Effectiveness of the back school. A review of the results of evidence- based evaluation Active back school: prophylactic management for low back pain. A randomized, controlled, 1-year follow-up study. Can Passive Prone Extensions of the Back Prevent Back Problems?: A Randomized, Controlled Intervention Trial of 314 Military Conscripts Back school in a first episode of compensated acute low back pain: a clinical trial to assess efficacy and prevent relapse. Learning Effects of a Back Education Program A controlled trial of an educational program to prevent low back injuries. Multidisciplinary Group Rehabilitation Versus Individual Physiotherapy for Chronic Nonspecific Low Back Pain: A Randomized 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 Children at Risk: Risk Factors for Low Back Pain in the Elementary School Environment A Randomized Study of Back School in Women With Chronic Low Back Pain: Quality of Life at Three, Six, and Twelve Months Follow-up Cost-Effectiveness of a Back School Intervention for Municipal Employees
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 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 Summary of Background Data . Back schools may be effective in treating back problems , but there is conflicting evidence of the effect on prevention . Objectives . To investigate if passive prone extensions of the back can prevent back problems . Study Design . Prospect i ve , r and omized controlled intervention trial . Methods . In total , 314 male conscripts were r and omized into two groups . After r and omization , 65 conscripts dropped out for administrative reasons , leaving 249 conscripts to participate fully in the study . Data were collected through question naires at the start of military duty and after 10 months . All conscripts in the intervention group had one 40-minute theoretical lesson on back problems and ergonomics and had to perform passive prone extensions of the back daily during the rest of their military duty . The control group had no intervention . Outcome variables were as follows : 1 ) number of persons with self-reported back problems during the last 3 weeks ; 2 ) number of persons with self-reported back problems during the last year ; and 3 ) number of persons who reported having consulted the regiment medical physician with back problems during their military service . Results . In an intention-to-treat analysis , significantly fewer persons in the intervention group versus those in the control group reported back problems during the last year ( 33%versus 51 % ) , and the number needed to prevent was 6 . Significantly fewer persons in the intervention group versus those in the control group consulted the regiment infirmary ( 9%versus 25 % ) , and the number needed to prevent was 6 . Conclusion . It may be possible to reduce the prevalence rate of back problems and the use of health care services during military service , at a low cost , using passive prone extensions of the back motivated by a back school approach , including the theory of the disc as a pain generator and ergonomic instructions 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 This study involved a post‐test only , control group design . Objectives To analyze the learning effects of back education programs ( video and classroom learning ) . Summary of Background Data Previous research has examined lost work time and workers ' compensation costs but has not addressed the learning effects of back schools . This study used the American Back School as the education intervention . The American Back School teaches students to maintain the lumbar lordosis while lifting . Methods The subjects ( n = 205 ) were assigned to three groups through modified r and omization . Three employees who previously sustained low back injury were placed in the back school group . The back school group , Group I , ( n = 74 ) attended a back school program that included cognitive learning strategies and practice in correct lifting . A video group , Group II , ( n = 64 ) viewed a similar program that consisted of spinal anatomy and biomechanics and instruction in correct lifting technique . A control group , Group III , ( n = 67 ) received no back education . One week after the education intervention , 145 of the subjects from the three groups had the lumbar lordosis measured with a flexible ruler while assuming a lifting position . The ruler was placed over the lumbar spinous processes , and the lordotic angle was calculated . A 12‐item multiple choice test and a 10‐item Likert scale were administered to 199 of the subjects in the three groups to determine the cognitive learning effect and the perceived relevance of the program , respectively . Results Multivariate analysis of variance was used and demonstrated significant differences between the back school group and the control group on the cognitive , psychomotor , and affective measures at the 0.001 level . No significant differences were found between the video and control groups on the measures with additional univariate testing . Conclusions The results indicate that the back school is an effective tool for influencing lifting posture and conveying information regarding spinal mechanics and lifting technique . In addition , the back school videos may not be an effective means of preventing  low back injury BACKGROUND Low back injuries are common and costly , accounting for 15 to 25 percent of injuries covered by workers ' compensation and 30 to 40 percent of the payments made under that program . The high costs of injury , the lack of effective treatment . and the evidence that there are behavioral risk factors have led to widespread use of employee education programs that teach safe lifting