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Manual material handling advice and assistive devices for preventing and treating back pain in workers

  • Review
  • Intervention




Training and assistive devices are considered major interventions to prevent back pain among workers exposed to manual material handling (MMH).


To determine the effectiveness of MMH advice and training and the provision of assistive devices in preventing and treating back pain.

Search strategy

We searched MEDLINE to November 2005, EMBASE to August 2005, and CENTRAL, the Back Group's Trials Register, CINAHL, Nioshtic, CISdoc, Science Citation Index, and PsychLIT to September 2005.

Selection criteria

We included randomised controlled trials (RCT) and cohort studies with a concurrent control group, aimed at changing human behaviour in MMH and measuring back pain, back pain-related disability or sickness absence.

Data collection and analysis

Two authors independently extracted the data and assessed the methodological quality using the criteria recommended by the Back Review Group for RCTs and MINORS for the cohort studies. One author of an original study supplied additional data for the review.

The results and conclusions are based on the primary analysis of RCTs. We conducted a secondary analysis with cohort studies. We compared and contrasted the conclusions from the primary and secondary analyses.

Main results

We included six RCTs (17,720 employees) and five cohort studies (772 employees). All studies focused on prevention of back pain. Two RCTs and all cohort studies met the majority of the quality criteria and were labelled high quality.

We summarized the strength of the evidence with a qualitative analysis since the lack of data precluded a statistical analysis.

There is moderate evidence that MMH advice and training are no more effective at preventing back pain or back pain-related disability than no intervention (four studies) or minor advice (one study). There is limited evidence that MMH advice and training are no more effective than physical exercise or back belt use in preventing back pain (three studies), and that MMH advice plus assistive devices are not more effective than MMH advice alone (one study) or no intervention (one study) in preventing back pain or related disability.

The results of the cohort studies were similar to the randomised studies.

Authors' conclusions

There is limited to moderate evidence that MMH advice and training with or without assistive devices do not prevent back pain, back pain-related disability or reduce sick leave when compared to no intervention or alternative interventions. There is no evidence available from RCTs for the effectiveness of MMH advice and training or MMH assistive devices for treating back pain.

Plain language summary

Advice on material handling techniques and using assistive devices to prevent and treat back pain in workers

Back pain is very common among adults. There is evidence that individuals who physically move or lift objects (manual material handling) on a regular basis increase the strain on their backs and the risk of developing back pain. In many occupations, it is difficult to avoid this. Training on proper lifting techniques and the use of mechanical aides (assistive devices) are considered important techniques to prevent back pain.

We included six randomised controlled trials (17,720 employees) and five cohort studies (772 employees) that examined the effects of training and the use of assistive devices on preventing low-back pain and reducing back-related disability. We found no studies that examined the effects of training or the use of assistive devices as part of a treatment plan for back pain.

We found limited to moderate evidence that, on average, there was no significant difference in reports of back pain, back-related disability or absence from work between groups who received training on proper lifting techniques and assistive devices and those who received exercise training, back belts or no training. Similarly, there was no difference between those who received intensive training and those who received shorter instruction. These findings were consistent when measured in the short-term or long-term and when examined in randomised trials or cohort studies.

These results are similar to other reviews that examined a range of possible prevention measures. Some of the other reviews found that workers who received training were satisfied and demonstrated increased knowledge on the subject, but this did not appear to consistently translate into behaviour change.

In conclusion, training workers about proper material handling techniques or providing them with assistive devices are not effective interventions by themselves in preventing back pain.