Lumbar supports for prevention and treatment of low back pain: a systematic review within the framework of the Cochrane Back Review Group.
METHODS
A systematic review of randomized and nonrandomized controlled trials.


BACKGROUND
Lumbar supports are used in the treatment of low back pain, but also to prevent the onset (primary prevention) or recurrences of a low back pain episode (secondary prevention).


OBJECTIVE
To assess the effects of lumbar sup-ports for prevention and treatment of nonspecific low back pain.


METHODS
The Medline, Cinahl, and Current Contents databases; the Cochrane Controlled Trials Register up to September 1999; and the Embase database up to September 1998 were all searched. References of identified trials and systematic reviews were reviewed and the Science Citation Index used to identify additional trials. Methodologic quality assessment and data extraction were performed by two reviewers independently. A quantitative analysis was performed in which the strength of evidence was classified as strong, moderate, limited or conflicting, and no evidence.


RESULTS
Five randomized and two nonrandomized preventive trials and six randomized therapeutic trials were included in the review. Only 4 of the 13 studies were of high quality. There was moderate evidence that lumbar supports are not effective for primary prevention. No evidence was found on the effectiveness of lumbar supports for secondary prevention. The systematic review of therapeutic trials showed that there is limited evidence that lumbar supports are more effective than no treatment, whereas it is still unclear whether lumbar supports are more effective than other interventions for treatment of low back pain.


CONCLUSIONS
There continues to be a need for high quality randomized 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 adequate compliance.
Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, The Netherlands.
P
P
Jellema
M W
MW
van Tulder
M N
MN
van Poppel
A L
AL
Nachemson
L M
LM
Bouter
D001915:Braces; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology / Q000517:prevention & control* / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008297:Male; D016032:Randomized Controlled Trials as Topic / Q000379:methods*