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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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