title: "Lovely Pie in the Sky Plans": A Qualitative Study of Clinicians' Perspectives on Guidelines for Managing Low Back Pain in Primary Care in England.
abstract: METHODS
  A qualitative study in south-west England primary care.
  
  
  OBJECTIVE
  To clarify the decision-making processes that result in the delivery of particular treatments to patients with low back pain (LBP) in primary care and to examine clinicians' perspectives on the English National Institute for Health and Care Excellence (NICE) clinical guidelines for managing LBP in primary care.
  
  
  BACKGROUND
  Merely publishing clinical guidelines is known to be insufficient to ensure their implementation. Gaining an in-depth understanding of clinicians' perspectives on specific clinical guidelines can suggest ways to improve the relevance of guidelines for clinical practice.
  
  
  METHODS
  We conducted semi-structured interviews with 53 purposively sampled clinicians. Participants were 16 general practitioners (GPs), 10 chiropractors, 8 acupuncturists, 8 physiotherapists, 7 osteopaths, and 4 nurses, from the public sector (20), private sector (21), or both (12). We used thematic analysis.
  
  
  RESULTS
  Official guidelines comprised just 1 of many inputs to clinical decision-making. Clinicians drew on personal experience and inter-professional networks and were constrained by organizational factors when deciding which treatment to prescribe, refer for, or deliver to an individual patient with LBP. Some found the guideline terminology-"non-specific LBP"-unfamiliar and of limited relevance to practice. They were frustrated by disparities between recommendations in the guidelines and the real-world situation of short consultation times, difficult-to-access specialist services, and sparse commissioning of guideline-recommended treatments.
  
  
  CONCLUSIONS
  The NICE guidelines for managing LBP in primary care are one, relatively peripheral, influence on clinical decision-making among GPs, chiropractors, acupuncturists, physiotherapists, osteopaths, and nurses. When revised, these guidelines could be made more clinically relevant by: ensuring that guideline terminology reflects clinical practice terminology; dispelling the image of guidelines as rigid and prohibiting patient-centered care; providing opportunities for clinicians to engage in experiential learning about guideline-recommended complementary therapies; and commissioning guideline-recommended treatments for public sector patients.
  
  
  METHODS
  N/A.
authors.affiliation: *Centre for Applications of Health Psychology, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK †Department of Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, UK ‡University of Amsterdam, Department of Communication Science, Amsterdam School of Communication Research ASCoR, Amsterdam, The Netherlands §Health Psychology Section, Psychology Department, Institute of Psychiatry, Kings College London, Guy's Hospital Campus, London, UK ¶Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire, UK.
authors.forename: Felicity L
authors.initials: FL
authors.lastname: Bishop
authors.forename: Alexandra L
authors.initials: AL
authors.lastname: Dima
authors.forename: Jason
authors.initials: J
authors.lastname: Ngui
authors.forename: Paul
authors.initials: P
authors.lastname: Little
authors.forename: Rona
authors.initials: R
authors.lastname: Moss-Morris
authors.forename: Nadine E
authors.initials: NE
authors.lastname: Foster
authors.forename: George T
authors.initials: GT
authors.lastname: Lewith
mesh_terms: D004739:England; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D036301:Qualitative Research