Working hours spent on repeated activities and prevalence of back pain

Identifying factors associated with physical therapy use versus non-use among injured workers with back pain in Washington State

BACKGROUND

There is little information about predictors of physical therapy (PT) use among injured workers with back pain. The primary objective of this study is to investigate the associations between PT use and baseline factors not routinely captured in workers' compensation (WC) data.

METHODS

We conducted a secondary analysis using the Washington State Workers' Compensation Disability Risk Identification Study Cohort, which combines self-reported surveys with claims data from the Washington State Department of Labor and Industries State Fund. Workers with an accepted or provisional WC claim for back injury between June 2002 and April 2004 were eligible. Baseline factors for PT use were selected from six domains (socio-demographic, pain and function, psychosocial, clinical, health behaviors, and employment-related). The outcome was a binary measure for PT use within 1 year of injury. Bivariate and multivariable logistic regression models were conducted to evaluate the associations between PT use and baseline factors.

RESULTS

Among the 1370 eligible study participants, we identified 673 (49%) who received at least one PT service. Baseline factors from five of the six domains (all but health behaviors) were associated with PT use, including gender, income, pain and function measures, injury severity rating, catastrophizing, recovery expectations, fear avoidance, mental health score, body mass index, first provider seen for injury, previous injury, and several work-related factors.

CONCLUSION

We identify baseline factors that are associated with PT use, which may be useful in addressing disparities in access to care for injured workers with back pain in a WC system.

Socioeconomic variation in the prevalence of pain by anatomical sites among middle-aged and older adults in India: a cross-sectional study

BACKGROUND

Pain is a significant global public health concern, particularly among individuals aged 45 and above. Its impact on the overall lifestyle of the individuals varies depending on the affected anatomical parts. Despite its widespread impact, there is limited awareness of the attributes of pain, making effective pain management challenging, particularly in India. This study aims to estimate the prevalence and variation in pain in different anatomical sites among middle-aged and older adults in India.

METHODS

A cross-sectional design was employed, utilising data from the first wave of the Longitudinal Aging Study in India (LASI), 2017-2018. The age-sex adjusted prevalence of pain by anatomical sites (the back, joints, and ankles) was estimated using a multivariate logistic regression model.

RESULTS

47% of individuals aged 45 years and above reported joint pain, 31% reported back pain and 20% suffered from ankle or foot pain. The prevalence of pain at all the anatomical sites increased with age and was reported higher among females. Relative to respondents aged 45-59 years, those aged 75 years and older exhibited a 41% higher likelihood of experiencing back pain (AOR: 1.41, 95% CI: 1.19-1.67), a 67% higher likelihood of joint pain (AOR: 1.67, 95% CI: 1.49-1.89), and a 32% higher likelihood of ankle/foot pain (AOR: 1.32, 95% CI: 1.16-1.50). In comparison to males, females had a 56% higher likelihood of encountering back pain (AOR: 1.56, 95% CI: 1.40-1.74), a 38% higher likelihood of joint pain (AOR: 1.38, 95% CI: 1.27-1.50), and a 35% higher likelihood of ankle/foot pain (AOR: 1.35, 95% CI: 1.17-1.57). We also found significant regional variations in pain prevalence, with higher rates in the mountainous regions of India.

CONCLUSION

This research highlights the high burden of pain in major anatomical sites among middle-aged and older adults in India and emphasises the need for increased awareness and effective pain management strategies.

Prevalence and risks factors of caregiving-related low back pain among caregivers of stroke survivors: a systematic review and meta-analysis

INTRODUCTION

Stroke causes disability that makes its survivors depend on caregivers for help. The caregivers offer help during lifting and transferring patients from one place to another. However, such activities result in the caregivers sustaining musculoskeletal injuries such as the low back pain (LBP). The aim of this study was to carry out a systematic review and meta-analysis to determine the prevalence of LBP and its risk factors among these caregivers.

EVIDENCE ACQUISITION

PubMED, Embase, Web of Science (WoS) and CINAHL were searched until January 2023, and cross-sectional studies were included. Data on prevalence of LBP due to caregiving activities and participants' characteristics such as sex and nature of caregiving were extracted.

EVIDENCE SYNTHESIS

Risks of bias of the included studies were assessed using Agency for healthcare Research and Quality (AHRQ) tool. The data were analyzed using both narrative and quantitative syntheses. In the quantitative synthesis, random effect model meta-analysis of the prevalence and odd of developing LBP between men and women; and between partial and complete caregivers was used. Fives studies (N.=644) were included. The results showed that the prevalence of LBP was 53.9%, with 96% CI from 50.0% to 57.8%. In addition, there was no statistically significant difference in the risk of developing LBP between men and women (OR=1.58, 95% CI=0.27 to 9.27, P=0.61); and between partial and complete caregivers (OR=1.33, 95% CI=0.32 to 5.61, P=0.70).

CONCLUSIONS

About half of caregivers of stroke survivors may experience LBP. Therefore, this should be considered during rehabilitation.

Treatment Beliefs and Practices towards Low Back Pain among Teachers in Asir Region, Saudi Arabia-A Cross-Sectional Study

The prevalence of low back pain (LBP) is increasing exponentially, with this public health issue affecting over 70% of the population. However, sedentary careers exacerbate the problem further, with professions such as teaching disproportionately affected. In addition, the general population does not seek interventions from medical professionals for LBP; instead, they opt to manage their pain with over-the-counter medications, such as sedatives. The purpose of this study was to explore practices and beliefs related to back pain treatment among schoolteachers in the Asir region. This cross-sectional study included a sample of 312 teachers from the Asir region, with data collected regarding the prevalence of back pain, management approaches, and beliefs surrounding medical interventions. Chi-square or exact tests defined the association between variables, with significance determined at p < 0.05. Our results revealed that 67.3% of Saudi Arabian teachers experienced LBP within the last two months, with a continuous condition representing 36.7% of cases. This study identified several different treatment modalities the participants use to manage their pain, including sedatives, best rest, kaiy (traditional cautery), and local adhesives, with sedatives being the most employed method. It also highlighted that increased daily working hours and total days worked significantly increased the prevalence of LBP (p < 0.05). Although a considerable number of the included teachers were highly educated, with some teaching experience, they had a poor level of awareness and an incorrect attitude towards pain management. Enhanced efforts should be made to improve teachers' awareness regarding back pain causes and management methods.

