A systematic review of workplace interventions to prevent low back pain. Lumbar supports and education for the prevention of low back pain in industry: a randomized controlled 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 Lumbar Supports to Prevent Recurrent Low Back Pain among Home Care Workers Lumbar supports for prevention and treatment of low back pain: a systematic review within the framework of the Cochrane Back Review Group. Evaluation of perifacet injections and paraspinal muscle rehabilitation in treatment of low back pain. A randomised controlled trial. The effectiveness of exercise programmes after lumbar disc surgery: a randomized controlled study Evaluation of low back pain and assessment of lumbar corsets with and without back supports. Effectiveness of a Lumbar Support Continuous Passive Motion Device in the Prevention of Low Back Pain During Prolonged Sitting The efficacy of an aerobic exercise and health education program for treatment of chronic low back pain. Are Back Supports Plus Education More Effective Than Education Alone in Promoting Recovery From Low Back Pain?: Results From a Randomized Clinical Trial A cost-benefit analysis of a California county's back injury prevention program. Reduction of Pain-Related Disability in Working Populations: A Randomized Intervention Study of the Effects of an Educational Booklet Addressing Psychosocial Risk Factors and Screening Workplaces for Physical Health Hazards Low back pain in young female gymnasts and the effect of specific segmental muscle control exercises of the lumbar spine: a prospective controlled intervention study Long-term effectiveness of an educational and physical intervention for preventing low-back pain recurrence: a randomized controlled trial. Impact of IT-enabled intervention on MRI use for back pain. Industrial back belts and low back pain: Mechanisms and outcomes [Feasability of a back school assessment programme]. Randomized Clinical Trial of Lumbar Instrumented Fusion and Cognitive Intervention and Exercises in Patients with Chronic Low Back Pain and Disc Degeneration Trunk Muscle Strength, Cross-sectional Area, and Density in Patients With Chronic Low Back Pain Randomized to Lumbar Fusion or Cognitive Intervention and Exercises Isolated lumbar extensor strengthening versus regular physical therapy in an army working population with nonacute low back pain: a randomized controlled trial. Exercises and education as secondary prevention for recurrent low back pain. Clinical Trial of Postoperative Dynamic Back Exercises After First Lumbar Discectomy
A systematic review of r and omised controlled trials was undertaken to evaluate the effectiveness of  workplace interventions  to prevent low back pain .  Potential trials were located by a computerised search supplemented with citation tracking . The method ological quality of the trials was assessed on 11 criteria and the level of evidence for each intervention was determined , based upon the amount , consistency and quality of evidence from the trials . The review located 13 trials that were generally of moderate quality . The trials suggest that work place exercise is effective , braces and education are ineffective , and workplace modification plus education is of unknown value in preventing low back pain 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 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 Context Lumbar supports are commonly used to prevent low back pain , but evidence on their effectiveness is lacking . Contribution This trial assigned 360 home care workers with a history of low back pain to a short course on healthy work habits , with or without worker-directed use of a lumbar support . Over 12 months , participants assigned to lumbar support had a similar number of sick days but fewer days with low back pain than did those assigned to the course only . Implication Adding lumbar supports to instruction on healthy work habits may decrease low back pain recurrence , but not absenteeism , among workers with previous low back pain . The Editors Low back pain is a common problem that results in high medical expenses , work absenteeism , and disability ( 1 ) . The reported 1-year prevalence ranges from 15 % to 40 % in a general population ( 2 ) and from 44 % to 72 % among home care workers ( 3 , 4 ) . Various ergonomic aids are marketed for the prevention of low back pain . Workers frequently use lumbar supports to prevent back pain ( 5 ) , but the effectiveness of such supports remains unclear . Recent systematic review s of the sparse evidence on lumbar supports ( 6 , 7 ) concluded that no evidence exists for the effectiveness of  lumbar supports  in the primary prevention of low back pain in the workplace , but 2 of the 4 included r and omized , controlled trials ( 8 , 9 ) reported that lumbar supports might be effective in workers with a history of low back pain ( secondary prevention ) . However , these findings were derived from subgroup analyses , and evidence from direct research on secondary prevention was not available . In cohort studies , a history of low back pain proved to be a strong predictor for the incidence of new episodes of low back pain ( 1012 ) . Home care workers with a history of low back pain may therefore be well suited to secondary