Evaluating Adherence to the National Institute for Health and Care Excellence (NICE) Guidelines in the Management of First-Presentation Low Back Pain: A Retrospective Audit in Primary Care.

Introduction Low back pain (LBP) is one of the most common presentations in primary care and a leading cause of disability worldwide. The global prevalence of LBP continues to rise, with an increasing burden on healthcare systems. Adherence to clinical guidelines is essential to optimise management and avoid unnecessary investigations. This audit aimed to assess adherence to the National Institute for Health and Care Excellence (NICE) guidelines in the management of first-presentation LBP in primary care. Methods This retrospective audit was conducted at a single general practice in Glasgow, Scotland. Data were collected from a random sample of 71 patients with their first episode of LBP and no red-flag symptoms between January 2024 and February 2025. Current practice was compared with the NICE guidelines for the management of first-presentation LBP. Patient selection was performed using a computer-generated random-number function in Microsoft Excel (Microsoft Corporation, Redmond, Washington) to minimise selection bias and ensure that the findings reflected typical patterns of LBP management within the practice population. Adherence to guidelines was assessed across key domains, including patient education, self-management advice, pharmacological treatment, and physiotherapy referral. Results The audit found that, overall, 39.4% (n = 28) of cases were fully compliant with the recommended NICE guidelines. Patient education was the most compliant method, which commonly included self-management advice regarding weight loss and regular exercise. Non-steroidal anti-inflammatory drugs were prescribed in 21.1% of cases, and opioids were prescribed in 9.9%, opposed to guideline advice. Physiotherapy self-referral occurred in 39.4% of cases, and fit notes for work absence were issued in 4.2%. These findings highlight a variation in clinical practice and areas to improve compliance with the NICE guidelines. Conclusion The audit identified significant gaps in adherence to the NICE guidelines in the management of first-presentation LBP in primary healthcare. Following the audit, a poster summarising the NICE guidelines was created and presented at a departmental meeting to promote staff awareness. This targeted education and feedback may improve compliance with evidence-based management of first-presentation LBP in primary care. A re-audit is planned to evaluate the improvement following these measures.