Effect on the process of care of an active strategy to implement clinical guidelines on physiotherapy for low back pain: a cluster randomised controlled trial
- G E Bekkering1,
- H J M Hendriks2,
- M W van Tulder3,
- D L Knol4,
- M Hoeijenbos5,
- R A B Oostendorp6,
- L M Bouter7
- 1Dutch Institute of Allied Health Care, Amersfoort and Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands
- 2Dutch Institute of Allied Health Care, Amersfoort and Department of Epidemiology, Maastricht University, The Netherlands
- 3Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam and Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
- 4Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands
- 5Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands
- 6University Medical Center, Centre of Quality of Care Research, Nijmegen; Dutch Institute of Allied Health Care, Amersfoort, The Netherlands and Free University of Brussels, Faculty of Medicine and Pharmacology, Postgraduate Education Manual Therapy, Brussels, Belgium
- 7Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands
- Correspondence to: Dr E Hendriks Dutch Institute of Allied Health Care, Research and Development, P O Box 1161, 3800 BD Amersfoort, The Netherlands; Hendriksparamedisch.org or erik.hendriksepid.unimaas.nl
- Accepted 23 July 2004
Abstract
Objectives: To evaluate the effect on the process of care of an active strategy to implement clinical guidelines on physiotherapy for low back pain.
Design: A cluster randomised controlled trial comparing an active strategy with standard dissemination.
Setting: Primary care physiotherapy practices.
Participants: 113 physiotherapists were randomly allocated to receive the guidelines by mail (control group) or to receive an additional active strategy (intervention group) which consisted of a multifaceted programme including education, discussion, role playing, feedback, and reminders.
Main outcome measures: Adherence to the guidelines was measured by means of individual patients’ forms recording the treatment completed by the physiotherapist. The forms were assessed using an algorithm based on the number of treatment sessions, treatment goals, interventions, and patient education.
Results: Physiotherapists in the intervention group more often correctly limited the number of treatment sessions for patients with a normal course of back pain (OR 2.39; 95% CI 1.12 to 5.12), more often set functional treatment goals (OR 1.99; 95% CI 1.06 to 3.72), more often used mainly active interventions (OR 2.79; 95% CI 1.19 to 6.55), and more often gave adequate patient education (OR 3.59; 95% CI 1.35 to 9.55). They also adhered more to all four criteria (OR 2.05; 95% CI 1.15 to 3.65).
Conclusions: The active strategy moderately improved adherence to the guidelines. Active strategies are recommended to implement the clinical guidelines on physiotherapy for low back pain.
Footnotes
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GEB, HJMH, MWvanT, DLK, MH, RABO, LMB conceived and designed the study and critically revised the manuscript; GEB collected and assembled the data; GEB, HJMH, MWvanT and DLK analysed and interpreted the data; HJMH, MWvanT, MH, RABO, LBM obtained funding. All authors will act as guarantor for this paper.
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This study was supported by a grant from the Ministry of Health, Welfare and Sports.
