Project Information

Health System Implementation of Clinical Practice Guidelines for Neck and Low Back Pain in Outpatient Physical Therapy Settings

Project Description: Spine related musculoskeletal pain is a public health problem and one of the most common reasons for seeking health care services. Physical therapists commonly treat patients with neck or low back pain (LBP) in outpatient settings; however unwarranted variation in clinical practice is widespread potentially resulting in suboptimal patient outcomes. System implementation of clinical practice guidelines (CPGs) for physical therapy management of neck and LBP provides a practical strategy to limit variability for highly prevalent musculoskeletal pain conditions, however requires processes which will promote a shift in clinician attitudes, beliefs, behaviors and organizational culture. Lack of multifaceted, frequent and ongoing implementation strategies have been suggested as key limitations to previous studies that have implemented neck and low back pain CPGs in health care settings. This proposed study will investigate implementation of a process to enhance CPG adherence to limit unwarranted variability in initial treatment decisions with high potential for providing more effective and efficient physical therapy management for patients with neck and LBP in outpatient settings. We will determine if physical therapy clinics that receive neck and LBP CPG training are associated with improved patient outcomes compared to those that have not received training. Neck and LBP specific disability and pain intensity will be assessed at intake, on a weekly basis and at discharge (Specific Aim 1a). Secondary patient outcomes will consist of patient satisfaction scores and direct physical therapy costs (Specific Aim 1b). Statistical analyses will evaluate for temporal effects of training considering the stepped wedge study design. For exploratory purposes we will determine if physical therapist adherence to neck and LBP CPG recommendations are maintained over time following initial implementation. CPG adherence will be assessed using pragmatic methods consisting of: 1) clinician checklists, 2) clinician interviews, 3) quality indicators, and 4) total proportion outcome measure assessments captured (Specific Aim 2).

QPI: Jason, Beneciuk, (

Collaborators: (; (; (


UF Health Big Aims: Reduce Variation None

MeSH Keywords: Health Services Research, Quality Improvement, Musculoskeletal Pain, implementation science, clinical practice guidelines, outpatient physical therapy