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Acute Pain | Chronic Pain | General

Back schools for low back pain

Clinical bottom line: Back schools appear to be useful in relieving low back pain, but results may not persist beyond 12 months. These finding need to be confirmed with evidence from well-designed trials.

Back schools usually involve information-giving interventions where patients are taught about anatomy and function of the back, mechanical strain and posture. Isometric exercises for abdominal muscles and physical activity programmes are also given. These interventions were originally developed in Sweden, and the content can vary widely.

Systematic review

Koes BW, van Tulder MW, van der Windt WM, Bouter LM. The efficacy of back schools: a review of randomized clinical trials. J Clin Epidemiol. 1994 Aug; 47(8): 851-62

Inclusion criteria were randomised controlled trials of back schools for low back pain; back school programme had an education and skills component together with an exercise regimen; intervention given by a trained specialist; full journal publication.

Reviewers based their conclusion on the conclusion of original trials, taking quality of trial into account. Measures of efficacy varied between trials.

Findings

Trials varied greatly in quality, very few were blind, and overall quality rating was low. Trials were in a mixture of acute, chronic and recurrent low back pain.

Seven of 16 trials reported better results from back school programme compared with usual care, short-waves, waiting list control, etc. These were generally the higher quality trials, and included the two highest quality trials (score "e 50 of a possible 100).

The four highest quality trials were all positive, and took place in occupational settings. No significant differences were apparent at 12 months, even though some interventions were intensive (e.g. three to five weeks of intensive exercise, etc).

Seven of 16 trials reported no difference or worse outcomes for the back school programme compared with reference treatment (similar to above)

In the remaining two trials, authors were unable to draw a conclusion. Both trials were of low quality.

Adverse effects

The review did not report on adverse effects

Further references

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