The Spine Journal
Volume 8, Issue 1 , Pages 28-39 , January 2008

Evidence-informed management of chronic low back pain with back schools, brief education, and fear-avoidance training

  • Jens Ivar Brox, MD, PhD

      Affiliations

    • Orthopedic Department, Rikshospitalet University, 0027 Oslo, Norway
    • Department of Education and Health Promotion, University of Bergen and Unifob Health, Norway
    • Corresponding Author InformationCorresponding author. Orthopedic Department, Rikshospitalet University Hospital, 0027 Oslo, Norway. Tel.: (47) 23-076029.
    • ,
  • Kjersti Storheim, PT, PhD

      Affiliations

    • Orthopedic Center, Ullevål University Hospital and Norwegian Research Center for Active Rehabilitation, Oslo, Norway
    • ,
  • Margreth Grotle, PT, PhD

      Affiliations

    • National Resource Center for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
    • ,
  • Torill H. Tveito, PhD

      Affiliations

    • Department of Education and Health Promotion, University of Bergen, Norway
    • ,
  • Aage Indahl, MD, PhD

      Affiliations

    • Hospital of Rehabilitation, Stavern, Norway
    • ,
  • Hege R. Eriksen, PSY, PhD

      Affiliations

    • Department of Education and Health Promotion, University of Bergen and Unifob Health, Norway

Received 26 September 2007 ,Accepted 13 October 2007.

