title: Effect of training and lifting equipment for preventing back pain in lifting and handling: systematic review.
abstract: OBJECTIVE
  To determine whether advice and training on working techniques and lifting equipment prevent back pain in jobs that involve heavy lifting.
  
  
  METHODS
  Medline, Embase, CENTRAL, Cochrane Back Group's specialised register, CINAHL, Nioshtic, CISdoc, Science Citation Index, and PsychLIT were searched up to September-November 2005.
  
  
  METHODS
  The primary search focused on randomised controlled trials and the secondary search on cohort studies with a concurrent control group. Interventions aimed to modify techniques for lifting and handling heavy objects or patients and including measurements for back pain, consequent disability, or sick leave as the main outcome were considered for the review. Two authors independently assessed eligibility of the studies and methodological quality of those included. For data synthesis, we summarised the results of studies comparing similar interventions. We used odds ratios and effect sizes to combine the results in a meta-analysis. Finally, we compared the conclusions of the primary and secondary analyses.
  
  
  RESULTS
  Six randomised trials and five cohort studies met the inclusion criteria. Two randomised trials and all cohort studies were labelled as high quality. Eight studies looked at lifting and moving patients, and three studies were conducted among baggage handlers or postal workers. Those in control groups received no intervention or minimal training, physical exercise, or use of back belts. None of the comparisons in randomised trials (17,720 participants) yielded significant differences. In the secondary analysis, none of the cohort studies (772 participants) had significant results, which supports the results of the randomised trials.
  
  
  CONCLUSIONS
  There is no evidence to support use of advice or training in working techniques with or without lifting equipment for preventing back pain or consequent disability. The findings challenge current widespread practice of advising workers on correct lifting technique.
authors.affiliation: Musculoskeletal Disorders Group, Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland. kari-pekka.martimo@ttl.fi
authors.forename: Kari-Pekka
authors.initials: KP
authors.lastname: Martimo
authors.forename: Jos
authors.initials: J
authors.lastname: Verbeek
authors.forename: Jaro
authors.initials: J
authors.lastname: Karppinen
authors.forename: Andrea D
authors.initials: AD
authors.lastname: Furlan
authors.forename: Esa-Pekka
authors.initials: EP
authors.lastname: Takala
authors.forename: P Paul F M
authors.initials: PP
authors.lastname: Kuijer
authors.forename: Merja
authors.initials: M
authors.lastname: Jauhiainen
authors.forename: Eira
authors.initials: E
authors.lastname: Viikari-Juntura
mesh_terms: D001416:Back Pain / Q000517:prevention & control*; D003376:Counseling; D006801:Humans; D017770:Lifting; D010353:Patient Education as Topic / Q000379:methods*; D016032:Randomized Controlled Trials as Topic