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.
- Attitude of Health Personnel
- Attitude to Health
- Data Collection
- Education, Medical, Continuing
- Guideline Adherence
- Health Care Surveys
- Health Knowledge, Attitudes, Practice
- Health Personnel
- 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