BACK SCHOOL IN A FIRST EPISODE OF COMPENSATED ACUTE LOW-BACK-PAIN - ACLINICAL-TRIAL TO ASSESS EFFICACY AND PREVENT RELAPSE

Objective: To assess the efficacy of a back school program for patient s with a first episode of acute work-related low back pain requiring c ompensation. Design: A randomized single-blind controlled trial. Setti ng: A private physiatric outpatient clinic. Patients: The mean duratio n of low back pain was 15 days. Intervention: Eligible patients were r andomized to a standard treatment program that included daily physioth erapy (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 Outcom e Measures: The primary outcomes were the time off work for the presen ting episode of back pain and the number and duration of recurrences i n the year following the study onset. Secondary outcomes included the level of pain, spinal mobility, active straight-leg raising, and funct ional disability assessed by the Oswestry and Roland-Morris scales. Re sults: Those randomized to the back school group gained significantly more knowledge, based on the multiple choice examination (p = .0001) a nd performed the exercise program significantly better (p = .0001) tha n the standard care group. There were no differences between the two t reatment groups for either of the primary outcomes. The median time to return to work from randomization was 33 days for both the back schoo l and the standard care groups (p = .48). The number of compensated re currences of low back pain over 1 year was similar (back school = 14, standard care = 10, p = .16), as was the median duration of these epis odes (back school = 25 days, standard 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 assessments.