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. 2016 Apr 26;4(4):CD008325.
doi: 10.1002/14651858.CD008325.pub2.

Back schools for acute and subacute non-specific low-back pain

Nolwenn Poquet  1 , Chung-Wei Christine Lin, Martijn W Heymans, Maurits W van Tulder, Rosmin Esmail, Bart W Koes, Christopher G Maher
Affiliations

Back schools for acute and subacute non-specific low-back pain

Nolwenn Poquet et al. Cochrane Database Syst Rev. .

Abstract

Background: Since the introduction of the Swedish back school in 1969, back schools have frequently been used for treating people with low-back pain (LBP). However, the content of back schools has changed and appears to vary widely today. In this review we defined back school as a therapeutic programme given to groups of people, which includes both education and exercise. This is an update of a Cochrane review first published in 1999, and updated in 2004. For this review update, we split the review into two distinct reviews which separated acute from chronic LBP.

Objectives: To assess the effectiveness of back schools on pain and disability for people with acute or subacute non-specific LBP. We also examined the effect on work status and adverse events.

Search methods: We searched CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, PubMed and two clinical trials registers up to 4 August 2015. We also checked the reference lists of articles and contacted experts in the field of research on LBP.

Selection criteria: We included randomised controlled trials (RCTs) or quasi-RCTs that reported on back school for acute or subacute non-specific LBP. The primary outcomes were pain and disability. The secondary outcomes were work status and adverse events. Back school had to be compared with another treatment, a placebo (or sham or attention control) or no treatment.

Data collection and analysis: We used the 2009 updated method guidelines for this Cochrane review. Two review authors independently screened the references, assessed the quality of the trials and extracted the data. We set the threshold for low risk of bias, a priori, as six or more of 13 internal validity criteria and no serious flaws (e.g. large drop-out rate). We classified the quality of the evidence into one of four levels (high, moderate, low or very low) using the adapted Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We contacted study authors for additional information. We collected adverse effects information from the trials.

Main results: The search update identified 273 new references, of which none fulfilled our inclusion criteria. We included four studies (643 participants) in this updated review, which were all included in the previous (2004) update. The quality of the evidence was very low for all outcomes. As data were too clinically heterogeneous to be pooled, we described individual trial results. The results indicate that there is very low quality evidence that back schools are no more effective than a placebo (or sham or attention control) or another treatment (physical therapies, myofascial therapy, joint manipulations, advice) on pain, disability, work status and adverse events at short-term, intermediate-term and long-term follow-up. There is very low quality evidence that shows a statistically significant difference between back schools and a placebo (or sham or attention control) for return to work at short-term follow-up in favour of back school. Very low quality evidence suggests that back school added to a back care programme is more effective than a back care programme alone for disability at short-term follow-up. Very low quality evidence also indicates that there is no difference in terms of adverse events between back school and myofascial therapy, joint manipulation and combined myofascial therapy and joint manipulation.

Authors' conclusions: It is uncertain if back schools are effective for acute and subacute non-specific LBP as there is only very low quality evidence available. While large well-conducted studies will likely provide more conclusive findings, back schools are not widely used interventions for acute and subacute LBP and further research into this area may not be a priority.

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Conflict of interest statement

Two review authors, Maurits van Tulder and Chris Maher, are on the Editorial Board of the Cochrane Back and Neck Review Group. Editors are required to conduct at least one Cochrane review. This requirement ensures that editors are aware of the processes and commitment needed to conduct reviews. None of the editors are first review authors. This involvement does not seem to be a source of conflict of interest in the Cochrane Back and Neck Review Group. Any editor who is a review author is excluded from editorial decisions on the Cochrane review in which they are contributors.

Nolwenn Poquet, Chris Lin, Martijn Heymans, Rosmin Esmail and Bart Koes have no known conflicts of interest.

