A recent Cochrane review finds very low-quality evidence on lumbar supports for chronic low back pain, meaning that no strong recommendations can be made either for or against their use.
Lumbar supports are inexpensive back or belt braces that stabilise the lower back, commonly prescribed and used worldwide for pain in the lower back.
Researchers based in Milan, Italy, reviewed eight randomised controlled trials involving just more than 500 adults aged between 25 and 78, comparing lumbar supports and other assistive devices, used either on their own or alongside treatments like pain medication and exercise, with no treatment or standard care.
Not enough evidence to support/reject braces
Across most comparisons, lumbar supports showed little to no benefit or very uncertain effects, with the possible exception of a small short-term reduction in pain intensity when added to pain medications such as ibuprofen.
However, the authors remain cautious about any conclusions from these small, imprecise trials, and have rated the overall quality of evidence as very low.
“Lumbar supports are widely used in clinical practice despite the fact we know virtually nothing about their effectiveness. Drawing from a very thin research base, we still don’t have enough evidence to make broad recommendations for or against their use,” said Dr Chiara Arienti, lead author from Humanitas University.
No side effects were found across the trials. However, this may reflect missing or under-reported data rather than an absence of harm. Nevertheless, the authors consider this finding to be consistent with their clinical experience.
Research concentrated in lower-income countries
One interesting finding was the geographic distribution of the research. Most of the trials identified were conducted in low- and middle-income countries (LMICs), with researchers from higher-income countries also appearing to have ties to those regions.
The authors suggest this pattern may reflect a disparity in access to treatment. In higher-income countries, clinical guidelines increasingly favour active interventions like exercise therapy, education, and biopsychosocial approaches for chronic low back pain. In settings where such treatments are less accessible, passive devices like lumbar supports may represent a more readily available option.
“It’s striking that most of the research on lumbar supports is coming from areas where active treatments are harder to access,” said Professor Stefano Negrini, senior author from University of Milan. “There’re enough data now showing that active treatments have a clinical effect on low back pain, but these treatments can be very expensive because they require rehabilitation professionals’ involvement.
“We have to ask ourselves whether we are looking at this problem only through the lens of the Global North, and whether that is the right perspective. These devices may play a different and important role in contexts where the alternative simply isn’t available.”
As ageing demographics shift the population profile in many countries, demand for accessible, low-cost passive treatments is likely to grow, meaning that current gaps in the evidence could become increasingly consequential.
The authors call for future research to prioritise research into their use among certain populations, particularly older adults and those in lower resource settings, for whom active treatment alternatives may not be readily available.
Study details
Assistive technologies (lumbar supports and other devices) for treating chronic low back pain
Published in Cochrane Database of Systematic Reviews on 2 September 2026
Chiara Arienti, Stefano Giuseppe Lazzarini, Fabio Zaina et al.
Abstract
Rationale
Low back pain (LBP) is a major global health problem. It is the most common cause of activity limitation among individuals under 45, and one of the most frequent reasons for visits to a doctor. The 2019 Global Burden of Disease study named LBP as the leading cause of the need for rehabilitation, estimated to affect 568m people. Its socioeconomic burden is substantial, with LBP‐related costs from productivity loss and healthcare services utilisation making a significant impact on national gross domestic products. In particular, chronic LBP (CLBP) – defined as pain, muscle tension, or stiffness lasting longer than 12 weeks – results in long‐term suffering and a considerable increase in healthcare expenditure. A wide variety of assistive technologies is utilised to manage CLBP. These aim to provide mechanical support, using diverse modalities and levels of assistance.
Objectives
To assess the benefits and harms of assistive technologies (i.e. non‐rigid and rigid lumbar braces, belts, supports, and devices to assist mobility and gait) in adults with chronic low back pain (CLBP).
Search methods
We searched CENTRAL, MEDLINE (PubMed), Embase, CINAHL, and trials registries up to 7 January 2025. We also searched the reference lists of included studies and any relevant systematic reviews.
Eligibility criteria
We included randomised controlled trials (RCTs) involving adults with CLBP comparing all types of assistive technologies versus placebo/sham, no intervention, or usual care. We planned to include non‐randomised studies of interventions (NRSIs) in the absence of RCT evidence for some types of assistive devices.
