High-quality controlled trials on preventing episodes of back problems: systematic literature review in working-age adults

Stanley J. Bigos, John Holland, Carole Holland, John S. Webster, Michele Battie, Judith A. Malmgren

This systematic review of controlled trials evaluates the effectiveness of interventions to prevent BP episodes in working age adults.  For systematic review inclusion, articles had to describe prospective controlled trials of interventions to prevent BPs in working-age adults, with intervention assignment either to individual participants or preexisting groups. Of 185 articles identified as potentially relevant, 20 trials (11%) met inclusion criteria.  Only exercise was found effective for preventing self-reported BPs in seven of eight trials. Other interventions were not found to reduce either incidence or severity of BP episodes compared with controls. Negative trials included five trials of education, four of lumbar supports, two of shoe inserts, and four of reduced lifting programs.

Twenty high-quality controlled trials found strong, consistent evidence to guide prevention of BP episodes in working-age adults. Trials found exercise interventions effective and other interventions not effective, including stress management, shoe inserts, back supports, ergonomic/back education, and reduced lifting programs. The varied successful exercise approaches suggest possible benefits beyond their intended physiologic goals.

The Spine Journal, 2009, 9(2), 147-168

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