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- Title
GLA:D<sup>®</sup> Back: implementation of group-based patient education integrated with exercises to support self-management of back pain - protocol for a hybrid effectiveness-implementation study.
- Authors
Kongsted, Alice; Ris, Inge; Kjaer, Per; Vach, Werner; Morsø, Lars; Hartvigsen, Jan
- Abstract
<bold>Background: </bold>Reassuring patient education and exercise therapy are widely recommended interventions for back pain in clinical guidelines. However, many patients are offered non-guideline endorsed options, and strategies for effective implementation of guideline-based care have not yet been developed. This protocol outlines the evaluation of a strategy for nationwide implementation of standardised patient education and exercise therapy for people with persistent or recurrent back pain in a hybrid implementation-effectiveness design. The strategy and the evaluation were planned using the framework of the Behaviour Change Wheel.<bold>Methods: </bold>The main activity of the implementation strategy is a two-days course for physiotherapists and chiropractors in delivering patient education and exercise therapy that is aimed at supporting patient self-management. This comes with ready-to-use patient education materials and exercise programs. The clinical intervention is a group-based program consisting of two sessions of patient education and 8 weeks of supervised exercises. The program uses a cognitive-behavioural approach and the aim of the exercise component is to restore the patient's ability and confidence to move freely. The implementation process is evaluated in a dynamic process monitoring the penetration, adoption and fidelity of the clinical intervention. The clinical intervention and potential effect mechanisms will be evaluated at the patient-level using measures of knowledge, skills, beliefs, performance, self-efficacy and success in self-management. The education of clinicians will be evaluated via clinician-level outcomes, including the Pain Attitudes and Beliefs Scale, the Practitioner Confidence Scale, and the Determinants of Implementation Behaviour Questionnaire. Effects at a national level will be investigated via data from national registries of health care utilisation and sick-leave.<bold>Discussion: </bold>This implementation-effectiveness study is designed to evaluate the process of implementing an evidence-based intervention for back pain. It will inform the development of strategies for implementing evidence-based care for musculoskeletal pain conditions, it will enhance the understanding of mechanisms for developing patient self-management skills, and it will demonstrate the outcomes that are achievable in everyday clinical practice.<bold>Trial Registration: </bold>ClinicalTrials.gov NCT03570463 . Registered 27 June 2018.
- Subjects
DENMARK; BACK exercises; PATIENT education; BACKACHE; EXERCISE therapy; EXERCISE; NATIONAL health services; TREATMENT of backaches; SPINAL adjustment; HUMAN services programs
- Publication
BMC Musculoskeletal Disorders, 2019, Vol 20, Issue 1, pN.PAG
- ISSN
1471-2474
- Publication type
journal article
- DOI
10.1186/s12891-019-2443-1