Recommendation Statement

Primary Care Interventions to Prevent Low Back Pain in Adults

U.S. Preventive Services Task Force (USPSTF)

This statement summarizes the current U.S. Preventive Services Task Force (USPSTF) recommendation on interventions to prevent low back pain, and updates the 1996 recommendation contained in the Guide to Clinical Preventive Services, Second Edition.¹

Summary of Recommendation

The U.S. Preventive Services Task Force (USPSTF) concludes that the evidence is insufficient to recommend for or against the routine use of interventions to prevent low back pain in adults in primary care settings.
Rating: I Recommendation.

Rationale: The USPSTF found no new good evidence for or against the use of back strengthening exercises or risk factor modification (e.g., increased physical activity, smoking cessation, or reduced alcohol consumption) for the primary prevention of low back pain in adults. There is limited evidence that educational sessions in occupational settings (e.g., back schools) produce modest short-term benefits in adults with recurrent or chronic low back pain, but no evidence that such education prevents back pain in healthy individuals or those at risk for back pain. Some interventions, such as mechanical supports, may increase the risk for low back pain. As a result, the USPSTF could not determine the balance between benefits and harms of the different interventions that may be used to prevent low back pain.

Background
Clinical Considerations
References
Members of the Task Force
Contact the Task Force
Available Products
Copyright and Electronic Dissemination

Task Force Ratings
Strength of Recommendations and Quality of Evidence

Background

The U.S. Preventive Services Task Force (USPSTF) last addressed counseling for the prevention of low back pain in the 1996 Guide to Clinical Preventive Services and found insufficient evidence to recommend for or against counseling patients to exercise, or the routine use of educational interventions, mechanical supports, or risk factor modification to prevent low back pain in asymptomatic adults (I Recommendation).¹

Since then, the USPSTF criteria to rate the strength of the evidence have changed. Therefore, the recommendation statement that follows has been updated and revised based on the current USPSTF methodology and rating of the strength of the evidence.²

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Clinical Considerations

Although exercise has not been shown to prevent low back pain, regular physical activity has other proven health benefits, including prevention of cardiovascular disease, hypertension, type 2 diabetes, obesity, and osteoporosis.
Neither lumbar supports nor back belts appears to be effective in reducing the incidence of low back pain.
Worksite interventions, including educational interventions, have some short-term benefit in reducing the incidence of low back pain. However, their applicability to the primary care setting is unknown.
Back schools may prevent further back injury for individuals with recurrent or chronic low back pain, but their long-term effectiveness has not been well studied.

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References

1. U.S. Preventive Services Task Force. Guide to Clinical Preventive Services, 2nd ed. Washington, DC: Office of Disease Prevention and Health Promotion, 1996.

2. Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow CD, Teutsch SM, Atkins D, for the Methods Word Group, third U.S. Preventive Services Task Force. Current methods of the U.S. Preventive Services Task Force: a review of the process. Am J Prev Med 2001;20(3S):21-35.

3. Primary Care Interventions to Prevent Low Back Pain: A Brief Evidence Update for the U.S. Preventive Services Task Force. Rockville, MD, Agency for Healthcare Research and Quality, 2004. Available at http://www.preventiveservices.ahrq.gov.

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Members of the Task Force

Members of the U.S. Preventive Services Task Force* are are Alfred O. Berg, M.D., M.P.H., Chair, USPSTF (Professor and Chair, Department of Family Medicine, University of Washington, Seattle, WA); Janet D. Allan, Ph.D., R.N., C.S., Vice-chair, USPSTF (Dean, School of Nursing, University of Maryland Baltimore, Baltimore, MD); Ned Calonge, M.D., M.P.H. (Acting Chief Medical Officer, Colorado Department of Public Health and Environment, Denver, CO); Paul Frame, M.D. (Tri-County Family Medicine, Cohocton, NY, and Clinical Professor of Family Medicine, University of Rochester, Rochester, NY); Joxel Garcia, M.D., M.B.A. (Deputy Director, Pan American Health Organization, Washington, DC); Russell Harris, M.D., M.P.H. (Associate Professor of Medicine, Sheps Center for Health Services Research, University of North Carolina School of Medicine, Chapel Hill, NC); Mark S. Johnson, M.D., M.P.H. (Professor of Family Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ); Jonathan D. Klein, M.D., M.P.H. (Associate Professor, Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY); Carol Loveland-Cherry, Ph.D., R.N. (Executive Associate Dean, School of Nursing, University of Michigan, Ann Arbor, MI); Virginia A. Moyer, M.D., M.P.H. (Professor, Department of Pediatrics, University of Texas at Houston, Houston, TX); C. Tracy Orleans, Ph.D. (Senior Scientist, The Robert Wood Johnson Foundation, Princeton, NJ); Albert L. Siu, M.D., M.S.P.H. (Professor of Medicine, Chief of Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY); Steven M. Teutsch, M.D., M.P.H. (Senior Director, Outcomes Research and Management, Merck & Company, Inc., West Point, PA); Carolyn Westhoff, M.D., M.Sc. (Professor of Obstetrics and Gynecology and Professor of Public Health, Columbia University, New York, NY); and Steven H. Woolf, M.D., M.P.H. (Professor, Department of Family Practice and Department of Preventive and Community Medicine and Director of Research, Department of Family Practice, Virginia Commonwealth University, Fairfax, VA).

* Member of the USPSTF at the time this recommendation was finalized. For a list of current Task Force members, go to www.ahrq.gov/clinic/uspstfab.htm.

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Contact the Task Force

Address correspondence to: Ned Calonge, M.D., M.P.H., Chair, U.S. Preventive Services Task Force; c/o Program Director, USPSTF; 540 Gaither Road; Rockville, MD 20850; E-mail: uspstf@ahrq.gov.

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Available Products

This recommendation statement and the brief update, Primary Care Interventions to Prevent Low Back Pain: A Brief Evidence Update for the U.S. Preventive Services Task Force,³ are available on the USPSTF Web site at http://www.preventiveservices.ahrq.gov. Individual copies of this statement are available online through the National Guideline Clearinghouse™ at: http://www.guideline.gov.

Recommendations made by the USPSTF are independent of the U.S. Government. They should not be construed as an official position of AHRQ or the U.S. Department of Health and Human Services.

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Copyright and Electronic Dissemination

This document is in the public domain within the United States. For information on reprinting, contact Randie Siegel, Director, Division of Printing and Electronic Publishing, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850. Requests for linking or to incorporate content in electronic resources should be sent to: info@ahrq.gov.

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Current as of February 2004

Internet Citation:

U.S. Preventive Services Task Force. Primary Care Interventions to Prevent Low Back Pain in Adults: Recommendation Statement. February 2004. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/3rduspstf/lowback/lowbackrs.htm

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