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

Predictors of musculoskeletal disorders among special education teachers in Sabah, Malaysia

Special education teachers encounter considerable occupational challenges, yet there is limited information concerning musculoskeletal disorders (MSD) within this group. Therefore, this study aimed to address this gap by determining the prevalence of MSD, investigating associated factors of MSD, and identifying predictors of MSD among special education teachers. A cross-sectional study was conducted among special education teachers in Kota Kinabalu and Penampang, Sabah. Data were collected through self-administered questionnaires and musculoskeletal fitness assessments. Chi-square tests and independent t-tests were utilized to determine factors associated with MSD, while multiple logistic regression was performed to develop a comprehensive predictive model for MSD, which was then validated and tested for model fitness. A total of 122 individuals participated in the study, yielding a response rate of 95 %. The findings revealed a high prevalence of MSD (77.9 %) among special education teachers, with the lower back, shoulder, neck, knee, upper back, and foot being the most affected regions. The multivariable regression model identified several predictors of MSD, including marital status (adjusted odds ratio [aOR] = 4.78, 95 % confidence interval [CI] = 1.49-15.40), body fat percentage (aOR = 1.06, 95 % CI = 1.00-1.12), teaching in prolonged standing for few days a week (aOR = 3.20, 95 % CI = 0.99-10.29) or every day (aOR = 6.20, 95 % CI = 1.44-26.70), mindfulness (aOR = 0.47, 95 % CI = 0.22-0.98), and back extensor strength (aOR = 5.86, 95 % CI = 1.92-17.92). This study highlights the necessity of implementing interventions focusing on the ergonomic, psychological, and musculoskeletal fitness components to mitigate the prevalence of MSD and improve the overall well-being of special education teachers.

A systematic review and meta-analysis of low back pain and its associated factors among school teachers in Africa

INTRODUCTION

Low back pain (LBP) is a key social, economic, and public health problem in the world. The impact of LBP is given less priority and is empirically unrepresented in low- and middle-income countries as a result of the focus on more pressing and life-threatening health issues, including infectious diseases. In Africa, the prevalence of LBP is irregular and increasing among schoolteachers on account of teaching activities performed under suboptimal working conditions. Therefore, the objective of this review was to estimate the pooled prevalence and associated factors of LBP among school teachers in Africa.

METHODS

This systematic review and meta-analysis was designed based on the PRISMA guidelines. A comprehensive systematic literature search focused on LBP in African school teachers was conducted using the PubMed/MEDLINE, CINAHL, and CABI databases, regardless of publication timelines, from October 20 to December 3, 2022. In addition, gray literature was searched using Google Scholar and Google Search. Data were extracted in Microsoft Excel by using the JBI data extraction checklist. The overall effect of LBP was estimated using a random effect model via DerSimonian-Laird weights. The pooled prevalence and odds ratio of associated factors with 95% CI were computed using STATA 14/SE software. The I² test and Egger's regression test were used to assess heterogeneity and publication bias, respectively.

RESULTS

A total of 585 articles were retrieved, and 11 eligible studies involving a total of 5,805 school teachers were included in this systematic review and meta-analysis. The overall estimated pooled prevalence of LBP in African school teachers was found to be 59.0% (95% CI: 52.0%-65.0%). Being female [POR: 1.53; 95% CI (1.19, 1.98)], being older [POR: 1.58; 95% CI (1.04, 2.40)], being physically inactive [POR: 1.92; 95% CI (1.04, 3.52)], having sleep problems [POR: 2.03; 95% CI (1.19, 3.44)] and having a history of injury [POR: 1.92; 95% CI (1.67, 2.21)] were factors significantly associated with LBP.

CONCLUSIONS

The pooled prevalence of LBP was high among school teachers in Africa compared to developed nations. Sex (female), older age, physical inactivity, sleep problems, and a history of previous injury were predictors of LBP. It is suggested that policymakers and administrators ought to gain awareness of LBP and its risk factors to put existing LBP preventive and control measures into action. Prophylactic management and therapeutic strategies for people with LBP should also be endorsed.

