The effectiveness of a posted information package on the beliefs and behavior of musculoskeletal practitioners: the UK Chiropractors, Osteopaths, and Musculoskeletal Physiotherapists Low Back Pain ManagemENT (COMPLeMENT) randomized trial

David W Evans; Alan C Breen; Tamar Pincus; Julius Sim; Martin Underwood; Steven Vogel; Nadine E Foster

doi:10.1097/BRS.0b013e3181d4e04b

The effectiveness of a posted information package on the beliefs and behavior of musculoskeletal practitioners: the UK Chiropractors, Osteopaths, and Musculoskeletal Physiotherapists Low Back Pain ManagemENT (COMPLeMENT) randomized trial

David W Evans, Alan C Breen, Tamar Pincus, Julius Sim, Martin Underwood, Steven Vogel, Nadine E Foster

Research output: Contribution to journal › Article › peer-review

52 Citations (Scopus)

Abstract

STUDY DESIGN: Randomized controlled trial.

OBJECTIVE: To investigate the effect of a printed information package on the low back pain (LBP)-related beliefs and reported behavior of musculoskeletal practitioners (chiropractors, osteopaths, and musculoskeletal physiotherapists) across the United Kingdom.

SUMMARY OF BACKGROUND DATA: A substantial proportion of musculoskeletal practitioners in United Kingdom does not follow current LBP guideline recommendations.

METHODS: In total, 1758 practitioners were randomly allocated to either of the 2 study arms. One arm was posted a printed information package containing guideline recommendations for the management of LBP (n = 876) and the other received no intervention (n = 882). The primary outcome measure consisted of 3 "quality indicators" (activity, work, and bed-rest) relating to a vignette of a patient with LBP, in which responses were dichotomized into either "guideline-inconsistent" or "guideline-consistent." The secondary outcome was the practitioners' LBP-related beliefs, measured using the Health Care Providers Pain and Impairment Relationship Scale. Outcomes were measured at baseline and at 6 months.

RESULTS: Follow-up at 6 months was 89%. The changes in reported behavior on the quality indicators were as follows: activity, odds ratio (OR) 1.29 (95% confidence interval, 1.03-1.61) and number needed to be treated (NNT), 19 (15-28); work, OR 1.35 (1.07-1.70) and NNT 19 (14-29); and bed-rest, OR 1.31 (0.97-1.76) and NNT 47 (33-103). The composite NNT for a change from guideline-inconsistent to guideline-consistent behavior on at least 1 of the 3 quality indicators was 10 (9-14). LBP-related beliefs were significantly improved in those who were sent the information package (P = 0.002), but only to a small degree (mean difference, 0.884 scale points; 95% confidence interval, 0.319-1.448).

CONCLUSION: Printed educational material can shift LBP-related beliefs and reported behaviors of musculoskeletal practitioners, toward practice that is more in line with guideline recommendations.

Original language	English
Pages (from-to)	858-66
Number of pages	9
Journal	Spine
Volume	35
Issue number	8
DOIs	https://doi.org/10.1097/BRS.0b013e3181d4e04b
Publication status	Published - 15 Apr 2010
Externally published	Yes

Keywords

Attitude of Health Personnel
Attitude to Health
Behavior
Chiropractic
Culture
Data Collection
Education, Medical, Continuing
Guideline Adherence
Health Care Surveys
Health Knowledge, Attitudes, Practice
Health Personnel
Humans
Low Back Pain
Osteopathic Physicians
Outcome Assessment (Health Care)
Physical Therapy Specialty
Physician-Patient Relations
Practice Guidelines as Topic
Practice Patterns, Physicians'
Quality Assurance, Health Care
Quality of Health Care
Surveys and Questionnaires
Treatment Outcome
United Kingdom
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

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Evans, D. W., Breen, A. C., Pincus, T., Sim, J., Underwood, M., Vogel, S., & Foster, N. E. (2010). The effectiveness of a posted information package on the beliefs and behavior of musculoskeletal practitioners: the UK Chiropractors, Osteopaths, and Musculoskeletal Physiotherapists Low Back Pain ManagemENT (COMPLeMENT) randomized trial. Spine, 35(8), 858-66. https://doi.org/10.1097/BRS.0b013e3181d4e04b

