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Open Access Study protocol

IMPaCT Back study protocol. Implementation of subgrouping for targeted treatment systems for low back pain patients in primary care: a prospective population-based sequential comparison

Nadine E Foster1*, Ricky Mullis2, Julie Young1, Carol Doyle13, Martyn Lewis1, David Whitehurst14, Elaine M Hay1 and IMPaCT Back Study team

Author Affiliations

1 Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire, ST5 5BG, UK

2 General Practice & Primary Care Research Unit, Department of Public Health & Primary Care, University of Cambridge, UK

3 Central and Eastern Cheshire Primary Care Trust, Universal House, Middlewich, Cheshire, UK

4 Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK

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BMC Musculoskeletal Disorders 2010, 11:186  doi:10.1186/1471-2474-11-186

Published: 20 August 2010



Prognostic assessment tools to identify subgroups of patients at risk of persistent low back pain who may benefit from targeted treatments have been developed and validated in primary care. The IMPaCT Back study is investigating the effects of introducing and supporting a subgrouping for targeted treatment system in primary care.


A prospective, population-based, quality improvement study in one Primary Care Trust in England with a before and after design. Phases 1 and 3 collect data on current practice, attitudes and behaviour of health care practitioners, patients' outcomes and health care costs. Phase 2 introduces and supports the subgrouping for targeted treatment system, via a multi-component, quality improvement intervention that includes educational courses and outreach visits led by opinion leaders, audit/feedback, mentoring and organisational support to embed the subgrouping tools within IT and clinical management systems.

We aim to recruit 1000 low back pain patients aged 18 years and over consulting 7 GP practices within one Primary Care Trust in England, UK. The study includes GPs in participating practices and physiotherapists in associated services. The primary objective is to determine the effect of the subgrouping for targeted treatment system on back pain related disability and catastrophising at 2 and 6 months, comparing data from phase 1 with phase 3. Key secondary objectives are to determine the impact on:

a) GPs' and physiotherapists' attitudes and behaviour regarding low back pain;

b) The process of care that patients receive;

c) The cost-effectiveness and sustainability of the new clinical system.


This paper details the rationale, design, methods, planned analysis and operational aspects of the IMPaCT Back study. We aim to determine whether the new subgrouping for targeted treatment system is implemented and sustained in primary care, and evaluate its impact on clinical decision-making, patient outcomes and costs.

Study registration

International Standard Randomised Controlled Trial Number Register ISRCTN55174281