Abstract
BackgroundDespite available evidence for optimal management of spinal pain, poor adherence to guidelines and wide variations in healthcare services persist. One of the objectives of the Canadian Chiropractic Guideline Initiative is to develop and evaluate targeted theory- and evidence-informed interventions to improve the management of non-specific neck pain by chiropractors. In order to systematically develop a knowledge translation (KT) intervention underpinned by the Theoretical Domains Framework (TDF), we explored the factors perceived to influence the use of multimodal care to manage non-specific neck pain, and mapped behaviour change techniques to key theoretical domains.MethodsIndividual telephone interviews exploring beliefs about managing neck pain were conducted with a purposive sample of 13 chiropractors. The interview guide was based upon the TDF. Interviews were digitally recorded, transcribed verbatim and analysed by two independent assessors using thematic content analysis. A 15-member expert panel formally met to design a KT intervention.ResultsNine TDF domains were identified as likely relevant. Key beliefs (and relevant domains of the TDF) included the following: influence of formal training, colleagues and patients on clinicians (Social Influences); availability of educational material (Environmental Context and Resources); and better clinical outcomes reinforcing the use of multimodal care (Reinforcement). Facilitating factors considered important included better communication (Skills); audits of patients’ treatment-related outcomes (Behavioural Regulation); awareness and agreement with guidelines (Knowledge); and tailoring of multimodal care (Memory, Attention and Decision Processes). Clinicians conveyed conflicting beliefs about perceived threats to professional autonomy (Social/Professional Role and Identity) and speed of recovery from either applying or ignoring the practice recommendations (Beliefs about Consequences). The expert panel mapped behaviour change techniques to key theoretical domains and identified relevant KT strategies and modes of delivery to increase the use of multimodal care among chiropractors.ConclusionsA multifaceted KT educational intervention targeting chiropractors’ management of neck pain was developed. The KT intervention consisted of an online education webinar series, clinical vignettes and a video underpinned by the Brief Action Planning model. The intervention was designed to reflect key theoretical domains, behaviour change techniques and intervention components. The effectiveness of the proposed intervention remains to be tested.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0213-5) contains supplementary material, which is available to authorized users.
Highlights
Despite available evidence for optimal management of spinal pain, poor adherence to guidelines and wide variations in healthcare services persist
The Canadian Chiropractic Association (CCA) and the Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards (CFCREAB) updated a Clinical Practice Guideline (CPG) on the management of non-specific neck pain to help improve the delivery of chiropractic care for patients with this condition [5]
The first key question “Who needs to do what, differently?” was addressed by specifying the target behaviours required to implement the neck pain guideline into practice. This was achieved by reviewing the key recommendations from the updated CCA-CFCREAB guideline on the management of non-specific neck pain [5], which stated that chiropractic practitioners needed to do the following: “Manage neck pain using multimodal treatment for acute and chronic neck pain patients” and “Recommend self-care for patients with and without contraindications to manual therapy”
Summary
Despite available evidence for optimal management of spinal pain, poor adherence to guidelines and wide variations in healthcare services persist. One of the objectives of the Canadian Chiropractic Guideline Initiative is to develop and evaluate targeted theory- and evidence-informed interventions to improve the management of non-specific neck pain by chiropractors. The Canadian Chiropractic Association (CCA) and the Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards (CFCREAB) updated a Clinical Practice Guideline (CPG) on the management of non-specific neck pain to help improve the delivery of chiropractic care for patients with this condition [5]. The guideline recommends that either a noninvasive combined approach or multimodal protocol including manual therapy, advice about self-management, and physical activity including exercise is an effective treatment strategy for acute and chronic neck pain. A survey of chronic neck and back pain patients indicated that less than half of attending healthcare practitioners, including physicians, chiropractors and physical therapists, prescribed exercise [9]
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