Effectiveness of the back school. A review of the results of evidence- based evaluation Cost-Effectiveness of a Back School Intervention for Municipal Employees The Cost‐Effectiveness of a Back School Program in Industry: A Longitudinal Controlled Field Study The Effectiveness of High-Intensity Versus Low-Intensity Back Schools in an Occupational Setting: A Pragmatic Randomized Controlled Trial Intermediate and Long-term Effects of a Standardized Back School for Inpatient Orthopedic Rehabilitation on Illness Knowledge and Self-management Behaviors: A Randomized Controlled Trial A back school in The Netherlands: evaluating the results. Knowledge and perceptions about back education among elementary school students, teachers, and parents in Belgium. Back school in a first episode of compensated acute low back pain: a clinical trial to assess efficacy and prevent relapse. Active back school: prophylactic management for low back pain. A randomized, controlled, 1-year follow-up study. Effectiveness of a back school program in low back pain. Psychological features and outcomes of the Back School treatment in patients with chronic non-specific low back pain. A randomized controlled study. Quality of life improved by multidisciplinary back school program in patıents with chronic non-specific low back pain: a single blind randomized controlled trial. "Active back school", prophylactic management for low back pain: three-year follow-up of a randomized, controlled trial. A Randomized Study of Back School in Women With Chronic Low Back Pain: Quality of Life at Three, Six, and Twelve Months Follow-up [Back school for patients with non-specific chronic low-back pain: benefits from the association of an exercise program with patient's education]. No Clinical Effect of Back Schools in an HMO A Randomized Prospective Trial Effects of Back School Education and Exercise in Back Injured Municipal Workers
Summary Back schools are high frequency-low cost interventions . Their effectiveness has lately been regarded with skepticism . The variety of back school programs makes an over-all evaluation difficult . The number of evaluative publications has increased dramatically during the last 10 years , including 18 r and omized controlled trials . Results of these studies have been contradictory . The results of two lately published r and omized controlled trials , of 18 r and omized controlled trials , of five systematic review s , two publications conducting metaanalyses , and five task forces presenting guidelines for clinical practice are reported . According to the conclusions of the review s there is limited to strong evidence for the effectiveness of back schools for chronic back pain . The metaanalyses show clear effects for knowledge and behavior change up to 6 months . Three of five task forces recommend back schools for acute pain respectively at worksite . Summarizing the results of the given evidence based recommendations it is concluded that back schools at work sites and back schools with intensive training is effective . There is still need to prove the effectiveness of single elements of the back school programs , of strategies to increase long term effects , the effectiveness for subtypes of patients and the effectiveness of back schools as part of a comprehensive orthopedic pain therapy . ZusammenfassungRückenschulen sind inzwischen weit verbreitete Programme , deren Wirksamkeit in letzter Zeit kritisch diskutiert wurde . Die Heterogenität der Programme i m Hinblick auf Ziele , Inhalte und Vermittlungsformen erschweren allgemeine Aussagen zur Wirksamkeit . Es liegt eine nahezu unüberschaubare Anzahl an Publikationen zur Evaluation von Rückenschulen vor , die unterschiedliche Wirksamkeitskriterien erhoben haben . Die vorliegenden Einzelstudien , darunter 18 mit einem kontrollierten r and omisierten Versuchsplan , kommen zu teilweise widersprechenden Result aten . Um dennoch zu einer allgemeinen Bewertung der Ergebnislage zu kommen , werden 2 jüngere Einzelstudien exemplarisch beschrieben , ebenso wie eine Übersicht über 18 r and omisierte kontrollierte Studien , Schlußfolgerungen von 5 Sammelreferaten , 2 Metaananalysen und 5 Expertenkommissionen , die „ Evidence based-Leitlinien “ zur Beh and lung von Rückenbeschwerden veröffentlichen . Von den Sammelreferaten kommt eines zu keinem Ergebnis , 3 beschreiben eine eingeschränkte Wirksamkeit und eines begründet eine starke Evidenz für die Wirksamkeit von Rückenschulen bei chronischen Beschwerden . Eine Metaanalyse errechnet große Effekte für Verhaltensänderungen und Kenntnisgewinn , die and ere größere Effekte für Rückenschulen als Teil von umfassenden Rehabilitationsprogrammen , 2 der Expertenkommissionen sehen keine Evidenz für die Wirksamkeit von Rückenschulen , 3 sehen die Wirksamkeit bei akuten Beschwerden bzw . am Arbeitsplatz als erwiesen . In der Gesamtbewertung erscheint die  Wirksamkeit von Rückenschulprogrammen