Short summary

GLA:D^® Back implements evidence based care for back pain by educating chiropractors and physiotherapists in delivering patient education and supervised exercises. The GLA:D^® Back project evaluates the process of the implementation, changes in clinicians' beliefs and behaviors, and patient outcomes following GLA:D^® Back.

Rationale

Clinical guidelines for treatment of back pain recommend patient education and supervised exercises. These interventions have positive effects in randomised trials, but little is known about ways to support implementation of such interventions and the possible effects on patient outcomes that can be achieved from a broad implementation.

The overall objectives of the GLA:D^® Back project is 1) to evaluate the process of implementing guideline recommended back pain care by means of training physiotherapist and chiropractors in delivering a standardised care package - GLA:D^® Back, and 2) to evaluate effects of implementation on clinician and patient outcomes.

We hypothesise that implementation of GLA:D^® Back introduces a change in clinicians' attitudes towards back pain care and in clinical behaviours. Further we propose that this change will lead to patients developing helpful attitudes towards back pain and improved physical functioning leading to increased self-management and in turn to positive effects on health care utilisation, daily function, quality of life, pain intensity, and work participation. 

Description of the cohort

Participating clinicians are chiropractors and physiotherapists who choose to sign up for the GLA:D^® Back education.

Participating patients are people who have GLA:D^® Back care at chiropractors and physiotherapists who have done the training for clinicians. For practical reasons, only Danish speaking patients are included. 

Data and biological material

Longitudinal data from clinician and patient reported questionnaires. 

Collaborating researchers and departments

Department of Sports Science and Clinical Biomechanics, SDU + Nordic Institute of Chiropractic and Clinical Biomechanics, Odense

• Associate Professor Alice Kongsted
• Professor Jan Hartvigsen

Department of Sports Science and Clinical Biomechanics, SDU + Department of Medical and Health Sciences, Linköping University, Sweden

• Postdoc Inge Ris Hansen

Department of Sports Science and Clinical Biomechanics, University of Southern Denmark

• Associate Professor Per Kjær

Institute for Medical Biometry and Statistics, Medical Faculty and Medical Center, University of Freiburg, Germany

• Professor Werner Vach

Department of Medical and Health Sciences, Linköping University, Sweden

• Professor Per Nilsen

Publications associated with the project

Ris, I., Broholm, D., Hartvigsen, J. et al. Adherence and characteristics of participants enrolled in a standardised programme of patient education and exercises for low back pain, GLA:D® Back - a prospective observational study. BMC Musculoskelet Disord 22, 473 (2021). https://doi.org/10.1186/s12891-021-04329-y

Ris I, Boyle E, Myburgh C, Hartvigsen J, Thomassen L, Kongsted A. Factors influencing implementation of the GLA:D Back, an educational/exercise intervention for low back pain: a mixed-methods study. JBI Evid Implement. 2021;19(4):394-408. Published 2021 May 10. doi:10.1097/XEB.0000000000000284

Morsø L, Bogh SB, Ris I, Kongsted A. Mind the gap - Evaluation of the promotion initiatives for implementation of the GLA:D® back clinician courses. Musculoskelet Sci Pract. 2021 Jun;53:102373. doi: 10.1016/j.msksp.2021.102373. Epub 2021 Mar 27. PMID: 33823485.