back pain or chondrocalcinosis or dermatomyositis or dupuytren? contracture or fibromyal$ or Fibrositis or Fibrositides or gout or hyperostos$ or low$ back or lupus or osteitis or osteoarthrit$ or osteoarthrop$ or osteochondr$ or Osteonecros$ or osteoporos$ or periarthriti$ or polymyalgia? or raynaud disease? or rheumatism or rheumatic disease? or sciatica or scleroderma$ or Spondylarthrit$) adj3 (care or treatment?)).ab. (24640)
4 (((cartiledge or connective tissue? or joint? or ligament? or muscula$ or myofascial or neck or soft tissue? or spine or spinal) adj2 (damage? or disease? or disorder? or injury or injuries or pain? or strain?)) and (care or treatment)).ti. (3734)
5 ((caplan? or felty's or Sjogren's or still's or wissler's) adj (disease? or syndrome?)).ti,ab. (15557)
6 ((elbow or hand? or knee or knees or leg or muscle or muscular$ or orthop?edic? or shoulder? or sprain$ or wrist?) adj4 (care or treatment)).ti,ab. (32341)
7 (athletic? adj2 (strain? or injury or injuries)).ti. (491)
8 (bone adj2 (fracture? or fractured)).ti. (2759)
9 ((bone? or cartiledge or connective tissue? or joint? or ligament? or muscula$ or myofascial or neck or soft tissue? or spine or spinal) adj2 (damage? or disease? or disorder? or injury or injuries or pain? or strain?)).ti. (49287)
10 *dermatomyositis/ or *Dupuytren contracture/ or *skin lupus erythematosus/ or *systemic lupus erythematosus/ or exp *backache/ or exp *leg pain/ or exp *musculoskeletal pain/ or *neck pain/ or *ischialgia/ or *Raynaud phenomenon/ or *scleroderma/ or exp *ARM INJURY/ or exp *TENDON INJURY/ or exp *SOFT TISSUE INJURY/ or exp *NECK INJURY/ or exp *HAND INJURY/ or exp *LEG INJURY/ or exp *SPINE INJURY/ or exp *SPINAL CORD INJURY/ or exp *HIP INJURY/ or *sport injury/ or *dislocation/ or exp *fracture/ or exp *sprain/ or muscle strain/ or exp *tendon injury/ (367353)
11 or/1‐10 [MSK conditions] (1404842)
12 *general practitioner/ (15844)
13 *general practice/ (39859)
14 exp *primary health care/ (40728)
15 ((family or general) adj2 (doctor? or medical practitioner? or medical practice? or practice? or practitioner? or physician$)).ti,ab. (117580)
16 (primary adj2 (care or health care or healthcare or medical care or patient care)).ti,ab. (104088)
17 or/12‐16 [Primary care] (231098)
18 controlled clinical trial/ or controlled study/ or randomized controlled trial/ [EM] (4244044)
19 (book or conference paper or editorial or letter or review).pt. not randomized controlled trial/ [Per BMJ Clinical Evidence filter] (4034696)
20 (random sampl$ or random digit$ or random effect$ or random survey or random regression).ti,ab. not randomized controlled trial/ [Per BMJ Clinical Evidence filter] (54247)
21 (animal$ not human$).sh,hw. (3913735)
22 18 not (or/19‐21) [Trial filter per BMJ CLinical Evidence] (2801374)
23 intervention?.ti. or (intervention? adj6 (clinician? or collaborat$ or community or complex or DESIGN$ or doctor? or educational or family doctor? or family physician? or family practitioner? or financial or GP or general practice? or hospital? or impact? or improv$ or individuali?e? or individuali?ing or interdisciplin$ or multicomponent or multi‐component or multidisciplin$ or multi‐disciplin$ or multifacet$ or multi‐facet$ or multimodal$ or multi‐modal$ or personali?e? or personali?ing or pharmacies or pharmacist? or pharmacy or physician? or practitioner? or prescrib$ or prescription? or primary care or professional$ or provider? or regulatory or regulatory or tailor$ or target$ or team$ or usual care)).ab. (201463)
24 (pre‐intervention? or preintervention? or "pre intervention?" or post‐intervention? or postintervention? or "post intervention?").ti,ab. [added 2.4] (12626)
25 (hospital$ or patient?).hw. and (study or studies or care or health$ or practitioner? or provider? or physician? or nurse? or nursing or doctor?).ti,hw. (1623934)
26 demonstration project?.ti,ab. (2357)
27 (pre‐post or "pre test$" or pretest$ or posttest$ or "post test$" or (pre adj5 post)).ti,ab. (93420)
28 (pre‐workshop or post‐workshop or (before adj3 workshop) or (after adj3 workshop)).ti,ab. (809)
29 trial.ti. or ((study adj3 aim?) or "our study").ab. (838686)
30 (before adj10 (after or during)).ti,ab. (474031)
31 deleted line; no impact on strategy
32 deleted line; no impact on strategy
33 (time points adj3 (over or multiple or three or four or five or six or seven or eight or nine or ten or eleven or twelve or month$ or hour? or day? or "more than")).ab. (11728)
34 pilot.ti. (49794)
35 deleted line; no impact on strategy
36 deleted line; no impact on strategy
37 (multicentre or multicenter or multi‐centre or multi‐center).ti. (39211)
38 random$.ti,ab. or controlled.ti. (932656)
39 (control adj3 (area or cohort? or compare? or condition or design or group? or intervention? or participant? or study)).ab. not (controlled clinical trial or randomized controlled trial).pt. [ML] (615626)
40 deleted line; no impact on strategy
41 review.ti. [EM] (312835)
42 (rat or rats or cow or cows or chicken? or horse or horses or mice or mouse or bovine or animal?).ti. (1654258)
43deleted line; no impact on strategy
44 (animal$ not human$).sh,hw. [EM] (3913735)
45 *experimental design/ or *pilot study/ or quasi experimental study/ [EM] (6990)
46 ("quasi‐experiment$" or quasiexperiment$ or "quasi random$" or quasirandom$ or "quasi control$" or quasicontrol$ or ((quasi$ or experimental) adj3 (method$ or study or trial or design$))).ti,ab. [EM] (128680)
47 ("time series" adj2 interrupt$).ti,ab. [EM] (1124)
48‐50 deleted lines; no impact on strategy
51 (or/23‐30,33‐34,37‐38,45‐47) not (or/41,44) [EPOC Methods Filter 2.4 EMBASE] (3323291)
52 48 not (or/41‐42,49) [EPOC Methods Filter 2.4 PsycInfo] (715574)
53 11 and 17 [MSK & Primary Care] (10572)
54 11 and 17 and 22 [MSK & PC & RCT] (2143)
55 (11 and 17 and 51) not 54 [MSK & PC & EPOC Filter] (3595)

Cochrane Library via OVID EBM Collection

Search date: October 2013

EBM Reviews ‐ Cochrane Database of Systematic Reviews <2005 to September 2013>, EBM Reviews ‐ ACP Journal Club <1991 to October 2013>, EBM Reviews ‐ Database of Abstracts of Reviews of Effects <3rd Quarter 2013>, EBM Reviews ‐ Cochrane Central Register of Controlled Trials <September 2013>, EBM Reviews ‐ Cochrane Methodology Register <3rd Quarter 2012>, EBM Reviews ‐ Health Technology Assessment <3rd Quarter 2013>, EBM Reviews ‐ NHS Economic Evaluation Database <3rd Quarter 2013>

1 exp musculoskeletal diseases/ or rheumatology/ or exp orthopedics/ or orthopedic procedures/ (20864)
2 (musculoskeletal or arthrit$ or orthop?edic? or osteo$ or polymyalg$ or periarthrit$).ti. (13266)
3 (arthritis or back pain or chondrocalcinosis or dermatomyositis or dupuytren? contracture or fibromyal$ or Fibrositis or Fibrositides or gout or hyperostos$ or low$ back or lupus or osteitis or osteoarthrit$ or osteoarthrop$ or osteochondr$ or Osteonecros$ or osteoporos$ or periarthriti$ or polymyalgia? or raynaud disease? or rheumatism or rheumatic disease? or sciatica or scleroderma$ or Spondylarthrit$).ti,ab. (19487)
4 (((cartiledge or connective tissue? or joint? or ligament? or muscula$ or myofascial or neck or soft tissue? or spine or spinal) adj2 (damage? or disease? or disorder? or injury or injuries or pain? or strain?)) and (care or treatment)).ti. (472)
5 ((caplan? or felty's or Sjogren's or still's or wissler's) adj (disease? or syndrome?)).ti,ab. (247)
6 ((elbow or hand? or knee or knees or leg or muscle or muscular$ or orthop?edic? or shoulder? or wrist?) adj2 (care or treatment? or injury or injuries or pain? or strain?)).ti,ab. (5343)
7 (athletic? adj2 (strain? or injury or injuries)).ti. (14)
8 Dermatomyositis/ or Dupuytren's Contracture/ or Lupus Erythematosus, Cutaneous/ or Lupus Erythematosus, Systemic/ or exp back pain/ or neck pain/ or sciatica/ or exp Raynaud Disease/ or exp Scleroderma, Systemic/ or exp arm injuries/ or athletic injuries/ or exp back injuries/ or exp dislocations/ or exp fractures bone/ or fractures cartilage/ or exp hand injuries/ or exp hip injuries/ or exp leg injuries/ or multiple trauma/ or exp neck injuries/ or soft tissue injuries/ or exp spinal cord injuries/ or exp spinal injuries/ or exp "sprains and strains"/ or exp tendon injuries/ or exp musculoskeletal system/ (28264)
9 or/1‐8 [MSK Rev] (53389
10 general practice/ or physicians, primary care/ [Terms added August 2012] (145)
11 family practice/ or physicians, family/ or primary health care/ (4521)
12 ((family or general) adj2 (doctor? or medicine or medical practitioner? or medical practice? or practice? or practitioner? or physician$)).ti,ab. [Increased adj Aug 2012] (6968)
13 (primary adj2 (care or health care or healthcare or medical care or patient care)).ti,ab. (7493)
14 or/10‐13 [Primary Care Rev ML] (13418)
15 9 and 14 (1090)
16 limit 15 to yr="2012 ‐ 2014" [Limit not valid in DARE; records were retained] (68)
17 from 16 keep 1‐3 [CDSR] (3)
18 from 16 keep 4‐7 [ACP] (4)
19 from 16 keep 8‐9 [DARE] (2)
20 from 16 keep 10‐53 [Central] (44)
21 from 16 keep 45‐53 [HTA] (9)
22 from 16 keep 63‐68 [EED] (6)

