DARE: Search Results
Document: 2
Group education interventions for people with low back pain: an overview of
the literature.
Cohen J E, Goel V, Frank J W, Bombardier C, Peloso P, Guillemin F.
Group education interventions for people with low back pain: an overview of
the literature.
Spine,
1994,
19(11),
pp.1214-1222
Record status
This record is a structured abstract written by CRD reviewers. The original
has met a set of quality criteria.
Author's objective
To make a recommendation regarding the effectiveness of group education as an
intervention for people with low back pain. Type of intervention
Treatment
Specific interventions included in the review
Group education for people with low back pain.
Participants included in the review
People with either acute or chronic low back pain.
Outcomes assessed in the review
The short-term outcomes were: pain intensity, pain duration, initial sick
leave duration, functional status, knowledge and spinal mobility. The
long-term outcomes were: number of pain recurrences, pain intensity, total
pain duration, total sick leave duration, functional status, spinal mobility
and number of contacts with health care providers.
Study designs of evaluations included in the review
Randomized controlled trials (RCTs), trials in which subjects were assigned on
the basis of order of entry into the study, studies using a block design and
studies using historical controls.
What sources were searched to identify primary studies?
MEDLINE was searched from 1986 to 1992. Health was searched from 1975 to 1992.
ERIC was searched from 1983 to 1992.PsycLIT was searched from 1987 to 1992.
In addition the reference lists of retreived papers were searched and other
papers located through personal communication.
Criteria on which the validity (or quality) of studies was assessed
Original study results had to be presented. Group education had to be a
primary component of the study intervention (studies involving 0ne-to-one
education were excluded). The study had to include a control group. Subjects
had to have experienced either acute or chronic low back pain. The article had
to be published in either English or French.
How were the judgements of validity (or quality) made?
Two independent reviewers who were blinded to the source and to the authors of
each study . Each study was given a score of 0, 1 or 2 (by each reviewer) for
each of the following categories: description of participants and setting,
group assignement and description of study interventions, measurement of
outcomes, analysis, and overall study quality. These points were summed
across categories and a final quality score was calculated as the mean of the
two raters' overall scores.
How were decisions on the relevence of primary studies made?
Not stated
How was the data extracted from primary studies?
By two independent reviewers.
Number of studies included
13 studies in total (total of 2052 subjects):
9 studies were randomized controlled trials (1515 subjects)
2 studies assigned subjects on the basis of order of entry into the study (93
subjects)
1 study used a block design (45 subjects)
1 study used a historical control group (399 subjects)
How were the studies combined?
Narrative review
How were differences between studies investigated?
The studies were grouped according to duration of back pain (i.e. chronic or
acute). They were further divided by the type of control group they used
(i.e. whether they provided passive treatment [placebo, no treatment or usual
care] or an active control group [exercise, physiotherapy, or other]).
Results of the review
Of the 13 studies cited only 6 were found to be sufficiently well-designed (on
the basis of the quality score allocated) for their findings to be discussed.
Of the 4 studies which focused on chronic back pain subjects, one found a
positive short-term effect on pain intensity. In the 2 studies with acute
cases group education was found by 1 study to reduce pain duration and initial
sick leave duration in the short-term. However, the intervention also
included work-site visits. The 6 studies provided no evidence of benefit for
group education on any of the long-term outcome measures.
Was any cost information reported?
No
Author's conclusions
There is insufficient evidence to recommend group education for people with
low back pain.
CRD commentary
This review presents a very thorough account of the methodology used plus a
very detailed table outlining the characteristics of each of the 13 studies.
The initial literature search found 89 articles of which 76 were excluded.
Reasons for exclusion can be obtained from the authors. No details about the
search strategy are presented, for example why MEDLINE was searched from 1986
to 1992, Health from 1986 to 1992, ERIC from 1983 to 1992 and PsycLIT from
1987 to 1992. The group education interventions were not uniformly of high
quality. Only 2 out of 13 interventions were rated as either good or very
good by both expert reviewers . On the whole the interventions were not
sufficiently described.
Subject index terms
Subject indexing assigned by NLM: Exercise/th [therapy]; Low-Back-Pain/rh
[rehabilitation]; Patient- Education; Adult-; Clinical-Trials; Middle-Age;
Randomized-Controlled- Trials; Treatment-Outcome
Correspondence address
Dr Longo, Department of Family and Community Medicine, University of
Missouri-Columbia, School of Medicine, Missouri 65212, USA.
Copyright
University of York, 1998
Database no.: DARE-940282