Factors Associated with Musculoskeletal Disorders among Regular and Special Education Teachers: A Narrative Review

Musculoskeletal disorder (MSD) is a major health problem, which can lead to an enormous burden to the institution as well as chronic disability to the individual. Teachers are at risk of developing MSD due to the exposure to various ergonomic risk factors. Teachers of special education, for example, are expected to perform extra duty such as lifting and moving students, feeding food, changing diapers, and helping them in ambulation. Although there is an adequate amount of scientific research on MSD's prevalence and its risk factors among regular teachers, only few studies have focused on special education teachers. This review aimed to address these gaps by describing the evidence from various papers on the prevalence of MSD among regular and special education teachers and the related risk factors. The papers have been gathered using electronic databases, including PubMed, Science Direct, Google Scholar, and Springer. The prevalence of MSD among regular teachers ranges from 48.7% to 73.7%, while the prevalence ranges from 38.7% to 94% in special education teachers. Risk factors, such as individual (age, duration of teaching, working hours, and work burden), physical (teaching activities, affected body areas), and psychological factors (stress, anxiety, fear), were identified. From the review, it is recommended to implement ergonomically designed workplaces, comprehensive ergonomic training, psychological approaches, and functional training among teachers at risk.

Relationship between psychosocial factors and objective physical function in special needs school staff members suffering from low back pain

Physical function impairment in patients with low back pain (LBP) occurs due to the influence of psychosocial factors. Only a few studies have objectively evaluated physical function. We aimed to objectively assess the physical functions of individuals subjects with LBP, and clarify the association between physical function and psychosocial factors. We enrolled 411 individuals with LBP working in special needs schools. We examined their degree of pain, and the psychosocial factors strength through the STarT Back Tool, which categorized them into the low-risk, medium-risk, and high-risk groups. We assessed their abdominal muscle endurance, lower limb muscle strength, and hip joint flexibility. The relationships between these physical functions and psychosocial factors were analyzed by logistic regression models. Those in the high-risk group had significantly lower abdominal muscle and lower limb muscle strength (p<0.001). After adjusting for confounding factors, the odds ratios of the high-risk compared to the low-risk group for low abdominal muscle endurance, lower limb muscle strength, and restricted right and left Straight Leg Raising were 5.47, 3.14, 2.65, and 3.12, respectively (95% CIs: 2.35-12.74, 1.43-6.89, 1.08-6.55, and 1.20-8.11, respectively). Therefore, the low physical function observed in the high-risk group was associated with their psychosocial factors.

Electromyographic activity of the neck muscles: Effects of varying standing height-derived teaching board heights

BACKGROUND

Despite the increasing emergence of modern facilities, the ancient practice of writing on a teaching board is still common in the teaching profession. Ergonomic guidelines of this practice are required for the prevention of work-related neck musculoskeletal disorders inherent of teachers.

OBJECTIVE

This study investigated the effects of varying teaching board heights on the activities of the neck muscles.

METHODS

Thirty participants (15 males and 15 females) participated in this experimental study. Each performed writing tasks on a teaching board set at five different heights derived from their standing height (SH) [(D 10 = SH minus 10% of SH; Norm H = SH; Sum 10 = SH plus 10% of SH; Sum 20 = SH plus 20% of SH; Sum 25 = SH plus 25% of SH)]. Electromyographic (EMG) activities of both components of the sternocleidomastoid and upper trapezius muscles were measured during each task. Asymmetry ratio of right and left muscle components were determined. Data were analyzed with one-way ANOVA.

RESULTS

EMG activities of the four muscles as well as their asymmetry ratios significantly (p< 0.01) increased with increasing board heights.

CONCLUSION

Teaching board-related tasks have increased possibilities of inducing neck disorders when performed beyond Norm H vertical heights.

Prevalence and associated occupational factors of low back pain among the bank employees in Dhaka City

OBJECTIVE

Low back pain (LBP) is one of the common health problems among full-time office employees that causes absenteeism from work. The aim of the study is to identify the association between occupational factors and LBP among full-time bank employees in Dhaka City.

MATERIALS AND METHODS

We conducted a cross-sectional study involving 593 full-time bank employees who were engaged in sedentary works. The 1-month complaint of LBP was measured using a subscale of subjective health complaints inventory. Multivariable logistic models were performed to identify variables related to LBP, and a random forest technique was performed to determine the top five important variables.