Dry immersion induced acute low back pain and its relationship with trunk myofascial viscoelastic changes

Microgravity induces spinal elongation and Low Back Pain (LBP) but the pathophysiology is unknown. Changes in paraspinal muscle viscoelastic properties may play a role. Dry Immersion (DI) is a ground-based microgravity analogue that induces changes in m. erector spinae superficial myofascial tissue tone within 2 h. This study sought to determine whether bilateral m. erector spinae tone, creep, and stiffness persist beyond 2 h; and if such changes correlate with DI-induced spinal elongation and/or LBP. Ten healthy males lay in the DI bath at the Institute of Biomedical Problems (Moscow, Russia) for 6 h. Bilateral lumbar (L1, L4) and thoracic (T11, T9) trunk myofascial tone, stiffness and creep (MyotonPRO), and subjective LBP (0-10 NRS) were recorded before DI, after 1h, 6 h of DI, and 30min post. The non-standing spinal length was evaluated on the bath lifting platform using a bespoke stadiometer before and following DI. DI significantly modulated m. erector spinae viscoelastic properties at L4, L1, T11, and T9 with no effect of laterality. Bilateral tissue tone was significantly reduced after 1 and 6 h DI at L4, L1, T11, and T9 to a similar extent. Stiffness was also reduced by DI at 1 h but partially recovered at 6 h for L4, L1, and T11. Creep was increased by DI at 1 h, with partial recovery at 6 h, although only T11 was significant. All properties returned to baseline 30 min following DI. Significant spinal elongation (1.17 ± 0.20 cm) with mild (at 1 h) to moderate (at 6 h) LBP was induced, mainly in the upper lumbar and lower thoracic regions. Spinal length increases positively correlated (Rho = 0.847, p = 0.024) with middle thoracic (T9) tone reduction, but with no other stiffness or creep changes. Spinal length positively correlated (Rho = 0.557, p = 0.039) with Max LBP; LBP failed to correlate with any m. erector spinae measured parameters. The DI-induced bilateral m. erector spinae tone, creep, and stiffness changes persist beyond 2 h. Evidence of spinal elongation and LBP allows suggesting that the trunk myofascial tissue changes could play a role in LBP pathogenesis observed in real and simulated microgravity. Further study is warranted with longer duration DI, assessment of IVD geometry, and vertebral column stability.

Low back pain and its determinants among wait staff in Gondar town, North West Ethiopia: A cross-sectional study

Background

Low back pain is a common public health issue in the working population and one of the leading causes of disability. It is the leading cause of work-related conditions and the most common reason for filing a workers' compensation claim in low- and middle-income countries. Ethiopia is a developing country; there is a shortage of working materials, skilled labor, and a lack of awareness of ergonomics posture, which lead to lifting heavy objects, long periods of standing, repetitive twisting, and same sustained posture for long periods of time without a shift. As a result, the purpose of this study was to assess the prevalence and associated factors of work-related low back pain among restaurant wait staff in Gondar, Ethiopia, in the year 2019.

Methods

Institution-based cross-sectional study, including 420 restaurant wait personnel, was undertaken from 1 March to 30 April 2019. A simple random sampling procedure was used to choose the restaurants and wait staff. A standardized Nordic questionnaire was used to collect data. Data were entered into Epi Info 7 and analyzed in SPSS version 20. The univariate and multivariate logistic regression analyses were calculated. The significance of associations was reported by a P-value of < 0.05 and an adjusted odds ratio (AOR). The model fitness checked by the Hosmer–Lemeshow goodness of fit test was used.

Result

In this study, a total of 420 participants (99.53% response rate) ranging in age from 17 to 53 years old participated, with 184 (43.8%) participants reporting low back pain at some point in the past 12 months. Female participants had a higher prevalence of 130 (70.6%). Sex (AOR = 2.98; 95% CI: 1.07–8.30), frequent exercise (AOR 0.47; 95% CI: 0.24, 0.93), extended standing (AOR 8.82; 95% CI: 3.30, 20.32], and repetitive tasks (AOR 7.49; 95% CI: 4.29, 13.19) were all found to be significant predictors in low back pain.

Conclusion

More than two-fifth of waitresses and waiters reported low back discomfort at some point in the past 12 months. Predisposing factors for low back discomfort among restaurant wait staff included being female, standing for long periods of time while serving, and performing repetitive tasks. Regular exercise was found to be a protective factor against low back pain in wait staff. Delivering ongoing safety training is among the most potent essential measures required in preventing low back pain.

Prevalence of Self-Reported Work-Related Lower Back Pain and Its Associated Factors in Ethiopia: A Systematic Review and Meta-Analysis

Introduction

Low back pain is the commonest musculoskeletal disorder affecting every socioeconomic group of the world's population. The lifetime risk of developing low back pain is about 60%–80%. The pooled prevalence and associated factors of low back pain have not yet been determined in Ethiopia. Thus, this study was aimed at assessing the overall prevalence of low back pain and its associated factors in Ethiopia.

Methods

A systematic search of PubMed, Scopus, Science Direct, and Google Scholar for observational studies reporting data on the prevalence and associated factors of low back pain was conducted. Relevant data were extracted with a standardized data extraction excel form. Stata 14 was employed for the meta-analysis. Heterogeneity was assessed by Cochran's Q test and I² values of a forest plot. Publication bias was checked using a funnel plot and Egger's test. A random-effects model was used in the analysis.

