Implementation of a Best Practice Primary Health Care Model for Low Back Pain
Condition: Low Back Pain
MeSH terms: Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      POPULATION: Low back pain (LBP) is a major health problem commonly requiring health care. In
      Sweden, primary care professionals require an evidenced based model of care for LBP.

      INTERVENTION: The multi-faceted implementation of a best practice BetterBack model of care
      for LBP.

      CONTROL: Current routine practice for LBP care before implementation of the BetterBack model
      of care.

      OUTCOME: Patient reported measures (function, activity, health), therapist reported measures
      (diagnosis, intervention, specialist referral, best practice self-confidence, determinants of
      implementation) and cost-effectiveness.

      AIM: To deliver best practice recommendations for LBP and study their most effective
      implementation through the BetterBack model of care.

      METHOD: A cluster randomised trial with dog leg design. The hypothesis is that the BetterBack
      model of care will result in significantly better patient and therapist outcomes as well as
      cost-effectiveness compared to current routine care.
    

Detailed description: 
      Low back pain (LBP) is a major health and socioeconomic burden. LBP is usually a result of
      benign dysfunction and context that affects the patient's perception of pain and limits their
      activity and participation. At present there are no national clinical guidelines or best
      practice models of care in Sweden focused on the primary care of low back pain.
      Implementation of a model of LBP primary care based on international evidence-based
      guidelines is needed to improve care and patient outcomes in Sweden. This project aims to
      investigate the effectiveness of a best practice model of care (BetterBack) for the primary
      care management of LBP. A cluster randomised trial with dog leg design will be conducted in
      the Östergötland Health care region. The hypothesis is that the BetterBack model of care will
      result in significantly better patient and therapist reported outcomes as well as
      cost-effectiveness compared to current routine care. This by improved patient outcomes in
      terms of physical function, low back pain intensity, activity level, work and quality of
      life. Furthermore, improved care processes and knowledge support for physiotherapists can
      lead to a smaller proportion of patients requiring specialist care.
    

Intervention name(s): Current routine practice; Multifaceted implementation of the BetterBack
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Current routine practice for the primary care management of LBP; The multifaceted intervention is composed of the following:
Forming an implementation forum including head of departments/managers of the rehabilitation units and the clinical researchers.
Forming a support team comprised of experience clinicians as local supervisors and faculty researchers as knowledge facilitators.
Developing the Betterback model of care through a collaboration of the implementation forum, support team and international experts.
Forming and delivering a 2-day package of education and training that the support team can utilize to assist the use of the BetterBack model of care by clinicians.
Allocation: Randomized
Intervention model: Sequential Assignment
Intervention model description: A cluster randomised trial with dog leg design
Masking: Single (Participant)
Primary purpose: Health Services Research
Keywords: Low back pain; Model of care; Primary health care; Implementation; Patient-rated outcome; Clinician-rated outcome; Cost-effectiveness