title: Testing the feasibility of a knowledge translation intervention designed to improve chiropractic care for adults with neck pain disorders: study protocol for a pilot cluster-randomized controlled trial.
abstract: BACKGROUND
  Neck pain in adults is common and a leading cause of physical disability. Recently, a guideline was developed for the management of non-specific neck pain (NSNP) with an aim to improve the quality of the delivery of chiropractic care. One key guideline recommendation is to undertake multimodal care for patients with NSNP. The aim of this pilot study is to determine the feasibility of implementing a multifaceted knowledge translation intervention by promoting the use of multimodal care by chiropractors managing patients with NSNP.
  
  
  METHODS
  The design is a cluster-randomized controlled pilot and feasibility trial. Chiropractors in private practice in Canada will be approached to participate in the study. Thirty consenting chiropractors will be randomized to receive either a theory-based educational intervention in the experimental group or simply a printed copy of the guideline in the control group. Each chiropractor will recruit five neck pain patients (a total of 150 patients) into the study. Development of the multifaceted intervention was informed by the results of a related qualitative study based on the Theoretical Domains Framework and consists of a series of three webinars, two online case scenarios, a self-management video on Brief Action Planning, and a printed copy of the practice guideline.Primary feasibility outcomesfor both chiropractors and patients include rates of (1) recruitment, (2) retention, and (3) adherence to the intervention. A checklist of proxy measures embedded within patient encounter forms will be used to assess chiropractors' compliance with guideline recommendations (e.g. exercise and self-care prescriptions) at study onset and at 3 months. Secondary outcomes include scores of behavioural constructs (level of knowledge and self-efficacy) for recommended multimodal care.Clinical outcomesinclude pain intensity and neck pain-specific disability. Analyses from this study will focus on generating point estimates and corresponding 95 % confidence intervals for parameters of a priori interest (recruitment, retention, adherence, pain intensity, Neck Disability Index).
  
  
  CONCLUSIONS
  Results of this study will inform the design of a larger cluster-randomized controlled trial aimed at evaluating the effectiveness of the theory-based tailored intervention and increasing the use of multimodal care by chiropractors managing patients with NSNP.
  
  
  BACKGROUND
  https://clinicaltrials.gov/, NCT02483091.
authors.affiliation: School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montréal, QC Canada ; Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Montréal, QC Canada.
authors.forename: Prakash
authors.initials: P
authors.lastname: Dhopte
authors.affiliation: School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montréal, QC Canada ; Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Montréal, QC Canada ; Clinical Epidemiology, McGill University Health Center, Montréal, QC Canada.
authors.forename: Sara
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montréal, QC Canada ; Clinical Epidemiology, McGill University Health Center, Montréal, QC Canada.
authors.forename: Nancy
authors.initials: N
authors.lastname: Mayo
authors.affiliation: School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, ON Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: French
authors.affiliation: School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC Canada ; International Collaboration on Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute, Vancouver, BC Canada ; Spine Program, Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, BC Canada ; The Cambie Chiropractic Centre, Vancouver, BC Canada.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Quon
authors.affiliation: School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montréal, QC Canada ; Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Montréal, QC Canada ; Département chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, QC Canada.
authors.forename: André
authors.identifier: 0000-0002-2818-6949
authors.initials: A
authors.lastname: Bussières
keywords: Brief Action Planning; Chiropractors; Clinical practice guidelines; Cluster-randomized controlled trial; Feasibility outcomes; Knowledge translation; Multimodal care; Neck pain