Table 1

Studies testing a one-off or single event implementation intervention

StudyIntervention and controlOutcome measuresResultsOverall intervention success
Dey et al., 2004 [29]IG: Educational outreach visit supported with PEM & access to back pain clinic for non-responders
CG: No intervention/usual care
Primary outcome measure(s) not stated.Only one in five outcomes was statistical significantly different between the IG and CG: Referral to PT or an education programme
1. Radiograph request rate1. 5.1 % IG v 13.7 % CG
ρ = 0.62
2. Sickness certification rate2. 17.7 % IG v 19.2 % CG
ρ = 0.74
3. Prescription of opioids or muscle relaxants (% patients)3. 18.7 % IG v 18.7 % CG
ρ = 0.99
4. Referral rate to secondary care4. 3.4 % IG v 2.3 % CG
ρ = 0.12
5. Referral rate to PT or an education programme5. 26 % IG v 13.8 % CG
ρ = 0.01*

Engers et al., 2004 [46]IG: 2 h educational workshop involving role-play, focusing on the psychosocial model of LBP backed up with PEM
CG: No intervention/usual care
Primary outcome measures:6 weeks:52 weeks:6 weeks:
No statistically significant differences at 6 weeks in the direction of the IG.
52 weeks:
Only one in five outcomes was statistically significantly different at 52 weeks: Consulting an HCP other than GP
1. Median pain intensity over last 7 days1. 2 IG v 1 CG
ρ = 0.06
1. 1 IG v 1 CG
ρ = 0.43
2. Functional status:
a. Median Roland Morris score
2a.
7.5 IG v 5 CG
ρ = 0.06
2a. 2 IG v 2 CG
ρ = 0.91
2. Functional status:
b. Median days not functional in last 6 weeks
2b.
7 IG v 2 CG
ρ = 0.03
2b. 0 IG v 0 CG
ρ = 0.37
3. Median days of work absenteeism in the last 6 weeks3. 7 IG v 3 CG
ρ = 0.01
3. 0 IG v 0 CG
ρ = 0.66
4. Healthcare use in the previous 6 weeks.4. 24 % return to GP and 40 % consulting other HCP IG v 17 % & 42 % CG
ρ = 0.05 and 0.65
4. 0 % & 36 % IG v 1 % & 50 % CG
ρ = 0.24 and 0.01*

Engers et al., 2005 [27]IG: 2 h educational workshop involving role-play, focusing on the psychosocial of LBP backed up with PEM
CG: No intervention/usual care
Primary outcome measure(s) not statedOnly a lower referral rate to a therapist achieved statistical significance
1. Referrals to a therapist1. 19 patients or 36 % of patients IG v 25 or 76 % CG
OR: 0.2; CI: 0.1 to 0.6; ρ ≤ 0.05* but actual value not stated
2. Prescription of pain medication on a time-contingent basis2. 19 or 62 % IG v 10 or 71 % CG
OR: 0.7; CI: 0.6 to 6.3; ρ not stated
3. Prescription of paracetamol3. 7 or 23 % IG v 1 or 7 % CG
OR: 4.8; CI: 0.1 to 181; ρ not stated
4. Prescription of NSAIDs4. 19 or 61 % IG v 10 or 71 % CG
OR and CI not stated; ρ not stated
5. Adequacy of patient education rated across nine measures5. Explained that no specific cause could be detected: 33 or 64 % IG v 22 or 67 % CG
OR: 0.9; CI: 0.3 to 2.8; ρ not stated
Explained that back pain will ease by itself: 36 or 69 % IG v 23 or 70 % CG
OR: 0.9; CI: 0.3 to 3.1; ρ not stated
Explained that there is no harm: 44 or 85 % IG v 20 or 61 % CG
OR: 3; CI: 0.6 to 16.3; ρ not stated
Explained that it is better to accept the pain: 29 or 56 % IG v 17 or 52 % CG
OR: 1.7; CI: 0.2 to 13.3; ρ not stated
Handed out an information pamphlet: 11 or 21 % IG v 4 or 12 % CG
OR: 1.6; CI: 0.4 to 7.8; ρ not stated
Advised to stay active: 42 or 81 % IG v 16 or 49 % CG
OR: 1.7; CI: 0.3 to 9.0; ρ not stated
Advised to gradually increase activity: 45 or 87 % IG v 9 or 58 % CG
OR: 3.3; CI: 0.7 to 17.0; ρ not stated
Advised which activities to increase when: 11 or 21 % IG v 5 or 16 % CG
OR: 2.1; CI: 0.7 to 11.5; ρ not stated
Advised to stop activity when in pain: 9 or 17 % IG v 7 or 21 % CG
OR: 2.1; CI: 0.7 to 11.5; ρ not stated

Matowe et al., 2002 [25]Postal dissemination of guidelines. No CG as the study was a TISPrimary outcome measure: Lumbar spine radiography request rate.Mean request rate reduced by 7.7 from 147.8 in the first month with a 0.4 reduction trend over 13 months
CI: −24.7 to 40.2; ρ not stated
The reported change did not reach statistical significance.

Stevenson et al., 2006 [30]IG: 5-h education session delivered by a local opinion leader
CG: Standard in-service session on knee pathologies
Primary outcome measure: Change in PTs’ clinical practice measured using a standardised discharge summary questionnaire assessing time spent using modalities targeted for NSLBPNumber of patients/% of patients with the modality recorded as being usedOnly changes in the advice to increase activity levels and attempting to change patient attitudes/beliefs about pain achieved statistical significance.
4 out of 6 primary outcome measures showed no significant difference between groups
1. Advice about work situation1. 42 or 37 % IG v 15 or 35 % CG
OR: 1.1; CI: 0.5 to 2.5; ρ not stated
2. Advice on return to normal duties2. 34 or 30 % IG v 13 or 30 % CG
OR: 1.1; CI: 0.4 to 3.0; ρ not stated
3. Advice to increase activity levels3. 36 or 32 % IG v 7 or 16 % CG
OR: 2.1: CI: 0.7 to 6.8; ρ ≤ 0.05* but actual value not stated
4. Encouraging early return to work4. 5 or 4 % IG v 1 or 2 % CG
OR: 1.6; CI: 0.1 to 23.1; ρ not stated
5. Encouraging to undertake activities themselves5. 16 or 14 % IG v 18 or 42 % CG
OR: 0.3; CI: 0.1 to 0.9; ρ not stated
6. Attempting to change patient attitudes/beliefs about pain6. 25 or 22 % IG v 4 or 9 % CG
OR: 2.6; CI: 0.7 to 9.5; ρ ≤ 0.05* but actual value not stated
Abbreviations: IG intervention group, CG control Group, CI confidence interval, HCP healthcare practitioner, NSAIDs non-steroidal anti-inflammatory drugs, OR odds ration, PEM printed educational materials, PT physiotherapy, SS statistical significance, TIS time interrupted series