Result

A total of thirty-two studies were included for the systematic review. Twenty-four and sixteen studies were used to pool the overall low back pain prevalence and associated factors, respectively. The overall pooled annual prevalence of low back pain in Ethiopia was estimated to be 54.05% (95% CI: 48.14–59.96). Age, sex, body mass index, work experience, working hours, lack of safety training, awkward working posture, work shift, prolonged standing, lifting heavy objects, sleeping disturbance, history of back trauma, previous medical history of musculoskeletal disorder, and lack of adequate rest interval at work were significantly associated with low back pain.

Conclusion

The current systematic review and meta-analysis revealed a higher prevalence of lower back pain in Ethiopia. Most of the low back pain epidemiological studies conducted in Ethiopia focused on specific occupational settings, making pooling of data and comparison with other countries challenging. Thus, further general population studies are recommended.

Low Back Pain and Associated Factors among Hairdressers in Northern Ethiopia: A Cross-Sectional Study

Low back pain is one of the major occupational health problems ranked the highest in terms of years lived with disability, and it has an economic burden on individuals and society in general. Hairdressers are high-risk professionals, but they are usually getting less attention in research and policy actions. The objective of this study is to assess the magnitude and associated factors of low back pain among hairdressers working in female beauty salons of Mekelle, Northern Ethiopia. A cross-sectional study was employed from January up to March 2018. A simple random sampling was applied to select 344 participants. Interviewer-administered, pretested, and structured questionnaire was used. Bivariate and multivariate binary logistic regression analyses were performed using SPSS version 23. A p value of <0.05 was used to declare statistical significance. A total of 314 hairdressers participated, with a 91.3% response rate. The study found that the prevalence of low back pain was 47.5% with 95% CI (41.8-53.1). Marital status (AOR: 0.40, 95% CI (0.23-0.71)), awkward posture (AOR: 2.59, 95%CI (1.45-4.63)), working greater than 4 days in a week (AOR: 5.12, 95% CI (1.94-13.70)), the task of washing the client's hair (AOR: 4.45, 95% CI (1.93-10.26)), having adjustable washing basin (AOR: 0.35, 95% CI (0.18-0.69)), job stress (AOR: 0.45, 95% CI (0.27-0.77)), and job satisfaction (AOR: 0.58, 95% CI (0.34-0.98)) were factors that show a statistically significant association with low back pain. This study found that low back pain is a major health problem among hairdressers. Marital status, awkward postures, working days per week, the task of washing the client's hair, adjustable washing basin, job stress, and job satisfaction show a strong association with low back pain. The result suggests that effective intervention strategies for low back pain need to include ergonomic improvements and psychosocial and behavioral aspects of the participants.

Successful Use of the Hybrid Assistive Limb for Care Support to Reduce Lumbar Load in a Simulated Patient Transfer

STUDY DESIGN

Prospective experimental study in humans.

PURPOSE

To determine whether the hybrid assistive limb (HAL) for Care Support can reduce lumbar load during a patient transfer.

OVERVIEW OF LITERATURE

The prevalence of work-related low back pain (LBP) among nurses is high. In particular, transferring patients poses a high risk for LBP due to the large lumbar load. Attempts to reduce the lumbar load are crucial to avoid the risk of LBP. Therefore, we investigated the effects of the HAL for Care Support.

METHODS

Nineteen volunteers (16 men, three women) lifted a 60-kg doll from a seated position to a standing position. The first transfer was performed without the HAL for Care Support, and the second was performed with the HAL for Care Support assistive robot. We evaluated transfer performance, the visual analog scale (VAS) score for lumbar fatigue, and electromyogram analyses of the trunk and hip.

RESULTS

Four participants (two men, two women) succeeded with the HAL for Care Support even though they were unable to perform the task without it. The mean lumbar fatigue VAS score for all participants without the HAL for Care Support was 62 mm, while that with it was 43 mm. With lumbar assistance from the HAL for Care Support, subjective lumbar fatigue during the transfer decreased significantly. A power analysis indicated adequate statistical power to detect a difference in the VAS score for lumbar fatigue (0.99). The activity of the left gluteus maximus alone increased significantly during transfers with the HAL for Care Support. No adverse events occurred during use of the HAL for Care Support for transfers.

CONCLUSIONS

The HAL for Care Support was able to reduce lumbar load in a simulated patient transfer.

Baropodometric evaluation of foot load distribution during gait in the group of professionally active nurses

OBJECTIVES

Nurses are extremely exposed to musculoskeletal overloads. Prolonged standing postural balance distributions, functional deficits and pain may affect the symmetry of the load on the feet. The study aimed to assess the distribution of foot load during gait among nurses.

METHODS

The sample of this prospective and observational study consisted of 37 female nurses with mean age of 39 years. The Nordic Musculoskeletal Questionnaire (NMQ) was used to evaluate musculoskeletal disturbances and baropodometric gait analysis (BGA) was performed to register distribution of foot load during gait.

RESULTS

We showed that 68% of nurses declare that they know the principles of workplace ergonomics, but only 14% comply with them. NMQ results indicate that as many as 73% of the respondents feel ailments in the "lower back" area. An asymmetry was observed in the load of IV-V of the metatarsal head between the left and right foot (P = .000) and in the load of the left and right lateral part of the heel (P = .028) in the BGA test. Correlations between ailments occurring in the neck area and loading of the lateral arch of the right foot (P = .032) were found. Moreover, the load in this area correlated positively with the occurrence of "lower back" pain (P = .045).

CONCLUSIONS

Nurses have asymmetric distribution of foot load during gait, which results in a discrepancy between the loads on the three main support points of the foot and which may affect nurses' work productivity.

