Evaluation of a Physician Education Intervention to Improve Primary Care for Low-Back Pain I

Cherkin, Dan; Deyo, Richard A.; BERG, ALFRED O.; Bergman, James; LISHNER, DENISE M.

doi:10.1097/00007632-199110000-00007

Cited by 43 publications

(23 citation statements)

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“…Recent studies have identified cigarette smoking as a risk factor of the persistence of back-related disability one year after a medical consultation in primary care (OR: 2.1; 95% CI: 1.0-4.3) [74] and of retirement from employment because of back pain in the general population (OR: 1.4; 95% CI: 1.2-1.7) [38]. 17 In men and women, fear-avoidance beliefs about work count among the most important modifiable determinants of ''Failure'' in RWGH, suggesting that preventive interventions should target this variable. Several recent studies have identified strong associations between fear-avoidance beliefs towards work and the future occupational status of workers affected by acute, subacute and chronic back pain [21,36,52,59].…”

Section: Interpretation Of Resultsmentioning

confidence: 99%

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Determinants of “return to work in good health” among workers with back pain who consult in primary care settings: a 2-year prospective study

et al. 2006

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Many factors have been linked to return to work after a back pain episode, but our understanding of this phenomenon is limited and cross-sectional dichotomous indices of return to work are not valid measures of this construct. To describe the course of ''return to work in good health'' (RWGH-a composite index of back pain outcome) among workers who consulted in primary care settings for back pain and identify its determinants, a 2-year prospective study was conducted. Subjects (n = 1,007, 68.4%) were workers who consulted in primary care settings of the Quebec City area for a nonspecific back pain. They completed five telephone interviews over 2 years (follow-up = 86%). Analyses linking baseline variables with 2-year outcome were conducted with polytomous logistic regression. The proportion of ''success'' in RWGH increased from 18% at 6 weeks to 57% at 2 years. In women, persistent pain, pain radiating to extremities, increasing job seniority, not having a unionized job, feeling that the physician did listen carefully and increasing fear-avoidance beliefs towards work and activity were determinants of ''failure'' in RWGH. In men, decreasing age, cigarette smoking, poor self-reported health status, pain in the thoracic area, previous back surgeries, a non-compensated injury, high pain levels, belief that job is below qualifications, likelihood of losing job, job status, satisfaction with health services and fear-avoidance beliefs towards work were all significant. RWGH among workers with back pain receives multiple influences, especially among men. In both genders, however, fear-avoidance beliefs about work are associated with failure and high self-efficacy is associated with success.

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Section: Interpretation Of Resultsmentioning

confidence: 99%

“…Characteristics of the patient-physician encounter were measured using 13 questions drawn from Cherkin et al [17] and Von Korff et al [86].…”

Section: Data Collectionmentioning

confidence: 99%

Determinants of “return to work in good health” among workers with back pain who consult in primary care settings: a 2-year prospective study

et al. 2006

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“…Our strategy included 5 contact hours. This is more than the 2-hour program of Cherkin et al, 42 but less than the 18-hour program of Curtis et al 41 A 192-hour program for physical therapists, which was given over a period of 12 months, improved outcomes in patients with chronic low back pain. 43 Although it may be expected that a more intense strategy automatically improves the results, this may not necessarily be true.…”

Section: Limitationsmentioning

confidence: 95%

Implementation of Clinical Guidelines on Physical Therapy for Patients With Low Back Pain: Randomized Trial Comparing Patient Outcomes After a Standard and Active Implementation Strategy

Bekkering¹,

Tulder²,

et al. 2005

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Background and Purpose. An active strategy was developed for the implementation of the clinical guidelines on physical therapy for patients with low back pain. The effect of this strategy on patients' physical functioning, coping strategy, and beliefs regarding their low back pain was studied. Subjects. One hundred thirteen primary care physical therapists treated a total of 500 patients. Methods. The physical therapists were randomly assigned to 1 of 2 groups. The control group received the guidelines by mail (standard passive method of dissemination). The intervention group, in contrast, received an additional active training strategy consisting of 2 sessions with education, group discussion, role playing, feedback, and reminders. Patients with low back pain, treated by the participating therapists, completed questionnaires on physical functioning, pain, sick leave, coping, and beliefs. Results. Physical functioning and pain in the 2 groups improved substantially in the first 12 weeks. Multilevel longitudinal analysis showed no differences between the 2 groups on any outcome measure during follow-up. Discussion and Conclusion. The authors found no additional benefit to applying an active strategy to implement the physical therapy guidelines for patients with low back pain. Active implementation strategies are not recommended if patient outcomes are to be improved.

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“…[17][18][19][20][21] Strategies aimed at changing the use of radiography for LBP in primary care toward an evidencebased approach have had mixed results. [22][23][24][25][26] Strategies that appear to have some success are those that use multiple interventions, such as audit and feedback and academic detailing, and use opinion leaders and/or peers deemed to be educationally influential to assist in the delivery of the interventions. 27,28 The purpose of this pilot study was to test the effectiveness of a multifaceted educational intervention strategy in reducing the perceived need for radiography use for acute LBP among chiropractors in a select community in Ontario.…”

Section: Introductionmentioning

confidence: 99%

Implementing Evidence-Based Guidelines for Radiography in Acute Low Back Pain: A Pilot Study in a Chiropractic Community

Ammendolia

Hogg‐Johnson

Bombardier

et al. 2004

Journal of Manipulative and Physiological Therapeutics

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Evaluation of a Physician Education Intervention to Improve Primary Care for Low-Back Pain I

Cited by 43 publications

References 0 publications

Determinants of “return to work in good health” among workers with back pain who consult in primary care settings: a 2-year prospective study

Determinants of “return to work in good health” among workers with back pain who consult in primary care settings: a 2-year prospective study

Implementation of Clinical Guidelines on Physical Therapy for Patients With Low Back Pain: Randomized Trial Comparing Patient Outcomes After a Standard and Active Implementation Strategy

Implementing Evidence-Based Guidelines for Radiography in Acute Low Back Pain: A Pilot Study in a Chiropractic Community

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