Abstract
Background context
Back problems (BPs), with their cost and disability, are a substantial burden for
individuals, employers, and society.
Purpose
This systematic review of controlled trials evaluates the effectiveness of interventions
to prevent BP episodes in working age adults.
Data sources
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.
Study selection
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.
Data extraction
Researchers extracted relevant information from controlled trials and graded methodological
quality. Because of heterogeneity of trials, meta-analysis was not performed.
Results
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.
Conclusions
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.
Keywords
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Article info
Publication history
Accepted:
November 5,
2008
Received:
October 29,
2008
Footnotes
FDA device/drug status: not applicable.
Nothing of value received from a commercial party related to this article.
Identification
Copyright
© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