gesichert , die am Arbeitsplatz durchgeführt werden und die eine intensive Schulung beinhalten . Darüber hinaus muß die Wirkung der Rückenschulen noch deutlicher belegt werden , u. a. die isolierte Wirkung einzelner Bausteine , von Maßnahmen zur Steigerung der Dauerhaftigkeit , der Indikation für bestimmte Patientengruppen und Wirkungen der Rückenschule als Best and teil der Orthopädischen Schmerztherapie This study investigated the effect of a back school rehabilitation program on lost work time , lost time cost , medical cost , and number of injuries in municipal employees . Seventy back-injured workers who participated in a 6-week back school  were compared on the dependent variables with 70 r and omly selected back-injured city employees who had not participated in a back school . Back school participants demonstrated a significant decrease on all dependent variables .  Back school participants had significantly fewer injuries in the 6-month postintervention period . No statistically significant differences were found between groups on the time and cost variables . Actual dollars saved in lost time and medical costs between groups was of practical value to the city . Study findings offer support for the back school as a cost-effective measure To define the cost-effectiveness of a back school program in industry , a controlled longitudinal field study was carried out in a Dutch bus company . The experimental group received a program consisting of information on back care , physical fitness , nutrition , stress , and relaxation . Objective data on absenteeism were collected and compared during a 6-year period for the control and experimental groups . Results showed that a tailor-made back school program reduced absenteeism by at least 5 days per year per employee , therefore being cost-effective to industry . A reduction was not observed in incidence , but in mean length of absenteeism . This effect turned out to be persistent during a 2-year period following the program Study Design . R and omized controlled trial . Objectives . To compare high- and low-intensity back schools with usual care in occupational health care . Summary of Background Data . The content and intensity of back schools vary widely and the method ologic quality of r and omized controlled trials is generally weak . Until now , no back school has proven to be superior for workers sick-listed because of subacute nonspecific low back pain . Methods . Workers ( n = 299 ) sick-listed for a period of 3 to 6 weeks because of nonspecific low back pain were recruited by the occupational physician and r and omly assigned to a high-intensity back school , a low-intensity back school , or care as usual . Outcome measures were days until return to work , total days of sick-leave , pain , functional status , kinesiophobia , and perceived recovery and were assessed at baseline and at 3 and 6 months of follow-up . Principal analyses were performed according to the intention-to-treat principle . Results . We r and omly allocated 299 workers . Workers in the low-intensity back school returned to work faster compared with usual care and the high-intensity back school , with hazard ratios of 1.4 ( P = 0.06 ) and 1.3 ( P = 0.09 ) , respectively . The comparison between high-intensity back school and usual care result ed in a hazard ratio of 1.0 ( P = 0.83 ) . The median number of sick-leave days was 68 , 75 , and 85 in the low-intensity back school , usual care , and high-intensity back school , respectively . Beneficial effects on functional status and kinesiophobia were found at 3 months in favor of the low-intensity back school . No substantial differences on pain and perceived recovery were found between groups . Conclusions . The low-intensity back school was most effective in reducing work absence , functional disability , and kinesiophobia , and more workers in this group scored a higher perceived recovery during the 6-month follow-up Objectives A back school is a m and atory part of the multimodal rehabilitation program for patients with chronic low back pain in Germany . However , no st and ardized and evaluated back school program has been available for routine use . In this study , we report the evaluation of a new back school that was developed based on theories of health behavior , treatment evidence , practice guidelines , and quality criteria for patient education . Methods R and omized controlled trial of patients with low back pain ( n=360 ) in inpatient orthopedic rehabilitation clinic in Germany . Intervention patients received the new back school  , whereas control patients a traditional back school ( usual care ) . Illness knowledge ( primary outcome ) and secondary behavioral and health outcomes were assessed at admission , discharge , and 6 and 12 months follow-up . Results Results showed a significant medium between-group treatment effect in patients ' knowledge about back pain at