Authors' objectives:

The aims of this study were to address the following questions:

- Can the effectiveness of back school programmes be verified through controlled studies (for which groups of persons or patients, for what objective, in which setting, and how should the programmes be organized with regard to content)?

- Have relevant side effects of back school programmes been demonstrated in controlled studies?

- Is it possible to derive clear diagnoses and coverage recommendations for back school programmes on the basis the existing evidence?

- Can a further need for research be identified, particularly with regard to the assessment of the effectiveness under conditions of everyday life as well as to the efficiency of the intervention?

Authors' results and conclusions: Back schools had not been addressed by any of the foreign HTA institutes as single topic. Thus we had to resort to assessments which treat the issue of "back schools" in a superordinate context. From the institutions visited, three publications, or guidelines, were in accordance with the criteria for inclusion. One publication by the English Royal College of General Practitioners was also included in the evaluation. The investigation of the electronic databases revealed 3 systematic reviews and 1 meta-analysis. Additionally, a further meta-analysis was identified in a congress volume. In the guidelines the following conclusions and recommendations are given for the employment of back schools in cases of non-specific back pain: - Back school programmes with instructions applying to specific workplaces can represent an effective supplement to individual therapies in patients with acute back pain. - The effectiveness of back school programmes cannot be verified outside the environment of the workplace. - Risks and side effects can be disregarded. - Back schools should not be used in the treatment of acute back pain. - No generally applicable recommendations can be given for carrying out back school programmes in cases of chronic back pain. - Further methodically qualified studies are called for, particularly in cases of chronic pain. In addition to this information the results of 3 systematic reviews and 2 meta-analyses were taken into consideration. The results of these publications confirmed the recommendations expressed in the guidelines. Above all the authors of the above mentioned surveys referred to difficulties in comparing different back school evaluations. Here, apart from very different methodological standards of the primary studies, problems arise which have their roots in the issue itself. The different targets of the back school programmes and their greatly varying contents are set out here. Furthermore the large amount of outcome parameters and their heterogeneity additionally restrict the comparability.

Authors' recommendations: Our conclusion is that with regard to the conditions in Germany the results of the publications listed above can be adopted since they report efficacy results which may be transferable to other countries. Classical back school programmes which aim at primary and secondary prevention should not be covered at the present moment in Germany, as it is not to be expected that this would provide a relevant contribution for resolving the sociomedical problem of non-specific back pain.

Authors' methods: Review, survey

Project Status: Completed

URL for project: http://www.dimdi.de/

Year Published: 1998

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Germany

Organisation Name: German Agency for HTA at the German Institute for Medical Documentation and Information

Contact Address: German Agency for Health Technology Assessment at the German Institute for Medical Documentation and Information, Waisenhausgasse 36-38a, D-50676 Cologne Germany

Contact Name: dahta@dimdi.de

Contact Email: dahta@dimdi.de

Copyright: German Agency for Health Technology Assessment at the German Institute for Medical Documentation and Information