Back injury prevention programs: A critical review of the literature.

Back schools are increasingly utilized as an injury prevention strategy employed at the worksite. Yet, evidence of the efficacy of back schools is limited and controversial. A review of the literature showed variance in methodologies and consequently, outcomes. Outcome measures used include physical capacity, functional abilities, costs, lost time, absenteeism, perception of pain, lifting performance, attitudes, and job satisfaction. In many studies, lack of randomization and control was found to be a limitation in experimental design. Studies which used the behavioral approach of measuring lifting behavior lacked followup and evidence of long-term effects. The type of education and feedback or reinforcement was an important issue not well-defined in the literature. A variety of hypothetical mechanisms were described as contributing to the outcome of back injury prevention programs. Additional controlled research is necessary to determine the specific mechanisms of change in an effort to further improve outcome in this area.