Clinical Practice Guidelines for Neck and Low Back Pain in Outpatient Physical Therapy
Condition: Neck Pain; Low Back Pain
MeSH terms: Back Pain; Low Back Pain; Neck Pain
Study type: Interventional

Summary: 
      This study will investigate implementation of a process to enhance Clinical Practice
      Guideline (CPG) adherence to limit unwarranted variability in initial treatment decisions
      with high potential for providing more effective and efficient physical therapy management
      for patients with neck and low back pain.
    

Detailed description: 
      Effective implementation of CPGs to augment initial clinical decision making during physical
      therapy management of patients with spine related musculoskeletal pain will have several
      important goals: 1) improve patient pain and disability outcomes, 2) limit over utilization
      of physical therapy services, and 3) increase adherence to limit unwarranted variation in
      clinical practice. This proposed pilot study proposal will test if a multifaceted
      intervention strategy for implementation of neck and low back CPG meets these goals and
      provide necessary data for larger system wide implementation efforts.

      Specific Aim 1: Determine if physical therapy clinics that receive neck and low back pain
      (LBP) clinical practice guideline (CPG) training are associated with improved patient
      outcomes compared to those that have not received training. Neck and LBP specific disability
      and pain intensity will be assessed at intake, on a weekly basis and at discharge (Specific
      Aim 1a). Secondary patient outcomes will consist of patient satisfaction scores (Specific Aim
      1b). Statistical analyses will evaluate for temporal effects of training considering the
      stepped wedge study design.

      Specific Aim 2: Determine if multifaceted interventions for CPG implementation positively
      impacts physical therapist beliefs, attitudes, knowledge and behaviors over time. CPG
      adherence (by clinicians) will be indirectly assessed using quantitative and qualitative
      methods consisting of: 1) clinician checklists, 2) clinician questionnaires, 3) quality
      indicators, and 4) total proportion outcome measure assessments (Specific Aim 2).
    

Intervention name(s): Clinical Practice Guideline Implementation; Standard Care
Intervention type(s): Behavioral; Other
Intervention description(s): The Study team will use several methods from the implementation strategy taxonomy of the Effective Practice and Organization of Care (EPOC) classification system to improve our likelihood for successful neck and low back pain implementation consisting of: 1) educational materials, workshops and outreach visits from trainers; 2) external consultant testimonials; 3) iterative quality improvement processes (including ongoing analysis of clinician feedback to improve process); 4) routine collection of patient reported outcomes to engage discussion among clinician groups and outpatient division leaders) and 5) local organization consensus process (including feedback from key outpatient division stakeholders).; Considering the stepped wedge design with a 12-week washout phase, clinics will be providing standard physical therapy prior to receiving clinical practice guideline training.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Intervention model description: cross-sectional stepped wedge design
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Outpatient Physical Therapy