Evaluating two implementation strategies for whiplash guidelines in physiotherapy: a cluster randomised trial.
OBJECTIVE
Are implementation strategies involving education any more effective than mere dissemination of clinical practice guidelines in changing physiotherapy practice and reducing patient disability after acute whiplash?


METHODS
Cluster-randomised trial.


METHODS
Twenty-seven physiotherapists from different private physiotherapy clinics and the 103 patients (4 dropouts) who presented to them with acute whiplash.


METHODS
The implementation group of physiotherapists underwent education by opinion leaders about whiplash guidelines and the dissemination group had the guidelines mailed to them.


METHODS
The primary outcome was patient disability, measured using the Functional Rating Index, collected on admission to the trial and at 1.5, 3, 6 and 12 months. Physiotherapist knowledge about the guidelines was measured using a custom-made questionnaire. Physiotherapist practice and cost of care were measured by audit of patient notes.


RESULTS
There were no significant differences between groups for any of the patient outcomes at any time. The implementation patients had 0.6 points (95% CI -7.8 to 6.6) less disability than the dissemination patients at 12 months; 44% more physiotherapists in the implementation group reported that they prescribed two out of the five guideline-recommended treatments; and 32% more physiotherapists actually prescribed them. The cost of care for patients in the implementation group was $255 (95% CI -1505 to 996) less than for patients in the dissemination group.


CONCLUSIONS
Although the active implementation program increased guideline-consistent practice, patient outcomes and cost of care were not affected.
Rebbeck
Trudy
T
University of Sydney, Lidcombe, NSW, Australia. t.rebbeck@fhs.usyd.edu.au
Maher
Christopher G
CG
Refshauge
Kathryn M
KM
D000328:Adult; D001291:Attitude of Health Personnel; D016000:Cluster Analysis; D003258:Consumer Behavior; D003362:Cost-Benefit Analysis; D004496:Education, Continuing / Q000379:methods; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D026741:Physical Therapy Modalities / Q000191:economics / Q000592:standards*; D026761:Physical Therapy Specialty / Q000193:education; D017410:Practice Guidelines as Topic; D014911:Whiplash Injuries / Q000534:rehabilitation*