Table 5 Study Description

Becker et al. Germany 2008 [30]

Cluster RCT with 2 intervention arms and 1 control arm.

Control arm guidelines only (C).

Two intervention groups - both received a multifaceted general practitioner education and GI one additionally received motivational counselling training for practice nurses (MC)

GI and MC trained in using LBP guideline for the DEGAM – 4 modules: 3 interaction seminars; information given on local facilities; 2 individual educational visits by study nurses. In MC group, 2 nurses per practice received 2 full day workshops and 1–3 supervision sessions and study coordinators contacted the nurses regularly.

Unit of analysis is the patient. Power calculation for small effects. Drop out analyses included.

Main Outcome: Hannover Functional Ability Questionnaire for Measuring Back Pain Related Functional Limitations. Secondary outcomes: Freiburg Questionnaire on Physical Ability; Korffs severity of chronic pain scale; Euro Quality of life questionnaire;

Fear Avoidance Beliefs questionnaire;

Days of sick leave.

Follow-up: 6 and 12 months.

After 6 months: functional capacity improvement more pronounced in intervention groups and significantly so for adjusted differed between MC and C groups; both GI and MC patients significantly less days in pain during previous 6 months and less patients in intervention groups indicated suffering permanent pain than C patients.

12 months: more pronounced reduction in days in pain in GI and MC compared to C group. Patients in MC group showed significant improvement in quality of life. Clinical guidelines improve outcome; physician education has a little benefit, motivational interviewing adds slightly more benefit but probably only useful for some patients.

Inclusion rate 44% which might be due to selection bias. Patient sample had wide representation of pain qualities and quantities as well as different motivational stages for behaviour change, so individual differences in effects of interventions may be masked. Included patients may have had lower levels of pain, higher physical activity and readiness for change than general LBP patients in general – may reduce external validity of the study. Validity of the FQPA for a primary care sample with low disability may be insufficient and may limit its discriminative power. Insufficient counselling sessions to draw conclusions.

Rubak et al. Denmark 2009 [31]

One year follow up of an RCT/1.5 day residential MI course for GPs and a half day follow up twice during first year.

Both I and C groups had half day course on intensive treatment of type 2 diabetes.

Unit of analysis is the patient. Sample size determined by power analysis.

Health Care Climates Questionnaire; Treatment Self-regulation Questionnaire; Diabetes Illness Representation Questionnaire; Summary of Diabetes self-care activities.

Follow-up: 12 months.

Patients in I group significantly more autonomous in their choice of action towards behavioural changes and more motivated to change behaviours; also significantly more aware of the importance of controlling their diabetes for specific factors.

Not blinded at randomization. No baseline data; Patients were newly diagnosed so there was no change behaviour and no statements regarding diabetes at baseline. No blinding of behavioural changes –Hawthorne effect may exist; but if so, existed in both groups. Involvement in study may have influenced and diminished effect of MI.