Systematic review of back schools, brief education, and fear-avoidance training for chronic low back pain

J.I.Brox, K. Storheim, M. Grotle, T.H. Tveito, A. Indahl and H.R. Eriksen

The purpose of this review was to assess the effectiveness of back schools, brief education, and fear-avoidance training for chronic low back pain (CLBP).  Conflicting evidence was found for back schools compared with waiting list, placebo, usual care, and exercises, and a cognitive behavioral back school. Strong evidence of effectiveness on sick leave and short-term disability compared with usual care was found for breif education. There was conflicting or limited evidence for back book or Internet discussion compared with waiting list, no intervention, massage, yoga, or exercises. Moderate evidence showed that there is no difference between rehabilitation including fear-avoidance training and spinal fusion.

Consistent recommendations are given for brief education in the clinical setting, and fear-avoidance training should be considered as an alternative to spinal fusion, and back schools may be considered in the occupational setting.

The Spine Journal, 2008, 8(6), 948-958

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