Cochrane Library, Issue 2, 2010 [Wiley]

Search Date: 2010‐08‐23 15:34:51.33

#1MeSH descriptor Musculoskeletal Diseases explode all trees
#2MeSH descriptor Rheumatology, this term only
#3MeSH descriptor Orthopedics explode all trees
#4MeSH descriptor Orthopedic Procedures, this term only
#5(musculoskeletal or arthritis or osteoarthritis):ab
#6(arthrit*):ti
#7((bone near/2 fracture*) or (bone near/2 fractured)):ti
#8(Chondrocalcinosis or dermatomyositis or dupuytren* contracture or fibromyalgia* or Fibrositis or Fibrositides or gout or hyperostos* or lupus or Musculoskeletal or orthopedic* or orthopaedic* or osteitis or osteoarthrit* or osteoarthrop* or osteochondr* or Osteonecros* or osteoporos* or periarthriti* or polymyalgia* or raynaud disease* or rheumati* or sciatica or scleroderma* or Spondylarthrit* or sprain*):ti
#9((caplan* or felty's or Sjogren's or still's or wissler's) near/ disease*):ti
#10((caplan* or felty's or Sjogren's or still's or wissler's) near/ syndrome*):ti
#11((bone* or cartiledge or connective tissue* or joint* or ligament* or muscula* or myofascial or neck or soft tissue* or spine or spinal) near/2 strain*):ti
#12((bone* or cartiledge or connective tissue* or joint* or ligament* or muscula* or myofascial or neck or soft tissue* or spine or spinal) near/2 damage*):ti
#13((bone* or cartiledge or connective tissue* or joint* or ligament* or muscula* or myofascial or neck or soft tissue* or spine or spinal) near/2 disease*):ti
#14((bone* or cartiledge or connective tissue* or joint* or ligament* or muscula* or myofascial or neck or soft tissue* or spine or spinal) near/2 disorder*):ti
#15((bone* or cartiledge or connective tissue* or joint* or ligament* or muscula* or myofascial or neck or soft tissue* or spine or spinal) near/2 injury):ti
#16((bone* or cartiledge or connective tissue* or joint* or ligament* or muscula* or myofascial or neck or soft tissue* or spine or spinal) near/2 pain*):ti
#17((bone* or cartiledge or connective tissue* or joint* or ligament* or muscula* or myofascial or neck or soft tissue* or spine or spinal) near/2 injuries):ti
#18((elbow) near/2 (injury or injuries or pain* or strain*)):ti
#19((shoulder) near/2 (injury or injuries or pain* or strain*)):ti
#20((hand*) near/2 (injury or injuries or pain* or strain*)):ti
#21(knee near/2 (injury or injuries or pain* or strain*)):ti
#22(athletic* near/2 (strain* or injury or injuries)):ti
#23MeSH descriptor Dermatomyositis, this term only
#24MeSH descriptor Dupuytren Contracture, this term only
#25MeSH descriptor Lupus Erythematosus, Cutaneous, this term only
#26MeSH descriptor Lupus Erythematosus, Systemic explode all trees
#27MeSH descriptor Back Pain explode all trees
#28MeSH descriptor Sciatica, this term only
#29MeSH descriptor Raynaud Disease, this term only
#30MeSH descriptor Scleroderma, Systemic explode all trees
#31MeSH descriptor Arm Injuries explode all trees
#32MeSH descriptor Neck Pain explode all trees
#33MeSH descriptor Athletic Injuries, this term only
#34MeSH descriptor Back Injuries explode all trees
#35MeSH descriptor Dislocations explode all trees
#36MeSH descriptor Fractures, Bone explode all trees
#37MeSH descriptor Fractures, Cartilage, this term only
#38MeSH descriptor Hand Injuries explode all trees
#39MeSH descriptor Hip Injuries explode all trees
#40MeSH descriptor Leg Injuries explode all trees
#41MeSH descriptor Multiple Trauma, this term only
#42MeSH descriptor Neck Injuries explode all trees
#43MeSH descriptor Soft Tissue Injuries, this term only
#44MeSH descriptor Spinal Cord Injuries explode all trees
#45MeSH descriptor Sprains and Strains explode all trees
#46MeSH descriptor Tendon Injuries explode all trees
#47MeSH descriptor Musculoskeletal System explode all trees
#48(#1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17 OR #18 OR #19 OR #20 OR #21 OR #22 OR #23 OR #24 OR #25 OR #26 OR #27 OR #28 OR #29 OR #30 OR #31 OR #32 OR #33 OR #34 OR #35 OR #36 OR #37 OR #38 OR #39 OR #40 OR #41 OR #42 OR #43 OR #44 OR #45 OR #46 OR #47)
#49MeSH descriptor Family Practice, this term only
#50MeSH descriptor Physicians, Family, this term only
#51MeSH descriptor Primary Health Care, this term only
#52(general near/ (doctor* or medicine or medical practitioner* or medical practice* or practice* or practitioner* or physician*)):ti,ab
#53(family near/ (doctor* or medicine or medical practitioner* or medical practice* or practice* or practitioner* or physician*)):ti,ab
#54(primary near/2 (care or health care or healthcare or medical care or patient care)):ti,ab
#55(#49 OR #50 OR #51 OR #52 OR #53 OR #54)
#56intervention*:ti
#57(intervention* near/6 (clinician* or collaborat* or community or complex or doctor* or educational or family doctor* or family physician* or family practitioner* or financial or GP or general practice* or hospital* or impact* or improv* or individuali*e* or individuali*ing or interdisciplin* or multicomponent or multi‐component or
multidisciplin* or multi‐disciplin* or multifacet* or multi‐facet* or multimodal* or multi‐modal* or personali*e* or personali*ing or pharmacies or pharmacist* or pharmacy or
physician* or practitioner* or prescrib* or prescription* or primary care or professional* or provider* or regulatory or regulatory or tailor* or target* or team* or usual care)):ab
#58((evidence near/4 intervention) or (evidence‐based near/4 intervention) or (evidence‐driven)):ti,ab
#59"practice‐based":ti,ab
#60(improv* near/3 (decision* or implement* or health care or healthcare or initiative* or management or multifacet* or multi‐facet* or multi‐component or practi*e* or practitioner* or prescrib* or prescription* or professional* or program* or programme* or provider*)):ti

#61(improv* near/2 (patient‐care or family practice or ((family or general) near/2 (practi*e or practitioner* or doctor*)) or primary care)):ab
#62recommended practice*:ti,ab
#63((information or evidence) near/2 uptake):ti,ab
#64(knowledge near/2 (application or broke* or creation or diffus* or disseminat* or exchang* or implement* or management or mobili* or translat* or transfer* or uptake or utili*)):ti,ab
#65(evidence* near/2 (exchang* or translat* or transfer*)):ti,ab
#66(KT near/2 (application or broke* or diffus* or disseminat* or decision* or exchang* or implement* or intervent* or mobili* or plan* or policy or policies or strateg* or translat* or transfer* or uptake or utili*)):ti,ab
#67((computer‐tailored or individuali*ing or individuali*ed or personali*e* or personali*ing or tailor*) near/2 (feedback or intervention* or information or plan*)):ti,ab
#68((conventional or evidence‐based or pattern or regular or routine or standard or traditional or usual) near/2 (care or healthcare or patient care or practice)):ti,ab #69(collaborative* or interdisciplin* or inter‐disciplin* or multidisciplin* or multi‐ disciplin* or team* or team‐based or skill‐ mix):ti
#70(skill* near/2 (mix or mixes)):ti,ab
#71((collaborative) near/2 (care or patient care or healthcare)):ab
#72((multidisciplinary) near/2 (care or patient care or healthcare)):ab
#73((interdisciplinary) near/2 (care or patient care or healthcare)):ab
#74(doctor‐driven or doctor‐led or GP‐LED or nurse‐led or nurse‐driven or pharmacist‐led or pharmacist‐driven or physician‐led or physician‐ driven):ti,ab
#75physician directed:ti,ab
#76(leaflet* or pamphlet* or "written information"):ti
#77((leaflet*) near/5 (intervention* or care or healthcare or physician* or practitioner* or provider*)):ab
#78((pamphlet*) near/5 (intervention* or care or healthcare or physician* or practitioner* or provider*)):ab
#79(("written information") near/5 (intervention* or care or healthcare or physician* or practitioner* or provider*)):ab
#80((academic detailing or e‐detailing) or (opinion* near/2 leader*)):ti,ab
#81("audit and feedback"):ti,ab
#82((physician* or doctor* or practitioner* or nurse* or provider*) near/ feedback):ti,ab
#83(clinician* near/2 (prompt or prompts or prompting)):ti,ab or (physician* near/2 (prompt or prompts or prompting)):ti,ab or (remind* near/2 (prompt or prompts or prompting)):ti,ab
#84(reminder* near/2 (clinician* or physician* or practitioner* or nurse* or doctor* or provider*)):ti,ab
#85MeSH descriptor Reminder Systems, this term only