discharge ( & eegr;2=0.081 ) , after 6 ( & eegr;2=0.056 ) , and 12 months ( & eegr;2=0.026 ) . Furthermore , small-to-medium effects were observed among the secondary self-management behaviors , such as physical activity , back exercises , back posture habits , and coping with pain , after 6 and 12 months . Discussion The superior effectiveness of the back school based on a biopsychosocial approach was demonstrated with regard to illness knowledge and self-management behaviors up to 1 year . Thus , the program may be recommended for dissemination within medical rehabilitation The use of an education program for patients with chronic low back pain ( Back School ) has been investigated . The effect evaluation is based on a pretest-post-test-control group design , including a follow-up after 8 weeks . The Maastricht Back School is based on the theory that pain is also maintained by emotional , cognitive and environmental factors . Information and training are given on these and physical factors . The purpose of the course is to teach patients to manage their own pain problem . The results suggest that the Back School program for patients with chronic low back pain can have a positive effect A back education program for Belgian elementary school children was evaluated using self-reported question naires before intervention and at three follow-up points during one year . Most children found the program interesting , important , and amusing . Intervention children ( n = 347 ) showed better back care knowledge than control  children ( n = 359 ) , and knowledge gained was retained over a period of one year . Back education did not result in increased fear-avoidance beliefs about physical activity , and intervention children reported more checking of their book bag weight than controls at all test moments . Self-reported behavior in relation to posture-related and back care related self-efficacy were affected only minimally by the program , possibly due to poor self-judgment . Involvement , fear-avoidance beliefs , and back care knowledge of teachers and parents of the intervention children showed low correlation with the children 's perceptions and knowledge . Sufficient promise exists to justify further development and evaluation of early back education OBJECTIVE To assess the efficacy of a back school program for patients with a first episode of acute work-related low back pain requiring compensation . DESIGN A r and omized single-blind controlled trial . SETTING A private physiatrics outpatient clinic . PATIENTS The mean duration of low back pain was 15 days . INTERVENTION Eligible patients were r and omized to a st and ard treatment program that included daily physiotherapy ( n = 86 ) or the same program with the addition of back school ( n = 82 ) . The back school program consisted of three 90-minute sessions given by a single trained instructor at 0 , 1 , and 8 weeks . MAIN OUTCOME MEASURES The primary outcomes were the time off work for the presenting episode of back pain and the number and duration of recurrences in the year following the study onset . Secondary outcomes included the level of pain , spinal mobility , active straight-leg raising , and functional disability assessed by the Oswestry and Rol and -Morris scales . RESULTS Those r and omized to the back school group gained significantly more knowledge , based on the multiple choice examination ( p = .0001 ) and performed the exercise program significantly better ( p = .0001 ) than the st and ard care group . There were no differences between the two treatment groups for either of the primary outcomes . The median time to return to work from r and omization was 33 days for both the back school and the st and ard care groups ( p = .48 ) . The number of compensated recurrences of low back pain over 1 year was similar ( back school = 14 , st and ard care = 10 , p = .16 ) , as was the median duration of these episodes ( back school = 25 days , st and ard care = 70 days , p = .21 ) . There were no significant differences favoring the back school group for any of the secondary outcomes at the posttreatment , 6-month , or 12-month assessment s. CONCLUSION A back school intervention in addition to st and ard care result ed in no reduction in the time to return to work or the number or duration of recurrences of low back pain requiring compensation over a period of one year STUDY DESIGN A r and omized , controlled , single-center trial with a stratified group design . OBJECTIVE To investigate the secondary prophylactic effect of the Active Back School program on minimizing recurrences of low back pain episodes . SUMMARY OF BACKGROUND DATA The results of back school interventions are controversial . Previous work often used short intervention periods and low doses of practical training . However , studies with the highest method ologic scores have shown the best results , especially when conducted in occupational