Study design: A systematic review of randomized controlled trials. Objectives: To evaluate the effectiveness of segmental stabilizing exercises for acute, subacute and chronic low back pain with regard to pain, recurrence of pain, disability and return to work. Methods: MEDLINE, EMBASE, CINAHL, Cochrane Controlled Trials Register, PEDro and article reference lists were searched from 1988 onward. Randomized controlled trials with segmental stabilizing exercises for adult low back pain patients were included. Four comparisons were foreseen: (1) effectiveness of segmental stabilizing exercises versus treatment by general practitioner (GP); (2) effectiveness of segmental stabilizing exercises versus other physiotherapy treatment; (3) effectiveness of segmental stabilizing exercises combined with other physiotherapy treatment versus treatment by GP and (4) effectiveness of segmental stabilizing exercises combined with other physiotherapy treatment versus other physiotherapy treatment. Results: Seven trials were included. For acute low back pain, segmental stabilizing exercises are equally effective in reducing short-term disability and pain and more effective in reducing long-term recurrence of low back pain than treatment by GP. For chronic low back pain, segmental stabilizing exercises are, in the short and long term, more effective than GP treatment and may be as effective as other physiotherapy treatments in reducing disability and pain. There is limited evidence that segmental stabilizing exercises additional to other physiotherapy treatment are equally effective for pain and more effective concerning disability than other physiotherapy treatments alone. There is no evidence concerning subacute low back pain. Conclusion: For low back pain, segmental stabilizing exercises are more effective than treatment by GP but they are not more effective than other physiotherapy interventions.

No abstract

A multimodal program is not superior to a general exercise program in influencing the process leading to chronic LBP in a population of nurses with a history of pain. The most likely explanation is a common psychological mechanism leading to improved pain interference that is irrespective of the program used. Considering the lower resources of the general exercise program, the expense for a multimodal program is not justified for the secondary prevention of LBP and disability.

The results suggest that treatments to improve lifting-capacity in individuals with mild low back pain should particularly address the reduction of fear-avoidance beliefs. Although strong conclusions cannot be drawn from this study due to methodological limitations, they may be helpful to assign patients to appropriate and most beneficial treatment programs, as well as to develop specific programs. Fear-reduction may be an important target for early interventions in regard to functional capacity.

ZusammenfassungFragestellung: Ziel dieses Übersichtsartikels ist die Darstellung des aktuellen Wissensstandes hinsichtlich der Effektivität von Präventionsprogrammen bei Pflegekräften mit Rückenschmer-zen. In der Prävention von Rückenschmerzen ist die Vermeidung von Chronifizierung ein Hauptziel. Daher fokussiert dieser Artikel auf sekundär präventiven Maûnahmen. Methodik: Die Literaturidentifikation wurde in drei Schritten durchgeführt: Zunächst wurde in Medline, Embase und Psychinfo nach Reviewartikeln für den Zeitraum von 1997 ± 2003 zu diesem Thema gesucht. Die Suchstrategie beinhaltete zunächst Reviews, die sich allgemein mit der Effektivität von Maûnahmen zur Prävention von Rückenbeschwerden und deren Chronifizierung beschäftig-ten. In einem zweiten und dritten Schritt wurden jene Reviews und randomisierte klinische Studien identifiziert, die sich speziell auf Präventionsprogramme gegen Rückenbeschwerden bei Pflegekräften konzentrierten. Ergebnisse: Zusammenfassend kann man feststellen, dass es einen Mangel an gesicherter Evidenz bezüglich der Effektivität von Präventionsmaûnahmen gegen Rückenbeschwerden gibt. Aussagen darüber, welche Interventionen für welche Art von Beschwerden und welche Zielgruppe geeignet sind, konnten nicht gefunden werden. Methodische Schwächen sowie eine Vielzahl unterschiedlicher Ansätze, Interventionen und Zielgruppen erklären diesen Wissensmangel, der im Gegensatz zu den Ressourcen steht, die für ent- AbstractPurpose: Aim of this article is to give an overview of the current literature on the effectiveness of prevention programs, especially for nurses with back pain. As the avoidance of chronicity is a major goal in the prevention of back pain, the article focuses on secondary prevention. Materials and method: This literature-overview was conducted in three phases. Firstly, three electronic databases were searched for reviews in the years 1997 ± 2003: Medline, Embase and Psychinfo. Reviews were selected if they are reporting on interventions designed to prevent some form of back pain or interventions designed to prevent chronicity. Additionally we focused in a second phase on reviews which dealt exclusively with the situation of nurses. Finally, in a third phase, we searched in the databases for randomised controlled trials (RCT's) on the same topic. Results: In general, there is a lack of evidence concerning the effectiveness of preventive interventions against back pain and which type of preventive intervention is most effective for what type of back pain problem and target group. Methodological deficiencies, the diversity of approaches and contents and the heterogeneity of settings may explain these discouraging results. An astonishing gap between the amount of resources spent on prevention of back pain and the effectiveness of these efforts has to be acknowledged. This is true for hospital employees and nurses in particular. In summary, only exercise programs have shown positive preventive effects Übersicht 13