This cluster randomised trial evaluated an intervention to decrease x-ray referrals and increase giving advice
to stay active for people with acute low back pain (LBP) in general practice.
Methods: General practices were randomised to either access to a guideline for acute LBP (control) or facilitated interactive
workshops (intervention). We measured behavioural predictors (e.g. knowledge, attitudes and intentions) and fear
avoidance beliefs. We were unable to recruit sufficient patients to measure our original primary outcomes so we introduced
other outcomes measured at the general practitioner (GP) level: behavioural simulation (clinical decision about vignettes)
and rates of x-ray and CT-scan (medical administrative data). All those not involved in the delivery of the intervention were
blinded to allocation.
Results: 47 practices (53 GPs) were randomised to the control and 45 practices (59 GPs) to the intervention. The number of
GPs available for analysis at 12 months varied by outcome due to missing confounder information; a minimum of 38 GPs
were available from the intervention group, and a minimum of 40 GPs from the control group. For the behavioural
constructs, although effect estimates were small, the intervention group GPs had greater intention of practising consistent
with the guideline for the clinical behaviour of x-ray referral. For behavioural simulation, intervention group GPs were more
likely to adhere to guideline recommendations about x-ray (OR 1.76, 95 CI 1.01, 3.05) and more likely to give advice to stay
active (OR 4.49, 95 CI 1.90 to 10.60). Imaging referral was not statistically significantly different between groups and the
potential importance of effects was unclear; rate ratio 0.87 (95 CI 0.68, 1.10) for x-ray or CT-scan.
Conclusions: The intervention led to small changes in GP intention to practice in a manner that is consistent with an
evidence-based guideline, but it did not result in statistically