Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Structured and Standardized Education or Advice for Chronic Primary low back pain in Adults.

The review rated every outcome as very uncertain evidence, meaning further trials are likely to change these results. Most trials were judged at high risk of bias, and the paper gives the count inconsistently: 13 of 15 in one place, 14 in another. Most of the numbers come from a single small trial each, so the ranges around them are very wide. No trial in all adults measured social participation including work, medication use or health literacy at any time point. For adults aged 60 and over there was no data at all on quality of life, harms, depression, anxiety, catastrophizing, self-efficacy, medication change or falls. No trial looked at whether results differed by race or ethnicity, and there were too few trials or participants to test differences by gender, leg pain, or how education was delivered. The review pooled trials comparing education with doing nothing together with trials where education was added to another treatment, which may have increased the differences between study results. Unpublished trials could not be included: only one of eight authors contacted replied, and no grey literature was searched.

The funding statement names the University of Zurich. The WHO commissioned the review to inform its chronic low back pain guideline. No other funder or competing interest is given in the text.

Do not read this as proof that education and advice work for chronic low back pain. The improvements in pain and function are small, most of the 15 trials were at high risk of bias, and the reviewers rated every outcome as very uncertain evidence that is likely to change. In the one trial that compared education with sham Kinesio taping, the sham did better for pain.