Factors predisposing to work-related lower back pain in automobile industry workers

Objective. This study aimed to assess the presence of lower back pain (LBP) in automobile industrial workers and correlate it with the factors known to be contributing to the development of work-related LBP. Method. Post ethical approval, an analytical cross-sectional assessment was conducted for a correlation study on 317 workers from different automobile industries, garages and service centres, who were then assessed by Nordic musculoskeletal questionnaire for the presence of LBP. Their pain intensity was assessed using a numerical rating scale, their core strength with a pressure biofeedback unit, their flexibility via the sitting and reach test and their work posture with the rapid entire body assessment tool. Pain intensity was correlated with core strength, flexibility and posture in all of the workers using Spearman's correlation coefficient r with α set at p ≤ 0.05 at a 95% confidence interval. Results. There was no significant correlation of the pain intensity with the core strength (r = 0.052, p = 0.424), flexibility (r = 0.020, p = 0.755) or posture (r = 0.002, p = 0.974). Conclusion. The present study indicates that internal factors like core strength and flexibility, and work postures have no correlation with intensity and severity of LBP in automobile industry workers.

MAGNETIC RESONANCE IMAGING PATHOLOGICAL EVIDENCE IN PATIENTS WITH LOW BACK PAIN IN SOUTHWEST NIGERIA

BACKGROUND

Low back pain, a condition that affects many individuals worldwide during their lifetime is receiving increasing attention due to the attendant chronic disability, absenteeism from work, loss of earning power, loss of quality of life and finances. Recently focus has been on the rising prevalence and search for steps to address low back pain risk factors now known to be modifiable. For the evaluation of low back pain, magnetic resonance imaging (MRI) has emerged as the imaging modality of choice.

AIM

To determine the prevalence and distribution of lumbosacral spine discs, osseous, ligamentum flavum and facet joint changes evaluated by MRI. And to further understand the lumbosacral spine biomechanics of MRI-related disco-osseous abnormalities among native African population with low back pain.

STUDY DESIGN

This was a retrospective study.

SETTING

University College Hospital, Ibadan, Nigeria.

METHODOLOGY

The Lumbosacral spine T1W and T2W sagittal and axial images and post gadolinium contrast images generated using a low field MRI scanner and body surface coil, in patients with low back pain, were evaluated in line with pre-defined spinal changes.

RESULTS

There were a total of one hundred and eight low back pain patients who had Magnetic resonance imaging between March 2015 and August 2016 in this study with a mean age of 49.9 years and a range of 8 to 77 years. There were 28(25.9%) patients aged 50 - 59 years; this age bracket had the highest number while those aged 20 years and below were 3.7%. In all, 80(74.1%) subjects had chronic low back pain. Abnormal Magnetic resonance findings were reported in 96.3%. Multiple disc affectation was seen in 75.3%; disc bulge (79.8%) was the commonest disc findings followed by dehydration in 74.0%. The L4/5 discs were commonly affected in disc dehydration in 59(76.6%) cases, anterior herniation in 22(61.1%) cases, ventrolateral herniations in 9(81.8%) cases, nerve root compression in 21(60%) cases, facet joint hypertrophy in 17/24(70.8%) cases and spinal canal stenosis in 32/47(68.1%) cases. Vertebral end plate changes occur mostly at L4 and L5 (74% at each level).

CONCLUSION

This study has shown that Magnetic Resonance Imaging changes in low back pain involved multiple discs and multilevel osseous pathologies, however, disc abnormalities are predominant. The L4-5, L5-S1 disc levels and L4 vertebra body were the most commonly affected sites among a native African population.

Muscle Activity Adaptations to Spinal Tissue Creep in the Presence of Muscle Fatigue

Aim

The aim of this study was to identify adaptations in muscle activity distribution to spinal tissue creep in presence of muscle fatigue.

Methods

Twenty-three healthy participants performed a fatigue task before and after 30 minutes of passive spinal tissue deformation in flexion. Right and left erector spinae activity was recorded using large-arrays surface electromyography (EMG). To characterize muscle activity distribution, dispersion was used. During the fatigue task, EMG amplitude root mean square (RMS), median frequency and dispersion in x- and y-axis were compared before and after spinal creep.

Results

Important fatigue-related changes in EMG median frequency were observed during muscle fatigue. Median frequency values showed a significant main creep effect, with lower median frequency values on the left side under the creep condition (p≤0.0001). A significant main creep effect on RMS values was also observed as RMS values were higher after creep deformation on the right side (p = 0.014); a similar tendency, although not significant, was observed on the left side (p = 0.06). A significant creep effects for x-axis dispersion values was observed, with higher dispersion values following the deformation protocol on the left side (p≤0.001). Regarding y-axis dispersion values, a significant creep x fatigue interaction effect was observed on the left side (p = 0.016); a similar tendency, although not significant, was observed on the right side (p = 0.08).

Conclusion

Combined muscle fatigue and creep deformation of spinal tissues led to changes in muscle activity amplitude, frequency domain and distribution.

Stress and law enforcers: testing the relationship between law enforcement work stressors and health-related issues

This study examines the relationship between law enforcement work-related stressors and health issues. Specifically, this study attempts to determine the effects of stress-producing factors (e.g. vigorous activities at work, shift change, perceived danger associated with police work, etc.) on physiological health-related issues (e.g. the number of reported health issues, high blood pressure, back pain, and headaches) and psychosocial behavior problems (e.g. alcohol consumption and cigarette smoking) among police officers. The analyses are based on a total 1632 law enforcement officers, who represent 51 police agencies in the three major cities, New York City, Dallas Texas, and Minneapolis, USA. The research findings that emerged from this study show that the number of days in vigorous activities and perceived physiological demands have the strongest influence on the number of health-related issues. Working without a partner and frequent shift changes had the strongest influence on alcohol consumption by police officers.

Prevalence of low back pain and associated risk factors amongst adult patients presenting to a Nigerian family practice clinic, a hospital-based study

Background

Low back pain (LBP) is a common health problem with concomitant disability which has assumed a public health importance in our setting.

Objectives

The aim of this study was to determine the prevalence of LBP and associated risk factors amongst adult patients attending the General Outpatients’ Clinic of the University College Hospital in Ibadan, Nigeria.

Method

This was a cross-sectional study of 485 respondents. A semi-structured questionnaire was used to obtain information on socio-demography, lifestyle, occupation and other risk factors associated with LBP.

