The Egyptian Rheumatologist (2015) 37, 147–150

H O S T E D BY
Egyptian Society of Rheumatic Diseases

The Egyptian Rheumatologist

www.rheumatology.eg.net
www.elsevier.com/locate/ejr

ORIGINAL ARTICLE

Effect of plaster corset in acute low back pain in less

developed country
a,*
Z. Zomalheto , A. Agbodande b, M. Avimadje a

a
Rheumatology Department of National Hospital, University Hubert Koutoukou Maga of Cotonou, Benin
b
Medecine Department of National Hospital, University Hubert Koutoukou Maga of Cotonou, Benin

Received 3 November 2014; accepted 3 November 2014

Available online 14 January 2015

KEYWORDS Abstract Aim of the work: To evaluate the effect of plaster corset in patients with acute low back
Acute low back pain; pain (LBP) in the Rheumatology Department of National Hospital University Hubert Koutoukou
Plaster corset; Maga of Cotonou (Benin).
Benin Patients and methods: A prospective case-control study was conducted from January 2012 to
June 2013. The selected patients suffered from acute low back pain and were treated with plaster
corset for thirty days associated with medical drugs compared to a control-group with the same dis-
ease treated only with medical drugs. Demographic data, clinical parameters and outcomes during
six months were collected. The primary endpoint was the reduction of visual analog score (VAS) for
pain and the functional disability was evaluated using the EIFEL score.
Results: Thirty-three patients were recruited in the plaster corset group (PG) and 34 patients of
matched age and sex in the control group. The mean VAS was 86.7 ± 21.3 and 88.3 ± 20.2 respec-
tively in the ‘‘PG’’ and ‘‘CG’’. The results showed a significant decrease of VAS after 3 months in
PG than in the CG (p = 0.023) but no significant difference was present after 6 months. The EIFEL
score significantly decreased in the PG compared to the CG after 6 months. The number of patients
who did not take any medication after three months was higher in the PG in contrast to the CG (27
patients versus 12).
Conclusion: Plaster corset can be complementarily used in addition to the medical treatment to
decrease the pain and functional disability and can help to reduce work stoppage.
Ó 2014 Production and hosting by Elsevier B.V. on behalf of Egyptian Society of Rheumatic Diseases.

1. Introduction

The prevalence of low back pain (LBP) is estimated at between

35 and 50% in both industrialized and less developed countries
* Corresponding author at: Rheumatologist, BP 2139 Abomey-calavi, [1–3]. A high prevalence of LBP (74.5%) among Tunisian hos-
Benin. Tel.: +229 95017779. pital staff was recently reported [4]. It is a public health prob-
E-mail address: zozaher@yahoo.fr (Z. Zomalheto). lem because of the socio-economic losses. The effects are more
Peer review under responsibility of Egyptian Society of Rheumatic important in the acute phases due to significant impairment of
Diseases. quality of life [2,5]. Evolution of LBP is frequently quickly
http://dx.doi.org/10.1016/j.ejr.2014.11.006
1110-1164 Ó 2014 Production and hosting by Elsevier B.V. on behalf of Egyptian Society of Rheumatic Diseases.
148 Z. Zomalheto et al.

favorable in few days with frequent risk of recurrence [6]. patient to recover. The lower cut allows the patient to sit, legs
Many propositions of treatment combined with immobiliza- at 90 degrees. From the back, the upper cutting edge passes
tion and pharmacological drugs are used to reduce the pain under the shoulder blades with a lower cutting so that the
to enable fast resumption of occupational and personal activ- patient can sit. To allow easy sitting, a finger’s breadth is
ities. The effectiveness of lumbar orthosis (corsets or belts) is left between the seat and the bottom edge of the corset, not
controversial [7–9]. The role of lumbar supports for prevention to pinch the buttocks. The corset should be well applied to
and treatment of low back pain was reviewed by Van Duijven- the lower back and tight in the abdominal region (Figs. 1
bode et al. [10]. and 2).
This study aims to evaluate the effect of plaster corset in
patients with acute low back pain in the Rheumatology unit 2.1. Scales
of the National University Hospital: Hubert Maga Koutoukou
(NHU-HKM) of Cotonou. – The pain VAS: It is measured on a 100 mm horizontal scale
from 0 (no pain) to 100 (maximal pain).
2. Patients and methods – The EIFEL scale: It is a valid and reliable self-questionnaire
for assessing functional capacity in low back pain [13]. It is
This was a prospective case-control study conducted from Jan- the French version of the Roland-Morris scale 10. It con-
uary 2012 to June 2013 in the rheumatology unit of the sists of 24 questions. The patient must answer each question
National Hospital University: Hubert Koutoukou Maga of in function of the difficulty applicable on the day the ques-
Cotonou. The patients between 18 and 65 years old were tionnaire is completed. Each question equals 1 point and
recruited over a period of 12 months and those who took part the total EIFEL score corresponds to the sum. Thus, a
met the following criteria: score of 24 corresponds to the most unfavorable situation
(total functional incapacity associated with their low back
– Having been consulted in the hospital rheumatology unit pain).
during the study period.
– Suffered from acute back pain (pain duration was less than Data collection was done initially, using a survey form
6 weeks [11]). which identified the general characteristics (age, sex, occupa-
– No contraindications to step I or step II analgesics (accord- tion, address, visual analog scale and EIFEL score) of the
ing to Word Health Organization pain ladder [12]), non-ste- two groups. The VAS for pain of patients was recorded in
roidal anti-inflammatory drugs, benzodiazepines and three follow-up visits at one, three and six months. The pri-
thiocolchicoside. mary endpoint was the reduction of visual analog score
– Signing the consent form after being explained to them. (DVAS). The study evaluated also the reduction of EIFEL
– Respected the follow-up visit for 6 months. scale and medical consumption.
The patients provided informed consents and ethical
The exclusion criteria were applied for patients with any of approval was obtained.
the following: Statistical analysis: Data was analyzed using EpiData
and SPSS17.0 software. Student’s test was used to compare
– Nerve root pain. the differences between both groups. Chi square test was
– Suffered from LBP during the year before. performed to compare between two qualitative variables.
– Performed a spinal operation. Statistical significance was set at p < 0.05. The data were
– LBP related to infection, inflammatory diseases or expressed as frequency, range, mean ± standard deviation
malignancy. (S.D.).
– Pregnancy.

