02151nas a2200169   4500000000100000008004100001653002400042653001200066100001700078700001500095700001300110245011400123300003500237490000700272050000600279520169600285       2006                            d10aPeer Reviewed Paper10aChecked1 aRefshauge K.1 aRebbeck T.1 aMaher C.00aEvaluating two implementation strategies for whiplash guidelines in physiotherapy: a cluster-randomised trial  a165-174. [Impact Factor 1.870]0 v52  aN3 a<p>
QUESTION: Are implementation strategies involving education any more effective than mere dissemination of clinical practice guidelines in changing physiotherapy practice and reducing patient disability after acute whiplash? DESIGN: Cluster-randomised trial. PARTICIPANTS: Twenty-seven physiotherapists from different private physiotherapy clinics and the 103 patients (4 dropouts) who presented to them with acute whiplash. INTERVENTION: The implementation group of physiotherapists underwent education by opinion leaders about whiplash guidelines and the dissemination group had the guidelines mailed to them. OUTCOME MEASURES: The primary outcome was patient disability, measured using the Functional Rating Index, collected on admission to the trial and at 1.5, 3, 6 and 12 months. Physiotherapist knowledge about the guidelines was measured using a custom-made questionnaire. Physiotherapist practice and cost of care were measured by audit of patient notes. RESULTS: There were no significant differences between groups for any of the patient outcomes at any time. The implementation patients had 0.6 points (95% CI -7.8 to 6.6) less disability than the dissemination patients at 12 months; 44% more physiotherapists in the implementation group reported that they prescribed two out of the five guideline-recommended treatments; and 32% more physiotherapists actually prescribed them. The cost of care for patients in the implementation group was $255 (95% CI -1505 to 996) less than for patients in the dissemination group. CONCLUSION: Although the active implementation program increased guideline-consistent practice, patient outcomes and cost of care were not affected.
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