title: Development of a theory- and evidence-based intervention to enhance implementation of physical therapy guidelines for the management of low back pain.
abstract: BACKGROUND
  Systematic planning could improve the generally moderate effectiveness of interventions to enhance adherence to clinical practice guidelines. The aim of our study was to demonstrate how the process of Intervention Mapping was used to develop an intervention to address the lack of adherence to the national CPG for low back pain by Dutch physical therapists.
  
  
  METHODS
  We systematically developed a program to improve adherence to the Dutch physical therapy guidelines for low back pain. Based on multi-method formative research, we formulated program and change objectives. Selected theory-based methods of change and practical applications were combined into an intervention program. Implementation and evaluation plans were developed.
  
  
  RESULTS
  Formative research revealed influential determinants for physical therapists and practice quality managers. Self-regulation was appropriate because both the physical therapists and the practice managers needed to monitor current practice and make and implement plans for change. The program stimulated interaction between practice levels by emphasizing collective goal setting. It combined practical applications, such as knowledge transfer and discussion-and-feedback, based on theory-based methods, such as consciousness raising and active learning. The implementation plan incorporated the wider environment. The evaluation plan included an effect and process evaluation.
  
  
  CONCLUSIONS
  Intervention Mapping is a useful framework for formative data in program planning in the field of clinical guideline implementation. However, a decision aid to select determinants of guideline adherence identified in the formative research to analyse the problem may increase the efficiency of the application of the Intervention Mapping process.
authors.affiliation: NUTRIM, Department of Health Promotion, Maastricht University; Faculty of Health, Medicine and Life Sciences, P,O, Box 616, Maastricht 6200, MD, The Netherlands. g.rutten@maastrichtuniversity.nl.
authors.forename: Geert M
authors.initials: GM
authors.lastname: Rutten
authors.forename: Janneke
authors.initials: J
authors.lastname: Harting
authors.forename: Leona K
authors.initials: LK
authors.lastname: Bartholomew
authors.forename: Jozé C
authors.initials: JC
authors.lastname: Braspenning
authors.forename: Rob
authors.initials: R
authors.lastname: van Dolder
authors.forename: Marcel Fgj
authors.initials: MF
authors.lastname: Heijmans
authors.forename: Erik Jm
authors.initials: EJ
authors.lastname: Hendriks
authors.forename: Stef Pj
authors.initials: SP
authors.lastname: Kremers
authors.forename: Roland Ps
authors.initials: RP
authors.lastname: van Peppen
authors.forename: Steven Tj
authors.initials: ST
authors.lastname: Rutten
authors.forename: Angelique
authors.initials: A
authors.lastname: Schlief
authors.forename: Nanne K
authors.initials: NK
authors.lastname: de Vries
authors.forename: Rob Ab
authors.initials: RA
authors.lastname: Oostendorp