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 The Association of Backpack Use and Back Pain in Adolescents Effectiveness of Back School program versus hydrotherapy in elderly patients with chronic non-specific low back pain: a randomized clinical trial. The Effectiveness of High-Intensity Versus Low-Intensity Back Schools in an Occupational Setting: A Pragmatic Randomized Controlled Trial Effects of Back School Education and Exercise in Back Injured Municipal Workers Economic Evaluation of an Intensive Group Training Protocol Compared With Usual Care Physiotherapy in Patients With Chronic Low Back Pain Secondary Prevention of Low‐Back Pain: A Clinical Trial A back school in The Netherlands: evaluating the results. A Web-Based Adolescent Positive Psychology Program in Schools: Randomized Controlled Trial Knowledge and perceptions about back education among elementary school students, teachers, and parents in Belgium. Five‐Year Follow‐Up Study of a Controlled Clinical Trial Using Light Mobilization and an Informative Approach to Low Back Pain Effects of a postural education program on school backpack habits related to low back pain in children An alternative design for small-scale school health experiments: does daily walking produce benefits in physical performance of school children?
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 Study Design . A cross-sectional study comprising the first phase of an ongoing , longitudinal prospect i ve study was conducted . Objective . To investigate the relation between backpack use  and back pain in adolescents . Summary of Background Data . The prevalence of nonspecific back pain increases dramatically during adolescence from less than 10 % in the pre – teen-age years up to 50 % in 15- to 16-year-olds . There is widespread concern that heavy backpacks carried by adolescents contribute to the development of back pain . Methods . A total of 1126 children , ages 12 to 18 years , participated by completing a question  naire about their health , activities , and backpack use . Each child ’s body weight , height , and backpack weight were measured . A child was classified as having back pain if one or more of the following were reported during the preceding month :  neck or back pain that had interfered with school or leisure ,  neck or back pain  with a severity rating of 2 or more on a scale 0 to 10 , a visit to a physician or therapist for neck or back pain , or exemption from physical education or sports because of neck or back pain . Results . Of 1122 backpack users , 74.4 % were classified as having back pain , vali date d by significantly poorer general health , more limited physical functioning , and more bodily pain . As compared with no or low use of backpacks at school , heavy use ( odds ratio , 1.98;P < 0.0001 ) was independently associated with back pain . Female gender and larger body mass index also were significantly associated with back pain . As compared with adolescents who had no back pain , adolescents with back pain carried significantly heavier backpacks that represented a significantly greater percentage of their body weights . Conclusion . The use of backpacks during the school day and backpack weights are independently associated with back pain BACKGROUND AND AIM OF THE WORK Chronic low back pain ( CLBP ) is a major cause of disability , for which clinical practice guidelines suggest exercise programs , such as Back School program ( stretching and selective muscle reinforcement techniques ) and Hydrotherapy technique , as an effective treatment to reduce pain intensity and disability . METHODS We enrolled 56 elderly individuals , affected by non-specific CLBP , whose pain had worsened in the last three months , which were r and omly allocated to Back School ( group A ) or to Hydrotherapy program ( group B ) . Each group underwent two one-hour-treatment sessions per week , over a 12-week period . Each patient was evaluated using the Rol and Morris Disability Question naire ( RMDQ ) and the 36-Item Short Form Health Survey ( SF-36 ) V2.0 at the beginning ( T0 ) , at the end of treatment ( T1 ) and at the 3-month follow-up ( T2 ) . RESULTS At T1 and T2 we observed a highly significant statistical difference in the values measured in both groups : at T1 in group A RMDQ improvement of 3.26±1.02 ( p<0.001 ) and SF-36 of 13.30±1.44 ( p<0.001 ) ; in group B RMDQ improvement of 4.96±0.71 ( p<0.001 ) and SF-36 of 14.19±1.98 ( p<0.001 ) . We have also evaluated the difference in effectiveness of the two programs and no significant statistical differences were found between the two groups . CONCLUSIONS Back School program and Hydrotherapy could be valid treatment options in the rehabilitation of non-specific CLBP in elderly people . Both therapies proved to be effective and can be used in association with other rehabilitation programs . We believe that Back School program should be favored for its simplicity and the small number of re sources required Study Design . R and omized controlled trial . Objectives . To compare high- and low-intensity back schools with usual care in occupational health care . Summary of Background Data . The content and intensity of back schools