A group of researchers at CLAHRC Oxford have developed an internet based training package called i-BEST which took all the essentials of an HTA-commissioned trial of cognitive behavioural therapy for low back pain (LBP), and packaged it into an e-learning package. The researchers have gone on to evaluate this course using a mixed methods approach – a small trial looking at learning outcomes, qualitative work, revision of the training and now a much larger implementation study. Six papers have been published on this work thanks to CLAHRC funding, with at least another two to follow. These papers have been instrumental in providing additional evidence in areas of clinical concern, and in describing the various challenges that were encountered in implementation (and solutions developed) for other researchers to learn from. The researchers have completed additional papers to confirm that it is not necessary to triage patients, and also provide important insights and re-assurances about how the intervention works.
Working with local commissioners, practitioners and managers, the researchers have gained a broadened understanding of the complexities of commissioning LBP services. In essence, a cheaper intervention is being provided, but it requires a change in the clinical pathway. It requires therapists to feel confident in taking on new interventions that they might not consider to be in their immediate domain of professional practice, and to mitigate against unnecessary triage.
Health generation will be quite substantial because of the high prevalence of the condition. The intervention will also save commissioners and the NHS a substantial amount of money if NHS therapy services are convinced to adopt it at the expense of using other more costly interventions. Free training will be provided to NHS practitioners, and at cost to people working outside of the NHS. The final evaluation will estimate how effective CLAHRC Oxford has been in achieving these outputs.
Contribution of CLAHRC Oxford
The NIHR CLAHRC funding has played an absolutely fundamental role in enabling the the study to progress from a robust randomised trial through to implementation. The work of the CLAHRC group is primarily in clinical trials, and developing interventions (which is funded in part by the Oxford BRC). If the CLAHRC funding had not been available, the researchers would not have been able to do any of this implementation work, including developing the package, studying the process at small scale, enabling them to get to grips with the implementation literature and issues, and network with clinical services and other experts to get the correct approach.
What happened next?
The intervention has already been incorporated into NICE guidelines. The researchers anticipate with the publication of another definitive study, the rationale and demand for CB interventions in LBP will continue to strengthen. They will keep the active implementation phase of this project open for as long as funding allows, and then will close with a report and reflection on how the whole process went. In the much longer term, they would like to track to see whether this becomes self-seeding within clinical practice and what the mechanism for that is.