Lumbar supports for prevention and treatment of low back pain

Abstract

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.

Conflict of interest statement

One author (Mireille van Poppel) has published a randomised trial on prevention of back pain that was included in this review (van Poppel 1998). She was not involved in any decision regarding selection, quality assessment, data extraction or analysis of this trial. Two authors (Maurits van Tulder, Mireille van Poppel) are authors of another included trial (Roelofs 2007). Neither was involved in any decision regarding selection, quality assessment, data extraction or analysis of this trial.

One author (Maurits van Tulder) is co‐editor of the Cochrane Back Review Group. Editors are required to conduct at least one Cochrane review. This requirement ensures that editors are aware of the processes and commitment needed to conduct reviews. None of the editors are first authors. This involvement does not seem to be a source of conflict of interest in the Back Review Group. Any editor who is a review author is excluded from editorial decisions on the review in which they are contributors.

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Summary of risks of bias