Background and aims
The concept of bad posture being a dominant driver of pain is commonly held belief in the society. This may explain the significant attention supportive clothing such as posture-correcting shirts has recently gained in Scandinavia and the USA. The aim of this scoping review was to present an overview and synthesis of the available evidence for the use of posture-correcting shirts aimed at reducing pain or postural discomfort and optimising function/posture.
A systematic search was conducted for literature investigating the effect of posture-correcting shirts on musculoskeletal pain or function. PubMed, Embase, CINAHL, PEDro and the Cochrane Library were searched for relevant literature. Results of the searches were evaluated by two independent reviewers in three separate steps based on title, abstract and full text. For data synthesis, the population, intervention, comparator and outcome were extracted. The quality of the literature was evaluated using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and the risk of bias was assessed using the Risk Of Bias In Non-randomized Studies – of Interventions (ROBINS-I) assessment tool or the RoB 2.0 tool for individually randomized, parallel group trials. The overall confidence in the literature was determined using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).
A total of 136 articles were identified and six of these were included in the review. These studies were heterogeneous with regards to aims, outcomes and methods, presenting contrasting results. The overall findings were that posture-correcting shirts change posture and subjectively have a positive effect on discomfort, energy levels and productivity. The quality of the included literature was poor to fair with only one study being of good quality. The risk of bias was serious or critical for the included studies. Overall, this resulted in very low confidence in available evidence. An important limitation of all studies was that they were conducted in pain-free individuals.
The contrasting findings and the low quality of current literature, questions the intended effect of posture-correcting shirts and whether the changes it creates are in fact useful for clinical practice. Moreover, the findings are contrasted by the available evidence regarding posture and pain with a particular focus on whether this management strategy may have a detrimental effect on people living with musculoskeletal pain. A major limitation to the existing literature on the effect of posture-correcting shirts is that no studies have investigated their effect in clinical populations.
Based on the available literature and the major limitation of no studies investigating clinical populations, there is no good quality evidence to support recommendation of posture-correcting shirts as a management strategy for musculoskeletal pain. Promotion of this product may reinforce the inaccurate and unhelpful message that poor posture leads to pain. The efficacy of such garments should be tested in clinical populations and not only in pain-free individuals, to assess whether there is any meaningful benefit of this management approach. Until then, the use of posture-correcting shirts for musculoskeletal pain is not supported by current evidence.
Mr. Thomas Kjær, librarian at the University College of Northern Denmark is acknowledged for his assistance on the literature search in this study.
Research funding: This scoping review did not receive any funding.
Conflict of interest: None of the authors of this paper have any conflicts of interest to declare.
Informed consent: Not applicable.
Ethical approval: Not applicable.
 Darlow B, Perry M, Stanley J, Mathieson F, Melloh M, Baxter GD, Dowell A. Cross-sectional survey of attitudes and beliefs about back pain in New Zealand. BMJ Open 2014;4:e004725.10.1136/bmjopen-2013-004725Search in Google Scholar
