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01.12.2018 | Research article | Ausgabe 1/2018 Open Access

BMC Musculoskeletal Disorders 1/2018

Promoting the use of self-management in novice chiropractors treating individuals with spine pain: the design of a theory-based knowledge translation intervention

BMC Musculoskeletal Disorders > Ausgabe 1/2018
Owis Eilayyan, Aliki Thomas, Marie-Christine Hallé, Sara Ahmed, Anthony C. Tibbles, Craig Jacobs, Silvano Mior, Connie Davis, Roni Evans, Michael J. Schneider, Fadi Alzoubi, Jan Barnsley, Cynthia R. Long, Andre Bussières
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12891-018-2241-1) contains supplementary material, which is available to authorized users.



Clinical practice guidelines generally recommend clinicians use self-management support (SMS) when managing patients with spine pain. However, even within the educational setting, the implementation of SMS remains suboptimal. The objectives of this study were to 1) estimate the organizational readiness for change toward using SMS at the Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario from the perspective of directors and deans, 2) estimate the attitudes and self-reported behaviours towards using evidence-based practice (EBP), and beliefs about pain management among supervisory clinicians and chiropractic interns, 3) identify potential barriers and enablers to using SMS, and 4) design a theory-based tailored Knowledge Translation (KT) intervention to increase the use of SMS.


Mixed method design. We administered three self-administered questionnaires to assess clinicians’ and interns’ attitudes and behaviours toward EBP, beliefs about pain management, and practice style. In addition, we conducted 3 focus groups with clinicians and interns based on the Theoretical Domain Framework (TDF) to explore their beliefs about using SMS for patients with spine pain. Data were analysed using deductive thematic analysis by 2 independent assessors. A panel of 7 experts mapped behaviour change techniques to key barriers identified informing the design of a KT intervention.


Participants showed high level of EBP knowledge, positive attitude of EBP, and moderate frequency of EBP use. A number of barrier factors were identified from clinicians (N = 6) and interns (N = 16) corresponding to 7 TDF domains: Knowledge; Skills; Environmental context and resources; Emotion; Beliefs about Capabilities; Memory, attention & decision making; and Social Influence. To address these barriers, the expert panel proposed a multifaceted KT intervention composed of a webinar and online educational module on a SMS guided by the Brief Action Planning, clinical vignettes, training workshop, and opinion leader support.


SMS strategies can help maximizing the health care services for patients with spine pain. This may in turn optimize patients’ health. The proposed theory-based KT intervention may facilitate the implementation of SMS among clinicians and interns.
Additional file 1: “Topic guide for focus groups with chiropractic interns and clinicians”. It provides the interview guide for focus group. (DOCX 14 kb)
Additional file 2: An Excel sheet that provides the raw data for clinicians and interns (XLSX 99 kb)
Additional file 3: An Excel sheet that provides the raw data for decision makers (XLSX 10 kb)
Additional file 4: “Thematic analysis based on the TDF – Clinicians”. It provides number of clinicians’ statements for each TDF domain, TDF specific beliefs and themes. (DOCX 17 kb)
Additional file 5: “Thematic analysis based on the TDF – Interns”. It provides number of clinicians’ statements for each TDF domain, TDF specific beliefs and themes. (DOCX 18 kb)
Additional file 6: “Specific Beliefs for each TDF with illustrative quotes – Clinicians”. It provides clinicians quotes representing specific TDF domains and beliefs. (DOCX 17 kb)
Additional file 7: “Specific Beliefs for each TDF with illustrative quotes – Interns”. It provides interns quotes representing specific TDF domains and beliefs. (DOCX 20 kb)
Additional file 8: “Mapping behaviour change techniques on key domains, proposed KT interventions and actions”. It provides a list of self-management-TDF barriers and the proposed KT interventions. (DOCX 19 kb)
Additional file 9: “Final Selection of KT Intervention Components and Related Learning”. It provides the final selection of KT intervention for clinicians and interns to promote the use of self-management support in the clinic. (DOCX 14 kb)
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