Enhanced implementation of low back pain guidelines in general practice: study protocol of a cluster randomised controlled trial

Riis, Allan; Jensen, Cathrine Elgaard; Bro, Flemming; Maindal, Helle Terkildsen; Petersen, Karin Dam; Jensen, Martin Bach

doi:10.1186/1748-5908-8-124

Cited by 13 publications

(24 citation statements)

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“…STarT has been validated in Danish [ 10 ]. SOS has been developed for the clinical trial and addresses barriers for recovery including occupational factors, disability compensation or pension claims, and psychosocial factors [ 6 ]. Earlier studies have previously indicated that patients involved in, for instance, a compensation claim have poor recovery prognosis, emphasising the importance of identifying these patients as early as possible in order to initiate proper treatment [ 11 , 12 ].…”

Section: Methodsmentioning

confidence: 99%

“…Alongside the clinical trial, an economic evaluation is conducted to assess the cost-effectiveness of an extended implementation strategy aimed to increase adherence to the guidelines, compared to the usual implementation strategy in Denmark. Further information on, among others, development of the extended implementation strategy and recruitment to the clinical trial are provided elsewhere [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Study protocol of an economic evaluation of an extended implementation strategy for the treatment of low back pain in general practice: a cluster randomised controlled trial

et al. 2014

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BackgroundIn Denmark, guidelines on low back pain management are currently being implemented; in association with this, a clinical trial is conducted. A health economic evaluation is carried out alongside the clinical trial to assess the cost-effectiveness of an extended implementation strategy to increase the general practitioners’ adherence to the guidelines. In addition to usual dissemination, the extended implementation strategy is composed of visits from a guideline facilitator, stratification tools, and feedback on guideline adherence. The aim of this paper is to provide the considerations on the design of the health economic evaluation.Methods/designThe economic evaluation is carried out alongside a cluster randomised controlled trial consisting of 60 general practices in the North Denmark Region. An expected 1,200 patients between the age of 18 and 65 years with a low back pain diagnosis will be enrolled. The economic evaluation comprises both a cost-effectiveness analyses and a cost-utility analysis. Effectiveness measures include referral to secondary care, health-related quality of life measured by EQ-5D-5L, and disability measured by the Roland Morris disability questionnaire. Cost measures include all relevant additional costs of the extended implementation strategy compared to usual implementation. The economic evaluation will be performed from both a societal perspective and a health sector perspective with a 12-month time horizon.DiscussionIt is expected that the extended implementation strategy will reduce the number of patients referred to secondary care. It is hypothesised that the additional upfront cost of extended implementation will be counterbalanced by improvements in clinical practice and patient-related outcomes, thereby rendering the extended implementation strategy cost-effective.Trial registrationClinicalTrials.gov: NCT01699256Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-014-0140-x) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Study protocol of an economic evaluation of an extended implementation strategy for the treatment of low back pain in general practice: a cluster randomised controlled trial

et al. 2014

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“…Training health‐care providers to competently provide these services would likely play an important role in this process. Being able to implement clinically effective behavioral interventions outside of the research context and finding the best ways to standardize dissemination to practitioners is a burgeoning area of research that needs to be further addressed in the field of headache 16,42‐45. A number of barriers can prevent patients from accessing and using evidence‐based behavioral and mind/body treatments for headache .…”

Section: Key Unanswered Research Questionsmentioning

confidence: 99%

“…Being able to implement clinically effective behavioral interventions outside of the research context and finding the best ways to standardize dissemination to practitioners is a burgeoning area of research that needs to be further addressed in the field of headache. 16,[42][43][44][45] A number of barriers can prevent patients from accessing and using evidence-based behavioral and mind/body treatments for headache. 46 As previously described, these interventions often require a significant commitment of time, energy, and in some cases financial resources, from patients.…”

Section: Key Unanswered Research Questionsmentioning

confidence: 99%

Behavioral and Mind/Body Interventions in Headache: Unanswered Questions and Future Research Directions

