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• Upper-extremity musculoskeletal disorders are a prevalent public health issue. • A short spa therapy intervention did not improve function more than self-management. • Adherence to home exercise was greater for self-management than spa therapy. • Self-management interventions may reduce disability and pain. Musculoskeletal disorders (MSDs) are common in the workplace and are a public health issue. Persistent pain despite conservative treatment or surgery may lead to poor long-term outcomes. To compare the effect of a combined 6-day program of exercise, self-management workshops and spa therapy with self-management on functional capacity in personal and professional daily life at 3 months in people with musculoskeletal disorders. We conducted a prospective, randomized controlled trial. Participants were employed (any type of work) and aged between 18 and 65 years, with latent or symptomatic upper extremity MSDs, with or without a history of sick leave. They were randomized to participate in 6 days (2 h per day) of spa therapy, exercise, and self-management workshops immediately (intervention) or at 3 months (control). The control group performed self-management until 3 months. The primary outcome was the score on the self-reported Quick Disability of Arm-Shoulder-Hand (QuickDASH) at 3 months. The primary analysis was conducted using analysis of covariance with baseline QuickDASH score as the covariate. In total, 150 participants were randomized (85 % women): 78 to the control group and 72 to the intervention group. At 3 months, the QuickDASH total and work scores did not differ between groups (effect-size [ES] = -0.15, 95 %CI, -0.38 to 0.09, p = 0.215, and ES = -0.11, 95 % CI, -0.35 to 0.12, p = 0.343). However, QuickDASH sport/performing arts score was significantly different between randomization groups at 3 months (ES =-0.25, 95 % CI, -0.48 to -0.02, p = 0.035). This study provided no evidence in favor of a short-course, personalized self-management, intensive spa therapy intervention over self-management alone for the management of upper-extremity MSDs. Trial registration: ClinicalTrials.gov (NCT02702466) retrospectively registered. [ABSTRACT FROM AUTHOR]

• Clinical practice guidelines for non-specific low back pain do not recommend the use of non-rigid lumbar supports despite several positive randomized controlled studies. • Non-rigid lumbar supports showed greater improvements in function and pain than the comparator. • Insufficient data prevented a comparison of the efficiency for acute, subacute and recurrent low back pain and meta-regression of responder phenotypes. • Further studies are needed to assess which patients can benefit the most from non-rigid lumbar supports based on patient phenotype and characteristics of low back pain. Clinical practice guidelines for non-specific low back pain do not recommend the use of non-rigid lumbar supports (NRLSs) despite the publication of several positive randomized controlled studies. We conducted a systematic review with meta-analysis to assess the efficacy of NRLSs in the treatment and prevention of non-specific low back pain. We searched for reports of randomized controlled trials in PubMed, Cochrane Library, EMBASE, Science Direct and Pedro databases. Data were analyzed by disease stage (acute, subacute, and chronic) and type of prevention (primary and secondary). The analysis of methodological quality involved the Physiotherapy Evidence Database (PEDro) scale. Of the 1581 records retrieved, only 4 full-text articles were included, with 777 patients: 378 in the NRLS group, and 348 in the control group. NRLSs conferred greater amelioration of disability (effect size −0.54, 95% CI −0.90; −0.17) and pain (−0.29, −0.46; −0.12) than standard management. Insufficient data prevented a comparison of the efficiency for acute, subacute and recurrent low back pain as well as meta-regression of responder phenotypes (sociodemographic and other patient characteristics). We demonstrated the overall efficacy of NRLSs for both disability and pain. However, further studies are needed to assess which patients can benefit the most from lumbar supports based on patient phenotype and the characteristics of low back pain. PROSPERO (CRD42018109855). [ABSTRACT FROM AUTHOR]

Objective We aimed to evaluate the place of lumbar support in the management of nonspecific low back pain. Material and methods We conducted a systematic review with the following databases: Pubmed, Cochrane Library, Science Direct and Pedro. The search strategy used the keywords low back pain; lumbar orthosis; lumbar belt; back support; lumbar support; lumbar brace. To be included, studies needed to have one or more keywords selected. The search was limited to French and English articles. The major exclusion criterion was studies included rigid orthotics of the trunk. High Authority of health statement was used to check the quality of reporting. Data were also analyzed according to stages of the disease (acute, subacute, and chronic) and in prevention (primary and secondary). Results We included 28 studies. Quality assessment was heterogeneous. The systematic review showed no official recommendations for lumbar support prescription among the general population. Lumbar support was effective on function, pain, and relative time intervals for dispensing medication with subacute low back pain. It was also effective with probability of low back pain recurrence in secondary prevention. Orthosis’ benefits were not highlighted probably due to the lack of observance, which was a limiting factor. It is a bias because observance was not systematically studied in the literature. To our knowledge, there is no meta-analysis because evaluation criteria are heterogeneous. Discussion/Conclusion To date, there is no proof to prescribe lumbar support in the management of low back pain general population. An individual prescription would be discussed for subacute low back pain or in secondary prevention. Further studies with a higher quality assessment are necessary in order to identify phenotypes of patients’ responders to lumbar support. The function would be preferred as a main assessment criterion. [ABSTRACT FROM AUTHOR]