Results

There were 288 (59.4%) female and 197 (40.6%) male respondents. The point prevalence of LBP was 46.8%. Occupational activities, previous back injury and tobacco smoking were significant associated factors for the total population. For the female respondents, logistic regression analysis showed that a waist circumference of 88 cm or more, dysmenorrhea, previous back injury and being engaged in an occupation were the most significant factors associated with LBP. However, previous back injury was the most significant factor associated with LBP for the male respondents.

Conclusion

The prevalence of LBP amongst adult patients in our setting is high, with preventable and treatable predisposing factors. Public health efforts should be directed at educating people on occupational activities and lifestyle habits.

Back pain among health care workers in a Saudi Aramco facility: prevalence and associated factors

The objective of this study was to identify risk factors for back pain among health care workers of Saudi Aramco. A validated questionnaire was used to collect information on back pain in the last 12 months as well as relevant risk factors among health care workers at a single Saudi Aramco health care facility. Completed responses were received from 964 of 3,295 workers. Three significant predictors for the presence of back pain were identified: female gender (odds ratio [OR] = 1.9, 95% confidence interval [CI] = 1.3-2.7), Saudi nationality (OR = 2.3, 95% CI = 1.4-3.9), and working as a surgeon (OR = 5.4, 95% CI = 1.4-21.5). Educational level was of borderline significance (OR = 1.6, 95% CI = 0.98-2.7). An interaction between gender and race was identified, with Saudi females being at particularly high risk of reporting back pain (OR = 3.9, 95% CI = 1.8-8.5). Gender, occupation, and nationality were identified as risk factors for back pain, and a particularly high risk was seen among female Saudis health care workers in Saudi Aramco. Nationality may be important because of cultural difference between groups, but also because of differences in benefits available.

Development and validation of a job exposure matrix for physical risk factors in low back pain

OBJECTIVES

The aim was to construct and validate a gender-specific job exposure matrix (JEM) for physical exposures to be used in epidemiological studies of low back pain (LBP).

MATERIALS AND METHODS

We utilized two large Finnish population surveys, one to construct the JEM and another to test matrix validity. The exposure axis of the matrix included exposures relevant to LBP (heavy physical work, heavy lifting, awkward trunk posture and whole body vibration) and exposures that increase the biomechanical load on the low back (arm elevation) or those that in combination with other known risk factors could be related to LBP (kneeling or squatting). Job titles with similar work tasks and exposures were grouped. Exposure information was based on face-to-face interviews. Validity of the matrix was explored by comparing the JEM (group-based) binary measures with individual-based measures. The predictive validity of the matrix against LBP was evaluated by comparing the associations of the group-based (JEM) exposures with those of individual-based exposures.

RESULTS

The matrix includes 348 job titles, representing 81% of all Finnish job titles in the early 2000s. The specificity of the constructed matrix was good, especially in women. The validity measured with kappa-statistic ranged from good to poor, being fair for most exposures. In men, all group-based (JEM) exposures were statistically significantly associated with one-month prevalence of LBP. In women, four out of six group-based exposures showed an association with LBP.

CONCLUSIONS

The gender-specific JEM for physical exposures showed relatively high specificity without compromising sensitivity. The matrix can therefore be considered as a valid instrument for exposure assessment in large-scale epidemiological studies, when more precise but more labour-intensive methods are not feasible. Although the matrix was based on Finnish data we foresee that it could be applicable, with some modifications, in other countries with a similar level of technology.

Low back pain among personal care workers in an old age home: work-related and individual factors

This cross-sectional study explored the work-related and individual factors that contributed to the occurrence of low back pain and affected activities of 36 personal care workers at an old age home in Hong Kong. The study was divided into four parts: (1) a questionnaire documenting workload exposure factors; (2) a musculoskeletal symptoms survey documenting the prevalence of low back pain in this group of workers; (3) a worksite evaluation focusing on personal care workers' work postures and the work environment; and (4) an evaluation of physical fitness and lifting capacities of personal care workers. Univariate followed by multiple logistic regression analyses were used to identify the risk factors associated with low back pain that affected work activities. The results revealed that low back pain was associated with the perceived physical demands of cleaning tasks (odds ratio [OR] = 7.28, 95% confidence interval [CI] = 1.35-39.35, p < .05), perceived demands of awkward sustained back (OR = 4.46, CI = 0.86-22.97, p = .074) and neck (OR = 0.18, CI = 0.04-0.81, p < .05) postures, and thermal stress at work (OR = 49.80, CI = 0.70-3541.79, p = .072). The results of the current study indicated that the work environment contributed to low back pain at work. Workers perceived that exertion in workplaces has a role in assessing workplace risk. To avoid progression of low back pain in the workplace, work adjustment or modification should be considered when workers report high levels of perceived exertion at work.

Low Back Pain among Personal Care Workers in an Old Age Home

This cross-sectional study explored the work-related and individual factors that contributed to the occurrence of low back pain and affected activities of 36 personal care workers at an old age home in Hong Kong. The study was divided into four parts: (1) a questionnaire documenting workload exposure factors; (2) a musculoskeletal symptoms survey documenting the prevalence of low back pain in this group of workers; (3) a worksite evaluation focusing on personal care workers' work postures and the work environment; and (4) an evaluation of physical fitness and lifting capacities of personal care workers. Univariate followed by multiple logistic regression analyses were used to identify the risk factors associated with low back pain that affected work activities. The results revealed that low back pain was associated with the perceived physical demands of cleaning tasks (odds ratio [OR] = 7.28, 95% confidence interval [CI] = 1.35–39.35, p < .05), perceived demands of awkward sustained back (OR = 4.46, CI = 0.86–22.97, p = .074) and neck (OR = 0.18, CI = 0.04–0.81, p < .05) postures, and thermal stress at work (OR = 49.80, CI = 0.70–3541.79, p = .072). The results of the current study indicated that the work environment contributed to low back pain at work. Workers perceived that exertion in workplaces has a role in assessing workplace risk. To avoid progression of low back pain in the workplace, work adjustment or modification should be considered when workers report high levels of perceived exertion at work.

