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Table 3 The recommendations including the level of evidence (A strong, B moderate, C limited and D consensus) of the multidisciplinary practice guideline for preventive measures directed at the worker and at work based on studies with outcomes in terms of low back pain and/or low back load

From: An Evidence-Based Multidisciplinary Practice Guideline to Reduce the Workload due to Lifting for Preventing Work-Related Low Back Pain

Preventive measure Recommendation Evidence
Training and advice for optimizing lifting posture and movement ‘It is theoretically possible that training and advice reduce the load of the low back in the order of 5 to 10%, but that it is unlikely that this will be achieved and uphold in practice. This recommendation is also in line with the Cochrane reviews on manual material handling advice and assistive devices for preventing and treating back pain in workers.’ A
Pre-employment medical examination ‘There is conflicting evidence in the two studies regarding the effect of a pre-employment examination that included a physical capacity evaluation on LBP. Due to the high rejection rate of candidates, a pre-employment medical examination is not recommended to reduce the risk of LBP.’ A
Back-belts ‘Back-belts are not more effective than no intervention or training in preventing low-back pain, and conflicting evidence whether lumbar supports were effective supplements to other preventive interventions. Therefore, the use back-belts as a personal protective device was not recommend.’ A
Personal lift assist devices ‘Personal lift assist devices are promising interventions in reducing the load on the low back. However, more research is needed to evaluate the effects on the longer term.’ C
Eliminate manual lifting   
Lifting devices patients ‘Lifting devices for patients are able to overcome manual lifting, although low back loading still occurs due to bending postures and the time it takes to prepare the patient for a transfer. Therefore in each setting a careful consideration has to be made. In addition, overhead or ceiling lifts are preferable above floor lifts.’ A
Lifting devices objects ‘The core group and project team concluded that case studies on the efficacy of lifting devices in construction, automotive industry and also fishing and agriculture show that in general the use of these devices reduce the low back load. However, this is not true for all tasks performed. A hindering factor is the increase in production time. Therefore in each setting a careful consideration has to be made.’ C
Production methods ‘A change in production methods for instance from manual lifting to pushing and pulling might result in a strong reduction of the low back load.’ C
Improve lifting situation   
Weight of object ‘A reduction in weight of the object does not always result in a reduction of the load of the low back due to a possible increase in exposure time or frequency or due to unfavourable characteristics of the load lifted.’ C
Vertical lifting distance ‘Aides to reduce the vertical lifting distance like scissor lifts or a scaffolding console can reduce the load on the low back considerable.’ B
Horizontal lifting distance and sliding friction ‘Aids to reduce the horizontal lifting distance or friction in patients transfers or while lifting objects like bridgeboards, rods, gliding sheets of rolling floors can reduce the load on the low back.’ A
Contact factor ‘Lifting belts for a better handling of patients contribute to a reduction of the low back loading while lifting.’ C
Organisational factors   
Lifting teams ‘Well-staffed lifting teams of specifically trained and equipped employees reduce the number of patient lifts that other colleagues had to perform without increasing the number of low back complaints in these lifting teams.’ B
Team lifting ‘Team lifting compared to one or two persons lifts does not result in an increased risk for low back pain.’ C
Regulations ‘The prohibition of manual lifting does only result in a reduction of low back loading if effective and efficient alternatives are available.’ D