New research shows back belts don't help, editorial: 'focus on psychosocial factors'

December 04, 2000

NEWS CHAPEL HILL -- A common sight at stores where employees lift boxes and appliances are "back belts" designed to support the spine during lifting, but do they really work? Do workers who use them suffer less back pain and take fewer sick days as a result? Until recently, the answers have been unclear.

Now it's time to consider back belts ordinary clothing, not useful safety devices, say two University of North Carolina at Chapel Hill experts who specialize in back pain and related ailments.

Although such apparel was long thought to reduce back pain and worker compensation claims, a new study provides further evidence that they don't work.

"Moreover, it is time to focus on the psychosocial elements of life, on and off the job, that render too much of back pain so intolerable that it is memorable and even incapacitating," wrote Dr. Nortin M. Hadler and Timothy S. Carey in the Dec. 6 issue of the Journal of the American Medical Association. "Therein lie potentially effective remedies to one of the most pressing public health issues facing industrialized countries."

Hadler and Carey are professors of medicine at the UNC-CH School of Medicine. Carey also is director of the Cecil G. Sheps Center for Health Services Research. Their editorial, written at the journal's request, reacts to a paper in the journal by a group led by Dr. James T. Wassell of the Centers for Disease Control and Prevention and National Institute for Occupational Safety and Health.

Wassell, Dr. Douglas Landsittel and colleagues studied 6,311 people whose work included lifting things at 160 new retail stores in 30 states and who completed both initial and follow-up interviews about low back pain and worker compensation claims. The study, which began with 9,377 workers, was the largest of its kind.

After adjusting for individual risk factors, "neither frequent back belt use nor a store policy that required belt use was associated with reduced incidence of back injury claims or low back pain," Wassell wrote. Levels of physical exertion at work made no difference.

The new research supports previous studies, especially one published in the journal two years ago, that showed no benefit to airline baggage handlers wearing back belts, Hadler and Carey said. It also tested the effectiveness of the belts among workers who chose, rather than were required, to wear them. The findings should interest workers, employers, health and safety officials and health-care providers.

"Any recommendation to wear back belts when exposed to tasks with this range of physical demands should be met with skepticism," the two UNC-CH physicians wrote. "The burden of proof should be on those who might still advocate them."

Back injuries are the leading cause of disability in the United States among people under age 45 and are the most expensive health-care problem for patients aged 30 to 50, Wassell and colleagues said. In 1995, low back pain cost $8.8 billion -- or 23 percent -- of total worker compensation payments.

According to the Bureau of Labor Statistics, 279, 507 back injuries due to over-exertion and resulting in lost workdays occurred in 1998, they said. In 1995, about four million back belts were sold to industry.
Note: Copies of the paper and editorial are available from the American Medical Association by calling 312-464-5374. Hadler and Carey can be reached at 919-966-0566 and 966-7100, respectively. Wassell or his colleague Dr. Douglas P. Landsittel can be reached through Fred Blosser at 202-260-8519.

UNC-CH News Services contact: David Williamson, 919-962-8596.
Sheps center contact: Carolyn Busse, 966-3847.

University of North Carolina at Chapel Hill

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