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Document: 17
The effectiveness of four interventions for the prevention of low back pain.
Lahad A, Malter A D, Berg A O, Deyo R A.
The effectiveness of four interventions for the prevention of low back
pain.
Journal of the American Medical Association,
1994,
272(16),
pp.1286-1291
Record status
This record is a structured abstract written by CRD reviewers. The original
has met a set of quality criteria.
Author's objective
To evaluate the effectiveness of four strategies to prevent low back pain in
the clinical setting. Type of intervention
Prevention
Specific interventions included in the review
Back and aerobic exercise, education, mechanical supports (corsets) and risk
factor modification.
Participants included in the review
Currently asymptomatic subjects with or without prior acute back pain.
Subjects with a history of chronic back pain were excluded.
Outcomes assessed in the review
Prevention of low back pain, also, knowledge about back pain, absenteeism from
work.
Study designs of evaluations included in the review
Randomised controlled trials, controlled trials, prospective observational
designs, case-control studies, case series, and prospective and
cross-sectional epidemiological studies.
What sources were searched to identify primary studies?
Medline was searched between 1966 and 1993. Bibliographies of identified
articles were searched to ensure that all pertinent articles had been
obtained. Back pain specialists reviewed the final bibliography for
completeness.
Criteria on which the validity (or quality) of studies was assessed
Studies had to contain original data about the prevention of low back pain for
asymptomatic individuals.
How were the judgements of validity (or quality) made?
Not stated.
How were decisions on the relevence of primary studies made?
Not stated.
How was the data extracted from primary studies?
Not stated.
Number of studies included
64 studies about the prevention of low back pain, including 2 randomised
controlled trials of exercise interventions (n=194), 3 randomised controlled
trials of educational interventions (n=329) and 2 randomised controlled trials
of exercise plus educational interventions (n=208).
How were the studies combined?
Narrative review, with studies graded according to the strength of their
design.
How were differences between studies investigated?
By type of study design. Differences between interventions were also
mentioned, (e.g. for educational interventions 'education' varied from being
given a pamphlet to being enrolled in a back school programme).
Results of the review
Exercise:
4 randomised controlled trials showed a statistically significant short-term
benefit from an exercise intervention.
1 controlled trial found no improvement in duration of recurrent back pain
episodes although subjects in the exercise group had significantly improved
aerobic capacity compared to the control group.
12 observational studies reported mixed support for decreased low back pain or
increased flexibility.
Education:
5 randomized controlled trials, only 1 of which reported a significant
decrease in subsequent low back pain, (this trial did however, combine
education with an exercise programme). Of the remaining 4 trials, although
they overall had negative results, 3 found significant differences in
intermediate outcomes, (e.g. increased knowledge about back pain).
5 out of 6 controlled trials also reported non-significant results. 1
controlled trial to prevent back pain associated with pregnancy, reported that
women in the intervention group had significantly less self-reported severe
back pain than controls (32% vs 54%).
4 observational studies reported mostly non-significant results from education
interventions.
Mechanical supports (limited to corsets): 1 randomised controlled trial
reported no differences in mean rates of work loss between the intervention
and control group. The other randomised controlled trial reported that the
intervention group, compared to the control group had increased knowledge and
decreases in days lost from work. However, no differences were found in
changes in abdominal strength, productivity and rates of injuries between the
groups.
Risk factor modification:
Epidemiological studies have linked smoking, obesity and psychological factors
to the development of back pain, but no studies have examined the effect of
modifying these risk factors on back pain risk.
Was any cost information reported?
No.
Author's conclusions
There is limited evidence to recommend exercise to prevent low back pain in
asymptomatic individuals. There is insufficient evidence to recommend other
prevention strategies. These conclusions are primarily based on studies
conducted in the workplace rather than in clinical settings and so should be
viewed with caution.
CRD commentary
The original objectives of this study, which were to evaluate the
effectiveness of four interventions for preventing low back pain in the
clinical setting, seem to have been only partially met, as out of the 3 types
of intervention (exercise, education and mechanical supports) only one study
was carried out in a non-work environment.
It is not clear how decisions were made about which of the 64 studies reviewed
were included and which were excluded.
Subject index terms
Subject Indexing from the National Library of medicine: Nicotine/tu
[Therapeutic-Use]; Smoking-Cessation; Administration,-Topical;
Confounding-Factors-Epidemiology; Nicotine/ad [Administration-&-Dosage];
Randomized-Controlled-Trials; Human
Correspondence address
Dr Malter, Back Pain Outcomes Assessment Team, University of Washington,
JD-23, Seattle, WA 98195, USA.
Copyright
University of York, 1998
Database no.: DARE-940860