RESULTS

The 1-month prevalence for LBP was found to be 36.6% among the bank employees, and the prevalence was the highest (64.3%) for the 51- to 59-year-old age group. The regression analysis indicates that respondents from both agegroups, 41-50 years (OR = 2.00, 95% confidence interval [CI] = 1.10-3.69) and 51-59 years age groups (OR = 5.14, 95% CI = 2.05-13.64), are significantly associated with LBP. Furthermore, obesity (OR = 2.06, 95% CI = 1.01-4.21), and prolong working hours (>9 hours) (OR = 1.42, 95% CI = 1.01-2.0) are positively associated with LBP. The top five important variables for LBP identified by random forest technique are: age, length of employment, prolong office hours, presence of chronic illness, and physical activity.

CONCLUSION

LBP is highly prevalent in full-time bank employees. The occupational factors, including the length of employment (>10 years) and long working hours, play a significant role in developing LBP among bank employees. Moreover, several factors, including age, chronic illness, obesity, and physical activity, should be taken into account in the prevention of LBP in bank employees.

Survey on chronic disabling low back pain among care workers at nursing care facilities: a multicenter collaborative cross-sectional study

Purpose: Care workers at nursing care facilities have a high rate of low back pain (LBP). Although increasing evidence has revealed the important role of psychosocial factors in chronic LBP, factors associated with chronic LBP interfering with work have not been fully investigated in Japanese workers at nursing care facilities. The present study aimed to determine the prevalence of chronic LBP interfering with work and related factors of chronic LBP including psychosocial factors, among workers at nursing care facilities.

Material and methods: Eligible participants in the present study were Japanese workers at 95 nursing care facilities in Ishikawa Prefecture (n=2,242). Of these, 1,345 participants completed a self-administered questionnaire that included the following items: individual characteristics, severity of LBP, sleep problem, fear-avoidance beliefs (Tampa Scale for Kinesiophobia: TSK), STarT Back Screening Tool (SBST), fatigue, somatizing tendency, and work-related stress such as job satisfaction, job demand, interpersonal stress at work, and social support. The logistic regression analysis was used to assess factors associated with chronic disabling LBP.

Results: Of participants who completed the questionnaires, 159 (11.8%) reported chronic LBP that interfered with their work. The multivariable analysis of related-factors of chronic disabling LBP found statistically significant associations with the following: high score of psychological subscale in SBST (adjusted odds ratio [aOR]: 5.83, 95% confidence interval [CI]: 3.55–9.59), high score of TSK (aOR: 1.08, 95% CI: 1.05–1.13), and high somatizing tendency (aOR: 2.07, 95% CI: 1.31–3.23).

Conclusion: Psychological factors, including fear-avoidance beliefs or somatizing tendency, showed significant association with chronic LBP that interfered with work, among workers at nursing care facilities. Our results suggest that these factors would need to be considered in addition to screening for the risk factors of LBP chronicity by SBST when evaluating workers with chronic disabling LBP.

Prognostic psychosocial factors for disabling low back pain in Japanese hospital workers

Background

Although the occupational health field has identified psychosocial factors as risk factors for low back pain that causes disability, the association between disabling low back pain and psychosocial factors has not been examined adequately in Japanese hospital workers. Therefore, this study examined the association between low back pain, which interfered with work, and psychosocial factors in Japanese hospital workers.

Method

This cross-sectional study was conducted at a hospital in Japan. In total, 280 hospital workers were recruited from various occupational settings. Of these, 203 completed a self-administered questionnaire that included items concerning individual characteristics, severity of low back pain, fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire), somatic symptoms (Somatic Symptom Scale-8), psychological distress (K6), workaholism, and work-related psychosocial factors (response rate: 72.5%). Logistic regression was used to explore risk factors associated with disabling low back pain.

Results

Of the 203 participants who completed questionnaires, 36 (17.7%) reported low back pain that interfered with their work. Multivariate analyses with individual factors and occupations adjusted for showed statistically significant associations between disabling low back pain and fear-avoidance beliefs (adjusted odds ratio [OR]: 2.619, 95% confidence interval [CI]: 1.003–6.538], somatic symptoms (OR: 4.034, 95% CI: 1.819–9.337), and interpersonal stress at work (OR: 2.619, 95% CI: 1.067–6.224).

Conclusions

Psychosocial factors, such as fear-avoidance beliefs, somatic symptoms, and interpersonal relationships at work, were important risk factors in low back pain that interfered with work in Japanese hospital workers. With respect to occupational health, consideration of psychosocial factors is required to reduce disability related to low back pain.