preventive measures . In a previous uncontrolled feasibility study , we found that home care workers who had frequent episodes of low back pain reported adherence rates of 61 % to 81 % with lumbar supports and a 45 % decrease in pain intensity when using lumbar supports ( 13 ) . We design ed the current trial to evaluate the effectiveness of adding worker-directed use of lumbar supports to a short course on healthy working methods to reduce low back pain and work absenteeism among home care workers with a history of low back pain . Methods Design Our r and omized , controlled trial included 2 groups . The control group received a short refresher course on healthy working methods provided by their employer at the start of their employment ( Appendix ) ; primary and secondary care for the management of low back pain was available as usual ( 14 ) . The intervention group received a lumbar support in addition to usual care . The intervention and data collection continued for 12 months after enrollment . The Medical Ethical Committee of the Erasmus University Medical Center , Rotterdam , the Netherl and s , approved the study . Participants All participants were recruited from employees of a large home care organization in Rotterdam . During staff meetings , all present team members completed a brief survey about study inclusion criteria that was distributed and collected by the team managers . We included persons who performed medical care or domestic tasks as a home care worker , were experiencing low back pain symptoms at the time of inquiry or had experienced 2 or more episodes ( on 2 consecutive days ) of low back pain symptoms in the 12 months before the inquiry , did not have specific low back pain ( for example , due to rheumatoid arthritis or vertebral fractures ) , and were not pregnant at the start of the study . Because of a possible association between lumbar supports and increased blood pressure and heart rate , we excluded workers receiving medical treatment for high blood pressure ( 15 ) . Employees who met the inclusion criteria received detailed information about the trial , and those who agreed to participate provided written consent . R and omization In the Netherl and s , home care workers provide 1 of 8 functions , each of which requires different skills and tasks . To ensure a balance in workload and working conditions between the 2 study groups , we stratified r and omization by these 8 functions . We also stratified r and omization by low back pain experience at baseline ( current pain vs. past pain ) . The r and omization process used a computer-generated r and om-number table with 16 strata ( 2 low back pain by 8 workplace functions ) , arranged in blocks of 8 within each stratum . After baseline measurements were completed , colleagues who were not otherwise involved in the study and who were blinded to participants ' baseline characteristics used the r and om-number table to allocate each participant to 1 of the study groups . Intervention All participants in the intervention group were instructed to wear the lumbar supports on working days on which they had or expected they might develop low back pain . Participants could select 1 of 4 types of lumbar supports , supplied by Bauerfeind B.V. , Haarlem , the Netherl and s. LumboTrain and LumboTrain Lady are individually adjustable , hook- and -loop fastening , fully elastic supports that are available in 5 sizes for men or women . LumboLoc and LordoLoc are more structured supports , with integrated stays in the back , that have individually adjustable hook- and -loop fastenings and are available in 6 sizes . Participants chose the lumbar support on the basis of fit and wearing comfort , and they were not given advice to direct their choice from among the 4 available supports . When measured by the research er for the lumbar support , the participants were advised to wear the support for a few days in a row , regardless of low back pain , in order to become accustomed to it . The expected duration of wearability of the lumbar supports was 1 year . The costs of the lumbar supports were 75 for LumboTrain and LumboTrain Lady , 56 for LumboLoc , and 50 for LordoLoc . Outcome Measures Our primary outcome measures were the number of days that participants reported low back pain per month and the number of calendar days of sick leave that participants took during the 12-month intervention . Secondary outcome measures were the average severity of low back pain in the previous week , rated on a scale of 0 to 10 ( 16 ) , and functional status in the previous week , measured by using a Dutch translation of the Quebec Back Pain Disability Scale ( on which 0 corresponds to no disablement and 100 corresponds to fully disabled ) ( 17 , 18 ) . Participants used a calendar to record the days per month on which they experienced low back pain . The intervention group was also asked to record on the calendar whether they had worn the lumbar support ;  thus , the calendars also served as a monitor for adherence to therapy . The calendars were collected for review after 1 , 3 , 6 , 9 , and 12 months . The number of calendar days of sick leave was derived from the staff register and was provided by the home care organization at the end of the study ; this information