A longitudinal observational study of back pain incidence, risk factors and occupational physical activity in Swedish marine trainees

Prevalence and risk factors of low back pain in military personnel: a systematic review

Purpose

Low back pain (LBP) has a significant impact on the general population, especially on military personnel. This study aimed to systematically review the relevant literature to determine the prevalence and risk factors of low back pain among military personnel from different military occupational categories.

Methods

For this systematic review, we searched Embase, PubMed, and Cochrane. We performed study selection, data extraction, and assessed the quality of the evidence using the adapted risk of bias assessment tool by Hoy et al. This review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This study is registered on the Center for Open Science, registration DOI: 10.17605/OSF.IO/HRGE8.

Results

Out of 860 papers, 19 studies met the inclusion criteria. More than 360 000 military people with lumbar pain situation were considered for inclusion in this systematic review. The 1-year prevalence of LBP could be up to 81.7% in the Army, 5.2% in the Marines, and 48.1% in the Air Force. Age (OR = 0.494-2.89), history of LBP (OR = 2.2-8.91), and sedentary position (OR = 0.55-3.63) were the most common physical, sociodemographic, and occupational risk factors, respectively.

Conclusions

Low back pain was prevalent among military personnel. There was heterogeneity in studies and a significant difference in prevalence and incidence across various occupational categories. Physical, sociodemographic, and occupational risk factors were researched more than psychological risk factors in the military.

Systematic Review of Injuries and Chronic Musculoskeletal Pain Among High-speed Boat Operators

INTRODUCTION

High-speed boat operators constitute a population at risk of work-related injuries and disabilities. This review aimed to summarize the available knowledge on workplace-related injuries and chronic musculoskeletal pain among high-speed boat operators.

MATERIALS AND METHODS

In this systematic review, we searched Medline, Embase, Scopus, and the Cochrane Library Database for studies, published from 1980 to 2022, on occupational health and hazards onboard high-speed boats. Studies and reports were eligible for inclusion if they evaluated, compared, used, or described harms associated with impact exposure onboard high-speed boats. Studies focusing on recreational injuries and operators of non-planing boats were excluded. The primary outcome of interest was the incidence of acute injuries. The secondary outcome measures comprised the presence of chronic musculoskeletal disorders, pain medication use, and days off work.

RESULTS

Of the 163 search results, 5 (2 prospective longitudinal and 3 cross-sectional cohort studies) were included in this systematic review. A total of 804 cases with 3,312 injuries sustained during 3,467 person-years onboard high-speed boats were included in the synthesis of the results. The pooled incidence rate was 1.0 per person-year. The most common injuries were related to the lower back (26%), followed by neck (16%) and head (12%) injuries. The pooled prevalence of chronic pain was 74% (95% CI: 73-75%) and 60% (95% CI: 59-62%) of the cohort consumed analgesics.

CONCLUSIONS

Despite very limited data, this review found evidence that high-speed boat operators have a higher rate of injuries and a higher prevalence of chronic pain than other naval service operators and the general workforce. Given the low certainty of these findings, further prospective research is required to verify the injury incidence and chronic pain prevalence among high-speed boat operators.

Use of accelerometers and inertial measurement units to quantify movement of tactical athletes: A systematic review

The dynamic work environments of tactical athletes are difficult to replicate in a laboratory. Accelerometers and inertial measurement units provide a way to characterize movement in the field. This systematic review identified how accelerometers and inertial measurement units are currently being used to quantify movement patterns of tactical athletes. Seven research and military databases were searched, producing 26,228 potential articles with 78 articles included in this review. The articles studied military personnel (73.1%), firefighters (19.2%), paramedics (3.8%), and law enforcement officers (3.8%). Accelerometers were the most used type of sensor, and physical activity was the primarily reported outcome variable. Seventy of the studies had fair or poor quality. Research on firefighters, emergency medical services, and law enforcement officers was limited. Future research should strive to make quantified movement data more accessible and user-friendly for non-research personnel, thereby prompting increased use in tactical athlete groups, especially first responder agencies.

Risk factors for low back pain in active military personnel: a systematic review

Purpose

Low back pain (LBP) is prevalent in military personnel. We aimed to systematically review the literature regarding risk factors for first-time LBP during military service among active duty military personnel.

