The use of a predefined framework of barriers to implementation triggered physicians to think about a broad range of barriers and potential interventions to improve guideline acceptance and guideline adherence [ 28].
– Lack of acceptance of guidelines as a work tool.
Acceptance of guidelines from a governmental institution was substantially lower than from physician networks or medical societies (36.2% vs. 53.4% vs. 62.0%).
Remote monitoring of implantable defibrillator-cardioverters is gaining wide-spread acceptance in guidelines and clinical practice, and the assessment of intracardiac electrograms from arrhythmias or oversensing episodes is relevant for clinical decision making in remotely monitored patients.
Further, the barriers include concerns about a "cook book" approach to medicine and oversimplification of complex clinical questions, lack of acceptance of guidelines' recommendations, practical barriers and a perceived challenge to the autonomy of the clinician.
Furthermore, it could be expected that the acceptance of guidelines will be substantially higher in clinical application, if in the planning of the studies aspects of external validity were already considered.
The third group, which included younger physicians with shorter experience, expressed a greater concordance of opinions regarding the acceptance of guidelines as a prescribing tool, explaining it as the result of early training in following evidence-based practice.
However, despite widespread acceptance, such guidelines tend to be consensus rather than evidence based with limited, and conflicting, evidence to support the use of manipulation [ 4- 6] or exercise [ 7- 9].