Effect of occupational health nursing practice on musculoskeletal pains among hospital nursing staff in South Korea

OBJECTIVE

The purpose of this study was to identify whether occupational health nursing variables serve as the contributing factors to musculoskeletal pains (MSP).

METHODS

A self-administered questionnaire composed of demographic characteristics, the practice of occupational health nursing and information regarding MSP was designed based on in-depth interviews with eight nurses. This study included 226 hospital nursing staff who worked at three university hospitals located in Seoul, South Korea. Statistical analysis was performed by using SPSS and AMOS 19.0.

RESULTS

Shoulder and neck pains occurred when subjects worked more than 46 h/week. Subjects who performed 'work-time adjustment' had lesser chance of having shoulder, leg/foot and wrist/finger pains. Overtime work hours showed an indirect effect on multiple sites of MSP by mediator variable, which was 'work-time adjustment'. Organized night duty days eventually decreased multiple sites of MSP.

CONCLUSION

Administration strategies for nurses to adjust work-time within 46 h/week should be considered.

Occupational back pain among schoolteachers in Jordan: estimated prevalence and factors associated with self-reported pain and work limitations

PURPOSE

To investigate the point prevalence of upper back pain and lower back pain in Jordanian schoolteachers and to estimate the work-related reported disability.

METHOD

A cross-sectional survey was used to assess back pain in a convenience sample of teachers in Jordan. Crude and weighted prevalence estimates of self-reported spinal pain and limited productivity were described. Demographic and occupational factors associated with self-reported pain and limited productivity were identified by multinomial/logistic regression.

RESULTS

Crude rates differed by gender, geographic location, school funding and grade levels of teaching. Weighted estimates for self-reported pain were 46% for females and 36% for males. Pain with limitation was 55% for males and 49% for females. Pain without limitation was associated with female gender (odds ratio [OR] = 5.26). Pain with limitations was associated with female gender (OR = 2.92), teaching in public school (OR = 2.06) and body mass index (OR = 1.1). Among subjects with pain, limitations were associated with male gender (OR = 2.34), teaching in public school (OR = 3.18) and pain in both upper and lower back (OR = 4.64).

CONCLUSIONS

Pain and occupational limitations are highly prevalent in schoolteachers in Jordan.

Work-related musculoskeletal disorders and ergonomic risk factors in special education teachers and teacher's aides

Background

Work-related musculoskeletal disorders (WMSDs) have become increasingly common among health-related professionals. Special education personnel who serve students with disabilities often experience physical strains; however, WMSDs have been overlooked in this population. The objectives of this study were to investigate the work-related ergonomics-associated factors in this population and to evaluate their correlation with the WMSDs prevalence.

Methods

A questionnaire with three domains, namely demographics, prevalence of work-related musculoskeletal disorders, and ergonomic factors, designed by our research team was delivered to educators who work in special education schools.

Results

Approximately 86 % of the 388 special education school teachers and teacher’s aides in this study experienced musculoskeletal disorders. The lower back, shoulder, and wrist were the three most affected regions. A logistic regression analysis revealed that the participants’ background factors, namely >5.5 years of experience (odds ratio [OR] = 4.090, 95 % CI: 1.350-12.390), students with multiple disorders (OR = 2.412, 95 % CI: 1.100-5.287), and other work-related ergonomic factors (assistance in diaper changing and others duties), were strongly associated with the prevalence of WMSD. Nap habit (OR = 0.442, 95 % CI: 0.230-0.851) and having teaching partners in the same class (OR = 0.486, 95 % CI: 0.250-0.945) resulted in low possibility of acquiring WMSDs. The use of supportive devices was associated with a low WMSD prevalence.

Conclusions

The present study revealed an association between WMSDs and specific job features among teachers and teacher’s aides in special education schools. Future efforts should emphasize examining safe student-handling ergonomics, formulating policies regarding student-teacher ratio, incorporating mandatory break times at the workplaces, and promoting personal health for preventing work-related injuries.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-2777-7) contains supplementary material, which is available to authorized users.

How can the health situation and well-being of staff at German schools for the severely handicapped be improved?

