None listed
Conditions
Brief summary
Little is known about ways to promote informed and effective treatment by providers other than medical practitioners. Expanding evidence demonstrates that interventions to change practice should be targeted at specific clinical behaviours and underpinned by appropriate behavioural theory. Existing research into behavioural change in medical practitioners may not be generalisable to other professionals. Acute low back pain (LBP) is common and chiropractors and physiotherapists provide most care for the condition in Australia. The NHMRC clinical practice guidelines (CPGs) for acute LBP provides recommendations with potential to improve quality of care and safety for people with LBP. Relevant CPG recommendations are that x-rays are rarely needed and that patients should be advised to remain active. We are currently investigating the effectiveness of a targeted, theory-based implementation strategy to implement CPGs in general practice (NHMRC project grant 334060). Whether implementation strategies are transferable between professional groups is not known. This project allows us to build on our completed work to date, incorporating qualitative interviews and surveys of physiotherapists and chiropractors to explore barriers and enablers to CPG uptake (NHMRC project grant 436767) in order to develop a targeted implementation strategy for use in physiotherapy and chiropractic clinics. A cluster randomised controlled trial will then be conducted to determine the effects of the strategy. Practices (n=136) will be randomised to receive either the developed implementation strategy, including strategies targeted at clinicians and patients, or to a control group receiving access to the CPG alone. We plan to recruit 2720 patients from the 136 practices. The outcomes of the implementation strategy will be assessed at the level of the practitioner (did the strategy result in a change of practice?) and the patient (did the practice change result in improved patient outcomes?). Subgroup analyses will investigate effects specific to chiropractors and physiotherapists.
Interventions
Participating clinicians from practices randomised to the intervention arm will receive an implementation strategy, underpinned by behavioural theory, designed to address the modifiable barriers to implementing an evidence-based guideline for acute low back pain (LBP) by physiotherapists and chiropractors.
The intervention will be one full-day interactive workshop (8 hours duration) led by trained facilitators (practising clinicians and academic researchers) and a single follow-up telephone cal
Participating clinicians from practices randomised to the intervention arm will receive an implementation strategy, underpinned by behavioural theory, designed to address the modifiable barriers to implementing an evidence-based guideline for acute low back pain (LBP) by physiotherapists and chiropractors. The intervention will be one full-day interactive workshop (8 hours duration) led by trained facilitators (practising clinicians and academic researchers) and a single follow-up telephone call 2-4 weeks after the workshop. The behaviour change techniques utilised in the workshop include: (a) social processes of encouragement, pressure and support; (b) persuasive communication; (c) information regarding behaviour and outcome; (d) feedback; (e) increasing skills, (f) rehearsal of relevant skills, (g) information provision; (h) prompts, triggers and cues; and (i) action planning and self monitoring.
Sponsors
School of Public Health and Preventive Medicine
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Educational / counselling / training
Masking
Blinded (masking used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Practices will be eligible for inclusion in the trial if (i) at least one chiropractor or physiotherapist provides written informed consent, (ii) the practice principal agrees to the practitioner/practice being involved in the cluster randomised controlled trial (C-RCT), (iii) the practice manager, where applicable, agrees to the practice being involved in the C-RCT, (iii) practice staff are willing to facilitate patient recruitment. Patient participants will be eligible for inclusion if (i) they attend a participating practice for acute non-specific LBP (duration of less than three months), (ii) provide written informed consent, (iii) are at least 18 years old, (iv) are able to write and understand English.
Exclusion criteria
Practices will be ineligible for inclusion in the trial if any of the chiropractors or physiotherapists at the practice are involved in the study Advisory Committee or have participated in Phase 1 interviews for the study. Patient participants will be ineligible for inclusion in the trial if (i) they are less than 18 years of age, (ii) are not able to give informed consent, (iii) the current episode of LBP has been present for more than three months. (iv) radicular leg pain is present, (v) they have had previous spinal surgery, (vi) “red flags” are present alerting the possibility of serious conditions such as malignancy, infection or fracture, (vii) they are pregnant, (viii) they do not speak English.
Outcome results
None listed