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Lumbar support devices 
Panel findings and recommendations: 
 -   Lumbar corsets and support belts have not been proven beneficial for treating patients with low back problems.  (Strength of Evidence =    D.) 
 -   Lumbar corsets, used preventively, may reduce time lost from work due to low back problems in individuals required to do frequent lifting at work.  (Strength of Evidence = C.)  
  Lumbar support devices for low back problems include lumbar corsets and support belts, back braces and molded jackets, and back rests for chairs and car seats.  The panel decided to evaluate only lumbar corsets and support belts for this guideline.  Among theories on why lumbar corsets and support belts might help treat or prevent low back problems are that they compress the abdomen (causing increased intra-abdominal pressure, which unloads the vertebral column) and/or that they act as a mechanical reminder to decrease bending.  Therapeutic objectives of lumbar supports are to control pain and/or protect against injury.   
Lumbar Corsets and Back Belts 
Literature Reviewed     Evidence on Efficacy   Potential Harms and Costs      Summary of Findings     Author's Example 
Lumbar Corsets and Back Belts 
  Literature Reviewed.  Of 31 articles screened, 3 RCTs about lumbar corsets and support belts met review criteria for adequate evidence about efficacy.131, 169, 170  Another article contained information used by the panel, but did not meet selection criteria. 171  None of these studies evaluated only patients with low back problems.  One evaluated only chronic low back pain patients. 171  One evaluated a mixed group of acute and chronic low back pain patients. 171  The other two studies evaluated the prevention of low back problems in workers doing frequent lifting tasks. 169, 170 
 Evidence on Efficacy.    Coxhead, Meade, Inskip, et al. 131 compared lumbar corset use to traction, exercise, and manipulation but included other interventions, making the direct effect of corset use difficult to determine.  
  Million, Haavik Nilsen, Jayson, et al.  171 compared the use of two types of lumbar corsets, one with and one without a lumbar support, in patients with chronic low back problems (all with symptoms longer than 6 months).  This study was an RCT, but had too few subjects to meet review criteria.  Although this study found a considerable and significant improvement in symptoms in the group wearing corsets with a lumbar support, no control group was used in the study to ascertain the effect of corset use as compared with no corset use. 
  Walsh and Schwartz, 170 in an RCT, evaluated 90 grocery warehouse workers not currently receiving treatment for low back problems.  Subjects were randomly assigned to three groups.  One group received a custom- molded lumbar corset plus a 1-hour training program on proper lifting, one the training program alone, and one no intervention.  During the 6-month study period, no significant differences were reported between groups in back injury rates or in time lost from work due to back problems.  However, the group assigned to lumbar corsets plus training showed significantly less time loss from work due to back symptoms during the 6 months of the study when compared with the prior 6-month period.  No similar significant effect was found for the other two groups. [It is worth noting that the Walsh and Schwartz outcome was based upon the prior 6 months to post intervention 6 months ratio of time lost from work and the control group was dissimilar to the intervention groups to the point of making a similar change in their ratio virtually impossible.]  Another by von Poppen et al,`98 found no effect and a large comparative prospective cohort study by Wassel et al.,`00 found not impact whether employers demanded, allowed or did not offer lumbar supports. Since a study by Kraus et al.`02 at first looked promising as supporting belts in a controlled study, until noting that no available data available on prior back problems which were significant risk factors where available in the intervention groups. Also Kraus et al.`02 had more 45-54 year old subjects in the control group than belt intervention group.  Only the 45-54 age group that met statistical significance of all belt wearers. Thus, it is impossible to confirm support for belts in the primary prevention of back problems in light of the non-supportive studies by van Poppen et al.`98 and Wassel et al.`00 and the noted group dissimilarities in both the Walsh et al,`90, and Kraus et al.`02.  
  Reddell, Congleton, Huchingson, et al., 169 in an RCT, evaluated 642 airline baggage handlers randomly assigned to use of a lumbar weightlifting belt, with and without a supplemental training class, or to the training class alone, or to no intervention.  The 1-hour training course included instruction on proper lifting techniques, and employees were given stretching exercises to be done before each flight.  Over an 8-month period, no significant differences were found between groups studied in back injury claims or in days lost from work.  However, the validity of these results is questionable since 58 percent of workers assigned to wear weightlifting belts stopped using them before the end of the study period.  
  Potential Harms and Costs. Some authors suggest that the prolonged use of lumbar corsets and support belts may lead to a decrease in strength of abdominal and back muscles, but no clear evidence of this was found in patients with low back problems.  Walsh and Schwartz170 found that no such weakness occurred in workers who wore lumbar corsets for 6 months as a preventive measure.  In the study by Reddell, Congleton, Huchingson, et al.,169 the majority of workers who stopped wearing weightlifting belts complained that the belts were too hot and/or too uncomfortable. 
  The cost of lumbar corsets and support belts varies from low to moderately expensive.   
Summary of Findings. There is no evidence that lumbar corsets or support belts are effective for treating low back problems and conflicting evidence on whether lumbar corsets and support belts are effective for preventing or reducing the impact of low back problems in subjects who do frequent lifting at work. Recent information as noted above indicates does not support the use of belts for primary prevention. 
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