 O’Sullivan K, O’Keeffe M, O’Sullivan L, O’Sullivan P, Dankaerts W. Perceptions of sitting posture among members of the community, both with and without non-specific chronic low back pain. Man Ther 2013;18:551–6.10.1016/j.math.2013.05.013Search in Google Scholar
 Setchell J, Costa N, Ferreira M, Makovey J, Nielsen M, Hodges PW. Individuals’ explanations for their persistent or recurrent low back pain: a cross-sectional survey. BMC Musculoskeletal Disorders 2017;18:466.10.1186/s12891-017-1831-7Search in Google Scholar
 O’Sullivan P, Smith A, Beales D, Straker L. Understanding adolescent low back pain from a multidimensional perspective: implications for management. J Orthop Sports Phys Ther 2017;47:741–51.10.2519/jospt.2017.7376Search in Google Scholar
 Murrie VL, Dixon AK, Hollingworth W, Wilson H, Doyle TA.Lumbar lordosis: study of patients with and without low back pain. Clinical anatomy (New York, NY) 2003;16:144–7.10.1002/ca.10114Search in Google Scholar
 Ettinger B, Black DM, Palermo L, Nevitt MC, Melnikoff S,Cummings SR. Kyphosis in older women and its relation to back pain, disability and osteopenia: the study of osteoporotic fractures. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 1994;4:55–60.10.1007/BF02352262Search in Google Scholar
 O’Sullivan PB, Smith AJ, Beales DJ, Straker LM. Association of biopsychosocial factors with degree of slump in sitting posture and self-report of back pain in adolescents: a cross-sectional study. Phys Ther 2011;91:470–83.10.2522/ptj.20100160Search in Google Scholar
 Smith A, Beales D, O’Sullivan P, Bear N, Straker L. Low back pain with impact at 17 years of age is predicted by early adolescent risk factors from multiple domains: analysis of the western australian pregnancy cohort (raine) study. J Orthop Sports Phys Ther 2017;47:752–62.10.2519/jospt.2017.7464Search in Google Scholar
 Darlow B, Dowell A, Baxter GD, Mathieson F, Perry M, Dean S. The enduring impact of what clinicians say to people with low back pain. Ann Fam Med 2013;11:527–34.10.1370/afm.1518Search in Google Scholar PubMed PubMed Central
 Suman A, Bostick GP, Schopflocher D, Russell AS, Ferrari R, Battie MC, Hu R, Buchbinder R, Gross DP. Long-term evaluation of a Canadian back pain mass media campaign. Eur Spine J 2017;26:2467–74.10.1007/s00586-017-5249-6Search in Google Scholar PubMed
 Buchbinder R, Jolley D, Wyatt M. 2001 Volvo Award Winner in Clinical Studies: effects of a media campaign on back pain beliefs and its potential influence on management of low back pain in general practice. Spine (Phila Pa 1976) 2001;26:2535–42.10.1097/00007632-200112010-00005Search in Google Scholar PubMed
 O’Keeffe M, Maher CG, Stanton TR, O’Connell NE, Deshpande S, Gross DP, O’Sullivan K. Mass media campaigns are needed to counter misconceptions about back pain and promote higher value care. Br J Sports Med 2018:bjsports-2018-099691. [Epub ahead of print]10.1136/bjsports-2018-099691Search in Google Scholar PubMed
 NIH National Heart LaBIN. Study quality assessment tools: quality assessment tool for observational cohort and cross-sectional studies: U.S. Department of Health & Human Services. Available at: https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools. Accessed: 29 Nov 2018.Search in Google Scholar
 Sterne JA, Hernan MA, Reeves BC, Savovic J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan AW, Churchill R, Deeks JJ, Hrobjartsson A, Kirkham J, Juni P, Loke YK, Pigott TD, Ramsay CR, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. Br Med J 2016;355:i4919.10.1136/bmj.i4919Search in Google Scholar PubMed PubMed Central
 Higgins JPT, Sterne JAC, Savović J, Page MJ, Hróbjartsson A, Boutron I, Reeves B, Eldridge S. A revised tool for assessing risk of bias in randomized trials. Cochrane Database Syst Rev 2016;10:29–31.Search in Google Scholar
 Guyatt G. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. Br Med J 2008;336:924–6.10.1136/bmj.39489.470347.ADSearch in Google Scholar PubMed PubMed Central
