One high quality study reported a decline in the incidence of low back disorders All four of the controlled field studies showed a significant reduction in physical work demands when lifting devices were part of the intervention A significant reduction in low back disorders in the longer term were measures in two of these studies Other recent studies confirm these findings Working height adjustment and transport mechanisation resulted in lower physical loading and a reduction of back complaints without the loss of productivity in construction work van der Molen et al 2004 9 A new good quality study in the construction industry Luijsterburg et al 2005 10 showed that using a new bricklaying method reduced workload on the back and shoulders The workers were satisfied with the new method but there was no clear difference in the MSDs between the intervention and comparison groups A slight decrease in sickness absence was seen in the intervention group In a healthcare programme introducing ergonomic consultation and financial support for purchasing ergonomic devices also resulted in decreased rates of MSDs although the study had no control group Fujishiro et al 2005 11
There appears to be strong evidence that the introduction of ergonomic improvements may reduce the physical workload Protective equipment Back belts have been recommended to be worn while handling heavy material They are believed to give mechanical advantages to the worker by providing support to the trunk and increasing the intra abdominal pressure In addition they may encourage the wearer to lift properly using biomechanically approved techniques Back belts have been evaluated in four reviews Linton and vanTulder 2001 Silverstein and Clark 2004 Tveito et al 2004 Ammendolia et al 2005 12 15 Three of these reviews Linton and van Tulder 2001 Silverstein and Clark 2004 Tveito et al 2004 12 14 concluded that back belts appear to have no effect on the number of episodes of sick leave or the costs associated with low back pain The most recent review Ammendolia et al 2005 15 evaluated 10 epidemiological studies including those in the other reviews Of five randomised controlled trials three showed no positive results with back belt use two cohort studies had conflicting results and two non randomised controlled studies and one survey showed positive results
The conclusion from all these reviews is that there is no conclusive evidence to support back belt use to prevent or reduce lost time from occupational low back pain Behavioural modification Back schools have trained workers in proper lifting techniques the adoption of sound working postures and in strengthening exercises and have been widely used for the treatment of back problems Studies that combined training with ergonomic measures in order to reduce the load on the back showed a positive response Bos et al 2006 16 In these studies mechanical aids are of benefit but no specific details can be given to compare the effects or to help with equipment provision The risk of back pain increases if there is a discrepancy between the workload and the physical capacity of the person doing the work This mismatch can also be reduced by improving the physical capacity of workers Therefore actions to promote health and physical activity have been advocated Hayden et al 2005 17 Physical training has also been an essential part of the rehabilitation of patients with back pain In a review of interventions for low back in the workplace six comparative studies on exercises were identified Tveitoet al 2004 14 In four of these reviews positive effects were found on low back pain new episodes of back pain sick leave or economic savings Another review made similar conclusions Linton and vanTulder 2001 12 Thus there is moderate evidence that physical exercise is beneficial for the prevention of low back disorders
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