THE EFFICACY OF BACK SCHOOLS - A REVIEW OF RANDOMIZED CLINICAL-TRIALS

The purpose of this study was to assess the efficacy of back school pr ogrammes for low-back pain. Data sources comprised computer-aided sear ch of published randomized clinical trials and assessment of the metho ds of the studies. 21 papers reporting on 16 randomized clinical trial s evaluating a back school programme were selected for the study. Data extraction included a score for quality of the methods, based on four categories: study population, interventions, effect measurement and d ata presentation and analysis; and the conclusion of the author(s) wit h regard to the efficacy of the back school programme. Only two studie s scored more than 50 points (maximum = 100 points) indicating the ove rall poor quality of the methods. Seven studies indicated that the bac k school programme was more effective than the reference treatment and seven reported it to be no better or worse than the reference treatme nt. In two studies the authors refrained from drawing a conclusion. Th e studies reporting positive results showed higher methods scores (4/7 positive vs 0/7 negative scored greater than or equal to 45 points). Reported benefits of back schools were usually of short duration only. There are major flaws in the design of most studies. The best studies indicated that back schools may be effective in occupational settings in acute, recurrent or chronic conditions. The most promising type of interventions were (modifications of) the ''Swedish back school'' and were quite intensive (a 3 to 5-week stay in a specialized centre). Fu ture research efforts should focus on the identification of patients w ho would benefit most from back schools. In addition, more attention s hould be paid to the cost-effectiveness of back schools.