Back problems (BPs), with their cost and disability, are a substantial burden for individuals, employers, and society.
This systematic review of controlled trials evaluates the effectiveness of interventions to prevent BP episodes in working age adults.
We 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.
For 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.
Researchers extracted relevant information from controlled trials and graded methodological quality. Because of heterogeneity of trials, meta-analysis was not performed.
Only 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.
Twenty 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 evidence
Systematic review Level I evidence.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to The Spine Journal
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Lost productive time and cost due to common pain conditions in the US workforce.JAMA. 2003; 290: 2443-2454
- Back pain exacerbations and lost productive time costs in United States workers.Spine. 2006; 31: 3052-3060
- AHCPR Clinical Practice Guideline #14: Acute Low Back Problems in Adults.(Pub. 95–0642) U.S. Department of Health and Human Services, Public Health Service Agency for Health Care Policy and Research, Rockville, MD1994
- Validity of the agency for healthcare research and quality clinical practice guidelines: how quickly do guidelines become outdated?.JAMA. 2001; 286: 1461-1467
- How to critically evaluate the literature on low back problems: the foundation for an evidence-based approach to care.Semin Spine Surg. 2003; 15: 54-67
- Updated method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group.Spine. 2003; 28: 1290-1299
- The effectiveness of four interventions for the prevention of low back pain.JAMA. 1994; 272: 1286-1291
- Preventive interventions for back and neck pain problems: what is the evidence?.Spine. 2001; 26: 778-787
- Low back pain interventions at the workplace: a systematic literature review.Occup Med. 2004; 54: 3-13
- An update of a systematic review of controlled clinical trials on the primary prevention of back pain at the workplace.Occup Med (Lond). 2004; 54 (Review. PMID: 15289592 [PubMed—indexed for MEDLINE]): 345-352
- Occupational health guidelines for the management of low back pain at work: evidence review.Occup Med. 2001; 51: 124-135
- Chapter 2: European guidelines for prevention in low back pain: November 2004.Eur Spine J. 2006; 15: S136-S168
- Guide to Evaluating the Effectiveness of Strategies for Preventing Work Injury: How to Show Whether a Safety Intervention Really Works.(NIOSH Pub. 2001-119) Department of Health and Human Services, Centers for Disease Control, National Institute for Occupational Safety and Health, 2001
- Methodology to update the practice recommendations of the American College of Occupational and Environmental Medicine's Occupational Medicine Guidelines, 2nd ed.J Occup Environ Med. 2008; 50: 282-295
- Biostatistics: A Methodology for the Health Sciences.John Wiley and Sons, Inc., New York1993
- Statistical Power Analysis for the Behavioral Sciences.2nd ed. Lawrence Erlbaum Associates, Hillsdale, New Jersey1988 (pp. 180–181)
- Modern Epidemiology.Lippincott Williams and Wilkins, Philadelphia PA1998
- Evaluation of a program to reduce back pain in nursing personnel.Rev Saude Publica. 2001 Aug; 35: 356-361
- A controlled trial of an educational program to prevent low back injuries.N Engl J Med. 1997; 337: 322-328
- Secondary prevention of low-back pain. A clinical trial.Spine. 1990; 15: 1317-1320
- Primary prevention of back symptoms and absence from work. A prospective randomized study among hospital employees.Spine. 1993; 18: 587-594
- Intensive education combined with low tech ergonomic intervention does not prevent low back pain in nurses.Occup Environ Med. 2005; 62: 13-17
- Effectiveness of a back pain prevention program: a cluster randomized controlled trial in an occupational setting.Spine. 2007; 32 (PMID: 17414902 [PubMed—indexed for MEDLINE]): 711-719
- Prevention of low back pain in female eldercare workers: randomized controlled work site trial.Spine. 2006; 31: 1761-1769
- A field trial of back belts to reduce the incidence of acute low back injuries in New York City home attendants.Int J Occup Environ Health. 2002; 8: 97-104
- Can passive prone extensions of the back prevent back problems? A randomized, controlled intervention trial of 314 military conscripts.Spine. 2002; 27: 2747-2752
- Can custom-made biomechanic shoe orthoses prevent problems in the back and lower extremities? A randomized, controlled intervention trial of 146 military conscripts.J Manipulative Physiol Ther. 2002; 25: 326-331
- Active back school: prophylactic management for low back pain. A randomized, controlled, 1-year follow-up study.Spine. 1999; 24: 865-871
- Long-term effects of supervised physical training in secondary prevention of low back pain.Eur Spine J. 2005; 14: 599-611
- A controlled randomized study of the effect of training with orthoses on the incidence of weight bearing induced back pain among infantry recruits.Spine. 2005; 30: 272-275
- Impact of ergonomic intervention on back pain among nurses.Scand J Work Environ Health. 2003; 29: 117-123
- The effect of a Mensendieck exercise program as secondary prophylaxis for recurrent low back pain. A randomized, controlled trial with 12-month follow-up.Spine. 1999; 24 (discussion 1592): 1585-1591
- Exercises and education as secondary prevention for recurrent low back pain.Physiother Res Int. 2001; 6: 27-39
- Control of the lumbar neutral zone decreases low back pain and improves self-evaluated work ability: a 12-month randomized controlled study.Spine. 2006; 31: E611-E620
- Lumbar supports and education for the prevention of low back pain in industry: a randomized controlled trial.JAMA. 1998; 279: 1789-1794
- The influence of prophylactic orthoses on abdominal strength and low back injury in the workplace.Am J Phys Med Rehabil. 1990; 69: 245-250
- A prospective study of back belts for prevention of back pain and injury.JAMA. 2000; 284: 2727-2732
- A randomized controlled trial to prevent patient lift and transfer injuries of health care workers.Spine. 2001; 26: 1739-1746
- Musculoskeletal disorders (MSDS) and workplace factors—a critical review of epidemiologic evidence for work-related musculoskeletal disorders of the neck, upper extremity, and low back.U.S. Department of Health and Human Services Public Health Service Centers for Disease Control and Prevention National Institute for Occupational Safety and Health, Cincinnati, OHJuly 1997
- Clinical Epidemiology: How to Do Clinical Practice Research.3rd ed. Lippincott Williams & Wilkins, Philadelphia2006
- Systematic reviews of injury-prevention strategies for occupational injuries: an overview.Am J Prev Med. 2000; 18: 1-3
- Toward a safe workplace: the role of systematic reviews.Am J Prev Med. 2000; 18: 4-5
- Interpreting Epidemiologic Evidence: Strategies for Study Design and Analysis.Oxford University Press, Oxford2003
- Critical Appraisal of Epidemiological Studies and Clinical Trials.3rd ed. Oxford University Press, Oxford2007
- Supplement on preventing occupational injuries.Am J Prev Med. 2001; 20
- Lumbar supports for prevention and treatment of low back pain.Cochrane Database Syst Rev. 2000; (CD001823. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD001823)
- Manual material handling advice and assistive devices for preventing and treating back pain in workers.Cochrane Database Syst Rev. 2007; (CD005958)
- A prospective study of work perceptions and psychosocial factors affecting the report of back injury.Spine. 1991; 16: 1-6
- A longitudinal, prospective study of industrial back injury reporting.Clinical Ortho Relat Res. 1992; 279: 21-34
- Does minor trauma cause serious low back illness?.Spine. 2006; 31: 2942-2949
Accepted: November 5, 2008
Received: October 29, 2008
FDA device/drug status: not applicable.
Nothing of value received from a commercial party related to this article.
© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.