Purpose and Background: Although numerous guidelines have been developed to aid practitioners and patients in managing back pain, there remains a gap between the evidence-based recommendations and daily practice. The current project set out to encourage collaboration between patients and professionals in primary care in closing the gap between evidence and practice and to improve the management of back pain.

Methods: 10 GP practice teams, consisting of patient representatives, GPs, clinical and non-clinical practice staff, were recruited for participation in a series of workshops and practice meetings. Collaboration between these professionals and patients was stimulated by providing training and information for all groups. The aim of the workshops was to use quality improvement tools and input from patients to identify barriers to more effective back pain management and come up with alternatives in order to provide more effective and efficient back pain services in primary care. Changes in service provision and patient care will be evaluated using qualitative and quantitative techniques.

Conclusion: Most practices managed to recruit patient representatives for their improvement projects and preliminary results show that all found the input from these patients essential in identifying barriers and solutions. Practices identified numerous areas for improvement but common themes were patient information and communication.

Purpose and Background: Reliable and valid RCTs are essential in guiding clinical practice, but shortcomings in methodological quality have been reported in RCTs on LBP. The aim of this paper was to use the results of a systematic review on exercise or manual therapies for persistent LBP to evaluate the effect of methodological quality, sample size and statistical rigour on the outcomes of these trials.

Methods and Results: The systematic review included 41 RCTs on exercise or manual therapies (i.e. manipulation, mobilisation and/or massage) for persistent (> 6 weeks) non-specific LBP. Quality of the RCTs was assessed using an adapted 10-point Van Tulder scale. Sample size was defined as the number of subjects in the intervention group. Adequate statistical testing was defined as analyses that compared the change in pain or function achieved by the intervention group with the change in the same parameter achieved by the control or alternative group. The results showed that the RCTs with smaller sample sizes or RCTs of lower methodological quality more often reported larger differences in effectiveness than RCTs of higher methodological quality or larger sample sizes. Furthermore, small differences in effectiveness reported by smaller RCTs were often not statistically significant, while larger trials showed that such differences actually were statistically significant.

Conclusion: Low methodological quality and small sample size has resulted in misinterpretation of RCTs. Small or low quality RCTs overestimated differences in effectiveness or failed to detect smaller but statistically significant differences. Future RCTs and systematic reviews should address these shortcomings in order to provide reliable guidance for clinical practice.

Many studies in UK and other countries over the past 15 years have shown a high one year prevalence of back pain in teenagers rising from around 12% at the age of 12 to adult levels in excess of 30% by the age of 19.

Around 8% of all adolescents are significantly affected by chronic or recurrent back or neck pain sufficient to compromise school attendance and/or sport. Girls report around 10% more disability than boys.

Adolescent back pain, especially when accompanied by MRI changes at the age of 15, is associated with continuing symptoms in adult life.

Associated risk factors are physical, environmental, psychosocial and genetic. Some of these can be rectified, others clearly cannot, but once identified, they can usually be managed satisfactorily to minimise disability.

Known physical factors include too little or occasionally too much exercise, also many schools do not have adequate lockers which necessitates carrying heavy loads of books, sports equipment, etc. often in inadequate bags. A maximum load of 15% of body weight is recommended.

Environmental factors include poorly designed lowest cost school furniture causing postural strain, which cannot be adjusted to take account of the half metre variation in height of 15 year olds. One size does not fit all. Much school furniture would be illegal in an office, School is the workplace of the child.

This paper reviews the recent literature which indicates that attention to these factors results in better school performance and less back pain but further research is required.