The influence of prophylactic orthoses on abdominal strength and low back injury in the workplace. A field trial of back belts to reduce the incidence of acute low back injuries in New York City home attendants. An evaluation of a weightlifting belt and back injury prevention training class for airline baggage handlers. Lumbar supports to prevent recurrent low back pain among home care workers: a randomized trial. Controlled trial of a back support ('Lumbotrain') in patients with non-specific low back pain. Lumbar supports and education for the prevention of low back pain in industry: a randomized controlled trial. Evaluation of low back pain and assessment of lumbar corsets with and without back supports. [Effects of elastic lumbar belts on the effect of a muscle training program for patients with chronic back pain].
This study was designed to determine the effect of multimodal intervention and the prevention of back injury, and to evaluate the adverse side effects of using a lumbosacral corset in the workplace. Subjects were 90 male warehouse workers randomly selected from over 800 employees at a grocery distribution center. Subjects were assigned to three groups: true controls, no back school, no brace orthoses; back school only; and back school plus wearing a custom molded lumbosacral orthosis. Comparisons of pre-testing and 6-month follow-up post-testing for abdominal strength, cognitive data, work injury incidence and productivity and use of health care services were evaluated. Controls and training-only group showed no changes in strength productivity or lost time. Orthoses and training-group showed no changes in strength productivity or accident rate; however, they showed substantially less lost time. This study supports the concept of using education and prophylactic bracing to prevent back injury and reduce time loss. It appears that the use of intermittent prophylactic bracing has no adverse affects on abdominal muscle strength and may contribute to decreased lost time from work injuries. To determine the effect of black belt use on the incidence of low back injury in home attendants, a cluster-randomized trial involving employees of nine home attendant agencies in New York City was conducted. Nine agencies employing 12,772 home attendants between June 1997 and September 1999 were randomized into three groups-one group received back belts with use instruction, one group received lifting advice only, and one group served as a control. Low back injury rates per 100 full-time equivalents and rate ratios adjusted for potential confounders were estimated with random-effects Poisson regression. The back-belt group had a lower rate of low back injury than did those in both the advice-only and control groups, though the differences were marginally significant. Age, body mass index, history of back injury, years worked as a home attendant, and level of exercise were associated with risk of low back injury. The findings suggest that use of back belts is associated with some reduction in risk of low back injury. This study evaluated the efficacy of a commercially available weightlifting belt in relation to reduction of lumbar injury incident rate and severity of injuries over an 8-month period. The study used 642 baggage handlers working for a major airline company as participants. Four treatment groups were randomly selected: a group receiving the belt only, a group receiving a 1 h training class only, a group receiving both a belt and a 1 h training class, and a control group receiving nothing. Two treatment groups were added which contained participants who discontinued use of the belt prior to the end of an 8-month study period. Results indicated that there were no significant differences for total lumbar injury incident rate, restricted workday case injury incident rate, lost workdays and restricted workdays rate, and worker's compensation rates. There was, however, a marginal significant difference for lost workday case injury incident rate. Groups with participants who wore the belt for a while then discontinued its use had a higher lost day case injury incident rate than did either the group receiving training only or the control group. Compliance was an overriding factor as the belt questionnaire response indicated that 58% of participants in the belt groups discontinued use of the belt before the end of 8 months. Comments made on the survey forms indicated that the belt was too hot. Similarly, comments suggested that the belt rubbed, pinched, and bruised ribs. Based on these results, the weightlifting belt used for this study cannot be recommended for use in aid of lifting during daily work activities of baggage handlers. Results indicate that use of the belts may, in fact, increase the risk of injury when not wearing a belt following a period of wearing a belt. As industries are experimenting with the use of belts, it is recommended that great care be taken in any further evaluation and close attention directed towards injuries which occur when not wearing the belt following a period of wearing the belt (ie, off-the-job injuries). People use lumbar supports to prevent low back pain. Secondary analyses from primary preventive studies suggest benefit among workers with previous low back pain, but definitive studies on the effectiveness of supports for the secondary prevention of low back pain are lacking.
                To determine the effectiveness of lumbar supports in the secondary prevention of low back pain.
                Randomized, controlled trial.
                Home care organization in the Netherlands.
                360 home care workers with self-reported history of low back pain.
                Short course on healthy working methods, with or without patient-directed use of 1 of 4 types of lumbar support.
                Primary outcomes were the number of days of low back pain and sick leave over 12 months. Secondary outcomes were the average severity of low back pain and function (Quebec Back Pain Disability scale) in the previous week.
                Over 12 months, participants in the lumbar support group reported an average of -52.7 days (CI, -59.6 to -45.1 days) fewer days with low back pain than participants who received only the short course. However, the total sick days in the lumbar support group did not decrease (-5 days [CI, -21.1 to 6.8 days]). Small but statistically significant differences in pain intensity and function favored lumbar support.
                Study participants were unblinded, and a substantial amount of missing data required imputation. Objective data on sick days due to low back pain were not available.