PURPOSE

The aim of the study was to describe measures suggested by staff at German schools for the severely handicapped regarding possibilities to improve their health situation and well-being at work. We further wanted to analyze whether sociodemographic, occupation-related, and health-related characteristics influence the type of measures proposed.

METHODS

The cross-sectional study was carried out between August 2010 and August 2012 at 13 schools for the handicapped focusing on motoric and/or holistic development of severely handicapped pupils. Data of teachers and educational staff were surveyed using written questionnaires. The analysis is based on free-text answers regarding the question: "What specific occupation-related measures would lead to an improvement of your well-being or health situation at the workplace?"

RESULTS

A total of 395 persons (response proportion: 59.7 %) with a mean age of 45 years and predominantly female (86.8 %) participated in our survey. A total of 205 persons answered the study question providing 456 improvement suggestions, which were classified into 6 main and 13 subcategories. The main categories were professional education and supervision, organization of working tasks and time, work safety and work equipment, social aspects of work, human resources and contractual framework, and other. Measures proposed were influenced by gender, burden by nursing activities, teaching, and administrative tasks, and frequency of deterioration in working atmosphere.

DISCUSSION

Proposed measures raise awareness for job-related health stressors and are a starting point to improve working conditions at these schools. Since suggestions vary widely by school and composition of staff, individual priorities have to be set and discussed with the school management.

Occupational injuries of teachers and educational staff at special schools with multiple and severely handicapped children in Rhineland-Palatinate (Germany): results of a cross-sectional study

OBJECTIVES

The present study aimed to describe the prevalence, type, and influencing factors of occupational injuries of staff working at special schools with multiple and severely handicapped pupils in Southwestern Germany.

METHODS

This cross-sectional study was carried out between August 2010 and August 2012 at 13 special schools with focus on motoric and/or holistic development of handicapped pupils in Rhineland-Palatinate (Germany). Participants were interviewed using a written questionnaire.

RESULTS

There were 395 participants (response proportion: 59.7%) in our study, with 390 being eligible for statistical analysis. Respondents were on average 45 years old and mainly female (86.9%). The 12-month injury prevalence was 16.9%. Joint dislocations, sprains, and torn ligaments (41.6%) were the main types of injuries. Pupils (59.8%) and auxiliary equipment (12.2%) were identified as the main causes of injury by the respondents. Multivariable logistic regression analysis showed that washing pupils (using auxiliary equipment) (aOR, 3.93; 95% CI, 1.66-9.31) and daily physical strain due to unexpected conduct of pupils (aOR, 3.70; 95% CI, 1.20-11.37) were the main influencing factors for an occupational injury.

CONCLUSIONS

Almost one in five persons suffered an occupational injury in the previous 12 months. Nursing activities, including close contact with pupils, were identified as the most important factors for an injury. In order to prevent injuries at special schools, a multifaceted approach is necessary. This includes sufficient supply of auxiliary devices including proper technical maintenance. Furthermore, regular participation in training for manual handling of heavy loads and schooling on the technical use of auxiliary devices should be encouraged.

Assessment of psychosocial risk factors for the development of non-specific chronic disabling low back pain in Japanese workers-findings from the Japan Epidemiological Research of Occupation-related Back Pain (JOB) study

To investigate the associations between psychosocial factors and the development of chronic disabling low back pain (LBP) in Japanese workers. A 1 yr prospective cohort of the Japan Epidemiological Research of Occupation-related Back Pain (JOB) study was used. The participants were office workers, nurses, sales/marketing personnel, and manufacturing engineers. Self-administered questionnaires were distributed twice: at baseline and 1 yr after baseline. The outcome of interest was the development of chronic disabling LBP during the 1 yr follow-up period. Incidence was calculated for the participants who experienced disabling LBP during the month prior to baseline. Logistic regression was used to assess risk factors for chronic disabling LBP. Of 5,310 participants responding at baseline (response rate: 86.5%), 3,811 completed the questionnaire at follow-up. Among 171 eligible participants who experienced disabling back pain during the month prior to baseline, 29 (17.0%) developed chronic disabling LBP during the follow-up period. Multivariate logistic regression analysis implied reward to work (not feeling rewarded, OR: 3.62, 95%CI: 1.17-11.19), anxiety (anxious, OR: 2.89, 95%CI: 0.97-8.57), and daily-life satisfaction (not satisfied, ORs: 4.14, 95%CI: 1.18-14.58) were significant. Psychosocial factors are key to the development of chronic disabling LBP in Japanese workers. Psychosocial interventions may reduce the impact of LBP in the workplace.

