Intermediate and Long-term Effects of a Standardized Back School for Inpatient Orthopedic Rehabilitation on Illness Knowledge and Self-management Behaviors

Abstract

A back school is a mandatory part of the multimodal rehabilitation program for patients with chronic low back pain in Germany. However, no standardized and evaluated back school program has been available for routine use. In this study, we report the evaluation of a new back school that was developed based on theories of health behavior, treatment evidence, practice guidelines, and quality criteria for patient education. Randomized controlled trial of patients with low back pain (n=360) in inpatient orthopedic rehabilitation clinic in Germany. Intervention patients received the new back school, whereas control patients a traditional back school (usual care). Illness knowledge (primary outcome) and secondary behavioral and health outcomes were assessed at admission, discharge, and 6 and 12 months follow-up. Results showed a significant medium between-group treatment effect in patients' knowledge about back pain at discharge (η²=0.081), after 6 (η²=0.056), and 12 months (η²=0.026). Furthermore, small-to-medium effects were observed among the secondary self-management behaviors, such as physical activity, back exercises, back posture habits, and coping with pain, after 6 and 12 months. The superior effectiveness of the back school based on a biopsychosocial approach was demonstrated with regard to illness knowledge and self-management behaviors up to 1 year. Thus, the program may be recommended for dissemination within medical rehabilitation.