                Adding patient-directed use of lumbar supports to a short course on healthy working methods may reduce the number of days when low back pain occurs, but not overall work absenteeism, among home care workers with previous low back pain. Further study of lumbar supports is warranted. A randomized, controlled, parallel-group clinical trial was carried out in general practice to assess the clinical efficacy of a new back support ('Lumbotrain') compared with 'standard therapy' of advice on rest and lifestyle in the treatment of patients with non-specific low back pain. A total of 216 patients entered this study (111 'Lumbotrain' group, 105 control group). All patients were allowed to take 1 g paracetamol up to 4-times daily if necessary for control of pain. Self-assessments were made daily by patients, over a period of 21 days, of pain levels at rest, on activity, at night, and limitation of activity using visual analogue scales. Details were also recorded of their ability to work or not, and the number of doses of paracetamol taken. At the end of the study period, patients assessed their overall response to treatment and those in the 'Lumbotrain' group were questioned on the comfort and ease of use of the back support. A clinical examination was carried out by the doctor at the start and end of the study period and an assessment made of the total range of active and passive back movement. Analysis of the daily diary records showed there were progressive, significant reductions in mean scores for all the pain and activity criteria in both groups and these were significantly greater in the 'Lumbotrain' group from Day 7 onwards. The times taken for reduction of symptom scores to 10% of initial values were significantly less in the 'Lumbotrain' group, such a degree of recovery occurring 2 to 4 days more rapidly than in the control group. A significantly higher proportion of patients in the 'Lumbotrain' group became able to work normally. After 3 weeks, 85% of patients in the 'Lumbotrain' group could work normally, as compared with 67% in the control group (p less than 0.02). Total analgesic consumption during the trial was significantly lower (p less than 0.0001) in the 'Lumbotrain' group (median 24.5 doses) than in the control group (median 51 doses). Overall clinical assessment scores were significantly superior in the 'Lumbotrain' group (p less than 0.002). Improvement was seen in 106 (95%) of 111 patients in the 'Lumbotrain' group, as compared with 79 (77%) of 103 of those in the control group (p less than 0.0002).(ABSTRACT TRUNCATED AT 400 WORDS) Low back pain is a frequent and costly health problem. Prevention of low back pain is important both for the individual patient and from an economic perspective.
                To assess the efficacy of lumbar supports and education in the prevention of low back pain in industry.
                A randomized controlled trial with a factorial design.
                The cargo department of an airline company in the Netherlands.
                A total of 312 workers were randomized, of whom 282 were available for the 6-month follow-up.
                Subjects were randomly assigned to 4 groups: (1) education (lifting instructions) and lumbar support, (2) education, (3) lumbar support, and (4) no intervention. Education consisted of 3 group sessions on lifting techniques with a total duration of 5 hours. Lumbar supports were recommended to be used during working hours for 6 months.
                Low back pain incidence and sick leave because of back pain during the 6-month intervention period.
                Compliance with wearing the lumbar support at least half the time was 43%. In the 282 subjects for whom data were available, no statistically significant differences in back pain incidence (48 [36%] of 134 with lumbar support vs 51 [34%] of 148 without, P=.81) or in sick leave because of low back pain (mean, 0.4 days per month with lumbar support vs 0.4 days without, P=.52) were found among the intervention groups. In a subgroup of subjects with low back pain at baseline, lumbar supports reduced the number of days with low back pain per month (median, 1.2 vs 6.5 days per month; P=.03).
                Overall, lumbar supports or education did not lead to a reduction in low back pain incidence or sick leave. The results of the subgroup analysis need to be confirmed by future research. Based on our results, the use of education or lumbar supports cannot be recommended in the prevention of low back pain in industry. A method is described for evaluating the progress of patients with back pain. Various symptoms were scored on analogue scales and spinal motion was measured by various techniques. These data were integrated to make subjective and objective indices respectively. Reasonable reproducibility of the measurements was obtained. This technique was used to elucidate the role of the lumbar support in surgical corsets in relief of back pain. Sufferers from back pain were randomly allocated to corsets with and without lumbar supports. There was significant improvement in those with a support compared with those without. On the other hand objective changes measured with the corset removed did not differ between the 2 groups. This study indicates that the spinal support in a lumbosacral corset makes a significant contribution towards the relief of symptoms. Aim of the study was to evaluate the influence of elastic lumbar belts on the effect of muscle training for patients with low back pain.
                97 male subjects aged from 23 to 42 years with and without low back pain participated in the investigation. The low back pain patients (n = 63) were randomized into a training group without and a training group with elastic lumbar belts and a control group. The subjects with healthy backs (n = 34) were divided age-matched into a training group with elastic lumbar belts and a control group. The three training groups took part in a muscle strenghtening program over 8 weeks. The control groups did not receive any alternative physiotherapeutic treatment. All groups were tested at the beginning, after 8 weeks and further 6 months later.
                The data obtained for the control groups remained virtually unchanged over the period of investigation. However, a significant increase of the muscle flexibility of the lower limbs could be proved for the training groups. Furthermore the coordination between the lumbar spine and pelvis when flexing the trunk deeply forward was more leveled out for the training groups with patients suffered low back pain. The results confirmed a reduction for pain severity and for limitations in activities of daily living as well. The modifications for the criteria investigated were significant stronger for the training group with patients using the elastic lumbar belt.
                The effectiveness of the muscle strengthening program for patients with low back pain could be improved significantly by means of the elastic lumbar belt as an applicable therapy instrument in the functional rehabilitation of spinal injuries.
There is moderate evidence that lumbar supports are not more effective than no intervention or training in preventing low-back pain, and conflicting evidence whether they are effective supplements to other preventive interventions. It remains unclear whether lumbar supports are more effective than no or other interventions for treating low-back pain.
There is still a need for high quality randomised trials on the effectiveness of lumbar supports. One of the most essential issues to tackle in these future trials seems to be the realization of an adequate compliance. Special attention should be paid to different outcome measures, types of patients and types of lumbar support.