#86((doctor* or nurse* or pharmacist* or physician* or practitioner*) near/2 behavio*r*):ti,ab
#87(nurse* near/4 substitut*):ti,ab
#88(practice pattern*):ti,ab or ((change* or changing) near/2 practice):ti,ab
#89MeSH descriptor Physician's Practice Patterns, this term only
#90(nurse‐practitioner* or physician* assistant*):ti
#91((doctor* or pharmacist* or physician*) near/2 role*):ab
#92MeSH descriptor Referral and Consultation, this term only
#93(Referral* and (primary care or specialist* or general practitioner* or change* or changing or improv* or impact or effect* or reduce* or reducing or increase* or increasing or optimi* or optimal or quality or healthcare or patient care or intensive care or emergency or chronic or management or administration)):ti,ab
#94(Referral* and (primary care or specialist* or general practitioner* or optimi*e* or optimal)):ti or (Referral* near/3 (primary care or specialist* or general practitioner* or optimi*e* or optimal)):ab
#95((nurse* or physician* or pharmacist* or provider*) near/2 initiative*):ti,ab
#96(virtual reality or VR Training or VR simulat* or (simulat* near/2 skill*)):ti,ab
#97(blog* or wiki* or PDA or "palm pilot* " or blackberr* or Twitter or tweet or tweeting or facebook or social networking or social marketing or youtube):ti,ab or blogging or (health 20 or healthcare 20 or health care 20 or web 20):ti,ab
#98(guideline adherence or (guideline* near/3 (adherence or compliance or concordance or implement* or UPTAKE))):ti,ab
#99((individuali* near/2 (care or healthcare or medical care)) or (integrated near/2 (care or healthcare or medical care)) or (patient‐centred or patient‐centered or patient‐control*)):ti,ab
#100quality improvement:ti,ab
#101(Patient satisfaction or algorithm*):ti,ab
#102MeSH descriptor Education, Pharmacy, Continuing, this term only
#103MeSH descriptor Education, Medical, Continuing, this term only
#104MeSH descriptor Education, Nursing, Continuing, this term only
#105MeSH descriptor Education, Professional, this term only
#106(continuing near/2 education near/3 (physician* or nurse* or nursing or practitioner* or doctor* or family physician* or general practitioner* or family doctor* or primary care or primary healthcare)):ab
#107(continuing near/3 education):ti
#108((continuing or "on the job" or "off the job" or postgrad* or post‐grad* or resident* or intern* or internship* or workplace) near/2 training):ti,ab
#109(((continuing or "on the job" or "off the job" or postgrad* or post‐grad* or resident* or intern* or internship* or workplace) near/2 education*) or (skill* near/ (education or training))):ti,ab
#110(#56 OR #57 OR #58 OR #59 OR #60 OR #61 OR #62 OR #63 OR #64 OR #65 OR #66 OR #67 OR #68 OR #69 OR #70 OR #71 OR #72 OR #73 OR #74 OR #75 OR #76 OR #77 OR #78 OR #79 OR #80 OR #81 OR #82 OR #83 OR #84 OR #85 OR #86 OR #87 OR #88 OR #89 OR #90 OR #91 OR #92 OR #93 OR #94 OR #95 OR #96 OR #97 OR #98 OR #99 OR #100 OR #101 OR #102 OR #103 OR #104 OR #105 OR #106 OR #107 OR #108 OR #109)

#111(#48 AND #55)
#112(#48 AND #55 AND #110)
#113(#111 OR #112)

CINAHL, EbscoHost 1980‐

Search dates: August 24, 2010 AND november 20, 2013

	Date: 20100101‐20131231 NOVEMBER 20, 2013	288
S52	S51 or S50 [All Results] AUGUST 24, 2010	608
S51	S49 and S46 (Results with EPOC 1.7 Filter)	485

S50	S49 and S45 (Results with RCT filter)	302
S49	S47 and S48 and S17 (S17= primary Care terms)	1681
S48	S18 or S19 or S20 or S21 or S22 or S23 (Education/Collaboration Intervention terms)	76261
S47	S1 or S2 or S3 or S4 or S5 or S6 or S7 or S8 or S9 or S10 or S11 or S12 or S13 or S14 or S15 or S16 (MSK terms)	404871
S46	S24 or S25 or S26 or S27 or S28 or S29 or S30 or S31 or S32 or S34 or S35 or S36 or S37 or S38 (EPOC Filter 1.7)	187032
S45	S39 or S40 or S41 or S42 or S43 or S44 (RCT filter)	126098
S44	TI ( “control* N1 clinical” or “control* N1 group” or “control N1 trial” or “control N1 study” or “control* N1 studies” or “control* N1 design” or “control N1 method” ) or AB ( “control N1 clinical” or “control* N1 group” or “control N1 trial” or “control N1 study” or “control* N1 studies” or “control* N1 design” or “control N1 method*” )	57555
S43	TI controlled or AB controlled	44233
S42	TI random* or AB random*	77414
S41	TI ( “clinical study” or “clinical studies” ) or AB ( “clinical study” or “clinical studies” )	11229
S40	(MM "Clinical Trials+")	6045
S39	TI ( (multicent* n2 design) or (multicent n2 study) or (multicent* n2 studies) or (multicent* n2 trial) ) or AB ( (multicent n2 design) or (multicent n2 study) or (multicent* n2 studies) or (multicent* n2 trial*) )	5282
S38	TI pilot	7878
S37	(MH "Pilot Studies")	20827
S36	AB "before‐and‐after"	12207
S35	AB time series	1089
S34	TI time series	141
S33	AB ( before* n7 during or before n3 after ) or AU ( before* n7 during or before n3 after )	19048
S32	TI ( (time point) or (period n4 interrupted) or (period* n4 multiple) or (period* n4 time) or (period* n4 various) or (period* n4 varying) or (period* n4 week) or (period n4 month) or (period n4 year) ) or AB ( (time point) or (period* n4 interrupted) or (period* n4 multiple) or (period* n4 time) or (period* n4 various) or (period* n4 varying) or (period* n4 week) or (period n4 month) or (period n4 year*) )	34841
S31	TI ( ( quasi‐experiment* or quasiexperiment* or quasi‐random* or quasirandom* or quasi control* or quasicontrol* or “quasi* W3 method” or “quasi W3 study” or “quasi* W3 studies” or “quasi* W3 trial” or “quasi* W3 design” or “experimental W3 method” or “experimental W3 study” or “experimental W3 studies” or “experimental W3 trial” or “experimental W3 design” ) ) or AB ( ( quasi‐experiment or quasiexperiment* or quasi‐random* or quasirandom* or quasi control* or quasicontrol* or “quasi* W3 method” or “quasi W3 study” or “quasi* W3 studies” or “quasi* W3 trial” or “quasi* W3 design” or “experimental W3 method” or “experimental W3 study” or “experimental W3 studies” or “experimental W3 trial” or “experimental W3 design*” ) )	8591
S30	TI pre w7 post or AB pre w7 post	6142
S29	MH "Multiple Time Series" or MH "Time Series"	922
S28	TI ( (comparative N2 study) or (comparative N2 studies) or “evaluation study” or "evaluation studies" ) or AB ( (comparative N2 study) or (comparative N2 studies) or “evaluation study” or "evaluation studies" )	5677
S27	MH Experimental Studies or Community Trials or Community Trials or Pretest‐Posttest Design + or Quasi‐Experimental Studies + Pilot Studies or Policy Studies + Multicenter Studies	24708
S26	TI ( "pre test" or pretest or posttest* or "post test" ) or AB ( "pre test" or pretest* or posttest* or "post test*" )	5942
S25	TI ( intervention* or multiintervention* or multi‐intervention* or postintervention* or post‐intervention* or preintervention* or pre‐intervention* ) or AB ( intervention* or multiintervention* or multi‐intervention* or postintervention* or post‐intervention* or preintervention* or pre‐intervention* )	105013
S24	(MH "Quasi‐Experimental Studies")	4258
S23	(MH "Professional Development")	10105
S22	(MH "Practice Patterns") OR (MH "Prescribing Patterns")	3110
S21	AB ( (multifacet* or multi‐facet* or multimodal* or multi‐modal* or multidisciplin* or interdisciplin* or collaborat* or shared or team‐based or team or skill‐mix or inter‐disciplin* or multi‐disciplin) ) and AB ( (care or practice or decsion or refer* or consult*) )	32079
S20	(MH "Education, Medical, Continuing") OR (MH "Education, Nursing, Continuing")	10047
S19	(MH "Multidisciplinary Care Team")	15543
S18	(MH "Referral and Consultation") OR (MH "Group Practice")	12699
S17	(MH "Family Practice") OR (MH "Physicians, Family") OR (MH "Primary Health Care") OR AB ("primary care" or "family physician" or "family doctor" or "primary health")	41203
S16	TI (caplan* or felty's or Sjogren's or still's or wissler's) N disease*	266964
S15	TI (Chondrocalcinosis or dermatomyositis or dupuytren* contracture or fibromyalgia* or Fibrositis or Fibrositides or gout or hyperostos* or lupus or Musculoskeletal or orthopedic* or orthopaedic* or osteitis or osteoarthrit* or osteoarthrop* or osteochondr* or Osteonecros* or osteoporos* or periarthriti* or polymyalgia* or raynaud disease* or rheumati* or sciatica or scleroderma* or Spondylarthrit* or sprain*)	19656
S14	(MH "Dermatomyositis") OR (MH "Musculoskeletal System+")	64039
S13	(MH "Back Pain+") OR (MH "Neck Pain")	13141
S12	(MH "Sciatica")	443
S11	(MH "Tendon Injuries+") OR (MH "Soft Tissue Injuries") OR (MH "Spinal Cord Injuries+") OR (MH "Dislocations+")	14157
S10	(MH "Multiple Trauma")	1104
S9	(MH "Dupuytren's Contracture") OR (MH "Scleroderma, Systemic+")	1057
S8	(MH "Raynaud's Disease")	299
S7	(MH "Back Injuries+") OR (MH "Arm Injuries+") OR (MH "Athletic Injuries+") OR (MH "Fractures+") OR (MH "Hand Injuries+") OR (MH "Leg Injuries+") OR (MH "Neck Injuries+") OR (MH "Sprains and Strains+")	38128
S6	(MH "Arthritis+")	19407
S5	(MH "Orthopedic Care") OR (MH "Orthopedic Surgery")	5307
S4	(MH "Orthopedics")	4192
S3	(MH "Rheumatology")	676
S2	(MH "Lupus Erythematosus, Systemic+")	2417
S1	(MH "Musculoskeletal Diseases+")	72861

Figure 1

Prisma study flow diagram.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 3

Risk of bias summary for ITS study design: review authors' judgements about each risk of bias item for each included study.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 4

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 5

Risk of bias graph for ITS study design: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.1

Comparison 1 Meta‐analysis of osteoporosis studies evaluating physician and patient interventions versus usual care, Outcome 1 Bone Mineral Density.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.2

Comparison 1 Meta‐analysis of osteoporosis studies evaluating physician and patient interventions versus usual care, Outcome 2 Osteoporosis medication.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.1

Comparison 2 Meta‐analysis of osteoporosis studies evaluating physician‐only interventions versus usual care, Outcome 1 Bone mineral density.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.2

Comparison 2 Meta‐analysis of osteoporosis studies evaluating physician‐only interventions versus usual care, Outcome 2 Osteoporosis medication.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.1

Comparison 3 Meta‐analysis of osteoporosis studies evaluating physician only interventions versus physician and patient interventions, Outcome 1 Bone mineral density.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.2

Comparison 3 Meta‐analysis of osteoporosis studies evaluating physician only interventions versus physician and patient interventions, Outcome 2 Medication.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Summary of findings for the main comparison. Primary care physician alerting system and a patient‐directed intervention (education and reminder to see their primary care physician) compared to standard care for osteoporosis management

