title: Back schools for the treatment of chronic low back pain: possibility of benefit but no convincing evidence after 47 years of research-systematic review and meta-analysis.
abstract: Back schools are interventions that comprise exercise and education components. We aimed to systematically review the randomized controlled trial evidence on back schools for the treatment of chronic low back pain. By searching MEDLINE, Embase, and Cochrane Central as well as bibliographies, we identified 31 studies for inclusion in our systematic review and 5 of these for inclusion in meta-analyses. Meta-analyses for pain scores and functional outcomes revealed statistical superiority of back schools vs no intervention for some comparisons but not others. No meta-analysis was feasible for the comparison of back schools vs other active treatments. Adverse events were poorly reported so that no reliable conclusions regarding the safety of back schools can be drawn, although some limited reassurance in this regard may be derived from the fact that few adverse events and no serious adverse events were reported in the back school groups in the studies that did report on safety. Overall, the evidence base for the use of back schools to treat chronic low back pain is weak; in nearly a half-century since back schools were first trialled, no unequivocal evidence of benefit has emerged.
authors.affiliation: Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Straube
authors.affiliation: Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Harden
authors.affiliation: Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany.
authors.forename: Heiko
authors.initials: H
authors.lastname: Schröder
authors.affiliation: Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany.
authors.forename: Barbora
authors.initials: B
authors.lastname: Arendacka
authors.affiliation: Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
authors.forename: Xiangning
authors.initials: X
authors.lastname: Fan
authors.affiliation: Pain Research and Nuffield Division of Anaesthetics, University of Oxford, The Churchill, Oxford, United Kingdom.
authors.forename: R Andrew
authors.initials: RA
authors.lastname: Moore
authors.affiliation: Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany.
authors.forename: Tim
authors.initials: T
authors.lastname: Friede
mesh_terms: D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D017116:Low Back Pain / Q000628:therapy*; D010353:Patient Education as Topic; D016032:Randomized Controlled Trials as Topic; D012574:Schools