"Sekolah belakang" untuk sakit belakang rendah tidak spesifik.
Abstract
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
Plain language summary
"Sekolah belakang" untuk sakit belakang rendah tidak spesifik.
Terdapat bukti sederhana yang mencadangkan "sekolah belakang" adalah lebih berkesan untuk sakit dan fungsi berbanding rawatan konservatif lain jika pesakit dengan sakit belakang rendah kronik (LBP) adalah daripada penjagaan primer, sekunder atau awam umum. Terdapat bukti bertentangan sama ada "sekolah belakang" lebih berkesan berbanding plasebo atau senarai menunggu untuk mengawal sakit, fungsi dan kembali bekerja.
Terdapat bukti sederhana mencadangkan "sekolah belakang" dalam persekitaran kerja mengurangkan sakit, memperbaiki fungsi dan status kembali bekerja dalam jangka masa pendek dan sederhana berbanding senaman, manipulasi, terapi fascia otot atau nasihat, plasebo atau senarai menunggu kawalan untuk pesakit dengan sakit belakang rendah kronik.