Methods

We searched six electronic databases (inception-April 2020) for randomised controlled trials, cohort studies, and case–control studies published in English in peer-reviewed journals. Eligible studies were independently critically appraised by paired reviewers and a descriptive synthesis was conducted.

Results

We screened 1981 records, reviewed 118 full-text articles, and synthesised data from eight acceptable quality cohort studies. Studies assessed physical (n = 4), sociodemographic (n = 2), and/or occupational factors (n = 5) associated with LBP. Two studies reported prior LBP was associated with a greater than twofold increased risk of LBP compared to those without prior LBP. Other factors consistently associated with LBP included previous musculoskeletal injury (n = 2), less time spent on physical training (n = 2), female sex (n = 2), and lower rank (n = 2). Factors associated with LBP from single studies included marital status, lower education level, blast injury, job duties, and service type. We found inconsistent associations for performance on physical fitness tests, age, and occupation type. Psychological risk factors were not assessed in any included studies.

Conclusion

In active duty personnel, prior history of LBP, previous musculoskeletal injury, less time in physical training, female sex, and lower rank were consistent risk factors for LBP. This information is relevant for researchers, active duty military personnel, and other decision makers. Future studies should explore causal relationships for LBP in this population.

PROSPERO registration number: CRD42018084549.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12998-021-00409-x.

Risk factors for musculoskeletal injuries in the military: a qualitative systematic review of the literature from the past two decades and a new prioritizing injury model

BACKGROUND

Musculoskeletal injuries (MSkIs) are a leading cause of health care utilization, as well as limited duty and disability in the US military and other armed forces. MSkIs affect members of the military during initial training, operational training, and deployment and have a direct negative impact on overall troop readiness. Currently, a systematic overview of all risk factors for MSkIs in the military is not available.

METHODS

A systematic literature search was carried out using the PubMed, Ovid/Medline, and Web of Science databases from January 1, 2000 to September 10, 2019. Additionally, a reference list scan was performed (using the "snowball method"). Thereafter, an international, multidisciplinary expert panel scored the level of evidence per risk factor, and a classification of modifiable/non-modifiable was made.

RESULTS

In total, 176 original papers and 3 meta-analyses were included in the review. A list of 57 reported potential risk factors was formed. For 21 risk factors, the level of evidence was considered moderate or strong. Based on this literature review and an in-depth analysis, the expert panel developed a model to display the most relevant risk factors identified, introducing the idea of the "order of importance" and including concepts that are modifiable/non-modifiable, as well as extrinsic/intrinsic risk factors.

CONCLUSIONS

This is the qualitative systematic review of studies on risk factors for MSkIs in the military that has attempted to be all-inclusive. A total of 57 different potential risk factors were identified, and a new, prioritizing injury model was developed. This model may help us to understand risk factors that can be addressed, and in which order they should be prioritized when planning intervention strategies within military groups.

Prognostic ability of STarT Back Screening Tool combined with work-related factors in patients with low back pain in primary care: a prospective study

OBJECTIVE

Primary care screening tools for patients with low back pain may improve outcome by identifying modifiable obstacles for recovery. The STarT Back Screening Tool (SBST) consists of nine biological and psychological items, with less focus on work-related factors. We aimed at testing the prognostic ability of SBST and the effect of adding items for future and present work ability.

METHODS

Prospective observational study in patients (n=158) attending primary care physical therapy for low back pain. The prognostic ability of SBST and the added prognostic value of two work items; expectation for future work ability and current work ability, were calculated for disability, pain and quality of life outcome at 3 months follow-up. The medium and high-risk group in the SBST were collapsed in the analyses due to few patients in the high-risk group. The prognostic ability was assessed using the explained variance (R²) of the outcomes from univariable and multivariable linear regression and beta values with 95% CIs were used to assess the prognostic value of individual items.

RESULTS

The SBST classified 107 (67.7%) patients as low risk and 51 (32.3%) patients as medium/high risk. SBST provided prognostic ability for disability (R²=0.35), pain (R²=0.25) and quality of life (R²=0.28). Expectation for return to work predicted outcome in univariable analyses but provided limited additional prognostic ability when added to the SBST. Present work ability provided additional prognostic ability for disability (β=-2.5; 95% CI=-3.6 to -1.4), pain (β=-0.2; 95% CI=-0.5 to -0.002) and quality of life (β=0.02; 95% CI=0.001 to 0.04) in the multivariable analyses. The explained variance (R²) when work ability was added to the SBST was 0.60, 0.49 and 0.47 for disability, pain and quality of life, respectively.

