Primary studies included in this broad synthesis

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Primary study

Unclassified

Lumbar supports and education for the prevention of low back pain in industry: a randomized controlled trial.

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Journal JAMA : the journal of the American Medical Association
Year 1998
Links Pubmed DOI

This article is included in 7 Systematic reviews Systematic reviews (7 references)

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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.

Primary study

Unclassified

The cost-effectiveness of spinal care education as a preventive strategy for spinal injury

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Authors Tuchin, P. , Pollard, H.
Journal Occupational Health and Industrial Medicine
Year 1998
Links yadda.icm.edu.pl Google Scholar

This article is included in 1 Systematic review Systematic reviews (1 reference)

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The objective of this study was to evaluate the cost-effectiveness of a spinal care lecture in reducing the number of spinal injury and associated costs in the workplace. A lecture was designed following a workplace inspection to assess the most likely risk factors for injury, to increase employees' awareness of back injury and how it might be avoided. Volunteer subjects, all from the same company, were randomly assigned to a study group (n = 34) and a central group (n = 27). The remaining employees (n = 60) formed a non-intervention (baseline) comparison group. The number and severity of injuries for both groups were monitored over a six-month period prior to and following the lecture. In addition, Oswestry pain and disability questionnaires were collected prior to the lecture and at the six-month follow-up period. The cost of reported back injuries decreased by 57% in the first three months for the educated group when compared to pre-intervention levels. At the six-month follow up, the cost of back injuries remained 40% lower than previous levels.

Primary study

Unclassified

A controlled trial of an educational program to prevent low back injuries.

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Journal The New England journal of medicine
Year 1997
Links Pubmed DOI

This article is included in 4 Systematic reviews Systematic reviews (4 references)

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BACKGROUND: Low back injuries are common and costly, accounting for 15 to 25 percent of injuries covered by workers' compensation and 30 to 40 percent of the payments made under that program. The high costs of injury, the lack of effective treatment. and the evidence that there are behavioral risk factors have led to widespread use of employee education programs that teach safe lifting and handling. The effectiveness of those programs, however, has received little rigorous evaluation. METHODS: We evaluated an educational program designed to prevent low back injury in a randomized, controlled trial involving about 4000 postal workers. The program, similar to that in wide use in so-called back schools, was taught by experienced physical therapists. Work units of workers and supervisors were trained in a two-session back school (three hours of training), followed by three to four reinforcement sessions over the succeeding few years. Injured subjects (from both the intervention and the control groups) were randomized a second time to receive either training or no training after their return to work. RESULTS: Physical therapists trained 2534 postal workers and 134 supervisors. Over 5.5 years of follow-up, 360 workers reported low back injuries, for a rate of 21.2 injuries per 1000 worker-years of risk. The median time off from work per injury was 14 days (range, 0 to 1717); the median cost was $204 (range, zero to $190,380). After their return to work, 75 workers were injured again. Our comparison of the intervention and control groups found that the education program did not reduce the rate of low back injury, the median cost per injury, the time off from work per injury, the rate of related musculoskeletal injuries, or the rate of repeated injury after return to work; only the subjects' knowledge of safe behavior was increased by the training. CONCLUSIONS: A large-scale, randomized, controlled trial of an educational program to prevent work-associated low back injury found no long-term benefits associated with training.

Primary study

Unclassified

Effect of a general fitness program on musculoskeletal symptoms, clinical status, physiological capacity, and perceived work environment among home care service personnel.

Journal Journal of occupational rehabilitation
Year 1995
Links Pubmed DOI

This article is included in 3 Systematic reviews Systematic reviews (3 references)

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The aim of the present controlled study was to evaluate the effect of a general fitness program, performed by an occupational health service, using pre-post assessment for a number of different outcome measures. A total of 160 employees working in the central home care service district of Umeå, Sweden were asked to participate in a program of a 1-year long exercise program. Of the 160 selected, 54 subjects declined to participate and nine subjects were rejected after a medical check up. The remaining 97 subjects participated in a schedule consisting of pre-post medical and physiotherapy examinations, questionnaires concerning sociodemography, musculoskeletal and general health complaints and work environment, physiological tests of cardiovascular fitness, and of strength and endurance of shoulder flexors and knee extensors, and registration of sick leave. The subjects were randomly assigned to an exercise (treatment) or control group. The exercise group trained twice a week for 1 year using a mixed program including exercises for coordination, strength/endurance, and fitness. The test schedule was repeated for both groups after 1 year. The exercise intervention was associated with positive changes in prevalence and intensity of musculoskeletal and psychosomatic complaints, better physiotherapy status (less muscle tightness, better neck mobility, and less tender points), increased shoulder strength and increased coordination in thigh muscles. However, the exercise group reported worse situations post-exercise concerning aspects of their physical and psychosocial work-environment (i.e., concerning ergonomy, influence, appreciation and communication with work manager), which might have been due to stress associated with the exercise situation.