covered 15 months , from 3 months before the start of the study until the end of the intervention . We could gather only general data on sick leave because employees are not obliged to specify their illness for the employer when they report themselves ill , and registration by a company doctor starts from 6 consecutive weeks of sick leave . We collected information on self-reported , low back painrelated sick leave ; however , this was not a predetermined outcome , and the results should be interpreted cautiously . We administered a question naire at baseline to obtain information on the secondary outcome measures and demographic characteristics ; history of low back pain ; job characteristics ( among others , the Job Content Question naire , Dutch translation [ 19 ] ) ; and other possible confounders , such as additional work ( hours per week and type ) , preference for study group assignment , confidence in pain reduction with use of the lumbar support ( scale of 0 to 10 ) , and confidence in improved functioning ( scale of 0 to 10 ) . Follow-up question naires were administered at 3 , 6 , 9 , and 12 months to measure the secondary outcomes . In the intervention group , these question naires also measured the general satisfaction with the lumbar support ( scale of 0 to 10 ) , several items on comfort of wearing ( 5-point Likert scale ) , and adherence to use of the lumbar support ( 7-point Likert scale ) . We recorded spontaneously reported side events and asked participants about side effects in the question naires . Statistical Analysis We estimated that with a power of 80 % , a significance level of 0.05 , and an SD of 20 days , we would need 140 participants in each study group to demonstrate a difference of 7 days of low back pain per year or sick leave per year between the 2 groups . To prevent inadequate power because of participant withdrawal or low adherence to therapy , we sought to enroll 400 home health care workers . We used a longitudinal marginal model with generalized estimating equation estimates to analyze the data , according to intention-to-treat principles . For the primary outcomes ( number of days of low back pain and number of days of sick leave ) , we used a negative-binomial count data model with a log-link and an exchangeable correlation structure . Covariates ( history of low back pain , body mass index , additional work , and pregnancy during follow-up ) were added to the model separately and were used in the final model if they statistically significantly contributed to the model ( P < 0.05 ) . The scale scores of the secondary outcomes were analyzed by using a normal distributed model and an exchangeable correlation structure . To investigate model misspecification and the effect of missing data , we performed sensitivity analyses in which we used various structures for the working correlation to estimate the models and used multiple imputation techniques to analyze 5 imputed data sets for missing data ( 20 ) . For all analyses , we used SAS , 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 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 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 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 eluci date the role of the lumbar support in surgical corsets in relief of back pain .  Sufferers from back pain were r and omly allocated to corsets with and without lumbar supports . There was significant improvement in those with a support compared with those without . On the other h and 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 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 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 . 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 Back-related injuries have become a major health problem in the workplace , affecting as many as 35 percent of the work force and accounting for about 25 percent of all compensation cl aims . This study evaluates a back injury prevention program  among employees in a northern California county in 1989 - 90 . Six divisions of the county government were selected for the study because they had the highest prevalence of back pain experienced and the most back-related injuries in recent years . Four of the six divisions were r and omly selected as the intervention group and the remaining two , the  control group . Overall , 77 percent or 205 of the targeted employees in the intervention group participated in the study . The intervention group was given an identical health risk assessment ( HRA ) before and after the 1-year back injury prevention program that offered employees a combination of education , training , physical fitness activities , and ergonomic improvement . The control group was neither given the HRA nor offered the program . The back injury and cost data of both the control and intervention groups were collected before and after the 1-year intervention . The results showed a modest overall decline in back pain prevalence rates , but significant improvement in satisfaction and reduction in risky behaviors . Cost-benefit analysis showed the net benefit of introducing back injury prevention program was $ 161,108 , and the return on investment is 179 percent . Therefore , the study offers suggestive evidence for the initial benefits