Outcomes
Our critical outcomes were pain, disability, health‐related quality of life, participant‐reported treatment success, falls, adverse events, and withdrawals due to any adverse events. Our important outcomes were depression, anxiety, social participation, and reduced use of painkillers. We did not assess the certainty of the evidence for important outcomes; thus, their results are not included in the abstract.
Risk of bias
We used the Cochrane tool RoB 1 to assess the risk of bias in the studies.
Synthesis methods
We conducted meta‐analysis using the random‐effects model to calculate the mean difference (MD) or standardised mean difference (SMD) with 95% confidence interval (CI) for all outcomes. We assessed the certainty of the evidence using the GRADE approach. When pooling was not possible, we calculated effect estimates for individual studies; when data were not available, we summarised the results narratively.
Included studies
We included eight RCTs involving a total of 501 participants. We did not identify any NRSIs meeting the inclusion criteria. Participants in the eight studies were adults of both sexes who had CLBP of at least one year’s duration being treated in the outpatient rehabilitation setting. All eight studies investigated the effects of lumbar supports; no eligible studies assessed other assistive technologies, such as mobility or gait aids. Seven of the studies added lumbar supports to ‘usual care’. Five of the studies were conducted in low‐ and middle‐income countries and three in high‐income countries.
Most of the included studies were at high or unclear risk of bias due to lack of blinding, incomplete outcome data, and selective reporting. We judged the certainty of the evidence to be low or very low.
Synthesis of results
The available evidence mainly addresses pain intensity and disability. We found some limited data on health‐related quality of life. None of the included studies reported participant‐reported treatment success, falls, adverse events, withdrawals due to any adverse events, or any of our other prespecified outcomes.
Compared with no intervention, lumbar supports may result in little to no difference in pain intensity in the intermediate term (three months), if we consider a minimum clinically meaningful change on the 0‐to‐100 pain scale to be 15 points (MD −8.00, 95% CI −15.02 to −0.98; 1 study, 107 participants), and may result in little to no difference in disability (MD −0.10, 95% CI −1.11 to 0.91; 1 study, 107 participants) (both low‐certainty evidence).
Compared with usual care (non‐steroidal anti‐inflammatory drugs (NSAIDs)), lumbar supports plus usual care (NSAIDs) may result in a small reduction in short‐term pain intensity (after three to four weeks), if we consider a minimum clinically meaningful change on the 0‐to‐100 pain scale to be 15 points (MD −17.66, 95% CI −24.22 to −11.09; I2 = 30%; 2 studies, 149 participants; low‐certainty evidence). However, the effect of lumbar supports added to usual care (NSAIDs) on disability is very uncertain (SMD −0.63, 95% CI −1.43 to 0.17; I2 = 76%; 2 studies, 149 participants; very low‐certainty evidence).
The evidence is very uncertain about the effect of lumbar supports plus usual care (education and exercise) compared with usual care (education and exercise) on pain intensity (MD −4.50, 95% CI −20.98 to 11.98; 1 study, 25 participants), disability (MD 2.80, 95% CI −21.58 to 27.18; 1 study, 24 participants), and health‐related quality of life (1 study, 25 participants) in the short term (six weeks) (all very low certainty evidence).
The evidence is also very uncertain about the effect of lumbar supports plus usual care (routine physical therapy) compared with usual care (routine physical therapy) on pain intensity (MD 3.10, 95% CI −5.89 to 12.09; 1 study, 41 participants) and disability (MD −4.27, 95% CI −7.71 to −0.83; 1 study, 41 participants) in the short term (four weeks) (both very low certainty evidence).
Authors’ conclusions
Lumbar supports may result in a small reduction in pain intensity when provided in addition to NSAIDs, but may offer little to no benefit for pain intensity and disability when used alone. The evidence regarding health‐related quality of life is very uncertain. No included studies reported on our other outcomes of interest or on adverse events, leaving uncertainty about the potential harms and broader functional impact of lumbar supports. Therefore, there is insufficient evidence to support the routine use of lumbar supports for managing CLBP. The absence of research on other assistive devices commonly used in clinical practice, particularly among people with disabilities or mobility limitations, is an evidence gap for future research to fill.
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