The patients were randomly grouped. The first group called

‘plaster group’ (PG) treated with plaster corset for 30 days in
addition to using the medical drugs including analgesics,
anti-inflammatory and myorelaxant. The second group was
the ‘control-group’ (CG) that received only medical treatment.
The analgesics used included tramadol or acetaminophen com-
bined with codeine and the anti-inflammatory drugs used were
diclofenac, ketoprofen or piroxicam. Thiocolchicoside was the
myorelaxant used for the study.
Analgesic treatment (especially acetaminophen) was main-
tained throughout the study period upon request while the
muscle relaxant thiocolchicoside was stopped after two weeks
of continuous take. No complications were encountered after
providing the plaster corset and no further medications were
required.
Fitting of the plaster corset: In front, the corset goes from
the pubic area to the lower tip of the sternum. It envelops Figure 1 A photo of a female patient with low back pain
the lower part of the chest under the breasts and forces the wearing plaster corset (from the front and back).
Effect of plaster corset in acute low back pain 149

Figure 2 A photo of a male patient with low back pain wearing plaster corset (from the front and back).

3. Results

Sociodemographic characteristics: Thirty-three patients were

recruited in the plaster group (PG) and 34 in the control group
(CG). The mean ages were 39.03 ± 12.1 and 38.02 ± 13.7 and
the sex ratio (male/female) was 0.64 and 0.71 respectively. The
age and sex distribution were not statistically significantly dif-
ferent between both groups. The characteristics of both groups
are summarized in Table 1.
Evolution of pain intensity: The mean of VAS were initially
86.7 ± 21.3 and 88.3 ± 20.2 respectively in the ‘‘PG’’ and
‘‘CG’’. There was a significantly higher decrease of VAS after
3 months in the PG (from 88 to 21) compared to the CG (from
88 to 39) (p = 0.023) (Fig. 3). No significant difference was Figure 3 Evolution of pain intensity (VAS) in patients with
found between the two groups after 6 months (p = 0.10). acute low back pain wearing a plaster corset [n = 33] (blue line) or
Evolution of EIFEL scale: EIFEL score decreased more sig- the control group [n = 34] (red line) over the period of the study
nificantly in PG (from 15 to 2.2) compared to the CG (from 15 (6 months).
to 10.5) after 3 months (p = 0.035) but this decrease was not
significant between the two groups after 6 months (p = 0.48)
(Fig. 4).
Change in pharmacologic drugs consumption: Proportion of
patients who did not take any medication after three months
was higher in the PG than CG (27 patients versus 12). Drugs
consumed daily in PG were acetaminophen (1000 mg) while
drugs consumed in CG were tramadol (150 mg) and acetami-
nophen combined with codeine (1500/180 mg). The difference
was significant at 1, 3 and 6 months; (p = 0.035, p = 0.031
and p = 0.04 respectively).

4. Discussion

The results of this study show the potential effects of plaster

corset in acute low back pain on pain intensity after three Figure 4 Evolution of EIFEL Scale) in patients with acute low
months (p = 0.023), functional capacity after 3 months back pain wearing a plaster corset [n = 33] (blue line) or the
(p = 0.035) and drug consumption after 6 months (p = 0.04). control group [n = 34] (red line) over the period of the study
To our knowledge, the effect of plaster corset has not been (6 months).
evaluated in acute LBP. However, plaster corset has been used
as a conservative treatment of spinal tuberculosis [14,15].
Table 1 Characteristics of the plaster corset and control Although there is limited evidence of efficiency of lumbar sup-
groups in patients with acute low back pain. ports for treatment of low back pain [10], these results confirm
Calmels et al. work that showed the beneficial effect of lumbar
Characteristics Plaster corset Control
belt in subacute back pain [16]. The results were significantly
Number 33 34 less for the CG. Valle-Jones et al. analyzed the benefits of
Mean age/range (years) 39.03 ± 12.1 [21–61] 38.02 ± 13.7 [20–63] wearing a back support in the treatment of acute non specific
Sex-ratio (M/F) 25/39 (0.64) 27/38(0.71)
LBP, at 10–12 days. After 21 days, all the patients were
Mean VAS 86.7 ± 21.3 88.3 ± 20.2
ameliorated for pain intensity, limitation activity level, and this
150 Z. Zomalheto et al.

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