Lumbar Supports to Prevent Recurrent Low Back Pain among Home Care Workers

A Randomized Trial

20 November 2007 | Volume 147 Issue 10 | Pages 685-692

Background: People use lumbar supports to prevent low back pain. Secondary analyses from primary preventive studies suggest benefit among workers with previous low back pain, but definitive studies on the effectiveness of supports for the secondary prevention of low back pain are lacking.

Objective: To determine the effectiveness of lumbar supports in the secondary prevention of low back pain.

Design: Randomized, controlled trial.

Setting: Home care organization in the Netherlands.

Patients: 360 home care workers with self-reported history of low back pain.

Intervention: Short course on healthy working methods, with or without patient-directed use of 1 of 4 types of lumbar support.

Measurements: Primary outcomes were the number of days of low back pain and sick leave over 12 months. Secondary outcomes were the average severity of low back pain and function (Quebec Back Pain Disability scale) in the previous week.

Results: Over 12 months, participants in the lumbar support group reported an average of –52.7 days (CI, –59.6 to –45.1 days) fewer days with low back pain than participants who received only the short course. However, the total sick days in the lumbar support group did not decrease (–5 days [CI, –21.1 to 6.8 days]). Small but statistically significant differences in pain intensity and function favored lumbar support.

Limitations: Study participants were unblinded, and a substantial amount of missing data required imputation. Objective data on sick days due to low back pain were not available.

Conclusion: Adding patient-directed use of lumbar supports to a short course on healthy working methods may reduce the number of days when low back pain occurs, but not overall work absenteeism, among home care workers with previous low back pain. Further study of lumbar supports is warranted.

Editors' Notes Context Lumbar supports are commonly used to prevent low back pain, but evidence on their effectiveness is lacking. Contribution This trial assigned 360 home care workers with a history of low back pain to a short course on healthy work habits, with or without worker-directed use of a lumbar support. Over 12 months, participants assigned to lumbar support had a similar number of sick days but fewer days with low back pain than did those assigned to the course only. Implication Adding lumbar supports to instruction on healthy work habits may decrease low back pain recurrence, but not absenteeism, among workers with previous low back pain. —The Editors

 

Author and Article Information

From Erasmus Medical Center, University Medical Center, Rotterdam; VU University Medical Center and EMGO Institute, Amsterdam; and Body{at}Work, Research Center Physical Activity, Work and Health, TNO-VU University Medical Center, Hoofddorp-Amsterdam, the Netherlands.

ISRCTN registration number: ISRCTN73707379.

Acknowledgment: The authors thank the study participants and managers at Thuiszorg Rotterdam, Rotterdam, the Netherlands, for their contribution.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Pepijn D.D.M. Roelofs, MSc, Department of General Practice, Erasmus Medical Center, PO Box 2040, NL-3000 CA Rotterdam, the Netherlands; e-mail, p.roelofs{at}erasmusmc.nl.

Current Author Addresses: Mr. Roelofs, Dr. Bierma-Zeinstra, Mr. Willemsen, and Dr. Koes: Department of General Practice, Erasmus Medical Center, PO Box 2040, NL-3000 CA Rotterdam, the Netherlands.

Drs. van Poppel, Jellema, and van Tulder: Institute for Research in Extramural Medicine (EMGO), VU University Medical Center, van der Boechorststraat 7, NL-1081 BT Amsterdam, the Netherlands.

Dr. van Mechelen: Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, van der Boechorststraat 7, NL-1081 BT Amsterdam, the Netherlands.

Author Contributions: Conception and design: P.D.D.M. Roelofs, M.N.M. van Poppel, P. Jellema, W. van Mechelen, B.W. Koes.

Analysis and interpretation of the data: P.D.D.M. Roelofs, S.M.A. Bierma-Zeinstra, S.P. Willemsen, M.W. van Tulder, B.W. Koes.

Drafting of the article: P.D.D.M. Roelofs, S.M.A. Bierma-Zeinstra, M.W. van Tulder.

Critical revision of the article for important intellectual content: S.M.A. Bierma-Zeinstra, P. Jellema, M.W. van Tulder, W. van Mechelen, B.W. Koes.

Final approval of the article: P.D.D.M. Roelofs, S.M.A. Bierma-Zeinstra, M.N.M. van Poppel, P. Jellema, S.P. Willemsen, M.W. van Tulder, W. van Mechelen, B.W. Koes.

Statistical expertise: S.P. Willemsen.

Obtaining of funding: M.N.M. van Poppel, W. van Mechelen, B.W. Koes.

Administrative, technical, or logistic support: P.D.D.M. Roelofs.

Collection and assembly of data: P.D.D.M. Roelofs.