Work-relatedness of selected chronic medical conditions and workers' compensation utilization: National health interview survey occupational health supplement data

BACKGROUND

An occupational health supplement (OHS) to the 1988 National Health Interview Survey (NHIS) bypassed many limitations of traditional occupational health surveillance systems, but the data collected about chronic work-related conditions have not yet been reported.

METHODS

We calculated the prevalence and proportion of cases related to work for the aggregation of 13 chronic conditions included in the NHIS-OHS, and for 11 conditions individually. For each of nine conditions, and for the aggregation of all conditions, we also calculated the prevalence of workers' compensation claims filed.

RESULTS

The overall prevalence of work-related chronic conditions was 7.5% (SE = 0.16). The work-related conditions with the highest prevalence were repeated trouble with the back/neck/spine (4.91%; SE = 0.13) and trouble hearing (1.14%; SE = 0.06). Overall, workers' compensation claims were filed for 39.0% (SE = 1.00) of work-related cases.

CONCLUSIONS

The burden of work-related illnesses in the US is substantial, and the workers' compensation system is underutilized.

Working conditions and musculoskeletal pain among Brazilian pottery workers

In the municipality of Pedreira in São Paulo State, Brazil, a large number of workers from the ceramic industry have left their jobs because of work related musculoskeletal disorders. The objectives of this study were to describe the work conditions pertaining to the ceramic industry, to determine the prevalence of musculoskeletal pain and to identify the associations between symptoms and organizational, biomechanical, psychosocial and individual variables. Nine ceramic manufacturers participated. The activities of 18 individuals were analyzed through direct observation. All workers answered a questionnaire about work and health (n = 235). The results found that the general working conditions in the pottery manufacturers were poor. A 38.5% prevalence of musculoskeletal pain was found. Repetition, tool use, lack of control over decisions, worries regarding work demands, relationship issues, work dissatisfaction and the wish to move on to another function were all associated with pain. We concluded that musculoskeletal pain is one of the outcomes of elevated human requirements resulting from working conditions and organization in the ceramic industry.

Health against the odds: experiences of employees in elder care from a gender perspective

Women-dominated elder care in Sweden is a low-paid, low-status job with a high prevalence of sick leave. Our aim was to analyze health experiences of employees in elder care from a gender perspective. All caregiving staff at two establishments providing care to the elderly were invited to participate in the study. A moderator led seven focus group discussions. Qualitative content analysis was used to analyze the transcribed focus groups. We identified two central themes in relation to the employees' health. "Working against the odds" describes gendered workplace stressors of a structural character, to a large extent triggered by societal processes outside the organization. "Making work matter" refers to gendered health resources with a relational character, constructed within the organization. Health-promoting programs directed toward women-dominated workplaces need to include a gender perspective, and focus on creating structural, supportive environments to avoid the negative health effects of the stressors.

Characterization of women's occupational musculoskeletal exposures

Although women are often characterized as having "safe" occupations, they are at risk of experiencing occupational musculoskeletal injuries. This cross-sectional study examined the health status, occupations, and job tasks of a random sample of working women (N = 123) to characterize their risk of occupational injury. The women had been employed, most full-time, in the 12 months prior to administration of the telephone survey. The women tended to cluster into two types of occupational exposures. Overall, the women rated their health as excellent. However, those with diagnosed musculoskeletal disorders had significantly worse scores on two scales of the Short Form Health Survey than those without musculoskeletal disorders. Women are exposed to occupational musculoskeletal stressors that increase their risk of experiencing musculoskeletal injuries.

Relationship between unemployment and health among health care professionals: health selection or health effect?

OBJECTIVE

The aim of this longitudinal study was to examine (a) the causal effect of unemployment 1990-1997 on health 1998-2001 (in-patient periods) and (b) the selection effect of health 1996-1999 on unemployment 2000-2002. We examined the effects of different diagnoses, namely, all causes, circulatory diseases, diseases of the digestive system, musculoskeletal diseases, and mental disorders.

METHODS

The data from the Central Register of Health Care Professionals of persons born 1945-1970 were linked to data from employment statistics and Finnish Hospital Discharge Register including 78,195 women and 12,455 men aged 31 to 56 in 2001. The associations were analyzed with logistic regression analyses and expressed as odds ratios (OR) and their 95% confidence intervals (CI).

RESULTS

After adjustments, existence of unemployment periods was associated with lower odds for in-patient periods due to musculoskeletal diseases for both women (OR=0.82, 95% CI=0.76-0.89) and men (OR=0.74, 95% CI=0.60-0.89). Unemployment periods were more likely among women (OR=1.65, 95% CI=1.33-2.04) and men (OR=2.54, 95% CI=1.44-4.48) having had in-patient periods due to mental diseases and among women also due to diseases of the digestive system (OR=1.17, 95% CI=1.04-1.31).

CONCLUSION

The present study found evidence for selection to unemployment according to mental diseases and diseases of the digestive system among health care professionals. In addition, our results show that unemployment periods may protect health care workers from musculoskeletal diseases.

Prevalence of and risk factors for different measures of low back pain among female nursing aides in Taiwanese nursing homes

Background

Although low back pain (LBP) among nursing staff, especially in nursing aides (NAs), has been a major health problem around the world, there is limited information on its prevalence in Taiwan. In addition, various measurements have been used to determine LBP; understanding the risk factors for each measurement of LBP is essential for prevention. This study aimed to assess the prevalence of and risk factors for different measures of LBP among NAs in Taiwan.

Methods

A cross-sectional study was conducted among 244 female NAs from 31 nursing homes in central Taiwan. A self-administered questionnaire, including the Nordic questionnaire and the Karasek's job content questionnaire, was used to collect data regarding five different measures of LBP and about demographic, physical and psychosocial factors. Also, on-site observation at the workplace was conducted to measure the frequency of five high risk patient-handling tasks.