of a back injury prevention program and lends support to the widely held belief that health promotion in the workplace can reduce employee health risks , increase healthful behaviors and attitudes , and improve attitudes toward the employer organization . Whether such intervention will continue to reap benefits in future years depends , to a large extent , on a favorable work environment and the maintenance and continuation of positive behavioral changes Study Design . Cluster r and omized controlled trial with 6 and 8 quarters of follow-up . Objective . To test the effects of giving evidence -based information addressing psychosocial risk factors for pain-related disability and of screening workplaces for physical health hazards at work on reducing new episodes and duration of pain-related and general absence taking . Summary of Background Data . The “ flag strategy ” for h and ling low back pain problems is recommended in many Western countries but , so far , r and omized intervention studies addressing psychosocial risk factors for disability related to low back pain show mixed results . Methods . We followed employees from 39 different work sites in western Denmark , who had received interventions consisting of either a carefully prepared booklet providing evidence -based information on common musculoskeletal pain problems alone or in combination with systematic workplace screening for physical work hazards .  Absence due to pain for at least 7 days and the cumulative numbers of absence days were the main outcome measures . General absence taking was analyzed , too . Company registration s of sickness absence in combination with self-report on the cause of a given absence spell was used to inform absence spells . Results . A total of 3808 of 4006 eligible employees provided information . Among 1063 participants in the control arm , 1458 in the information arm , and 1287 in the  information and workplace screening  arm , 4.6 % , 6.9 % , and 4.6 % , respectively , experienced pain-related absence , and 27.8 % , 27.2 % , and 24.0 % , respectively , experienced general absence taking during follow-up . No positive effect on the risk of the 2 measures of absence or on the cumulative duration of absence among cases was seen . Conclusion . Results did not support population -based interventions addressing psychosocial risk factors for pain-related disability alone or in combination with workplace screening as effective in reducing the risk of pain-related absence taking or the duration of absence Prospect i ve controlled intervention study . To evaluate a specific segmental muscle training program of the lumbar spine in order to prevent and reduce low back pain in young female teamgym gymnasts . Teamgym is a team sport comprising three events : trampette , tumbling and floor programme . In a recent study , it was found that teamgym gymnasts practice and compete despite suffering from back pain . Specific muscle control exercises of the lumbar spine have shown good results in reducing pain intensity and functional disability levels in patients with low back pain . To our knowledge , this type of training has not been studied in an adolescent athletic population before . Fifty-one gymnasts , with and without LBP , 11–16 years old , from three top-level gymnastics team participated in the study comprising 12 weeks . Every day the gymnasts answered a question naire regarding low back pain . After baseline ( 4 weeks ) the intervention group performed a specific segmental muscle training program . Twenty-four gymnasts ( 47 % ) reported low back pain during baseline . Nine gymnasts failed to answer the question naire every day and the following results are based on 42 gymnasts ( intervention group , n = 30 , and control group , n = 12 ) . Gymnasts in the intervention group reported significantly less number of days with low back pain at completion compared to baseline ( P = 0.02 ) . Gymnasts in the control group showed no difference in terms of days with low back pain or intensity of low back pain between baseline and completion . Eight gymnasts ( out of 15 ) with LBP in the intervention group became pain free . Specific segmental muscle control exercises of the lumbar spine may be of value in preventing and reducing low back pain in young teamgym gymnasts OBJECTIVE Low-back pain ( LBP ) is a common and recurrent condition , but the evidence is scarce about effective strategies to prevent recurrence and disability in the longer term . This study investigated the effect of a light exercise program , initiated in the workplace and continued at home , in reducing recurrence of  LBP  episodes  among healthcare workers . METHODS A total of 353 healthcare workers from ten hospitals were enrolled in a r and omized controlled trial ( RCT ) and were r and omized to the intervention or control groups , the latter of which received usual care . The intervention comprised three steps : ( i ) a 2-hour education session , ( ii ) five weekly 90-minutes exercise training sessions in the workplace , and ( iii ) a home-based self-managed exercise program . The main outcome was recurrence of LBP with sick-leave at 24-months follow-up . RESULTS At two-year follow-up , 35 workers ( 24 % ) in the intervention group and 31 workers ( 21 % ) in the control