CONCLUSIONS

Adding one work ability item to the SBST gives additional prognostic information across core outcomes. Clinical trial number: NCT03626389.

Lower back pain at workplace: prevalence and risk factors

Objective — analysis of lower back pain (LBP) prevalence and risk factors for its development in employees with different conditions at their workplace, depending on their age, length of service, occupational factors, and physical activity. Material and Methods — As a result of a simultaneous cross-sectional study, 3300 employees with different conditions at their workplace were examined. To study the relationships between LBP prevalence and risk factors, we used the results of employees’ survey and physical examination, along with the data on their physical activity and working conditions. Results — The workplace posture was the most common production-related risk factor for developing LBP. The second most common risk factor was the weight of the load being lifted and carried, followed by general vibration at a workplace. The least significant factor was a bending motion. According to our data, LBP prevalence in all observation groups was increasing with both age and length of employment. Over 50% of those working in hazardous conditions at the age of 50 yo and higher had LBP. Low physical activity at a workplace led to a statistically significant increase in the chances of LBP emergence. Conclusion — In employees without exposure to harmful risk factors in the form of physical exertion and general vibration, the prevalence of LBP was significantly lower than in workers in harmful working conditions. The combined effect of static and dynamic physical activities at a workplace had a more pronounced negative impact on workers’ health. Low physical activity was a significant risk factor for LBP development.

Musculoskeletal disorders and their associations with health- and work-related factors: a cross-sectional comparison between Swedish air force personnel and army soldiers

BACKGROUND

The high numbers of musculoskeletal disorders (MSD) among soldiers in the Swedish Armed Forces has led to the implementation of an effective prevention program, the musculoskeletal screening protocol (MSP), including questionnaires, physical tests and individual intervention of their MSD. A corresponding MSP for the Swedish Air Force is also needed due to earlier reported high prevalence of MSD. We therefore investigated the prevalence of MSD in Swedish Air Force personnel (AF) and compared this to Swedish Army deployed soldiers (DS). Individual, health- and work-related factors associated with MSD were also investigated.

METHODS

Cross-sectional questionnaire-based study on 166 male AF and 185 DS. AF consisted of fighter pilots, helicopter pilots and rear crew from one Swedish air base.

RESULTS

The one-year and point prevalence, respectively, of MSD were significantly higher for AF compared to DS with regard to both the upper quarter of the body (i.e. neck, shoulder and thoracic regions) (AF = 54.8 and 31.3%, DS = 26.1 and 13.6%, p = 0.01) and the lumbar region (AF = 38.0 and 18.7%, DS = 22.2 and 7.1%, p = 0.00). No significant differences were present between fighter pilots, helicopter pilots and rear crew regarding MSD prevalence. Factors significantly associated with having both upper quarter and lumbar regions MSD were group (i.e. greater odds for AF than DS) and self-reported physical health as less than excellent. Additionally, being older and taller were also factors associated with lumbar region MSD.

DISCUSSION

Despite a generally healthy lifestyle, MSD were commonly reported by AF and DS, with generally higher prevalence in AF who mainly reported MSD in the upper quarter of the body. The results from this study indicate that the MSP can be a meaningful tool to prevent MSD in air force personnel and that questions regarding general health and MSD in specific body regions should be included in screening protocols. The development of the preventive program MSP is therefore recommended for the Swedish Air Force.

The Association Between Fitness Test Scores and Musculoskeletal Injury in Police Officers

A police officer’s career is hazardous and physically demanding. In order to perform occupational tasks effectively and without injury, officers require adequate physical abilities. The aim of this study was to investigate the relationship between scores on several fitness tests and musculoskeletal injury in a group of municipal police officers. This retrospective study used existing data to examine the relationship between risk of injury and fitness test performance. Injured and uninjured police officers scored significantly differently on several fitness measures. A multivariate regression indicated that a combination of age, sex, number of pull ups completed and maximal oxygen consumption (VO_2max) best explained injury risk. Additionally, the findings indicated an interaction between sex and VO_2max, and so the effect of VO_2max on injury risk cannot be understood without accounting for sex.