Document Detail


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.
MedLine Citation:
PMID:  20308941     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
David W Evans; Alan C Breen; Tamar Pincus; Julius Sim; Martin Underwood; Steven Vogel; Nadine E Foster
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Spine     Volume:  35     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-04-16     Completed Date:  2010-07-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  858-66     Citation Subset:  IM    
Affiliation:
School of Health and Rehabilitation, Keele University, Staffordshire, United Kingdom.
Data Bank Information
Bank Name/Acc. No.:
ISRCTN/ISRCTN77245761
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MeSH Terms
Descriptor/Qualifier:
Attitude of Health Personnel
Attitude to Health
Behavior
Chiropractic / methods,  statistics & numerical data,  trends
Culture*
Data Collection
Education, Medical, Continuing / methods*,  statistics & numerical data
Great Britain
Guideline Adherence / statistics & numerical data,  trends*
Health Care Surveys
Health Knowledge, Attitudes, Practice
Health Personnel
Humans
Low Back Pain / psychology,  therapy*
Osteopathic Physicians / statistics & numerical data,  trends
Outcome Assessment (Health Care)
Physical Therapy (Specialty) / methods,  statistics & numerical data,  trends
Physician's Practice Patterns / statistics & numerical data,  trends*
Physician-Patient Relations
Practice Guidelines as Topic*
Quality Assurance, Health Care / methods
Quality of Health Care / statistics & numerical data,  trends
Questionnaires
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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