group had at least one LBP recurrence with sick leave . No effect was observed between groups [ odds ratio ( OR ) 1.22 , 95 % confidence interval ( 95 % CI ) 0.67 - 2.23 , P=0.516 ] . The intervention was effective in reducing fear avoidance with a mean reduction of -3.6 ( 95 % CI -4.8- -2.4 ) points on the fear-avoidance beliefs question naire score for physical activity ( FABQ-P ) in the intervention group compared with -1.3 ( 95 % CI -2.2- -0.3 ) points in the control group ( P<0.05 ) . It was also effective in improving muscle endurance with a mean increase of 13.9 ( 95 % CI 3.3 - 24.5 ) minutes on the Sorensen test in the intervention group compared with -8.3 ( 95 % CI-17.5 - 0.9 ) minutes in the control group ( P<0.05 ) . Healthcare utilization was reduced in the intervention group for painkillers , medical visits , imaging and outpatient physiotherapy . CONCLUSION It was not possible to conclude about the effectiveness of a light exercise program to reduce LBP recurrence episodes in the long-term in healthcare workers . However , it was effective to improve muscle endurance , and to reduce fear-avoidance beliefs and healthcare utilization . Further studies are necessary in order to identify effective interventions to reduce LBP recurrence and related sick-leaves BACKGROUND The purpose of this study was to examine the impact of a multifaceted , clinical decision support (CDS)-enabled intervention on magnetic resonance imaging ( MRI ) use in adult primary care patients with low back pain . METHODS After a baseline observation period , we implemented a CDS targeting lumbar-spine MRI use in primary care patients with low back pain through our computerized physician order entry , as well as 2 accountability tools : m and atory peer-to-peer consultation when test utility was uncertain and quarterly practice pattern variation reports to providers . Our primary outcome measure was rate of lumbar-spine MRI use . Secondary measures included utilization of MRI of any body part , comparing it with that of a concurrent national comparison , as well as proportion of lumbar-spine MRI performed in the study cohort that was adherent to evidence -based guideline . Chi-squared , t-tests , and logistic regression were used to assess pre- and postintervention differences . RESULTS In the study cohort preintervention , 5.3 % of low back pain-related primary care visits result ed in lumbar-spine MRI , compared with 3.7 % of visits postintervention ( P < .0001 , adjusted odds ratio 0.68 ) . There was a 30.8 % relative decrease ( 6.5 % vs 4.5 % , P < .0001 , adjusted odds ratio 0.67 ) in the use of MRI of any body part by the primary care providers in the study cohort . This difference was not detected in the control cohort ( 5.6 % vs 5.3 % , P = .712 ) . In the study cohort , adherence to evidence -based guideline in the use of lumbar-spine MRI increased from 78 % to 96 % ( P = .0002 ) . CONCLUSIONS CDS and associated accountability tools may reduce potentially inappropriate imaging in patients with low back pain The recent increased utilization of industrial back belts as personal protective equipment in the workplace has generated considerable controversy among occupational health and safety professionals in the United States . The purpose of this article is to review the literature regarding proposed mechanisms of action of these devices and studies related to outcome of belt utilization in the prevention of  low back pain and disability  in the workplace . At the present time , neither the suspected mechanisms of action nor the efficacy of these devices in the primary , secondary , and tertiary prevention of work-related low back pain has been adequately demonstrated in clinical trials . As a result , generally accepted guidelines regarding the safe use of belts in the occupational setting have not been established . Based on this review it is recommended that further well-controlled , prospect i ve , r and omized clinical trials are necessary to evaluate the effectiveness of these devices as personal protective equipment . During the interim , the decision to prescribe belts to employees in the workplace should be at the discretion of an adequately trained occupational health care provider . These devices should not be provided as an alternative to appropriate administrative and /or engineering controls OBJECTIVES Testing the feasability of a back school assessment programme in two population s of people suffering with chronic low back pain . MATERIAL Twenty-nine patients were r and omly included in a chronic low back pain assessment programme ( 15 patients waiting for back school and 14 patients after back school ) . METHODS The programme was made of the measure of the age , the sex , the body mass index , the pain ( VAS , St Antoine Hospitals Pain Question naire - SAPQ ) , the anxiety , the depression , the RIII nociceptive reflex , the fingertip-floor distance , the strength of the flexors and of the extensors of the lumbar spine ( CybexR 6000 isocinetic dynamometer ) , the lumbar function ( EIFEL , Dougados ) , the Dallas self- question naire . The Back School Education programme was made of five sessions ( information , ergonomics , extension exercises ) . RESULTS Comparing the two population s we did not observe significant