setting s and coupled with a comprehensive rehabilitation program . METHODS By block r and omization , 19 men and 24 women were allocated to Active Back School , with 18 men and 20 women as control subjects . The Slumps test and number of low back pain episodes during the previous 36 months were used as stratification factors . There were no significant differences between the groups with regard to demographic factors and initially observed variables . Active Back School consisted of 20 lessons over a 13-week period . Each lesson was divided into a 20-minute theoretical part and a 40-minute exercise part . All participants were examined on enrollment , then 5 and 12 months after initiation of the program . Outcome measures were recurrence of low back pain episodes and number of days of sick leave . RESULTS The recurrence of new low back pain episodes was significantly lower ( P < 0.05 ) and the time from inclusion to the first new episode significantly longer ( P < 0.01 ) in the Active Back School group than in the control group . In the Active Back School group , seven participants took sick leave because of low back pain episodes during the first 12 months of follow-up compared with 11 among the control subjects . The number of sick leave days was significantly lower ( P < 0.05 ) in the Active Back School group than in the control group . CONCLUSION Active Back School reduced the recurrence and severity of new low back pain episodes according to results of follow-up examinations performed 5 and 12 months after enrollment OBJECTIVES To evaluate the effectiveness of a back school program in pain , functional status , quality of life , and in anxiety and depression in patients with non-specific low back pain . METHODS Sixty patients with low back pain were r and omized to an intervention and control group . The intervention group underwent a five-weekly back school program . The control group was seen in weekly medical visits , without educative approaches . Both groups took acetaminophen as analgesic medication . All subjects were evaluated by a blind physiotherapist after r and omization , 30 , 60 and 120 days . Roll and -Morris , SF-36 , STAI and Beck question naires , pain visual analogical scale and Schober 's test were applied . Non-steroidal anti-inflammatory drugs ( NSAID ) consumption was considered co-intervention . The statistical analyses were performed using Pearson 's Chi-Square analysis and Student 's t-test to compare the baseline characteristics of the groups and the analysis of variance ( ANOVA ) with repeated measures to assess changes inter/intra groups . RESULTS There were no significant differences in the baseline characteristics between the two groups . Fifty-five patients completed the study . The intervention group showed a significant improvement in the general health domain , assessed by SF-36 , and also in the reduction of acetaminophen and NSAID intake . There was no significant difference between the groups in pain , functional status , anxiety or depression . CONCLUSION The back school program was more effective than any educational intervention in general health status and in decreasing acetaminophen and NSAID intake . It was ineffective in the other quality of life domains , in pain , functional status , anxiety and depression BACKGROUND Low back pain is a worldwide health problem , affecting up to 80 % of adult population . Psychological factors are involved in its development and maintenance . Many clinical trials have evaluated the efficacy of different interventions for chronic non-specific low back pain . In this field , Back School program has been demonstrated effective for people with chronic non-specific low back . AIM To evaluate the relationship between the effects of the Back School treatment and psychological features measured by MMPI-II of patients with chronic non-specific low back pain . DESIGN A r and omised controlled trial with three and six-month follow-up . SETTING Ambulatory rehabilitative university centre . POPULATION Fifty patients with chronic non-specific low back pain out of 77 screened patients . METHODS Patients were r and omly placed in a 3:2 form and were allocated into two groups ( Treatment versus Control ) . The Treatment Group participated to an intensive multidisciplinary Back School program ( BSG , N.=29 ) , while the Control Group received medical assistance ( CG , N.