vary widely and the method ologic quality of r and omized controlled trials is generally weak . Until now , no back school has proven to be superior for workers sick-listed because of subacute nonspecific low back pain . Methods . Workers ( n = 299 ) sick-listed for a period of 3 to 6 weeks because of nonspecific low back pain were recruited by the occupational physician and r and omly assigned to a high-intensity back school , a low-intensity back school , or care as usual . Outcome measures were days until return to work , total days of sick-leave , pain , functional status , kinesiophobia , and perceived recovery and were assessed at baseline and at 3 and 6 months of follow-up . Principal analyses were performed according to the intention-to-treat principle . Results . We r and omly allocated 299 workers . Workers in the low-intensity back school returned to work faster compared with usual care and the high-intensity back school , with hazard ratios of 1.4 ( P = 0.06 ) and 1.3 ( P = 0.09 ) , respectively . The comparison between high-intensity back school and usual care result ed in a hazard ratio of 1.0 ( P = 0.83 ) . The median number of sick-leave days was 68 , 75 , and 85 in the low-intensity back school , usual care , and high-intensity back school , respectively . Beneficial effects on functional status and kinesiophobia were found at 3 months in favor of the low-intensity back school . No substantial differences on pain and perceived recovery were found between groups . Conclusions . The low-intensity back school was most effective in reducing work absence , functional disability , and kinesiophobia , and more workers in this group scored a higher perceived recovery during the 6-month follow-up Low back injury is the leading cause of compensable injury . A National Health Objective for the year 2000 is to increase to at least 50 % the number of worksites offering back injury protection programs . The 6 week Back School intervention included exercise and education . A portion of the sample of 74 back injured municipal employees also was assigned r and omly to a counseling intervention . Pre-intervention and post-intervention testing revealed significant posttest increases in back strength and flexibility . Significant improvements also were noted in psychological well being , depression , anxiety , and perceptions of pain . No significant differences were found , on any of the measures , between employees who did and who did not receive the counseling intervention . Method ological concerns relate to the possibility of sampling bias and instrumentation . Future research with control groups is needed , as well as the testing of interventions that may be both effective and require less work release time Study Design . Economic evaluation from a societal perspective conducted alongside a r and omized controlled trial with a follow-up of 52 weeks . Objective . To evaluate the cost effectiveness and cost utility of an intensive group training protocol compared with usual care physiotherapy in patients with nonspecific chronic low back pain . The intensive group training protocol combines exercise therapy , back school , and behavioral principles . Summary of Background Data . Two studies found a significant reduction in absenteeism for a grade d activity program in occupational health care . This program has not yet been evaluated in a primary care physiotherapy setting . Methods . Participating physical therapists in primary care recruited 114 patients with chronic nonspecific low back pain . Eligible patients were r and omized to either the protocol group or the guideline group . Outcome measures included functional status ( Rol and Morris Disability Question naire ) , pain intensity ( 11-point numerical rating scale ) , general perceived effect and quality of life ( EuroQol-5D ) . Cost data were measured with cost diaries and included direct and indirect costs related to low back pain . Results . After 52 weeks , the direct health care costs were significantly higher for patients in the protocol group , largely due to the costs of the intervention . The mean difference in total costs amounted to & OV0556 ; 233 ( 95 % confidence interval : & OV0556 ; −2.185 ; & OV0556 ; 2.764 ) . The cost-effectiveness planes indicated no significant differences in cost effectiveness between the 2 groups . Conclusion . The results of this economic evaluation showed no difference in total costs between the protocol group and the guideline group . The differences in effects were small and not statistically significant . At present , national implementation of the protocol is not recommended A clinical trial , aim ed at secondary prevention of low-back pain , was performed in 142 hospital employees reporting at least three annual episodes of this condition . Participants were r and omly assigned to one of three groups : a calisthenics program ( CAL ) for 3 months with biweekly sessions of flexion exercises , a back school program ( 5 sessions ) , and a control group . The effectiveness of the two intervention programs was evaluated over a 1-year period . Baseline preintervention data and evaluation at the end of 3 months of intervention and