Review Article

European Spine Journal

, Volume 21, Issue 12, pp 2520-2530

Effectiveness of preventive back educational interventions for low back pain: a critical review of randomized controlled clinical trials

  • C. DemoulinAffiliated withDepartment of Motricity Sciences and Rehabilitation, University of LiègeBelgian Back Society (BBS)Section Rachis de la Société Française de Rhumatologie (SFR) Email author 
  • , M. MartyAffiliated withSection Rachis de la Société Française de Rhumatologie (SFR)Division of Rheumatology, Henri-Mondor Hospital, University of Paris 12
  • , S. GenevayAffiliated withSection Rachis de la Société Française de Rhumatologie (SFR)Division of Rheumatology, University Hospital of Geneva
  • , M. VanderthommenAffiliated withDepartment of Motricity Sciences and Rehabilitation, University of LiègeBelgian Back Society (BBS)
  • , G. MahieuAffiliated withBelgian Back Society (BBS)Section Rachis de la Société Française de Rhumatologie (SFR)Back Unit, Dinant Hospital Centre
  • , Y. HenrotinAffiliated withDepartment of Motricity Sciences and Rehabilitation, University of LiègeBelgian Back Society (BBS)Section Rachis de la Société Française de Rhumatologie (SFR)Bone and Cartilage Research Unit, University of Liège

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Abstract

Purpose

A systematic search was conducted to study the efficiency of preventive educational interventions mainly focused on a biomechanical/biomedical model.

Methods

The Pubmed electronic database and the Cochrane Library were searched based on a combination of keywords related to low back pain (LBP) and posture education. Only randomized controlled trial (RCT) studying the efficiency on outcomes directly related to LBP of a preventive intervention programme mainly based on education of proper care of the back for subjects not seeking treatment were included. References of the articles meeting these inclusion criteria were also checked to identify other potential citations. Besides, a methodological study assessment of the included RCTs was performed.

Results

Nine studies, all conducted at the workplace were included in this review. Their mean quality level was low (5.1/12) and among the four studies with a huge sample size (n > 400 subjects), only one had an acceptable methodological quality score (6/12). The education interventions differed widely from one study to another. No significant differences between the control and education groups were found at the follow-up in eight out of the nine studies on the incidence of back pain, disability and sick leave.

Conclusions

The results of the RCTs included in this review suggest that educational interventions mainly focused on a biomechanical/biomedical model are not effective in preventing LBP. However, taking into account the methodological quality level of the RCTs as well as the very short and heterogeneous interventions often proposed, additional high-quality studies with a longer education period are needed to conclude that such interventions are inefficient.

Keywords

Prevention Education Low back pain Review Back school