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Back schools for non-specific low-back pain.

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 STRATEGY

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.

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 reviewers, 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.

REVIEWERS' 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.

Authors+Show Affiliations

VUMC/Institute for Research in Extramural Medicine, Van der Boechorststraat 7, Amsterdam, Netherlands, 1081 BT.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

15494995

Citation

Heymans, M W., et al. "Back Schools for Non-specific Low-back Pain." The Cochrane Database of Systematic Reviews, 2004, p. CD000261.
Heymans MW, van Tulder MW, Esmail R, et al. Back schools for non-specific low-back pain. Cochrane Database Syst Rev. 2004.
Heymans, M. W., van Tulder, M. W., Esmail, R., Bombardier, C., & Koes, B. W. (2004). Back schools for non-specific low-back pain. The Cochrane Database of Systematic Reviews, (4), CD000261.
Heymans MW, et al. Back Schools for Non-specific Low-back Pain. Cochrane Database Syst Rev. 2004 Oct 18;(4)CD000261. PubMed PMID: 15494995.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Back schools for non-specific low-back pain. AU - Heymans,M W, AU - van Tulder,M W, AU - Esmail,R, AU - Bombardier,C, AU - Koes,B W, Y1 - 2004/10/18/ PY - 2004/10/21/pubmed PY - 2005/3/24/medline PY - 2004/10/21/entrez SP - CD000261 EP - CD000261 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 4 N2 - 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 STRATEGY: 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. 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 reviewers, 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. REVIEWERS' 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. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/15494995/Back_schools_for_non_specific_low_back_pain_ L2 - https://doi.org/10.1002/14651858.CD000261.pub2 DB - PRIME DP - Unbound Medicine ER -