1. Background  Uptake of clinical guideline recommendations on the delivery of Self-Management Support (SMS) among chiropractors treating spine pain is suboptimal 1  Implementing clinical guidelines during chiropractic training may promote sustained use of SMS in practice and improve heath outcomes among patients presenting with spine pain  Little is known about barriers to using SMS among chiropractic interns, supervisory clinicians, and their patients Objectives 1) Identify barriers and facilitators to uptake of SMS in outpatient teaching chiropractic clinics 2) Evaluate the feasibility, process and effects of implementing a tailored knowledge translation (KT) intervention to increase the use of SMS Setting The Canadian Memorial Chiropractic College (CMCC):  A major chiropractic teaching institution in Ontario, Canada;  Has a clinic system composed of 20 Patient Management Teams (PMTs); each constituted of 1 supervisory clinician and 7-9 interns Implementing guidelines into chiropractic teaching clinics: A mixed methods pilot randomized controlled study M.-C. Hallé 1,2, A. Thomas 1,2, S. Ahmed 1,2, P. Côté 3,4, C. Davis 5,6, R. Evans 7, C. Jacobs 4, M.J. Schneider 8, P. Stern 4, A.C. Tibbles 4, A. Bussières 1,2 1 School of Physical and Occupational Therapy, McGill University, 2 Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, 3 University of Ontario Institute of Technology, 4 Canadian Memorial Chiropractic College, 5 University of British Columbia, 6 Centre for Collaboration, Motivation and Innovation 7 University of Minnesota, 8 University of Pittsburgh Discussion Core expertise We have established a strong partnership with CMCC knowledge users. This diverse research team brings expertise in guideline implementation, KT, RCTs, qualitative methods, chiropractic practice, curriculum development and management of CMCC outpatient clinics. Expected outcomes This study will provide knowledge on the factors influencing guideline implementation in teaching clinical settings and evidence for conducting a larger trial. It will contribute to sustained use of SMS strategies in future clinicians and guide allocation of appropriate resources. Methods Design: Mixed methods combining qualitative methods (focus groups and interviews) and a pilot cluster randomized controlled trial (c-RCT) Phase 1A: Identifying barriers and facilitators to uptake of SMS o Survey Decision makers: Organizational Readiness for Implementing Change 2 Decision makers: Organizational Readiness for Implementing Change 2 Clinical supervisors and interns: Modified Knowledge, Attitude and Behaviour Questionnaire 3 Practice Style Trait Questionnaire 4 Pain Attitudes and Beliefs Scale 5 Clinical supervisors and interns: Modified Knowledge, Attitude and Behaviour Questionnaire 3 Practice Style Trait Questionnaire 4 Pain Attitudes and Beliefs Scale 5 Patients: Patient Activation Measure 6 Patients: Patient Activation Measure 6  Data analysis using descriptive statistics o Focus groups Clinical supervisors (n= 6-8) and interns (n= 12-16): Based on the Theoretical Domains Framework (TDF) Clinical supervisors (n= 6-8) and interns (n= 12-16): Based on the Theoretical Domains Framework (TDF)  Data analysis using qualitative content analysis Phase 1B: Adapting a KT intervention Phase 2A: Implementing a KT intervention Phase 2B: Evaluating feasibility, process and effects o Semi-structured interviews Patients (n= 10-13): Based on the TDF Patients (n= 10-13): Based on the TDF  Data analysis using qualitative content analysis Existing 3-component KT intervention consisting of: Webinar on the Brief Action Planning (BAP), a SMS strategy (see Figure 1) Learning modules Interactive clinical vignettes Tailoring will be based on factors identified in Phase 1A Existing 3-component KT intervention consisting of: Webinar on the Brief Action Planning (BAP), a SMS strategy (see Figure 1) Learning modules Interactive clinical vignettes Tailoring will be based on factors identified in Phase 1A Feasibility : Recruitment, adherence and retention rates Process : Nominal group technique with end users (see Figure 2) Effects: Interns (frequency of use, knowledge, self-efficacy) and patients related outcomes (quality of life, self-efficacy, pain, disability) Analysis: Descriptive statistics to characterize feasibility measures Generalized estimating equations to calculate between and within group differences for patients and interns outcomes Feasibility : Recruitment, adherence and retention rates Process : Nominal group technique with end users (see Figure 2) Effects: Interns (frequency of use, knowledge, self-efficacy) and patients related outcomes (quality of life, self-efficacy, pain, disability) Analysis: Descriptive statistics to characterize feasibility measures Generalized estimating equations to calculate between and within group differences for patients and interns outcomes c-RCT Random allocation of 20 PMTs in 2 groups: Experimental: KT intervention Control: Copy of the guideline Training: clinicians will complete a BAP certification Delivery: certified clinicians will prompt interns to view components of the KT intervention Intervention for control group: 3 months later Patient recruitment: n=5 patients/intern c-RCT Random allocation of 20 PMTs in 2 groups: Experimental: KT intervention Control: Copy of the guideline Training: clinicians will complete a BAP certification Delivery: certified clinicians will prompt interns to view components of the KT intervention Intervention for control group: 3 months later Patient recruitment: n=5 patients/intern Figure 2: Nominal Group Technique Process Figure 1: Brief Action Planning Flow Chart References 1.National Report. The Canadian Chiropractic Association A comprehensive inventory of practical information about Canada’s licensed chiropractors. 2011. 2.Shea CM, Jacobs SR, Esserman DA, Bruce K, Weiner BJ. Organizational readiness for implementing change: a psychometric assessment of a new measure. Implementation Science. 2014;9(1):1. 3.Shi Q, Chesworth BM, Law M, Haynes RB, MacDermid JC. A modified evidence-based practice- knowledge, attitudes, behaviour and decisions/outcomes questionnaire is valid across multiple professions involved in pain management. BMC medical education. 2014;14(1):263. 4.Green L, Gorenflo DW, Wyszewianski L, Research MCfFP. Validating an instrument for selecting interventions to change physician practice patterns. J Fam Pract. 2002;51(11):938-942. Acknowledgements Heather Owens, Canadian Chiropractic Guideline Initiative Funding: CRIR and Canadian Chiropractic Guideline Initiative 5.Houben R, Ostelo RW, Vlaeyen JW, Wolters PM, Peters M, Berg SG. Health care providers' orientations towards common low back pain predict perceived harmfulness of physical activities and recommendations regarding return to normal activity. European Journal of Pain. 2005;9(2):173-183. 6.Hibbard J, Gilburt H. Supporting people to manage their health. An introduction to patient activation. London: The King's Fund. 2014.