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Occup Environ Med. 1997 December; 54(12): 841–847.
PMCID: PMC1128963

A systematic review of controlled clinical trials on the prevention of back pain in industry.


OBJECTIVE: To assess the effectiveness of lumbar supports, education, and exercise in the prevention of back pain in industry. METHODS: A computerised search for controlled clinical trials was conducted. A criteria list was used to assess the methodological quality of the studies. The available evidence for the effectiveness of the interventions was graded with a rating system for the level of evidence. Effect sizes of individual studies were combined if the studies were sufficiently similar. RESULTS: 11 studies were identified for the review. The methodological quality of all studies was low, with a maximum score of three out of seven for internal validity. There was no evidence for the effectiveness of lumbar supports due to contradictory outcomes of the studies. Five of the six studies on education reported no effect. Thus there is limited evidence that education does not help to prevent back pain. All three studies on exercise reported a positive result, indicating limited evidence for the effectiveness of exercise. The combined effect size for exercise was 0.53, which is a medium sized effect. CONCLUSIONS: Although widely used, there is little evaluative research on the preventive measures studied here. The review showed that there is limited evidence that exercise has some effect in the prevention of back pain and that education is not effective. No conclusive evidence was found for or against the effectiveness of lumbar supports. Research of higher methodological quality is needed before firm conclusions on the effectiveness of lumbar supports, education, and exercise in the prevention of back pain in industry can be drawn.

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Selected References

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  • van Tulder MW, Koes BW, Bouter LM. A cost-of-illness study of back pain in The Netherlands. Pain. 1995 Aug;62(2):233–240. [PubMed]
  • Lahad A, Malter AD, Berg AO, Deyo RA. The effectiveness of four interventions for the prevention of low back pain. JAMA. 1994 Oct 26;272(16):1286–1291. [PubMed]
  • Genaidy AM, Simmons RJ, Christensen DM. Can back supports relieve the load on the lumbar spine for employees engaged in industrial operations? Ergonomics. 1995 May;38(5):996–1010. [PubMed]
  • Minor SD. Use of back belts in occupational settings. Phys Ther. 1996 Apr;76(4):403–408. [PubMed]
  • Nordin M, Cedraschi C, Balagué F, Roux EB. Back schools in prevention of chronicity. Baillieres Clin Rheumatol. 1992 Oct;6(3):685–703. [PubMed]
  • Koes BW, van Tulder MW, van der Windt WM, Bouter LM. The efficacy of back schools: a review of randomized clinical trials. J Clin Epidemiol. 1994 Aug;47(8):851–862. [PubMed]
  • Koes BW, Bouter LM, Beckerman H, van der Heijden GJ, Knipschild PG. Physiotherapy exercises and back pain: a blinded review. BMJ. 1991 Jun 29;302(6792):1572–1576. [PMC free article] [PubMed]
  • Walsh NE, Schwartz RK. The influence of prophylactic orthoses on abdominal strength and low back injury in the workplace. Am J Phys Med Rehabil. 1990 Oct;69(5):245–250. [PubMed]
  • Reddell CR, Congleton JJ, Dale Huchingson R, Montgomery JF. An evaluation of a weightlifting belt and back injury prevention training class for airline baggage handlers. Appl Ergon. 1992 Oct;23(5):319–329. [PubMed]
  • Donchin M, Woolf O, Kaplan L, Floman Y. Secondary prevention of low-back pain. A clinical trial. Spine (Phila Pa 1976) 1990 Dec;15(12):1317–1320. [PubMed]
  • Daltroy LH, Iversen MD, Larson MG, Ryan J, Zwerling C, Fossel AH, Liang MH. Teaching and social support: effects on knowledge, attitudes, and behaviors to prevent low back injuries in industry. Health Educ Q. 1993 Spring;20(1):43–62. [PubMed]
  • Feldstein A, Valanis B, Vollmer W, Stevens N, Overton C. The Back Injury Prevention Project pilot study. Assessing the effectiveness of back attack, an injury prevention program among nurses, aides, and orderlies. J Occup Med. 1993 Feb;35(2):114–120. [PubMed]
  • Gundewall B, Liljeqvist M, Hansson T. Primary prevention of back symptoms and absence from work. A prospective randomized study among hospital employees. Spine (Phila Pa 1976) 1993 Apr;18(5):587–594. [PubMed]
  • Kellett KM, Kellett DA, Nordholm LA. Effects of an exercise program on sick leave due to back pain. Phys Ther. 1991 Apr;71(4):283–293. [PubMed]
  • Chalmers TC, Smith H, Jr, Blackburn B, Silverman B, Schroeder B, Reitman D, Ambroz A. A method for assessing the quality of a randomized control trial. Control Clin Trials. 1981 May;2(1):31–49. [PubMed]
  • Moher D, Jadad AR, Nichol G, Penman M, Tugwell P, Walsh S. Assessing the quality of randomized controlled trials: an annotated bibliography of scales and checklists. Control Clin Trials. 1995 Feb;16(1):62–73. [PubMed]
  • Scheer SJ, Radack KL, O'Brien DR., Jr Randomized controlled trials in industrial low back pain relating to return to work. Part 1. Acute interventions. Arch Phys Med Rehabil. 1995 Oct;76(10):966–973. [PubMed]
  • Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA. 1995 Feb 1;273(5):408–412. [PubMed]
  • Gebhardt WA. Effectiveness of training to prevent job-related back pain: a meta-analysis. Br J Clin Psychol. 1994 Nov;33(Pt 4):571–574. [PubMed]

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