Evidence map›Paper›PMID 14521638›Full record

Trial reportJournal of general internal medicine2003

Randomized controlled trial of education and feedback for implementation of guidelines for acute low back pain.

Joel M Schectman, W Scott Schroth, Dante Verme, John D Voss

Abstract readClinical TrialRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of general internal medicine, 2003. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 58 papers, 20 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
58citing papers in PubMed, 20 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

58 citing papers in PubMed, 20 syntheses or guidelines pooled it.

  1. Pooled it
  2. Audit and feedback: effects on professional practice.The Cochrane database of systematic reviews · 2025
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  4. Interventions for promoting evidence-based guideline-consistent surgery in low back pain: a systematic review and meta-analysis of randomised controlled trials.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2022
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  7. Strategies to reduce the use of low-value medical tests in primary care: a systematic review.The British journal of general practice : the journal of the Royal College of General Practitioners · 2020
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  15. Effectiveness of interventions designed to reduce the use of imaging for low-back pain: a systematic review.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2015
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  20. Content and outcome of usual primary care for back pain: a systematic review.The British journal of general practice : the journal of the Royal College of General Practitioners · 2008
    Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Joel M SchectmanDepartment of Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA. js3dv@virginia.edu
W Scott Schroth
Dante Verme
John D Voss

Funding

PRACTICE GUIDELINES IN PRIMARY CARER01HS007069 · AHRQ · GEORGE WASHINGTON UNIVERSITY · PI SCHROTH, W S · 1993 to 1995
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AHRQ HHS R01 HS07069
6 · The paper itself

Abstract

objectiveThe effect of clinical guidelines on resource utilization for complex conditions with substantial barriers to clinician behavior change has not been well studied. We report the impact of a multifaceted guideline implementation intervention on primary care clinician utilization of radiologic and specialty services for the care of acute low back pain.

designPhysician groups were randomized to receive guideline education and individual feedback, supporting patient education materials, both, or neither. The impact on guideline adherence and resource utilization was evaluated during the 12-month period before and after implementation.

participantsFourteen physician groups with 120 primary care physician and associate practitioners from 2 group model HMO practices.

interventionsGuideline implementation utilized an education/audit/feedback model with local peer opinion leaders. The patient education component included written and videotaped materials on the care of low back pain. MAIN

resultsThe clinician intervention was associated with an absolute increase in guideline-consistent behavior of 5.4% in the intervention group versus a decline of 2.7% in the control group (P =.04). The patient education intervention produced no significant change in guideline-consistent behavior, but was poorly adopted. Patient characteristics including duration of pain, prior history of low back pain, and number of visits during the illness episode were strong predictors of service utilization and guideline-consistent behavior.

conclusionsImplementation of an education and feedback-supported acute low back pain care guideline for primary care clinicians was associated with an increase in guideline-consistent behavior. Patient education materials did not enhance guideline effectiveness. Implementation barriers could limit the utility of this approach in usual care settings.

Indexed as

Acute DiseaseAdultData CollectionDiagnostic ImagingFemaleGuideline AdherenceHealth Plan ImplementationHumansLow Back PainMaleMiddle AgedPatient Education as TopicPhysical Therapy SpecialtyPractice Patterns, Physicians'Program DevelopmentReferral and Consultation

Identifiers

PMID14521638
PMCPMC1494929

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.