Study designs of evaluations included in the review
Randomised controlled trials (RCTs) that were classified as high or medium quality, and had at least 10 patients per treatment group, were eligible for inclusion in the review. Studies using alternate allocation were excluded.
Specific interventions included in the review
Studies that evaluated interventions that included advice and/or patient education were eligible for inclusion. The included studies evaluated advice alone and advice in conjunction with a variety of different interventions (including exercise, ‘the Back Book’, general practitioner advice, Back School, bed rest, functional restoration programme, manipulation, massage, stretching and motivation), either alone or in combination. Control interventions included advice plus booklets or leaflets, advice only, analgesics, bed rest, usual care, versions of Back School, intensive physical training, exercise, sham exercise and behavioural treatment.
Participants included in the review
Studies of symptomatic patients with acute (less than four weeks), sub-acute (four to 12 weeks) and chronic (more than 12 weeks) low back pain were eligible for inclusion. Studies of patients with possible serious spinal pathology, spinal surgery in the previous year or fibromyalgia were excluded. Studies had to report sufficient information on the category of low back pain and report results separately for the different phases of low back pain. Male and female patients in the included studies were aged from 16 to 79 years.
Outcomes assessed in the review
Inclusion criteria were not specified in terms of the outcomes. The recommended review outcomes were back-specific function (Roland-Morris/Oswestry Disability Questionnaire), generic health status (Short-Form 36/EuroQol Questionnaire), pain (frequency and severity of low back pain/ Body Pain Scale of the Short-Form 36), work disability and patient satisfaction (Patient Satisfaction Scale/Global question). Outcomes assessed using the McGill Pain Questionnaire, Aberdeen Back Pain Scale, Sickness Impact Profile and Waddell Disability Index were also acceptable. Studies that included non recommended outcomes were also included. The review also assessed adverse effects.
How were decisions on the relevance of primary studies made?
Two reviewers independently selected the studies and resolved any disagreements by consensus.