8 Back schools in prevention of chronicity M. NORDIN C. CEDRASCHI F. BALAGUE E. B. ROUX Back schools were first introduced in the early 1970s as an alternative or a complement to the rehabilitation of low back pain patients (Mattmiller, 1980; Zachrisson-Forssell, 1981; Hall and Iceton, 1983). Since then, back schools have grown popular. These educational programmes generally emphasize physical training and/or behavioural conditioning. They also include basic anatomical and biomechanical concepts with the assumption that knowledge of these aspects is necessary for the integration of the practical applications (Fitzgerald Miller, 1983). Most educational program- mes for low back pain patients focus on changes in behaviours and in attitudes in the patient. The patient is encouraged to take a greater part in the management of the back problem and to be an active agent in the recovery process (Fisk et al, 1983). Self-care behaviours are promoted, more or less successfully (see Linton and Kamwendo, 1987; Klingenstierna, 1991; Schlapbach and Gerber, 1991 for reviews). EDUCATIONAL CONCEPTS The learning process In a teaching programme the patient/student is asked to adapt to new information. According to the piagetian theory, adaptation is a process defined as an equilibration between assimilation and accommodation. Assimilation can be defined as the process through which the individual takes information from the environment and incorporates it into existing mental schemes or structures. Within the same theory, accommodation involves the process through which mental schemes and structures are modified through contact with external reality. Both assimilation and accommodation actively participate in the construction and adaptation of mental schemes (Piaget, 1977). A patient given new information, as in an educational programme, tends to select the information that is personally relevant and to incorporate it into prior knowledge. The assimilation Bailli~re's Clinical Rheumatology-- 685 Vol. 6, No. 3, October1992 Copyright 9 1992,byBailli~re Tindall ISBN0-7020-1637-3 Allrightsofreproduction in anyform reserved