after an additional 6 months were collected . A monthly surveillance for the whole year showed a mean of 4.5 “ painful months ” in the CAL group versus 7.3 and 7.4 months in the back school and control groups , respectively ( P < 0.0001 ) . The superiority of the CAL group was achieved partly because of the significant increase in trunk forward flexion and to initial increment in abdominal muscle strength . The increased trunk flexion was associated with the rate of participation in the CAL sessions . Further research is needed to answer the question of “ intensity versus type of exercise ” by comparing different intervention programs , with similar intensity The use of an education program for patients with chronic low back pain ( Back School ) has been investigated . The effect evaluation is based on a pretest-post-test-control group design , including a follow-up after 8 weeks . The Maastricht Back School is based on the theory that pain is also maintained by emotional , cognitive and environmental factors . Information and training are given on these and physical factors . The purpose of the course is to teach patients to manage their own pain problem . The results suggest that the Back School program for patients with chronic low back pain can have a positive effect Background Adolescent mental health is characterized by relatively high rates of psychiatric disorders and low levels of help-seeking behaviors . Existing mental health programs aim ed at addressing these issues in adolescents have repeated inconsistent results . Such programs have generally been based on techniques derived from cognitive behavioral therapy , which may not be ideally suited to early intervention among adolescent sample s. Positive psychology , which seeks to improve well-being rather than alleviate psychological symptoms , offers an alternative approach . A previous community study of adolescents found that informal engagement in an online positive psychology program for up to 6 weeks yielded significant improvements in both well-being and depression symptoms . However , this approach had not been trialed among adolescents in a structured format and within a school setting . Objective This study examines the feasibility of an online school-based positive psychology program delivered in a structured format over a 6-week period utilizing a workbook to guide students through website content and interactive exercises . Methods Students from four high schools were r and omly allocated by classroom to either the positive psychology condition , " Bite Back " , or the control condition . The Bite Back condition consisted of positive psychology exercises and information , while the control condition used a series of non-psychology entertainment websites . Both interventions were delivered online for 6 hours over a period of 4 - 6 weeks during class time . Symptom measures and measures of well-being/flourishing and life satisfaction were administered at baseline and post intervention . Results Data were analyzed using multilevel linear modeling . Both conditions demonstrated reductions in depression , stress , and total symptom scores without any significant differences between the two conditions . Both the Bite Back and control conditions also demonstrated significant improvements in life satisfaction scores post intervention . However , only the control condition demonstrated significant increases in flourishing scores post intervention . Conclusions Results suggest that a structured online positive psychology program administered within the school curriculum was not effective when compared to the control condition . The limitations of online program delivery in school setting s including logistic considerations are also relevant to the contradictory findings of this study . Trial Registration Australian New Zeal and Clinical Trials Registry : ACTRN1261200057831 ; https://www.anzctr.org.au/Trial/ Registration /Trial Review .aspx?id=362489 ( Archived by Webcite at http://www.webcitation.org/6NXmjwfAy ) A back education program for Belgian elementary school children was evaluated using self-reported question naires before intervention and at three follow-up points during one year . Most children found the program interesting , important , and amusing . Intervention children ( n = 347 ) showed better back care knowledge than control  children ( n = 359 ) , and knowledge gained was retained over a period of one year . Back education did not result in increased fear-avoidance beliefs about physical activity , and intervention children reported more checking of their book bag weight than controls at all test moments . Self-reported behavior in relation to posture-related and back care related self-efficacy were affected only minimally by the program , possibly due to poor self-judgment . Involvement , fear-avoidance beliefs , and back care knowledge of teachers and parents of the intervention children showed low correlation with the children 's perceptions and knowledge . Sufficient promise exists to justify further development and evaluation of early back education Study Design . A controlled clinical trial . Objectives . To examine the long‐term effect of an