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Back schools for non‐specific low‐back pain.

Abstract

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Background

Since the introduction of the Swedish back school in 1969, back schools have frequently been used for treating patients with low‐back pain (LBP). However, the content of back schools has changed and appears to vary widely today.

Objectives

To assess the effectiveness of back schools for patients with non‐specific LBP.

Search methods

We searched the MEDLINE and EMBASE databases and the Cochrane Central Register of Controlled Trials to May 2003 for relevant trials reported in English, Dutch, French or German. We also screened references from relevant reviews and included trials. The literature search has now been updated to November 2004. No additional trials were identified.

Selection criteria

Randomized controlled trials (RCTs) that reported on any type of back school for non‐specific LBP were included.

Data collection and analysis

Four reviewer authors, blinded to authors, institution and journal, independently extracted the data and assessed the quality of the trials. We set the high quality level, a priori, at a trial meeting six or more of 11 internal validity criteria. As data were clinically and statistically too heterogeneous to perform a meta‐analysis, we used a qualitative review (best evidence synthesis) to summarize the results. The evidence was classified into four levels (strong, moderate, limited or no evidence), taking into account the methodological quality of the studies. We also evaluated the clinical relevance of the studies.

Main results

Nineteen RCTs (3584 patients) were included in this updated review. Overall, the methodological quality was low, with only six trials considered to be high quality. It was not possible to perform relevant subgroup analyses for LBP with radiation versus LBP without radiation. The results indicate that there is moderate evidence suggesting that back schools have better short and intermediate‐term effects on pain and functional status than other treatments for patients with recurrent and chronic LBP. There is moderate evidence suggesting that back schools for chronic LBP in an occupational setting, are more effective than other treatments and placebo or waiting list controls on pain, functional status and return to work during short and intermediate‐term follow‐up. In general, the clinical relevance of the studies was rated as insufficient.

Authors' conclusions

There is moderate evidence suggesting that back schools, in an occupational setting, reduce pain, and improve function and return‐to‐work status, in the short and intermediate‐term, compared to exercises, manipulation, myofascial therapy, advice, placebo or waiting list controls, for patients with chronic and recurrent LBP. However, future trials should improve methodological quality and clinical relevance and evaluate the cost‐effectiveness of back schools.

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Plain language summary

Back schools for non‐specific low‐back pain

There is moderate evidence suggesting that back schools are more effective for pain and function than other conservative treatments if the patients with chronic low‐back pain (LBP) are from the general public, primary or secondary care. There is conflicting evidence whether back schools are more effective than placebo or waiting list controls for pain, function and return‐to‐work.

There is moderate evidence suggesting that back schools, in an occupational setting, reduce pain, and improve function and return‐to‐work status, in the short and intermediate‐term, compared to exercises, manipulation, myofascial therapy or advice, placebo or waiting list controls, for patients with chronic LBP.