This lecture was given by Dr Raymond Ostelo of the EMGO Institute, VU University Medical Center, Amsterdam, to the North British Pain Association Spring Scientific Meeting in Edinburgh on Friday 18th May, 2007. His lecture forms part of a conference "Blurring the Boundaries - Managing Pain in Primary Care and Secondary Care".

1. www.wspg.org.uk West of Scotland Pain Group www.nbpa.org.uk North British Pain Association

2. Guidelines What difference do they make? a Dutch perspective Raymond Ostelo, PhD, PT EMGO Institute, VU University Medical Centre Institute for Health Sciences, VU University Acknowledgement: Maurits van Tulder, Arno Engers

5. Many myths

11. Development and Implementation Cycle of Guidelines

12. Implementing Evidence Building Evidence Systematical Literature studies Clinical guidelines study the optimal implementation strategies Audit / monitoring Study the effect of implementation define health care problem Experimental studies Observational studies Economical evaluation

13. Implementing Evidence Building Evidence Systematical Literature studies Clinical guidelines study the optimal implementation strategies Audit / monitoring Study the effect of implementation Low Back Problem Experimental studies Observational studies Economical evaluation

14. Implementing Evidence Building Evidence Systematical Literature studies Clinical guidelines study the optimal implementation strategies Audit / monitoring Study the effect of implementation Low Back Problem RCTs on effectiveness & Cost effectiveness

15. Implementing Evidence Building Evidence Sufficient number of systematic (or structured) reviews Clinical guidelines study the optimal implementation strategies Audit / monitoring Study the effect of implementation Low Back Problem RCTs on effectiveness & Cost effectiveness

21. Jacob (1785-1863) & Wilhelm (1786-1859) Grimm

39. Physiotherapists 113 PTs randomised 61 Standard Dissemination 2 drop outs 11 no data 4 drop outs 11 no data   - - 52 Active Implementation N=37 N=48 Same as Engers

42. Results process outcomes: % agreement with guidelines 1: ≤ 3 sessions 4: adequate information 2: adequate goals 5: all recommendations 3: active interventions

43. Results patient-centered outcomes Functional status (QBPDS) Pain intensity (NRS) Work absenteeism, coping, beliefs similar results l l l l l l l

48. Key messages Development : Adhere to guidelines for development Dissemination should be planned, targeted and evaluated & needs to be supplemented by active implementation strategies