Low back schools. A critical review

The purpose of this article is to review and evaluate the empirical literature concerning low back schools. Although the low back school is a popular method of dealing with the growing number of patients with back pain, a general lack of studies exists of the effectiveness of this intervention technique. The studies that have been conducted, moreover, often lack control conditions and appropriate measurement techniques. The goal of most schools is to increase "self-care" behaviors and thereby decrease other related problems, such as pain intensity and absenteeism. The literature, however, provides limited support for the idea that a low back school can influence variables such as the number of health care contacts, sick leave, work status, pain intensity or duration, activity level, or medication consumption. Whether the patient's level of knowledge improves as a result of attending the low back school is unclear. Some evidence suggests that patients' attitudes toward back care do change. We conclude, therefore, that more information is needed about the effects of low back schools so that they may be improved. A central concept of low back school programs that should be examined is patient compliance. How well patients comprehend the material presented in the low back school or whether the school results in behavioral changes in the participants remains to be determined.