et al. 2014

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Background.-Many unanswered questions remain regarding behavioral and mind/body interventions in the treatment of primary headache disorders in adults.Methods.-We reviewed the literature to ascertain the most pressing unanswered research questions regarding behavioral and mind/body interventions for headache.Results.-We identify the most pressing unanswered research questions in this field, describe ideal and practical ways to address these questions, and outline steps needed to facilitate these research efforts. We discuss proposed mechanisms of action of behavioral and mind/body interventions and outline goals for future research in this field.Conclusions.-Although challenges arise from the complex nature of the interventions under study, research that adheres to published study design and reporting standards and focuses closely on answering key questions is most likely to lead to progress in achieving these goals. Key words: alternative medicine, headache, mind/body Abbreviations: CAM complementary and alternative medicine, TTH tension-type headacheNon-pharmacological interventions have long been perceived by patients and providers as beneficial for headaches, and strong evidence supports the useful effects of certain nonpharmacological interventions for migraine and tension-type headache (TTH). The US Headache Consortium Guidelines for prevention of migraine identified Grade A evidence to support several specific non-pharmacological interventions including relaxation training, thermal biofeedback combined with relaxation training, electromyographic (EMG) biofeedback, and cognitive behavioral therapy (CBT) 1 (labeled as "evidence-based behavioral interventions" for this paper). The combination of preventive drug therapy and evidence-based behavioral therapies was identified as having Grade B evidence for producing added clinical benefit, although data published since these guidelines were issued is likely to change the evidence to Grade A when the guidelines are updated. 2,3 In addition to evidence-based behavioral interventions, a recent study found that more than 50% of US adults with migraines/severe headaches reported having used complementary and alternative medicine (CAM) techniques, most commonly "mind/body therapies" such as meditation and yoga. 4 Thus, although data most strongly support evidence-based behavioral interventions, it seems that mind/body interventions are used frequently by adults with primary headache disorders. Despite their use, many unanswered questions remain regarding these non-pharmacological interventions in the treatment of primary headache disorders in adults. In 2005, Headache published an entire series of peer-reviewed papers (many cited in this review) that provided in-depth analysis of numerous methodological issues and suggested solutions in behavioral headache research. Given the increased utilization of mind/body therapies and potentially similar underlying mechanisms between evidencebased behavioral interventions and mind/body therapies, the goal of this paper is to id...

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“…This previous study applied a multifaceted intervention, which included as a key component multi professional outreach visits to general practices in order to educate GPs about guideline-endorsed treatments including providing patients with high quality information. We believe this intervention can be further improved by integrating it into the organisation of the GP clinics by enhancing the function of the multi professional team in the general practice [13] and utilisation of the increasing number of available clinical staff members [14].…”

Section: Introductionmentioning

confidence: 99%

Involving clinical staff members in the management of low back pain in general practice: a qualitative interview study

Knudsen

Thomsen

Andersen

et al. 2019

Preprint

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Background Low back pain (LBP) is the leading cause of disability worldwide. Patient education and self-management have the potential to improve the care of patients. However, high workload and little available time for consultations are argued to challenge the delivery of optimal care in general practice. Involving clinical staff members in the management of diabetes and of patients with hypertension has shown to be feasible. Consequently, involving clinical staff members in providing education and information to patients may improve the delivery of patient information and education. However, this require a shift in the division of tasks and general practitioners’ (GPs’) barriers and facilitators for this is currently unknown. The aim is to explore GPs’ barriers and facilitators to involve clinical staff members in the treatment of LBP in general practice. Methods This is a qualitative, semi-structured interview study. We used the phenomenological approach to study experiences and attitudes towards changing the management of patients with LBP from the GPs’ perspectives. Analysis was conducted using inductive descriptive methods. Results We conducted five 60-minute interviews with Danish GPs. All GPs had experience with task delegation, but it varied which tasks the GPs delegated and to which types of clinical staff members. The following barriers towards clinical staff member involvement were identified: Patients with LBP is a heterogeneous group with a variety of treatment needs, the examination and treatment can be considered as one coherent process, and it would require external support. Involving clinical staff members can release GP time. Another facilitator was the possibility for improving the uptake of clinical guidelines and involvement of practice nurses was considered to improve the provision of patient education and lead to greater patient self-management. Conclusion While some GPs currently consider delegation to clinical staff members a good idea in the treatment of LBP, others prefer the existing treatment strategy without clinical staff member involvement. Consequently, healthcare providers need to address existing barriers and facilitators for involving clinical staff members when advocating for a future multi professional treatment strategy of LBP in general practice.

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Enhanced implementation of low back pain guidelines in general practice: study protocol of a cluster randomised controlled trial

Cited by 13 publications

References 14 publications

Study protocol of an economic evaluation of an extended implementation strategy for the treatment of low back pain in general practice: a cluster randomised controlled trial

Study protocol of an economic evaluation of an extended implementation strategy for the treatment of low back pain in general practice: a cluster randomised controlled trial

Behavioral and Mind/Body Interventions in Headache: Unanswered Questions and Future Research Directions

Involving clinical staff members in the management of low back pain in general practice: a qualitative interview study

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