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Chronic Back Pain: 'Back School Programme' improves short-term quality of life
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August 2013
Chronic Back Pain: 'Back School Programme' improves short-term quality of life
Study Type:Therapy
OE Level Evidence:2
Journal Level of Evidence:N/A
Low back pain education and short term quality of life: a randomized trial
BMC Musculoskelet Disord. 2007 Feb 28;8:21.Did you know you're eligible to earn 0.5 CME credits for reading this report? Click Here
Synopsis
102 female patients suffering from chronic back pain were randomized to either an intervention group receiving a 'Back School Programme' in combination with medication, or to a control group only receiving medication. This study aimed to compare improvements in quality of life between groups. The results at 3 months indicated that the 'Back School Programme' intervention was successful in improving physical and mental health related measures, and could improve patients' quality of life.
Publication Funding Details
+
Funding:
Non-funded
Conflicts:
None disclosed
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Yes = 1
Uncertain = 0.5
Not Relevant = 0
No = 0
The Reporting Criteria Assessment evaluates the transparency with which authors report the methodological and trial characteristics of the trial within the publication. The assessment is divided into five categories which are presented below.
1/4
Randomization
1/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
3/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
The Fragility Index is a tool that aids in the interpretation of significant findings, providing a measure of strength for a result. The Fragility Index represents the number of consecutive events that need to be added to a dichotomous outcome to make the finding no longer significant. A small number represents a weaker finding and a large number represents a stronger finding.
Why was this study needed now?
Individuals with chronic back pain experience many debilitating physical disruptions, including increased pain, decreased muscle tone and overall health, as well as psychological dysfunction, and decreased social interaction. Numerous studies have been conducted to investigate possible interventions that address back pain, one of which, is the Back School Programme. It has been suggested that this programme may reduce back pain, improve function, and expedite return to work. However, there is a paucity of evidence evaluating the efficacy of this programme. This study was needed to examine how the Back School Programme affects health related quality of life measures.
What was the principal research question?
Does the 'Back School Programme' intervention improve quality of life in patients suffering from chronic back pain, over a 3 month period?
Study Characteristics
-
Population:
102 women, over the age of 18 years, with chronic back pain lasting for at least 90 days.
Intervention:
Education Group: Patients received the 'Back School Programme', as well as medication (Acetaminophen, NSAID, Chlordiazepoxide). This 'Back School Programme' intervention was four days in length, consisting of five sessions, with the end goal of helping patients attain a healthy functioning level. Patients were empowered to achieve their own goals with the help of a clinical psychologist, PhD level educator (to provide advice about healthy lifestyle habits), rheumatologist (to educate patient regarding anatomy of spine and proper movements), as well as a physical therapist. Patients in this group received an additional interdisciplinary evaluation and an educational intervention lasting four days. (n=50; Mean age: 42.9 +/- 10.7 years)
Comparison:
Control Group: Patients in clinic group received medication under physician supervision (Acetaminophen, non-steroidal anti-inflammatory drugs [NSAIDs], Chlordiazepoxide). (n=52; Mean age: 44.7 +/- 10.8 years)
Outcomes:
The main outcome of this study was quality of life (measured by any increase in quality of life score on the Short Form Health Survey [SF-36; 0-100], compared to baseline). Eight subscales of the SF-36 were assessed: physical functioning (PF), role limitations due to physical problems (RP), bodily pain (BP), vitality (VT), general health perceptions (GH), social functioning (SF), role limitations due to emotional problems (RE) and mental health (MH).
Methods:
RCT
Time:
Data was collected at admission and again at end of the 3 month study period.
What were the important findings?
- With regards to baseline data, there were no significant differences between both groups (p>0.05).
- Over the 3 month study period, the education group showed significant improvements for all subscales of the quality of life questionnaire/Short Form Health Survey (SF-36) (p<0.001).
- In the control group receiving medication, there were only significant improvements on 3 subscales: bodily pain (p=0.001), vitality (p=0.02), and mental health (p=0.04). These findings were less significant than the resulting improvements seen in the 'Back School Programme' group.
What should I remember most?
Patients participating in the 'Back School Programme' enjoyed significantly greater improvements in quality of life measures (all 8 SF-36 subscales) compared to those only receiving medication.
How will this affect the care of my patients?
Th results of this study indicated that both physical functioning, as well as mental health can be significantly improved with the 'Back School Programme' in patients with chronic low back pain. Further studies are needed to examine the long-term effects and to further investigate the efficacy of this education programme.
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