Lumbar supports and education for the prevention of low back pain in industry: a randomized controlled trial. Are Back Supports Plus Education More Effective Than Education Alone in Promoting Recovery From Low Back Pain?: Results From a Randomized Clinical Trial Brief psychosocial education, not core stabilization, reduced incidence of low back pain: results from the Prevention of Low Back Pain in the Military (POLM) cluster randomized trial Treatment of Chronic Lower Back Pain with Lumbar Extension and Whole-Body Vibration Exercise: A Randomized Controlled Trial The effectiveness of exercise programmes after lumbar disc surgery: a randomized controlled study Evaluation of perifacet injections and paraspinal muscle rehabilitation in treatment of low back pain. A randomised controlled trial. Lumbar supports for prevention and treatment of low back pain: a systematic review within the framework of the Cochrane Back Review Group. The efficacy of an aerobic exercise and health education program for treatment of chronic low back pain. Effectiveness of a Lumbar Support Continuous Passive Motion Device in the Prevention of Low Back Pain During Prolonged Sitting
CONTEXT 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 . OBJECTIVE To assess the efficacy of lumbar supports and education in the prevention of low back pain in industry . DESIGN A r and omized controlled trial with a factorial design . SETTING The cargo department of an airline company in the Netherl and s. PARTICIPANTS A total of 312 workers were r and omized , of whom 282 were available for the 6-month follow-up . INTERVENTIONS Subjects were r and omly 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 . MAIN OUTCOME MEASURES Low back pain incidence and sick leave because of back pain during the 6-month intervention period . RESULTS 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 ) . CONCLUSIONS 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 can not be recommended in the prevention of low back pain in industry Study Design . R and omized clinical trial . Objectives . To evaluate the effectiveness of a back support plus education versus education alone in promoting recovery from a work-related low back disorder ( WR-LBD ) while simultaneously considering personal , health , and occupational factors and the impact of occupational factors on recovery . Summary of Background Data . No r and omized studies of active industrial workers with low back disorders exist regarding the effectiveness of back supports plus education . Methods . A total of 433 actively employed hourly union workers who had a recent diagnosis of a WR-LBD : 1 ) those who wore a specially design ed back support plus received education on back health ; and 2 ) those who received education on back health only .  Demographic , health , medical , and occupational factors were obtained through interview or abstract ion of computer files ; individual ergonomic exposures were measured with a lumbar motion monitor . Outcomes evaluated over a 12-month period included : self-reported measures of back pain , back pain disability level , physical health , mental health , and administrative measures of recurrence , lost work time , and medical care utilization . Results . There was no difference between the study groups with respect to mental or physical health , low back pain , back pain disability , neurogenic symptoms , lost work time , likelihood of recurrence of an episode of a back disorder , or other administrative measures of healthcare utilization or lost work time . However , significant decreases in low back pain , low back pain disability , neurogenic symptoms , and an increase in physical health were observed over the 12 months of observation in both study groups . The only occupational variable found to influence was plant group whereby service parts operations workers in the back support plus education group experienced a lower likelihood of WR-LBD recurrence . Conclusion . Although there was no overall effect on self-reported recovery or administrative measures or lost work time between the study groups , a back support plus health education may have some value in preventing recurrent WR-LBD in industrial workers who work in psychosocial environments and perform manual material h and ling tasks similar to those found in parts distribution centers Background Effective strategies for the primary prevention of low back pain ( LBP ) remain elusive with few large-scale clinical trials investigating exercise and education approaches . The purpose of this trial was to determine whether core stabilization alone or in combination with psychosocial education prevented incidence of low back pain in comparison to traditional lumbar exercise . Methods The Prevention of Low Back Pain in the Military study was a cluster r and omized clinical study with four intervention arms and a two-year follow-up . Participants were recruited from a military training setting from 2007 to 2008 . Soldiers in 20 consecutive companies were considered for eligibility ( n = 7,616 ) . Of those , 1,741 were ineligible and 1,550 were eligible but refused participation . For the 4,325 Soldiers enrolled with no previous history of LBP average age was 22.0 years ( SD = 4.2 ) and there were 3,082 males ( 71.3 % ) . Companies were r and omly assigned to receive traditional lumbar exercise , traditional lumbar exercise with psychosocial education , core stabilization exercise , or core stabilization with psychosocial education , The psychosocial education session occurred during one session and the exercise programs were done daily for 5 minutes over 12 weeks . The primary outcome for this trial was incidence of low back pain result ing in the seeking of health care . Results