Sunday, February 2, 2014

Lower Back Pain (LBP) prevention - clinical information

seems like researchers don't care much for the subject of back pain prevention!

General population (P)

P1: physical exercise
Evidence. Two systematic reviews18,19 and one primary care guideline20 were found on
exercise for prevention in the general population. All the authors’ main conclusions
were that physical exercise has a positive effect in the prevention of back pain, further
episodes and work absence. Effect sizes were reported to be small to moderate. One
systematic review found for pregnant women21 concluded that water gymnastics has a
preventive effect on future back pain.
Recommendation. Physical exercise is recommended to prevent absence due to back
pain and the occurrence or duration of further back pain episodes (level A). The effect
size is moderate. There is insufficient evidence to recommend for or against any specific
kind of exercise, or the frequency/intensity of training (level B). Water gymnastics could
be recommended to reduce (short-term) back pain and extended work loss during and
following pregnancy (level C).

P2: information/education/training (back schools)
Evidence: information and education. One systematic review22 found inconsistent results
on the effect of information for prevention in back pain. More recently, a controlled trial
of a public health multimedia campaign found improved beliefs about back pain, a
reduction in days off work and reduced use of the health care system.23
Recommendation: information and education. Information and education about back pain,
if based on biopsychosocial principles, should be considered for the general population;
it improves back beliefs and can have a positive influence on health and vocational
outcomes, although the effect size might be relatively small (level C). Information and
education focused principally on a biomedical or biomechanical model cannot be
recommended (level C).
Evidence: back schools/training. A recent Cochrane review24 defined back school as a
group intervention, conducted or supervised by a paramedical therapist or a medical
specialist, which consisted of both an education/skills programme and exercises. The
authors found that there was: (1) conflicting evidence on the effectiveness of back
schools on further work loss; (2) limited evidence that back schools show no
differences in long term recurrence rates of LBP episodes. The authors concluded that
back schools might be effective for patients with recurrent and chronic pain, with the
most promising interventions being those with a high intensity (3–5-weeks stay in
specialized centres). The effect sizes of these interventions were judged small.
Recommendation: back schools/training. Back schools based on a biomechanical approach
with emphasis on teaching lifting techniques are not recommended (level A).

P3: lumbar supports/back belts
Evidence. Two systematic reviews18,19 and one primary care guideline20 evaluated five
RCTs and two non-randomized trials on lumbar supports/back belts for prevention of
back pain or back problems. All concluded that lumbar support or back belts are no
more beneficial than either no intervention or other preventive interventions, and that
they might even be detrimental. The combination of back belts with back school is no
better or worse than back school alone.
Recommendation. Lumbar supports/back belts are not recommended for prevention in
LBP among the general population (level A).

P4: furniture
Evidence: mattresses.No systematic reviews on the use of mattresses for the prevention
of back pain were found. Twelve published studies were found, which reported
interventions aiming at reducing back pain by using different mattresses. The design of
the studies, their methodological quality and the results do not allow any conclusions
with respect to prevention in back pain, although one RCT suggests that patients might
have less pain with a medium-firm rather than hard mattress.25
Recommendation: mattresses. There is insufficient robust evidence to recommend for or
against any specific mattresses for prevention in back pain (level C), although existing
persistent symptoms might reduce with a medium-firm rather than a hard mattress
(level C).
Evidence: chairs. No acceptable evidence for any preventive aspects of chairs was found;
the three studies retrieved had inappropriate methodology.

Recommendation: chairs. There is insufficient evidence to recommend for or against any
specific chairs for prevention in LBP (level D).

P5: shoe insoles/correction of leg length discrepancies
Evidence. No systematic reviews on the use of shoe insoles, shock-absorbing heel
inserts or orthoses for the prevention of back pain were found. Seven clinical trials
reported interventions aiming to reduce back pain by use of different insoles: only two
of those reported a beneficial effect from orthoses.26,27 No acceptable study
concerning prevention of LBP by correction of leg length discrepancy was identified.
Recommendation. The use of shoe insoles or orthoses is not recommended for
prevention of back problems (level A). There is insufficient evidence to recommend for
or against correction of leg length inequality for prevention in LBP (level D).
How to prevent low back pain 545P6: manipulation
Evidence. No acceptable studies reporting on the value of regular manipulative
treatment for prevention of LBP were found.
Recommendation. No evidence was found to support recommending regular
manipulative treatment for the prevention in LBP (level D).

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