Acute Lower Back Problems in Adults - Back School

Structured Patient Education: Back School

Panel findings and recommendations:

• In the workplace, back schools with worksite–specific education may be effective adjuncts to individual education efforts by the clinician in the treatment of patients with acute low back problems. (Strength of Evidence = C.)
  
• The efficacy of back schools in nonoccupational settings has yet to be demonstrated. (Strength of Evidence = C.)

Back school is defined here as a structured program of education about low back problems, usually in a group setting. The therapeutic objectives are to give the patient information on the anatomy and natural history of disorders of the back; to teach the principles underlying posture, daily activities, and sports; and thereby to increase functional work capacity.

Literature Reviewed.

Of 35 articles screened for this topic, 15 reporting on 12 RCTs met criteria for review. [72] <http://text.nlm.nih.gov>– [86] <http://text.nlm.nih.gov>
Two meta–analyses regarding back schools were also examined. [87, <http://text.nlm.nih.gov> 88] <http://text.nlm.nih.gov> The panel used information from one other study that did not meet selection criteria. [89] <http://text.nlm.nih.gov>

Evidence on Efficacy.

One of the few studies demonstrating the efficacy of back school [72] <http://text.nlm.nih.gov> was conducted in the medical department of a Swedish automotive assembly plant. The 217 subjects all had nonspecific low back pain for less than 3 months and were randomly assigned to one of three interventions: back school, combined physiotherapy exercise, or placebo shortwave diathermy. The back school intervention consisted of four 45–minute sessions in 2 weeks and included the following topics: anatomy and causes of low back problems, muscle function and posture, ergonomics, and advice on physical activity. Patients attending back school had a shorter duration of sick leave during the initial episode than the other two treatment groups, but at the 1–year followup neither the number nor the length of absences from work owing to recurrences differed among the three treatment groups.
A meta–analysis by Keijsers, Bouter, and Meertens [87] <http://text.nlm.nih.gov>evaluated eight studies of back schools done in group settings. [72, <http://text.nlm.nih.gov> 73, <http://text.nlm.nih.gov> 76, <http://text.nlm.nih.gov> 79, <http://text.nlm.nih.gov> 81, <http://text.nlm.nih.gov> 85, <http://text.nlm.nih.gov> 86, <http://text.nlm.nih.gov> 89] <http://text.nlm.nih.gov> These studies of back schools were compared in terms of program duration and content, patient selection criteria, number of patients, interventions, and outcome measures used. All eight studies were found to have major methodological problems. The authors found that although there was insufficient evidence to form a strong and valid judgment on the efficacy of back schools, the available evidence suggested that back schools are at most marginally effective.
Another meta–analysis by Linton and Kamwendo [88] <http://text.nlm.nih.gov> reviewed the scientific literature on back schools and reported some positive effects in studies of patients with acute back pain. However, the authors found that most studies of back schools lacked adequate control groups and that the evidence on efficacy is inconclusive.

Potential Harms and Costs.

The potential risks and harms of back schools are considered low. Costs are variable, depending on the number of sessions and the setting, and range from moderately inexpensive to expensive.

Summary of Findings.

Available data on formal patient education programs, or back schools, vary in terms of program quality, length, content, costs, and outcomes. Only one study of a structured low back education program, performed in industry, was found to have a positive short–term impact on acute low back problems although no effect was seen at 1–year followup. [72] <http://text.nlm.nih.gov> In summary, the published evidence on back school as a treatment for acute low back problems is limited in quantity and the results are contradictory.


Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults.
Clinical Practice Guideline No. 14. AHCPR Publication No. 95–0642.
Rockville, MD: Agency for Health Care Policy and Research, Public Health
Service, U.S. Department of Health and Human Services. December 1994.