Primary care physician alerting system and a patient‐directed intervention (education and reminder to see their primary care physician) compared to usual care for osteoporosis management
Patient or population: General practitioners/family doctors involved in the management of patients with osteoporosis Settings: Primary care Intervention: Primary care physician alerting system and a patient‐directed intervention (education and reminder to see their primary care physician) Comparison: Usual care
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Certainty of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Usual care	A physician alerting system and a patient‐directed intervention (education and reminder to see their primary care physician)
Bone Mineral Density ¹ Follow‐up: 6‐12 months	Study population		RR 4.44 (3.54 to 5.55)	3386 (3 studies)	⊕⊕⊕⊕ high³
	49 per 1000	220 per 1000 (124 to 390)
	Moderate
	39 per 1000	176 per 1000 (99 to 311)
Osteoporosis medication ² Follow‐up: 6‐12 months	Study population		RR 1.71 (1.50 to 1.94)	4223 (5 studies)	⊕⊕⊕⊕ high³
	131 per 1000	241 per 1000 ³ (193 to 301)
	Moderate
	106 per 1000	195 per 1000 ³ (156 to 244)
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio;
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹ Bone mineral density (BMD) testing is an important outcome for osteoporosis because it leads to the diagnosis of the condition. This is one of the GP behaviour‐related outcomes (primary outcome) ² Osteoporosis medication prescribing is an important outcome for osteoporosis management as it is the main aspect of treatment. This is one of the GP behaviour‐related outcomes (primary outcome) ³ One of the five studies (Roux 2013) had two intervention comparison groups which were combined to create a single pair‐wise comparison as recommended in chapter 16.5.4 of the Cochrane Handbook.

Summary of findings for the main comparison. Primary care physician alerting system and a patient‐directed intervention (education and reminder to see their primary care physician) compared to standard care for osteoporosis management

Primary care physician alerting system compared to Primary care physician alerting system and a patient‐directed intervention (education and reminder to see their primary care physician) for osteoporosis management
Patient or population: General practitioners/family doctors involved in the management of patients with osteoporosis Settings: Primary care Intervention: Primary care physician alerting system Comparison: Primary care physician alerting system and a patient‐directed intervention (education and reminder to see their primary care physician)
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Certainty of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Primary care physician alerting system and a patient‐directed intervention (education and reminder to see their primary care physician)	Primary care physician alerting system
Bone mineral density¹ Follow‐up: 6‐12 months	Study population		RR 0.94 (0.81 to 1.09)	2995 (2 studies)	⊕⊕⊕⊖ moderate³
	192 per 1000	194 per 1000 (123 to 261)
	Moderate
	254 per 1000	257 per 1000 (163 to 345)
Medication² Follow‐up: 6‐12 months	Study population		RR 0.93 (0.79 to 1.10)	2995 (2 studies)	⊕⊕⊕⊖ moderate³
	167 per 1000	176 per 1000 (115 to 264)
	Moderate
	182 per 1000	191 per 1000 (126 to 288)
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio;
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹ Bone mineral density (BMD) testing is an important outcome for osteoporosis because it leads to the diagnosis of the condition. This is one of the GP behaviour‐related outcomes (primary outcome) ² Osteoporosis medication prescribing is an important outcome for osteoporosis management as it is the main aspect of treatment. This is one of the GP behaviour‐related outcomes (primary outcome) ³ The quality of evidence was downgraded because only two studies were included, one of which had a small number of participants and events.

Professional interventions for GPs on the management of osteoporosis compared to usual care
Patient or population: General practitioners/family doctors involved in the management of patients with osteoporosis Settings: Primary care Intervention: Professional interventions (targeting physician‐only) Comparison: Usual care
Outcomes	Impact (including effect sizes wherever available)	Number of Participants (studies)	Certainty of the evidence (GRADE)	Comments
Health professional (GP) behaviour‐related outcomes Bone Mineral Density (BMD) testing Osteoporosis medication (appropriate prescribing)	BMD RR 4.75 (95% CI 3.62 to 6.24) Osteoporosis medication RR 1.52 (95% CI 1.26 to 1.84)	BMD 3047 (2 studies) Osteoporosis medication 3047 (2 studies)	BMD ⊕⊕⊕⊖ moderate¹ Osteoporosis ⊕⊕⊕⊖ moderate¹
Patient outcomes Fragility fractures Hospitalisation				None of the included studies assessed these outcomes
Economic outcomes Health service costs (including prescribing costs) Cost effectiveness	Majumdar 2007, assessed the cost effectiveness of the study Majumdar 2008, and concluded that the intervention led to a per patient cost saving of CAD 13 (USD 9) and a gain of 0.012 quality‐adjusted life years.	272 participants (1 study)	⊕⊕⊖⊖ low²
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence Interval; RR: Risk Ratio
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹The quality of evidence was downgraded because only two studies were included, one of which had a small number of participants and events, and in view of the considerable statistical heterogeneity observed. ² The quality of evidence was downgraded because only one study was included which had some risk of bias.

Table 1: Classification of relevant interventions from EPOC taxonomy
Intervention	Description
Distribution of educational materials	Distribution of published or printed recommendations for clinical care, including clinical practice guidelines, audio‐visual materials and electronic publications. The materials may have been delivered personally or through mass mailings.
Educational meetings	Healthcare providers who have participated in conferences, lectures, workshops or traineeships
Local consensus processes	Inclusion of participating providers in discussion to ensure that they agreed that the chosen clinical problem was important and the approach to managing the problem was appropriate
Educational outreach visits	Use of a trained person who met with providers in their practice settings to give information with the intent of changing the provider’s practice. The information given may have included feedback on the performance of the provider(s)
Local opinion leaders	Use of providers nominated by their colleagues as ‘educationally influential’. The investigators must have explicitly stated that their colleagues identified the opinion leaders
Patient‐mediated	New clinical information (not previously available) collected directly from patients and given to the provider e.g. depression scores from an instrument
Audit and feedback	Any summary of clinical performance of health care over a specified period of time. The summary may also have included recommendations for clinical action. The information may have been obtained from medical records, computerised databases, or observations from patients
Reminders	Patient or encounter specific information, provided verbally, on paper or on a computer screen, which is designed or intended to prompt a health professional to recall information. This would usually be encountered through their general education; in the medical records or through interactions with peers, and so remind them to perform or avoid some action to aid individual patient care. Computer aided decision support and drugs dosage are included.
Marketing	Use of personal interviewing, group discussion (‘focus groups’), or a survey of targeted providers to identify barriers to change and subsequent design of an intervention that addresses identified barriers
Mass media	(i) Varied use of communication that reached great numbers of people including television, radio, newspapers, posters, leaflets, and booklets, alone or in conjunction with other interventions; (ii) Targeted at the population level
Other	Patient‐directed (education and reminders to see their primary care physician)

Table 2. Intervention types used in each study (N.B. All interventions evaluated were professional)
Intervention methods ^1,2	No. of Studies	Studies ³
Distribution of educational materials	27	Becker 2008; Bessette 2011; Bishop 2006; Boyd 2002; Broadhurst 2007; Chassany 2006; Ciaschini 2010; Cranney 2008; Dey 2004; Eccles 2001; Engers 2005; Feldstein 2006; French 2013; Hazard 1997; Hollingworth 2002; Kerry 2000; Leslie 2012; Majumdar 2008; Rahme 2005; Robling 2002; Rosemann 2007; Roux 2013; Rozental 2008; Schectman 2003; Solomon 2007a; Stross 1985; Watson 2008
Educational meetings	10	Becker 2008; Chassany 2006; Engers 2005; French 2013; Gormley 2003; Huas 2006; Rahme 2005; Rosemann 2007; Schectman 2003, Watson 2008
Local consensus processes	0
Educational outreach visits	6	Becker 2008; Broadhurst 2007; Dey 2004; Robling 2002; Schectman 2003; Solomon 2007a
Local opinion leaders	3	Majumdar 2008; Stross 1985; Schectman 2003
Patient‐mediated	6	Boyd 2002; Ciaschini 2010; Cranney 2008; Huas 2006; Roux 2013; Rozental 2008
Audit and feedback	4	Eccles 2001; Kerry 2000; Robling 2002; Schectman 2003
Reminders	11	Bishop 2006; Ciaschini 2010; Cranney 2008; Eccles 2001; Feldstein 2006; Hazard 1997; Lafata 2007; Leslie 2012; Majumdar 2008; Roux 2013; Rozental 2008
Marketing	0
Mass media	0
Patient‐directed⁴	12	Becker 2008; Bessette 2011; Bishop 2006; Leslie 2012; Ciaschini 2010; Cranney 2008; Feldstein 2006; Lafata 2007; Majumdar 2008; Rosemann 2007; Roux 2013; Solomon 2007a
1. Category of intervention as classified by the EPOC taxonomy EPOC 2007 [9] 2. See Table 1 for definition of each intervention 3. Some studies used more than one intervention type and these are listed against their corresponding category 4. Patient‐directed interventions targeted patients and included patient education and reminders to see their primary‐care physician. These were included in the review only if they were a component of a professional intervention targeting primary‐care physicians

Table 3. Intervention combinations compared to a no‐intervention control group
Intervention combinations	No. of comparisons	Study ID
Single component interventions:
Distribution of educational materials	1	Rahme 2005
Patient‐directed	3	Lafata 2007; Leslie 2012; Solomon 2007a
Educational meetings, workshops	1	Rahme 2005
Multifaceted interventions: Two intervention components
Distribution of educational material + reminders	4	Bishop 2006; Feldstein 2006; Hazard 1997; Leslie 2012
Distribution of educational material + educational outreach visits	4	Broadhurst 2007; Chassany 2006; Dey 2004; Solomon 2007a
Distribution of educational material + educational meeting/workshop	6	Chassany 2006; Engers 2005; French 2013; Rahme 2005; Rosemann 2007; Watson 2008
Distribution of educational material + local opinion leaders	1	Stross 1985
Distribution of educational material + audit/feedback	1	Kerry 2000
Patient‐mediated + educational meeting/workshop	1	Huas 2006
Patient‐directed +reminder	1	Lafata 2007
Patient‐directed + educational material	1	Bessette 2011
Multifaceted interventions: Three intervention components
Patient‐directed + educational material + reminder	3	Bishop 2006; Feldstein 2006, Leslie 2012
Patient‐directed + educational material + educational meeting/workshop	1	Rosemann 2007
Patient‐directed + educational material + educational outreach visit	1	Solomon 2007a
Multifaceted interventions: Four intervention components
Patient‐directed + distribution of educational material + reminder + local opinion leaders	1	Majumdar 2008
Patient‐mediated + distribution of educational material + reminders + patient‐directed (education and reminders)	3	Ciaschini 2010; Cranney 2008; Roux 2013
Multifaceted interventions: Five intervention components
Distribution of educational material + educational meetings/workshops + audit + educational outreach visit + local opinion leaders	1	Schectman 2003

