Orthoses in the Treatment of Non-Specific Back Pain - A Systematic Review

Non-specific back pain is of great importance in health economics, due to its high impact on the ability to work and the need for rehabilitation. The effectiveness of orthoses in patients with low back pain is unclear, as these studies have heterogenous designs and methodological weaknesses.The aim of this work is to formulate evidence-based recommendations for the use of orthoses in patients with low back pain.The literature search was conducted according to the PRISMA protocol (Preferred Reporting Items for Systematic reviews and Meta-Analyses) at PubMed, ScienceDirect, Cochrane and Google Scholar. The risk of bias in the studies was assessed using the Cochrane risk of bias tool, version 2 (RoB2), for randomised studies and risk of bias in non-randomised studies of interventions tool (ROBINS-I) for non-randomised studies. The level of evidence was determined according to the Agency for Health Care Policy and Research (AHCPR).21 studies were included. The study design and level of evidence were distributed as follows: 20 RCTs and 1 non-RCT, as well as 14 Ib, 6 IIb, and 1 III according to the AHCPR. As regards the risk of bias, 9 studies showed a severe risk, 8 moderate risk, and 4 low risk in at least one subdomain. Treatment with orthoses was investigated in 3 studies for acute non-specific back pain and in 12 studies for chronic back pain. The recorded endpoints were pain reduction, effects on balance, compliance, daily and workplace activities, and imaging. A comparative analysis of orthosis types was conducted in 5 studies.Treatment of non-specific low back pain with thoracolumbar orthoses results in a significant reduction in pain, although the exact effect size remains unclear. However, based on the available and analysed studies, no general evidence-based recommendation for the use of thoracolumbar orthoses for non-specific low back pain can be formulated.