The effect of a back belt on torso motion--survey in an express package delivery company

Lumbar supports for prevention and treatment of low back pain

BACKGROUND

Lumbar supports are used in the treatment of low-back pain patients, to prevent the onset of low-back pain (primary prevention) or to prevent recurrences of a low-back pain episode (secondary prevention).

OBJECTIVES

To assess the effects of lumbar supports for prevention and treatment of non-specific low-back pain.

SEARCH STRATEGY

We updated the search in the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and CINAHL to December 2006. We also screened references given in relevant reviews and identified trials, and contacted experts to identify additional RCTs.

SELECTION CRITERIA

Randomized controlled trials that reported on any type of lumbar supports as preventive or therapeutic intervention for non-specific low-back pain.

DATA COLLECTION AND ANALYSIS

One review author generated the electronic search. Two review authors independently identified trials that met the inclusion criteria. One review author extracted data on the study population, interventions, and final results. The methodological quality and the clinical relevance were independently assessed by two review authors. Because it was not possible to perform a quantitative analysis, we performed a qualitative analysis in which the strength of evidence on the effectiveness of lumbar supports was classified as strong, moderate, limited, conflicting, or no evidence.

MAIN RESULTS

Seven preventive studies (14,437 people) and eight treatment studies (1361 people) were included in this updated review. Overall, the methodological quality of the studies was rather low. Only five of the fifteen studies met 50% or more of the internal validity items. There was moderate evidence that lumbar supports are not more effective than no intervention or training in preventing low-back pain, and conflicting evidence whether lumbar supports are effective supplements to other preventive interventions. It is still unclear if lumbar supports are more effective than no or other interventions for the treatment of low-back pain.

AUTHORS' CONCLUSIONS

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 randomized 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.

WITHDRAWN: Lumbar supports for prevention and treatment of low-back pain

BACKGROUND

Lumbar supports are used in the treatment of low back pain patients to make the impairment and disability vanish or decrease. Lumbar supports are also used to prevent the onset of low back pain (primary prevention) or to prevent recurrences of a low back pain episode (secondary prevention).

OBJECTIVES

The objective of this systematic review was to assess the effects of lumbar supports for prevention and treatment of non-specific low back pain.

SEARCH STRATEGY

We searched the Medline, Cinahl and Current Contents databases and the Cochrane Controlled Trials Register up to September 1999, and the Embase database up to September 1998. We also screened references given in relevant reviews and identified controlled trials, and used Science Citation Index to identify additional controlled trials.

SELECTION CRITERIA

Controlled clinical trials that reported on any type of lumbar supports as preventive or therapeutic intervention for non-specific low back pain were included.

DATA COLLECTION AND ANALYSIS

One author extracted data from the trials considering characteristics of the study population, characteristics of the interventions and the final results for each outcome measure. The author compared these findings to data regarding the same characteristics of the same studies published already in other reviews. The methodological quality was independently assessed by two authors. Because it was not possible to perform a quantitative analysis, a qualitative meta-analysis was performed in which the strength of evidence on the effectiveness of lumbar supports was classified as being strong, moderate, limited or conflicting, and no evidence.

MAIN RESULTS

Five randomized and two nonrandomized controlled preventive trials and six randomized therapeutic trials were included in our review. Overall the methodological quality of the studies included in our review was rather low. Only four of the thirteen studies scored positive on 50% or more of the the internal validity items. There was moderate evidence that for primary prevention lumbar supports are not more effective than other types of treatment or no intervention. 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, while it is still unclear if lumbar supports are more effective than other interventions for treatment of low back pain.

AUTHORS' CONCLUSIONS

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 realisation of an adequate compliance.

Effect of a Back Belt on Reaching Postures

OBJECTIVE

The present study investigated the effect of a back belt on reach actions.

SUBJECTS

Sixteen undergraduate college students (8 male students, 8 female students) ranging in age from 18 to 22 years. Thirteen subjects were included in the final analysis.

SETTING

The Department of Psychology at Miami University, Oxford, Ohio

METHODS

Using a well-established set of procedures developed in our laboratory for studying reaching, seated adult participants reached for and retrieved an object placed at various distances from them. Reach distances included values both closer than and farther than each subject's maximum seated reach. The reach task had 2 conditions: picking up and retrieving a small block and skewering and retrieving a small bead with a needle. For each task condition, each subject either wore the belt or did not use a belt.

