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BackgroundIt often remains unclear to investigators how their research contributes to the work of the commissioner. We initiated the ‘Risk Model’ case study to gain insight into how a Dutch National Institute for Public Health and the Environment (RIVM) project and its knowledge products contribute to the commissioner’s work, the commissioner being the Health Care Inspectorate. We aimed to identify the alignment efforts that influenced the research project contributions. Based on the literature, we expected interaction between investigators and key users to be the most determining factor for the contributions of a research project.MethodsIn this qualitative case study, we analyzed the alignment efforts and contributions in the Risk Model project by means of document analysis and interviews according to the evaluation method Contribution Mapping. Furthermore, a map of the research process was drafted and a feedback session was organized. After the feedback session with stakeholders discussing the findings, we completed the case study report.ResultsBoth organizations had divergent views on the ownership of the research product and the relationship between RIVM and the Inspectorate, which resulted in different expectations. The RIVM considered the use of the risk models to be problematic, but the inspectors had a positive opinion about its contributions. Investigators, inspectors, and managers were not aware of these remarkably different perceptions. In this research project, we identified six relevant categories of both horizontal alignment efforts (between investigators and key users) as well as vertical alignment efforts (within own organization) that influenced the contributions to the Inspectorate’s work.ConclusionsRelevant alignment efforts influencing the contributions of the project became manifest at three levels: the first level directly relates to the project, the second to the organizational environment, and the third to the formal and historical relationship between the organizations. Both external and internal alignments influence the contributions of a research project. Based on the findings, we recommend that research institutes invest in a reflective attitude towards the social aspects of research projects at all levels of the organization and develop alignment strategies to enhance the contributions of research.

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Although the back school is a popular treatment for patients with low back pain, especially in Scandinavian countries, very few well-designed studies into the effectiveness of this type of treatment have been performed. Back schools are programs in a group setting, directed toward pain management and consisting of elements of education and/or training of skills. The Maastricht Back School is designed to be a combination of all those elements about which we consider a back school should give information and training. In order to determine the effectiveness of the Maastricht Back School, we conducted a randomized trial (n = 77) comparing a group that attended back school with a waiting list control group. The most important measures of effect were pain management, pain, medical consumption, and absenteeism from work. The overall response was 85.5%. The results of an intention-to-treat analysis of the data collected 2 and 6 months after randomization consistently suggested inefficacy of the Maastricht Back School for all effect parameters (except for the effect parameter knowledge). Though the present study certainly had some limitations, we question the clinical relevancy of back schools.

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