References 

  1. Zachrisson-Forssell M. The Swedish back school. Physiotherapy. 1980;66:112–114
  2. Nachemson A, Elfstrom G. Intravital dynamic pressure measurements in lumbar discs. A study of common movements, maneuvers and exercises. Scand J Rehabil Med Suppl. 1970;1:1–40
  3. Klaber Moffett JA, Chase SM, Portek I, Ennis JR. A controlled, prospective study to evaluate the effectiveness of a back school in the relief of chronic low back pain. Spine. 1986;11:120–122
  4. Harkapaa K, Jarvikoski A, Mellin G, Hurri H. A controlled study on the outcome of inpatient and outpatient treatment of low back pain. Part I. Pain, disability, compliance, and reported treatment benefits three months after treatment. Scand J Rehabil Med. 1989;21:81–89
  5. Waddell G. 1987 Volvo award in clinical sciences. A new clinical model for the treatment of low-back pain. Spine. 1987;12:632–644
  6. Indahl A, Velund L, Reikeraas O. Good prognosis for low back pain when left untampered. A randomized clinical trial. Spine. 1995;20:473–477
  7. Frost H, Lamb SE, Doll HA, Carver PT, Stewart-Brown S. Randomised controlled trial of physiotherapy compared with advice for low back pain. BMJ. 2004;329:708
  8. Rivero-Arias O, Gray A, Frost H, Lamb SE, Stewart-Brown S. Cost-utility analysis of physiotherapy treatment compared with physiotherapy advice in low back pain. Spine. 2006;31:1381–1387
  9. Cherkin DC, Deyo RA, Street JH, Hunt M, Barlow W. Pitfalls of patient education. Limited success of a program for back pain in primary care. Spine. 1996;21:345–355
  10. Lethem J, Slade PD, Troup JD, Bentley G. Outline of a Fear-Avoidance Model of exaggerated pain perception—I. Behav Res Ther. 1983;21:401–408
  11. Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993;52:157–168
  12. Vlaeyen JW, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000;85:317–332
  13. Keller A, Johansen JG, Hellesnes J, Brox JI. Predictors of isokinetic back muscle strength in patients with low back pain. Spine. 1999;24:275–280
  14. Brox JI, Brevik JI, Ljunggren AE, Staff PH. Influence of anthropometric and psychological variables pain and disability on isometric endurance of shoulder abduction in patients with rotator tendinosis of the shoulder. Scand J Rehabil Med. 1996;28:193–200
  15. Vlaeyen JW, Kole-Snijders AM, Boeren RG, van EH. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain. 1995;62:363–372
  16. Al-Obaidi SM, Nelson RM, Al-Awadhi S, Al-Shuwaie N. The role of anticipation and fear of pain in the persistence of avoidance behavior in patients with chronic low back pain. Spine. 2000;25:1126–1131
  17. Moseley GL. Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chronic low back pain. Eur J Pain. 2004;8:39–45
  18. Crombez G, Vlaeyen JW, Heuts PH, Lysens R. Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability. Pain. 1999;80:329–339
  19. Airaksinen O, Brox JI, Cedraschi C, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15:S192–S300
  20. Kori SH, Miller RP, Todd DD. Kinesiophobia: a new view of chronic pain behavior. Pain Manag. 1990;3:35–43
  21. Grotle M, Vollestad NK, Veierod MB, Brox JI. Fear-avoidance beliefs and distress in relation to disability in acute and chronic low back pain. Pain. 2004;112:343–352
  22. Ursin H. Press stop to start: the role of inhibition for choice and health. Psychoneuroendocrinology. 2005;30:1059–1065
  23. Eriksen HR, Murison R, Pensgaard AM, Ursin H. Cognitive activation theory of stress (CATS): from fish brains to the Olympics. Psychoneuroendocrinology. 2005;30:933–938
  24. Oxman AD, Guyatt GH. Validation of an index of the quality of review articles. J Clin Epidemiol. 1991;44:1271–1278
  25. van Tulder MW, Assendelft WJ, Koes BW, Bouter LM. Method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group for Spinal Disorders. Spine. 1997;22:2323–2330
  26. Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for nonspecific low back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine. 2005;30:2153–2163
  27. Cohen JE, Goel V, Frank JW, Bombardier C, Peloso P, Guillemin F. Group education interventions for people with low back pain. An overview of the literature. Spine. 1994;19:1214–1222
  28. Koes BW, van Tulder MW, van der Windt WM, Bouter LM. The efficacy of back schools: a review of randomized clinical trials. J Clin Epidemiol. 1994;47:851–862
  29. van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low back pain. Cochrane Database Syst Rev. 2000;CD000261
  30. Maier-Riehle B, Harter M. The effects of back schools—a meta-analysis. Int J Rehabil Res. 2001;24:199–206
  31. Tveito TH, Hysing M, Eriksen HR. Low back pain interventions at the workplace: a systematic literature review. Occup Med (Lond). 2004;54:3–13
  32. Kool JP, Oesch PR, Bachmann S, et al. Increasing days at work using function-centered rehabilitation in nonacute nonspecific low back pain: a randomized controlled trial. Arch Phys Med Rehabil. 2005;86:857–864
  33. Linton SJ, Bradley LA, Jensen I, Spangfort E, Sundell L. The secondary prevention of low back pain: a controlled study with follow-up. Pain. 1989;36:197–207
  34. Penttinen J, Nevala-Puranen N, Airaksinen O, Jaaskelainen M, Sintonen H, Takala J. Randomized controlled trial of back school with and without peer support. J Occup Rehabil. 2002;12:21–29
  35. Postacchini F, Facchini M, Palieri P. Efficacy of various forms of conservative treatment in low back pain: a comparative study. Neuro-orthopedics. 1988;6:28–35
  36. Dalichau S, Perrey RM, Solbach T, Elliehausen HJ. Erfahrungen bei der Durchfuhrung eines berufsbezogenen Rückenschulmodells in Baugewerbe. Arbeitsmedizin. 1998;48:72–80
  37. Heymans MW, de Vet HC, Bongers PM, Knol DL, Koes BW, van MW. The effectiveness of high-intensity versus low-intensity back schools in an occupational setting: a pragmatic randomized controlled trial. Spine. 2006;31:1075–1082
  38. Lankhorst GJ, Van de Stadt RJ, Vogelaar TW, Van der Korst JK, Prevo AJ. The effect of the Swedish Back School in chronic idiopathic low back pain. A prospective controlled study. Scand J Rehabil Med. 1983;15:141–145
  39. Hurri H. The Swedish back school in chronic low back pain. Part I. Benefits Scand J Rehabil Med. 1989;21:33–40
  40. Keijsers JF, Groenman NH, Gerards FM, van OE, Steenbakkers M. A back school in The Netherlands: evaluating the results. Patient Educ Couns. 1989;14:31–44
