title: Barriers to primary care clinician adherence to clinical guidelines for the management of low back pain: protocol of a systematic review and meta-synthesis of qualitative studies.
abstract: BACKGROUND
  Low back pain is the highest ranked condition contributing to years lived with disability, and is a significant economic and societal burden. Evidence-based clinical practice guidelines are designed to improve quality of care and reduce practice variation by providing graded recommendations based on the best available evidence. Studies of low back pain guideline implementation have shown no or modest effects at changing clinical practice.
  
  
  OBJECTIVE
  To identify enablers and barriers to adherence to clinical practice guidelines for the management of low back pain.
  
  
  METHODS
  A systematic review and meta-synthesis of qualitative studies that will be conducted and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement guidelines. Eight databases will be searched using a priori inclusion/exclusion criteria. Two independent reviewers will conduct a structured review and meta-synthesis, and a third reviewer will arbitrate where there is disagreement. This protocol has been registered on PROSPERO 2014.
  
  
  BACKGROUND
  Ethical approval is not required. The systematic review will be published in a peer-reviewed journal. The review will also be disseminated electronically, in print and at conferences. Updates of the review will be conducted to inform and guide healthcare translation into practice.
  
  
  BACKGROUND
  PROSPERO 2014:CRD42014012961. Available from http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014012961.
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia Monash Department of Clinical Epidemiology, Cabrini Hospital, Melbourne, Australia.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Slade
authors.affiliation: Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Kent
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia School of Nursing & Midwifery, Deakin University, Melbourne, Australia Alfred Health, Melbourne, Australia.
authors.forename: Tracey
authors.initials: T
authors.lastname: Bucknall
authors.affiliation: Health Professions Education and Educational Research (HealthPEER), Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Molloy
authors.affiliation: Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, UK.
authors.forename: Shilpa
authors.initials: S
authors.lastname: Patel
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia Monash Department of Clinical Epidemiology, Cabrini Hospital, Melbourne, Australia.
authors.forename: Rachelle
authors.initials: R
authors.lastname: Buchbinder
mesh_terms: D001291:Attitude of Health Personnel; D019983:Guideline Adherence; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000628:therapy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D036301:Qualitative Research; D058028:Research Report; D000078202:Systematic Reviews as Topic; D015201:Meta-Analysis as Topic
keywords: PRIMARY CARE; QUALITATIVE RESEARCH