Presentation T P24

T P24 (Poster Presentation):
Cost-effectiveness of a patient and professional based multimedia campaign as innovative implementation strategy to improve low back pain guideline adherence

Presented by: Arnela Suman

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Suman A1, Schaafsma FG1, Anema JR1, Tulder MW van2, Elders PJM3

  1. Department of Public and Occupational Health, VU University medical center, EMGO+ Institute for Health and Care Research, Amsterdam
  2. Department of Health Sciences, VU University, Amsterdam
  3. Department of General Practice and Elderly Care Medicine, VU University medical center, EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands



Low back pain (LBP) is one of the most prevalent and expensive public health problems in western society. In most cases LBP is nonspecific and will recover within three weeks. Despite global initiatives to discourage early diagnostic imaging for LBP, there is still a large number of ineffective and costly referrals, leading to chronicity, disability and medicalization. In 2010, in The Netherlands an integrated care guideline for nonspecific LBP was developed, focusing on improvement of patients’ beliefs and functional status and enhancing interdisciplinary coordination. This study evaluates the (cost)effectiveness of a patient and professional based implementation strategy (adapted from an effective Australian campaign) to implement this guideline in daily practice in The Netherlands.


In a longitudinal stepped wedge RCT the implementation strategy is compared to usual implementation of the LBP guideline. The strategy consists of an interactive and interdisciplinary training session for General Practitioners (GPs), physiotherapists (PTs) and occupational physicians (OPs), and a multimedia campaign for LBP patients. Participants are 30 GP practices with PTs and OPs from their network, and 500 LBP patients who visited their GP in the three previous months. The GPs, PTs and OPs are randomized in four clusters based on their region. Patients are included four times during the trial period of 16 months and are randomized according to their GP allocation.


Primary outcome measure is patient beliefs about LBP. Secondary outcome measures on patient level are: functional status, pain coping, quality of life, interference of LBP with daily activities and societal participation, including paid work. Secondary outcome measures on professional level are: guideline adherence, referral rate for diagnostics/treatment, and knowledge of and confidence in LBP management. All outcome measures are assessed using questionnaires at baseline and after three, six, and 12 months (patients) and after three months (professionals). The cost-effectiveness analysis is performed from societal perspective. Costs of the implementation strategy, health care consumption and productivity loss will be measured, valued and analyzed.


The study will start inclusion of participant in May 2014. First results are expected in 2015.

Schedule Details

Tuesday September 30
12:45 - 13:45 Poster Viewing
Session: Disability management