Improving the care for people with acute low-back pain by allied health professionals: a cluster randomised controlled trial

INTERVENTION: Participating clinicians from practices randomised to the intervention arm will receive an implementation strategy, underpinned by behavioural theory, designed to address the modifiable barriers to implementing an evidence‐based guideline for acute low back pain (LBP) by physiotherapists and chiropractors. The intervention will be one full‐day interactive workshop (8 hours duration) led by trained facilitators (practising clinicians and academic researchers) and a single follow‐up telephone call 2‐4 weeks after the workshop. The behaviour change techniques utilised in the workshop include: (a) social processes of encouragement, pressure and support; (b) persuasive communication; (c) information regarding behaviour and outcome; (d) feedback; (e) increasing skills, (f) rehearsal of relevant skills, (g) information provision; (h) prompts, triggers and cues; and (i) action planning and self monitoring. CONDITION: Acute non‐specific low‐back pain PRIMARY OUTCOME: Low‐back pain specific disability (measured via Roland‐Morris Disability Questionnaire [Roland M, Morris R. A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low‐back pain. Spine 1983;8:141‐4]) X‐ray referral (measured via practitioner‐reported encounter forms with consecutive patients who have acute non‐specific low back pain) SECONDARY OUTCOME: Advice to stay active (measured via practitioner‐reported encounter forms with consecutive patients who have acute non‐specific low back pain) Advised bed rest (measured via practitioner‐reported encounter forms with consecutive patients who have acute non‐specific low back pain) Any imaging referral (measured via practitioner‐reported encounter forms with consecutive patients who have acute non‐specific low back pain) Health service utilisation used by patient (measured via Health Service Utilisation items in questionnaire) Imaging referral excluding x‐ray (measured via files of consecutive patients who have acute non‐specific low back pain who consent to file audit). Patient fear avoidance beliefs (measured via Fear Avoidance Beliefs Questionnaire [Waddell G, Newton M, Henderson I, et al. A Fear‐Avoidance Beliefs Questionnaire (FABQ) and the role of fear‐avoidance beliefs in chronic low back pain and disability. Pain 1993;52:157‐68]) Patient quality of life (measured via Assessment of Quality of Life Questionnaire [Hawthorne G, Richardson J & Osborne R. The assessment of Quality of Life (AQoL) instrument: a psychometric measure of health‐related quality of life. Quality of Life Research 1999;8:209‐224]) Patient reports referral for an x‐ray or received an x‐ray from their chiropractor or physiotherapist for the current episode of low‐back pain (measured via questionnaire) Patient usual pain (measured via questionnaire using an 11‐point numerical rating scale (0‐10)) Practitioner behavioural constructs (attitudes, beliefs and intentions) measured via questionnaire Practitioner fear avoidance beliefs (measured via questionnaire) X‐ray referral (measured via files of consecutive patients who have acute non‐specific low back pain who consent to file audit). INCLUSION CRITERIA: Practices will be eligible for inclusion in the trial if (i) at least one chiropractor or physiotherapist provides written informed consent, (ii) the practice principal agrees to the practitioner/practice being involved in the cluster randomised controlled trial (C‐RCT), (iii) the practice manager, where applicable, agrees to the practice being involved in the C‐RCT, (iii) practice staff are willing to facilitate patient recruitment. Patient participants will be eligible for inclusion if (i) they attend a participating practice for acute non‐specific LBP (duration of less than three months), (ii) provide written informed consent, (iii) are at least 18 years old, (iv) are able to write and understand English.