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title = "The effectiveness of a posted information package on the beliefs and behavior of musculoskeletal practitioners: the UK Chiropractors, Osteopaths, and Musculoskeletal Physiotherapists Low Back Pain ManagemENT (COMPLeMENT) randomized trial",

abstract = "STUDY DESIGN: Randomized controlled trial.OBJECTIVE: To investigate the effect of a printed information package on the low back pain (LBP)-related beliefs and reported behavior of musculoskeletal practitioners (chiropractors, osteopaths, and musculoskeletal physiotherapists) across the United Kingdom.SUMMARY OF BACKGROUND DATA: A substantial proportion of musculoskeletal practitioners in United Kingdom does not follow current LBP guideline recommendations.METHODS: In total, 1758 practitioners were randomly allocated to either of the 2 study arms. One arm was posted a printed information package containing guideline recommendations for the management of LBP (n = 876) and the other received no intervention (n = 882). The primary outcome measure consisted of 3 {"}quality indicators{"} (activity, work, and bed-rest) relating to a vignette of a patient with LBP, in which responses were dichotomized into either {"}guideline-inconsistent{"} or {"}guideline-consistent.{"} The secondary outcome was the practitioners' LBP-related beliefs, measured using the Health Care Providers Pain and Impairment Relationship Scale. Outcomes were measured at baseline and at 6 months.RESULTS: Follow-up at 6 months was 89%. The changes in reported behavior on the quality indicators were as follows: activity, odds ratio (OR) 1.29 (95% confidence interval, 1.03-1.61) and number needed to be treated (NNT), 19 (15-28); work, OR 1.35 (1.07-1.70) and NNT 19 (14-29); and bed-rest, OR 1.31 (0.97-1.76) and NNT 47 (33-103). The composite NNT for a change from guideline-inconsistent to guideline-consistent behavior on at least 1 of the 3 quality indicators was 10 (9-14). LBP-related beliefs were significantly improved in those who were sent the information package (P = 0.002), but only to a small degree (mean difference, 0.884 scale points; 95% confidence interval, 0.319-1.448).CONCLUSION: Printed educational material can shift LBP-related beliefs and reported behaviors of musculoskeletal practitioners, toward practice that is more in line with guideline recommendations.",

keywords = "Attitude of Health Personnel, Attitude to Health, Behavior, Chiropractic, Culture, Data Collection, Education, Medical, Continuing, Guideline Adherence, Health Care Surveys, Health Knowledge, Attitudes, Practice, Health Personnel, Humans, Low Back Pain, Osteopathic Physicians, Outcome Assessment (Health Care), Physical Therapy Specialty, Physician-Patient Relations, Practice Guidelines as Topic, Practice Patterns, Physicians', Quality Assurance, Health Care, Quality of Health Care, Surveys and Questionnaires, Treatment Outcome, United Kingdom, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't",

author = "Evans, {David W} and Breen, {Alan C} and Tamar Pincus and Julius Sim and Martin Underwood and Steven Vogel and Foster, {Nadine E}",

year = "2010",

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day = "15",

doi = "10.1097/BRS.0b013e3181d4e04b",

language = "English",

volume = "35",

pages = "858--66",

journal = "Spine",

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Evans, DW, Breen, AC, Pincus, T, Sim, J, Underwood, M, Vogel, S & Foster, NE 2010, 'The effectiveness of a posted information package on the beliefs and behavior of musculoskeletal practitioners: the UK Chiropractors, Osteopaths, and Musculoskeletal Physiotherapists Low Back Pain ManagemENT (COMPLeMENT) randomized trial', Spine, vol. 35, no. 8, pp. 858-66. https://doi.org/10.1097/BRS.0b013e3181d4e04b

The effectiveness of a posted information package on the beliefs and behavior of musculoskeletal practitioners: the UK Chiropractors, Osteopaths, and Musculoskeletal Physiotherapists Low Back Pain ManagemENT (COMPLeMENT) randomized trial. / Evans, David W; Breen, Alan C; Pincus, Tamar et al.
In: Spine, Vol. 35, No. 8, 15.04.2010, p. 858-66.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - The effectiveness of a posted information package on the beliefs and behavior of musculoskeletal practitioners

T2 - the UK Chiropractors, Osteopaths, and Musculoskeletal Physiotherapists Low Back Pain ManagemENT (COMPLeMENT) randomized trial