Figures

1
1
Study flow diagram
2
2
'Risk of bias' summary: review authors' judgements about each 'Risk of bias' item for each included study.
3
3
'Risk of bias' graph: review authors' judgements about each 'Risk of bias' item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 Back schools versus combined physical therapies for acute and subacute LBP, Outcome 1 Pain short‐term (pain index 0 to 70).
1.2
1.2. Analysis
Comparison 1 Back schools versus combined physical therapies for acute and subacute LBP, Outcome 2 Work absence < 21 days.
1.3
1.3. Analysis
Comparison 1 Back schools versus combined physical therapies for acute and subacute LBP, Outcome 3 Work absence > 21 days.
2.1
2.1. Analysis
Comparison 2 Back schools versus short‐wave diathermy at the lowest intensity for acute and subacute LBP, Outcome 1 Pain short‐term (pain index 0 to 70).
2.2
2.2. Analysis
Comparison 2 Back schools versus short‐wave diathermy at the lowest intensity for acute and subacute LBP, Outcome 2 Work absence > 21 days.
3.1
3.1. Analysis
Comparison 3 Back schools versus myofascial therapy for acute and subacute LBP, Outcome 1 Pain short‐term (VAS 0 to 10).
3.2
3.2. Analysis
Comparison 3 Back schools versus myofascial therapy for acute and subacute LBP, Outcome 2 Pain intermediate‐term (VAS 0 to 10).
3.3
3.3. Analysis
Comparison 3 Back schools versus myofascial therapy for acute and subacute LBP, Outcome 3 Disability short‐term (RMDQ 0 to 24).
3.4
3.4. Analysis
Comparison 3 Back schools versus myofascial therapy for acute and subacute LBP, Outcome 4 Disability intermediate‐term (RMDQ 0 to 24).
3.5
3.5. Analysis
Comparison 3 Back schools versus myofascial therapy for acute and subacute LBP, Outcome 5 Adverse events.
4.1
4.1. Analysis
Comparison 4 Back schools versus joint manipulation for acute and subacute LBP, Outcome 1 Pain short‐term (VAS 0 to 10).
4.2
4.2. Analysis
Comparison 4 Back schools versus joint manipulation for acute and subacute LBP, Outcome 2 Pain intermediate‐term (VAS 0 to 10).
4.3
4.3. Analysis
Comparison 4 Back schools versus joint manipulation for acute and subacute LBP, Outcome 3 Disability short‐term (RMDQ 0 to 24).
4.4
4.4. Analysis
Comparison 4 Back schools versus joint manipulation for acute and subacute LBP, Outcome 4 Disability intermediate‐term (RMDQ 0 to 24).
4.5
4.5. Analysis
Comparison 4 Back schools versus joint manipulation for acute and subacute LBP, Outcome 5 Adverse events.
5.1
5.1. Analysis
Comparison 5 Back schools versus joint manipulation and myofascial therapy for acute and subacute LBP, Outcome 1 Pain short‐term (VAS 0 to 10).
5.2
5.2. Analysis
Comparison 5 Back schools versus joint manipulation and myofascial therapy for acute and subacute LBP, Outcome 2 Pain intermediate‐term (VAS 0 to 10).
5.3
5.3. Analysis
Comparison 5 Back schools versus joint manipulation and myofascial therapy for acute and subacute LBP, Outcome 3 Disability short‐term (RMDQ 0 to 24).
5.4
5.4. Analysis
Comparison 5 Back schools versus joint manipulation and myofascial therapy for acute and subacute LBP, Outcome 4 Disability intermediate‐term (RMDQ 0 to 24).
5.5
5.5. Analysis
Comparison 5 Back schools versus joint manipulation and myofascial therapy for acute and subacute LBP, Outcome 5 Adverse events.
6.1
6.1. Analysis
Comparison 6 Back school + other treatment versus other treatment alone for acute and subacute LBP, Outcome 1 Pain short‐term (VAS 0 to 10).
6.2
6.2. Analysis
Comparison 6 Back school + other treatment versus other treatment alone for acute and subacute LBP, Outcome 2 Pain intermediate‐term (VAS 0 to 10).
6.3
6.3. Analysis
Comparison 6 Back school + other treatment versus other treatment alone for acute and subacute LBP, Outcome 3 Pain long‐term (VAS 0 to 10).
6.4
6.4. Analysis
Comparison 6 Back school + other treatment versus other treatment alone for acute and subacute LBP, Outcome 4 Disability short‐term (RMDQ 0 to 24).
6.5
6.5. Analysis
Comparison 6 Back school + other treatment versus other treatment alone for acute and subacute LBP, Outcome 5 Disability intermediate‐term (RMDQ 0 to 24).
6.6
6.6. Analysis
Comparison 6 Back school + other treatment versus other treatment alone for acute and subacute LBP, Outcome 6 Disability long‐term (RMDQ 0 to 24).
6.7
6.7. Analysis
Comparison 6 Back school + other treatment versus other treatment alone for acute and subacute LBP, Outcome 7 Work absence at 30 days.
6.8
6.8. Analysis
Comparison 6 Back school + other treatment versus other treatment alone for acute and subacute LBP, Outcome 8 Work absence at 60 days.
7.1
7.1. Analysis
Comparison 7 Back school versus advice for acute or subacute LBP, Outcome 1 Days of sick‐leave at 1 year.
See this image and copyright information in PMC

Update of

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