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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

Slade, Susan C, Kent, Peter, Patel, Shilpa, Bucknall, Tracey and Buchbinder, Rachelle 2016, 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, Clinical journal of pain, vol. 32, no. 9, pp. 800-816, doi: 10.1097/AJP.0000000000000324.

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Title 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
Author(s) Slade, Susan C
Kent, Peter
Patel, Shilpa
Bucknall, Tracey
Buchbinder, Rachelle
Journal name Clinical journal of pain
Volume number 32
Issue number 9
Start page 800
End page 816
Total pages 17
Publisher Lippincott, Williams & Wilkins
Place of publication Philadelphia, Pa.
Publication date 2016-09
ISSN 0749-8047
1536-5409
Keyword(s) low back pain
clinical practice guidelines
adherence
qualitative review
implementation
Summary INTRODUCTION: Despite the availability of evidence-based guidelines for the management of low back pain that contain consistent messages, large evidence-practice gaps in primary care remain.

OBJECTIVES: To perform a systematic review and meta-synthesis of qualitative studies that have explored primary care clinicians' perceptions and beliefs about guidelines for low back pain, including perceived enablers and barriers to guideline adherence.

METHODS: Studies investigatingperceptions 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. We searched major databases up to 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: Seventeen studies, with a total of 705 participants, were included. We identified three key emergent themes and eight subthemes: (1) guideline implementation and adherence beliefs and perceptions; (2) maintaining the patient-clinician relationship with imaging referrals; (3) barriers to guideline implementation. Clinicians believed that guidelines were categorical, prescriptive and constrained professional practice; however popular clinical practices superseded the guidelines. Imaging referrals were used to manage consultations and to obtain definitive diagnoses. Clinicians' perceptions reflected a lack of content knowledge and understanding of how guidelines are developed.

DISCUSSION: 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.
Language eng
DOI 10.1097/AJP.0000000000000324
Field of Research 1103 Clinical Sciences
1109 Neurosciences
111099 Nursing not elsewhere classified
Socio Economic Objective 920210 Nursing
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2016, Wolters Kluwer
Persistent URL http://hdl.handle.net/10536/DRO/DU:30080865

Document type: Journal Article
Collection: School of Nursing and Midwifery
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Created: Wed, 20 Jan 2016, 09:03:15 EST

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