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Evaluating two implementation strategies for whiplash guidelines in physiotherapy: a cluster-randomised trial |
Rebbeck T, Maher CG, Refshauge KM |
Australian Journal of Physiotherapy 2006;52(3):165-174 |
clinical trial |
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed* |
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 -1,505 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.
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