Di Fabio R P
Department of Physical Medicine and Rehabilitation, UMHC, University of Minnesota, Minneapolis 55455, USA.
Phys Ther. 1995 Oct;75(10):865-78. doi: 10.1093/ptj/75.10.865.
The use of back school as a treatment for low back pain is widespread, but determining the efficacy of this approach is complicated by variations in back schools and study methods across clinical trials. The purpose of this study was to conduct a meta-analysis to synthesize existing evidence on the efficacy of back school as either a primary intervention or a part of a comprehensive rehabilitation program for patients with low back pain.
The results of 19 prospective randomized controlled trials were evaluated. Quantitative reviewing procedures were used to calculate the effect sizes that compared patients receiving back school with those in a control or comparison group. Effect sizes were computed for 206 hypothesis tests involving 2,373 patients.
The average effect size for comprehensive rehabilitation programs that included back school (d = 0.28) was larger than the average effect size for programs that offered back school as the primary intervention (d = -0.14). When effect sizes were stratified by program type and outcome, the comprehensive programs were superior to primary back school programs with respect to pain reduction, increased spinal mobility, and increased strength. Both types of programs showed reasonable success with education/compliance outcomes (d = 0.27-0.28). Lower effect sizes were found among the types of programs for disability and work/vocational outcomes (d < or = 0.20).
Back schools were most efficacious when coupled with a comprehensive rehabilitation program. Efficacy was supported for the treatment of pain and physical impairments and for education/compliance outcomes. Work/vocational and disability outcomes, however, were not improved substantially beyond control levels in comprehensive or primary back school programs. [Di Fabio RP. Efficacy of comprehensive rehabilitation programs and back school for patients with low back pain: a meta-analysis.
将“回校训练”作为治疗腰痛的方法已广泛应用，但由于各临床试验中“回校训练”方式及研究方法存在差异，确定该方法的疗效变得复杂。本研究旨在进行一项荟萃分析，以综合现有证据，探讨“回校训练”作为主要干预措施或作为腰痛患者综合康复计划一部分的疗效。
评估了19项前瞻性随机对照试验的结果。采用定量综述程序计算效应量，以比较接受“回校训练”的患者与对照组或比较组患者。对涉及2373例患者的206项假设检验计算了效应量。
包含“回校训练”的综合康复计划的平均效应量（d = 0.28）大于以“回校训练”作为主要干预措施的计划的平均效应量（d = -0.14）。当按计划类型和结果对效应量进行分层时，综合计划在减轻疼痛、增加脊柱活动度和增强力量方面优于主要的“回校训练”计划。两种类型的计划在教育/依从性结果方面均显示出合理的成效（d = 0.27 - 0.28）。在针对残疾以及工作/职业结果的计划类型中发现较低的效应量（d≤0.20）。
“回校训练”与综合康复计划相结合时效果最佳。其对疼痛和身体损伤的治疗以及教育/依从性结果的疗效得到了支持。然而，在综合或主要的“回校训练”计划中，工作/职业和残疾结果并未比对照水平有实质性改善。[迪法比奥·R·P。综合康复计划和“回校训练”对腰痛患者的疗效：一项荟萃分析。
