What is the role of back schools in the prevention of low back pain (LBP) and sciatica?

Updated: Aug 22, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Although back schools to educate and train patients have been popular internationally, they have been ineffective as preventive measures. However, back schools have had a 94-96% rate of patient satisfaction. In a prospective randomized clinical trial to compare exercise alone with back-school education plus exercise, the back-school group had significant improvements in pain and disability. Furthermore, at 16 weeks, the exercise-only group had reverted to their original level of disability, whereas the back-school group had continued improvement. Other studies have shown that patients with LBP who participate in back schools return to work earlier, seek less follow-up medical attention, and have less frequent episodes of pain than other patients. [277]

Swedish-style back schools generally provide education and information about LBP problems, ergonomic instruction, and back exercises. For cLBP, the evidence is somewhat conflicting, but there is some evidence overall that back schools may be effective in improving short-term pain and functional outcomes, but not long-term outcomes. [273, 106] Previous systematic reviews that are available for evaluating back schools largely included multidisciplinary interventions where back schools played a minor role. Most studies included various types of physiotherapy including exercise, massage, electrotherapy, thermotherapy, and other modalities, which makes it difficult to evaluate the effectiveness of back schools alone. One high-quality study showed evidence that back schools contributed significantly to overall outcomes only when offered between weeks 4 and 16 of treatment following onset or injury. [278]

Brief education is defined as advice given verbally or nonverbally after consultation and usually involves only short contact with healthcare professionals through patient-led self-management groups, educational booklets, and online discussion groups. These interventions often encourage self-management, assist in staying active, and reduce potential concerns about LBP. Two high-quality reviews reported that adding exercise, stabilization exercises, and manipulation was not cost-effective in patients with cLBP. In at least 2 of the included trials, differences seemed evident between the placebo, which was deduced from clinical examination and advice, and education via a back book that was emailed to the participant (nocebo). Observed results demonstrated positive effects from active contact. [278]

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