PURPOSE: Evaluate benefits and harms of education/advice for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline. METHODS: Electronic databases were searched for randomized controlled trials (RCTs) assessing education/advice compared with placebo/sham, usual care, or no intervention (including comparison interventions where the attributable effect of education/advice could be isolated). We conducted meta-analyses and graded the certainty of evidence. RESULTS: We screened 2514 citations and 86 full text RCTs and included 15 RCTs. Most outcomes were assessed 3 to 6 months post-intervention. Compared with no intervention, education/advice improved pain (10 RCTs, MD -1.1, 95% CI -1.63 to -0.56), function (10 RCTs, SMD -0.51, 95% CI -0.89 to -0.12), physical health-related quality of life (HRQoL) (2 RCTs, MD 24.27, 95% CI 12.93 to 35.61), fear avoidance (5 RCTs, SMD -1.4, 95% CI -2.51 to -0.29), depression (1 RCT; MD 2.10, 95% CI 1.05 to 3.15), and self-efficacy (1 RCT; MD 4.4, 95% CI 2.77 to 6.03). Education/advice conferred less benefit than sham Kinesio Taping for improving fear avoidance regarding physical activity (1 RCT, MD 5.41, 95% CI 0.28 to 10.54). Compared with usual care, education/advice improved pain (1 RCT, MD -2.10, 95% CI -3.13 to -1.07) and function (1 RCT, MD -7.80, 95% CI -14.28 to -1.32). There was little or no difference between education/advice and comparisons for other outcomes. For all outcomes, the certainty of evidence was very low. CONCLUSION: Education/advice in adults with CPLBP was associated with improvements in pain, function, HRQoL, and psychological outcomes, but with very low certainty.

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