Results

Based on the subjects' reports on the previous twelve months, the prevalence rates for pain lasting for at least one day, seeking of medical care, intense pain, sick leave, and chronic pain were 66.0%, 43.9%, 38.1%, 10.7%, and 8.6%, respectively. While multiple logistic regression analyses indicated that the risk factors varied with different measures of LBP, at least one high risk patient-handling task and one psychosocial factor were observed to be associated each LBP related measure. Three risk factors, including manual transfer of patients between bed/wheelchair and bath cart, perceived physical exertion, and psychological demands, were consistently associated with different measures of LBP. Besides, age was found to be associated with an increased risk of only chronic pain.

Conclusion

The prevalence of LBP among NAs in Taiwan is high and should be actively addressed. Certain manual patient-transfer tasks and psychological demands seemed to play more important roles in severe LBP (such as care seeking, intense pain, and sick leave) than in minor LBP (pain lasting for at least one day). Because different LBP related measures might be involved with different etiological risk factors, any LBP reduction interventions that aim to improve ergonomic and psychosocial work environments for NAs should take this information into consideration.

Study of the prevalence and risk factors for low back pain in truck drivers in the state of São Paulo, Brazil

OBJECTIVE

To investigate the prevalence of low back pain in truck drivers and check for possible risk factors related to the presence of low back pain.

METHODS

A questionnaire was developed including personal factors such as age, practice of physical and sports activities, general health habits, occupation-related issues, and factors associated with low back pain. The body mass index (ratio of body weight to the square of height, kg/m2) was calculated. Of 489 male truck drivers assessed, 410 were enrolled into the study. The statistical analysis was divided into 2 stages: descriptive analysis of data, and binary logistical regression, where the response (dependent) variable (presence of low back pain) was associated with each independent variable to check for correlation with low back pain.

RESULTS

Of the 410 truck drivers evaluated, 242 (59%) presented with low back pain, while 168 (41%) did not have low back pain. The only factor correlated with the presence of low back pain was the number of working hours; the other factors had no correlation with low back pain.

CONCLUSION

The prevalence of low back pain in truck drivers was 59%. The number of working hours was the only variable associated with occurrence of low back pain, with an average of about 1 hour longer work time for drivers with low back pain compared to those without it and with an odds ratio of 1.07 (P = 0.026).

Severe back pain among farmworker high school students from Starr County, Texas: baseline results

PURPOSE

This cohort study is among the first to estimate the prevalence of and examine potential risk factors for severe back pain (resulting in medical care, 4+ hours of time lost, or pain lasting 1+ weeks) among adolescent farmworkers. These youth often perform tasks requiring bent/stooped postures and heavy lifting.

METHODS

Of 2536 students who participated (response rate across the three public high schools, 61.2% to 83.9%), 410 students were farmworkers (largely Hispanic and migrant). Students completed a self-administered Web-based survey including farm work/nonfarm work and back-pain items relating to a 9-month period.

RESULTS

The prevalence of severe back pain was 15.7% among farmworkers and 12.4% among nonworkers. The prevalence increased to 19.1% among farm workers (n = 131) who also did nonfarm work. A multiple logistic regression for farmworkers showed that significantly increased adjusted odds ratios for severe back pain were female sex (4.59); prior accident/back injury (9.04); feeling tense, stressed, or anxious sometimes/often (4.11); lifting/carrying heavy objects not at work (2.98); current tobacco use (2.79); 6+ years involved in migrant farm work (5.02); working with/around knives (3.87); and working on corn crops (3.40).

CONCLUSIONS

Areas for further research include ergonomic exposure assessments and examining the effects of doing farm work and nonfarm work simultaneously.

Why Do Women Have Back Pain More Than Men?

OBJECTIVES

In comparison with men, women have a healthier lifestyle, are more rarely overweight, have less stressful occupations, or are not employed outside the home. The "gender pain bias" is the fact that women nevertheless have a higher prevalence of back pain. This paper looks at the possible underlying reasons for this as yet unexplained gender difference, using Stokols' socioecological health model as a basis.

METHODS

The first National Health Survey for the Federal Republic of Germany was carried out from October 1997 to March 1999. It comprised a representative total sample of 5315 persons between the ages of 20 and 64. The participants took part in a medical examination and answered a self-report form. chi test and logistic regression analyses were used to investigate correlations between self-reported low back pain and gender-specific biopsychobehavioral and sociophysical environmental factors.

RESULTS

Seven-day back pain prevalence in the Federal Republic of Germany is 32% for men and 40% for women. Prevalences are significantly higher for overweight subjects, persons with a marked somatization tendency or a low level of social support, physically inactive individuals, smokers, elderly subjects, the nonemployed, "blue collar workers" and lower socioeconomic groups. From a multivariate perspective, however, none of these factors reduces (and hence sufficiently explains) the gender difference. Factoring in the gender-specific somatization tendency reduces the odds ratios of women versus men from 1.42 to 1.23.

DISCUSSION

In view of the gender difference in pain prevalence, which remains stable despite a multivariate perspective, there is clearly a need for more research into the reasons underlying the gender difference. We believe that future studies should look at rarely investigated constructs such as "sex role expectancies," "anxiety," "ethnicity," and "family history" and take anatomic differences in muscle strength into account.

Occupations associated with a high risk of self-reported back pain: representative outcomes of a back pain prevalence study in the Federal Republic of Germany

Given the increasing medical and economic implications of back pain, occupation-specific prevalence data may provide important pointers for preventive programmes targeted at promoting preventive behaviour and improving conditions. The National German Health Survey is the first study to provide the basis for a representative nationwide analysis of back pain prevalence by occupational category. The net sample comprises a total of 3,488 earners aged 18-69. One in three earners in the Federal Republic of Germany (34%) experienced back pain during the 7 days prior to being interviewed. The 1-year prevalence rate is 60%. Occupational categories associated with a lower-than-average back pain prevalence are highly qualified professionals, senior management, and production occupations associated with a comparatively low degree of manual labour. In contrast, an above-average prevalence was identified for occupations associated with physically strenuous work involving one-sided postures, moving, carrying and holding heavy weights, and work typically performed in poor conditions or bad weather. Our data demonstrates significant inter-occupational differences in terms of self-reported back pain. The results underline the importance of measures to promote preventive behaviour and improve the working conditions of those in low-skill manual labour occupations.

