High-quality controlled trials on preventing episodes of back problems: systematic literature review in working-age adults |
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| Authors: | Stanley J Bigos John Holland Carole Holland John S Webster Michele Battie Judith A Malmgren |
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| Institution: | 1. University of British Columbia James Hogg Research Centre, Vancouver, BC, Canada;2. Division of Respirology, St. Paul''s Hospital, Vancouver, BC, Canada;1. Department of Physical Therapy, High Point University, 833 Montlieu Ave., High Point, NC 27262, USA;2. Department of Community and Family Medicine, Duke University, Durham, NC 27707, USA;3. Department of Physical Therapy, University of Florida, 355 Tigert Hall, Gainesville, FL 32611, USA;4. Department of Physical Therapy, Walsh University, 2020 East Maple St, North Canton, OH 44720, USA;1. Department of Psychology, University of Sheffield, United Kingdom;2. King''s College London, Department of Psychological Medicine, Cutcombe Road, London, SE5 9RJ, United Kingdom |
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| Abstract: | Background contextBack problems (BPs), with their cost and disability, are a substantial burden for individuals, employers, and society.PurposeThis systematic review of controlled trials evaluates the effectiveness of interventions to prevent BP episodes in working age adults.Data sourcesWe searched MEDLINE/EMBASE through May 2007, and COCHRANE/Trials Registry through August 22, 2008 using search terms of back pain, back injuries or sciatica, linked to prevention, control, workplace interventions, or ergonomics and searched article bibliographies.Study selectionFor systematic review inclusion, articles had to describe prospective controlled trials of interventions to prevent BPs in working-age adults, with intervention assignment either to individual participants or preexisting groups. Of 185 articles identified as potentially relevant, 20 trials (11%) met inclusion criteria.Data extractionResearchers extracted relevant information from controlled trials and graded methodological quality. Because of heterogeneity of trials, meta-analysis was not performed.ResultsOnly exercise was found effective for preventing self-reported BPs in seven of eight trials (effect size 0.39 to >0.69). Other interventions were not found to reduce either incidence or severity of BP episodes compared with controls. Negative trials included five trials of education, four of lumbar supports, two of shoe inserts, and four of reduced lifting programs.ConclusionsTwenty high-quality controlled trials found strong, consistent evidence to guide prevention of BP episodes in working-age adults. Trials found exercise interventions effective and other interventions not effective, including stress management, shoe inserts, back supports, ergonomic/back education, and reduced lifting programs. The varied successful exercise approaches suggest possible benefits beyond their intended physiologic goals.Level of evidenceSystematic review Level I evidence. |
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