 Cipriani DJ, Yu TS, Lyssanova O. Perceived influence of a compression, posture-cueing shirt on cyclists’ ride experience and post-ride recovery. J Chiropr Med 2014;13:21–7.10.1016/j.jcm.2014.01.007Search in Google Scholar PubMed PubMed Central
 Decker M, Gomas KA, Narvy SJ, Vangsness CT. The influence of a dynamic elastic garment on musculoskeletal and respiratory wellness in computer users. Int J Occup Saf Ergon 2016;22:550–6.10.1080/10803548.2016.1182321Search in Google Scholar
 Zappala J, Orrego C, Boe E, Fechner H, Salminen D, Cipriani DJ. Influence of posture-cuing shirt on tennis serve kinematics in division III tennis players. J Chiropr Med 2017;16:49–53.10.1016/j.jcm.2016.05.003Search in Google Scholar
 Manor J, Hibberd E, Petschauer M, Myers J. Acute effects of posture shirts on rounded-shoulder and forward-head posture in college students. J Sport Rehabil 2016;25:309–14.10.1123/jsr.2014-0304Search in Google Scholar
 Gascon SS, Gilmer GG, Hanks MM, Washington JK, Oliver GD. Biomechanical influences of a postural compression garment on scapular positioning. Int J Sports Phys Ther 2018;13:700–6.10.26603/ijspt20180700Search in Google Scholar
 Cole AK, McGrath ML, Harrington SE, Padua DA, Rucinski TJ, Prentice WE. Scapular bracing and alteration of posture and muscle activity in overhead athletes with poor posture. J Athl Train 2013;48:12–24.10.4085/1062-6050-48.1.13Search in Google Scholar
 van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database Syst Rev 2008;16:1–36.10.1002/14651858.CD001823.pub3Search in Google Scholar
 Chang NJ, Chou W, Hsiao PC, Chang WD, Lo YM. Acute effects of Kinesio taping on pain, disability and back extensor muscle endurance in patients with low back pain caused by magnetic resonance imaging-confirmed lumbar disc degeneration. J Back Musculoskelet Rehabil 2018;31:85–93.10.3233/BMR-169681Search in Google Scholar
 Szeto GP, Straker L, Raine S. A field comparison of neck and shoulder postures in symptomatic and asymptomatic office workers. Appl Ergon 2002;33:75–84.10.1016/S0003-6870(01)00043-6Search in Google Scholar
 Kim E-K, Kim JS. Correlation between rounded shoulder posture, neck disability indices, and degree of forward head posture. J Phys Ther Sci 2016;28:2929–32.10.1589/jpts.28.2929Search in Google Scholar PubMed PubMed Central
 Im B, Kim Y, Chung Y, Hwang S. Effects of scapular stabilization exercise on neck posture and muscle activation in individuals with neck pain and forward head posture. J Phys Ther Sci 2016;28:951–5.10.1589/jpts.28.951Search in Google Scholar PubMed PubMed Central
 Richards KV, Beales DJ, Smith AJ, O’Sullivan PB, Straker LM. Neck posture clusters and their association with biopsychosocial factors and neck pain in Australian adolescents. Phys Ther 2016;96:1576–87.10.2522/ptj.20150660Search in Google Scholar PubMed
 Dawson AP, Schluter PJ, Hodges PW, Stewart S, Turner C. Fear of movement, passive coping, manual handling, and severe or radiating pain increase the likelihood of sick leave due to low back pain. Pain 2011;152:1517–24.10.1016/j.pain.2011.02.041Search in Google Scholar PubMed
 Christensen ST, Hartvigsen J. Spinal curves and health: a systematic critical review of the epidemiological literature dealing with associations between sagittal spinal curves and health. J Manipulative Physiol Ther 2008;31:690–714.10.1016/j.jmpt.2008.10.004Search in Google Scholar PubMed
 Hoffmann K, Peersman W, George A, Dorner TE. Associations and synergistic effects for psychological distress and chronic back pain on the utilization of different levels of ambulatory health care. A Cross-Sectional Study from Austria. PLoS One 2015;10:e0134136.10.1371/journal.pone.0134136Search in Google Scholar PubMed PubMed Central
 Diepenmaat AC, van der Wal MF, de Vet HC, Hirasing RA. Neck/shoulder, low back, and arm pain in relation to computer use, physical activity, stress, and depression among Dutch adolescents. Pediatrics 2006;117:412–6.10.1542/peds.2004-2766Search in Google Scholar PubMed
