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Implementation Science
Published in: Implementation Science 1/2010

Open Access 01-12-2010 | Study protocol

Improving the care for people with acute low-back pain by allied health professionals (the ALIGN trial): A cluster randomised trial protocol

Authors: Joanne E McKenzie, Denise A O'Connor, Matthew J Page, Duncan S Mortimer, Simon D French, Bruce F Walker, Jennifer L Keating, Jeremy M Grimshaw, Susan Michie, Jill J Francis, Sally E Green

Published in: Implementation Science | Issue 1/2010

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Abstract

Background

Variability between clinical practice guideline recommendations and actual clinical practice exists in many areas of health care. A 2004 systematic review examining the effectiveness of guideline implementation interventions concluded there was a lack of evidence to support decisions about effective interventions to promote the uptake of guidelines. Further, the review recommended the use of theory in the development of implementation interventions. A clinical practice guideline for the management of acute low-back pain has been developed in Australia (2003). Acute low-back pain is a common condition, has a high burden, and there is some indication of an evidence-practice gap in the allied health setting. This provides an opportunity to develop and test a theory-based implementation intervention which, if effective, may provide benefits for patients with this condition.

Aims

This study aims to estimate the effectiveness of a theory-based intervention to increase allied health practitioners' (physiotherapists and chiropractors in Victoria, Australia) compliance with a clinical practice guideline for acute non-specific low back pain (LBP), compared with providing practitioners with a printed copy of the guideline. Specifically, our primary objectives are to establish if the intervention is effective in reducing the percentage of acute non-specific LBP patients who are either referred for or receive an x-ray, and improving mean level of disability for patients three months post-onset of acute LBP.

Methods

The design of the study is a cluster randomised trial. Restricted randomisation was used to randomise 210 practices (clusters) to an intervention or control group. Practitioners in the control group received a printed copy of the guideline. Practitioners in the intervention group received a theory-based intervention developed to address prospectively identified barriers to practitioner compliance with the guideline. The intervention primarily consisted of an educational symposium. Patients aged 18 years or older who visit a participating practitioner for acute non-specific LBP of less than three months duration over a two-week data collection period, three months post the intervention symposia, are eligible for inclusion. Sample size calculations are based on recruiting between 15 to 40 patients per practice. Outcome assessors will be blinded to group allocation.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12609001022257 (date registered 25th November 2009)
Appendix
Available only for authorised users
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Metadata
Title
Improving the care for people with acute low-back pain by allied health professionals (the ALIGN trial): A cluster randomised trial protocol
Authors
Joanne E McKenzie
Denise A O'Connor
Matthew J Page
Duncan S Mortimer
Simon D French
Bruce F Walker
Jennifer L Keating
Jeremy M Grimshaw
Susan Michie
Jill J Francis
Sally E Green
Publication date
01-12-2010
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2010
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/1748-5908-5-86

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Implementation Science 1/2010 Go to the issue

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Conservation of resources theory and research use in health systems

Study protocol

A randomized trial to evaluate e-learning interventions designed to improve learner's performance, satisfaction, and self-efficacy with the AGREE II

Research article

Process evaluation of a participatory ergonomics programme to prevent low back pain and neck pain among workers

Study protocol

Systematic evaluation of implementation fidelity of complex interventions in health and social care

Research article

Usability evaluation of a clinical decision support tool for osteoporosis disease management

Research article

Part II, Provider perspectives: should patients be activated to request evidence-based medicine? a qualitative study of the VA project to implement diuretics (VAPID)