No Support in Study for Back Belts as Injury Preventers

Dec. 5, 2000 -- Back-support belts may be more of a fashion statement than a workplace injury-prevention device, suggest researchers from the National Institute of Occupational Safety and Health.

A study of more than 9,000 materials-handling employees from Wal-Mart stores in 30 states found that back-injury disability claims and reports of back pain were about the same over a six-month period whether or not employees wore belts for heavy lifting. The findings are reported in the Dec. 6, 2000 issue of Journal of the American Medical Association.

"We found that there was no significant difference in two different outcomes: back pain and also back injury as measured by worker's comp claims," says co-author Douglas P. Landsittel, PhD, research statistician at the National Institute for Occupational Safety and Health, a branch of the CDC in Morgantown, W.Va.

They came to this conclusion by following materials handlers in 160 new or recently reopened Wal-Mart stores, 89 of which had a mandatory back-belt use policy, and 71 of which had a voluntary policy. They looked at back-injury workers' compensation claims and rates of self-reported low back pain.

People who were more likely to report back pain (but not make injury claims) included those who frequently lifted loads heavier than 20 pounds, women, former smokers, and those who reported poor job satisfaction. Current smokers were more likely than nonsmokers to file workers' compensation claims for back-related injuries.

"Results based on these multiple analyses of data all converge to a common conclusion: back-belt use is not associated with reduced incidence of back injury claims or low back pain in material handlers," the authors write.

Representatives of other giant retail chains have quite different perspectives, however. Chris Kibler, director of safety for the Atlanta-based Home Depot Corporation, tells WebMD, "we've been using them for several years, and we do have a mandatory policy that requires their use unless the employee has a medical condition that is documented [that would preclude the use of a belt], and we're planning on continuing with that policy,"

A spokeswoman for BJ's Wholesale Clubs, a chain of retail warehouse stores, tells WebMD that her company also requires that back-belts be used by all materials-handling employees, and that the devices are offered, along with training in proper lifting techniques, to other employees who want them.

Those corporate policies are backed by the results of a study conducted by Jess F. Kraus, MPH, PhD and colleagues at the Southern California Injury Prevention Research Center at UCLA. They had the good fortune to approach Home Depot about doing a study of back-injury just when the company had made an 180 degree switch from a corporate policy prohibiting back-belt use by employees to a policy requiring their use. Because the policy change happened one store at a time on different schedules, the researchers were able to do a before-and-after study of the effects of belt use on back injury.

They found that the rate of acute low-back injuries fell by about a third after implementation of the policy. This effect was seen in both men and women, in younger workers and those aged 55 and older, and among employees whose jobs included either light- or heavy-duty lifting, says co-author David L. McArthur, PhD, MPH.

"The results were far more than we expected, and at one point the group of us that were sitting around analyzing it said 'these numbers can't be right, let's go back and do it again just to make sure that we haven't slipped a digit somewhere,' and in fact we did go all the way back and reconfirm every step just so that we knew for a fact that the degree of difference was so large," McArthur tells WebMD.

But in an editorial accompanying the Wal-Mart study in JAMA, Nortin M. Hadler, PhD and Timothy S. Carey, MD, MPH from the department of medicine at the University of North Carolina at Chapel Hill, write that "The findings suggest back belts should be viewed as no more than an option in apparel. Furthermore, any recommendation to wear back belts when exposed to tasks with this range of physical demand should be met with skepticism; the burden of proof should be on those who might still advocate them."

They contend that recalled back pain and back-injury claims may be related as much to individual perceptions of pain as they are to actual physical injury or degree of incapacitation, and that work-safety and worker's compensation regulations give incentive to employees to report back-related disability as being related to a workplace accident.

"It is no wonder that in addition to the lack of benefit from back belts, [the researchers] could show that job dissatisfaction and prior workers' compensation claims were associated with memorable and compensable," they write. "The challenge is to fashion employment that is comfortable when workers are well and accommodating when they are ill of incapacitated, including those with regional back pain."