informative approach to low back pain . Summary of Background Data . In management and prevention of low back pain , back school based on an ergonomic approach have played an important role . The effect of such informative interventions is not clear . Methods . A 5‐year follow‐up study was done on patients included in a previous study . The outcome was measured by return to work or still on sick leave . The patients were allocated to an intervention group ( n = 245 ) and a control group ( n = 244 ) . Only the intervention group was called in for examination and intervention and answered a battery of tests for psychological and health factors . The intervention apart from the clinical examination consisted of education in a " mini back school . " The program was based on a new medical model for low back pain . Results . Forty‐seven ( 19 % ) of the patients in the intervention group , compared with 84 patients ( 34 % ) in the control group , were still on sick leave after 5 years ( P < 0.001 ) . There were fewer recurrences of sick leave ( P < 0.03 ) in the intervention group than in the control group . Based on Internal Health Locus of Control , number of children , and income , 75 % were correctly classified as nonreturners in the intervention group . Conclusions . This study indicates that subchronic low back pain may be managed successfully with an approach that includes clinical examination combined with information for patients about the nature of the problem , provided in a manner design ed to reduce fear and give them reason to resume light activity Purpose Population based studies have demonstrated that children and adolescents often complain of low back pain . A group-r and omized controlled trial was carried out to investigate the effects of a postural education program on school backpack habits related to low back pain in children aged 10–12 year . Methods The study sample included 137 children aged 10.7 years ( SD = 0.672 ) . Six classes from two primary schools were r and omly allocated into experimental group ( EG ) ( N = 63 ) or control group ( CG ) ( N = 74 ) . The EG received a postural education program over 6 weeks consisting of six sessions , while the CG followed the usual school curriculum . A question naire was fulfilled by the participants at pre-test , post-test , and 3 months after the intervention finished . The outcomes collected were : ( 1 ) try to load the minimum weight possible , ( 2 ) carry school backpack on two shoulders , ( 3 ) belief that school backpack weight does not affect to the back , and ( 4 ) the use of locker or something similar at school . A sum score was computed from the four items . Results Single healthy items mostly improved after the intervention and remained improved after 3-month follow-up in EG , while no substantial changes were observed in the CG . Healthy backpack use habits score was significantly increased at post-test compared to baseline in the EG ( P < 0.000 ) , and remained significantly increased after 3-month , compared to baseline ( P = 0.001 ) . No significant changes were observed in the CG ( P > 0.2 ) . Conclusions The present study findings confirm that children are able to learn healthy backpack habits which might prevent future low back pain BACKGROUND The mainstream r and omized clinical trial is not always feasible in a school setting . There might be practical and ethical issues that make dividing school classes into an intervention and a control group impossible or undesirable , and there is a need to explore the validity of alternative design s and analyses . METHODS An alternative to a r and omized clinical trial in a physical performance experiment at a school is introduced and evaluated . The before-intervention data are utilized as control data for the intervention data in addition to adjust for pre-intervention differences . The strict class year structure of school data makes this possible . In a rural school in inl and Norway , all school children joined the project of walking in a rugged terrain outside school for 20 min every school day during one school year . Measurements of low back static endurance , hamstrings flexibility , st and ing balance and cardiovascular fitness were made before and after the intervention . As intervention and ' aging ' were confounded , the special use of the pre-intervention data , ' age-adjusted ' , is proposed to solve this issue . A comparison with having an independent control group is performed . RESULTS The alternative analysing method is judged to yield valid results without having an independent control group . The age-adjusted analyses showed 11 % increase in low back static endurance , 8 % increase in hamstrings flexibility , 69 % increase in balance and 6 - 13 % increase in cardiovascular fitness . The effects were largest among those children who had the lowest performances before the intervention . CONCLUSION The introduced statistical methods display that , in a school population , evaluations from an experiment can be made without an independent control group . A 20-min walk during school time for 1 year seemed to improve physical performance
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 .