title: A novel back school using a multidisciplinary team approach featuring quantitative functional evaluation and therapeutic exercises for patients with chronic low back pain: the Japanese experience in the general setting.
abstract: METHODS
  A prospective cohort study.
  
  
  OBJECTIVE
  To introduce a novel back school for the treatment of patients with chronic low back pain (CLBP), and to report its clinical results.
  
  
  BACKGROUND
  Although back school is one of the treatment methods for patients with CLBP, its efficacy and appropriate style remain controversial. No studies have been published regarding the combined program of back school with a multidisciplinary team approach.
  
  
  METHODS
  A total of 182 patients with CLBP (74 men and 108 women; average age, 43.8 years) participated in this study. All patients were enrolled in the back school using a multidisciplinary team approach featuring quantitative functional evaluation and therapeutic exercises. The following outcome measures were evaluated at the baseline, and 6 and 12 months after the enrollment: the level of pain evaluated with a Visual Analog Scale (VAS), flexibility of trunk and hamstrings (finger-floor distance, straight leg raising), trunk muscle strength and endurance, frequency of therapeutic exercises, and self-reported patient satisfaction.
  
  
  RESULTS
  An averaged VAS score was 6.2 before enrollment in the program and 2.8 at follow-up. The pain improved in 141 patients (80.8%), did not change in 27 (15.4%), and was aggravated in 7 (3.8%). There was statistically significant improvement of finger-floor distance, trunk muscle strength, and endurance in the patients whose pain was relieved after enrollment in the program (P < 0.05). The compliance with the exercise program was significantly correlated with the clinical results (P < 0.05).
  
  
  CONCLUSIONS
  We developed a novel back school using a multidisciplinary team approach, featuring quantitative functional evaluation and therapeutic exercises. The current study demonstrated that our program could provide a satisfactory result for the treatment of patients with CLBP. The quantitative functional evaluation was a worthwhile outcome measure when evaluating the efficacy of the treatment program. Teaching body mechanics and performing the therapeutic exercises through the multidisciplinary team approach are essential to managing CLBP in a general setting.
authors.affiliation: Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Hokkaido, Japan. oshirado@m4.dion.ne.jp
authors.forename: Osamu
authors.initials: O
authors.lastname: Shirado
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Ito
authors.forename: Toyo
authors.initials: T
authors.lastname: Kikumoto
authors.forename: Naoki
authors.initials: N
authors.lastname: Takeda
authors.forename: Akio
authors.initials: A
authors.lastname: Minami
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Strax
mesh_terms: D000328:Adult; D002908:Chronic Disease; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D007564:Japan; D017116:Low Back Pain / Q000503:physiopathology* / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D016896:Treatment Outcome