Abstract
BackgroundClinical guidelines for management of low back pain (LBP) are not routinely implemented in practice, and guidelines rarely offer tools for implementation. Therefore, we developed GLA:D® Back, a standardised intervention of patient education and supervised exercises. This pilot study tested the feasibility of implementing GLA:D Back in clinical practice in Denmark by delivering a course for physiotherapists and chiropractors. It should further inform the planning of an implementation-effectiveness study using a pre-post group design alongside nation-wide implementation.MethodsThirty-one clinicians from nine clinics participated. Feasibility of implementation was evaluated in terms of adoption and through focus group interviews and a feedback meeting. Patient-level data, including pain, disability, and pain enablement, were collected from (1) LBP patients visiting the clinics during a pre-specified 2-week period 2 months prior to clinicians attending the GLA:D Back course (n = 84), (2) LBP patients consulting during a 2-week period 2 months after the course (n = 77), and (3) those enrolled in GLA:D Back during 4 months after implementation (n = 89). Patient data were collected at baseline and at 4 months.ResultsClinicians’ evaluations of the course were positive and resulted in several modifications. The clinical intervention was adopted by all test sites. Most patient characteristics were similar across groups. Patients mainly had persistent LBP (73% > 3 months) and most had been treated for more than 4 weeks at inclusion. Patients in GLA:D Back were more often retired (30% vs. 16% before implementation) and at high risk of poor prognosis (25% vs. 13%). Procedures for data collection were feasible, and outcomes after implementation, especially with GLA:D Back, were as good as or better than before implementation. Recruiting patients and achieving comparable pre- and post-groups was difficult.ConclusionsImplementation of the GLA:D Back clinical intervention in Danish primary care physiotherapy and chiropractic clinics was feasible through a 2-day clinician course. Both clinicians and patients were satisfied with the programme, and patient-reported outcomes were slightly better than outcomes in patients registered before implementation. It was not deemed possible to conduct an implementation-effectiveness trial as part of a nation-wide implementation.
Highlights
Clinical guidelines for management of low back pain (LBP) are not routinely implemented in practice, and guidelines rarely offer tools for implementation
Clinicians and patients responded to electronic questionnaires in Research Electronic Data Capture (REDCap) that is licenced by the Open Patient data Explorative Network (OPEN)
We included all patients enrolled in Good Life with osteoArthritis in Denmark (GLA):D Back up until 4 months after the clinician course (GLA:D Back group) in order to recruit a volume of GLA:D Back participants that would allow determining the characteristics of the target group for GLA:D Back and estimating their outcomes
Summary
Clinical guidelines for management of low back pain (LBP) are not routinely implemented in practice, and guidelines rarely offer tools for implementation. We developed GLA:D® Back, a standardised intervention of patient education and supervised exercises This pilot study tested the feasibility of implementing GLA:D Back in clinical practice in Denmark by delivering a course for physiotherapists and chiropractors. Clinical guidelines for the treatment of back pain consistently recommend that patients are educated about their condition and are encouraged to remain physically active and at work while some include supervised exercise therapy that may or may not be combined with manual therapies [1] These recommendations are not routinely implemented in clinical practice [2] causing many people to receive care that is ineffective [3, 4]. It is taught to clinicians in a 2-day course and monitored in a clinical registry [10]
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