Systematic review finds little evidence in support of back belts

Is wearing a back belt really effective in preventing and/or reducing occupational low-back pain? According to a new systematic review by researchers at the Institute for Work & Health, there is limited evidence to support their use.

There is no convincing evidence that wearing back belts in the workplace reduces injury or lost-time following an injury, says IWH researcher Dr. Carlo Ammendolia, who led the study. The systematic review, carried out by Ammendolia, and IWH scientists Drs. Michael Kerr and Claire Bombardier, evaluated previous studies on the use of back belts. The belts, usually made of plastic or elastic, are designed to support the lumbar spine and abdomen. They are typically worn while lifting or carrying heavy loads.

The researchers identified ten studies from the existing scientific literature including five randomized controlled trials (RCTs), which are considered the “gold standard” in quality of evidence. All of the studies focused on workers – such as health-care workers, airline baggage handlers and construction workers – whose jobs exposed them to heavy lifting and/or repetitive tasks, like bending and lifting. The studies compared the incidence and duration off work once an injury had occurred among those who wore the belts and those who didn’t.

In general, most of the fair- and good-quality studies we looked at found that workers with no prior history of low-back pain were unlikely to benefit from wearing a back belt, says Ammendolia. There was no change in the number of injuries reported, or any reduction in lost-time claims.

So is there any benefit at all from wearing back belts? Ammendolia says that there may be some limited benefit for workers who have a history low-back pain. However, we still require more research in this area before giving any definite recommendations. He cautions that if back belts are worn, they should only be used for a short period of time, such as two to three weeks following an injury, and workers should be weaned off of them as soon as possible. Back belts can give a false sense of security to workers who have experienced back pain in the past, explains Ammendolia. Prolonged use can restrict range of motion, lead to weakening of the back muscles and a psychological dependence.

While several systematic reviews on back belt use have already been published, this study is unique because it evaluated both clinical trials and observational studies and included a recent randomized controlled trial which was the largest of its kind. This is the most up-to-date and most inclusive study, says Ammendolia. There were no restrictions on the study designs that we reviewed.

Back injuries account for 20 to 30 per cent of all lost-time claims and are the leading overall cause of lost productivity in the workplace, according to the Association of Workers’ Compensation Boards of Canada. Back belts have failed to be effective. As we continue to examine the effectiveness of primary prevention methods for low-back injury, we should also devote efforts to secondary prevention. While we may not be able to prevent back injuries all the time, we can prevent and reduce ongoing disability, says Ammendolia.

Source: At Work, Issue 43, Winter 2006: Institute for Work & Health, Toronto