Effectiveness of implementing a best practice primary healthcare model for low back pain (BetterBack) compared with current routine care in the Swedish context: an internal pilot study informed protocol for an effectiveness-implementation hybrid type 2 trial

BMC Musculoskelet Disord

et al. 2018

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BackgroundClinical guidelines recommend that people with back pain be given information and education about their back pain, advice to remain active and at work, and exercises to improve mobility and physical activity. Guidelines, however, rarely describe how this is best delivered. The aim of this paper is to present the development, theories, and underlying evidence for ‘GLA:D Back’ - a group education and exercise program that translates guideline recommendations into a clinician-delivered program for the promotion of self-management in people with persistent/recurrent back pain.MethodsGLA:D Back, which included a rationale and objectives for the program, theory and evidence for the interventions, and program materials, was developed using an iterative process. The content of patient education and exercise programs tested in randomised trials was extracted and a multidisciplinary team of expert researchers and clinicians prioritised common elements hypothesised to improve back pain beliefs and management skills. The program was tested on eight people with persistent back pain in a university clinic and 152 patients from nine primary care physiotherapy and chiropractic clinics. Following feedback from the clinicians and patients involved, the working version of the program was created.ResultsEducational components included pain mechanisms, pain modulation, active coping strategies, imaging, physical activity, and exercise that emphasised a balance between the sum of demands and the individual’s capacity. These were operationalised in PowerPoint presentations with supporting text to aid clinicians in delivering two one-hour patient education lectures.The exercise program included 16 supervised one-hour sessions over 8 weeks, each comprising a warm-up section and eight types of exercises for general flexibility and strengthening of six different muscle groups at four levels of difficulty. The aims of the exercises were to improve overall back fitness and, at the same time, encourage patients to explore variations in movement by incorporating education content into the exercise sessions.ConclusionFrom current best evidence about prognostic factors in back pain and effective treatments for back pain, research and clinical experts developed a ready-to-use structured program - GLA:D® Back - to support self-management for people with persistent/recurrent back pain.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2334-x) contains supplementary material, which is available to authorized users.

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

GLA:D® Back group-based patient education integrated with exercises to support self-management of back pain - development, theories and scientific evidence -

Kjær

BMC Musculoskelet Disord

et al. 2018

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“…The BetterBackJ model of care in Sweden [15] and the GLA:D® Back programme in Denmark [16] are bestpractice programs for LBP in primary care. They have been developed in collaboration between researchers in the two countries to support the implementation of guideline consistent care.…”

Section: Settingmentioning

confidence: 99%

“…All clinicians from public physiotherapy clinics in the Östergötland health care region in Sweden (n=110) involved in a Hybrid type 2 implementation-cluster randomised effectiveness trial (BetterBackJ ClinicalTrials.gov NCT03147300) [15] and clinicians from private primary care clinics (physiotherapists and chiropractors) in Denmark (n=488) involved in a Hybrid type 3 implementation-observational clinical intervention cohort (GLA:D Back) [16,29] were asked to complete the DIBQ-t after a 2-day educational course. During the course, the clinicians were trained in delivering the programs to patients through lectures and workshops [15]. The items (statements about implementation) in DIBQ-t were scored on a 5point Likert Scale anchored 'strongly agree', agree', 'neither agree nor disagree', 'disagree', and 'strongly disagree' and for items 5-9 similarly anchored 'very easy', 'easy', 'neither easy nor di cult', 'di cult', and 'very di cult'.…”

Section: Phase 3 and 4 -Feasibility And Construct Validitymentioning

confidence: 99%

“…Therefore, they may choose to rely upon experience and well-established habits using an intuitive, experiential approach [12,14]. In an effort to rectify these barriers of guideline implementation identi ed in previous literature, best-practice LBP primary care programs have been developed in Sweden and Denmark aiming to facilitate the adoption of guideline consistent care in the management of people seeking care for LBP [15,16].…”

Section: Introductionmentioning

confidence: 99%

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Tailoring the Determinants of Implementation Behaviour Questionnaire (DIBQ) to best-practice low back pain primary care program implementation: a mixed-methods validity-testing in Sweden and Denmark

