Abstract: The search update identified 273 new references, of which none fulfilled our inclusion criteria. We included four studies (643 participants) in this updated review, which were all included in the previous (2004) update. The quality of the evidence was very low for all outcomes. As data were too clinically heterogeneous to be pooled, we described individual trial results. The results indicate that there is very low quality evidence that back schools are no more effective than a placebo (or sham or attention control) or another treatment (physical therapies, myofascial therapy, joint manipulations, advice) on pain, disability, work status and adverse events at short-term, intermediate-term and long-term follow-up. There is very low quality evidence that shows a statistically significant difference between back schools and a placebo (or sham or attention control) for return to work at short-term follow-up in favour of back school. Very low quality evidence suggests that back school added to a back care programme is more effective than a back care programme alone for disability at short-term follow-up. Very low quality evidence also indicates that there is no difference in terms of adverse events between back school and myofascial therapy, joint manipulation and combined myofascial therapy and joint manipulation. It is uncertain if back schools are effective for acute and subacute non-specific LBP as there is only very low quality evidence available. While large well-conducted studies will likely provide more conclusive findings, back schools are not widely used interventions for acute and subacute LBP and further research into this area may not be a priority.

Plain-language summary: We included four studies in this review, which we included in the previous version of this review, which means that we did not identify any new relevant studies for inclusion in this update. The treatment comparisons were too dissimilar to be pooled and half of the studies were at high risk of bias. The quality of the evidence was very low for all outcomes. One study compared back school with a placebo (sham treatment) and found no difference between groups for pain at short-term follow-up. Concerning work status, people in the back school group had a significantly shorter duration of sick-leave than people in the placebo group at short-term follow-up. Four studies compared back school with another treatment (physical therapies, myofascial therapy, joint manipulations, advice). Overall, there were no differences between groups for pain, disability, work status and adverse events at any time of follow-up. Only one study showed that back school added to a back care programme was more effective than back school alone for disability at short-term follow-up. The included studies are insufficient to clearly answer our question and the inclusion of other well-designed studies is very likely to change the conclusions. However, back schools do not seem to be a treatment widely used nowadays for people with acute and subacute non-specific low-back pain and are not endorsed by guidelines. The quality of the evidence was very low for all the outcomes according to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. This was due to poor study designs and imprecision in the results.