Back schools for the treatment of chronic low back pain: possibility of benefit but no convincing evidence after 47 years of research-systematic review and meta-analysis

Sebastian Straube, Markus Harden, Heiko Schröder, Barbora Arendacka, Xiangning Fan, R Andrew Moore, Tim Friede, Sebastian Straube, Markus Harden, Heiko Schröder, Barbora Arendacka, Xiangning Fan, R Andrew Moore, Tim Friede

Abstract

Back schools are interventions that comprise exercise and education components. We aimed to systematically review the randomized controlled trial evidence on back schools for the treatment of chronic low back pain. By searching MEDLINE, Embase, and Cochrane Central as well as bibliographies, we identified 31 studies for inclusion in our systematic review and 5 of these for inclusion in meta-analyses. Meta-analyses for pain scores and functional outcomes revealed statistical superiority of back schools vs no intervention for some comparisons but not others. No meta-analysis was feasible for the comparison of back schools vs other active treatments. Adverse events were poorly reported so that no reliable conclusions regarding the safety of back schools can be drawn, although some limited reassurance in this regard may be derived from the fact that few adverse events and no serious adverse events were reported in the back school groups in the studies that did report on safety. Overall, the evidence base for the use of back schools to treat chronic low back pain is weak; in nearly a half-century since back schools were first trialled, no unequivocal evidence of benefit has emerged.

Conflict of interest statement

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1.
Figure 1.
Study selection.
Figure 2.
Figure 2.
Visualization of all 31 included studies reporting on the efficacy of back schools, describing trial duration and total sample size (inset scale) over time. The comparator treatments to the back school treatments are colour-coded as shown in the figure.
Figure 3.
Figure 3.
Risk of bias assessed using the Cochrane Risk of Bias tool.
Figure 4.
Figure 4.
Changes in visual analogue pain scores (0- to 10-cm scale) in studies comparing participants taking part in back school programs with control groups (no treatment). CI, confidence interval, IV, inverse variance, Random, random-effects model.
Figure 5.
Figure 5.
Changes in Roland Morris Disability Questionnaire scores in studies comparing participants taking part in back school programs with control groups (no treatment). CI, confidence interval, IV, inverse variance, Random, random-effects model.
Figure 6.
Figure 6.
Changes in Short Form (36) Health Survey physical component scores in studies comparing participants taking part in back school programs with control groups (no treatment). CI, confidence interval, IV, inverse variance, Random, random-effects model.
Figure 7.
Figure 7.
Changes in Short Form (36) Health Survey mental component scores in studies comparing participants taking part in back school programs with control groups (no treatment); CI, confidence interval, IV, inverse variance, Random, random-effects model.
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5028160/bin/jop-157-2160-g014.jpg

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