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Lumbar Supports and Education for the Prevention of Low Back Pain in Industry
A Randomized Controlled Trial
Mireille N. M. van Poppel, MSc;
Bart W. Koes, PhD;
Trudy van der Ploeg, MD;
Tjabe Smid, PhD;
Lex M. Bouter, PhD
JAMA. 1998;279:1789-1794.
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 randomized controlled trial with a factorial design.
Setting.— The cargo department of an airline company in the Netherlands.
Participants.— A total of 312 workers were randomized, of whom 282 were available for the 6-month follow-up.
Interventions.— 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.
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 cannot be recommended in the prevention of low back pain in industry.
From the Institute for Research in Extramural Medicine (Ms van Poppel and Drs Koes, Smid, and Bouter) and the Faculty of Movement Sciences (Dr Smid), Vrije Universiteit, Amsterdam, the Netherlands; and the Department of Health, Safety, and Environment, KLM Royal Dutch Airlines, Schiphol Airport, the Netherlands (Drs van der Ploeg and Smid).
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