Prevalence of and risk factors for low back pain among staffs in schools for physically and mentally handicapped children

The objective of this study is to clarify the prevalence of and risk factors for low back pain (LBP) in schools for physically and mentally handicapped children. This study design is a cross-sectional study. The subjects included were 1,869 staff members from 19 prefectural schools for children in Shizuoka Prefecture, Japan, which included schools for the blind, deaf-mutes, physically handicapped, and mentally retarded children. A total of 975 subjects completed two postal questionnaires which included morbidity, demographic factors, nursing activity, and psychosocial factors. The answer rate was 52%. The one-month prevalence of LBP was 45%. According to the classification of nursing activity, assistance in movement 1.67 (95% CI 1.27-2.14), excretory function 1.45 (1.11-1.88), and feeding 1.44 (1.10-1.90) showed significant increases in the odds ratio. The adjusted odds ratio significantly increased by 2.35 (1.78-3.11) in the group with depression symptoms as well as in the group with job stressors such as quantitative, qualitative, and physical work loads, job control, utilization of technique, interpersonal conflicts, and degree of satisfaction with their work/home life.

Workplace stress, lifestyle and social factors as correlates of back pain: a representative study of the German working population

OBJECTIVES

To investigate the prevalence of back pain in the German working population and the relationship between back pain and workplace stresses, lifestyle and social factors.

METHODS

The first National Health Survey of the Federal Republic of Germany was carried out between October 1997 and March 1999. It comprised a representative epidemiological cross-sectional study of the working population, with a total sample of 3,488 persons between the ages of 18 and 69 years. The participants took part in a medical examination and answered a self-rating questionnaire. The relationship between subjective back pain and workplace stresses and social and lifestyle factors was investigated with bivariate tests and multiple logistical regression analyses.

RESULTS

The 7-day prevalence for back pain in the German working population was found to be 34%, and the 1-year prevalence was 60%. The odds ratios were significantly higher in women, persons of lower socioeconomic status, married and depressed persons and non-athletes. Carrying heavy loads or maintaining a single working posture were the most significant work-related correlates of back pain, for members of both the female and male working population, while environmental stress and psychological stress correlated significantly with back pain in men only.

CONCLUSIONS

This study reports the first representative epidemiological prevalence data for back pain, and its correlates and potential risk factors, for the German working population. To reduce the negative impact of back pain the most promising behavioural and conditional prevention measures in the workplace would be to reduce carrying stress and to vary working posture. In addition, a more active, athletic lifestyle, plus the avoidance of being overweight, should provide an additional protective or preventive effect.

Sick leave among home-care personnel: a longitudinal study of risk factors

BACKGROUND

Sick leave due to neck, shoulder and back disorders (NSBD) is higher among health-care workers, especially nursing aides/assistant nurses, compared with employees in other occupations. More information is needed about predictors of sick leave among health care workers. The aim of the study was to assess whether self-reported factors related to health, work and leisure time could predict: 1) future certified sick leave due to any cause, in nursing aides/assistant nurses (Study group I) and 2) future self-reported sick leave due to NSBD in nursing aides/assistant nurses (Study group II).

METHODS

Study group I, comprised 443 female nursing aides/assistant nurses, not on sick leave at baseline when a questionnaire was completed. Data on certified sick leave were collected after 18 months. Study group II comprised 274 of the women, who at baseline reported no sick leave during the preceding year due to NSBD and who participated at the 18 month follow-up. Data on sick leave due to NSBD were collected from the questionnaire at 18 months. The associations between future sick leave and factors related to health, work and leisure time were tested by logistic regression analyses.

RESULTS

Health-related factors such as previous low back disorders (OR: 1.89; 95% CI 1.20-2.97) and previous sick leave (OR 6.40; 95%CI 3.97-10.31), were associated with a higher risk of future sick leave due to any cause. Factors related to health, work and leisure time, i.e. previous low back disorders (OR: 4.45; 95% CI 1.27-15.77) previous sick leave, not due to NSBD (OR 3.30; 95%CI 1.33-8.17), high strain work (OR 2.34; 95%CI 1.05-5.23) and high perceived physical exertion in domestic work (OR 2.56; 95%CI 1.12-5.86) were associated with a higher risk of future sick leave due to NSBD. In the final analyses, previous low back disorders and previous sick leave remained significant in both study groups.

CONCLUSION

The results suggest a focus on previous low back disorders and previous sick leave for the design of early prevention programmes aiming at reducing future sick leave due to any cause, as well as due to NSBD, among nursing aides/assistant nurses. A multifactorial approach may be of importance in the early prevention of sick leave due to NSBD.

Work-related musculoskeletal problems among women workers in the semiconductor industry in Peninsular Malaysia

A cross-sectional study to identify the prevalence of musculoskeletal problems and work-related risk factors was conducted among 906 women semiconductor workers. Highest prevalences were pain in the lower limbs, neck/shoulders, and upper back, and highest exposures were prolonged (> or = four hours per workshift) hand/wrist movement, standing, and lifting with hands. After logistic regression, lower-limb pain was significantly associated with standing, neck/shoulder pain with sitting and lifting, upper-back pain with climbing steps, low back pain with hand/wrist movement, and hand/wrist pain with lifting. Neck/shoulder pain was significantly higher for workers with shorter working durations, while lower-limb pain was significantly higher for workers with longer working durations. End-of-line assembly workers had significantly higher odds ratios for pain at all sites, while middle-of-line workers had higher odds ratios for pain in neck/shoulders and upper back, and wafer-fabrication workers had higher odds ratios for pain in low back and lower limbs.