Hebetraining zur Rückenschmerzprävention unnötig?
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD005958/frame.html
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http://www.bmj.com/cgi/content/full/bmj.39463.418380.BEv1
Abstract BMJ
Objectives To determine whether advice and training on working techniques and lifting equipment prevent back pain in jobs that involve heavy lifting.
Data sources Medline, Embase, CENTRAL, Cochrane Back Group’s specialised register, CINAHL, Nioshtic, CISdoc, Science Citation Index, and PsychLIT were searched up to September-November 2005.
Review methods The primary search focused on randomised controlled trials and the secondary search on cohort studies with a concurrent control group. Interventions aimed to modify techniques for lifting and handling heavy objects or patients and including measurements for back pain, consequent disability, or sick leave as the main outcome were considered for the review. Two authors independently assessed eligibility of the studies and methodological quality of those included. For data synthesis, we summarised the results of studies comparing similar interventions. We used odds ratios and effect sizes to combine the results in a meta-analysis. Finally, we compared the conclusions of the primary and secondary analyses.
Results Six randomised trials and five cohort studies met the inclusion criteria. Two randomised trials and all cohort studies were labelled as high quality. Eight studies looked at lifting and moving patients, and three studies were conducted among baggage handlers or postal workers. Those in control groups received no intervention or minimal training, physical exercise, or use of back belts. None of the comparisons in randomised trials (17 720 participants) yielded significant differences. In the secondary analysis, none of the cohort studies (772 participants) had significant results, which supports the results of the randomised trials.
Conclusions There is no evidence to support use of advice or training in working techniques with or without lifting equipment for preventing back pain or consequent disability. The findings challenge current widespread practice of advising workers on correct lifting technique.
Abstract Cochrane library
Training and assistive devices are considered major interventions to prevent back pain among workers exposed to manual material handling (MMH).
To determine the effectiveness of MMH advice and training and the provision of assistive devices in preventing and treating back pain.
We searched MEDLINE to November 2005, EMBASE to August 2005, and CENTRAL, the Back Group's Trials Register, CINAHL, Nioshtic, CISdoc, Science Citation Index, and PsychLIT to September 2005.
We included randomized controlled trials (RCT) and cohort studies with a concurrent control group, aimed at changing human behaviour in MMH and measuring back pain, back pain-related disability or sickness absence.
Two authors independently extracted the data and assessed the methodological quality using the criteria recommended by the Back Review Group for RCTs and MINORS for the cohort studies. One author of an original study supplied additional data for the review.
The results and conclusions are based on the primary analysis of RCTs. We conducted a secondary analysis with cohort studies. We compared and contrasted the conclusions from the primary and secondary analyses.
We included six RCTs (17,720 employees) and five cohort studies (772 employees). All studies focused on prevention of back pain. Two RCTs and all cohort studies met the majority of the quality criteria and were labeled high quality.
We summarized the strength of the evidence with a qualitative analysis since the lack of data precluded a statistical analysis.
There is moderate evidence that MMH advice and training are no more effective at preventing back pain or back pain-related disability than no intervention (four studies) or minor advice (one study). There is limited evidence that MMH advice and training are no more effective than physical exercise or back belt use in preventing back pain (three studies), and that MMH advice plus assistive devices are not more effective than MMH advice alone (one study) or no intervention (one study) in preventing back pain or related disability.
The results of the cohort studies were similar to the randomised studies.
There is limited to moderate evidence that MMH advice and training with or without assistive devices do not prevent back pain, back pain-related disability or reduce sick leave when compared to no intervention or alternative interventions. There is no evidence available from RCTs for the effectiveness of MMH advice and training or MMH assistive devices for treating back pain.
Plain language summary
Advice on material handling techniques and using assistive devices to prevent and treat back pain in workers
Back pain is very common among adults. There is evidence that individuals who physically move or lift objects (manual material handling) on a regular basis increase the strain on their backs and the risk of developing back pain. In many occupations, it is difficult to avoid this. Training on proper lifting techniques and the use of mechanical aides (assistive devices) are considered important techniques to prevent back pain.
We included six randomized controlled trials (17,720 employees) and five cohort studies (772 employees) that examined the effects of training and the use of assistive devices on preventing low-back pain and reducing back-related disability. We found no studies that examined the effects of training or the use of assistive devices as part of a treatment plan for back pain.
We found limited to moderate evidence that, on average, there was no significant difference in reports of back pain, back-related disability or absence from work between groups who received training on proper lifting techniques and assistive devices and those who received exercise training, back belts or no training. Similarly, there was no difference between those who received intensive training and those who received shorter instruction. These findings were consistent when measured in the short-term or long-term and when examined in randomized trials or cohort studies.
These results are similar to other reviews that examined a range of possible prevention measures. Some of the other reviews found that workers who received training were satisfied and demonstrated increased knowledge on the subject, but this did not appear to consistently translate into behaviour change.
In conclusion, training workers about proper material handling techniques or providing them with assistive devices are not effective interventions by themselves in preventing back pain.