=21 ) . Medication was the same in both groups . Then , patients were subgrouped in those with at least an elevation in one scale of MMPI-II , and those without it . The Short Form 36 Health Status Survey for the assessment of quality of life ( primary outcome measure ) , pain Visual Analogue Scale , Waddel Index and Oswestry Disability Index were collected at baseline , at the end of treatment , and at the three and six-month follow-up . RESULTS Only the two treated subgroups showed a significant improvements in terms of quality of life , disability and pain . Among treated subjects , only those with at least one scale elevation in MMPI-II showed also a significant improvement in terms of Short Form 36 mental composite score and relevant subscores . CONCLUSION These results suggest that Back School program has positive effects , even in terms of mental components of quality of life in patients with scale elevations of MMPI-II . Probably these findings are due to its educational and cognitive-behavioural characteristics . CLINICAL REHABILITATION IMPACT Because of its educational purpose s , the Back School treatment can have positive effects also on the mental status of patients with low back pain when it affects their psychological features STUDY DESIGN A three and six months follow-up in a r and omized controlled trial . BACKGROUND Back School has become a widespread exercise program for low back pain ( LBP ) , since its introduction in 1969 . Back School could improve quality of life ( QoL ) , but there are controversial data regarding its effectiveness . AIM To evaluate the effects of the Back School program on quality of life ( primary outcome ) , disability and pain perceptions ( secondary outcomes ) in patients with chronic and non-specific low back pain . SETTING Rehabilitative specialized centre . POPULATION Seventy four patients with chronic non-specific LBP . METHODS Patients were r and omly placed in a 3:2 form and were allocated into 2 groups ( treated-control ) . Treatment group participated in a intensive multidisciplinary Back School program including brief education and active back exercises ( BSG , N.=41 ) , while the control group received medical assistance ( CG , N.=29 ) . Medication was the same in both groups . The Short Form 36 Health Status Survey , Waddel Index , Oswestry Disability Index and Visual Analogue Scale were collected at baseline , at the end of treatment , and at the three and six month follow-up . RESULTS Quality of life significantly improved along time more in BSG , both in Physical and Mental Composite Score ( repeated measure Anova : interaction time per group : P<0.001 and P=0.002 , respectively ) . We also observed a significant improvement in disability scores along time ( P<0.001 ) in BSG with significant differences between groups at three and at six months for Waddell Index ( P=0.006 and P=0.009 respectively ) and for Oswestry Disability Index ( P=0.018 and 0.011 respectively ) . Moreover , pain perception score VAS showed a reduction in both groups , but it was significantly lower in BSG at end of treatment and both follow-ups ( P<0.001 ) . CONCLUSION Our Back School program can be considered an effective treatment in people with chronıc non-specıfıc LBP The purpose of the present study was to investigate the long-term effect of the Active Back School programme on minimizing recurrences of episodes of low back pain .  Forty-three subjects were r and omly allocated to the Active Back School group and 38 to the control group .  There were no significant differences between the groups with regard to baseline characteristics . The Active Back School programme comprised 20 lessons each divided into a 20-min theoretical and a 40-min exercise part during a 13-week period . Nine participants ( 11 % ) dropped out during the study period . Recurrence of new low back pain episodes was significantly less ( p = 0.04 ) , and the time from inclusion to the first new low back pain episode was significantly on the side of the Active Back School group ( p < 0.01 ) . The duration of sick leave was found to be significantly shorter ( p < 0.01 ) in the Active Back School group compared to the control group . The Active Back School reduced the recurrence and severity of new low back pain episodes at 36 months ' follow-up Study Design . A r and omized controlled trial . Objective . To examine the effects of the back school program on quality of life in women with chronic low back pain . Summary of Background Data . There is a controversial debate whether back school program might improve quality of life in back pain patients . This study aim ed to address this issue . Methods . One hundred and two eligible women were r and omly allocated into 2 groups . The 2 groups including back school group who received the back school program plus medication ( n = 50 ) and clinic group who received just medication ( n = 52 ) were compared at 4 points in time . Data were collected at baseline and at 3 , 6 , and 12 months follow-up using the SF-36 question naire . Repeated measures analysis was performed to compare quality of life scores in 2 groups . Results . Quality of life scores were significantly different between 2 groups throughout the study ( P < 0.0001 ) indicating a better quality of life among intervention group . Conclusion . The back school program might improve the quality of life score in women with chronic low back pain OBJECTIVE < < Back School > > has been used as a way of preventing and treating back pain since 1969 , but reports in the literature on its effectiveness remain controversial . The purpose of this trial was to evaluate efficacy of a back school program for non- -specific chronic low-back pain . PATIENTS AND METHODS Seventy patients were r and omized into two groups : experimental group ( 34 patients ) and control group ( 36 patients ) . Experimental group patients participated in a theoretical and practical back school program , which was composed of 4 weekly classes of 60 minutes .  