QUESTION: Are implementation strategies involving education any more effective than mere dissemination of clinical practice guidelines in changing physiotherapy practice and reducing patient disability after acute whiplash? DESIGN: Cluster-randomised trial. PARTICIPANTS: Twenty-seven physiotherapists from different private physiotherapy clinics and the 103 patients (4 dropouts) who presented to them with acute whiplash. INTERVENTION: The implementation group of physiotherapists underwent education by opinion leaders about whiplash guidelines and the dissemination group had the guidelines mailed to them. OUTCOME MEASURES: The primary outcome was patient disability, measured using the Functional Rating Index, collected on admission to the trial and at 1.5, 3, 6 and 12 months. Physiotherapist knowledge about the guidelines was measured using a custom-made questionnaire. Physiotherapist practice and cost of care were measured by audit of patient notes. RESULTS: There were no significant differences between groups for any of the patient outcomes at any time. The implementation patients had 0.6 points (95% CI -7.8 to 6.6) less disability than the dissemination patients at 12 months; 44% more physiotherapists in the implementation group reported that they prescribed two out of the five guideline-recommended treatments; and 32% more physiotherapists actually prescribed them. The cost of care for patients in the implementation group was $255 (95% CI -1505 to 996) less than for patients in the dissemination group. CONCLUSION: Although the active implementation program increased guideline-consistent practice, patient outcomes and cost of care were not affected.
RCT Entities:
QUESTION: Are implementation strategies involving education any more effective than mere dissemination of clinical practice guidelines in changing physiotherapy practice and reducing patient disability after acute whiplash? DESIGN: Cluster-randomised trial. PARTICIPANTS: Twenty-seven physiotherapists from different private physiotherapy clinics and the 103 patients (4 dropouts) who presented to them with acute whiplash. INTERVENTION: The implementation group of physiotherapists underwent education by opinion leaders about whiplash guidelines and the dissemination group had the guidelines mailed to them. OUTCOME MEASURES: The primary outcome was patient disability, measured using the Functional Rating Index, collected on admission to the trial and at 1.5, 3, 6 and 12 months. Physiotherapist knowledge about the guidelines was measured using a custom-made questionnaire. Physiotherapist practice and cost of care were measured by audit of patient notes. RESULTS: There were no significant differences between groups for any of the patient outcomes at any time. The implementation patients had 0.6 points (95% CI -7.8 to 6.6) less disability than the dissemination patients at 12 months; 44% more physiotherapists in the implementation group reported that they prescribed two out of the five guideline-recommended treatments; and 32% more physiotherapists actually prescribed them. The cost of care for patients in the implementation group was $255 (95% CI -1505 to 996) less than for patients in the dissemination group. CONCLUSION: Although the active implementation program increased guideline-consistent practice, patient outcomes and cost of care were not affected.
Authors: Gerd Flodgren; Elena Parmelli; Gaby Doumit; Melina Gattellari; Mary Ann O'Brien; Jeremy Grimshaw; Martin P Eccles Journal: Cochrane Database Syst Rev Date: 2011-08-10
Authors: Charles Philip Gabel; Antonio Cuesta-Vargas; Sebastian Barr; Stephanie Winkeljohn Black; Jason W Osborne; Markus Melloh Journal: Eur Spine J Date: 2016-04-04 Impact factor: 3.134
Authors: Geert M Rutten; Janneke Harting; L Kay Bartholomew; Angelique Schlief; Rob A B Oostendorp; Nanne K de Vries Journal: BMC Health Serv Res Date: 2013-05-25 Impact factor: 2.655