Primary study

Unclassified

The effectiveness of back belts on occupational back injuries and worker perception

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Journal Professional Safety
Year 1995

This article is included in 3 Systematic reviews Systematic reviews (3 references)

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Manual materials handling is a major industrial hazard in terms of the incidence of low-back injuries sustained during; lifting activities. Employees involve in heavy lifting have been found to experience almost eight times as many low-back injuries as those performing more sedentary tasks (Snook). At least 25 percent of all reported occupational injuries in the U.S. are attributed to overexertion; these injuries often lead to long absences from work, disability, premature retirement or career changes (Snook). Estimates suggest that more than 50 percent of all compensable back-pain incidents stem from manual materials handling, and that these injuries may account for up to one-fourth of all workers' compensation indemnity expenditures

Primary study

Unclassified

Primary prevention of back symptoms and absence from work. A prospective randomized study among hospital employees.

Journal Spine
Year 1993
Links Pubmed DOI

This article is included in 4 Systematic reviews Systematic reviews (4 references)

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The personnel at a geriatric hospital were randomized 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, resulting in a cost/benefit ratio greater than 10.

Primary study

Unclassified

A cost-benefit analysis of a California county's back injury prevention program.

Authors Shi L
Journal Public health reports (Washington, D.C. : 1974)
Year 1993
Links Pubmed PubMed Central

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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Back-related injuries have become a major health problem in the workplace, affecting as many as 35 percent of the work force and accounting for about 25 percent of all compensation claims. This study evaluates a back injury prevention program among employees in a northern California county in 1989-90. Six divisions of the county government were selected for the study because they had the highest prevalence of back pain experienced and the most back-related injuries in recent years. Four of the six divisions were randomly selected as the intervention group and the remaining two, the control group. Overall, 77 percent or 205 of the targeted employees in the intervention group participated in the study. The intervention group was given an identical health risk assessment (HRA) before and after the 1-year back injury prevention program that offered employees a combination of education, training, physical fitness activities, and ergonomic improvement. The control group was neither given the HRA nor offered the program. The back injury and cost data of both the control and intervention groups were collected before and after the 1-year intervention. The results showed a modest overall decline in back pain prevalence rates, but significant improvement in satisfaction and reduction in risky behaviors. Cost-benefit analysis showed the net benefit of introducing back injury prevention program was $161,108, and the return on investment is 179 percent. Therefore, the study offers suggestive evidence for the initial benefits of a back injury prevention program and lends support to the widely held belief that health promotion in the workplace can reduce employee health risks, increase healthful behaviors and attitudes, and improve attitudes toward the employer organization.Whether such intervention will continue to reap benefits in future years depends, to a large extent,on a favorable work environment and the maintenance and continuation of positive behavioral changes.

Primary study

Unclassified

A randomized crossover investigation of a back pain and disability prevention program: Possible mechanisms of change

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Journal Journal of Occupational Rehabilitation
Year 1993
Links Pubmed DOI Google Scholar

This article is included in 1 Systematic review Systematic reviews (1 reference)

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An educational program emphasizing symmetrical use of back muscles was studied at a health care facility that had high time lost injury rates due to back strains. 172 employees were involved, with half studying an educational program entitled "Back to Balance" and the remainder serving as controls. After 3 mo, the controls studied the program. All Ss completed the McGill Pain Questionnaire and received cervical and lumbar paraspinal dynamic EMG evaluations pre- and posttreatment and after 3 and 12 mo. Administrative indices (costs, incidence, and time lost injury rate) were obtained for the 3 yrs prestudy and for the 1 yr of the study. The 1-yr results showed decreased pain, retained knowledge that was generalized to the home, and significantly improved symmetry of both sets of muscles. Administrative data revealed a 72% decrease in the time lost injury rate, with reduced costs.

Primary study

Unclassified

An evaluation of a weightlifting belt and back injury prevention training class for airline baggage handlers.

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Journal Applied ergonomics
Year 1992
Links Pubmed DOI

This article is included in 6 Systematic reviews Systematic reviews (6 references)

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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 handlers working for a major airline company as participants. Four treatment groups were randomly 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 questionnaire 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 cannot be recommended for use in aid of lifting during daily work activities of baggage handlers. 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).

Primary study

Unclassified

Effects of an exercise program on sick leave due to back pain.

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Journal Physical therapy
Year 1991
Links Pubmed DOI

This article is included in 4 Systematic reviews Systematic reviews (4 references)

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The purposes 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 randomly 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.