Non-rigid lumbar supports for the management of non-specific low back pain: A literature review and meta-analysis.

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).

Short-term pain evolution in chronic low back pain with Modic type 1 changes treated by a lumbar rigid brace: A retrospective study.

BACKGROUND: Blocking the lumbar or lumbosacral spine with a custom-made rigid lumbar brace, based on the mechanical origin of active discopathy, is a therapeutic option for low back pain, but no study has yet defined its applicability in low back pain. OBJECTIVE: To assess the pain evolution of individuals with non-specific chronic low back pain associated with Modic type 1 changes treated with custom-made rigid lumbar brace. METHODS: This was a retrospective observational study conducted in the Physical Medicine and Rehabilitation unit at Clermont-Ferrand University Hospital, France, between January 2014 and December 2016. Inclusion criteria were adults with non-specific chronic low back pain associated with Modic type 1 changes on the lumbar or lumbosacral spine confirmed by MRI. Patients had 4 consultations with the physician (baseline, 5 weeks, 3 months, and 5 months). The brace was progressively withdrawn at 3 months. The main outcome was pain improvement of at least 30% at 3 months (visual pain scale). The secondary outcome was an improvement of at least 50%. We also studied the association between pain improvement at the 2 thresholds (30 and 50%) and clinical data, level of Modic type 1 changes, and pain recurrence after withdrawal of the brace. RESULTS: Among the 174 patients who wore the brace, 62 were included in the study; 49/62 (79%) showed improvement of at least 30% at 3 months. Two months after brace withdrawal, pain recurred for 30/46 patients (16 missing data). No sociodemographic, clinical or radiographic criteria were associated with pain evolution. CONCLUSION: In the present study, a rigid lumbar brace worn for 3 months was associated with a 30% reduction in pain for 79% of patients with chronic low back pain and active discopathy. However, the retrospective open and uncontrolled design of our study limits our interpretation about a specific treatment effect. A prospective randomized controlled trial is needed to clarify the effect of a rigid lumbar brace in this condition.

Facilitators and barriers to physical activity in people with chronic low back pain: A qualitative study.

BACKGROUND: For medical teams, one of the main objectives of rehabilitation for people with chronic low back pain is adherence to physical activity (PA). OBJECTIVE: The objective of this study was to identify PA barriers and facilitators in this population. METHODS: This qualitative study included 4 discussion groups and 16 semi-structured interviews conducted among people with non-specific chronic low back pain who were involved in a specific rehabilitation program or seen in primary care settings. RESULTS: Three main themes were identified: physical factors, psychological factors and socio-environmental factors. The main barrier to PA practice is pain. Psychological barriers were associated with the difficulty in integrating PA in the person's daily life. Environmental barriers were dominated by lack of time. Facilitators identified associated the supervised nature of the physical activity (supervision by professionals) and group practice, which improved people's adherence. CONCLUSION: The results of this study will allow teams to target relevant educational objectives for these people and develop dedicated self-management programs.