Exercise for the primary, secondary and tertiary prevention of low back pain in the workplace: a systematic review.
BACKGROUND
Low back pain (LBP) is one of the most costly conditions to manage in occupational health. Individuals with chronic or recurring LBP experience difficulties returning to work due to disability. Given the personal and financial cost of LBP, there is a need for effective interventions aimed at preventing LBP in the workplace. The aim of this systematic review was to examine the effectiveness of exercises in decreasing LBP incidence, LBP intensity and the impact of LBP and disability.


METHODS
A comprehensive literature search of controlled trials published between 1978 and 2007 was conducted and a total of 15 studies were subsequently reviewed and analyzed.


RESULTS
There was strong evidence that exercise was effective in reducing the severity and activity interference from LBP. However, due to the poor methodological quality of studies and conflicting results, there was only limited evidence supporting the use of exercise to prevent LBP episodes in the workplace. Other methodological limitations such as differing combinations of exercise, study populations, participant presentation, workloads and outcome measures; levels of exercise adherence and a lack of reporting on effect sizes, adverse effects, and types of sub-groups, make it difficult to draw definitive conclusions on the efficacy of workplace exercise in preventing LBP.


CONCLUSIONS
Only two out of the 15 studies reviewed were high in methodological quality and showed significant reductions in LBP intensity with exercise. Future research is needed to clarify which exercises are effective and the dose-response relationships regarding exercise and outcomes.
Bell
Julie Ann
JA
Centre for Research into Disability and Society, School of Occupational Therapy and Social Work, Curtin University of Technology, GPO Box U1987, Perth, WA, 6845, Australia. j.netto@curtin.edu.au
Burnett
Angus
A
D005081:Exercise Therapy; D006801:Humans; D017116:Low Back Pain / Q000517:prevention & control*; D009784:Occupational Diseases / Q000517:prevention & control*; D011322:Primary Prevention; D012107:Research Design; D055502:Secondary Prevention; D055512:Tertiary Prevention; D016896:Treatment Outcome; D017132:Workplace