differences concerning the age , the body mass index , the anxiety and depression levels , the pain ( VAS , SAPA , RIII nociceptive reflex ) , the lumbar stiffness , the lumbar disability , the quality of life ; the patients who had achieved back school had a peak torque of the flexors and a ratio flexors/extensors significantly lower . Comparing men and women we observed significant differences in the SAPQ and the muscles strength . The SAPQ was correlated with the depression and anxiety levels , the lumbar disability , the peak torque of the flexors . The VAS was correlated with the age , the lumbar stiffness , the depression level , the peak torque of the flexors . The RIII nociceptive reflex was correlated with the ratio flexors/extensors . CONCLUSION This study present some biases but this objective assessment of chronic low back pain appeared as feasible . The pain must be investigated in term of intensity , expression , alleviation . The impairment of the flexors muscles in women and after back school has to be confirmed . The different tests are relevant to determinate the efficiency of the back school programmes Study Design . Single blind r and omized study . Objectives . To compare the effectiveness of  lumbar instrumented fusion with cognitive intervention and exercises in patients with chronic low back pain and disc degeneration . Summary of Background Data . To the authors ’ best knowledge , only one r and omized study has evaluated the effectiveness of lumbar fusion . The Swedish Lumbar Spine Study reported that lumbar fusion was better than continuing physiotherapy and care by the family physician . Patients and Methods . Sixty-four patients aged 25–60 years with low back pain lasting longer than 1 year and evidence of disc degeneration at L4–L5 and /or L5–S1 at radiographic examination were r and omized to either lumbar fusion with posterior transpedicular screws and postoperative physiotherapy , or cognitive intervention and exercises . The cognitive intervention consisted of a lecture to give the patient an underst and ing that ordinary physical activity would not harm the disc and a recommendation to use the back and bend it . This was reinforced by three daily physical exercise sessions for 3 weeks . The main outcome measure was the Oswestry Disability Index . Results . At the 1-year follow-up visit , 97 % of the patients , including 6 patients who had either not attended treatment or changed groups , were examined . The Oswestry Disability Index was significantly reduced from 41 to 26 after surgery , compared with 42 to 30 after cognitive intervention and exercises . The mean difference between groups was 2.3 ( −6.7 to 11.4 ) ( P = 0.33 ) . Improvements inback pain , use of analgesics , emotional distress , life satisfaction , and return to work were not different . Fear-avoidance beliefs and fingertip-floor distance were reduced more after nonoperative treatment , and lower limb pain was reduced more after surgery . The success rateaccording to an independent observer was 70 % after surgery and 76 % after cognitive intervention and exercises .  The early complication rate in the surgical group was 18 % . Conclusion . The main outcome measure showed equal improvement in patients with chronic low back pain and disc degeneration r and omized to cognitive intervention and exercises , or lumbar fusion Study Design . A r and omized study . Objectives . To compare muscle strength , cross-sectional area , and density of the back muscles in two categories of patients with chronic low back pain , r and omized to either lumbar fusion or cognitive intervention and exercises . Summary of Background Data . In two clinical trials , patients with chronic low back pain plus disc degeneration and postlaminectomy syndrome , respectively , were r and omized to either lumbar fusion or cognitive intervention and exercises . We have previously reported that results for the primary outcome were similar at the 1-year follow-up examination . Methods . As the treatment alternatives and test procedures were identical , the two trials were merged into one . A total of 124 patients 25 to 60 years of age were included .  Muscle strength , measured by isokinetic test device and by the Biering-Sørensen Test , was measured in 112 patients , and the cross-sectional area and density of the back muscles were measured in 61 patients at the inclusion and at the 1-year follow-up examination . Results . The exercise group performed significantly better in muscle strength than did the lumbar fusion group , with the mean difference at 184 Nm ( 95 % confidence interval , 64–303 Nm ; P = 0.003 ) and for the Biering-Sørensen Test 21 seconds ( 95 % confidence interval , 6–36 seconds ; P = 0.006 ) . The density at L3–L4 decreased in the lumbar fusion group but remained unchanged in the exercise group . The mean difference was 5.3 HU ( 95 % confidence interval , 1.1–9.5 HU ; P = 0.01 ) . The cross-sectional area was unchanged in both groups . Conclusions . Patients with chronic low back pain who followed cognitive intervention and exercise programs improved significantly in muscle strength compared with patients who underwent lumbar fusion . In the lumbar fusion group , density decreased significantly at L3–L4 compared with the exercise group