There were no adverse events reported . Evaluable patient analysis ( 4,147/4,325 provided data ) indicated no differences in low back incidence result ing in the seeking of health care between those receiving the traditional exercise and core stabilization exercise programs . However , brief psychosocial education prevented low back pain episodes regardless of the assigned exercise approach , result ing in a 3.3 % ( 95 % CI : 1.1 to 5.5 % ) decrease over two years ( numbers needed to treat ( NNT ) = 30.3 , 95 % CI = 18.2 to 90.9 ) . Conclusions Core stabilization has been advocated as preventative , but offered no such benefit when compared to traditional lumbar exercise in this trial . Instead , a brief psychosocial education program that reduced fear and threat of low back pain decreased incidence of low back pain result ing in the seeking of health care . Since this trial was conducted in a military setting , future studies are necessary to determine if these findings can be translated into civilian population s . Trial Registration NCT00373009 at Clinical Trials.gov - http:// clinical Study Design . A r and omized controlled trial with a 6-month follow-up period was conducted . Objective . To compare lumbar extension exercise and whole-body vibration exercise for chronic lower back pain . Summary of Background Data . Chronic lower back pain involves muscular as well as connective and neural systems . Different types of physiotherapy are applied for its treatment . Industrial vibration is regarded as a risk factor . Recently , vibration exercise has been developed as a new type of physiotherapy . It is thought to activate muscles via reflexes . Methods . In this study , 60 patients with chronic lower back pain devoid of “ specific ” spine diseases , who had a mean age of 51.7 years and a pain history of 13.1 years , practice d either isodynamic lumbar extension or vibration exercise for 3 months . Outcome measures were lumbar extension torque , pain sensation ( visual analog scale ) , and pain-related disability ( pain disability index ) . Results . A significant and comparable reduction in pain sensation and pain-related disability was observed in both groups . Lumbar extension torque increased significantly in the vibration exercise group ( 30.1 Nm/kg ) , but significantly more in the lumbar extension group ( + 59.2 Nm/kg ; SEM 10.2;P < 0.05 ) . No correlation was found between gain in lumbar torque and pain relief or pain-related disability ( P > 0.2 ) . Conclusions . The current data indicate that poor lumbar muscle force probably is not the exclusive cause of chronic lower back pain . Different types of exercise therapy tend to yield comparable results . Interestingly , well-controlled vibration may be the cure rather than the cause of lower back pain Objective : To compare two different exercise programmes versus a control group , after lumbar disc surgery . Design : A prospect i ve , single-blind , r and omized controlled study . Setting : Outpatient clinic of Istanbul Faculty of Medicine , Department of Physical Medicine and Rehabilitation . Subjects : Sixty patients diagnosed as having single level lumbar disc herniation with clinical examination and MRI evaluation and who had undergone lumbar discectomy ( post-operative first month ) at a single level . Patients with serious pathologies involving the cardiac and respiratory systems that could prevent them from doing exercises were excluded . Intervention : The patients were r and omly split into three groups . The first group received an intensive exercise programme and back school education while the second group received a home exercise programme and back school education . The third group was defined as the control group and did not receive education or exercise . Main measures : The patients were evaluated at the beginning and end of the treatment with clinical parameters , pain levels , endurance tests and weight-lifting tests , modified Oswestry Disability Index , Beck Depression Inventory , Low Back Pain Rating Scale and return to work . Results : The groups doing exercises experienced a decrease in the severity of pain and disability , also functional parameters showed better improvement than the control group . The intensive exercise programme was better than the home exercise programme . Conclusions : It seems that intensive exercise is more effective in reduction of pain and disability , but whether it is cost-effective is not clear BACKGROUND Lumbar paraspinal muscle dysfunction and Low Back Pain are strongly correlated . The best treatment for non-specific Low Back Pain is still controversial . OBJECTIVE To evaluate the efficacy of lumbar multifidus muscle retraining exercises and perifacet multifidus injections in the treatment of Low Back Pain . MATERIAL AND METHODS 63 patients with non-specific LBP , with or without leg pain , and magnetic resonance images of paraspinal muscle degeneration only , were r and omised to one of three treatment groups : A- Back education and st and ard physiotherapy for 10 weeks , B- Back education and gym ball exercise for 10 weeks or C- Perifacet injection into the lumbar multifidus muscle with methylprednisolone . The Oswestry Disability Index was used as the primary outcome measure and the SF-36 , modified Zung depression index , modified somatic perception and McGill pain question naires were used as secondary outcome measures . RESULTS 56 patients completed the trial . The Oswestry Disability Index improved in general from a mean of 29.9 to 25.9 , but there were no statistically significant differences between the groups . Low back pain improved most in group C ( P<0.02 ) , while physical activities and social functioning were improved the most in group B ( P<0.03 ) . CONCLUSION Perifacet injection and back education including a gym ball exercise program may be more effective than back education alone in relieving pain and improving physical capacity respectively . Back education including gym ball exercise could be used for non-specific Low Back Pain , as the ultimate goal should be to restore function STUDY DESIGN A systematic review of r and omized and nonr and omized controlled trials . SUMMARY OF BACKGROUND DATA Lumbar supports are used in the treatment of low back pain , but also to prevent the onset ( primary prevention ) or recurrences of a low back pain episode ( secondary prevention ) . OBJECTIVES To assess the effects of lumbar sup-ports for prevention and treatment of nonspecific low back pain .  