Effectiveness of the back school. A review of the results of evidence- based evaluation

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 randomized controlled trials. Results of these studies have been contradictory. The results of two lately published randomized controlled trials, of 18 randomized controlled trials, of five systematic reviews, two publications conducting metaanalyses, and five task forces presenting guidelines for clinical practice are reported. According to the conclusions of the reviews 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.