Psychological features and outcomes of the Back School treatment in patients with chronic non-specific low back pain. A randomized controlled study

Background. Low back pain is a worldwide health problem, affecting up to 80% of adult population. Psychological factors are involved in its development and maintenance. Many clinical trials have evaluated the efficacy of different interventions for chronic nonspecific low back pain. In this field, Back School program has been demonstrated effective for people with chronic non-specific low back. Aim. To evaluate the relationship between the effects of the Back School treatment and psychological features measured by MMPI-II of patients with chronic non-specific low back pain. Design. A randomised controlled trial with three and six-month follow-up. Setting. Ambulatory rehabilitative university centre. Population. Fifty patients with chronic non-specific low back pain out of 77 screened patients. Methods. Patients were randomly placed in a 3:2 form and were allocated into two groups (Treatment versus Control). The Treatment Group participated to an intensive multidisciplinary Back School program (BSG, N.=29), while the Control Group received medical assistance (CG, N.=21). Medication was the same in both groups. Then, patients were subgrouped in those with at least an elevation in one scale of MMPI-II, and those without it. The Short Form 36 Health Status Survey for the assessment of quality of life (primary outcome measure), pain Visual Analogue Scale, Waddel Index and Oswestry Disability Index were collected at baseline, at the end of treatment, and at the three and six-month follow-up. Results. Only the two treated subgroups showed a significant improvements in terms of quality of life, disability and pain. Among treated subjects, only those with at least one scale elevation in MMPI-II showed also a significant improvement in terms of Short Form 36 mental composite score and relevant subscores. Conclusion. These results suggest that Back School program has positive effects, even in terms of mental components of quality of life in patients with scale elevations of MMPI-H. Probably these findings are due to its educational and cognitive-behavioural characteristics. Clinical rehabilitation impact. Because of its educational purposes, the Back School treatment can have positive effects also on the mental status of patients with low back pain when it affects their psychological features.