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Physiotherapists are better at putting guidelines for treating low back pain into practice if these are introduced in an active, wide ranging programme, a randomised controlled trial has reported, for the first time.
Physiotherapists who had been through the programme were twice as likely to comply with the evidence based guidelines—like ordering fewer treatment sessions for patients with a normal course of lower back pain and recommending active interventions and functional treatment goals—as those who had not. They were over three times as likely to engage in sufficient patient education.
The effect was modest, but the researchers suggest that the volunteer status of all physiotherapists in the trial—and their enthusiasm for evidence based care—may mask the true difference. Nevertheless, the results still showed that physiotherapists must resist overtreating those patients with a normal course to their back pain.
The participants were from 68 private primary care physiotherapy practices agreeing to take part of those randomly selected by the Royal Dutch Society for Physiotherapy. Fifty two physiotherapists were randomly allocated to the active programme, and 61 merely received the guidelines in a standard mailing. The care process was assessed from each patient’s treatment forms by blinded independent assessors. Results for 37 (48) physiotherapists and 247 (253) patients were analysed, respectively.
Evidence based guidelines for physiotherapists’ care of generalised back pain have been sent to all physiotherapists in the Netherlands. The trial sought to test the usefulness of the active programme already devised to improve their implementation.
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