***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Radiographic instability seemingly enjoys the status of a well-defined clinical syndrome . The concept is widely used , and specific treatments , usually spinal fusion , are routinely performed based on the diagnosis . The minimum st and ards necessary to establish radiographic instability as a legitimate clinical syndrome have not been established , however . The primary purpose of this study was to determine if treatment involving bracing , exercise , and education controlling either flexion or extension postures , would result in a distinctive pattern of favorable or unfavorable results , depending on the type of radiographic instability ( retrodisplacement or spondylolisthesis ) . Fifty-six patients meeting strict study inclusion and radiographic evaluation criteria were assigned signed to a bracing treatment ( flexion , extension , placebo-control ) according to a r and omization scheme , design ed to ensure equal representation of translation categories ( retro , normal , spondy ) across treatment groups , and assessed at admission and 1-month follow-up . The sample was relatively evenly divided between men ( 46 % ) and women ( 54 % ) , and by age . Translation classification was related to both gender and age , with men more likely classified as retro and women more likely spondy and patients in their 20s having lower incidence of spondy and higher incidence of normal translation . Translation classification was not related to selected indices of low-back pain history . Brace treatments were not shown to reduce patient range of motion or lessen trunk strength . A significant treatment by time interaction for the modified pain interference ( VAS ) scale indicated improvement for patients in extension compared with patients in flexion and control-placebo treatments . In conjunction with no significant three-way interaction between treatment , translation classification , and time , it was hypothesized that radiographic instability might more appropriately be considered a corroborative sign of advanced discogenic problems . Improvement in extension treatment , regardless of the type of radiographic abnormality , suggests that the treating clinician might consider extension treatment for chronic low-back pain patients . Causes and implication s for the failure of this study to provide support for considering radiographic instability as a clinical syndrome are considered and future directions for this area of research suggested CONTEXT Low back pain is a frequent and costly health problem . Prevention of low back pain is important both for the individual patient and from an economic perspective . OBJECTIVE To assess the efficacy of lumbar supports and education in the prevention of low back pain in industry . DESIGN A r and omized controlled trial with a factorial design . SETTING The cargo department of an airline company in the Netherl and s. PARTICIPANTS A total of 312 workers were r and omized , of whom 282 were available for the 6-month follow-up . INTERVENTIONS Subjects were r and omly assigned to 4 groups : ( 1 ) education ( lifting instructions ) and lumbar support , ( 2 ) education , ( 3 ) lumbar support , and ( 4 ) no intervention . Education consisted of 3 group sessions on lifting techniques with a total duration of 5 hours . Lumbar supports were recommended to be used during working hours for 6 months . MAIN OUTCOME MEASURES Low back pain incidence and sick leave because of back pain during the 6-month intervention period . RESULTS Compliance with wearing the lumbar support at least half the time was 43 % . In the 282 subjects for whom data were available , no statistically significant differences in back pain incidence ( 48 [ 36 % ] of 134 with lumbar support vs 51 [ 34 % ] of 148 without , P=.81 ) or in sick leave because of low back pain ( mean , 0.4 days per month with lumbar support vs 0.4 days without , P=.52 ) were found among the intervention groups . In a subgroup of subjects with low back pain at baseline , lumbar supports reduced the number of days with low back pain per month ( median , 1.2 vs 6.5 days per month ; P=.03 ) . CONCLUSIONS Overall , lumbar supports or education did not lead to a reduction in low back pain incidence or sick leave . The results of the subgroup analysis need to be confirmed by future research . Based on our results , the use of education or lumbar supports can not be recommended in the prevention of low back pain in industry In a multicentre trial 456 selected patients with low back pain were r and omly allocated to one of four treatments-manipulation , definitive physiotherapy , corset , or analgesic tablets . Patients were reassessed clinical ly after three weeks ' treatment and again after a further three weeks . Question naires were used to find out the patients ' condition three months and one year after admission to the trial . There were never any important differences among the four groups of patients . A few patients responded well and quickly to manipulation , but there was no way of identifying such patients in advance . The response to a corset was slow , but the long-tern effects were at least as good as those of the other treatments . Patients treated only with analgesics  fared marginally worse than those on the other three treatments . There is no strong reason , however , for recommending manipulation over physiotherapy or corset This study was design ed to determine the effect of multimodal intervention and the prevention of back injury , and to evaluate the adverse side effects of using a lumbosacral corset in the workplace . Subjects were 90 male warehouse workers r and omly selected from over 800 employees at a grocery distribution center . Subjects were assigned to three groups : true controls , no back school , no brace orthoses ; back school only ; and back school plus wearing a custom molded lumbosacral orthosis . Comparisons of pre-testing and 6-month follow-up posttesting for abdominal strength , cognitive data , work injury incidence and productivity and use of health care services were evaluated . Controls and training-only group showed no changes in strength productivity or lost time . Orthoses and training-group showed no changes in strength productivity or accident rate ; however , they showed substantially less lost time . This study supports the concept of using education and prophylactic bracing to prevent back injury and reduce time loss . It appears that the use of intermittent prophylactic bracing has no adverse affects on abdominal muscle strength and may contribute to decreased lost time from work injuries