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Comprehensive Rehabilitation for Low back Pain and Back Schools

  • Margareta Nordin
Chapter

Abstract

Comprehensive rehabilitation for lower back pain and back schools have both been reviewed by systematic reviews and large task-forces. These two topics will be reviewed for changes in management of the patient reporting low back pain in the subacute or chronic stage. There is evidence for back school efficacy in Cochrane reviews (1999 and 2004). There is moderate evidence suggesting that back schools, in an occupational setting, reduce pain and improve function and return-to-work status in the short and intermediate term, compared to exercises, manipulation, myofascial therapy, advice, placebo, or waiting list controls, for patients with chronic and recurrent LBP. However, future trials should improve methodological quality and clinical relevance and evaluate the cost-effectiveness of back schools, and back schools based on traditional biomedical/biomechanical information, advice, and instruction are not recommended for prevention in LBP (strong evidence). High-intensity programs, which comprise both an educational/skills program and exercises, can be recommended for patients with recurrent and persistent back pain (moderate evidence). Back schools based on traditional biomedical/biomechanical information, advice, and instruction are not recommended for prevention in LBP (strong evidence). There is insufficient evidence to recommend for or against psychosocial information delivered at the worksite (weak evidence), but information oriented toward promoting activity and improving coping may promote a positive shift in beliefs (weak evidence). The components of comprehensive rehabilitation include exercise, cognitive behavioral treatment (CBT), education, and others. Few systematic reviews have been carried out as the field is still relatively new in combination treatment. The Cochrane Review (2002) concludes “that there is moderate evidence of positive effectiveness of multidisciplinary rehabilitation for sub-acute low back pain and that a workplace visit increases the effectiveness. But because this evidence is based on trials that had some methodological shortcomings, and several expensive multidisciplinary rehabilitation programs are commonly used for uncomplicated/nonspecific sub-acute low back problems, there is an obvious need for high quality trials in this field.”

Keywords

Cognitive Behavioral Therapy Exercise Regimen Moderate Evidence Passive Treatment Comprehensive Rehabilitation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  1. 1.Occupational and Industrial Orthopaedic Center (OIOC), Graduate Program of Ergonomics and BiomechanicsNew York University (NYU)New YorkUSA
  2. 2.Hospital for Joint Diseases, NYU Langone Medical Center, CDC/NIOSH Education and Research Center (ERC)New York UniversityNew YorkUSA

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