A review of controlled trials.
To determine which interventions are used to prevent back and neck pain problems as well as what the evidence is for their utility.
Given the difficulty in successfully treating long-term back and neck pain problems, there has been a call for preventive interventions. Little is known, however, about the value of preventive efforts for nonpatients, e.g., in the general population or workplace.
The literature was systematically searched to locate all investigations that were: 1) specifically designed as a preventive intervention; 2) randomized or nonrandomized controlled trials; and, 3) using subjects not seeking treatment. Outcome was evaluated on the key variables of reported pain, report of injury, dysfunction, time off work, health-care utilization, and cost. Conclusions were drawn using a grading system.
Twenty-seven investigations meeting the criteria were found for educational efforts, lumbar supports, exercises, ergonomics, and risk factor modification. For back schools, only one of the nine randomized trials reported a significant effect, and there was strong evidence that back schools are not effective in prevention. Because the randomized trials concerning lumbar supports were consistently negative, there is strong evidence that they are not effective in prevention. Exercises, conversely, showed stable positive results in randomized controlled trials, giving consistent evidence of relatively moderate utility in prevention. Because no properly controlled trials were found for ergonomic interventions or risk factor modification, there was not good quality evidence available to draw a conclusion.
The results concerning prevention for subjects not seeking medical care are sobering. Only exercises provided sufficient evidence to conclude that they are an effective preventive intervention. There is a dire lack of controlled trials examining broad-based multidimensional programs. The need for high quality outcome studies is underscored.
From the *Department of Occupational and Environmental Medicine, Örebro Medical Center, Örebro, Sweden, and the
†Institute for Research in Extramural Medicine, Free University, Amsterdam, The Netherlands.
Acknowledgment date: June 2, 1999.
First revision date: December 13, 2000.
Second revision date: May 19, 2000.
Acceptance date: September 8, 2000.
Device status category: 1.
Conflict of interest category: 12.
Address reprint requests to
Steven J. Linton, PhD
Department of Occupational and Environmental Medicine
Örebro Medical Center
701 85 Örebro