Evaluating two implementation strategies for whiplash guidelines in physiotherapy: A cluster-randomised trial

Trudy Rebbeck*, Christopher G. Maher, Kathryn M. Refshauge

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

80 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)165-174
Number of pages10
JournalAustralian Journal of Physiotherapy
Issue number3
Publication statusPublished - 2006
Externally publishedYes


  • Health plan implementation
  • Practice guidelines
  • Whiplash injuries


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