• Mandy Corbett, Nadine Foster, and Bie Nio Ong.
• Arthritis Research Campaign National Primary Care Centre, Keele University, Staffordshire, UK. m.corbett@cphc.keele.ac.uk
• Fam Pract. 2009 Oct 1; 26 (5): 359364359-64.

BackgroundThe implementation of guideline recommendations in primary care has become widespread. The treatment of low back pain (LBP) has followed suite. Research shows that the use of LBP guidelines is influenced by the believability of the underlying evidence, the GPs consultation style and uncertainties surrounding diagnosis and treatment.ObjectiveTo qualitatively examine the attitudes and self-reported behaviour of GPs in relation to guideline adherence for patients with LBP.MethodA mixed-method design combining a national UK-based survey of GPs and physiotherapists with an embedded qualitative study. This report focuses only on the GP interviews. We explored GPs' experience of managing LBP patients and the rationale for treatment offered to a patient described in a written vignette. All interviews were digitally recorded, fully transcribed and analysed using the constant comparative method.ResultsGPs encountered difficulties adhering to guideline recommendations for LBP patients. They experienced particular tensions between recommendations to stay active versus the expectation of being prescribed rest. GPs expressed that chronic LBP often poses an intractable problem requiring specialist advice. The perception that guideline recommendations are 'imposed' may create resistance, and the evidence base is not always considered believable.ConclusionsGPs acknowledge guideline recommendations but divergence occurs in implementation. This is due to GPs focussing on the whole person-not just one condition-and the importance of maintaining the doctor-patient relationship, which relies on effective negotiation of mutual perceptions and expectations. Further exploration on how consultation processes can be constructed to effectively combine evidence with patient-centred care is needed.

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