Evans, David W., Breen, Alan C., Pincus, Tamar, Sim, Julius, Underwood, M. (Martin) M.D., Vogel, Steven and Foster, Nadine E.. (2010) The effectiveness of a posted information package on the beliefs and behavior of musculoskeletal practitioners the UK chiropractors, osteopaths, and musculoskeletal hysiotherapists Low Back Pain Management (COMPLeMENT) randomized trial. Spine, Vol.35 (No.8). pp. 858-866. ISSN 0362-2436

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Abstract

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.

Item Type:	Journal Article
Subjects:	R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry R Medicine > RC Internal medicine
Divisions:	Faculty of Medicine > Warwick Medical School
Journal or Publication Title:	Spine
Publisher:	Lippincott Williams & Wilkins
ISSN:	0362-2436
Date:	15 April 2010
Volume:	Vol.35
Number:	No.8
Number of Pages:	9
Page Range:	pp. 858-866
Identification Number:	10.1097/BRS.0b013e3181d4e04b
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
Funder:	Osteopathic Educational Foundation, Anglo-European College of Chiropractic TAM Club, General Osteopathic Council, British Chiropractic Association, National Institutes of Health Research (NIHR), UK
URI:	http://wrap.warwick.ac.uk/id/eprint/6057

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