English National Institute for Health and Care Excellence (NICE) offered clinical guidelines for managing low back pain (LBP) in primary care.

But guidelines were deemed just one of many aides to clinical decision-making. Physicians draw on personal experience, inter-professional networks and are constrained by organizational factors when deciding which treatment to prescribe, refer for, or deliver to a 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 real-world situations.

Conclusion. The NICE guidelines for managing LBP in primary care were a relatively peripheral influence on decision-making among GPs, chiropractors, acupuncturists, physiotherapists, osteopaths, and nurses.

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