Can the Enhanced Transtheoretical Model Intervention (ETMI) be Implemented in a Public Health Organization

Study Overview
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Brief Summary
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The aim of this study is to assess whether the ETMI method can be implemented among primary care practitioners in the central district of Maccabi Health Services and examine whether it provides a medical and economic advantage.

Detailed Description
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An implementation study- a prospective cohort study with pre- and post-intervention by retrieving economic and therapeutic outcome data from MHS databases. The intervention group will be the Central District of MHS, among 220 primary care practitioners (100 Physicians and 120 physiotherapists) and their patients (n=7,000) who suffer from back pain and receive treatment. We will investigate the relationship between the care received and outcomes in terms of healthcare utilization, costs, and patient-relevant outcomes.

Official Title
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Can the Enhanced Transtheoretical Model Intervention (ETMI) be Implemented in a Public Health Organization- an Implementation Study

Conditions
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Low Back Pain

Intervention / Treatment
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* Other: the Enhanced Transtheoretical Model Intervention (ETMI)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: primary care practitioners and their patients, who suffer from back pain and receive treatment. patients who suffer from back pain and receive treatment with or without leg radiation Exclusion Criteria: no

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Central District<br>The ETMI method will be implemented in this group | Other: the Enhanced Transtheoretical Model Intervention (ETMI)<br>* ETMI consists of a physical and functional examination, a discussion about the role of physical activity matched to the patient stage of change, and guided through motivational interviewing techniques, exposure to fast walking, and goal setting. The patient receives a postcard outlining the main messages about physical activity and four simple stretches. The ETMI method consists of four parts: Creating a therapeutic alliance (communication skills and reassurance) Clear messages to the patient: Mandatory 3 sentences: (1. physical activity is the only thing that will help your back pain over time. 2. It's easy to reduce your pain now - but the important thing is to prevent the next episode, 3. Your body must be strong and flexible.) Exposure to brisk walking (brisk walking in the corridor, hand by hand with the therapist) and graded activity. Postcard with reminder messages on how to self manage the back.<br>|
| North District<br>control | |
| Hasharon District<br>control | |
| South District<br>control | |
| Jerusalem and Hasfhela District<br>control | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| ETMI Code |  | baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Lumbar Computerized Adaptive Test (LCAT) | LCAT is a computerized adaptive test, meaning that the administration selects items from the item bank one at a time based on an administrative algorithm. The final calculated functional score ranges on a linear scale of 0-100, higher measures representing higher function. Additionally, the system predicts a risk-adjusted functional score at discharge. The adjusting is on: functional score at admission, age, sex, chronicity as number of days from onset of the treated condition, number of related surgeries, exercise history and use of medication to treat LBP.MCID for the LCAT is 3-9 points depending on the first score. LCAT has been tested for validity by comparing it to the Oswestry Low Back Pain Disability Questionnaire and has a high level of reliability in the English version (α = 0.92).Several studies have been published using the LCAT's Hebrew version. | baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Low Back Pain, implementation study, Enhanced Transtheoretical Model Intervention, Public Health