Non-rigid lumbar supports for the management of non-specific low back pain: a literature review and meta-analysis - 16/06/20

Doi : 10.1016/j.rehab.2020.05.010

Paul Gignoux, MD ^1,⁶, Charlotte Lanhers, MD, MSc ^1,^2,⁶, Frédéric Dutheil, MD, PhD ^3,^4,⁶, Laura Boutevillain, MD ^5,⁶, Bruno Pereira, PhD ^5,⁶, Emmanuel Coudeyre, MD, PhD ^1,^6,⁎
¹ Service de Médecine Physique et de Réadaptation, CHU Clermont-Ferrand, Université Clermont Auvergne, INRAE, UNH, F-63000 Clermont–Ferrand, France
² Centre de Médecine Physique et de Réadaptation Notre Dame, F-63400 Chamalières, France
³ Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont–Ferrand, CHU Clermont–Ferrand, Preventive and Occupational Medicine, WittyFit, F–63000 Clermont–Ferrand, France
⁴ Australian Catholic University, Faculty of Health, School of Exercise Science, Melbourne, Victoria 3065, Australia
⁵ Service de Médecine Physique et de réadaptation, Centre Médico-chirurgical des Massues, F–69000 Lyon, France
⁶ University Hospital of Clermont-Ferrand, CHU Clermont–Ferrand, Clinical Research and Innovation Direction, Biostatistics, F–63000 Clermont-Ferrand, France

^⁎Corresponding author: Service de Médecine Physique et de Réadaptation, CHU Clermont-Ferrand, Hopital Louise Michel, 63118 Cébazat, FranceService de Médecine Physique et de Réadaptation, CHU Clermont-Ferrand, Hopital Louise MichelCébazat63118France

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Abstract

Background: Clinical practice guidelines for non-specific low back pain do not recommend the use of non-rigid lumbar supports (NRLSs) despite the publication of several positive randomized controlled studies.

Objective: We conducted a systematic review with meta-analysis to assess the efficacy of NRLSs in the treatment and prevention of non-specific low back pain.

Methods: We searched for reports of randomized controlled trials in PubMed, Cochrane Library, EMBASE, Science Direct and Pedro databases. Data were analyzed by disease stage (acute, subacute, and chronic) and type of prevention (primary and secondary). The analysis of methodological quality involved the Physiotherapy Evidence Database (PEDro) scale.

Results: Of the 1581 records retrieved, only 4 full-text articles were included, with 777 patients: 378 in the NRLS group, and 348 in the control group. NRLSs conferred greater amelioration of disability (effect size -0.54, 95% CI -0.90; -0.17) and pain (-0.29, -0.46; -0.12) than standard management. Insufficient data prevented a comparison of the efficiency for acute, subacute and recurrent low back pain as well as meta-regression of responder phenotypes (sociodemographic and other patient characteristics).

Conclusion: We demonstrated the overall efficacy of NRLSs for both disability and pain. However, further studies are needed to assess which patients can benefit the most from lumbar supports based on patient phenotype and the characteristics of low back pain.

PROSPERO (CRD42018109855).

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Keywords : low back pain, acute, chronic, subacute, lumbar support, meta-analysis, prevention