OBJECTIVE To evaluate the effectiveness of specific lumbar extensor training compared with regular physical therapy ( PT ) in workers with nonspecific nonacute low back pain ( LBP ) . DESIGN A multicenter r and omized controlled trial with 1-year follow-up . SETTING PT department in ( military primary care ) health centers . PARTICIPANTS Predominantly male soldiers ( N=129 ) with 4 weeks or more of low back complaints who were referred by the health center 's general practitioner for PT ( mean age , 35.9+/-10.8 y ; range , 20 - 56 y ) , of whom 127 r and omized participants were included in the analyses . One patient withdrew because of adverse effects during treatment . INTERVENTIONS Participants were assigned to 1 of 2 treatment programs : ( 1 ) a 10-week device-supported isolated lumbar extension training , twice a week , or ( 2 ) regular PT , mainly consisting of exercise therapy and aerobic activities . MAIN OUTCOME MEASURES Functional status ( Rol and -Morris Disability Question naire , Patient-Specific Functional Scale ) and global perceived effect were assessed in the short term ( 5 wk , 10 wk ) and long term ( 6 mo , 12 mo ) . RESULTS Both groups showed a favorable development in main outcomes over time : short-term improvements ( after 10 weeks of treatment ) remained stable or even slightly increased throughout the 12-month follow-up . No significant differences between the 2 groups were shown for any of the outcome measures , at any time . CONCLUSIONS Consistent with prior evidence , specific back strengthening does not seem to offer incremental benefits in LBP management compared with regular PT care that mainly consists of general exercise therapy . ( IS RCT N identifier IS RCT N19334317 . BACKGROUND AND PURPOSE Exercise and education is a common physiotherapy approach in the prevention of low back pain . A Mensendieck exercise programme consisting of exercises and ergonomical education has , in a previous study , been shown to be effective in preventing recurrent low back pain during one-year follow-up . The purpose of the present study was to evaluate the long-term effect of the Mensendieck exercise programme on people with recurrent episodes of low back pain who , when entering the study , had finished treatment for their last episode of low back pain . METHOD A r and omized controlled clinical trial in which 41 women and 36 men were allocated to either a Mensendieck or control group . The Mensendieck subjects received 20 group sessions of exercises and ergonomical education over 13 weeks . The control subjects were not offered any prophylactic therapy , but were free to receive treatment or exercises . Outcome measures were the number of recurrences of low back pain , sick leave , low back function and general functional status . RESULTS At three-year follow-up , 11 subjects had been lost to the study . Survival analysis showed a significant reduction ( p = 0.02 ) in subjects experiencing recurrent low back pain in the Mensendieck group compared to the control group . Significant improvements in pain and function scores were reported in both groups . There was no significant difference between the groups in pain , function or sick leave . CONCLUSION A Mensendieck exercise programme seems efficient in reducing recurrent episodes of low back pain at three-year follow-up , but it did not influence sick leave , pain or function scores Ninety-six patients who had undergone first-time discectomy for herniated lumbar intervertebral discs were consecutively r and omized to two physical rehabilitation programs : a program of high-intensity , dynamic back extension and abdominal exercises with occurrence of low back pain being the limiting factor or a traditional program of mild , generally mobilityimproving exercises within pain limits . Both groups underwent 14 hours of treatment during a 6-week period 5 weeks after surgery . At 26 weeks ' follow-up , results indicated that patients who did the high-intensity exercises experienced greater success with regard to the patient disabilityindex and work capabilities . After 1 year , a trend that favored the use of intensive exercises could be observed . No differences were found in pain or objective measurements . A rehabilitation program of intensive exercises with occurrence of back pain being the limiting factor appears to increase patient behavioral support , result ing in work capacity improvements and patient self-rated disability levels . The results indicate that a 6-wk , 14-hr postoperative rehabilitation program is inadequate if objective postoperative deficit improvements are the desired goal
Since three of four RCTs on lumbar supports reported no effect , there is no evidence for the effectiveness of lumbar supports .
The four RCTs on exercise consistently reported a positive effect , indicating limited evidence for the effectiveness of exercise .
CONCLUSION There is no evidence for the effectiveness of lumbar supports or education in the primary prevention of low back pain at the workplace .
There is limited evidence for the efficacy of exercise , and the effect that can be obtained is moderate .
OBJECTIVE To up date the evidence on the effectiveness of lumbar supports , education and exercise in the primary prevention of low back pain at the workplace .