Barriers and facilitators to the implementation of orthodontic mini implants in clinical practice: a systematic review

Meursinge Reynders et al. Systematic Reviews Barriers and facilitators to the implementation of orthodontic mini implants in clinical practice: a systematic review Reint Meursinge Reynders 0 1 Laura Ronchi 0 Luisa Ladu 0 Nicola Di Girolamo 2 Jan de Lange 5 Nia Roberts 4 Sharon Mickan 3 0 Via Matteo Bandello 15 , 20123 Milan , Italy 1 Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam , Meibergdreef 9, 1105 AZ Amsterdam , The Netherlands 2 Department of Veterinary Sciences, University of Bologna , Via Tolara di Sopra 50, 40064 Ozzano dell'Emilia, BO , Italy 3 Department of Allied Health, Gold Coast Health and Griffith University , Queensland, QLD 4222 , Australia 4 Bodleian Health Care libraries, Cairns Library Level 3, John Radcliffe Hospital, University of Oxford , Oxford OX3 9DU , UK 5 Department of Oral and Maxillofacial Surgery, Academic Medical Center and Academisch Centrum Tandheelkunde Amsterdam (ACTA), University of Amsterdam , Meibergdreef 9, 1105 AZ Amsterdam , The Netherlands Background: Numerous surveys have shown that orthodontic mini implants (OMIs) are underused in clinical practice. To investigate this implementation issue, we conducted a systematic review to (1) identify barriers and facilitators to the implementation of OMIs for all potential stakeholders and (2) quantify these implementation constructs, i.e., record their prevalence. We also recorded the prevalence of clinicians in the eligible studies that do not use OMIs. Methods: Methods were based on our published protocol. Broad-spectrum eligibility criteria were defined. A barrier was defined as any variable that impedes or obstructs the use of OMIs and a facilitator as any variable that eases and promotes their use. Over 30 databases including gray literature were searched until 15 January 2016. The Joanna Briggs Institute tool for studies reporting prevalence and incidence data was used to critically appraise the included studies. Outcomes were qualitatively synthesized, and meta-analyses were only conducted when pre-set criteria were fulfilled. Three reviewers conducted all research procedures independently. We also contacted authors of eligible studies to obtain additional information. Results: Three surveys fulfilled the eligibility criteria. Seventeen implementation constructs were identified in these studies and were extracted from a total of 165 patients and 1391 clinicians. Eight of the 17 constructs were scored by more than 50 % of the pertinent stakeholders. Three of these constructs overlapped between studies. Contacting of authors clarified various uncertainties but was not always successful. Limitations of the eligible studies included (1) the small number of studies; (2) not defining the research questions, i.e., the primary outcomes; (3) the research design (surveys) of the studies and the exclusive use of closed-ended questions; (4) not consulting standards for identifying implementation constructs; (5) the lack of pilot testing; (6) high heterogeneity; (7) the risk of reporting bias; and (8) additional shortcomings. Meta-analyses were not possible because of these limitations. Two eligible studies found that respectively 56.3 % (952/1691) and 40.16 % (439/1093) of clinicians do not use OMIs. (Continued on next page) © 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. - (Continued from previous page) Conclusions: Notwithstanding the limitations of the eligible studies, their findings were important because (1) 17 implementation constructs were identified of which 8 were scored by more than 50 % of the stakeholders; (2) the various shortcomings showed how to improve on future implementation studies; and (3) the underuse of OMIs in the selected studies and in the literature demonstrated the need to identify, quantify, and address implementation constructs. Prioritizing of future research questions on OMIs with all pertinent stakeholders is an important first step and could redirect research studies on OMIs towards implementation issues. Patients, clinicians, researchers, policymakers, insurance companies, implant companies, and research sponsors will all be beneficiaries. Background Getting effective healthcare innovations into practice is often suboptimal [1–3]. This implementation issue also applies to orthodontic mini implants (OMIs) because surveys worldwide have shown that many clinicians rarely or never use these devi (...truncated)