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Group education interventions for low back pain



Clinical bottom line: Studies were too diverse to show whether group education therapy is effective in the management of acute or chronic low back pain.


Systematic review:

Cohen JE, Goel V, Frank JW, Bombardier C, Peloso P, Guilemin F. Group education interventions for people with low back pain. Spine 1994; 19: 1214-1222.

Date review completed: July 1992

Number of trials included: 9 randomised studies

Number of patients: (Acute pain, 684; chronic pain, 831)

Control groups: Education plus telephone support, usual care, callisthenics, no treatment, self-hypnosis, physical/exercise training.

Main outcomes: Short-term outcomes were pain intensity or duration, sick leave duration, functional status, knowledge and spinal mobility. Additionally, for long-term outcomes: number of pain occurrences, and number of contacts with healthcare professionals.

Inclusion criteria were controlled studies which assessed group education as a primary component of the study intervention for the treatment of patients with either acute or chronic low back pain.

Medline (1986-July 1992), Health (1975 to July 1992), ERIC (1983 to July 1992) and PsychLit (1987 to July 1992) were searched for studies which assessed the effectiveness of group education on back pain. Bibliographies and personal communication were used as sources of additional citations. Only articles published in English or French were assessed. Studies which assessed one-to-one education were excluded. Chronic pain was defined as having a duration of more than six months.


Findings:

Thirteen studies were included. Details of the nine randomised studies only are provided below. The included studies assessed group education interventions over a variety of treatment durations and follow-up. A number of different outcomes were used in the trials which meant that studies were not comparable and different active (e.g. callisthenics, self-hypnosis) and passive controls (e.g. no treatment) were used.

Acute pain:

In acute pain (less than six month's duration), significantly greater reductions in pain duration and initial sick leave were reported with group education compared with placebo in one trial (217 patients) for short-term follow-up. In the long-term (up to 12 months), one study (100 patients) showed group education to be significantly more effective than the McKenzie method in reducing the number of pain recurrences, pain intensity and contact with healthcare professionals.

Chronic pain:

In chronic pain, short-term findings from one trial (142 patients) showed that group education was significantly less effective than calisthenics in improving spinal mobility. Long-term findings in one study (204 patients) reported significant improvements in functional status and spinal mobility with group education compared with no treatment.

No other study showed any significant benefit of group education over control for any outcome.


Adverse effects

Adverse effects were not mentioned.

 

Comment

These studies say very little about the effectiveness of group education. The main message of the review was that there is insufficient evidence to show that group education therapy works. Studies were too diverse to compare. Methodologically sound studies which assess standard outcomes over appropriate treatment durations and follow up are required to determine whether group education therapy is effective.

Further reading


Related topics


Identifier

AT129 - 397 GROUP EDUCATION INTERVENTIONS FOR LOW BACK PAIN: Sep-2000