Table 4. Intervention combinations compared to a different intervention
Intervention combinations	No. of comparisons	Study ID
Single component interventions:
Educational meetings/workshops vs distribution of educational material	1	Rahme 2005
Educational meetings/workshops vs a different educational meeting/workshop	1	Gormley 2003
Multifaceted interventions: Two intervention components
Distribution of educational material + patient‐mediated vs the same intervention but less intensive	1	Boyd 2002
Distribution of educational material + educational outreach visit vs distribution of educational material	1	Robling 2002
Distribution of educational material + audit vs distribution of educational material	2	Robling 2002; Eccles 2001
Distribution of educational material + audit vs distribution of educational material + reminder	1	Eccles 2001
Distribution of educational material + outreach vs distribution of educational material + audit	1	Robling 2002
Distribution of educational material + educational outreach visit vs patient‐directed	1	Solomon 2007a
Distribution of educational material + patient‐directed vs the same (more intensive)	1	Bessette 2011
Patient‐directed + reminder vs patient‐directed	1	Lafata 2007
Distribution of educational material + reminder vs distribution of educational material	1	Eccles 2001
Distribution of educational material + reminder vs patient‐mediated	1	Rozental 2008
Distribution of educational material + educational meeting/workshop vs educational meeting/workshop	1	Rahme 2005
Distribution of educational material + educational meeting/workshop vs distribution of educational material	1	Rahme 2005
Multifaceted interventions: Three intervention components
Distribution of educational material + reminders + patient‐directed vs distribution of educational material + reminders	2	Bishop 2006; Feldstein 2006
Distribution of educational material + reminder + patient‐directed vs patient‐directed	1	Leslie 2012
Distribution of educational material + audit + reminders vs distribution of educational material	1	Eccles 2001
Distribution of educational material + audit + reminders vs distribution of educational material + audit	1	Eccles 2001
Distribution of educational material + audit + reminders vs distribution of educational material + reminders		Eccles 2001
Distribution of educational material + audit + outreach vs distribution of educational material + outreach	1	Robling 2002
Distribution of educational material + audit + outreach vs distribution of educational material + audit	1	Robling 2002
Distribution of educational material + audit + outreach vs distribution of educational material	1	Robling 2002
Distribution of educational material + educational meetings/workshops + educational outreach visits vs distribution of educational material	1	Becker 2008
Distribution of educational material + educational outreach visit + patient‐directed vs patient‐directed	1	Solomon 2007a
Distribution of educational material + educational outreach visit + patient‐directed vs distribution of educational material + educational outreach visit	1	Solomon 2007a
Distribution of educational material + educational meeting/workshop + patient‐directed vs distribution of educational material + educational meeting/workshop	1	Rosemann 2007
Multifaceted interventions: Four intervention components
Distribution of educational material + educational meetings/workshops + educational outreach visits + patient‐directed vs distribution of educational material	1	Becker 2008
Distribution of educational material + educational meetings/workshops +educational outreach visits + patient directed vs distribution of educational material + educational meetings/workshops + educational outreach visits	1	Becker 2008
Patient‐mediated + distribution of education material + reminders + patient‐directed (education and reminders) vs patient‐mediated + distribution of education material + reminders + patient‐directed (education and reminders)	1	Roux 2013

(Study) Intervention	Int pre (%) ¹	C pre (%)²	Int post (%)³	C post (%)⁴	ARD ⁵	Risk difference ⁶ ^{(P value if reported by authors)}	Relative % change post ⁷	Risk ratio ⁸
(Bessette 2011)^* Patient education and reminder to see their physician (patient directed), education of physician via the patient (distribution of educational material)	‐	‐	14.72%	11.96%	‐	2.8%	23%	1.2
(Bessette 2011)^* Patient education (including video on osteoporosis) and reminder to see their physician, education of physician via the patient (distribution of educational material)	‐	‐	15.81%	11.96%	‐	3.9%	32%	1.3
(Cranney 2008)** Patient‐specific mailed letter to primary are physician (including guidelines) and patient education and reminder	‐	‐	64/125 (51%)	36/145 (25%)	‐	26.4% (P< 0.0001)	106%	2.1
(Feldstein 2006) Patient‐specific Electronic Medical Record (EMR) reminders to primary‐care provider informing them of patient increased risk and guidelines. Sent twice.	‐	‐	40/101 (39.6%)	2/103 (1.9%)	‐	37.7% (P< 0.01)	1940%	20.4
(Feldstein 2006) EMR reminder plus patient‐directed intervention: education and reminder	‐	‐	36/110 (32.7%)	2/103 (1.9%)	‐	30.8% (P< 0.01)	1585%	16.9
(Lafata 2007)** Patient‐directed: 2 mailings (educational and reminders)	‐	‐	720/3367 (21.4%)	313/2901 (10.8%)	‐	10.6% (P< 0.001)	98%	2
(Lafata 2007)** Physician prompt: Electronic Medical Record (EMR) reminder to physician and biweekly mailing plus patient‐directed: 2 mailings (educational and reminders)	‐	‐	1181/4086 (28.9%)	313/2901 (10.8%)	‐	18.1% (P< 0.001)	168%	2.7
(Leslie 2012) Physician reminder plus educational material			224/1363 (16.4%)	58/1480 (3.9%)	‐	12.5%	319%	4.2
(Leslie 2012) Physician reminder plus educational material plus patient‐directed intervention (reminder to see their physician)	‐	‐	258/1421 (18.2%)	58/1480 (3.9%)	‐	14.2%	363%	4.6
(Majumdar 2008) Patient education, physician patient‐specific reminders by mail/fax, physician guidelines endorsed by opinion leaders	‐	‐	71/137 (51.8%)	24/135 (17.8%)	‐	34% (P< 0.001)	192%	2.9
(Solomon 2007a)** Patient directed (3 mailed letters educational)	‐	‐	249/3274 (7.6%)	224/3268 (6.9%)	‐	0.8% (NS)	11%	1.1
(Solomon 2007a)** Physician education following an academic‐detailing approach	‐	‐	183/3574 (5.1%)	224/3268 (6.9%)	‐	‐1.7% (NS)	‐25%	0.7
(Solomon 2007b)** Combination of both physician and patient education	‐	‐	223/3339 (6.7%)	224/3268 (6.9%)	‐	‐0.2% (NS)	‐3%	1
1. Intervention group pre‐intervention proportion 2. Control group pre‐intervention proportion 3. Intervention group post‐intervention proportion 4. Control group post‐intervention proportion 5. ARD = [Int post (%) minus C post (%)] minus [Int pre (%) minus C pre (%)]. The direction of effect has been adjusted so that a positive result represents a beneficial intervention outcome, according to Grimshaw 2004. 6. Risk Difference (RD) is the absolute % change post‐intervention = Int post (%) minus C post (%). This is considered to be "small" if ≤ 5%, "modest" if > 5% and ≤10%,"moderate" if > 10% but ≤ 20%, and "large" if > 20%.The direction of effect has been adjusted so that a positive result represents a beneficial intervention outcome, according to Grimshaw 2004. 7. Relative % change post = absolute % change post divided by C post (%). The direction of effect has been adjusted so that a positive result represents a beneficial intervention outcome, according to Grimshaw 2004. 8. Risk ratio (RR) = Int post (%) divided by C post (%) BMD: bone mineral density; C: control group; Int: intervention group; ARD: adjusted risk difference; NS: not significant * In the study by Bessette 2011, the outcomes reported above include the participants with a diagnosis following the intervention. The women were considered "diagnosed" if they received a BMD test, if they were informed by their physician that they were suffering from osteoporosis and/or if they were initiated on osteoporosis medication. Therefore, the above percentages do not necessarily mean that the women received a BMD test. ** The data reported above for the studies by Cranney 2008, Lafata 2007 and Solomon 2007b does not account for clustering. We did not have access to sufficient information to adjust the data for clustering.

(Study) Interventions	Int 1 pre (%) ¹	Int 2 pre (%)²	Int 1 post (%)³	Int 2 post (%)⁴	ARD ⁵	Risk difference⁶ ^{(P value if reported by authors)}	Relative % change post ⁷	Risk ratio ⁸
(Bessette 2011)* Patient education, education of physician via the patient, reminder to family physician versus Patient education (including video on osteoporosis), education of physician via the patient, reminder to family physician			14.72%	15.81%		‐1.1%	‐7%	0.9
(Boyd 2002) Patient‐specific letter to primary care physician containing information on results and recommendations: standard versus extended letter	‐	‐	25/83 (30.1%)	29/78 (37.2%)	‐	‐7.1%	‐19%	0.8
(Feldstein 2007) Patient‐specific Electronic Medical Record (EMR) reminders to primary‐care provider informing them of patient increased risk and guidelines (sent twice) versus EMR plus patient‐directed intervention (education and reminder)	‐	‐	40/101 (39.6%)	36/110 (32.7%)	‐	6.9%	21%	1.2
(Lafata 2007) Patient‐directed: 2 mailings (educational and reminders) versus** physician prompt: Electronic Medical Record (EMR) reminder to physician and biweekly mailing plus patient‐directed: 2 mailings (educational and reminders)	‐	‐	720/3367 (21.4%)	1181/4086 (28.9%)	‐	‐7.5%	‐26%	0.7
(Leslie 2012) Physician reminder plus educational material versus physician reminder plus educational material plus patient‐directed intervention (reminder to see their physician)	‐	‐	224/1363 (16.4%)	258/1421 (18.2%)	‐	‐1.7% (NS)	‐9%	0.9
(Rozental 2008) Patient‐specific letter to primary‐care physician outlining guidelines versus orthopaedic surgeon ordering BMD and forwarding results to primary‐care physician			7/23 (30.4%)	25/27(92.6%)	‐	‐62.2%	‐67%	0.3
(Solomon 2007a) Patient‐directed (3 mailed letters educational) versus** physician education following an academic‐detailing approach	‐	‐	249/3274 (7.6%)	183/3574 (5.1%)	‐	2.5%	49%	1.5
(Solomon 2007a) Patient‐directed (3 mailed letters educational) versus** combination of both physician and patient education	‐	‐	249/3274 (7.6%)	223/3339 (6.7%)	‐	0.9%	14%	1.1
(Solomon 2007a) Physician education following an academic‐detailing approach versus** combination of both physician and patient education	‐	‐	183/3574 (5.1%)	223/3339 (6.7%)	‐	‐1.6%	‐23%	0.8
1. Intervention 1 group pre‐intervention proportion 2. Intervention 2 group pre‐intervention proportion 3. Intervention 1 group post‐intervention proportion 4. Intervention 2 group post‐intervention proportion 5. ARD = [Int 1 post (%) minus Int 2 post (%)] minus [Int 1 pre (%) minus Int 2 pre (%)]. The direction of effect has been adjusted so that a positive result represents a beneficial intervention 1 outcome, according to Grimshaw 2004. 6. Risk Difference (RD) is the absolute % change post‐intervention = Int 1 post (%) minus Int 2 post (%). This is considered to be "small" if ≤ 5%, "modest" if > 5% and ≤10%,"moderate" if > 10% but ≤ 20%, and "large" if > 20%.The direction of effect has been adjusted so that a positive result represents a beneficial intervention 1 outcome. 7. Relative % change post = absolute % change post divided by Int 2 post (%). The direction of effect has been adjusted so that a positive result represents a beneficial intervention 1 outcome, according to Grimshaw 2004. 8. Risk ratio (RR) = Int 1 post (%) divided by Int 2 post (%) BMD: bone mineral density; Int 1: intervention 1 group; Int 2: Intervention 2 group; ARD: adjusted risk difference; NS: not significant * In the study by Bessette 2011, the outcomes reported above include the participants with a diagnosis following the intervention. The women were considered "diagnosed" if they received a BMD test, if they were informed by their physician that they were suffering from osteoporosis and/or if they were initiated on osteoporosis medication. Therefore, the above percentages do not necessarily mean that the women received a BMD test. **The data reported above for the studies by Lafata 2007 and Solomon 2007b does not account for clustering. We did not have access to sufficient information to adjust the data for clustering.