AU - Evans, David W

AU - Breen, Alan C

AU - Pincus, Tamar

AU - Sim, Julius

AU - Underwood, Martin

AU - Vogel, Steven

AU - Foster, Nadine E

PY - 2010/4/15

Y1 - 2010/4/15

N2 - STUDY DESIGN: Randomized controlled trial.OBJECTIVE: To investigate the effect of a printed information package on the low back pain (LBP)-related beliefs and reported behavior of musculoskeletal practitioners (chiropractors, osteopaths, and musculoskeletal physiotherapists) across the United Kingdom.SUMMARY OF BACKGROUND DATA: A substantial proportion of musculoskeletal practitioners in United Kingdom does not follow current LBP guideline recommendations.METHODS: In total, 1758 practitioners were randomly allocated to either of the 2 study arms. One arm was posted a printed information package containing guideline recommendations for the management of LBP (n = 876) and the other received no intervention (n = 882). The primary outcome measure consisted of 3 "quality indicators" (activity, work, and bed-rest) relating to a vignette of a patient with LBP, in which responses were dichotomized into either "guideline-inconsistent" or "guideline-consistent." The secondary outcome was the practitioners' LBP-related beliefs, measured using the Health Care Providers Pain and Impairment Relationship Scale. Outcomes were measured at baseline and at 6 months.RESULTS: Follow-up at 6 months was 89%. The changes in reported behavior on the quality indicators were as follows: activity, odds ratio (OR) 1.29 (95% confidence interval, 1.03-1.61) and number needed to be treated (NNT), 19 (15-28); work, OR 1.35 (1.07-1.70) and NNT 19 (14-29); and bed-rest, OR 1.31 (0.97-1.76) and NNT 47 (33-103). The composite NNT for a change from guideline-inconsistent to guideline-consistent behavior on at least 1 of the 3 quality indicators was 10 (9-14). LBP-related beliefs were significantly improved in those who were sent the information package (P = 0.002), but only to a small degree (mean difference, 0.884 scale points; 95% confidence interval, 0.319-1.448).CONCLUSION: Printed educational material can shift LBP-related beliefs and reported behaviors of musculoskeletal practitioners, toward practice that is more in line with guideline recommendations.

AB - STUDY DESIGN: Randomized controlled trial.OBJECTIVE: To investigate the effect of a printed information package on the low back pain (LBP)-related beliefs and reported behavior of musculoskeletal practitioners (chiropractors, osteopaths, and musculoskeletal physiotherapists) across the United Kingdom.SUMMARY OF BACKGROUND DATA: A substantial proportion of musculoskeletal practitioners in United Kingdom does not follow current LBP guideline recommendations.METHODS: In total, 1758 practitioners were randomly allocated to either of the 2 study arms. One arm was posted a printed information package containing guideline recommendations for the management of LBP (n = 876) and the other received no intervention (n = 882). The primary outcome measure consisted of 3 "quality indicators" (activity, work, and bed-rest) relating to a vignette of a patient with LBP, in which responses were dichotomized into either "guideline-inconsistent" or "guideline-consistent." The secondary outcome was the practitioners' LBP-related beliefs, measured using the Health Care Providers Pain and Impairment Relationship Scale. Outcomes were measured at baseline and at 6 months.RESULTS: Follow-up at 6 months was 89%. The changes in reported behavior on the quality indicators were as follows: activity, odds ratio (OR) 1.29 (95% confidence interval, 1.03-1.61) and number needed to be treated (NNT), 19 (15-28); work, OR 1.35 (1.07-1.70) and NNT 19 (14-29); and bed-rest, OR 1.31 (0.97-1.76) and NNT 47 (33-103). The composite NNT for a change from guideline-inconsistent to guideline-consistent behavior on at least 1 of the 3 quality indicators was 10 (9-14). LBP-related beliefs were significantly improved in those who were sent the information package (P = 0.002), but only to a small degree (mean difference, 0.884 scale points; 95% confidence interval, 0.319-1.448).CONCLUSION: Printed educational material can shift LBP-related beliefs and reported behaviors of musculoskeletal practitioners, toward practice that is more in line with guideline recommendations.

KW - Attitude of Health Personnel

KW - Attitude to Health

KW - Behavior

KW - Chiropractic

KW - Culture

KW - Data Collection

KW - Education, Medical, Continuing

KW - Guideline Adherence

KW - Health Care Surveys

KW - Health Knowledge, Attitudes, Practice

KW - Health Personnel

KW - Humans

KW - Low Back Pain

KW - Osteopathic Physicians

KW - Outcome Assessment (Health Care)

KW - Physical Therapy Specialty

KW - Physician-Patient Relations

KW - Practice Guidelines as Topic

KW - Practice Patterns, Physicians'

KW - Quality Assurance, Health Care

KW - Quality of Health Care

KW - Surveys and Questionnaires

KW - Treatment Outcome

KW - United Kingdom

KW - Journal Article

KW - Randomized Controlled Trial

KW - Research Support, Non-U.S. Gov't

U2 - 10.1097/BRS.0b013e3181d4e04b

DO - 10.1097/BRS.0b013e3181d4e04b

M3 - Article

C2 - 20308941

SN - 0362-2436

VL - 35

SP - 858

EP - 866

JO - Spine

JF - Spine

IS - 8

ER -

Evans DW, Breen AC, Pincus T, Sim J, Underwood M, Vogel S et al. The effectiveness of a posted information package on the beliefs and behavior of musculoskeletal practitioners: the UK Chiropractors, Osteopaths, and Musculoskeletal Physiotherapists Low Back Pain ManagemENT (COMPLeMENT) randomized trial. Spine. 2010 Apr 15;35(8):858-66. doi: 10.1097/BRS.0b013e3181d4e04b