Lumbar support and nonspecific low back pain: Evidence for daily practice.

OBJECTIVE: We aimed to evaluate the place of lumbar support in the management of nonspecific low back pain.

MATERIAL AND METHODS: We conducted a systematic review with the following databases: Pubmed, Cochrane Library, Science Direct and Pedro. The search strategy used the keywords low back pain; lumbar orthosis; lumbar belt; back support; lumbar support; lumbar brace. To be included, studies needed to have one or more keywords selected. The search was limited to French and English articles. The major exclusion criterion was studies included rigid orthotics of the trunk. High Authority of health statement was used to check the quality of reporting. Data were also analyzed according to stages of the disease (acute, subacute, and chronic) and in prevention (primary and secondary).

RESULTS: We included 28 studies. Quality assessment was heterogeneous. The systematic review showed no official recommendations for lumbar support prescription among the general population. Lumbar support was effective on function, pain, and relative time intervals for dispensing medication with subacute low back pain. It was also effective with probability of low back pain recurrence in secondary prevention. Orthosis' benefits were not highlighted probably due to the lack of observance, which was a limiting factor. It is a bias because observance was not systematically studied in the literature. To our knowledge, there is no meta-analysis because evaluation criteria are heterogeneous.

DISCUSSION/CONCLUSION: To date, there is no proof to prescribe lumbar support in the management of low back pain general population. An individual prescription would be discussed for subacute low back pain or in secondary prevention. Further studies with a higher quality assessment are necessary in order to identify phenotypes of patients' responders to lumbar support. The function would be preferred as a main assessment criterion.