(Study) Intervention	Outcome	Int pre (%) ¹	C pre (%)²	Int post (%)³	C post (%)⁴	ARD ⁵	Risk difference ⁶ ^{(P value if reported by authors)}	Relative % change post ⁷	Risk ratio ⁸
(Bishop 2006) Physician education (guidelines) and 3 patient‐specific reminder letters	Education and reassurance according to guideline 0 ‐ 4 weeks post‐onset	‐	‐	10% (16/162)	7% (10/149)		3.2%	47%	1.5
	Exercise according to guideline 0 ‐ 4 weeks post‐onset	‐	‐	38% (62/162)	43% (64/149)		‐4.7%	‐11%	0.9
	Appropriate medication according to guideline 0 ‐ 4 weeks post‐onset	‐	‐	85% (138/162)	77% (115/149)		8% (P=0.14)	10%	1.1
	Spinal manipulation according to guideline 0 ‐ 4 weeks post‐onset	‐	‐	2.5% (4/162)	6% (9/149)		‐3.6%	‐59%	0.4
	Guideline‐discordant physician recommended treatment 0 ‐ 4 weeks post‐onset	‐	‐	10% (16/162)	17% (25/149)		6.9% (P=0.05)	41%	0.6
	Supervised exercise programme (recommended treatment 5 ‐ 12 weeks post‐onset)	‐	‐	19% (29/154)	14% (21/149)		4.7% (P=0.11)	34%	1.3
	Return to work (recommended treatment 5 ‐ 12 weeks post‐onset)	‐	‐	24% (37/154)	17% (25/149)		7.2% (P=0.18)	43%	1.4
	Refer to interdisciplinary programme (recommended treatment 5 ‐ 12 weeks post‐onset)	‐	‐	4% (6/154)	2% (3/149)		1.9%	94%	1.9
	Physiotherapy > 4 weeks (guideline‐discordant)	‐	‐	41% (63/154)	43% (64/149)		2%	5%	1
	Continued use of spinal manipulation therapy (guideline‐discordant)	‐	‐	‐(no data available)	33% (49/149)		‐ (P=0.04)	‐
(Bishop 2006) Physician education, reminders and also patient education and 3 reminders	Education and reassurance according to guideline 0 ‐ 4 weeks post‐onset	‐	‐	6% (9/151)	7% (10/149)		‐0.8%	‐11%	0.9
	Exercise according to guideline 0 ‐ 4 weeks post‐onset	‐	‐	53% (80/151)	43% (64/149)		10% (P=0.05)	23%	1.2
	Appropriate medication according to guideline 0 ‐ 4 weeks post‐onset	‐	‐	81% (122/151)	77% (115/149)		3.6% (P=0.08)	5%	1
	Spinal manipulation according to guideline 0 ‐ 4 weeks post‐onset	‐	‐	5% (8/151)	6% (9/149)		‐0.7%	‐12%	0.9
	Guideline‐discordant physician recommended treatment 0 ‐ 4 weeks post‐onset	‐	‐	18% (27/151)	17% (25/149)		‐1.1%	‐7%	1.1
	Supervised exercise programme (recommended treatment 5 ‐ 12 weeks post‐onset)	‐	‐	18% (26/145)	14% (21/149)		3.8% (P=0.07)	27%	1.3
	Return to work (recommended treatment 5 ‐ 12 weeks post‐onset)	‐	‐	23% (33/145)	17% (25/149)		6% (P=0.14)	36%	1.4
	Refer to interdisciplinary programme (recommended treatment 5 ‐ 12 weeks post‐onset)	‐	‐	0	2% (3/149)		‐2%	‐100%	0
	Physiotherapy > 4 weeks (guideline‐discordant)	‐	‐	42% (61/145)	43% (64/149)		0.9%	2%	1
	Continued use of spinal manipulation therapy (guideline‐discordant)	‐	‐	3% (4/145)	33% (49/149)		30.1% (P=0.05)	92%	0.1
(Dey 2004)* Intervention (aimed at general practitioners): guidelines discussion (educational component), patient information leaflets, access to fast‐track physiotherapy and triage services for patients with persistent symptoms (organisational component) versus usual care (control)*	X‐ray referrals			15.1% (43/284)	13.7% (42/308)		‐1.4% (P=0.62)	‐10%	1.1
	Sickness certificates			17.9 % (34/190)	19.2% (40/206)		1.3% (P=0.74)	7%	0.9
	Prescriptions for opioids or muscle relaxants			18.6% (84/452)	18.7% (92/491)		0.1 (P=0.99)	1	1
	Referrals to secondary care			3.4% (33/962)	2.3% (24/1044)		‐1.1% (P=0.12)	‐49%	1.5
	Referrals to physiotherapy or educational programme	‐	‐	26.3% (44/167)	13.8% (25/181)	‐	‐12.6% (P=0.01)	‐91%	1.9
(Engers 2005)** Intervention (aimed at general practitioners): guidelines on low back pain, 2‐hour workshop, 2 scientific articles, guidelines on low back pain for occupational physicians, tool for patient education and management‐decision tool. Control group: usual care	Referral to a therapist	‐	‐	22.9% (75/328)	27.4% (79/288)	‐	4.6%	17%	0.8
	Prescription of pain medication on a time‐contingent basis	‐	‐	70% (139/328)	69% (130/288)	‐	2.8%	6%	0.9
	Handed patient information leaflet	‐	‐	36.9% (121/328)	38.2% (110/288)	‐	‐1.3%	‐3%	1
	Advised patient to stay active	‐	‐	95.1% (312/328)	89.2% (257/288)	‐	5.9%	7%	1.1
	Advised patient to gradually increase activity	‐	‐	78% (256/328)	65.3% (188/288)	‐	12.8%	20%	1.2
	Advised patient which activities to increase at what moment	‐	‐	18% (58/328)	9% (26/288)	‐	8.7%	96%	2
(French 2013)* Intervention (aimed at general practitioners): Interactive, educational workshops plus educational material disseminated (via DVDs); Control group: usual care	Number of x‐ray requests out of total number of patients seen	‐	‐	0.83% (67/8,085)	1.02% (80/7,826)		0.2% (P=0.2)	19%	0.8
	Number of CT requests out of total number of patients seen	‐	‐	0.61% (64/10,419)	0.66% (66/10,085)	‐	0.0% (P=0.6)	7%	0.9
(Hazard 1997) Intervention (aimed at physicians): notification that patient was at a high risk of disability and guidelines on management. Control group: usual care	3‐month work absence rates	‐	‐	28.6% (8/28)	24% (6/25)	‐	‐4.6% (NS)	‐19%	1.2
(Schectman 2003) Intervention (aimed at physicians): guideline on low back pain, 90‐minute educational session on guideline implementation delivered by local opinion leaders and audit report summarising performance against the guideline plus outreach visit. Control group: usual care plus/minus patient education (pamphlet and video)	Lumbosacral X‐ray total utilisation (% of patients based on episode of care)	31%	21%	19%	18%	9%	‐1%	‐6%	1.1
	Lumbosacral X‐ray not consistent with guideline	14.5%	8.2%	8.1%	8.6%	6.8%	0.5%	6%	0.9
	Lumbosacral CT/MRI total utilisation (% of patients based on episode of care)	7.6%	5.6%	5.6%	7.1%	3.5%	1.5%	21%	0.8
	Lumbosacral CT/MRI not consistent with guideline	5.7%	3.5%	3.5%	5.4%	4.1%	1.9%	35%	0.6
	Physical therapy referral total utilisation (% of patients based on episode of care)	12%	13%	10%	13%	2%	3%	23%	0.8
	Physical therapy referral not consistent with guideline	10%	10.9%	9.2%	12%	1.9%	2.8%	23%	0.8
	Specialty referral total utilisation (% of patients based on episode of care)	12%	5.9%	8.6%	7.1%	4.6%	‐1.5%	‐21%	1.2
	Specialty referral not consistent with guideline	9.5%	4%	7.1%	5.6%	4%	‐1.5%	‐27%	1.3
1. Intervention group pre‐intervention proportion 2. Control group pre‐intervention proportion 3. Intervention group post‐intervention proportion 4. Control group post‐intervention proportion 5. ARD = [Int post (%) minus C post (%)] minus [Int pre (%) minus C pre (%)]. The direction of effect has been adjusted so that a positive result represents a beneficial intervention outcome, according to Grimshaw 2004. 6. Risk Difference (RD) is the absolute % change post‐intervention = Int post (%) minus C post (%). This is considered to be "small" if ≤ 5%, "modest" if > 5% and ≤10%,"moderate" if > 10% but ≤ 20%, and "large" if > 20%.The direction of effect has been adjusted so that a positive result represents a beneficial intervention outcome, according to Grimshaw 2004. 7. Relative % change post = absolute % change post divided by C post (%). The direction of effect has been adjusted so that a positive result represents a beneficial intervention outcome, according to Grimshaw 2004. 8. Risk ratio (RR) = Int post (%) divided by C post (%) C: control group; Int: intervention group; ARD: adjusted risk difference; NS: not significant CT/MRI: computed tomography/magnetic resonance imaging * Dey 2004 reported the Intercluster Correlation (ICC) for the results (mean cluster size=95.1) and this was used to calculate the above effective sample sizes according to chapter 16.3.4 of the Cochrane Handbook, Higgins 2011a. The data reported above for the study by Engers 2005 does not account for clustering. We did not have access to sufficient information to adjust the data for clustering. *French 2013 reported Intercluster Correlation (ICC for x‐rays 0.004 and for CTs 0.003, mean cluster size=2,154) and this was used to calculate the above effective sample sizes according to chapter 16.3.4 of the Cochrane Handbook, Higgins 2011a

