Table 1 Studies testing a one-off or single event implementation intervention
Study | Intervention and control | Outcome measures | Results | Overall intervention success | ||
|---|---|---|---|---|---|---|
Dey et al., 2004 [29] | IG: Educational outreach visit supported with PEM & access to back pain clinic for non-responders CG: No intervention/usual care | Primary outcome measure(s) not stated. | Only one in five outcomes was statistical significantly different between the IG and CG: Referral to PT or an education programme | |||
1. Radiograph request rate | 1. 5.1 % IG v 13.7 % CG ρ = 0.62 | |||||
2. Sickness certification rate | 2. 17.7 % IG v 19.2 % CG ρ = 0.74 | |||||
3. Prescription of opioids or muscle relaxants (% patients) | 3. 18.7 % IG v 18.7 % CG ρ = 0.99 | |||||
4. Referral rate to secondary care | 4. 3.4 % IG v 2.3 % CG ρ = 0.12 | |||||
5. Referral rate to PT or an education programme | 5. 26 % IG v 13.8 % CG ρ = 0.01* | |||||
Engers et al., 2004 [46] | IG: 2 h educational workshop involving role-play, focusing on the psychosocial model of LBP backed up with PEM CG: No intervention/usual care | Primary outcome measures: | 6 weeks: | 52 weeks: | 6 weeks: No statistically significant differences at 6 weeks in the direction of the IG. | 52 weeks: Only one in five outcomes was statistically significantly different at 52 weeks: Consulting an HCP other than GP |
1. Median pain intensity over last 7 days | 1. 2 IG v 1 CG ρ = 0.06 | 1. 1 IG v 1 CG ρ = 0.43 | ||||
2. Functional status: a. Median Roland Morris score | 2a. 7.5 IG v 5 CG ρ = 0.06 | 2a. 2 IG v 2 CG ρ = 0.91 | ||||
2. Functional status: b. Median days not functional in last 6 weeks | 2b. 7 IG v 2 CG ρ = 0.03 | 2b. 0 IG v 0 CG ρ = 0.37 | ||||
3. Median days of work absenteeism in the last 6 weeks | 3. 7 IG v 3 CG ρ = 0.01 | 3. 0 IG v 0 CG ρ = 0.66 | ||||
4. Healthcare use in the previous 6 weeks. | 4. 24 % return to GP and 40 % consulting other HCP IG v 17 % & 42 % CG ρ = 0.05 and 0.65 | 4. 0 % & 36 % IG v 1 % & 50 % CG ρ = 0.24 and 0.01* | ||||
Engers et al., 2005 [27] | IG: 2 h educational workshop involving role-play, focusing on the psychosocial of LBP backed up with PEM CG: No intervention/usual care | Primary outcome measure(s) not stated | Only a lower referral rate to a therapist achieved statistical significance | |||
1. Referrals to a therapist | 1. 19 patients or 36 % of patients IG v 25 or 76 % CG OR: 0.2; CI: 0.1 to 0.6; ρ ≤ 0.05* but actual value not stated | |||||
2. Prescription of pain medication on a time-contingent basis | 2. 19 or 62 % IG v 10 or 71 % CG OR: 0.7; CI: 0.6 to 6.3; ρ not stated | |||||
3. Prescription of paracetamol | 3. 7 or 23 % IG v 1 or 7 % CG OR: 4.8; CI: 0.1 to 181; ρ not stated | |||||
4. Prescription of NSAIDs | 4. 19 or 61 % IG v 10 or 71 % CG OR and CI not stated; ρ not stated | |||||
5. Adequacy of patient education rated across nine measures | 5. Explained that no specific cause could be detected: 33 or 64 % IG v 22 or 67 % CG OR: 0.9; CI: 0.3 to 2.8; ρ not stated Explained that back pain will ease by itself: 36 or 69 % IG v 23 or 70 % CG OR: 0.9; CI: 0.3 to 3.1; ρ not stated Explained that there is no harm: 44 or 85 % IG v 20 or 61 % CG OR: 3; CI: 0.6 to 16.3; ρ not stated Explained that it is better to accept the pain: 29 or 56 % IG v 17 or 52 % CG OR: 1.7; CI: 0.2 to 13.3; ρ not stated Handed out an information pamphlet: 11 or 21 % IG v 4 or 12 % CG OR: 1.6; CI: 0.4 to 7.8; ρ not stated Advised to stay active: 42 or 81 % IG v 16 or 49 % CG OR: 1.7; CI: 0.3 to 9.0; ρ not stated Advised to gradually increase activity: 45 or 87 % IG v 9 or 58 % CG OR: 3.3; CI: 0.7 to 17.0; ρ not stated Advised which activities to increase when: 11 or 21 % IG v 5 or 16 % CG OR: 2.1; CI: 0.7 to 11.5; ρ not stated Advised to stop activity when in pain: 9 or 17 % IG v 7 or 21 % CG OR: 2.1; CI: 0.7 to 11.5; ρ not stated | |||||
Matowe et al., 2002 [25] | Postal dissemination of guidelines. No CG as the study was a TIS | Primary outcome measure: Lumbar spine radiography request rate. | Mean request rate reduced by 7.7 from 147.8 in the first month with a 0.4 reduction trend over 13 months CI: −24.7 to 40.2; ρ not stated | The reported change did not reach statistical significance. | ||
Stevenson et al., 2006 [30] | IG: 5-h education session delivered by a local opinion leader CG: Standard in-service session on knee pathologies | Primary outcome measure: Change in PTs’ clinical practice measured using a standardised discharge summary questionnaire assessing time spent using modalities targeted for NSLBP | Number of patients/% of patients with the modality recorded as being used | Only changes in the advice to increase activity levels and attempting to change patient attitudes/beliefs about pain achieved statistical significance. 4 out of 6 primary outcome measures showed no significant difference between groups | ||
1. Advice about work situation | 1. 42 or 37 % IG v 15 or 35 % CG OR: 1.1; CI: 0.5 to 2.5; ρ not stated | |||||
2. Advice on return to normal duties | 2. 34 or 30 % IG v 13 or 30 % CG OR: 1.1; CI: 0.4 to 3.0; ρ not stated | |||||
3. Advice to increase activity levels | 3. 36 or 32 % IG v 7 or 16 % CG OR: 2.1: CI: 0.7 to 6.8; ρ ≤ 0.05* but actual value not stated | |||||
4. Encouraging early return to work | 4. 5 or 4 % IG v 1 or 2 % CG OR: 1.6; CI: 0.1 to 23.1; ρ not stated | |||||
5. Encouraging to undertake activities themselves | 5. 16 or 14 % IG v 18 or 42 % CG OR: 0.3; CI: 0.1 to 0.9; ρ not stated | |||||
6. Attempting to change patient attitudes/beliefs about pain | 6. 25 or 22 % IG v 4 or 9 % CG OR: 2.6; CI: 0.7 to 9.5; ρ ≤ 0.05* but actual value not stated | |||||