Evaluation of a theory-informed implementation intervention for the management of acute low back pain in general medical practice: the IMPLEMENT cluster randomised trial.

<h4>Introduction</h4>This cluster randomised trial evaluated an intervention to decrease x-ray referrals and increase giving advice to stay active for people with acute low back pain (LBP) in general practice.<h4>Methods</h4>General practices were randomised to either access...

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Autores principales:	Simon D French, Joanne E McKenzie, Denise A O'Connor, Jeremy M Grimshaw, Duncan Mortimer, Jill J Francis, Susan Michie, Neil Spike, Peter Schattner, Peter Kent, Rachelle Buchbinder, Matthew J Page, Sally E Green
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/65bdbaf4d2ef43d6894b3a3b859e366c
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spelling	oai:doaj.org-article:65bdbaf4d2ef43d6894b3a3b859e366c2021-11-18T07:41:56ZEvaluation of a theory-informed implementation intervention for the management of acute low back pain in general medical practice: the IMPLEMENT cluster randomised trial.1932-620310.1371/journal.pone.0065471https://doaj.org/article/65bdbaf4d2ef43d6894b3a3b859e366c2013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23785427/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Introduction</h4>This cluster randomised trial evaluated an intervention to decrease x-ray referrals and increase giving advice to stay active for people with acute low back pain (LBP) in general practice.<h4>Methods</h4>General practices were randomised to either access to a guideline for acute LBP (control) or facilitated interactive workshops (intervention). We measured behavioural predictors (e.g. knowledge, attitudes and intentions) and fear avoidance beliefs. We were unable to recruit sufficient patients to measure our original primary outcomes so we introduced other outcomes measured at the general practitioner (GP) level: behavioural simulation (clinical decision about vignettes) and rates of x-ray and CT-scan (medical administrative data). All those not involved in the delivery of the intervention were blinded to allocation.<h4>Results</h4>47 practices (53 GPs) were randomised to the control and 45 practices (59 GPs) to the intervention. The number of GPs available for analysis at 12 months varied by outcome due to missing confounder information; a minimum of 38 GPs were available from the intervention group, and a minimum of 40 GPs from the control group. For the behavioural constructs, although effect estimates were small, the intervention group GPs had greater intention of practising consistent with the guideline for the clinical behaviour of x-ray referral. For behavioural simulation, intervention group GPs were more likely to adhere to guideline recommendations about x-ray (OR 1.76, 95%CI 1.01, 3.05) and more likely to give advice to stay active (OR 4.49, 95%CI 1.90 to 10.60). Imaging referral was not statistically significantly different between groups and the potential importance of effects was unclear; rate ratio 0.87 (95%CI 0.68, 1.10) for x-ray or CT-scan.<h4>Conclusions</h4>The intervention led to small changes in GP intention to practice in a manner that is consistent with an evidence-based guideline, but it did not result in statistically significant changes in actual behaviour.<h4>Trial registration</h4>Australian New Zealand Clinical Trials Registry ACTRN012606000098538.Simon D FrenchJoanne E McKenzieDenise A O'ConnorJeremy M GrimshawDuncan MortimerJill J FrancisSusan MichieNeil SpikePeter SchattnerPeter KentRachelle BuchbinderMatthew J PageSally E GreenPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 6, p e65471 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Simon D French Joanne E McKenzie Denise A O'Connor Jeremy M Grimshaw Duncan Mortimer Jill J Francis Susan Michie Neil Spike Peter Schattner Peter Kent Rachelle Buchbinder Matthew J Page Sally E Green Evaluation of a theory-informed implementation intervention for the management of acute low back pain in general medical practice: the IMPLEMENT cluster randomised trial.
description	<h4>Introduction</h4>This cluster randomised trial evaluated an intervention to decrease x-ray referrals and increase giving advice to stay active for people with acute low back pain (LBP) in general practice.<h4>Methods</h4>General practices were randomised to either access to a guideline for acute LBP (control) or facilitated interactive workshops (intervention). We measured behavioural predictors (e.g. knowledge, attitudes and intentions) and fear avoidance beliefs. We were unable to recruit sufficient patients to measure our original primary outcomes so we introduced other outcomes measured at the general practitioner (GP) level: behavioural simulation (clinical decision about vignettes) and rates of x-ray and CT-scan (medical administrative data). All those not involved in the delivery of the intervention were blinded to allocation.<h4>Results</h4>47 practices (53 GPs) were randomised to the control and 45 practices (59 GPs) to the intervention. The number of GPs available for analysis at 12 months varied by outcome due to missing confounder information; a minimum of 38 GPs were available from the intervention group, and a minimum of 40 GPs from the control group. For the behavioural constructs, although effect estimates were small, the intervention group GPs had greater intention of practising consistent with the guideline for the clinical behaviour of x-ray referral. For behavioural simulation, intervention group GPs were more likely to adhere to guideline recommendations about x-ray (OR 1.76, 95%CI 1.01, 3.05) and more likely to give advice to stay active (OR 4.49, 95%CI 1.90 to 10.60). Imaging referral was not statistically significantly different between groups and the potential importance of effects was unclear; rate ratio 0.87 (95%CI 0.68, 1.10) for x-ray or CT-scan.<h4>Conclusions</h4>The intervention led to small changes in GP intention to practice in a manner that is consistent with an evidence-based guideline, but it did not result in statistically significant changes in actual behaviour.<h4>Trial registration</h4>Australian New Zealand Clinical Trials Registry ACTRN012606000098538.
format	article
author	Simon D French Joanne E McKenzie Denise A O'Connor Jeremy M Grimshaw Duncan Mortimer Jill J Francis Susan Michie Neil Spike Peter Schattner Peter Kent Rachelle Buchbinder Matthew J Page Sally E Green
author_facet	Simon D French Joanne E McKenzie Denise A O'Connor Jeremy M Grimshaw Duncan Mortimer Jill J Francis Susan Michie Neil Spike Peter Schattner Peter Kent Rachelle Buchbinder Matthew J Page Sally E Green
author_sort	Simon D French
title	Evaluation of a theory-informed implementation intervention for the management of acute low back pain in general medical practice: the IMPLEMENT cluster randomised trial.
title_short	Evaluation of a theory-informed implementation intervention for the management of acute low back pain in general medical practice: the IMPLEMENT cluster randomised trial.
title_full	Evaluation of a theory-informed implementation intervention for the management of acute low back pain in general medical practice: the IMPLEMENT cluster randomised trial.
title_fullStr	Evaluation of a theory-informed implementation intervention for the management of acute low back pain in general medical practice: the IMPLEMENT cluster randomised trial.
title_full_unstemmed	Evaluation of a theory-informed implementation intervention for the management of acute low back pain in general medical practice: the IMPLEMENT cluster randomised trial.
title_sort	evaluation of a theory-informed implementation intervention for the management of acute low back pain in general medical practice: the implement cluster randomised trial.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/65bdbaf4d2ef43d6894b3a3b859e366c
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Evaluation of a theory-informed implementation intervention for the management of acute low back pain in general medical practice: the IMPLEMENT cluster randomised trial.

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