(Study) Intervention 1 versus intervention 2	Outcome	Int 1 pre (%) ¹	Int 2 pre (%)²	Int 1 post (%)³	Int 2 post (%)⁴	ARD ⁵	Risk difference ⁶ ^{(P value if reported by authors)}	Relative % change post ⁷	Risk ratio ⁸
(Bishop 2006) Physician education (guidelines) and 3 patient‐specific reminder letters versus physician education, reminders and also patient education and 3 reminders	Education and reassurance according to guideline 0 ‐ 4 weeks post‐onset	‐	‐	10% (16/162)	6% (9/151)	‐	3.9% (NS)	66%	1.7
	Exercise according to guideline 0 ‐ 4 weeks post‐onset	‐	‐	38% (62/162)	53% (80/151)	‐	‐14.7% (P=0.0083)	‐28%	0.7
	Appropriate medication according to guideline 0 ‐ 4 weeks post‐onset	‐	‐	85% (138/162)	81% (122/151)	‐	4.4% (NS)	5%	1.1
	Spinal manipulation according to guideline 0 ‐ 4 weeks post‐onset	‐	‐	2.5% (4/162)	5% (13/151)	‐	‐6.1% (P=0.018)	‐71%	0.3
	Guideline‐discordant physician‐recommended treatment 0 ‐ 4 weeks post‐onset	‐	‐	10% (16/162)	18% (27/151)	‐	8% (P=0.04)	45%	0.6
	Supervised exercise programme (recommended treatment 5 ‐ 12 weeks post‐onset)	‐	‐	19% (29/154)	18% (26/145)	‐	0.9% (NS)	5%	1.1
	Return to work (recommended treatment 5 ‐ 12 weeks post‐onset)	‐	‐	24% (37/154)	23% (33/145)	‐	1.3% (NS)	6%	1.1
	Refer to interdisciplinary programme (recommended treatment 5 ‐ 12 weeks post‐onset)	‐	‐	4% (6/154)	0	‐	3.9% (P=0.02)	‐	‐
	Physiotherapy > 4 weeks (guideline‐discordant)	‐	‐	41% (63/154)	42% (61/145)	‐	1.2% (NS)	3%	1
	Continued use of spinal manipulation therapy (guideline‐discordant)	‐	‐	‐ (no data available)	3% (4/145)	‐	‐	‐	‐
(Eccles 2001)* Feedback on number of spinal radiographs 6 months before and 6 months after the intervention plus guideline dissemination versus guideline dissemination	Lumbar spine radiographs concordant with guidelines	‐	‐	35.4% (64/181)	43.6% (120/275)	‐	‐8.3%	‐19%	0.8
(Eccles 2001)* Reminder messages on radiograph reports plus guideline dissemination versus guideline dissemination	Lumbar spine radiographs concordant with guidelines	‐	‐	41.2% (35/85)	43.6% (120/275)	‐	‐2.5%	‐6%	0.9
(Eccles 2001)* Feedback on number of spinal radiographs 6 months before and 6 months after the intervention plus guideline dissemination plus reminder messages on radiograph reports versus guideline dissemination	Lumbar spine radiographs concordant with guidelines	‐	‐	36% (89/247)	43.6% (120/275)	‐	‐7.6%	‐17%	0.8
(Eccles 2001)* Feedback on number of spinal radiographs 6 months before and 6 months after the intervention plus guideline dissemination versus reminder messages on radiograph reports plus guideline dissemination	Lumbar spine radiographs concordant with guidelines	‐	‐	35.4% (64/181)	41.2% (35/85)	‐	‐5.8%	‐14%	0.9
1. Intervention 1 group pre‐intervention proportion 2. Intervention 2 group pre‐intervention proportion 3. Intervention 1 group post‐intervention proportion 4. Intervention 2 group post‐intervention proportion 5. ARD = [Int 1 post (%) minus Int 2 post (%)] minus [Int 1 pre (%) minus Int 2 pre (%)]. The direction of effect has been adjusted so that a positive result represents a beneficial intervention 1 outcome, according to Grimshaw 2004. 6. Risk Difference (RD) is the absolute % change post‐intervention = Int 1 post (%) minus Int 2 post (%). This is considered to be "small" if ≤ 5%, "modest" if > 5% and ≤10%,"moderate" if > 10% but ≤ 20%, and "large" if > 20%.The direction of effect has been adjusted so that a positive result represents a beneficial intervention 1 outcome. 7. Relative % change post = absolute % change post divided by Int 2 post (%). The direction of effect has been adjusted so that a positive result represents a beneficial intervention 1 outcome, according to Grimshaw 2004. 8. Risk ratio (RR) = Int 1 post (%) divided by Int 2 post (%) Int 1: intervention 1 group; Int 2: Intervention 2 group; ARD: Adjusted risk difference; NS: not significant *The data reported above for the study by Eccles 2001 does not account for clustering. We did not have access to sufficient information to adjust the data for clustering.

	Idioma de la Revisión Cochrane Escoja su idioma de preferencia para las revisiones Cochrane y otros contenidos. Las secciones sin una traducción aparecerán en inglés.

	Idioma de la web Escoja su idioma de preferencia para la web de la Biblioteca Cochrane.

Study	Intervention	Outcome	Mean pre (SD)	Mean post (SD)	Mean post minus mean pre	Relative % change pre to post	SMD pre to post	Mean change in level (p value)	Mean change in slope (p value)
Hollingworth 2002	Educational material	Back x‐rays ordered	1133 (50)	1208.7 (111.5)	‐75.7	‐6.7	‐1.51	‐121.5 (P = 0.167)	6.8 (P = 0.776)

