Are back supports plus education more effective than education alone in promoting recovery from low back pain?: Results from a randomized clinical trial.

STUDY DESIGN: Randomized clinical trial. OBJECTIVES: To evaluate the effectiveness of a back support plus education versus education alone in promoting recovery from a work-related low back disorder (WR-LBD) while simultaneously considering personal, health, and occupational factors and the impact of occupational factors on recovery. SUMMARY OF BACKGROUND DATA: No randomized studies of active industrial workers with low back disorders exist regarding the effectiveness of back supports plus education. METHODS: A total of 433 actively employed hourly union workers who had a recent diagnosis of a WR-LBD: 1) those who wore a specially designed back support plus received education on back health; and 2) those who received education on back health only. Demographic, health, medical, and occupational factors were obtained through interview or abstraction of computer files; individual ergonomic exposures were measured with a lumbar motion monitor. Outcomes evaluated over a 12-month period included: self-reported measures of back pain, back pain disability level, physical health, mental health, and administrative measures of recurrence, lost work time, and medical care utilization. RESULTS: There was no difference between the study groups with respect to mental or physical health, low back pain, back pain disability, neurogenic symptoms, lost work time, likelihood of recurrence of an episode of a back disorder, or other administrative measures of healthcare utilization or lost work time. However, significant decreases in low back pain, low back pain disability, neurogenic symptoms, and an increase in physical health were observed over the 12 months of observation in both study groups. The only occupational variable found to influence was plant group whereby service parts operations workers in the back support plus education group experienced a lower likelihood of WR-LBD recurrence. CONCLUSION: Although there was no overall effect on self-reported recovery or administrative measures or lost work time between the study groups, a back support plus health education may have some value in preventing recurrent WR-LBD in industrial workers who work in psychosocial environments and perform manual material handling tasks similar to those found in parts distribution centers.

Participation in occupational health longitudinal studies: predictors of missed visits and dropouts.

PURPOSE: The purpose of this study is to determine whether demographics, health, and job factors influence continued participation of employed persons in a longitudinal intervention study of tertiary prevention for work-related low-back disorders (WR-LBDs). METHODS: Four hundred fifty-four actively employed persons had enrolled in an intervention study of back supports and education to promote recovery from a WR-LBD. Baseline values were examined according to whether individuals continued in the study, missed a visit, or dropped out; frequency of missed visits; and early or late dropouts at follow-up intervals of 1, 2, 6, and 12 months. RESULTS: Workers who did not complete all study visits were significantly more likely to be younger and have poorer self-reported health. Individuals with a greater percentage of body fat dropped out early. Significantly more missed visits were observed among those who had arthritis and longer duration of low-back pain symptoms. Job factors did not influence study participation. CONCLUSIONS: Continued participation in a longitudinal study of working adults was influenced by age, health status, and factors related to the primary condition targeted by the intervention study. Strategies aimed at those who report lower levels of health and symptoms related to the condition under study may promote follow-up participation in longitudinal studies. Thus, even among actively employed persons, one should not assume that all workers are "healthy."