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Research Review Corner: Preventing Back Problems |
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Written by Shawn Thistle
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Background Information:
It is well known that back problems (BPs) are common and very expensive
on an individual and societal level. There is a vast amount of
scientific literature on back pain, and a substantial number of
high-quality trials now exist to provide an evidentiary basis for the
prevention of new back pain episodes. The purpose of this systematic
review was to analyze these prospective controlled trials to evaluate
the effectiveness of various prevention interventions aimed at reducing
BPs in working-aged adults.
Pertinent Results:
- Interventions evaluated in the studies included clinical or
educational approaches (exercise or education), personal appliances
(back supports or shoe inserts), ergonomic equipment (lift assists
etc.), activity modifications (changes in physical activities or work
duties), and administrative or social interventions (such as work
policies or social changes).
- 20 prospective controlled trials
met inclusion criteria and evaluated the following interventions:
exercise (8), ergonomic/back education (4), stress management (1),
lumbar back support belts (4), shoe inserts (2), and programs for
reducing lifting tasks as work via policy change, training, or
mechanical lifting devices (4)
- All 20 trials included had
high quality scores, 90 per cent investigated workplace settings, and
50 per cent involved health care workers
- five trials measured objective outcomes, while 15 measured only subjective outcomes
- Meta-analysis was not performed due to substantial heterogeneity of interventions, outcomes, and study designs
- Exercise was the only intervention found to be effective - 7/8 trials reported statistically significant reduction in BPs
- five
of the seven successful exercise programs included 45-60 minutes of
supervised exercise, twice per week for 3-12 months (most also
encouraged additional exercise without supervision)
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Specific exercise techniques included McKenzie, active and passive back extensions, core stabilization, “Williams” exercises1, and Mensendieck trunk exercises2
- NO other intervention was found effective in reducing BPs
- Negative
results were found in all studies on ergonomic/back education, stress
management, lumbar supports, shoe inserts, and programs for reducing
lifting tasks
Conclusions and Practical Application:
This systematic review had very consistent results, providing strong
evidence to either support or refute the use of various interventions
for reducing back problems in working-aged adults. In summary, there is
strong evidence that exercise programs are effective and that other
interventions (ergonomic, back school, stress management, back
supports, shoe inserts, and programs for reducing lifting) are not
effective for reducing back problems.
The positive results regarding exercise from this review are consistent with previous literature reviews on this topic 3-5.
The effectiveness of varied exercise approaches may suggest a general
benefit of exercise beyond specific physiological goals of increasing
strength, endurance or flexibility. Although it cannot be claimed with
certainty, it is within reason that patients performing exercise
interventions gain a sense of confidence and self-empowerment from
exercise that can improve their clinical outcome, and health in
general. The take- home point, from this study (and others,) is to get
your back pain patients active and incorporate some form of exercise in
their plan of management!
Study Methods:
This study employed rigorous methodology that is consistent with
systematic review recommendations from the Cochrane Back Review Group.
Three authors independently reviewed potential studies. Articles were
included only if they were high-quality, prospective randomized
controlled trials (RCTs) that assigned interventions aimed at reducing
back problems to individuals or pre-existing groups; or other
controlled trials that assigned such interventions to pre-existing
groups that appeared to be equivalent at baseline for factors that
could affect outcomes. All studies had to adequately present
quantitative results and utilize acceptable clinical or functional
outcome measures:
- Objective outcomes: filing a work injury claim, work time loss, and/or costs related to back pain episodes
- Subjective
outcomes: patient recall of frequency/duration, symptom severity,
functional disability, or back treatment or limitations related to back
pain
“Back problems” in this review were defined as back symptoms or
activity limitation caused by back pain or back-related limb symptoms
(this is similar to the well known AHCPR Back Guideline). Patient
populations for the included studies were between the ages of 18-65,
with or without current symptoms or prior back problems. Studies
including patients with serious spinal pathology or other non-spinal
causes of referred back pain were excluded. •
Additional References:
- Donchin M et al. Secondary prevention of low back pain: A clinical trial. Spine 1990; 15: 1317-1320.
- Soukup
MG et al. Exercises and education as secondary prevention for recurrent
low back pain. Physiother Res Int 2001; 6: 27-39.
- Lahad A et al. The effectiveness of four interventions for the prevention of back pain. JAMA 1994; 272: 1286-1291.
- Linton
SJ, van Tulder M. Preventive interventions for back and neck pain
problems: what is the evidence? Spine 2001; 26: 778-787.
- Tveito
TH, Hysing M, Eriksen HR. Low back pain interventions at the workplace:
a systematic literature review. Occup Med 2004; 54: 3-13.
| This brief review is a sample of the content posted weekly on Research Review Service and is one of over 60 reviews available per year of the latest scientific literature in chiropractic. RRS is approved for 4.0 CEUs/year by CMCC. |
Dr.
Shawn Thistle is the founder and president of Research Review Service
Inc., an online, subscription-based service designed to help busy
practitioners to integrate current, relevant scientific evidence into
their practice. Shawn graduated from CMCC and holds an Honours Degree
in Kinesiology from McMaster University. He also holds a certificate in
Contemporary Medical Acupuncture from McMaster University, and is a
Certified Active Release Techniques (ART®) Provider. For more
information about the Research Review Service, visit www.researchreviewservice.com
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