and h and ling . The effectiveness of those programs , however , has received little rigorous evaluation . METHODS We evaluated an educational program design ed to prevent low back injury in a r and omized , controlled trial involving about 4000 postal workers . The program , similar to that in wide use in so-called back schools , was taught by experienced physical therapists . Work units of workers and supervisors were trained in a two-session back school ( three hours of training ) , followed by three to four reinforcement sessions over the succeeding few years . Injured subjects ( from both the intervention and the control groups ) were r and omized a second time to receive either training or no training after their return to work . RESULTS Physical therapists trained 2534 postal workers and 134 supervisors . Over 5.5 years of follow-up , 360 workers reported low back injuries , for a rate of 21.2 injuries per 1000 worker-years of risk . The median time off from work per injury was 14 days ( range , 0 to 1717 ) ; the median cost was $ 204 ( range , zero to $ 190,380 ) . After their return to work , 75 workers were injured again . Our comparison of the intervention and control groups found that the education program did not reduce the rate of low back injury , the median cost per injury , the time off from work per injury , the rate of related musculoskeletal injuries , or the rate of repeated injury after return to work ; only the subjects ' knowledge of safe behavior was increased by the training . CONCLUSIONS A large-scale , r and omized , controlled trial of an educational program to prevent work-associated low back injury found no long-term benefits associated with training Study Design . A r and omized trial . Objective . To evaluate the effectiveness of a semi-intensive multidisciplinary rehabilitation for patients with chronic low back pain in an outpatient setting . Summary and Background Data . Systematic review s have shown that there is strong evidence that intensive multidisciplinary treatment ( > 100 hours ) , which includes functional restoration , improves function among chronic patients with low back pain , and moderate evidence that it reduces pain but contradictory evidence regarding improvement of working ability . However , there is paucity of data whether semi-intensive outpatient multidisciplinary rehabilitation in groups is more effective than individual physiotherapy . Material s and Methods . A total of 120 women employed as healthcare and social care professionals with nonspecific chronic low back pain were recruited from two occupational healthcare centers . The patients were r and omized into two intervention programs . Multidisciplinary rehabilitation ( n = 59 ) was conducted in groups and comprised of physical training , workplace interventions , back school , relaxation training , and cognitive-behavioral stress management methods for 70 hours . The individual physiotherapy ( n = 61 ) included physical exercise and passive treatment methods administered for 10 hours . Main outcome measures were : back pain and sciatic pain intensity , disability , sick leaves , healthcare consumption , symptoms of depression , and beliefs of working ability after 2 years . Results . There were no statistically significant differences between the two treatment groups in main outcome measures just after rehabilitation , at 6- , at 12- , or 24-month follow-up . In both intervention arms , however , the before- and -after comparison showed favorable effects , and the effects were still maintained at 2 years follow-up . Conclusions . The results of this study indicate that semilight outpatient multidisciplinary rehabilitation program for female chronic low back pain patients does not offer incremental benefits when compared with rehabilitation carried out by a physiotherapist having a cognitive-behavioral way of administering the treatment 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 Study Design . A prevalence survey of 101 r and omly selected elementary schools in the Israel Central District . Objectives . To identify and describe risk factors for  low back pain that exist in the elementary school environment . Summary of Background Data . Recent surveys report a high prevalence of low back pain in children and adolescents that increases with age , with a correlation between low back pain in adolescence and that experienced in adulthood . Environmental risk factors have been associated with the development of low back pain in children . Because of the significant amount of time children spend in their school environment , risk factors need to be identified in this environment . Methods . A question naire , completed by school nurses , measured risk factors among 10,000 children in elementary schools in Israel . These included backpack and student weight , the availability of storage facilities , the  appropriateness of chair and desk height to student height  ,  seating arrangements during frontal lessons  , and  physical activity at recess . Results . Between 30 % and 54 % of students carried > 15 % of their body weight . Nearly 15 % of the first grade rs and 20 % of sixth grade rs had inappropriate chairs . In 74 % of the classes , students sat with their side facing the teacher and in 35 % students sat with their backs . In 6 % of schools , no physical activity is offered at recess . Conclusions . Shortcomings were found in all areas investigated . There is an urgent need for health promotion programs to increase awareness and reduce risks in the school environment 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 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
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 .