Trial reportPloS one2013
Economic evaluation of active implementation versus guideline dissemination for evidence-based care of acute low-back pain in a general practice setting.
Trial report in PloS one, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 5 of them syntheses that pooled 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.
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.
Who cites it
17 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Cost of Low-Value Imaging Worldwide: A Systematic Review.Applied health economics and health policy · 2024Pooled it
- 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 · 2022Pooled it
- Use of health economic evaluation in the implementation and improvement science fields-a systematic literature review.Implementation science : IS · 2019Pooled it
- Effectiveness of multifaceted implementation strategies for the implementation of back and neck pain guidelines in health care: a systematic review.Implementation science : IS · 2016Pooled it
- Pooled it
- Trial
- Economic evaluation of the NET intervention versus guideline dissemination for management of mild head injury in hospital emergency departments.Implementation science : IS · 2018Trial
- Trial
- Cost-Effectiveness of IMPRovE: A Multicomponent Intervention to Increase Adherence to Guideline Recommendations for the Diagnosis and Management of Work-Related Mental Health Conditions in General Practice.Journal of occupational rehabilitation · 2026Article
- Trial-Based Economic Evaluations Conducted alongside Studies Embedded in Australian Healthcare Services and Programs: A Scoping Review.PharmacoEconomics - open · 2026Review
- Measuring evidence-based clinical guideline compliance in the paediatric intensive care unit.BMJ open quality · 2024Article
- Implementation Initiatives to Improve Low Back Pain Care in Australia: A Scoping Review.Pain medicine (Malden, Mass.) · 2022Article
- Scoping review of costs of implementation strategies in community, public health and healthcare settings.BMJ open · 2022Article
- Clinician education unlikely effective for guideline-adherent medication prescription in low back pain: systematic review and meta-analysis of RCTs.EClinicalMedicine · 2022Article
- A micro costing analysis of the development of a primary care intervention to improve the uptake of diabetic retinopathy screening.Implementation science : IS · 2021Article
- A national intervention to reduce imaging for low back pain by general practitioners: a retrospective economic program evaluation using Medicare Benefits Schedule data.BMC health services research · 2019Article
- Economic evaluation of implementation strategies in health care.Implementation science : IS · 2014Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe development and publication of clinical practice guidelines for acute low-back pain has resulted in evidence-based recommendations that have the potential to improve the quality and safety of care for acute low-back pain. Development and dissemination of guidelines may not, however, be sufficient to produce improvements in clinical practice; further investment in active implementation of guideline recommendations may be required. Further research is required to quantify the trade-off between the additional upfront cost of active implementation of guideline recommendations for low-back pain and any resulting improvements in clinical practice.
methodsCost-effectiveness analysis alongside the IMPLEMENT trial from a health sector perspective to compare active implementation of guideline recommendations via the IMPLEMENT intervention (plus standard dissemination) against standard dissemination alone.
resultsThe base-case analysis suggests that delivery of the IMPLEMENT intervention dominates standard dissemination (less costly and more effective), yielding savings of $135 per x-ray referral avoided (-$462.93/3.43). However, confidence intervals around point estimates for the primary outcome suggest that--irrespective of willingness to pay (WTP)--we cannot be at least 95% confident that the IMPLEMENT intervention differs in value from standard dissemination.
conclusionsOur findings demonstrate that moving beyond development and dissemination to active implementation entails a significant additional upfront investment that may not be offset by health gains and/or reductions in health service utilization of sufficient magnitude to render active implementation cost-effective.
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Registered trials
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.