Prospective studies of interventions to prevent back problems (back symptoms or activity limitation caused by back pain or back-related limb symptoms (sciatica)) in adults aged 18 to 65 were eligible for the review. Interventions to limit disability in patients with existing back problems were excluded, as were studies of people with serious underlying spinal pathology or non-spinal causes of referred back pain. Studies had to be randomised controlled trials (RCTs) or non-randomised trials without obvious bias in treatment assignment and with comparable treatment groups at baseline, and had to meet a number of quality criteria (listed) to be included. Participants could be people with or without current symptoms or previous back problems, provided they were not actively seeking treatment or unable to work because of back problems at baseline. Studies had to report clinical or functional outcomes (not changes in anatomical or physiological measures or knowledge).
Interventions in included trials involved exercise, education, lumbar supports, shoe orthoses and programmes to reduce lifting load. Most trials recruited a mixture of participants with and without previous back problems but some involved only people with a previous history of back problems.
Three reviewers independently selected studies for the review.