Suppr
超能文献

张贴信息包对肌肉骨骼从业者的信念和行为的影响：英国脊椎指压治疗师、整骨医生和肌肉骨骼物理治疗师腰痛管理（COMPLeMENT）随机试验。

The effectiveness of a posted information package on the beliefs and behavior of musculoskeletal practitioners: the UK Chiropractors, Osteopaths, and Musculoskeletal Physiotherapists Low Back Pain ManagemENT (COMPLeMENT) randomized trial.

机构信息

School of Health and Rehabilitation, Keele University, Staffordshire, United Kingdom.

出版信息

Spine (Phila Pa 1976). 2010 Apr 15;35(8):858-66. doi: 10.1097/BRS.0b013e3181d4e04b.

DOI:10.1097/BRS.0b013e3181d4e04b

PMID:20308941

Abstract

STUDY DESIGN

Randomized controlled trial.

OBJECTIVE

To investigate the effect of a printed information package on the low back pain (LBP)-related beliefs and reported behavior of musculoskeletal practitioners (chiropractors, osteopaths, and musculoskeletal physiotherapists) across the United Kingdom.

SUMMARY OF BACKGROUND DATA

A substantial proportion of musculoskeletal practitioners in United Kingdom does not follow current LBP guideline recommendations.

METHODS

In total, 1758 practitioners were randomly allocated to either of the 2 study arms. One arm was posted a printed information package containing guideline recommendations for the management of LBP (n = 876) and the other received no intervention (n = 882). The primary outcome measure consisted of 3 "quality indicators" (activity, work, and bed-rest) relating to a vignette of a patient with LBP, in which responses were dichotomized into either "guideline-inconsistent" or "guideline-consistent." The secondary outcome was the practitioners' LBP-related beliefs, measured using the Health Care Providers Pain and Impairment Relationship Scale. Outcomes were measured at baseline and at 6 months.

RESULTS

Follow-up at 6 months was 89%. The changes in reported behavior on the quality indicators were as follows: activity, odds ratio (OR) 1.29 (95% confidence interval, 1.03-1.61) and number needed to be treated (NNT), 19 (15-28); work, OR 1.35 (1.07-1.70) and NNT 19 (14-29); and bed-rest, OR 1.31 (0.97-1.76) and NNT 47 (33-103). The composite NNT for a change from guideline-inconsistent to guideline-consistent behavior on at least 1 of the 3 quality indicators was 10 (9-14). LBP-related beliefs were significantly improved in those who were sent the information package (P = 0.002), but only to a small degree (mean difference, 0.884 scale points; 95% confidence interval, 0.319-1.448).

CONCLUSION

Printed educational material can shift LBP-related beliefs and reported behaviors of musculoskeletal practitioners, toward practice that is more in line with guideline recommendations.

摘要

研究设计

随机对照试验。

目的

研究在英国，印刷信息包对肌肉骨骼从业者（包括脊椎治疗师、整骨医师和肌肉骨骼物理治疗师）的腰痛（LBP）相关信念和报告行为的影响。

背景资料概要

英国相当一部分肌肉骨骼从业者没有遵循当前的 LBP 指南建议。

方法

共有 1758 名从业者被随机分配到两个研究组。一组收到包含 LBP 管理指南建议的印刷信息包（n = 876），另一组则未收到干预（n = 882）。主要结果指标包括与 LBP 患者病例相关的 3 个“质量指标”（活动、工作和卧床休息），其结果被分为“与指南不一致”或“与指南一致”。次要结果是从业者的 LBP 相关信念，使用医疗保健提供者疼痛和损伤关系量表进行测量。结果在基线和 6 个月时进行测量。

结果

6 个月时的随访率为 89%。质量指标报告行为的变化如下：活动，比值比（OR）为 1.29（95%置信区间，1.03-1.61），需要治疗的人数（NNT）为 19（15-28）；工作，OR 为 1.35（1.07-1.70），NNT 为 19（14-29）；卧床休息，OR 为 1.31（0.97-1.76），NNT 为 47（33-103）。至少有 1 项质量指标从“与指南不一致”变为“与指南一致”的复合 NNT 为 10（9-14）。收到信息包的从业者的 LBP 相关信念显著改善（P = 0.002），但仅略有改善（平均差异为 0.884 量表分；95%置信区间，0.319-1.448）。