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Wassell JT, Gardner LI, Landsittel DP, et al. A prospective study of back belts for prevention of back pain and injury. JAMA 2000; 284:
In the most comprehensive study of back- belt use ever conducted, researchers from the National Institute for Occupational Safety and Health (NIOSH) found no evidence that back belts prevent back injuries.
NIOSH researchers conducted interviews of 9,377 employees who were involved in lifting or material handling at 160 retail stores across the country. They gathered information on back-belt wearing habits as well as work history, lifestyle habits, job activities, demographic characteristics, and job satisfaction.
For a two-year period, the researchers then tracked workers’ compensation claims for job-related back injuries and self-reported back pain. They asked employees if they had experienced any low back pain in the six months prior to the follow-up interview. Patients with long-term back problems were ruled out through the survey information collected at the start of the project. Some 6,311 workers completed the follow-up interview.
Store policies requiring back-belt use were widely ignored. "In the stores requiring belt use, 58% of employees reported wearing belts usually every day; 14%, once or twice a week; and 28%, never," the authors state. "In the stores with voluntary belt use, 33% of employees reported wearing belts usually every day; 11%, once or twice a week; and 56%, never."
But it hardly seemed to matter. Researchers found no significant difference either in injury claims or self-reported back pain between workers who wore back belts and those who didn’t.
"There were no statistically significant protective effects comparing employees who wore belts usually every day with employees who never wore belts for either back injury claims or low back pain," they reported. "There were no statistically significant protective effects comparing employees who wore belts once or twice a week with employees who never wore belts for either back injury claims or back pain."
Workers who usually wore back belts had 3.38 injury claims per 100 full-time equivalent employees (FTE); 17.1% reported back pain. Those who infrequently or never wore back belts had injury rates of 2.76 cases per 100 FTEs; 17.5% reported back pain.
A history of back injury was the strongest risk factor for predicting either a back-injury claim or reported back pain among employees, regardless of back-belt use. The scope of this project adds weight to the findings.
The authors noted that some other studies of back belts have assumed that a store policy requiring their use equated to actual back-belt use. "By directly interviewing employees about their belt-wearing habits, our study more closely measures typical belt use in the workplace rather than implied belt use based on store policy," the authors say.
"Our study evaluates back belts using a prospective design in new stores distributed over a wide geographic region, concurrent comparison groups, comprehensive individual interviews, detailed exposure information, a job satisfaction measure, multivariable regression analysis, and sufficient sample size," they state.
Their finding is definitive: "We found no effects of belt wearing in various subgroups: employees with and without a history of previous back injury, employees with consistent self-reported belt wearing habits from baseline to follow-up interviews, and employees with the most strenuous job."
This study reinforces a previous NIOSH finding, from 1994, that said there is no scientific evidence that back belts reduce back injury.