Schröder

et al. 2020

Preprint

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Background: Best-practice low back pain (LBP) primary care programs have been developed based on evidence-based clinical guidelines and are implemented in Sweden and Denmark. The Theoretical Domains Framework and its linkage to The Behavioural Change Wheel has been utilised in the design of the implementation object and its implementation strategy. Based on the Theoretical Domains Framework domains, the Determinants of Implementation Behaviour Questionnaire (DIBQ) has been developed to evaluate implementation determinants but its feasibility and validity needs to be tested and adapted to study specific contexts while maintaining its linkage to the Behavioural Change Wheel. The aim of this study was to tailor the DIBQ for evaluation of the implementation processes for best-practice LBP primary care programs in Sweden and Denmark. More specifically, the objectives were to i) Translate the DIBQ into Swedish and Danish, ii) Adapt the DIBQ into DIBQ-tailored (DIBQ-t) to study content validity, iii) Test the DIBQ-t for feasibility and iv) Perform initial validity testing of DIBQ-t. Methods: A mixed methods design with a four-step process was used. First, forward translation of the DIBQ, then adaptation into DIBQ-t using qualitative face validity assessed by the project group followed by quantitative content validity assessment by an expert group. Finally, primary care clinicians completed the DIBQ-t directly after participation in a 2-day educational course prior to the implementation of the program to determine feasibility and construct validity using confirmatory factor analyses. Results: In total 598 clinicians out of 609 responded, with only 2% of the items missing. The final DIBQ-t included 28 items describing 10 of the original 18 TDF domains and was considered feasible. The confirmatory factor analyses showed good fit after removing items 4 and 13 with the lowest domain loading. The DIBQ-t maintained linkage to all domains of the Capability–Opportunity-Motivation-Behaviour model within the Behavioural Change Wheel. The clinicians´ expectations according to the DIBQ-t indicate facilitating determinants outweighing barriers at the initiation of implementation processes. Conclusions: The study resulted in a tailored version of the DIBQ, DIBQ-t, which is feasible and valid for evaluating clinicians’ expectations regarding implementation determinants of best-practice LBP primary care programs.

Adapting the determinants of implementation behavior questionnaire to evaluate implementation of a structured low back pain programme using mixed‐methods

Schröder

et al. 2021

Health Science Reports

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Background and Aims Best‐practice low back pain (LBP) primary care programmes have been developed based on evidence‐based clinical guidelines and implemented in Sweden and Denmark. The theoretical domains framework (TDF) was utilized in the design of the implementation strategy. Based on the TDF domains, the Determinants of Implementation Behavior Questionnaire (DIBQ) has been developed to evaluate implementation determinants, but its feasibility and validity need to be tested and adapted to study specific contexts. This study aimed to tailor the DIBQ for evaluation of implementation for LBP primary care programmes. The objectives were to (a) translate the DIBQ into Swedish and Danish, (b) adapt the DIBQ into DIBQ‐tailored (DIBQ‐t) to study content validity, (c) test the DIBQ‐t for feasibility, and (d) perform validity testing of DIBQ‐t. Methods We used a mixed‐methods design. First, forward translation of the DIBQ, then adaptation into DIBQ‐t using qualitative face validity and quantitative content validity was done. Finally, to determine feasibility and construct validity using confirmatory factor analyses, we used data from DIBQ‐t collected after the programmes' 2‐day course. Results The final DIBQ‐t included 28 items describing 10 of the original 18 DIBQ domains and was considered feasible. A total of 598 clinicians out of 609 responded to the DIBQ‐t, with only 2‰ of the items missing. The confirmatory factor analyses showed a good fit after removing two items with the lowest domain loading. The DIBQ‐t maintained linkage to all domains within the Behavioral Change Wheel. The clinicians' expectations, according to the DIBQ‐t, indicate facilitating determinants outweighing barriers at the initiation of implementation processes. Conclusions The study resulted in a feasible and valid version of a questionnaire for evaluating clinicians' expectations regarding implementation determinants of best‐practice LBP primary care programmes.