RESULTS

Results indicate that when subjects wore the belt while reaching, they tended to have initial transition points (sitting to nonsitting) closer to their bodies than while not wearing the belt. That is, for a distant object, subjects were more likely to raise their bodies out of the chair rather than perform an extreme seated reach, possibly acting to preserve a greater margin of safety.

CONCLUSIONS

The back belt consistently modified reaching postures by limiting extreme ranges of motion during a task that required enhanced stability. Furthermore, the methodology and analysis presented in this article when applied to chiropractic will allow us to begin thoughtful investigation of the effects of chiropractic adjustments on postural transitions and margin of safety.

The effect of wearing a back belt on spine kinematics during asymmetric lifting of large and small boxes

STUDY DESIGN

A crossover design was used to evaluate kinematic measurements collected with an infrared-based motion measurement system.

OBJECTIVES

To evaluate belt effects on spine kinematics during asymmetric lifting of large and small boxes and to test for carryover effects between trials from belts.

SUMMARY OF BACKGROUND DATA

Conflicting evidence in the literature exists regarding whether belts are beneficial or detrimental to manual material handlers. Studies have not examined belt effects when lifting different sized boxes, nor carryover effects from belts.

METHODS

Twenty-eight subjects with manual-handling experience (17 male and 11 female) were randomly assigned to lift either a large or small box (weighing 9.4 kg), from a sagittally symmetric origin at pallet height to a 79 cm height, 60 degrees to the right. Spine flexion, lateral bending and twisting, hip and knee flexion, and angular velocity measurements of the torso with respect to the pelvis were collected for each of three lifting periods, 50 lifts each at 3 lifts per minute, with 18-minute breaks between periods.

RESULTS

Belts significantly reduced maximum spine flexion, spine flexion and extension angular velocities, and torso left lateral bending angular velocity, and increased hip and knee flexion, regardless of box size. When lifting large boxes, belts significantly reduced torso right lateral bending and torso left twisting. No significant differential carryover effects were detected from belts.

CONCLUSIONS

Subjects with belts lifted more slowly and used more of a squat-lift technique, regardless of box size. Belts reduced more torso motions while lifting large boxes.

Lumbar supports for prevention and treatment of low back pain: a systematic review within the framework of the Cochrane Back Review Group

STUDY DESIGN

A systematic review of randomized and nonrandomized 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 databases; the Cochrane Controlled Trials Register up to September 1999; and the Embase database up to September 1998 were all searched. References of identified trials and systematic reviews were reviewed and the Science Citation Index used to identify additional trials. Methodologic quality assessment and data extraction were performed by two reviewers 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 randomized and two nonrandomized preventive trials and six randomized 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 randomized 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.

Mechanisms of action of lumbar supports: a systematic review

STUDY DESIGN

A systematic review and meta-analysis of studies on the putative mechanisms of action of lumbar supports in lifting activities.

OBJECTIVE

To summarize the evidence bearing on the putative mechanisms of action of lumbar supports.

SUMMARY OF BACKGROUND DATA

A restriction of trunk motion and a reduction in required back muscle forces in lifting are two proposed mechanisms of action of lumbar supports. Available studies on these putative mechanisms of action of lumbar supports have reported contradictory results.

METHODS

A literature search for controlled studies on mechanisms of action of lumbar supports was conducted. The methodologic quality of the studies was assessed. The evidence for the two proposed mechanisms of action of lumbar supports was determined in meta-analyses.

RESULTS

Thirty-three studies were selected for the review. There was evidence that lumbar supports reduce trunk motion for flexion-extension and lateral bending, with overall effect sizes of 0.70 (95% confidence interval [CI] 0.39-1. 01) and 1.13 (95% CI 0.17-2.08), respectively. The overall effect size for rotation was not statistically significant (0.69; 95% CI -0. 40-4.31). There was no evidence that lumbar supports reduce the electromyogram activity of erector spinae muscles (effect size of 0. 09; 95% CI -0.41-0.59) or increase the intra-abdominal pressure (effect size of 0.26; 95% CI -0.07-0.59).

CONCLUSION

There is evidence that lumbar supports reduce trunk motion for flexion-extension and lateral bending. More research is needed on the separate outcome measures for trunk motion before definite conclusions can be drawn about the work conditions in which lumbar supports may be most effective. Studies of trunk motion at the workplace or during specified lifting tasks would be especially useful in this regard.