Clinical effectiveness of lumbosacral orthoses in chronic non-specific low back pain: a systematic review.
Eray Yüceel, Tuğba Kuru Çolak, Aleyna Karahan and 4 others
Braces for chronic low back pain did not show consistent benefit across 11 trials of 606 people.
Some improved pain or disability short-term, one made outcomes worse, and longer-term evidence is limited.
Key findings
1Results were mixed: some trials found short-term improvement in pain or disability with a brace, while one trial found that adding a one-size lumbar orthosis to a standardized exercise and education programme made disability and quality of life worse than the same programme without a brace, and that trial was stopped early.
2None of the included trials found that wearing a brace caused muscle atrophy or increased muscle fatigue, even over six months of use combined with physiotherapy or NSAIDs.
3In three related Iranian trials, adding a four-week non-extendible brace to routine physiotherapy produced similar postural sway and postural control results as physiotherapy alone, with only functional disability showing greater improvement in the braced group.
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What it does not show
Only 11 trials, all small, with total unique participants of 606; individual trial sample sizes ranged from 40 to 143. Blinding of participants and therapists was rarely achieved, and assessor blinding was inconsistent, which matters because most primary outcomes (pain, disability) are subjective and patient-reported. Three of the 11 studies by the same Iranian group appear to involve the same patient cohort, so the effective number of independent trials is closer to 9. Four studies recorded baseline pain but did not report post-intervention pain, making it impossible to judge within-group or between-group change in those trials. Brace types, wearing schedules, treatment durations (single session to 12 months), and comparator interventions differed so much across trials that direct comparison is difficult. Only Turkish and English publications were included, potentially excluding relevant work in other languages. Predominantly short-term follow-up; only two studies assessed outcomes beyond 12 weeks. Psychosocial outcomes (fear-avoidance, kinesiophobia, catastrophising) were assessed in only one trial, and adherence to brace wearing was poorly reported across all trials. Qualitative synthesis only; no meta-analysis was performed, so no pooled effect estimate is available.
Declared interests
The authors declared that no financial support was received for the work or its publication. No industry funding, sponsor involvement in study design, or manuscript drafting was reported.
The easy way to misread this
Do not read this review as evidence that lumbosacral braces are effective for chronic low back pain, or as evidence that they are harmless. One trial found that adding a brace to exercise and education made disability and quality of life worse than the same programme without a brace, and the trial was stopped early. The remaining trials used different brace designs, different comparators, different co-interventions, and different follow-up lengths, so no single conclusion about brace effectiveness can be drawn. The absence of muscle atrophy in these trials does not rule out deconditioning with longer or more continuous use, because the longest follow-up was six months and adherence was poorly reported.
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