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Shirado, Osamu; Ito, Toshikazu; Kikumoto, Toyo; Takeda, Naoki; Minami, Akio; Strax, Thomas E. A Novel Back School Using a Multidisciplinary Team Approach Featuring Quantitative Functional Evaluation and Therapeutic Exercises for Patients With Chronic Low Back Pain: The Japanese Experience in the General Setting. Spine. 30(10):1219-1225, May 15, 2005. doi: 10.1097/01.brs.0000162279.94779.05



Study Design. A prospective cohort study.

Objectives. To introduce a novel back school for the treatment of patients with chronic low back pain (CLBP), and to report its clinical results.

Summary of Background Data. Although back school is one of the treatment methods for patients with CLBP, its efficacy and appropriate style remain controversial. No studies have been published regarding the combined program of back school with a multidisciplinary team approach.

Methods. A total of 182 patients with CLBP (74 men and 108 women; average age, 43.8 years) participated in this study. All patients were enrolled in the back school using a multidisciplinary team approach featuring quantitative functional evaluation and therapeutic exercises. The following outcome measures were evaluated at the baseline, and 6 and 12 months after the enrollment: the level of pain evaluated with a Visual Analog Scale (VAS), flexibility of trunk and hamstrings (finger-floor distance, straight leg raising), trunk muscle strength and endurance, frequency of therapeutic exercises, and self-reported patient satisfaction.

Results. An averaged VAS score was 6.2 before enrollment in the program and 2.8 at follow-up. The pain improved in 141 patients (80.8%), did not change in 27 (15.4%), and was aggravated in 7 (3.8%). There was statistically significant improvement of finger-floor distance, trunk muscle strength, and endurance in the patients whose pain was relieved after enrollment in the program (P < 0.05). The compliance with the exercise program was significantly correlated with the clinical results (P < 0.05).

Conclusions. We developed a novel back school using a multidisciplinary team approach, featuring quantitative functional evaluation and therapeutic exercises. The current study demonstrated that our program could provide a satisfactory result for the treatment of patients with CLBP. The quantitative functional evaluation was a worthwhile outcome measure when evaluating the efficacy of the treatment program. Teaching body mechanics and performing the therapeutic exercises through the multidisciplinary team approach are essential to managing CLBP in a general setting.


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