title: Effect on the process of care of an active strategy to implement clinical guidelines on physiotherapy for low back pain: a cluster randomised controlled trial.
abstract: OBJECTIVE
  To evaluate the effect on the process of care of an active strategy to implement clinical guidelines on physiotherapy for low back pain.
  
  
  METHODS
  A cluster randomised controlled trial comparing an active strategy with standard dissemination.
  
  
  METHODS
  Primary care physiotherapy practices.
  
  
  METHODS
  113 physiotherapists were randomly allocated to receive the guidelines by mail (control group) or to receive an additional active strategy (intervention group) which consisted of a multifaceted programme including education, discussion, role playing, feedback, and reminders.
  
  
  METHODS
  Adherence to the guidelines was measured by means of individual patients' forms recording the treatment completed by the physiotherapist. The forms were assessed using an algorithm based on the number of treatment sessions, treatment goals, interventions, and patient education.
  
  
  RESULTS
  Physiotherapists in the intervention group more often correctly limited the number of treatment sessions for patients with a normal course of back pain (OR 2.39; 95% CI 1.12 to 5.12), more often set functional treatment goals (OR 1.99; 95% CI 1.06 to 3.72), more often used mainly active interventions (OR 2.79; 95% CI 1.19 to 6.55), and more often gave adequate patient education (OR 3.59; 95% CI 1.35 to 9.55). They also adhered more to all four criteria (OR 2.05; 95% CI 1.15 to 3.65).
  
  
  CONCLUSIONS
  The active strategy moderately improved adherence to the guidelines. Active strategies are recommended to implement the clinical guidelines on physiotherapy for low back pain.
authors.affiliation: Dutch Institute of Allied Health Care, Amersfoort, The Netherlands.
authors.forename: G E
authors.initials: GE
authors.lastname: Bekkering
authors.forename: H J M
authors.initials: HJ
authors.lastname: Hendriks
authors.forename: M W
authors.initials: MW
authors.lastname: van Tulder
authors.forename: D L
authors.initials: DL
authors.lastname: Knol
authors.forename: M
authors.initials: M
authors.lastname: Hoeijenbos
authors.forename: R A B
authors.initials: RA
authors.lastname: Oostendorp
authors.forename: L M
authors.initials: LM
authors.lastname: Bouter
mesh_terms: D019317:Evidence-Based Medicine; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D033181:Information Dissemination; D017116:Low Back Pain / Q000628:therapy*; D009426:Netherlands; D026741:Physical Therapy Modalities / Q000592:standards*; D026761:Physical Therapy Specialty / Q000193:education* / Q000592:standards / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards; D017064:Process Assessment, Health Care