(Study) Intervention	Outcome	Int pre mean (SD)¹	C pre mean (SD)²	Int post mean (SD)³	C post mean (SD)⁴	MD ⁵	Relative % change ⁶	Adjusted relative % change⁷	SMD⁸ (P value)⁹
(Chassany 2006)* GP training on relationships and communication, pain evaluation, prescription and negotiation of a patient contract delivered in a 4‐hour interactive session plus 8 reminders on recommendations	Pain relief (SPID)	‐	‐	315.6 (289.5)	264.7 (242.9)	50.9	19%	19%	0.2 (P< 0.0001)
	Intensity of pain in motion on VAS	63.7 (13.8)	62.8 (13.5)	‐29 (23.1)	‐24.8 (21.1)	4.2	17%	‐21%	0.2 (P=0.01)
	Lequesne Index	9.2 (2.9)	9.8 (3.2)	‐2.5 (2.5)	‐2.0 (2.4)	0.5	25%	5%	0.2 (P< 0.0001)
	WOMAC index pain	9.3 (3.0)	9.6 (2.8)	‐2.9 (3.4)	‐2.2 (2.9)	0.7	32%	‐18%	0.2 (P< 0.0001)
	WOMAC index stiffness	4.1 (1.4)	4.0 (1.4)	‐1.2 (1.6)	‐0.8 (1.4)	0.4	50%	‐62%	0.3 (P=0.0004)
	WOMAC index physical function	31.2 (10.9)	32.8 (9.5)	‐8.7 (10.7)	‐6.1 (8.8)	2.6	43%	‐16%	0.3 (P< 0.0001)
	WOMAC index global score	44.6 (14.4)	46.4 (12.5)	‐12.9 (14.8)	‐9.2 (12.2)	3.7	40%	‐21%	0.3 (P< 0.0001)
	Acetaminophen consumption	‐	‐	3400 (800)	2900 (900)	‐500	‐17%	‐17%	‐0.6 (P< 0.0001)
(Rosemann 2007)* Intervention (aimed at GPs): 2 interactive 8‐hour meetings focusing on arthritis self management, guideline dissemination and patient information material versus control (usual care)	Quality of life (AIMS2‐SF scores) Lower body	2.67 (1.88)	2.65 (1.85)	2.48	2.62	‐0.14	‐5%	‐6%	‐0.1 (P=0.349)
	Quality of life (AIMS2‐SF scores) Upper body	1.47 (2.25)	1.33 (2.09)	1.43	1.34	0.09	7%	‐4%	0.1 P=0.694)
	Quality of life (AIMS2‐SF scores) Symptom	4.87 (2.13)	4.81 (2.18)	4.51	4.72	‐0.21	‐4%	‐6%	‐0.2 (P=0.119)
	Quality of life (AIMS2‐SF scores) Affect	2.89 (1.35)	2.88 (1.33)	2.92	2.83	0.09	3%	3%	0.1 (P=0.610)
	Quality of life (AIMS2‐SF scores) Social	4.52 (1.88)	4.69 (1.80)	4.43	4.62	‐0.19	‐4%	0%	‐0.3 P=0.776
	GP contacts	4.56 (6.13)	4.82 (6.00)	4.44	4.6	0.16	3%	‐2%	0.1 (P=0.339)
	Referrals to orthopaedics	1.58 (3.43)	1.76 (3.52)	1.49	1.75	0.26	15%	5%	0.8 (P=0.153)
	Radiographs	0.82 (3.12)	0.79 (2.78)	0.75	0.85	0.1	12%	15%	0.2 (P=0.05)
	Non‐medical practitioners	0.11 (3.01)	0.36 (3.28)	0.09	0.32	0.23	72%	‐6%	0.6 (P=0.687)
	Physiotherapy	4.70 (9.10)	5.81 (11.10)	4.63	5.77	1.14	20%	1%	2 (P=0.242)
	Acupuncture	0.83 (3.45)	0.97 (3.80)	0.8	0.97	0.17	18%	3%	0.2 (P=0.821)
(Rosemann 2007)* Intervention (aimed at GPs) as above plus patient case management via telephone by practice nurses versus control (usual care)	Quality of life (AIMS2‐SF scores) Lower body	3.01 (2.11)	2.65 (1.85)	2.61	2.62	‐0.01	0%	‐14%	0 (P=0.049)
	Quality of life (AIMS2‐SF scores) Upper body	1.68 (2.44)	1.33 (2.09)	1.62	1.34	0.28	21%	‐5%	0.2 (P=0.621)
	Quality of life (AIMS2‐SF scores) Symptom	5.02 (2.29)	4.81 (2.18)	4.42	4.72	‐0.3	‐6%	‐11%	‐0.2 (P=0.048)
	Quality of life (AIMS2‐SF scores) Affect	3.04 (1.39)	2.88 (1.33)	2.98	2.83	0.15	5%	0%	0.2 (P=0.691)
	Quality of life (AIMS2‐SF scores) Social	4.79 (1.80)	4.69 (1.80)	4.736	4.62	0.116	3%	0%	0.1 (P< 0.001)
	GP contacts	5.01 (5.78)	4.82 (6.00)	4.9	4.6	‐0.3	‐7%	‐2%	‐0.2 (P=0.823)
	Referrals to orthopaedics	1.76 (3.52)	1.76 (3.52)	1.52	1.75	0.23	13%	13%	0.2 (P=0.044)
	Radiographs	0.80 (3.01)	0.79 (2.78)	0.71	0.85	0.14	16%	18%	0.4 (P=0.031)
	Non‐medical practitioners	0.50 (4.20)	0.36 (3.28)	0.47	0.32	‐0.15	‐47%	‐3%	‐0.4 (P=0.225)
	Physiotherapy	5.22 (10.03)	5.81 (11.10)	5.08	5.77	0.69	12%	2%	1.3 (P=0.129)
	Acupuncture	0.77 (3.99)	0.97 (3.80)	0.72	1.09	0.37	34%	16%	0.4 (P=0.769)
(Stross 1985)** Intervention: Educationally‐influential physicians (EIs) led education of primary‐care physicians: self‐study programme including textbook, audiovisual materials and recent articles on osteoarthritis versus control (usual care)	Length of stay for OA patients	8.8	8.4	8.4	8.6	0.2	2%	7%	NR
	Length of stay for total hip arthroplasty (THA) patients	17.2	16.6	15.2	16.0	0.8	5%	9%	NR
1. Intervention group pre‐intervention mean (standard deviation) 2. Control group pre‐intervention mean (standard deviation) 3. Intervention group post‐intervention mean (standard deviation) 4. Control group pos‐tintervention mean (standard deviation) 5. Mean Difference (MD)=Difference between post‐intervention means. The direction of effect has been adjusted so that a positive result represents a beneficial intervention outcome, according to Grimshaw 2004. 6. Relative percentage change post‐intervention = (Int post mean ‐ Control post mean)/Control post mean 7. Adjusted relative percentage change= (Int post mean‐Control post mean)‐(Int pre mean ‐ Control pre mean)/Control post mean. The direction of effect has been adjusted so that a positive result represents a beneficial intervention outcome. 8. SMD=Standardised Mean Difference=(Int post mean‐Control post mean)/SD pooled. The direction of effect has been adjusted so that a positive result represents a beneficial intervention outcome, according to Grimshaw 2004. 9. P value reported by study authors AIMS2‐SF: Arthritis Impact Measurement Scales Short Form WOMAC: Western Ontario and McMaster Universities Osteoarthritis Index * There are potential unit of analysis errors in the reported results as the study did not account for clustering and did not provide sufficient data to allow an approximate analysis according to chapter 16.3.4 of the Cochrane Handbook, Higgins 2011a. **The study did not report standard deviations and therefore we were unable to calculate the SMD. There are potential unit of analysis errors in the reported results as the study did not account for clustering and did not provide sufficient data to allow an approximate analysis according to chapter 16.3.4 of the Cochrane Handbook, Higgins 2011a.

(Study) Intervention 1 versus Intervention 2	Outcome	Int 1 pre mean (SD)¹	Int 2 pre mean (SD)²	Int 1 post mean (SD)³	Int 2 post mean (SD)⁴	MD ⁵	Relative % change ⁶	Adjusted relative % change⁷	SMD⁸ (P value)⁹
(Rosemann 2007)* Intervention (aimed at GPs): 2 interactive 8‐hour meetings focusing on arthritis self management, guideline dissemination and patient information material versus Intervention (aimed at GPs) as above plus patient case management via telephone by practice nurses	Quality of life (AIMS2‐SF scores) Lower body	2.67 (1.88)	3.01 (2.11)	2.48 (1.1)	2.61 (1.4)	‐0.13	‐5%	0%	‐0.1
	Quality of life (AIMS2‐SF scores) Upper body	1.47 (2.25)	1.68 (2.44)	1.43 (1.5)	1.62 (1.3)	‐0.19	‐12%	‐6%	‐0.1
	Quality of life (AIMS2‐SF scores) Symptom	4.87 (2.13)	5.02 (2.29)	4.51 (1.0)	4.42 (1.8)	0.09	2%	12%	0.1
	Quality of life (AIMS2‐SF scores) Affect	2.89 (1.35)	3.04 (1.39)	2.92 (0.8)	2.98 (0.9)	‐0.06	‐2%	‐1%	‐0.1
	Quality of life (AIMS2‐SF scores) Social	4.52 (1.88)	4.79 (1.80)	4.43 (0.6)	4.736 (1.2)	‐0.31	‐6%	‐25%	‐0.3
	GP contacts	4.56 (6.13)	5.01 (5.78)	4.44 (1.7)	4.9 (1.6)	0.46	9%	37%	0.3
	Referrals to orthopaedics	1.58 (3.43)	1.76 (3.52)	1.49 (0.4)	1.52 (1.3)	0.03	2%	‐9%	0.0
	Radiographs	0.82 (3.12)	0.80 (3.01)	0.75 (0.6)	0.71 (0.4)	‐0.04	‐6%	‐1%	‐0.1
	Non‐medical practitioners	0.11 (3.01)	0.50 (4.20)	0.09 (0.4)	0.47 (0.4)	0.38	81%	‐45%	0.9
	Physiotherapy	4.70 (9.10)	5.22 (10.03)	4.63 (0.6)	5.08 (0.6)	0.45	9%	35%	0.7
	Acupuncture	0.83 (3.45)	0.77 (3.99)	0.8 (1.3)	0.72 (1.3)	‐0.08	‐11%	0%	‐0.1
1. Intervention 1 group pre‐intervention mean (standard deviation) 2. Intervention 2 group pre‐intervention mean (standard deviation) 3. Intervention 1 group post‐intervention mean (standard deviation) 4. Intervention 2 group postintervention mean (standard deviation) 5. Mean Difference (MD)=Difference between post‐intervention means. The direction of effect has been adjusted so that a positive result represents a beneficial intervention 1 outcome, according to Grimshaw 2004. 6. Relative percentage change post‐intervention = (Int1 post mean ‐ Int2 post mean)/Int2 post mean. The direction of effect has been adjusted so that a positive result represents a beneficial intervention 1 outcome, according to Grimshaw 2004. 7. Adjusted relative percentage change= (Int1 post mean‐Int2 post mean)‐(Int1 pre mean ‐ Int2 pre mean)/Int2 post mean. The direction of effect has been adjusted so that a positive result represents a beneficial intervention 1 outcome. 8. SMD=Standardised Mean Difference=(Int1 post mean‐Int2 post mean)/SD pooled. The direction of effect has been adjusted so that a positive result represents a beneficial intervention 1 outcome, according to Grimshaw 2004. 9. P value reported by study authors AIMS2‐SF: Arthritis Impact Measurement Scales Short Form * There are unit of analysis errors in the reported results because the available data did not account for the effect of clustering.

Table 23: Summary of median absolute effect sizes (risk difference) of dichotomous outcomes for interventions aiming to increase or decrease a clinical behaviour
Study characteristic: behaviour targeted	Number of comparisons (n studies)	Median absolute effect size	Interquartile range	Range
Increase an existing clinical behaviour according to guidelines	68 (14)	5%	0.6% to 12.6%	‐7.8% to 57.2%
Decrease an existing clinical behaviour according to guidelines	26 (7)	1.1%	‐1.1% to 3%	‐12.6% to 30.1%

Table 24: Summary of median effect sizes (risk difference) of dichotomous outcomes for interventions aiming to increase or decrease a clinical behaviour (including only comparisons from Low Back Pain studies)
Study characteristic: behaviour targeted	Number of comparisons (n studies)	Median absolute effect size	Interquartile range	Range
Increase an existing clinical behaviour according to guidelines	18 (2)	3.7%	‐0.8% to 6.9%	‐4.7% to 12.8%
Decrease an existing clinical behaviour according to guidelines	23 (6)	0.5%	‐1.1% to 2.4%	‐12.6% to 30.1%

Table 25: Summary of median effect sizes (risk difference) of dichotomous outcomes for interventions aiming to increase or decrease a clinical behaviour (including only comparisons from Osteoarthritis studies)
Study characteristic: behaviour targeted	Number of comparisons (n studies)	Median absolute effect size	Interquartile range	Range
Increase an existing clinical behaviour according to guidelines	18 (3)	6.3%	‐0.2% to 10%	‐7.8% to 57.2%
Decrease an existing clinical behaviour according to guidelines	3 (1)	7.8%	6.1% to 13.4%	4.4% to 18.9%

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Bone Mineral Density Show forest plot	3	3386	Risk Ratio (M‐H, Fixed, 95% CI)	4.44 [3.54, 5.55]

2 Osteoporosis medication Show forest plot	5	4223	Risk Ratio (M‐H, Fixed, 95% CI)	1.71 [1.50, 1.94]

Idioma de la Revisión Cochrane

Idioma de la web

Appendices

Appendix 1. Search strategies

MEDLINE OVID

EMBASE OVID

Cochrane Library via OVID EBM Collection

Cochrane Library, Issue 2, 2010 [Wiley]

CINAHL, EbscoHost 1980‐

Copiar o descargar referencia

Idioma de la Revisión Cochrane

Idioma de la web

Instituciones a las que se accedió previamente

Usuarios institucionales

Instituciones a las que se accedió previamente

Otras opciones de acceso