GLA:D (R) Back Australia: a mixed methods feasibility study for implementation
journal contributionposted on 03.05.2022, 06:58 authored by Matthew Fernandez, Anika Young, Alice Kongsted, Jan Hartvigsen, Christian BartonChristian Barton, Jason WallisJason Wallis, Peter Kent, Greg Kawchuk, Hazel Jenkins, Mark Hancock, Simon D French
Background: Practice-based guidelines recommend patient education and exercise as first-line care for low back pain (LBP); however, these recommendations are not routinely delivered in practice. GLA:D® Back, developed in Denmark to assist clinicians to implement guideline recommendations, offers a structured education and supervised exercise program for people with LBP in addition to a clinical registry to evaluate patient outcomes. In this study we evaluated the feasibility of implementing the GLA:D® Back program in Australia. We considered clinician and patient recruitment and retention, program fidelity, exploring clinicians’ and patients’ experiences with the program, and participant outcome data collection. Methods: Clinicians (chiropractors and physiotherapists) were recruited and participated in a 2-day GLA:D® Back training course. Patients were eligible to participate if they had persistent or recurrent LBP. Feasibility domains included the ability to: (1) recruit clinicians to undergo training; (2) recruit and retain patients in the program; (3) observe program fidelity; and (4) perceive barriers and facilitators for GLA:D® Back implementation. We also collected data related to: (5) clinician confidence, attitudes, and behaviour; and (6) patient self-reported outcomes related to pain, disability, and performance tests. Results: Twenty clinicians (8 chiropractors, 12 physiotherapists) participated in the training, with 55% (11/20) offering GLA:D® Back to their patients. Fifty-seven patients were enrolled in the program, with 67% (38/57) attending the final follow-up assessment. Loss to follow up was mainly due to the effects of the COVID-19 pandemic. We observed program fidelity, with clinicians generally delivering the program as intended. Interviews revealed two clinician themes related to: (i) intervention acceptability; and (ii) barriers and facilitators to implementation. Patient interviews revealed themes related to: (i) intervention acceptability; and (ii) program efficacy. At 3 months follow-up, clinicians demonstrated high treatment confidence and biomedical orientation. Patient outcomes trended towards improvement. Conclusion: GLA:D® Back implementation in Australia appears feasible based on clinician recruitment, program acceptability and potential benefits for patient outcomes from the small sample of participating clinicians and patients. However, COVID-19 impacted patient recruitment, retention, and data collection. To scale-up GLA:D® Back in private and public settings, further work is warranted to address associated barriers, and to leverage facilitators.
This study was funded by the Macquarie University New Staff (MQNS) grant and the Australia & New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network Seeding grant. The funders had no role in study design, results interpretation, or manuscript writing.
JournalChiropractic and Manual Therapies
Article NumberARTN 17
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ATTITUDESBELIEFSCLINICAL-PRACTICEExerciseFeasibilityImplementationLife Sciences & BiomedicineLow back painMANAGEMENTOUTCOMESPAINPatient educationPRIMARY-CARERehabilitationRELIABILITYRESPONSIVENESSScience & TechnologySelf-managementTESTSCOVID-19Exercise TherapyFeasibility StudiesHumansLow Back PainPandemicsPhysical TherapistsOrthopedics