Acute Low-back pain Implementing Guidelines into practice (ALIGN)

Acute low back pain is a common condition and, in combination, chiropractors and physiotherapists provide much of the care for the condition in Australia. The recent development and publication of National Health and Medical Research Council clinical practice guidelines for acute low back pain has provided recommendations with the potential to improve the quality of care and safety for people with acute low back pain. Particularly relevant messages of this clinical practice guideline are that x-rays are rarely needed and that patients should be advised to remain active.

We are currently investigating the effectiveness of a targeted, theory-based implementation strategy developed to implement these clinical practice guidelines in general practice (see IMPLEMENT). However, whether or not implementation strategies are transferable between professional groups is not yet established. This proposed project allows us to build on our work to date, contrast barriers and enablers to practice between settings and to potentially improve the quality and safety of management of acute low back pain by allied health practitioners.

This project is funded by the Australian National Health and Medical Research Council. It is a two stage project with the following aims:

  1. to identify the barriers and enablers to implementing an evidence-based clinical practice guideline for acute low-back pain in allied health clinical practice using a theoretical framework;
  2. to develop and pilot a targeted implementation strategy to increase the uptake of the evidence-based clinical practice guideline which addresses the modifiable barriers;
  3. to test the effectiveness and cost effectiveness of this strategy for implementing an evidence based clinical practice guideline for acute low back pain in allied health in a cluster randomised controlled trial

A mixed methods design will be used for this project. A qualitative approach using semi-structured interviews with physiotherapists, chiropractors and the patients of both will be conducted to identify the barriers and enablers to implementation of the clinical practice guideline. The interviews will be underpinned by a theoretical framework grounded in behavioural theory. Information from the interviews will be used to develop a survey to canvas views of a larger population of chiropractors and physiotherapists. The results of the interviews and survey will inform the development of a targeted implementation strategy suitable for use in physiotherapy and chiropractic clinics. Potential interventions include educational strategies, patient and practitioner information via various media, reminder systems and peer leadership.

A cluster randomised controlled trial will then be conducted to determine the effects of the strategy. Practices will be randomised to receive either the developed implementation strategy, including strategies targeted at clinicians and patients, or to a control group receiving access to the clinical practice guideline alone. The outcomes of the implementation strategy will be assessed at the level of the practitioner (did the strategy result in a change of practice?) and the patient (did the practice change result in improved patient outcomes?). Subgroup analyses will investigate effects specific to chiropractors and physiotherapists.

Chief Investigator:

Associate Professor Sally Green

Other investigators:

Ms Joanne McKenzie, Prof Jeremy Grimshaw, Mr Duncan Mortimer, Prof Jenny Keating, Dr Bruce Walker, Dr Denise O’Connor, Dr Simon French, Prof Susan Michie, Dr Jill Francis.

Research Assistants:

Dr Kerry Murphy


Denise O'Connor at or on +61 3 9903 0371.