Back schools for non-specific low back pain
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M W van Tulder1, R Esmail, C Bombardier
1Institute for Research in Extramural Medicine, Vrije Universiteit, van der Boechorststraat 7, Amsterdam, Netherlands, 1081 BT. mw.van_tulder.emgo@med.vu.nl
Background:
Since the introduction of the Swedish back school in 1980, the content of back schools has changed and appears to vary widely today. Back schools are frequently used in the treatment of low back pain patients.
Objectives:
The objective of this systematic review was to assess the effects of back schools for patients with non-specific low back pain.
Search Strategy:
We searched the Medline and Embase databases up to December 1997 and the Cochrane Controlled Trials Register up to December 1998 if reported in English, Dutch, French or German. We also screened references given in relevant reviews and identified randomised trials.
Selection Criteria:
Only randomised trials that reported on any type of back school for non-specific low back pain were included.
Data Collection And Analysis:
Two reviewers blinded with respect to authors, institution and journal independently extracted the data and assessed trial quality. Our preset "high quality" level was 6 or more out of 11 internal validity criteria with positive scores. As data were statistically and clinically too heterogeneous, a qualitative review (best evidence synthesis) was performed. The evidence was classified into 4 levels (strong, moderate, limited or no evidence) taking into account the methodological quality of the studies.
Main Results:
Fifteen RCTs were included in our systematic review. Overall, the methodological quality was low. Only 3 trials were considered high quality. It was not possible to make relevant subgroup analyses for radiation versus no radiation or to have a relevant subgroup of studies reporting on acute low back pain only. The results indicate that there is moderate evidence that back schools have better short-term effects than other treatments for chronic low back pain, and that there is moderate evidence that back schools in an occupational setting are more effective compared to 'placebo' or waiting list controls.
Reviewer'S Conclusions:
Back schools may be effective for patients with recurrent and chronic low back pain in occupational settings, but little is known about the cost-effectiveness of back schools.
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