A prospect i ve epidemiologic study was conducted in two units ( 140 beds and 57 nursing assistants ) of a nursing home to demonstrate the efficacy of an ergonomic intervention strategy to reduce  back stress to nursing personnel . The total programme involved the following : determining patient h and ling tasks perceived to be most stressful by the nursing assistants ( NAs ) ; performing an ergonomic evaluation of these tasks ; and conducting a laboratory study to select patient transferring devices perceived to produce less physical stress than existing manual patient-h and ling methods . The intervention phase included training NAs in the use of these devices , modifying toilets and shower rooms , and applying techniques to patient care . Immediately after completing the intervention programme , a post-intervention analysis ( which lasted eight months in unit 1 and four months in unit 2 ) was performed . A biomechanical evaluation of the physical dem and s required to perform stressful patient-h and ling tasks showed that the mean compressive force on the L5/S1 disc , the mean h and force required to make a transfer , and the strength requirements ( expressed as percentage female population capable ) were 1964 N , 122 N , and 83 % after intervention as compared to 4751 N , 312 N , and 41 % before intervention . Subjectively , the mean rating of perceived exertion was less than ' very light ' after intervention as compared to between ' somewhat hard ' and ' hard ' before intervention . Overall , the mean acceptability rates for the walking belt and the mechanical hoist were 81 % and 87 % for patient transfers . The incidence rate for back injuries prior to the intervention , 83 per 200,000 work-hours , decreased to 47 per 200,000 work-hours after the intervention . There were no injuries result ing in lost or restricted work days during the last four months of the post-intervention . It is concluded that an appropriate ergonomic intervention programme offers great promise in reducing physical stress and risk of low-back pain to nursing personnel . However , large-scale studies in different nursing homes are needed to confirm the above findings A method is described for evaluating the progress of patients with back pain .  Various symptoms were scored on analogue scales and spinal motion was measured by various techniques . These data were integrated to make subjective and objective indices respectively . Reasonable reproducibility of the measurements was obtained . This technique was used to eluci date the role of the lumbar support in surgical corsets in relief of back pain .  Sufferers from back pain were r and omly allocated to corsets with and without lumbar supports . There was significant improvement in those with a support compared with those without . On the other h and objective changes measured with the corset removed did not differ between the 2 groups . This study indicates that the spinal support in a lumbosacral corset makes a significant contribution towards the relief of symptoms This study evaluated the efficacy of a commercially available weightlifting belt in relation to reduction of lumbar injury incident rate and severity of injuries over an 8-month period . The study used 642 baggage h and lers working for a major airline company as participants . Four treatment groups were r and omly selected : a group receiving the belt only , a group receiving a 1 h training class only , a group receiving both a belt and a 1 h training class , and a control group receiving nothing . Two treatment groups were added which contained participants who discontinued use of the belt prior to the end of an 8-month study period . Results indicated that there were no significant differences for total lumbar injury incident rate , restricted workday case injury incident rate , lost workdays and restricted workdays rate , and worker 's compensation rates . There was , however , a marginal significant difference for lost workday case injury incident rate . Groups with participants who wore the belt for a while then discontinued its use had a higher lost day case injury incident rate than did either the group receiving training only or the control group . Compliance was an overriding factor as the belt question naire response indicated that 58 % of participants in the belt groups discontinued use of the belt before the end of 8 months . Comments made on the survey forms indicated that the belt was too hot . Similarly , comments suggested that the belt rubbed , pinched , and bruised ribs . Based on these results , the weightlifting belt used for this study can not be recommended for use in aid of lifting during daily work activities of baggage h and lers . Results indicate that use of the belts may , in fact , increase the risk of injury when not wearing a belt following a period of wearing a belt . As industries are experimenting with the use of belts , it is recommended that great care be taken in any further evaluation and close attention directed towards injuries which occur when not wearing the belt following a period of wearing the belt ( ie , off-the-job injuries ) In this controlled prospect i ve study of the Auto-traction method for the treatment of lumbago-sciatica , 82 patients were r and omly allocated to either treatment with Auto-traction for up to three 1-hour sessions in 1 week , or they were given a corset and advised to rest .  The orthopaedic surgeons participating in the study worked at six different hospitals and all had limited experience of the Auto-traction method obtained during a 1-week course . All patients were clinical ly evaluated by an independent observer who also performed the follow-up examinations 1 and 3 weeks after the treatment sessions . In addition a 3-month follow-up was performed by letter . The Auto-traction method gave prompt relief of pain and a normalizing of the SLR test more often than treatment with only a corset and rest . The difference between the two treatment groups was statistically significant . The immediate difference noted between the treatment groups had decreased slightly at 3 weeks but was still statistically significant at this time 
    Output:
    
There was moderate evidence that lumbar supports are not effective for primary prevention .
No evidence was found on the effectiveness of lumbar supports for secondary prevention .
The systematic review of therapeutic trials showed that there is limited evidence that lumbar supports are more effective than no treatment , whereas it is still unclear whether lumbar supports are more effective than other interventions for treatment of low back pain .