Enhanced Implementation of Low Back Pain Guidelines in General Practice

NCT ID: NCT01699256

Last Updated: 2016-11-30

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

1101 participants

Study Classification

INTERVENTIONAL

Study Start Date

2012-10-31

Study Completion Date

2016-05-31

Brief Summary

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The aim of this study is to evaluate whether an enhanced strategy of implementation of the new guideline will lower the number of patients getting referred to secondary care spine centres compared to a normal implementation strategy.

Detailed Description

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Introduction:

There is a need for more knowledge on how to introduce new guidelines effectively in general practice. A new low back pain treatment guideline is implemented in Denmark. This guideline demands that patients with low back pain who have not improved after eight weeks of primary care treatment should be referred to a secondary care spine centre.

Methods:

This is a cluster randomized trial. One hundred general practices define clusters and are randomly allocated to enhanced or usual implementation of the new guideline. The practices are all situated in the North Denmark Region and count two hundred general practitioners (GPs).

General practices in the control group will receive normal implementation of the new guideline, which include newsletters and briefings. In contrast the intervention group will receive an enhanced implementation strategy, adding visits from a consultant, two different stratification tools and feedback on guideline compliance. The two stratification tools: The STarT back screening tool (STarT) and a "Social and Occupational Screening" tool (SOS). The two screening tools subgroups patients and aids the clinicians in their choice of treatment.

Discussion:

To evaluate how change in behaviour may improve guideline adherence and patient treatment we plan two Ph.d. studies in relation to this study; one focusing on the clinical and an one on the economic aspects of the study. In addition a qualitative study is planned for patients refered to specialists in social medicine.

Conditions

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Low Back Pain

Keywords

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General Practice Low Back Pain Guideline Health Plan Implementation Referral and Consultation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Investigators

Study Groups

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Enhanced strategy

Enhanced implementation strategy

Group Type EXPERIMENTAL

Enhanced guideline implementation strategy

Intervention Type BEHAVIORAL

Enhanced guideline implementation strategy

Strategy as usual

Normal implementation strategy

Group Type ACTIVE_COMPARATOR

Guideline implementation as usual

Intervention Type BEHAVIORAL

Newsletters and Invitation to Meetings

Interventions

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Guideline implementation as usual

Newsletters and Invitation to Meetings

Intervention Type BEHAVIORAL

Enhanced guideline implementation strategy

Enhanced guideline implementation strategy

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Provider number in the North Denmark Region (Practice level)
* ICPC coded: L02, L03, L84, and L86 (Patient level)
* Age 18-65 years (Patient level)

Exclusion Criteria

* No signed written consent form (Practice level)
* Earlier participation in project testing (Practice level)
* Already included (Patient level)
* Patients with "red flags"/signs of serious pathology (Patient level)
* Pregnancy (Patient level)
* Insufficient Danish language skills (Patient level)
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Aalborg University

OTHER

Sponsor Role collaborator

University of Aarhus

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Allan Riis, Master

Role: PRINCIPAL_INVESTIGATOR

University of Aarhus

Locations

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Research Unit for General Practice in the North Denmark Region

Aalborg, Aalborg, Denmark

Site Status

Countries

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Denmark

References

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Riis A, Rathleff MS, Jensen CE, Jensen MB. Predictive ability of the start back tool: an ancillary analysis of a low back pain trial from Danish general practice. BMC Musculoskelet Disord. 2017 Aug 23;18(1):360. doi: 10.1186/s12891-017-1727-6.

Reference Type DERIVED
PMID: 28835238 (View on PubMed)

Riis A, Jensen CE, Bro F, Maindal HT, Petersen KD, Bendtsen MD, Jensen MB. A multifaceted implementation strategy versus passive implementation of low back pain guidelines in general practice: a cluster randomised controlled trial. Implement Sci. 2016 Oct 21;11(1):143. doi: 10.1186/s13012-016-0509-0.

Reference Type DERIVED
PMID: 27769263 (View on PubMed)

Jensen CE, Riis A, Pedersen KM, Jensen MB, Petersen KD. Study protocol of an economic evaluation of an extended implementation strategy for the treatment of low back pain in general practice: a cluster randomised controlled trial. Implement Sci. 2014 Oct 8;9:140. doi: 10.1186/s13012-014-0140-x.

Reference Type DERIVED
PMID: 25293975 (View on PubMed)

Riis A, Jensen CE, Bro F, Maindal HT, Petersen KD, Jensen MB. Enhanced implementation of low back pain guidelines in general practice: study protocol of a cluster randomised controlled trial. Implement Sci. 2013 Oct 20;8:124. doi: 10.1186/1748-5908-8-124.

Reference Type DERIVED
PMID: 24139140 (View on PubMed)

Other Identifiers

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2008-58-0028

Identifier Type: -

Identifier Source: org_study_id