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Am Fam Physician. 1998;58(7):1671

A frequent cause of disability in the work-place is low back injury. Strategies to reduce the incidence of low back injury in the work-place include education and the use of lumbar supports. Van Poppel and associates conducted a randomized trial to determine if education and used lumbar supports reduced the number of back pain episodes reported by a group of airline cargo workers.

A total of 312 persons were included in the six-month study and were randomly assigned to one of four groups: group 1 used lumbar supports and received education about proper lifting techniques; group 2 received education but used no lumbar supports; group 3 used lumbar supports but did not receive education; and group 4 had no intervention. The type of lumbar support used by study participants had hook-and-loop fasteners, flexible stays and an anchor belt but no shoulder straps. Education consisted of three sessions on lifting techniques, for a total of five hours. The third session included individual on-the-job instruction. Demographic information, history of back pain and presence of low back pain were assessed at baseline. Occurrence of low back pain and use of sick leave for back pain were assessed monthly during the study, as was compliance with wearing the lumbar support.

There were no significant differences in age, history of back problems or amount of sick leave taken because of back problems among the groups at baseline. More than one half of the workers (60 percent) expected the lumbar supports to reduce low back pain, and 69 percent thought that the lifting education would be useful. After the education sessions, 11 percent of the workers said they followed proper lifting techniques as taught, 73 percent said they lifted as taught some of the time, and 11 percent said they never followed the lifting techniques. Only 43 percent of the workers reported wearing lumbar supports more than one half of the time. About one half of the study subjects thought the supports were too restrictive, uncomfortable or too hot. On the other hand, about one half of the participants also reported that the lumbar support was easy to use and was supportive of the back.

In workers who had no history of low back pain, the use of interventions did not significantly reduce the number of sick days used because of back pain. In those who reported a history of low back pain at baseline, there was a slight decrease in the number of sick days taken because of back pain in the group using lumbar support.

The authors conclude that the use of lumbar support, lumbar support plus education or education alone did not prevent back pain. Further research is needed to determine the effectiveness of lumbar supports in workers who have a history of low back pain. In an accompanying editorial, Dillingham concurs that further research is needed to determine if the use of lumbar supports can reduce disability, costs and loss of productivity attributed to back injury in the workplace.

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Copyright © 1998 by the American Academy of Family Physicians.

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