***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: The recent increased utilization of industrial back belts as personal protective equipment in the workplace has generated considerable controversy among occupational health and safety professionals in the United States . The purpose of this article is to review the literature regarding proposed mechanisms of action of these devices and studies related to outcome of belt utilization in the prevention of  low back pain and disability  in the workplace . At the present time , neither the suspected mechanisms of action nor the efficacy of these devices in the primary , secondary , and tertiary prevention of work-related low back pain has been adequately demonstrated in clinical trials . As a result , generally accepted guidelines regarding the safe use of belts in the occupational setting have not been established . Based on this review it is recommended that further well-controlled , prospect i ve , r and omized clinical trials are necessary to evaluate the effectiveness of these devices as personal protective equipment . During the interim , the decision to prescribe belts to employees in the workplace should be at the discretion of an adequately trained occupational health care provider . These devices should not be provided as an alternative to appropriate administrative and /or engineering controls 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 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 Study Design A r and omized prospect i ve trial of manipulation , massage , corset and transcutaneous muscle stimulation ( TMS ) was conducted in patients with subacute low back pain . Objectives The authors determined the relative efficacy of chiropractic treatment to massage , corset , and TMS . Summary of Background Data Although all of these treatments are used for subacute low back pain treatment , there have been few comparative trials using objective outcome criteria . Patients were enrolled for a period of 3 weeks . They were evaluated once a week by question naires , visual analog scale , range of motion , maximum voluntary extension effort , straight leg raising and Biering-Sorensen fatigue test . The dropout rate was highest in the muscle stimulation and corset groups and lowest in the manipulation group . Rates of full compliance did not differ significantly across treatments . A measure of patient confidence was greatest in the manipulation group . Results After 3 weeks , the manipulation group scored the greatest improvements in flexion and pain while the massage group had the best extension effort and fatigue time , and the muscle stimulation group the best extension . Conclusion None of the changes in physical outcome measures ( range of motion , fatigue , strength or pain ) were significantly different between any of the groups 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 
    Output:
    
There was moderate evidence that for primary prevention lumbar supports are not more effective than other types of treatment or no intervention .
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 , while it is still unclear if lumbar supports are more effective than other interventions for treatment of low back pain .