My Achin' Back!
Abstract & Commentary
By Barbara A. Phillips, MD, MSPH, Professor of Medicine, University of Kentucky; Director, Sleep Disorders Center, Samaritan Hospital, Lexington. Dr. Phillips reports no financial relationship to this field of study.
Synopsis: Neither training in working techniques nor use of lifting equipment appears to prevent back pain or back-related disability.
Source: Kari-Pekka Martimo K, et al. Effect of training and lifting equipment for preventing back pain in lifting and handling: systematic review. BMJ. 2008. (doi:10.1136/bmj.39463.418380.BE)
This report is the result of a meta analysisthat was conducted using detailed searching of multiple databases to find studies that aimed to modify the participants' lifting techniques at work and which measured back pain, consequent disability, or absence related to back pain as the main outcomes. The authors found 11 out of 3611 possible studies that were of high enough quality and detail to be included in this meta analysis. Of these, 6 were randomized trials and 5 were cohort studies. Most of the studies (three randomized trials and five cohort studies) involved care of patients. One trial studied postal workers and two investigated baggage handlers. The number of participants in these reports varied from 45 to 12,772, and the follow-up times ranged from eight weeks to 5.5 years. The authors included only analyses of workers who were not actively seeking treatment for current back pain at the time of enrollment, and who had enough work-related strain on the back so that intervention might reasonably be expected to make a difference. The training interventions that were assessed in the included trials were generally the use of instruction on lifting techniques varying in intensity from a single session to training once a week for two years. In some reports, the training was supported by follow-up and feedback in the workplace. Five of the included studies encouraged participants to use available lifting aids, and some used a professional instructor.
There was no difference in back pain (odds ratio 0.99, 95% confidence interval 0.54 to 1.81) or related disability at intermediate or long-term follow-up when comparing the groups that received training to those who received no intervention in the randomized trials. Similar findings were demonstrated in the cohort studies. With regard to use of lifting equipment, a comparison of a group receiving training and lifting equipment with the groups receiving training only or no intervention at all in one randomized trial showed no difference in back pain or back-related disability at intermediate follow-up of either comparison.
The authors note, "Many health professionals are involved in training and advising workers on lifting and handling. Even though there may be other reasons to continue this practice, this review does not provide evidence that it prevents back pain."
Commentary
Revolutionary as it seems, this paper is not the only evidence that we are wasting a lot of time and energy on useless training with regard to prevention of back problems. Apparently too late to be included in this analysis, two other relevant, high quality trials have recently been published. One of these showed no effect of training in transfer techniques on subsequent back pain on a two year follow-up of health care workers caring for elderly people.1 The other failed to show that training on lifting in a distribution center affected rates of back injury over a one year follow-up.2
Specific techniques to reduce the load on the back have been advocated by highly respected authorities;3,4 we appear to have developed an entire, unsubstantiated dogma about how to prevent back injury; At present, there does not seem to be much evidence to support the use of these (or any other) training techniques to prevent back injury related to heavy lifting. Yet back pain and its prevention are big business because back pain is highly prevalent and enormously expensive, particularly among workers lifting heavy loads. The answers are most definitely not in yet. For now, the best strategy would appear to be avoiding heavy loads altogether!
References
1. Jensen LD, et al. Prevention of low back pain in female eldercare workers: randomized controlled work site trial. Spine. 2006;31:1761-1769.
2. Lavender SA, et al. Spine. 2007;32:487-494.
3. National Institute for Occupational Safety and Health. Simple solutions for lifting, holding, and handling materials. Introduction. In: Simple solutions: ergonomics for construction workers. 2007. (NIOSH Publication No 2007-122.) www.cdc.gov/niosh/docs/2007-122/.
4. European Agency for Safety and Health at Work. Hazards and risks associated with manual handling of loads in the workplace. 2007. http://osha.europa.eu/publications/factsheets/73.
Neither training in working techniques nor use of lifting equipment appears to prevent back pain or back-related disability.Subscribe Now for Access
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