Can the use of a lumbar belt be recommended for the prevention or treatment of low back pain?
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- Answered 15 Sep 2019 Conflict of interest declaration: None To find the answer I did this search in Trip http://bit.ly/trip_lumbarbelts. I searched for either lumbar belts or lumbar support (I’m treating belts as a subset of ‘support’ which possibly includes other interventions than just belts. This showed a 2008 Cochrane Review  from 2008 which concludes: “There is moderate evidence that lumbar supports are not more effective than no intervention or training in preventing low-back pain, and conflicting evidence whether they are effective supplements to other preventive interventions. It remains unclear whether lumbar supports are more effective than no or other interventions for treating low-back pain. There is still a need for high quality randomized trials on the effectiveness of lumbar supports. One of the most essential issues to tackle in these future trials seems to be the realization of an adequate compliance. Special attention should be paid to different outcome measures, types of patients and types of lumbar support.” Two more recent pieces of secondary evidence, both from 2017 suggest the evidence for lumbar support has improved. The American College of Physicians guideline “Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain”  reports: “Lumbar Supports Low-quality evidence showed no difference in pain or function between lumbar supports added to an educational program compared with an educational program alone or other active interventions in patients with acute or subacute low back pain” AND “Evidence was insufficient to compare lumbar support versus no lumbar support. Low-quality evidence showed no difference between a lumbar support plus exercise (muscle strengthening) versus exercise alone for pain or function at 8 weeks or 6 months. Low-quality evidence showed no clear differences between lumbar supports and other active treatments (traction, spinal manipulation, exercise, physiotherapy, or TENS) for pain or function.” The other 2017 article was “Low back pain and radicular pain: evaluation and management” produced by the Belgian Health Care Knowledge Centre . In section 3.2.4. they discuss “Orthotics and appliances” which included belts. They write “Nevertheless the widespread use of orthotics and appliances, its clinical effectiveness remains uncertain.” When specifically looking at “Scientific evidence regarding belts/corsets” they report, in relation to back pain with no sciatica: “Single interventions: The single small study comparing lumbar belts to usual care (only comparison found) showed no clinical difference in function, pain and responder criteria for pain improvement.” AND “Belts/corsets as adjunct in combined interventions: No evidence was available.” A more recent systematic review explored prevention “Occupational interventions for the prevention of back pain: Overview of systematic reviews” , table 3 states that “Lumbar support (back belts, braces, chair back rests) - Evidence of no effectiveness” “Lumbar support as an approach to prevent LBP in the workplace has recently gained popularity but the evidence to support its application is, at best, conflicting. In keeping with our findings, both the U.S. National Institute for Occupational Safety and Health (NIOSH) and the Canadian Centre for Occupational Health and Safety recommend against the use of back belts as a preventive measure at the workplace.” I found one dissenting perspective from 2018 “Effectiveness of Lumbar Support in Management of Low Back Pain: A Systematic Review”  from the Online Journal of Health and Allied Sciences. This concludes: “The lumbar support belt appeared to be as effective as additional intervention together with usual care in the management of non-specific low back pain.” I post this last one with some hesitation as the journal is not in PubMed (or Trip) so I have no idea of the veracity of the journal (for instance, is it peer reviewed?). References 1) https://www.ncbi.nlm.nih.gov/pubmed/18425875 2) https://annals.org/aim/fullarticle/2603228/noninvasive-treatments-acute-subacute-chronic-low-back-pain-clinical-practice 3) https://kce.fgov.be/sites/default/files/atoms/files/KCE_287_Low_back_pain_Report_0.pdf 4) https://www.sciencedirect.com/science/article/pii/S0022437517304176 5) https://www.ojhas.org/issue68/2018-4-3.html
- Answered 15 Sep 2019 Conflict of interest declaration: None Infographics in this paper are useful to guide patients on "Prevention and treatment of low back pain: evidence, challenges, and promising directions". https://www.ncbi.nlm.nih.gov/pubmed/29573872 I am afraid I cannot post the infographic here.
- Answered 15 Sep 2019 Conflict of interest declaration: None Excuse me for the inaccurate previous link, I cannot edit my previous answer. The infographics is in Spanish and can be found in Twitter. It is based on the Lancet paper. https://twitter.com/DrAlfonsoVidal/status/1001170669223206914?s=20