title: Secondary Prevention of Low‐Back Pain: A Clinical Trial Teaching and Social Support: Effects on Knowledge, Attitudes, and Behaviors to Prevent Low Back Injuries in Industry The Influence of Prophylactic Orthoses on Abdominal Strength and Low Back Injury in the Workplace Primary Prevention of Back Symptoms and Absence from Work: A Prospective Randomized Study Among Hospital Employees The Cost‐Effectiveness of a Back School Program in Industry: A Longitudinal Controlled Field Study Assessing the quality of randomized controlled trials: an annotated bibliography of scales and checklists. Physiotherapy exercises and back pain: a blinded review. Effects of an exercise program on sick leave due to back pain. An evaluation of a weightlifting belt and back injury prevention training class for airline baggage handlers.
abstract: A clinical trial , aim ed at secondary prevention of low-back pain , was performed in 142 hospital employees reporting at least three annual episodes of this condition . Participants were r and omly assigned to one of three groups : a calisthenics program ( CAL ) for 3 months with biweekly sessions of flexion exercises , a back school program ( 5 sessions ) , and a control group . The effectiveness of the two intervention programs was evaluated over a 1-year period . Baseline preintervention data and evaluation at the end of 3 months of intervention and after an additional 6 months were collected . A monthly surveillance for the whole year showed a mean of 4.5 “ painful months ” in the CAL group versus 7.3 and 7.4 months in the back school and control groups , respectively ( P < 0.0001 ) . The superiority of the CAL group was achieved partly because of the significant increase in trunk forward flexion and to initial increment in abdominal muscle strength . The increased trunk flexion was associated with the rate of participation in the CAL sessions . Further research is needed to answer the question of “ intensity versus type of exercise ” by comparing different intervention programs , with similar intensity This study was funded in part by NIH grant AR36308 The authors thank the employees of the United States Postal Service and the American Postal Workers Union ( APWU ) , Boston Metro Area Local , and Maith and lers Local 301 for their help and cooperation ; therapists from the Department of Rehabilitation Services , Bngham and Women 's Hospital for help in training workers ; and Ms Nancy Tanner for This study was design ed to determine the effect of multimodal intervention and the prevention of back injury , and to evaluate the adverse side effects of using a lumbosacral corset in the workplace . Subjects were 90 male warehouse workers r and omly selected from over 800 employees at a grocery distribution center . Subjects were assigned to three groups : true controls , no back school , no brace orthoses ; back school only ; and back school plus wearing a custom molded lumbosacral orthosis . Comparisons of pre-testing and 6-month follow-up posttesting for abdominal strength , cognitive data , work injury incidence and productivity and use of health care services were evaluated . Controls and training-only group showed no changes in strength productivity or lost time . Orthoses and training-group showed no changes in strength productivity or accident rate ; however , they showed substantially less lost time . This study supports the concept of using education and prophylactic bracing to prevent back injury and reduce time loss . It appears that the use of intermittent prophylactic bracing has no adverse affects on abdominal muscle strength and may contribute to decreased lost time from work injuries The personnel at a geriatric hospital were r and omized into two groups . One group was allowed to exercise during working hours to improve back muscle strength , endurance , and coordination . The other group did not participate in the exercise program and received no further advice or information . After 13 months , the training group had increased back muscle strength . One subject had been absent from work 28 days in the training group whereas 12 subjects had been absent 155 days from work because of low back pain in the control group ( P<0.004 ) . The back pain complaints and intensity of back pain in the training group also decreased in a statistically significant way . Every hour spent by the physiotherapist on the training group reduced the work absence among the participants by 1.3 days , result ing in a cost/benefit ratio greater than 10 To define the cost-effectiveness of a back school program in industry , a controlled longitudinal field study was carried out in a Dutch bus company . The experimental group received a program consisting of information on back care , physical fitness , nutrition , stress , and relaxation . Objective data on absenteeism were collected and compared during a 6-year period for the control and experimental groups . Results showed that a tailor-made back school program reduced absenteeism by at least 5 days per year per employee , therefore being cost-effective to industry . A reduction was not observed in incidence , but in mean length of absenteeism . This effect turned out to be persistent during a 2-year period following the program Assessing the quality of r and omized controlled trials ( RCTs ) is