Education and Counseling to Prevent Low Back Pain
Effectiveness of Counseling
Education is the most common back pain prevention strategy used in the occupational setting and may also be used by clinicians.44,64,65 Education through "back school" training, including information on back biomechanics, preferred lifting strategies, optimal posture, exercises to prevent back pain, and stress and pain management, has been effective in reducing employment-related injuries and relieving chronic low back pain.66-70 Such programs are delivered in the workplace, however, and are not necessarily generalizable to education in the clinical setting.71 Other types of education programs that are potentially relevant to clinicians have also been evaluated. The studies all included patients with and without prior back pain, generally had small sample sizes, and except for one, were conducted in the workplace. As it would be difficult to do a blinded trial on back education, and since patient reports of low back pain are inherently subjective, all the results have a potential for subject bias.
There have been five randomized controlled trials of educational interventions for the prevention of low back pain. Already described above, two of these combined education with exercise interventions, and one combined education with back supports.22,37,39 In the trial37 of hospital employees randomized to either exercise, back education, or control groups, both exercise and education groups' knowledge of body mechanics improved. The education group, however, had no reduction of low back pain episodes. In the trial39 randomizing nurses to either exercise and low back education or to no intervention, intervention subjects had greater improvements in self-reported pain, fatigue, and activities of daily living at 6-month followup; the effects of education, however, could not be separated from those of the exercise intervention. The previously cited randomized trial22 that evaluated both lumbar supports (corsets) and back education for warehouse workers included a group that received only a 1-hour educational program stressing proper lifting techniques. Those in the educational program had significantly greater knowledge about low back pain than did controls at 6-month followup. Patients with a previous history of injury had lower injury rates and days lost from work after the education compared with controls, while there was no effect on subjects with no history of back injury. In another randomized controlled trial in U.S. postal workers, knowledge about back pain was higher in those attending an educational program, but self-reported frequency of "tired backs" was no different at 2.5-year followup.72 In the fifth trial, teenagers enrolled in a summer work program were randomized to a 1-hour session providing information about proper lifting techniques and two on-the-job feedback sessions, or to simple orientation sessions. While the intervention subjects were rated as having better body mechanics than controls at 4-week followup, followup data were not available beyond 4 weeks and the incidence of back pain was not measured.73