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Table 4 Comments subtracted using the metaplan technique from group discussions of GPs.

From: Acceptance and perceived barriers of implementing a guideline for managing low back in general practice

Topic Comments of GPs
Guideline in general ■ Patients need to be taken serious
■ Guideline downplays patients' pain
Communication ■ Difficulties conveying the non-biomechanic diagnosis
■ Mentioning the guideline approved by university increases credibility
■ Difficulties "selling" psychotherapy for LBP
Physical activity ■ Is easier to promote in younger people
■ Is mainly attractive for women
■ It is hard to motivate elder man
■ It is hard to motivate and give reasons for physical activity to physically hard working patients
Physiotherapy ■ Patient are highly satisfied with physical therapy
■ Knowledge deficits about what physical therapist can do
■ Suspicion that PT change prescription for physical therapy into massage
Imaging ■ General agreement on its low impact on patient care and therapeutic decisions
■ Patients want imaging
■ Increases prestige of the condition
■ Refusal of imaging could be perceived as cost-saving measure
■ Postponing imaging requires more counselling time
Cooperation with orthopaedic surgeons ■ Orthopaedic surgeons are (ab)used to get rid of difficult patients.
■ Fear of being blamed of missing something albeit not important
■ Troubles with access for patients with suspicion of serious complication or severe pain
■ Routine imaging and routine prescription of physiotherapy by orthopaedic surgeons make GPs appear as "poor man's choice"
Injections ■ Injections are popular particular among elder patients
■ Replacement of injections with non-steroidals by injections of local anaesthetics
Patient education ■ There should be public education on the radio and on tv about the ineffectiveness of bed rest, imaging etc.