Study Design. A randomized, 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 methodologic scores have shown the best results, especially when conducted in occupational settings and coupled with a comprehensive rehabilitation program.
Methods. By block randomization, 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.
Low back pain is a major diagnostic and therapeutic problem, causing suffering and great expense to the community. 4 The amount of health care and disability insurance payments has been increasing, and low back pain (LBP) and disability have been referred to as a Western epidemic. 37 In 90% of cases, recovery occurs within 2 months. 13 However, recurrence occurs frequently 14 and may predispose patients to the development of more serious and chronic back problems.
Low back pain is regarded as a multifactorial problem. 31,36 The biomechanical etiology, however, is considered important. 21 Physical therapy to prevent relapse is based on the assumption that there is a close relation between the way humans solve movement tasks and the development of LBP.
Several back schools and back rehabilitation programs have been developed to teach people proper lifting technique and body mechanics according to currently accepted ergonomic principles. 33,34 Such interventions have been part of prevention and management of LBP by physical therapists since 1969. 17
The efficacy of back schools, however, remains controversial. 8,15,23,32 Cohen 7 concluded that there is insufficient evidence to recommend group education for people with LBP. Revel 32 claimed in his review that back school interventions have no effect. Koes et al 20 concluded that there are major methodologic flaws in most of the studies evaluating the effect of back schools. However, the studies with the highest methodologic scores have indicated that back schools may be effective when conducted in occupational settings, 20 especially when coupled with a comprehensive rehabilitation program. 9
Different contexts, study populations, and outcome measures, as well as insufficient descriptions of the back school interventions complicate comparisons across clinical trials. 10,26,27,38 In addition, back schools differ in their content, length, and educational approach, 20,33 but are mostly of short duration with a focus on theoretical education and little practical training. 3,8,10,23,40
Clinical experience with patients who have LBP shows that changing movement habits and posture takes time and practice. Furthermore, improving body awareness and understanding how to apply basic ergonomic principles also needs practice. These facts gave rise to the development of the authors' back school concept. The course is called Active Back School (ABS).
The aim of the present study was to assess the secondary prophylactic effect of the ABS program on minimizing recurrence of LBP episodes.