Testing the effectiveness of an innovative information package on practitioner reported behaviour and beliefs: The UK Chiropractors, Osteopaths and Musculoskeletal Physiotherapists Low back pain ManagemENT (COMPLeMENT) trial [ISRCTN77245761]

Abstract

Background: Low back pain (LBP) is a common and costly problem. Initiatives designed to assist practitioner and patient decisions about appropriate healthcare for LBP include printed evidence-based clinical guidelines. The three professional groups of chiropractic, osteopathy and musculoskeletal physiotherapy in the UK share common ground with their approaches to managing LBP and are amongst those targeted by LBP guidelines. Even so, many seem unaware that such guidelines exist. Furthermore, the behaviour of at least some of these practitioners differs from that recommended in these guidelines.

Evaluating Acupuncture and Standard carE for pregnant women with Back pain (EASE Back): a feasibility study and pilot randomised trial

“…48 The questionnaire captured information about respondents' demographics and clinical practice including years in practice, practice setting, postgraduate training in musculoskeletal pain, women's health and acupuncture as well as experience of managing women with pregnancy-related back pain. The questionnaire investigated current clinical care using a patient vignette of a specific, typical case developed from a real patient example following recommendations from other studies [50][51][52] and was pilot tested with 18 physiotherapists. The patient vignette is reproduced below, whereas the full questionnaire is provided in Appendix 1.…”

Fear-avoidance Beliefs About Back Pain in Patients With Acute LBP

“…Because health care providers play a central role in patients' information and education in primary care practice, general practitioners (GPs) could greatly influence patients' fears, avoidance attitudes and beliefs and therefore the evolution and costs of LBP (21 Linton 2002). Several studies have suggested that the fear-avoidance beliefs of health care providers' could influence how they manage patients (22,23,24), and an information package containing the usual guidelines on LBP has been developed to modify therapists' behaviors and beliefs (25). However, 2 recent studies, one cross-sectional (26) and one longitudinal (27), have reported a lack of association between disability and fear-avoidance beliefs in the same sample of acute LBP patients, and the authors questioned the validity of the fear-avoidance model in early stages of LBP, despite substantial levels of fear-avoidance beliefs in these patients.…”

Advancing evidence-based practice in primary care physiotherapy : Guideline implementation, clinical practice, and patient preferences

“…A smaller impact was seen after implementation of a guideline for LBP among physiotherapists and other musculoskeletal practitioners in the UK [106]. In that study, a 5% difference in guideline adherence rate was reported between an implementation via posted information of a guideline for LBP and the control group who received no intervention.…”

“…Besides RCTs, eight observational studies, of variable quality and size, and one qualitative study on EBP implementation in physiotherapy settings were also included in some of the reviews. One relevant RCT [106], not included in any of the reviews, was also identified. The results of these studies were mixed, but showed a tendency for improved self-reported attitudes or knowledge after what was mostly multicomponent strategies that included education.…”