METHODS The Medline , Cinahl , and Current Contents data bases ; the Cochrane Controlled Trials Register up to September 1999 ; and the Embase data base up to September 1998 were all search ed . References of identified trials and systematic review s were review ed and the Science Citation Index used to identify additional trials . Method ologic quality assessment and data extraction were performed by two review ers independently . A quantitative analysis was performed in which the strength of evidence was classified as strong , moderate , limited or conflicting , and no evidence . RESULTS Five r and omized and two nonr and omized preventive trials and six r and omized therapeutic trials were included in the review . Only 4 of the 13 studies were of high quality . There was moderate evidence that lumbar supports are not effective for primary prevention . No evidence was found on the effectiveness of lumbar supports for secondary prevention . The systematic review of therapeutic trials showed that there is limited evidence that lumbar supports are more effective than no treatment , whereas it is still unclear whether lumbar supports are more effective than other interventions for treatment of low back pain . CONCLUSIONS There continues to be a need for high quality r and omized 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 adequate compliance Low back pain is one of the most common and important musculoskeletal disorders . In addition , chronic low back pain can deteriorate the patient 's physical , psychosocial and socioeconomic status . The objective of this quasi-experimental research was to assess the efficacy of an aerobic exercise and health education program in the treatment of chronic low back pain .  Seventy-two patients whose ages ranged from 30 to 50 years who had chronic low back pain were enrolled and r and omly assigned into two groups . Eight men and 28 women in the experimental group participated in a series of 3 health education sessions and an aerobic exercise training program . Nine men and 27 women in the control group received regular health education and a lumbar flexion exercise program . After a 3-month period of treatment , the results revealed the experimental group had statistically significant improvement of pain score and resting pulse rates when compared to the values of the control group ( p-value < 0.001 and < 0.01 , respectively ) . The average serum High Density Lipoprotein-Cholesterol ( HDL-C ) in the experimental group was also significantly higher ( p-value < 0.05 ) than that of the control group . This health education program is useful and may be applicable to patients with chronic low back pain  as an alternative treatment Study Design . Subjective ratings of discomfort were compared between a fixed lumbar support and lumbar support continuous passive motion ( CPM ) device . Objective . To compare a fixed lumbar support with a lumbar support CPM device during prolonged sitting . Summary of Background Data . To prevent low back pain during prolonged sitting , an inflatable lumbar support CPM has been developed . There are no studies that compare static lumbar support with lumbar CPM using the same pressure in the cushions . Methods . A total of 31 male volunteers without low back pain sat in the same chair for a 2-hour period on each of 3 consecutive days under 3 r and omized test methods : 1 , no lumbar support ; 2 , static lumbar support ; and 3 , lumbar support CPM . Each subject rated low back pain , stiffness , fatigue , and buttock numbness on a visual analog scale ( VAS ) .  Fixed lumbar support and CPM device were compared with a same inflation pressure in the cushion . For 10 subjects , the whole body posture and the pressure distribution changes of the human-seat interface during CPM were evaluated . Results . Compared with no lumbar support , a significant improvement in VAS scores for low back pain , stiffness , and fatigue was obtained with both static lumbar support and with lumbar support CPM ( P < 0.005 ) . A significant ( P < 0.005 ) improvement for buttock numbness was obtained only with lumbar support CPM . There were no statistical differences in all VAS scores between the fixed lumbar support and the CPM device . A forward rotation of the pelvic region was obtained during inflation of the cushion during CPM . Significant differences ( P < 0.05 ) were found between cushion inflation and deflation periods both in contact areas and in the peak pressures at the human-seat interface . Conclusion . There were no statistical differences in the subjective ratings of discomfort between the fixed lumbar support and the CPM device
There was no evidence for the effectiveness of lumbar supports due to contradictory outcomes of the studies .
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 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 .
OBJECTIVE : To assess the effectiveness of lumbar supports , education , and exercise in the prevention of back pain in industry .