Control group patients  were allocated at a waiting list . Three evaluations took place ( baseline , after 4 and 16 weeks ) . The following variables were analyzed : pain intensity ( visual numeric analogue scale ) , functional disability ( Rol and -Morris Disability Question naire ) and spinal mobility ( Schöber index ) . Statistical analysis for intra-group and inter-group used significance level of p < 0.05 . RESULTS 57 patients were analyzed ( 29 in experimental group and 28 in control group ) . A statistically significant improvement was observed only in the experimental group , regarding pain intensity , functional disability and spine mobility . Such improvements have persisted after 16 weeks in pain intensity and functional disability variables . In the inter-group analysis we observed a statistically significant difference in the second and third evaluations concerning the functional disability variables and spinal mobility . CONCLUSION The Back School program proposed in this study seems to be effective for non-specific chronic low back pain In a prospect i ve trial , 222 adults with low-back pain of at least 2 weeks ' duration in a Health Maintenance Organization ( HMO ) were r and omly assigned to usual care ( UC ) , a 4-hour back school psychoeducational session ( LBS ) , or the same back school plus a 1-year “ compliance package ” program design ed to encourage appropriate self-management for back pain ( CP ) . Sixty-four percent of LBS and CP subjects attended their back school sessions . Follow-up measurement of pain level ( using the Visual Analogue Scale ) , functional status ( using the Sickness Impact Profile ) , and various other indicators of health status showed no measurable effect of either treatment condition ( LBS or CP ) compared with UC at 3 , 6 , 12 , and 18 months after entry into the study . Initial disability resolved by 3 months in most patients , and a minority of subjects ( 10–15 % ) showed residual or recurrent functional Impairment 1 year after entry . Health care utilization tended to be slightly higher after intervention In the CP group . With or without follow-up encouragement , back school instructions given in a single 4-hour session had no measurable impact on the comfort or functional status of the majority of patients with new onset back pain in this HMO Low back injury is the leading cause of compensable injury . A National Health Objective for the year 2000 is to increase to at least 50 % the number of worksites offering back injury protection programs . The 6 week Back School intervention included exercise and education . A portion of the sample of 74 back injured municipal employees also was assigned r and omly to a counseling intervention . Pre-intervention and post-intervention testing revealed significant posttest increases in back strength and flexibility . Significant improvements also were noted in psychological well being , depression , anxiety , and perceptions of pain . No significant differences were found , on any of the measures , between employees who did and who did not receive the counseling intervention . Method ological concerns relate to the possibility of sampling bias and instrumentation . Future research with control groups is needed , as well as the testing of interventions that may be both effective and require less work release time
According to the conclusions of the review s there is limited to strong evidence for the effectiveness of back schools for chronic back pain .
Summarizing the results of the given evidence based recommendations it is concluded that back schools at work sites and back schools with intensive training is effective .
Eine Metaanalyse errechnet große Effekte für Verhaltensänderungen und Kenntnisgewinn , die and ere größere Effekte für Rückenschulen als Teil von umfassenden Rehabilitationsprogrammen , 2 der Expertenkommissionen sehen keine Evidenz für die Wirksamkeit von Rückenschulen , 3 sehen die Wirksamkeit bei akuten Beschwerden bzw .
Summary Back schools are high frequency-low cost interventions .
Their effectiveness has lately been regarded with skepticism .
The variety of back school programs makes an over-all evaluation difficult .
The number of evaluative publications has increased dramatically during the last 10 years , including 18 r and omized controlled trials .
Results of these studies have been contradictory .