Background/Purpose: Low back pain is the highest ranked condition contributing to years lived with disability according to the most recent Global Burden of Disease study and is associated with significant societal and individual cost. Despite the availability of consistent evidence-based treatment recommendations for low back pain, management in primary care remains suboptimal with overreliance on imaging and medical intervention. We performed a systematic review and meta-synthesis of qualitative studies that explored what primary care clinicians believe about clinical practice guidelines for low back pain, including perceived enablers and barriers to guideline adherence.

Methods: The study was registered with PROSPERO (CRD42014012961) and our methods conformed to Cochrane Collaboration guidelines, the PRISMA Statement and the COREQ Checklist. Studies investigating perceptions and beliefs about low back pain guidelines were included if participants were primary care clinicians and qualitative methods had been used for both data collection and analysis. Only English-language studies were included. Eight electronic databases were searched from inception until July 2014. Pairs of reviewers independently screened titles and abstracts, extracted data, appraised method quality using the CASP checklist, conducted thematic analysis and synthesized the results in narrative format.  

Results: From a search yield of 1880 titles, 32 papers were read in full and 17 papers fulfilled inclusion criteria. Studies were conducted in UK, Canada, USA, Netherlands, Germany, Israel, New Zealand and Norway and included general practitioners, physical therapists, chiropractors, osteopaths and occupational therapists.

All studies reported research aims, a justification for qualitative methods and a purposive sampling strategy and the majority reported recruitment and data collection details. However, many studies failed to report other key study components to allow full method quality assessment. We identified three key themes: clinicians have beliefs/perceptions that influence guideline implementation and adherence; they have beliefs/perceptions about patient expectations within the clinician-patient relationship; and they have beliefs/perceptions that act as barriers to guideline adherence.

Clinicians believe that guidelines are categorical, prescriptive and constrain professional practice, that popular clinical practices supersede the guidelines, and imaging can be used to manage consultations. Their perceptions reflect lack of content knowledge and understanding of how guidelines are developed.

Conclusion: Addressing misconceptions and other barriers to uptake of evidence-based guidelines for managing low back pain is needed to improve knowledge transfer and close the evidence-practice gap in the treatment of this common condition. 

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/barriers-to-primary-care-clinician-adherence-to-clinical-guidelines-for-the-management-of-low-back-pain-a-systematic-review-and-meta-synthesis-of-qualitative-studies/