Preventive interventions for back and neck pain problems - What is the evidence?

Study Design. A review of controlled trials. Objectives. To determine which interventions are used to prevent back and n eck pain problems as well as what the evidence is for their utility. Summary of Background Data. Given the difficulty in successfully treating l ong-term back and neck pain problems, there has been a call for preventive interventions. Little is known, however, about the value of preventive effo rts for nonpatients, e.g., in the general population or workplace. Methods. The literature was systematically searched to locale all investiga tions that were: 1) specifically designed as a preventive intervention; 2) randomized or nonrandomized controlled trials; and, 3) using subjects not s eeking treatment. Outcome was evaluated on the key variables of reported pa in, report of injury, dysfunction, time off work, health-care utilization, and cost. Conclusions were drawn using a grading system. Results. Twenty-seven investigations meeting the criteria were found for ed ucational efforts, lumbar supports, exercises, ergonomics, and risk factor modification. For back schools, only one of the nine randomized trials repo rted a significant effect, and there was strong evidence that back schools are not effective in prevention. Because the randomized trials concerning l umbar supports were consistently negative, there is strong evidence that th ey are not effective in prevention. Exercises, conversely, showed stable po sitive results in randomized controlled trials, giving consistent evidence of relatively moderate utility in prevention. Because no properly controlle d trials were found for ergonomic interventions or risk factor modification , there was not good quality evidence available to draw a conclusion. Conclusions. The results concerning prevention for subjects not seeking med ical care are sobering. Only exercises provided sufficient evidence to conc lude that they are an effective preventive intervention. There is a dire la ck of controlled trials examining broad-based multidimensional programs. Th e need for high quality outcome studies is underscored.