title: High-quality controlled trials on preventing episodes of back problems: systematic literature review in working-age adults.
abstract: BACKGROUND
  Back problems (BPs), with their cost and disability, are a substantial burden for individuals, employers, and society.
  
  
  OBJECTIVE
  This systematic review of controlled trials evaluates the effectiveness of interventions to prevent BP episodes in working age adults.
  
  
  METHODS
  We searched MEDLINE/EMBASE through May 2007, and COCHRANE/Trials Registry through August 22, 2008 using search terms of back pain, back injuries or sciatica, linked to prevention, control, workplace interventions, or ergonomics and searched article bibliographies.
  
  
  METHODS
  For systematic review inclusion, articles had to describe prospective controlled trials of interventions to prevent BPs in working-age adults, with intervention assignment either to individual participants or preexisting groups. Of 185 articles identified as potentially relevant, 20 trials (11%) met inclusion criteria.
  
  
  METHODS
  Researchers extracted relevant information from controlled trials and graded methodological quality. Because of heterogeneity of trials, meta-analysis was not performed.
  
  
  RESULTS
  Only exercise was found effective for preventing self-reported BPs in seven of eight trials (effect size 0.39 to >0.69). Other interventions were not found to reduce either incidence or severity of BP episodes compared with controls. Negative trials included five trials of education, four of lumbar supports, two of shoe inserts, and four of reduced lifting programs.
  
  
  CONCLUSIONS
  Twenty high-quality controlled trials found strong, consistent evidence to guide prevention of BP episodes in working-age adults. Trials found exercise interventions effective and other interventions not effective, including stress management, shoe inserts, back supports, ergonomic/back education, and reduced lifting programs. The varied successful exercise approaches suggest possible benefits beyond their intended physiologic goals.
  
  
  METHODS
  Systematic review Level I evidence.
authors.affiliation: Department of Orthopedic Surgery, University of Washington, Seattle, WA, USA. sstanjb@aol.com
authors.forename: Stanley J
authors.initials: SJ
authors.lastname: Bigos
authors.forename: John
authors.initials: J
authors.lastname: Holland
authors.forename: Carole
authors.initials: C
authors.lastname: Holland
authors.forename: John S
authors.initials: JS
authors.lastname: Webster
authors.forename: Michele
authors.initials: M
authors.lastname: Battie
authors.forename: Judith A
authors.initials: JA
authors.lastname: Malmgren
mesh_terms: D000328:Adult; D019567:Back Injuries / Q000517:prevention & control* / Q000534:rehabilitation*; D001416:Back Pain / Q000517:prevention & control* / Q000534:rehabilitation*; D015444:Exercise / Q000502:physiology*; D005081:Exercise Therapy / Q000379:methods; D006801:Humans; D009989:Orthotic Devices; D011613:Psychotherapy / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D012585:Sciatica / Q000534:rehabilitation