  41. Keijsers J, Steenbakkers M, Meertens RM, Bouter LM, Kok GJ. The efficacy of the back school: a randomized trial. Arthritis Care Res. 1990;3:204–209
  42. Donchin M, Woolf O, Kaplan L, Floman Y. Secondary prevention of low-back pain. A clinical trial. Spine. 1990;15:1317–1320
  43. Lonn JH, Glomsrod B, Soukup MG, Bo K, Larsen S. Active back school: prophylactic management for low back pain. A randomized, controlled, 1-year follow-up study. Spine. 1999;24:865–871
  44. Glomsrod B, Lonn JH, Soukup MG, Bo K, Larsen S. “Active back school”, prophylactic management for low back pain: three-year follow-up of a randomized, controlled trial. J Rehabil Med. 2001;33:26–30
  45. Hay EM, Mullis R, Lewis M, et al. Comparison of physical treatments versus a brief pain-management programme for back pain in primary care: a randomised clinical trial in physiotherapy practice. Lancet. 2005;365:2024–2030
  46. Moseley L. Combined physiotherapy and education is efficacious for chronic low back pain. Aust J Physiother. 2002;48:297–302
  47. Niemisto L, Lahtinen-Suopanki T, Rissanen P, Lindgren KA, Sarna S, Hurri H. A randomized trial of combined manipulation, stabilizing exercises, and physician consultation compared to physician consultation alone for chronic low back pain. Spine. 2003;28:2185–2191
  48. Moseley GL, Nicholas MK, Hodges PW. A randomized controlled trial of intensive neurophysiology education in chronic low back pain. Clin J Pain. 2004;20:324–330
  49. Niemisto L, Rissanen P, Sarna S, Lahtinen-Suopanki T, Lindgren KA, Hurri H. Cost-effectiveness of combined manipulation, stabilizing exercises, and physician consultation compared to physician consultation alone for chronic low back pain: a prospective randomized trial with 2-year follow-up. Spine. 2005;30:1109–1115
  50. Sherman KJ, Cherkin DC, Erro J, Miglioretti DL, Deyo RA. Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomized, controlled trial. Ann Intern Med. 2005;143:849–856
  51. Williams KA, Petronis J, Smith D, et al. Effect of Iyengar yoga therapy for chronic low back pain. Pain. 2005;115:107–117
  52. Goldby LJ, Moore AP, Doust J, Trew ME. A randomized controlled trial investigating the efficiency of musculoskeletal physiotherapy on chronic low back disorder. Spine. 2006;31:1083–1093
  53. Cherkin DC, Eisenberg D, Sherman KJ, et al. Randomized trial comparing traditional Chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain. Arch Intern Med. 2001;161:1081–1088
  54. Indahl A, Haldorsen EH, Holm S, Reikeras O, Ursin H. Five-year follow-up study of a controlled clinical trial using light mobilization and an informative approach to low back pain. Spine. 1998;23:2625–2630
  55. Von KM, Moore JE, Lorig K, et al. A randomized trial of a lay person-led self-management group intervention for back pain patients in primary care. Spine. 1998;23:2608–2615
  56. Hagen EM, Eriksen HR, Ursin H. Does early intervention with a light mobilization program reduce long-term sick leave for low back pain?. Spine. 2000;25:1973–1976
  57. Hagen HEM, Grasdal A, Eriksen HR. Does early intervention with a light mobilization program reduce long-term sick leave for low back pain: a 3-year follow-up study. Spine. 2003;28:2309–2315
  58. Lorig KR, Laurent DD, Deyo RA, Marnell ME, Minor MA, Ritter PL. Can a Back Pain E-mail Discussion Group improve health status and lower health care costs?: a randomized study. Arch Intern Med. 2002;162:792–796
  59. Storheim K, Brox JI, Holm I, Koller AK, Bo K. Intensive group training versus cognitive intervention in sub-acute low back pain: short-term results of a single-blind randomized controlled trial. J Rehabil Med. 2003;35:132–140
  60. Karjalainen K, Malmivaara A, Pohjolainen T, et al. Mini-intervention for subacute low back pain: a randomized controlled trial. Spine. 2003;28:533–540
  61. Karjalainen K, Malmivaara A, Mutanen P, Roine R, Hurri H, Pohjolainen T. Mini-intervention for subacute low back pain: two-year follow-up and modifiers of effectiveness. Spine. 2004;29:1069–1076
  62. Buhrman M, Faltenhag S, Strom L, Andersson G. Controlled trial of Internet-based treatment with telephone support for chronic back pain. Pain. 2004;111:368–377
  63. Vlaeyen JW, de Jonge J, Geilen M, Heuts PH, van BG. Graded exposure in vivo in the treatment of pain-related fear: a replicated single-case experimental design in four patients with chronic low back pain. Behav Res Ther. 2001;39:151–166
  64. de J, Vlaeyen JW, Onghena P, Goossens ME, Geilen M, Mulder H. Fear of movement/(re)injury in chronic low back pain: education or exposure in vivo as mediator to fear reduction?. Clin J Pain. 2005;21:9–17
  65. Vlaeyen JW, de Jonge J, Geilen M, Heuts PH, van BG. The treatment of fear of movement/(re)injury in chronic low back pain: further evidence on the effectiveness of exposure in vivo. Clin J Pain. 2002;18:251–261
  66. Brox JI, Sorensen R, Friis A, et al. Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration. Spine. 2003;28:1913–1921
  67. Von Korff M, Balderson BH, Saunders K, et al. A trial of an activating intervention for chronic back pain in primary care and physical therapy settings. Pain. 2005;113:323–330
  68. Brox JI, Reikeras O, Nygaard O, et al. Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disc herniation: a prospective randomized controlled study. Pain. 2006;122:145–155
  69. Keller A, Brox JI, Gunderson R, Holm I, Friis A, Reikeras O. Trunk muscle strength, cross-sectional area, and density in patients with chronic low back pain randomized to lumbar fusion or cognitive intervention and exercises. Spine. 2004;29:3–8
  70. Thompson GW. The placebo effect and health. New York: Prometheus Books; 2005;
  71. Mannion AF, Muntener M, Taimela S, Dvorak J. A randomized clinical trial of three active therapies for chronic low back pain. Spine. 1999;24:2435–2448
  72. George SZ, Fritz JM, Bialosky JE, Donald DA. The effect of a fear-avoidance-based physical therapy intervention for patients with acute low back pain: results of a randomized clinical trial. Spine. 2003;28:2551–2560
  73. Hagen KB, Hilde G, Jamtvedt G, Winnem M. Bed rest for acute low-back pain and sciatica. Cochrane Database Syst Rev. 2004;CD001254

 FDA device/drug status: not applicable.

 Nothing of value received from a commercial entity related to this manuscript.

PII: S1529-9430(07)00901-1

doi: 10.1016/j.spinee.2007.10.008

The Spine Journal
Volume 8, Issue 1 , Pages 28-39 , January 2008

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