OBJECTIVE: To systematically review the evidence and provide recommendations for primary health care providers on the use of back belts for primary prevention of low back pain at work. OPTIONS: Combination of back belts, education and exercise for primary prevention of back pain. OUTCOMES: The incidence of reported low back pain and the duration of lost time (absenteeism) from work for low back pain, as compared between initially asymptomatic workers with and without back belts. EVIDENCE: Medline, CINAHL, Embase and HealthSTAR databases were searched for relevant articles published up to June 2002 using the following keywords: back, lumbar, spine, belts, supports, braces, orthotic devices, prevention and occupational. Pertinent references from articles obtained from the above search were also reviewed. BENEFITS, HARMS AND COSTS: Back injuries account for over 25% of all lost time claims in Canada, making it the largest single category for all Workers' compensation claims. Low back pain is also estimated to be the most costly ailment of working age adults. Prevention programs directed at the worker, including education, exercise, pre-employment screening and the use of back belts, are by far the most common preventive strategy in industry. Potential negative effects of back belts use include rubbing, pinching or bruising of ribs, hampered sitting and driving, excessive sweating and a false sense of security. Other potential risks based on laboratory studies include cardiovascular strain, back muscle weakening and abdominal hernia. VALUES: The strength of the evidence was evaluated using the methods of the Canadian Task Force for Preventive Health Care. RECOMMENDATIONS: The CTF concludes that the existing evidence (levels I, II-2) is conflicting and does not allow making a recommendation for or against the use of back belts to either prevent occupational low back pain or to reduce lost work time due to occupational low back pain (C Recommendation). VALIDATION: The findings of this analysis were reviewed through an iterative process by the members of the Canadian Task Force for Preventive Health Care. SPONSORS: The Canadian Task Force for Preventive Health Care is funded through partnership between the Provincial and Territorial Ministries of Health and Health Canada.

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