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A Review of Research on Elastic Lower Back Support Belts
Injury Prevention and Pain Relief
Around the same time and the publication of the NIOSH Study, a six-year study conducted by UCLA and CalOSHA with Home Depot (see sidebar on page 34) found a 34 percent reduction in back injuries when employees were required to wear back sup ports.
"As more and more studies came out in favor of back supports, NIOSH felt the need to defend its original position and began to develop the protocols for its own study," continues Wilson.
The 2000 study, however, according to some, suffers from at least three flaws.
* First, "NIOSH changed its protocols midstream," states Wilson. "In most cases, when the need to change protocols exists in a study, the researchers stop the study and start over. In this case, though, NIOSH did not. It continued on instead." (The study involved employees hired by a national general merchandise retailer that was opening and expanding a number of stores.)
Example: "In the original protocol, it was set up so that half of the stores would have a mandatory back support program, highly monitored, with safety professionals in place to monitor and observe usage," notes Wilson. "The other half of the stores would use no back supports at all."
But as the study was getting under way, the employer, which had had a back support program for a number of years and had seen benefits to it, balked at the protocol. "Since they had found benefits to back supports, they naturally felt it would be inappropriate to deny any of their employees the right to wear back supports, because of issues of potential liability," notes Wilson.
Compromise Protocol
The result was a compromise protocol: "The study group would not be required to wear belts, and the control group would be allowed to wear belts," notes Shumate. "In a good study, the study group would have been required to wear belts, and the control group would not have been allowed to wear them."
"In sum, there was no control group in the study," adds Wilson.
Training and Usage compliance Failures
* As noted, the study was conducted among new employees who had been hired by a national general merchandise retailer. They received only cursory introductory training. The NIOSH report states that: "All employees, when first hired and regardless of store policy, received a short introductory information and training session on proper lifting and belt use via videotape or interactive computer-based learning.
"The employer provided a training video that focused on proper lifting techniques and the proper use of back supports," states James T. Wassell, Ph.D., associate director, biostatistical science, Division of Safety Research, with NIOSH in Morgantown, W.V., who coauthored the study. "Employees were sent into a room by themselves to go through the training."
But there were no safety specialists to explain the training or answer questions.
* Finally, the employees did not receive consistent daily guidance from trained supervisors experienced in safe lifting techniques. "The stores varied in terms of how much managers enforced store policy related to belt usage," adds Dr. Wassell.
Employees, in sum, were left on their own to pay attention to the training, understand it, and follow the recommendations on proper lifting and proper use of belts.
OSHA Changing Position In Favor of Lower Back Belts
Shumate relates another concern with the study: "Even OSHA, which originally agreed with NIOSH's position on back supports, has recently changed. While its first draft of the since-repealed ergonomics standard did not consider back belts to be PPE (personal protective equipment), the final version did." He cites wording from the preamble to the standard: "OSHA's review of the voluminous record on back belts shows that back belts may have a protective effect in certain industrial settings, such as unexpected loading of the spine."
Perspective
Assuming that everyone involved in the safety profession is committed to the safety of employees, why is there is so much disagreement about the value of back support systems? There may be a simple answer. NIOSH and a number of safety experts actively encourage employers to follow the hierarchy of safety, which suggests a three-step process:
* Engineer out the hazard. In the case of back safety, this means employers should eliminate lifting as much as possible, replacing any lifting that is necessary with mechanical systems, so that humans no longer have to lift at all.
* Use administrative controls in situations where engineering controls cannot be used. Examples here include job rotation, frequent breaks, and other strategies so employees are not required to lift continuously or as often.
* Finally, offer PPE (personal protective equipment) to employees to protect them selves. In the case of lifting, this would involve the use of back supports.
One expert, who requested anonymity, notes: "NIOSH is strongly committed to engineering controls, where lifting is eliminated or where equipment is used to lift," he states. "Unfortunately, the agency tends to see engineering controls and back support systems as being mutually exclusive. The agency feels that, if it discredits back supports, employers will stop using them and focus their energies on engineering controls instead. It is our belief, however, that employers can and should use all three strategies--engineering controls, administrative controls, and PPE."
Employers - To Support or Not to Support
Given the evidence, should you have a back support program? There seems to be enough evidence to suggest that such products can be useful tools in your arsenal of weapons against the debilitating costs of back injuries. The question is, How do you integrate the supports into your overall back safety program?
Probably the best advice is to follow NIOSH's general safety hierarchy recommendations. First, engineer out as many lift ing requirements as possible. "Consider using tilt tables, scissor-lift tables, lift trucks, pallet trucks, hoists, and other equipment," suggests safety consultant Swartz. Second, use whatever administrative controls are possible and make sense. Then, experiment with the use of back support systems. In other words, whether you elect to have your employees wear back supports or not, they should not be the sole or even primary strategy you use in your back safety program.
If you do elect to use back support systems, be sure employees receive thorough, in-person training conducted by qualified professionals on how to lift properly and how to wear and use back supports properly. "Belts will not help if employees are not properly trained in how to lift and how to wear the belts," emphasizes Swartz. "For example, belts should be worn below the navel. Many people mistakenly wear them higher, which won't provide any protection. Another problem is that some people wear them tightly all day. They should be loose most of the time, then tightened just before a lift."
Compiled from an article by William Atkinsen 2001
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