If the documentation and recommendations of this report are followed, a range of treatments will definitively disappear from the health care systems handling of low-back pain, and more effective patient episodes of care will represent far a bigger fraction of cases.
In crucial areas implementation of the results of the report should go through interdisciplinary formed reference programmes and clinical guidelines. One obvious subject could be a reference programme with guidelines for working out correct x-ray procedures of the low back, carried out in co-operation with radiologists, surgeons, chiropractors, rheumatologists, general practitioners etc. In addition reference programmes describing in which cases blood tests are necessary, should be worked out.
Economic aspects influence practice behaviour, and changes in collective agreements and contracts may cause great effect.
Broad implementation strategies including a combination of printed materials, problem oriented education, collegiate influence from opinion leaders, audit feedback of actual treatment activity and visits by colleagues to the clinic are best suited in order to obtain changes in clinical behaviour.
It is important that the patient early in the treatment course takes an active part by receiving detailed information. Information about the problem and treatment is most often repeated several times before the patient gets full insight into the matter. Individual information is recommended and should be based on the individual situation and need. A strengthened individual information effort towards the patient both in the primary-and in the secondary sector is an important aspect for the strengthening of future efforts. The collective agreements possibility to promote this information effort should be analysed critically.
A shared patient record and electronic communication system should be developed and tested so that the practitioners can share information about diagnosis and treatment already carried out.
Common and improved training of physicians, chiropractors and physiotherapists should be developed so the professions get a more equal approach to the individual patient. These courses should also include other relevant professional groups such as teachers of relaxation and psychologists. Relevant professional academic environments should support the training. Particular courses for social-/rehabilitation staff should be given higher priority than it is the case today.