Sixty-four studies about the prevention of lower-back pain, including 2 RCTs of exercise interventions (n=194), 3 RCTs of educational interventions (n=329) and 2 RCTs of exercise plus educational interventions (n=208).
Exercise:
4 RCTs showed a statistically-significant short-term benefit from an exercise intervention.
1 controlled trial found no improvement in duration of recurrent back pain episodes, although patients in the exercise group had significantly improved aerobic capacity compared to the control group.
12 observational studies reported mixed support for decreased lower-back pain or increased flexibility.
Education:
5 RCTs, of which only 1 reported a significant decrease in subsequent lower-back pain. However, this trial did combine education with an exercise programme. Of the remaining 4 trials, although they had negative results overall, 3 found significant differences in intermediate outcomes, e.g. increased knowledge about back pain.
5 out of 6 controlled trials also reported non significant results. 1 controlled trial, to prevent pregnancy-associated back pain, reported that women in the intervention group had significantly less self-reported severe back pain than controls (32 versus 54%).
4 observational studies reported mostly non significant results from education interventions.
Mechanical supports (limited to corsets): 1 RCT reported no differences in mean rates of work loss between the intervention and control group; the other RCT reported that the intervention group had increased knowledge and decreases absenteeism, compared to the control group. However, no differences were found in changes in abdominal strength, productivity and rates of injuries between the groups.
Risk factor modification:
Epidemiological studies have linked smoking, obesity and psychological factors to the development of back pain, but no studies have examined the effect of modifying these risk factors on back pain risk.