Dey 2004.

Methods	Type of targeted behaviour: decrease in test ordering (lumbar x‐rays) + referrals + prescribing Study design: cluster RCT Country: UK
Participants	Setting: primary care 24 practices, 2187 patients Condition: acute LBP
Interventions	1. Professional intervention (educational outreach visit + distribution of educational materials) + organisational intervention (case management: access to a fast‐track physiotherapy service + access to a back clinic) 2. Standard practice control group
Outcomes	Professional practice: rate of referral for lumbar spine x‐ray within 3 months; number of sickness certificates issued; number prescribed opioids or muscle relaxants; number referred to secondary care; number referred to physio or educational program Patient level: none
Notes	Justification for intervention type: previous studies cited for effectiveness of educational outreach; theory ‘elaboration likelihood model of persuasion’ used for outreach visits Intervention fidelity: not reported
Risk of bias
Bias	Authors' judgement	Support for judgement
Adequate sequence generation?	Low risk	Minimisation with a random element
Allocation concealment?	Low risk	Central allocation
Blinding? All outcomes	High risk	From report: "Owing to financial constraints, only one research assistant was employed, and blind outcome assessment was not possible."
Incomplete outcome data addressed? All outcomes	Low risk
Free of selective reporting?	Unclear risk	Insufficient information provided
Free of other bias?	Low risk