 O’Sullivan P, Beales D, Jensen L, Murray K, Myers T. Characteristics of chronic non-specific musculoskeletal pain in children and adolescents attending a rheumatology outpatients clinic: a cross-sectional study. Pediatr Rheumatol Online J 2011;9:3.10.1186/1546-0096-9-3Search in Google Scholar PubMed PubMed Central
 Urquhart DM, Bell RJ, Cicuttini FM, Cui J, Forbes A, Davis SR. Negative beliefs about low back pain are associated with high pain intensity and high level disability in community-based women. BMC Musculoskeletal Disorders 2008;9:148.10.1186/1471-2474-9-148Search in Google Scholar PubMed PubMed Central
 Falla D, Gizzi L, Tschapek M, Erlenwein J, Petzke F. Reduced task-induced variations in the distribution of activity across back muscle regions in individuals with low back pain. Pain 2014;155:944–53.10.1016/j.pain.2014.01.027Search in Google Scholar PubMed
 Falla D, Gizzi L, Parsa H, Dieterich A, Petzke F. People with chronic neck pain walk with a stiffer spine. J Orthop Sports Phys Ther 2017;47:268–77.10.2519/jospt.2017.6768Search in Google Scholar PubMed
 Wong KCH, Lee RYW, Yeung SS. The association between back pain and trunk posture of workers in a special school for the severe handicaps. BMC Musculoskeletal Disorders 2009;10:43.10.1186/1471-2474-10-43Search in Google Scholar PubMed PubMed Central
 Lima M, Ferreira AS, Reis FJJ, Paes V, Meziat-Filho N. Chronic low back pain and back muscle activity during functional tasks. Gait Posture 2018;61:250–6.10.1016/j.gaitpost.2018.01.021Search in Google Scholar PubMed
 Sheeran L, Sparkes V, Caterson B, Busse-Morris M, van Deursen R. Spinal position sense and trunk muscle activity during sitting and standing in nonspecific chronic low back pain: classification analysis. Spine (Phila Pa 1976) 2012;37:E486–95.10.1097/BRS.0b013e31823b00ceSearch in Google Scholar PubMed
 IASP. Part III: pain terms, a current list with definitions and notes on usage. In: Merskey H, Bogduk N, editors. Seattle: IASP Press; 1994.Search in Google Scholar
 Bunzli S, Smith A, Schutze R, Lin I, O’Sullivan P. Making sense of low back pain and pain-related fear. J Orthop Sports Phys Ther 2017;47:628–36.10.2519/jospt.2017.7434Search in Google Scholar PubMed
 O’Sullivan K, O’Sullivan P, O’Sullivan L, Dankaerts W. What do physiotherapists consider to be the best sitting spinal posture? Man Ther 2012;17:432–7.10.1016/j.math.2012.04.007Search in Google Scholar PubMed
 D’Amico M, Kinel E, Roncoletta P. Normative 3D opto-electronic stereo-photogrammetric posture and spine morphology data in young healthy adult population. PLoS One 2017;12:e0179619.10.1371/journal.pone.0179619Search in Google Scholar PubMed PubMed Central
 Nemmers TM, Miller JW, Hartman MD. Variability of the forward head posture in healthy community-dwelling older women. J Geriatr Phys Ther (2001) 2009;32:10–4.10.1519/00139143-200932010-00003Search in Google Scholar PubMed
 Bunzli S, Smith A, Schutze R, O’Sullivan P. Beliefs underlying pain-related fear and how they evolve: a qualitative investigation in people with chronic back pain and high pain-related fear. BMJ Open 2015;5:e008847.10.1136/bmjopen-2015-008847Search in Google Scholar PubMed PubMed Central
 Sloan TJ, Walsh DA. Explanatory and diagnostic labels and perceived prognosis in chronic low back pain. Spine (Phila Pa 1976) 2010;35:E1120–5.10.1097/BRS.0b013e3181e089a9Search in Google Scholar PubMed
 Barker KL, Reid M, Minns Lowe CJ. Divided by a lack of common language? A qualitative study exploring the use of language by health professionals treating back pain. BMC Musculoskelet Disord 2009;10:123.10.1186/1471-2474-10-123Search in Google Scholar PubMed PubMed Central
 Bunzli S, McEvoy S, Dankaerts W, O’Sullivan P, O’Sullivan K. Patient perspectives on participation in cognitive functional therapy for chronic low back pain. Phys Ther 2016;96:1397–407.10.2522/ptj.20140570Search in Google Scholar PubMed
©2019 Scandinavian Association for the Study of Pain. Published by Walter de Gruyter GmbH, Berlin/Boston. All rights reserved.