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.
OBJECTIVE
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.


METHODS
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.


CONCLUSIONS
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.
Bekkering
Geertruida E
GE
Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, United Kingdom. G.E.Bekkering@bristol.ac.uk
van Tulder
Maurits W
MW
Hendriks
Erik J M
EJ
Koopmanschap
Marc A
MA
Knol
Dirk L
DL
Bouter
Lex M
LM
Oostendorp
Rob A B
RA
D004496:Education, Continuing; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D033181:Information Dissemination / Q000379:methods; D017116:Low Back Pain / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D026741:Physical Therapy Modalities / Q000193:education; D026761:Physical Therapy Specialty / Q000193:education; D017410:Practice Guidelines as Topic; D012044:Regression Analysis; D016896:Treatment Outcome