Article

Effect of firmness of mattress on chronic non-specific low-back pain: Randomised, double-blind, controlled, multicentre trial

Hospital Universitario Ramón y Cajal, Madrid, Madrid, Spain
The Lancet (Impact Factor: 45.22). 12/2003; 362(9396):1599-604. DOI: 10.1016/S0140-6736(03)14792-7
Source: PubMed

ABSTRACT

A firm mattress is commonly believed to be beneficial for low-back pain, although evidence supporting this recommendation is lacking. We assessed the effect of different firmnesses of mattresses on the clinical course of patients with chronic non-specific low-back pain.
In a randomised, double-blind, controlled, multicentre trial, we assessed 313 adults who had chronic non-specific low-back pain, but no referred pain, who complained of backache while lying in bed and on rising. Mattress firmness is rated on a scale developed by the European Committee for Standardisation. The H(s) scale starts at 1.0 (firmest) and stops at 10.0 (softest). We randomly assigned participants firm mattresses (H(s)=2.3) or medium-firm mattresses (H(s)=5.6). We did clinical assessments at baseline and at 90 days. Primary endpoints were improvements in pain while lying in bed, pain on rising, and disability.
At 90 days, patients with medium-firm mattresses had better outcomes for pain in bed (odds ratio 2.36 [95% CI 1.13-4.93]), pain on rising (1.93 [0.97-3.86]), and disability (2.10 [1.24-3.56]) than did patients with firm mattresses. Throughout the study period, patients with medium-firm mattresses also had less daytime low-back pain (p=0.059), pain while lying in bed (p=0.064), and pain on rising (p=0.008) than did patients with firm mattresses.
A mattress of medium firmness improves pain and disability among patients with chronic non-specific low-back pain.

Download full-text

Full-text

Available from: Francisco M Kovacs
  • Source
    • "In addition to its effect on sleep, bed comfort is often linked to low back pain, a leading cause of temporary disability and sick leave (Ehrlich, 2003). Although the causes of non-specific back complaints are not well understood, it has been shown that low quality bed systems may contribute significantly to the onset or persistence of low back pain (Kovacs et al., 2003). Consequently, it comes to no surprise that ergonomic aspects of bed design have evolved substantially during the last decade. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study aims at evaluating spinal alignment during sleep by combining personalized human models with mattress indentation measurements. A generic surface model has been developed that can be personalized based on anthropometric parameters derived from silhouette extraction. Shape assessment of the personalized surface models, performed by comparison with 3-D surface scans of the trunk, showed a mean unsigned distance of 9.77 mm between modeled and scanned surface meshes. The surface model is combined with an inner skeleton model, allowing the model to simulate distinct sleep postures. An automatic fitting algorithm sets the appropriate degrees of freedom to position the model on the measured indentation according to the adopted sleep posture. Validation on lateral sleep positions showed good intraclass correlations (0.73–0.88) between estimated and measured angular spinal deformations, indicating that silhouette-derived body shape models provide a valuable tool for the unobtrusive assessment of spinal alignment during sleep.Relevance to industry: A common drawback of the available techniques to assess spinal deformation on bedding systems is that they interfere with the actual sleep process. The current study presents a novel method based on silhouette-derived body shape models in order to estimate spine shape during sleep unobtrusively.
    Full-text · Article · Sep 2012 · International Journal of Industrial Ergonomics
  • Source
    • "An objective definition of " firm " and " medium-firm " was not provided by the authors. Nevertheless, compared with the old baseline mattress, both of the new mattresses were associated with less back pain than the old mattress, although the medium-firm mattress was best (Kovacs et al., 2003). Bergholt et al assigned 141 patients with chronic low-back pain in a randomized parallel arm design to either a waterbed, body-contouring mattress, or a firm futon mattress for one month. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Six married couples (12 adults, mean age 34.8 years) were randomized as couples in a cross-over design to sleep on a queen-size conventional mattress for 2 weeks and a specially-designed pressure-relief mattress for 2 weeks. The pressure-relief mattress was designed to reduce the number of contact points exceeding 30 mm Hg. Actigraphic measurements of sleep and self-reports of sleep and daytime symptoms were collected at baseline for 2 weeks on each couple's home mattress and box springs at home, followed by 2 weeks of data collection on each randomized mattress for a total of 6 weeks of data collection. Pressure maps were created for each participant on each sleeping surface. There were no significant differences between the randomized sleeping surfaces for any measure of actigraphic sleep or self-reported sleep and daytime symptoms. However, poor pressure relief performance of the home mattress was associated with better actigraphic sleep on the randomized pressure-relief mattress. We conclude that while pressure-relief mattresses may not be universally preferred, baseline characteristics of the sleeper and/or their mattress may explain performance and sleeper preferences on future mattress selection.
    Preview · Article · Jun 2011 · Applied ergonomics
  • Source
    • "However, Sullivan added, ''Health-wise, a firmer bed surface is recommended for people with a bad back to keep the spine from sagging or from tiring the back muscles.'' Recently, a between-subject, double-blind study showed that the use of medium-firm mattresses rather than firm mattresses for 90 days provided greater relief to people who had chronic non-specific low-back pain (Kovacs et al., 2003). This study points out that at least for people with low-back pain, it is not appropriate to select beds based on the firmer the better principle. "
    [Show abstract] [Hide abstract]
    ABSTRACT: In this study, we investigated the feasibility of applying manual muscle testing (MMT) for bedding selection and examined the bedding effect on sleep. Four lay testers with limited training in MMT performed muscle tests for the selection of the bedding systems from five different mattresses and eight different pillows for 14 participants with mild sleep-related respiratory disturbances. For each participant individually, two bedding systems-one inducing stronger muscle forces and the other inducing weaker forces-were selected. The tester-participant pairs showed 85% and 100% agreement, respectively, for the selection of mattresses and pillows that induced the strongest muscle forces. The firmness of the mattress and the height of the pillow were significantly correlated with the body weight and body mass index of the participants for the selected strong bedding system but not for the weak bedding system. Finally, differences were observed between the strong and the weak bedding systems with regard to sleep-related respiratory disturbances and the percentage of slow-wave sleep. It was concluded that MMT can be performed by inexperienced testers for the selection of bedding systems.
    Full-text · Article · Apr 2008 · Applied Ergonomics
Show more