Study Title: High-quality trials on preventing episodes of back problems: systematic literature review in working-age adults Authors: Bigos SJ, Holland J, Holland C, et al. Publication Information: The Spine Journal 2009; 9: 147-168. BACKGROUND INFORMATION It is well known that back problems (BPs) are common and very expensive on an individual and societal level. There is a vast amount of scientifi c literature on back pain, and a substantial number of high-quality trials now exist to provide an evidentiary basis for the prevention of new back pain episodes. The purpose of this systematic review was to analyze these prospective controlled trials to evaluate the effectiveness of various prevention interventions aimed at reducing BPs in working-aged adults. • • • Dr. Shawn Thistle is the founder and president of Research Review Service Inc., an online, subscription- based service designed to help busy practitioners to integrate current, relevant scientific evidence into their practice. Shawn graduated from CMCC and holds an Hon- ours Degree in Kinesiology from McMaster University. He also holds a certificate in Contemporary Medi- cal Acupuncture from McMaster University, and is a Certified Active Release Techniques (ART®) Pro- vider. For more information about the Research Review Service, visit www.researchreviewservice.com. • • • • • • • PERTINENT RESULTS: Interventions evaluated in the studies included clinical or educational approaches (exer- cise or education), personal appliances (back supports or shoe inserts), ergonomic equip- ment (lift assists etc.), activity modifi cations (changes in physical activities or work duties), and administrative or social interventions (such as work policies or social changes). 20 prospective controlled trials met inclusion criteria and evaluated the following inter- ventions: exercise (8), ergonomic/back education (4), stress management (1), lumbar back support belts (4), shoe inserts (2), and programs for reducing lifting tasks as work via policy change, training, or mechanical lifting devices (4) All 20 trials included had high quality scores, 90 per cent investigated workplace settings, and 50 per cent involved health care workers fi ve trials measured objective outcomes, while 15 measured only subjective outcomes Meta-analysis was not performed due to substantial heterogeneity of interventions, out- comes, and study designs Exercise was the only intervention found to be effective - 7/8 trials reported statistically signifi cant reduction in BPs fi ve of the seven successful exercise programs included 45-60 minutes of supervised exer- cise, twice per week for 3-12 months (most also encouraged additional exercise without supervision) Specifi c exercise techniques included McKenzie, active and passive back extensions, core stabilization, “Williams” exercises1 , and Mensendieck trunk exercises2 NO other intervention was found effective in reducing BPs Negative results were found in all studies on ergonomic/back education, stress manage- ment, lumbar supports, shoe inserts, and programs for reducing lifting tasks PRACTICAL APPLICATION The positive results regarding exercise from this review are consistent with previous literature reviews on this topic3-5 . The effectiveness of varied exercise approaches may suggest a gen- eral benefi t of exercise beyond specifi c physiological goals of increasing strength, endurance or fl exibility. Although it cannot be claimed with certainty, it is within reason that patients performing exercise interventions gain a sense of confi dence and self-empowerment from exercise that can improve their clinical outcome, and health in general. The take- home point, from this study (and others,) is to get your back pain patients active and incorporate some form of exercise in their plan of management! To view this review in its entirety, (including study methods, conclusions, and references) please visit www.canadianchiropractor.ca.• This brief review is a sample of the content posted weekly on Research Review Service and is one of over 60 reviews available per year of the latest scientific literature in chiropractic. RRS is approved for 4.0 CEUs/year by CMCC. 38 • CANADIAN CHIROPRACTOR | JULY/AUGUST 2009 www.canadianchiropractor.ca Shawn Thistle, BKin (Hons), DC, CSCS
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