Send to

Choose Destination
Trials. 2017 Nov 9;18(1):526. doi: 10.1186/s13063-017-2279-7.

Determining the impact of a new physiotherapist-led primary care model for back pain: protocol for a pilot cluster randomized controlled trial.

Author information

School of Rehabilitation Therapy, Queen's University, 31 George Street, Kingston, Ontario, K7L 3N6, Canada.
Department of Family Medicine, Queen's University, Kingston, Canada.
School of Rehabilitation Therapy, Queen's University, 31 George Street, Kingston, Ontario, K7L 3N6, Canada.
Keele University, Keele, UK.
Physical Therapy, Western University, London, Canada.
School of Rehabilitation Science, McMaster University, Hamilton, Canada.
Ottawa Hospital Research Institute, Ottawa, Canada.
School of Physical and Occupational Therapy, McGill University, Montreal, Canada.
Canadian Pain Coalition, Oshawa, Canada.
McMaster Family Health Team, Hamilton, Canada.



Back pain is a leading contributor to disability, healthcare costs, and lost work. Family physicians are the most common first point of contact in the healthcare system for people with back pain, but physiotherapists (PTs) may be able to support the primary care team through evidence-based primary care. A cluster randomized trial is needed to determine the clinical, health system, and societal impact of a primary care model that integrates physiotherapists at the first visit for people with back pain. Prior to conducting a future fully powered cluster randomized trial, we need to demonstrate feasibility of the methods. Therefore, the purpose of this pilot study will be to: 1) Determine feasibility of patient recruitment, assessment procedures, and retention. 2) Determine the feasibility of training and implementation of a new PT-led primary care model for low back pain (LBP) 3) Explore the perspectives of patients and healthcare providers (HCPs) related to their experiences and attitudes towards the new service delivery model, barriers/facilitators to implementation, perceived satisfaction, perceived value, and impact on clinic processes and patient outcomes.


This pilot cluster randomized controlled trial will enroll four sites and randomize them to implement a new PT-led primary care model for back pain or a usual physician-led primary care model. All adults booking a primary care visit for back pain will be invited to participate. Feasibility outcomes will include: recruitment and retention rates, completeness of assessment data, PT training participation and confidence after training, and PT treatment fidelity. Secondary outcomes will include the clinical, health system, cost, and process outcomes planned for the future fully powered cluster trial. Results will be analyzed and reported descriptively and qualitatively. To explore perspectives of both HCPs and patients, we will conduct semi-structured qualitative interviews with patients and focus groups with HCPs from participants in the PT-led primary care sites.


If this pilot demonstrates feasibility, a fully powered trial will provide evidence that has the potential to transform primary care for back pain. The full trial will inform future service design, whether these models should be more widely implemented, and training agendas.

TRIAL REGISTRATION:, NCT03320148 . Submitted for registration on 17 September 2017.


Cluster randomized trial; Low back pain; Physiotherapy; Primary care

[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center