Authors�� contributions BC conceived the study. All authors contributed to data collection, analysis http://www.selleckchem.com/products/MG132.html and interpretation. All authors read and approved the final manuscript.
Adherence to clinical practice guidelines (CPGs) is limited, and interventions to enhance uptake have been only moderately effective [1,2]. This could be because, despite the increased attention to behavioural and organizational theory application in implementation science, few interventions to improve adherence are based on a coherent theoretical framework and formative research [3,4]. Intervention development should include formative research to provide an analysis of influential barriers to and facilitators of CPG implementation and a deliberate matching of theoretical behavioural and environmental change methods to these factors [5,6].
Non-specific low back pain constitutes a serious public health problem associated with significant socioeconomic burden, and physical therapy is expected to contribute to the reduction or elimination of this burden [7]. Although only 2-7% of the patients with acute low back pain develop chronic low back pain, recurrent and chronic low back pain account for 75-85% of total worker��s absenteeism. To support physical therapists as they manage patients with low back pain, the Royal Dutch Association for Physical Therapy developed a national physical therapy [8] and a separate manual therapy CPG [9]. The guidelines urge clinical reasoning, assessment and management of psychosocial factors, and documentation including outcome measurement.
Their four main features are: applying the International Classification of Functioning, Disability and Health (ICF); identifying and applying patient profiles with duration, course, and psychosocial factors influencing recovery; restricting the application of manipulative physical therapy and limiting the number of treatment sessions; and focusing on patient behaviour to restore physical activity and social participation. Previous studies support the assumption that greater adherence to CPGs for low back pain provide a cost advantage [10,11], and a recent study related guideline adherence to improved physical functioning [12]. The aim of our study was to demonstrate how the process of Intervention Mapping [13]can be used to develop an intervention to address the lack of adherence to the national CPG for low back pain by Dutch physical therapists [14,15].
After its development, the intervention was evaluated on its feasibility and potential effectiveness in a pilot test of which the results are reported elsewhere [16]. Formative research and program development Program planning team and procedures AV-951 The three core project team members, a doctoral candidate, faculty member and project coordinator, performed the formative research and initial program development.