The impact of continuous use of lumbosacral orthoses on trunk motor performance: a systematic review with meta-analysis

Abstract

Background context: Lumbosacral orthosis (LSO) is prescribed by general practitioners for the management of low back pain. It may be speculated that continuous use of an LSO for a prolonged period reduces mechanical loading to the trunk muscle in daily living and results in impairments of the trunk muscle.

Purpose: This study aims to investigate whether trunk motor performances are impaired by the continuous use of an LSO.

Study design/setting: This is a systematic review with meta-analysis.

Materials and methods: A systematic search was undertaken using PubMed, EMBASE, MEDLINE, CINAHL, SCOPUS, and Cochrane Library from inception to November 2016. Inclusion criteria were (1) the use of an LSO for ≥2 days, (2) the use of a soft LSO designed for musculoskeletal conditions, (3) absence of cointervention except education, and (4) measures of trunk motor performance. The following were excluded: (1) studies with insufficient data and (2) studies with poor methodological quality (<9/16) in the modified McMaster Critical Review Form for Quantitative Studies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to determine the quality of evidence.

Results: Data of eight studies were analyzed. The most common measures for motor performances were the maximum strength of the trunk flexors and extensors and the endurance and fatigability of the trunk extensors. In all measures, 95% confidence intervals of the pooled standardized mean difference between the control or preintervention group and the intervention or postintervention group included zero. Further, quality of evidence ranged from low to very low in the GRADE system in all findings of the meta-analyses.

Conclusions: The meta-analyses demonstrated no negative effect by the continuous use of an LSO for 1-6 months. However, the quality of evidence ranged from low to very low, and more high-quality trials are required to draw a definitive conclusion on the impact of the continuous use of an LSO on trunk motor performances.

Keywords: Lumbosacral region; Muscle; Muscle contraction; Muscle fatigue; Orthotic devices; Skeletal; Torso.