Article type
Year
Abstract
Introduction: Back schools were introduced in the seventies' as treatment modality for patients with back pain. Nowadays back schools (in different forms and intensity) are available and frequently used in many countries.
Objective: To assess the efficacy of back school programmes for low-back pain. To investigate whether the widespread use of back schools is supported by results of well conducted randomized clinical trials.
Methods: Literature search with computerized data-bases (MEDLINE, EMBASE) for randomized clinical trials evaluating the efficacy of back schools, covering the period 1966-1992. All publications were assessed for their methodological quality by two reviewers independently using a set of methodological criteria. The outcomes of the trials are presented in relation to their methodological quality.
Results: We identified 23 relevant publications in which 16 therapeutic trials were presented. Only 2 studies scored more than 50 points (Maximum = 100 points) indicating the overall poor quality of the methods. Seven studies indicated that the back school programme was more effective than the reference treatment and seven reported it to be no better or worse than the reference treatment. In two studies the authors refrained from drawing a conclusion. The studies reporting positive results showed higher methods scores (4/7 positive versus 0/7 negative scored ? 45 points). Reported benefits of back schools were usually of short duration only.
Discussion: There are major flaws in the design of most studies. The best studies indicated that back schools may be effective in occupational settings in acute, recurrent or chronic conditions. The most promising type of interventions were (modifications of) the 'Swedish back school' and were quite intensive (a 3 to 5-week stay in a specialized centre). Future research efforts should focus on the identification of patients who would benefit most from back schools. In addition, more attention should be paid to the cost-effectiveness of back schools.
Objective: To assess the efficacy of back school programmes for low-back pain. To investigate whether the widespread use of back schools is supported by results of well conducted randomized clinical trials.
Methods: Literature search with computerized data-bases (MEDLINE, EMBASE) for randomized clinical trials evaluating the efficacy of back schools, covering the period 1966-1992. All publications were assessed for their methodological quality by two reviewers independently using a set of methodological criteria. The outcomes of the trials are presented in relation to their methodological quality.
Results: We identified 23 relevant publications in which 16 therapeutic trials were presented. Only 2 studies scored more than 50 points (Maximum = 100 points) indicating the overall poor quality of the methods. Seven studies indicated that the back school programme was more effective than the reference treatment and seven reported it to be no better or worse than the reference treatment. In two studies the authors refrained from drawing a conclusion. The studies reporting positive results showed higher methods scores (4/7 positive versus 0/7 negative scored ? 45 points). Reported benefits of back schools were usually of short duration only.
Discussion: There are major flaws in the design of most studies. The best studies indicated that back schools may be effective in occupational settings in acute, recurrent or chronic conditions. The most promising type of interventions were (modifications of) the 'Swedish back school' and were quite intensive (a 3 to 5-week stay in a specialized centre). Future research efforts should focus on the identification of patients who would benefit most from back schools. In addition, more attention should be paid to the cost-effectiveness of back schools.