The efficacy of back schools: A review of randomized clinical trials

doi:10.1016/0895-4356(94)90188-0

Journal of Clinical Epidemiology

Volume 47, Issue 8, August 1994, Pages 851-862

https://doi.org/10.1016/0895-4356(94)90188-0 Get rights and content

Abstract

The purpose of this study was to assess the efficacy of back school programmes for low-back pain. Data sources comprised computer-aided search of published randomized clinical trials and assessment of the methods of the studies. 21 papers reporting on 16 randomized clinical trials evaluating a back school programme were selected for the study.

Data extraction included a score for quality of the methods, based on four categories: study population, interventions, effect measurement and data presentation and analysis; and the conclusion of the author(s) with regard to the efficacy of the back school programme. Only two studies scored more than 50 points (maximum= 100 points) indicating the overall poor quality of the methods. Seven studies indicated that the back school programme was more effective than the reference treatment and seven reported it to be no better or worse than the reference treatment. In two studies the authors refrained from drawing a conclusion. The studies reporting positive results showed higher methods scores $47$ positive vs $07$ negative scored ⩾45 points). Reported benefits of back schools were usually of short duration only. There are major flaws in the design of most studies. The best studies indicated that back schools may be effective in occupational settings in acute, recurrent or chronic conditions. The most promising type of interventions were (modifications of) the “Swedish back school” and were quite intensive (a 3 to 5-week stay in a specialized centre). Future research efforts should focus on the identification of patients who would benefit most from back schools. In addition, more attention should be paid to the cost-effectiveness of back schools.

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A systematic review was conducted. Searches were performed on 13 databases. Only randomized controlled trials enrolling patients ≥ 18 years of age were included. Risk of bias was assessed with the Cochrane Collaboration’s tool and interrater agreement between authors for full-texts selection was evaluated with Cohen’s Kappa. No meta-analysis was performed and qualitative analysis was conducted.
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To evaluate the evidence for the effectiveness of neuroscience education (NE) for pain, disability, anxiety, and stress in chronic musculoskeletal (MSK) pain.
Systematic searches were conducted on Biomed Central, BMJ.com, CINAHL, the Cochrane Library, NLM Central Gateway, OVID, ProQuest (Digital Dissertations), PsycInfo, PubMed/Medline, ScienceDirect, and Web of Science. Secondary searching (PEARLing) was undertaken, whereby reference lists of the selected articles were reviewed for additional references not identified in the primary search.
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For chronic MSK pain disorders, there is compelling evidence that an educational strategy addressing neurophysiology and neurobiology of pain can have a positive effect on pain, disability, catastrophization, and physical performance.

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Original articleThe efficacy of back schools: A review of randomized clinical trials

Abstract

J Clin Epidemiol

J Clin Epidemiol

Pain

Patient Educ Counsel

Controlled Clin Trials

The epidemiology of spinal disorders

Back pain and sciatica

N Engl J Med

Newest knowledge of low-back pain: a critical look

Clin Orthop

Physiotherapy exercises and back pain: a blinded review

Br Med J

Spinal manipulation and mobilization for back and neck pain: a blinded review

Br Med J

The Swedish back school

Physiotherapy

The efficacy of back schools. Empirical evidence and its impact on health care practice

Inventarisatie van rugscholen in Nederland

A controlled study on the outcome of inpatient and outpatient treatment of low-back pain. Part I

Scand J Rehab Med

A controlled study on the outcome of inpatient and outpatient treatment of low-back pain. Part II

Scand J Rehab Med

A controlled study on the outcome of inpatient and outpatient treatment of low-back pain. Part III

Scand J Rehab Med

A controlled study on the outcome of inpatient and outpatient treatment of low-back pain. Part IV

Scand J Rehab Med

Original article
The efficacy of back schools: A review of randomized clinical trials