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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

Author

Listed:
  • 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

Abstract

Introduction: 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. Methods: 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. Results: 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. Conclusions: 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. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN012606000098538

Suggested Citation

  • 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, 2013. "Evaluation of a Theory-Informed Implementation Intervention for the Management of Acute Low Back Pain in General Medical Practice: The IMPLEMENT Cluster Randomised Trial," PLOS ONE, Public Library of Science, vol. 8(6), pages 1-15, June.
    • Handle: RePEc:plo:pone00:0065471
    DOI: 10.1371/journal.pone.0065471
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    References listed on IDEAS

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    1. Ajzen, Icek, 1991. "The theory of planned behavior," Organizational Behavior and Human Decision Processes, Elsevier, vol. 50(2), pages 179-211, December.
    2. Sandra M. Eldridge & Obioha C. Ukoumunne & John B. Carlin, 2009. "The Intra‐Cluster Correlation Coefficient in Cluster Randomized Trials: A Review of Definitions," International Statistical Review, International Statistical Institute, vol. 77(3), pages 378-394, December.
    3. Bonetti, Debbie & Eccles, Martin & Johnston, Marie & Steen, Nick & Grimshaw, Jeremy & Baker, Rachel & Walker, Anne & Pitts, Nigel, 2005. "Guiding the design and selection of interventions to influence the implementation of evidence-based practice: an experimental simulation of a complex intervention trial," Social Science & Medicine, Elsevier, vol. 60(9), pages 2135-2147, May.
    4. Kenneth F Schulz & Douglas G Altman & David Moher & for the CONSORT Group, 2010. "CONSORT 2010 Statement: Updated Guidelines for Reporting Parallel Group Randomised Trials," PLOS Medicine, Public Library of Science, vol. 7(3), pages 1-7, March.
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    1. Duncan Mortimer & Simon D French & Joanne E McKenzie & Denise A O′Connor & Sally E Green, 2013. "Economic Evaluation of Active Implementation versus Guideline Dissemination for Evidence-Based Care of Acute Low-Back Pain in a General Practice Setting," PLOS ONE, Public Library of Science, vol. 8(10), pages 1-8, October.
    2. Alice Grady & Kirsty Seward & Meghan Finch & Luke Wolfenden & Rebecca Wyse & John Wiggers & Christophe Lecathelinais & Sze Lin Yoong, 2020. "A Three-Arm Randomised Controlled Trial of High- and Low-Intensity Implementation Strategies to Support Centre-Based Childcare Service Implementation of Nutrition Guidelines: 12-Month Follow-Up," IJERPH, MDPI, vol. 17(13), pages 1-20, June.

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