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 methods

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 randomised 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.

 

Plain language summary

Lumbar supports for the prevention and treatment of low-back pain

Lumbar supports (also called braces or corsets) are used in the prevention and treatment of low-back pain. This review is important because low-back pain is very common. Prevention and treatment are important both to people with back pain and to society, which bears the expense of back pain treatment and sick leave due to back pain.

We included seven studies on prevention (14,437 people) and eight studies on treatment (1361 people) in this review.

Prevention:
There was little or no difference between individuals with low-back pain who used back supports and those who received no treatment (five studies, 13,995 people), or education on lifting techniques (two studies, 954 people) in back pain prevention or reduction of sick leave.

In one study (82 people), back supports added to back school (patient education about recovering from back pain) were helpful in reducing the number of days of sick leave but not in preventing back pain. Back supports plus usual medical care reduced the number of days of low-back pain and improved function, but did not reduce sick leave (one study, 360 people).

Treatment:
In four studies (1170 people), there was little or no difference between patients with acute or chronic back pain who used back supports and those who received no treatment in short-term pain reduction or overall improvement.

There is conflicting evidence (two studies, 550 people) about whether back supports are better than nothing in helping low-back pain patients return to work faster, however in three studies (410 patients), they were better than nothing in helping individuals with subacute and chronic low-back pain recover function in the short term.

In three studies (954 people), there was little or no difference in short-term pain reduction, overall improvement and return-to-work between those who used back supports and those who received manipulation, physiotherapy, or electrical stimulation. One study (164 people) reported mixed results on whether back supports improved function more than massage and in another study (19 people), use of a lumbar corset with back support was more effective in reducing pain in the short-term than a corset alone.

Conclusions from this review should be viewed with caution due to the low quality of many of the studies. In the future, researchers should report side effects from wearing back supports and measure how many hours per day the supports are actually worn.

 

摘要

背景

預防及治療下背痛的腰椎支持

腰椎支持被使用在治療下背疼痛的患者身上來預防下背痛的產生(預防主要目的)或是預防下背痛的再復發(預防次要目的)。

目標

評估腰椎支持對於預防及治療非特異性下背痛的療效。

搜尋策略

我們更新了Cochrane Central Register of Controlled Trials、PubMed、EMBASE、以及CINAHL的搜尋直到2006年12月。 我們也掃瞄了相關文章、找到的試驗的參考文獻，並且連絡專家以獲得額外的隨機對照試驗(RCTs)。

選擇標準

研究用來預防或治療非特異性下背疼痛的任何種類的腰椎支持的隨機對照試驗。

資料收集與分析

一位文獻回顧作者負責電子資料搜尋。另兩位文獻回顧作者獨立地分辨符合納入條件的試驗。還有一位文獻回顧作者擷取研究分佈、介入因子、及最後結果的數據。 方法品質及臨床相關性由兩位文獻回顧作者獨立地評估。 因為不可能實行定量性研究的關係，我們使用了定質性研究，便是將腰椎支持療效證據的強度分為強、中、弱、矛盾的、或無證據。

主要結論

本篇最新的文獻回顧納入了七個研究腰椎支持的預防性效果的研究(共14437個人)及八個研究治療效果的研究(共1361個人)。整體來說， 研究方法品質比較低。在15個研究中只有5個符合一半或一半以上的內部效力項目。有中等量的證據指出在預防下背痛發生的病患身上使用腰椎支持法並不比毫無治療訓練來的有效，更有其他證據對於使用腰椎支持法存有質疑，認為其不見得比其他治療法來的有效。對於使用腰椎治療法來治療下背痛是否比毫無使用其他治療法的有效這點仍然不明。

作者結論

中等證據指出腰椎支持在預防下背痛發生的患者身上並不比毫無使用治療法來的有效，並有證據對於腰椎支持法是否比起其他治療法有效的說法存有質疑。 對於使用腰椎治療法來治療下背痛是否比毫無使用其他治療法的有效這點仍然不明。 我們仍然需要高品質的隨機試驗來研究腰椎支持法的療效。 要與這些未來的試驗相關的最重要的議題之一似乎就是要有足夠的試驗量。 我們應該將注意力放在不同的結果測量、病患種類、和腰椎支持療法的種類。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

腰椎支持療法被用來預防及治療下背痛。 腰椎支持療法(又被稱為支架或束腹)被用來預防及治療下背痛。 本篇文獻回顧之所以重要是因為下背痛非常地普遍。預防及治療下背痛對於患者及需要負擔治療費用和員工請病假的社會皆非常重要。 我們納入了七個研究預防性療效的研究(包括14437人)和八個研究治療性療效的研究(包括1361人)在本篇文獻回顧中。預防性療效組: 在預防疼痛及降低請病假率的方面，那些使用了腰椎支持法且並未接受其他治療(五個試驗共13995位患者)、抬高技巧(兩個試驗共954位病患)的下背痛患者，彼此之間幾乎沒有任何的不同。 在一個研究中(共82人)，在背部教室(病患接受關於從背痛中復原的衛教課程)中加入背部支持的課程時，對於降低病患請病假的天數非常有效但是對預防下背痛的效果卻不彰。 背部支持加上一般的醫療照護可以降低下背痛天數並改善功能，但無法降低請病假天數(一個共360人參與的研究)。 治療性療效組:在四個研究中(共1170位病患)，針對減輕短期疼痛並改善整體功能方面來說，使用背部支持的急性或慢性背痛患者與從未接受過治療的患者之間幾乎沒有不同。 有個證據相當矛盾(兩項共550人的研究)，關於是否使用背部支持比起從未接受過治療的患者在促進病人回到工作岡位上有較佳的結果，然而在三個研究中(共410位患者)，使用背部支持的患者比起從未接受過治療的患者在急性與慢性下背痛的短期復原功能上要來的好。 在三個試驗中(共954位病患)，針對減少短期疼痛、促進整體功能和回到工作岡位上的速度方面，使用背部支持的患者比起接受推拿、物理治療、或電療的病患可以說是幾乎沒有任何不同。 一個研究中(共164位病患)提出關於是否背部支持比起按摩要更能夠促進功能的混合性的結果， 同時另一個試驗(共19人)中，選擇使用背架配合背部支持是比單用背架更能降低短期疼痛的效果。 因為受到許多試驗的低品質影響，我們需要更謹慎的檢視本篇文獻回顧的結論。 在未來的研究中，研究者應該要報告出使用背部支持的副作用，並確實測量一天之中患者穿著背架的時間有多長。