| |
ALIGN
Acute Low-back pain Implementing Guidelines iNto practice.
Acute low back pain is a common condition and, in combination,
chiropractors and physiotherapists provide much of the
care for the condition in Australia. The recent development
and publication of National Health and Medical Research
Council clinical practice guidelines for acute low back
pain has provided recommendations with the potential
to improve the quality of care and safety for people
with acute low back pain. Particularly relevant messages
of this clinical practice guideline are that x-rays
are rarely needed and that patients should be advised
to remain active.
We are currently investigating the effectiveness of
a targeted, theory-based implementation strategy developed
to implement these clinical practice guidelines in general
practice (see http://www.cochrane.org.au/projects/implement.php).
However, whether or not implementation strategies are
transferable between professional groups is not yet
established. This proposed project allows us to build
on our work to date, contrast barriers and enablers
to practice between settings and to potentially improve
the quality and safety of management of acute low back
pain by allied health practitioners.
This project is funded by the Australian National Health
and Medical Research Council. It is a two stage project
with the following aims:
- to identify the barriers and enablers to implementing
an evidence-based clinical practice guideline for
acute low-back pain in allied health clinical practice
using a theoretical framework;
- to develop and pilot a targeted implementation strategy
to increase the uptake of the evidence-based clinical
practice guideline which addresses the modifiable
barriers;
- to test the effectiveness and cost effectiveness
of this strategy for implementing an evidence based
clinical practice guideline for acute low back pain
in allied health in a cluster randomised controlled
trial
A mixed methods design will be used for this project.
A qualitative approach using semi-structured interviews
with physiotherapists, chiropractors and the patients
of both will be conducted to identify the barriers and
enablers to implementation of the clinical practice
guideline. The interviews will be underpinned by a theoretical
framework grounded in behavioural theory. Information
from the interviews will be used to develop a survey
to canvas views of a larger population of chiropractors
and physiotherapists. The results of the interviews
and survey will inform the development of a targeted
implementation strategy suitable for use in physiotherapy
and chiropractic clinics. Potential interventions include
educational strategies, patient and practitioner information
via various media, reminder systems and peer leadership.
A cluster randomised controlled trial will then be conducted
to determine the effects of the strategy. Practices
will be randomised to receive either the developed implementation
strategy, including strategies targeted at clinicians
and patients, or to a control group receiving access
to the clinical practice guideline alone. The outcomes
of the implementation strategy will be assessed at the
level of the practitioner (did the strategy result in
a change of practice?) and the patient (did the practice
change result in improved patient outcomes?). Subgroup
analyses will investigate effects specific to chiropractors
and physiotherapists.
Chief Investigator:
Associate Professor Sally Green
Other investigators:
Ms Joanne McKenzie, Prof Jeremy Grimshaw, Mr Duncan
Mortimer, Prof Jenny Keating, Dr Bruce Walker, Dr Denise
O’Connor, Dr Simon French, Prof Susan Michie,
Dr Jill Francis.
Research Assistants:
Dr Kerry Murphy
Contact:
denise.oconnor@med.monash.edu.au;
phone: 03 9594 7528. |
|
