Schectman 2003.

Methods	Type of targeted behaviour: general management of a problem Study design: cluster RCT Country: USA
Participants	Setting: primary care 14 practices, 106 providers, 4066 patients Condition: acute LBP
Interventions	1. Professional intervention (distribution of educational materials + educational meeting (including local opinion leader) + audit and feedback) 2. Patient mediated (education materials: pamphlet and video) 3. 1 + 2 4. No intervention control group Results presented as (1 + 3) vs (2 + 4).
Outcomes	Professional practice: proportion of lumbar plain x‐rays, CT or MRI consistent with guideline within 12 months; subspecialty referral; physiotherapy referral Patient level: beliefs about care, satisfaction with care, clinical outcome measures
Notes	Justification for intervention type: stated that needed multi‐factorial approach Intervention fidelity: not reported
Risk of bias
Bias	Authors' judgement	Support for judgement
Adequate sequence generation?	Unclear risk	From report: “Clinician practices were stratified by affiliation (academic vs nonacademic) and then, using sealed envelopes, randomized by an investigator to 4 groups in a 2 × 2 factorial design”
Allocation concealment?	Unclear risk	Envelopes used but not described as numbered or opaque
Blinding? All outcomes	Unclear risk	Chart audit, but no indication if assessors blinded to allocation or not
Incomplete outcome data addressed? All outcomes	Unclear risk	Not explicitly reported if all charts audited
Free of selective reporting?	Unclear risk	Insufficient information provided
Free of other bias?	High risk	Only 50% follow up of professionals; baseline imbalance for radiologic and specialty services; decision about grouping of analysis made post‐hoc after demonstrated no effect for patient education; potential unit of analysis error