important and relatively new . Quality gives us an estimate of the likelihood that the results are a valid estimate of the truth . We present an annotated bibliography of scales and checklists developed to assess quality . Twenty-five scales and nine checklists have been developed to assess quality . The checklists are most useful in providing investigators with guidelines as to what information should be included in reporting RCTs . The scales give readers a quantitative index of the likelihood that the reported methodology and results are free of bias . There are several shortcomings with these scales . Future scale development is likely to be most beneficial if questions common to all trials are assessed , if the scale is easy to use , and if it is developed with sufficient rigor OBJECTIVE --To determine the quality of r and omised controlled trials of exercise therapy for back pain . DESIGN --Computer aided search of published papers and blinded assessment of the methods of studies . SUBJECTS--23 r and omised controlled trials , of which 16 studied exercise therapy given by physiotherapists to individual patients with back pain . Other conservative treatments could be included . MAIN OUTCOME MEASURES --Score for quality of methods ( based on four main categories : study population , interventions , measurement of effect , and data presentation and analysis ) and main conclusion of author(s ) with regard to exercise therapy . RESULTS --Only four studies scored more than 50 points ( maximum 100 ) , indicating that most were of poor quality . Six studies found that exercise was better than reference treatments and 10 reported it to be no better or worse than the reference treatment . Those reporting positive results tended to have higher methods scores ( 4/6 positive v 4/10 negative scored greater than or equal to 42 ) . CONCLUSIONS --No conclusion can be drawn about whether exercise therapy is better than other conservative treatments for back pain or whether a specific type of exercise is more effective . Further trials are needed in which greater attention is paid to methods of study The purpose s of this study were to evaluate the effect of a weekly exercise program on  short-term sick leave ( less than 50 days ) attributable to back pain and to determine whether changes in absenteeism were related to changes in cardiovascular fitness . Subjects were r and omly assigned to an exercise group ( n = 58 ) and a control group ( n = 53 ) .  Sick leave attributable to back pain was determined in the intervention period of 1 1/2 years and a comparable 1 1/2-year period prior to the study . In the exercise group , the number of episodes of back pain and the number of sick-leave days attributable to back pain in the intervention period decreased by over 50 % . Absenteeism attributable to back pain increased in the control group . The decrease in sick leave in the exercise group was not accompanied by any change in cardiovascular fitness . Suggestions for establishing exercise programs are given This study evaluated the efficacy of a commercially available weightlifting belt in relation to reduction of lumbar injury incident rate and severity of injuries over an 8-month period . The study used 642 baggage h and lers working for a major airline company as participants . Four treatment groups were r and omly selected : a group receiving the belt only , a group receiving a 1 h training class only , a group receiving both a belt and a 1 h training class , and a control group receiving nothing . Two treatment groups were added which contained participants who discontinued use of the belt prior to the end of an 8-month study period . Results indicated that there were no significant differences for total lumbar injury incident rate , restricted workday case injury incident rate , lost workdays and restricted workdays rate , and worker 's compensation rates . There was , however , a marginal significant difference for lost workday case injury incident rate . Groups with participants who wore the belt for a while then discontinued its use had a higher lost day case injury incident rate than did either the group receiving training only or the control group . Compliance was an overriding factor as the belt question naire response indicated that 58 % of participants in the belt groups discontinued use of the belt before the end of 8 months . Comments made on the survey forms indicated that the belt was too hot . Similarly , comments suggested that the belt rubbed , pinched , and bruised ribs . Based on these results , the weightlifting belt used for this study can not be recommended for use in aid of lifting during daily work activities of baggage h and lers . Results indicate that use of the belts may , in fact , increase the risk of injury when not wearing a belt following a period of wearing a belt . As industries are experimenting with the use of belts , it is recommended that great care be taken in any further evaluation and close attention directed towards injuries which occur when not wearing the belt following a period of wearing the belt ( ie , off-the-job injuries )
target: 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 .
background: OBJECTIVE : To assess the effectiveness of lumbar supports , education , and exercise in the prevention of back pain in industry .