A Prospective Controlled Study of Low Back School in the General Population

Abstract

SUMMARYThere are no data on the efficacy of a back school in primary prevention of back pain in the general population or on the characteristics of the population who volunteers. After announcement in the local press, 494 healthy adults volunteered and paid for a back school course in Switzerland. A total of 371 controls were matched for sex, age, profession, nationality and back pain. A statistically significant decrease in numbers of doctor's visits was found by the participants during the following 6 months compared with the controls. However, there were no significant between-group differences in the four remaining parameters (presence and intensity of back pain, drug intake and sick leave). Three-quarters of participants changed their attitudes after the back school. Volunteering for a back pain prevention programme was associated with the presence of back pain problems. Reasons for volunteering are further discussed. Overall, the results of this study showed that a back school for the general population may not solve the problem of low back pain, but improves self-help in a subgroup of the population. Primary prevention programmes have also been developed to reduce the occurrence of low back pain. In primary prevention, studies with control groups and data on lost workdays are rare, and results of educational programmes are conflicting [26]. However, in prospective studies in industry, the expected rate of back pain [27], compensation claims [28] and absenteeism [29] has been reduced.The Swiss League against Rheumatism (SLR) started a nationwide back school programme for the general population in 1990. The first 772 participants were prospectively evaluated and compared to a sample of 593 control subjects.Primary prevention addresses healthy individuals. In patients, educational programmes aim at encouraging the patient to take part in the management of his back problem and to be an active agent in the recovery process, with the underlying assumption that motivation is linked to symptoms [30,31]. As participation in a programme such as the one evaluated in this study is voluntary, it raises the question of reasons for volunteering, especially when the course is intended for the general population and is organized outside of the workplace.The evaluation of this back school programme focused on two aspects: what impact does the back school have on the participants in terms of back pain (prevalence and intensity) and its consequences (number of doctor's visits, drug intake and sick leave); and who volunteers for such a programme. METHODS SettingThe SLR back school was widely advertised in the local press of major urban areas. It consisted of eight weekly lessons of 90 min in the evening. Participants were taught in small groups (7-12 participants) and were charged the equivalent of US$80.The lessons were given by a physiotherapist trained in back school education. A multidisciplinary team of health professionals of Swiss rehabilitation units had prepared a 200 page handbook as a didactic base for the teachers...

A Controlled Trial of an Educational Program to Prevent Low Back Injuries

“…Several recent studies of back schools have found improved intermediate outcomes associated with training, such as increased knowledge, safer behavior, and fewer visits to a doctor, but no reductions in injury rates or sick leave. [22][23][24][25] We developed a back school for the primary prevention of low back injury and evaluated it in a large, randomized, controlled trial in an industrial setting, which included all employees of the two facilities involved. The program's design and its effect on workers' knowledge and behavior have been described elsewhere 26 ; the effect on rates of low back injury is described here.…”

A Novel Back School Using a Multidisciplinary Team Approach Featuring Quantitative Functional Evaluation and Therapeutic Exercises for Patients With Chronic Low Back Pain

“…[1][2][3][4][5][6][7][8][9] Many treatment methods have been developed and utilized to solve this problem. Conservative treatment is the gold standard for treating patients with low back pain (LBP).…”

“…[1][2][3][4][5][6][7][8] It is mainly a "therapist-driven" program and is applied to patients who are involved in any of the three phases: primary, secondary, and tertiary rehabilitation. 9 Its purposes lie in educating patients on the nature of their low back disorders, and helping them to form an active and positive attitude.…”

“…8,10 In contrast, others question the efficacy of back schools. 2,6 There are several issues to consider in evaluating the effectiveness of back schools.…”

“…12,13 Second, the study participants and settings for back school were different. 6,12 The patients involved with workers' compensation, litigation, or disability insurance were included, or sometimes excluded.…”