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Physician-reported barriers to using evidence-based recommendations for low back pain in clinical practice: a systematic review and synthesis of qualitative studies using the Theoretical Domains Framework.

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dc.contributor.author Hall, Amanda M.
dc.contributor.author Scurrey, Samantha R.
dc.contributor.author Pike, Andrea E.
dc.contributor.author Albury, Charlotte
dc.contributor.author Richmond, Helen L.
dc.contributor.author Matthews, James
dc.contributor.author Toomey, Elaine C.
dc.contributor.author Hayden, Jill A.
dc.contributor.author Etchegary, Holly
dc.date.accessioned 2020-11-11T11:38:40Z
dc.date.available 2020-11-11T11:38:40Z
dc.date.issued 2019
dc.identifier.issn 1748-5908
dc.identifier.uri http://hdl.handle.net/10344/9436
dc.description peer-reviewed en_US
dc.description.abstract Background: Adoption of low back pain guidelines is a well-documented problem. Information to guide the development of behaviour change interventions is needed. The review is the first to synthesise the evidence regarding physicians’ barriers to providing evidence-based care for LBP using the Theoretical Domains Framework (TDF). Using the TDF allowed us to map specific physician-reported barriers to individual guideline recommendations. Therefore, the results can provide direction to future interventions to increase physician compliance with evidencebased care for LBP. Methods: We searched the literature for qualitative studies from inception to July 2018. Two authors independently screened titles, abstracts, and full texts for eligibility and extracted data on study characteristics, reporting quality, and methodological rigour. Guided by a TDF coding manual, two reviewers independently coded the individual study themes using NVivo. After coding, we assessed confidence in the findings using the GRADE-CERQual approach. Results: Fourteen studies (n = 318 physicians) from 9 countries reported barriers to adopting one of the 5 guidelinerecommended behaviours regarding in-clinic diagnostic assessments (9 studies, n = 198), advice on activity (7 studies, n = 194), medication prescription (2 studies, n = 39), imaging referrals (11 studies, n = 270), and treatment/specialist referrals (8 studies, n = 193). Imaging behaviour is influenced by (1) social influence—from patients requesting an image or wanting a diagnosis (n = 252, 9 studies), (2) beliefs about consequence—physicians believe that providing a scan will reassure patients (n = 175, 6 studies), and (3) environmental context and resources—physicians report a lack of time to have a conversation with patients about diagnosis and why a scan is not needed (n = 179, 6 studies). Referrals to conservative care is influenced by environmental context and resources—long wait-times or a complete lack of access to adjunct services prevented physicians from referring to these services (n = 82, 5 studies). Conclusions: Physicians face numerous barriers to providing evidence-based LBP care which we have mapped onto 7 TDF domains. Two to five TDF domains are involved in determining physician behaviour, confirming the complexity of this problem. This is important as interventions often target a single domain where multiple domains are involved. Interventions designed to address all the domains involved while considering context-specific factors may prove most successful in increasing guideline adoption. Registration: PROSPERO 2017, CRD42017070703 en_US
dc.language.iso eng en_US
dc.publisher BMC en_US
dc.relation.ispartofseries Implementation Science;14:49
dc.relation.uri https://doi.org/10.1186/s13012-019-0884-4
dc.subject theoretical domains framework en_US
dc.subject implementation en_US
dc.subject behaviour change en_US
dc.subject low back pain en_US
dc.subject guidelines en_US
dc.title Physician-reported barriers to using evidence-based recommendations for low back pain in clinical practice: a systematic review and synthesis of qualitative studies using the Theoretical Domains Framework. en_US
dc.type info:eu-repo/semantics/article en_US
dc.type.supercollection all_ul_research en_US
dc.type.supercollection ul_published_reviewed en_US
dc.date.updated 2020-11-11T09:35:38Z
dc.description.version PUBLISHED
dc.identifier.doi 10.1186/s13012-019-0884-4
dc.rights.accessrights info:eu-repo/semantics/openAccess en_US
dc.internal.rssid 2966524
dc.internal.copyrightchecked Yes
dc.identifier.journaltitle Implementation science : IS
dc.description.status peer-reviewed


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