title: IMPLEmenting a clinical practice guideline for acute low back pain evidence-based manageMENT in general practice (IMPLEMENT): cluster randomised controlled trial study protocol.
abstract: BACKGROUND
  Evidence generated from reliable research is not frequently implemented into clinical practice. Evidence-based clinical practice guidelines are a potential vehicle to achieve this. A recent systematic review of implementation strategies of guideline dissemination concluded that there was a lack of evidence regarding effective strategies to promote the uptake of guidelines. Recommendations from this review, and other studies, have suggested the use of interventions that are theoretically based because these may be more effective than those that are not. An evidence-based clinical practice guideline for the management of acute low back pain was recently developed in Australia. This provides an opportunity to develop and test a theory-based implementation intervention for a condition which is common, has a high burden, and for which there is an evidence-practice gap in the primary care setting.
  
  
  OBJECTIVE
  This study aims to test the effectiveness of a theory-based intervention for implementing a clinical practice guideline for acute low back pain in general practice in Victoria, Australia. Specifically, our primary objectives are to establish if the intervention is effective in reducing the percentage of patients who are referred for a plain x-ray, and improving mean level of disability for patients three months post-consultation.
  
  
  METHODS
  This study protocol describes the details of a cluster randomised controlled trial. Ninety-two general practices (clusters), which include at least one consenting general practitioner, will be randomised to an intervention or control arm using restricted randomisation. Patients aged 18 years or older who visit a participating practitioner for acute non-specific low back pain of less than three months duration will be eligible for inclusion. An average of twenty-five patients per general practice will be recruited, providing a total of 2,300 patient participants. General practitioners in the control arm will receive access to the guideline using the existing dissemination strategy. Practitioners in the intervention arm will be invited to participate in facilitated face-to-face workshops that have been underpinned by behavioural theory. Investigators (not involved in the delivery of the intervention), patients, outcome assessors and the study statistician will be blinded to group allocation.
authors.affiliation: Monash Institute of Health Services Research, Monash University, Melbourne, Australia. joanne.mckenzie@med.monash.edu.au
authors.forename: Joanne E
authors.initials: JE
authors.lastname: McKenzie
authors.forename: Simon D
authors.initials: SD
authors.lastname: French
authors.forename: Denise A
authors.initials: DA
authors.lastname: O'Connor
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Grimshaw
authors.forename: Duncan
authors.initials: D
authors.lastname: Mortimer
authors.forename: Susan
authors.initials: S
authors.lastname: Michie
authors.forename: Jill
authors.initials: J
authors.lastname: Francis
authors.forename: Neil
authors.initials: N
authors.lastname: Spike
authors.forename: Peter
authors.initials: P
authors.lastname: Schattner
authors.forename: Peter M
authors.initials: PM
authors.lastname: Kent
authors.forename: Rachelle
authors.initials: R
authors.lastname: Buchbinder
authors.forename: Sally E
authors.initials: SE
authors.lastname: Green