Potential risk factors of persistent low back pain developing from mild low back pain in urban Japanese workers

Study Design

Two-year, prospective cohort data from the Japan epidemiological research of occupation-related back pain study in urban settings were used for this analysis.

Objective

To examine the association between aggravated low back pain and psychosocial factors among Japanese workers with mild low back pain.

Summary of Background Data

Although psychosocial factors are strongly indicated as yellow flags of low back pain (LBP) leading to disability, the association between aggravated LBP and psychosocial factors has not been well assessed in Japanese workers.

Methods

At baseline, 5,310 participants responded to a self-administered questionnaire including questions about individual characteristics, ergonomic work demands, and work-related psychosocial factors (response rate: 86.5%), with 3,811 respondents completing the 1-year follow-up questionnaire. The target outcome was aggravation of mild LBP into persistent LBP during the follow-up period. Incidence was calculated for the participants with mild LBP during the past year at baseline. Logistic regression was used to explore risk factors associated with persistent LBP.

Results

Of 1,675 participants who had mild LBP during the preceding year, 43 (2.6%) developed persistent LBP during the follow-up year. Multivariate analyses adjusted for individual factors and an ergonomic factor found statistically significant or almost significant associations of the following psychosocial factors with persistent LBP: interpersonal stress at work [adjusted odds ratio (OR): 1.96 and 95% confidence interval (95%CI): 1.00–3.82], job satisfaction (OR: 2.34, 95%CI: 1.21–4.54), depression (OR: 1.92, 95%CI: 1.00–3.69), somatic symptoms (OR: 2.78, 95%CI: 1.44–5.40), support from supervisors (OR: 2.01, 95%CI: 1.05–3.85), previous sick-leave due to LBP (OR: 1.94, 95%CI: 0.98–3.86) and family history of LBP with disability (OR: 1.98, 95%CI: 1.04–3.78).

Conclusions

Psychosocial factors are important risk factors for persistent LBP in urban Japanese workers. It may be necessary to take psychosocial factors into account, along with physical work demands, to reduce LBP related disability.

Prevalence and influencing factors of chronic back pain among staff at special schools with multiple and severely handicapped children in Germany: results of a cross-sectional study

Background

In Germany, about 70,000 teachers and educational staff were teaching at more than 3,000 special schools during the school year 2010/2011. Nursing services like lifting pupils form a substantial part of the work content of the staff at special schools. Since nursing care often involves carrying and lifting pupils, there is a reason to assume an adverse effect on the musculoskeletal health of teachers and other professionals. With the present study we aimed to describe the prevalence and risk factors of chronic back pain among employees at this type of school.

Methods

The cross-sectional survey was carried out between August 2010 and August 2012 at 13 special schools focusing on motoric and/or holistic development of handicapped children in Rhineland-Palatinate (Germany). Teachers and educational staff were interviewed using a questionnaire. We applied multivariable logistic regression analyses to identify influencing factors of chronic back pain.

Results

Altogether 395 persons (response rate: 59.7%) participated in our study. Respondents were mostly female (86.8%) with a mean age of 45 years. The prevalence of chronic back pain was 38.7%. More than 40% reported frequently carrying and lifting heavy loads (>20 kg). Age [adjusted OR = 1.03 (95%-CI 1.00-1.05) for 1-year increase in age], current smoking [adjusted OR = 2.31 (95%-CI 1.27-4.23)], depression/depressive mood [adjusted OR = 1.85 (95%-CI 1.12-3.06)], frequently carrying and lifting heavy loads [adjusted OR = 2.69 (95%-CI 1.53-4.75)], and frequent exposure to environmental impacts [adjusted OR = 2.18 (95%-CI 1.26-3.76)] were influencing factors of chronic back pain in the final multivariable regression model.

Conclusions

A large proportion of teachers and educational staff suffered from chronic back pain in our study, indicating a high need for treatment in this professional group. Increasing age, current smoking, a diagnosed depression/depressive mood, carrying and lifting heavy loads, and exposure to environmental impacts were associated with chronic back pain. Due to the sparse literature on the topic, further studies using a longitudinal design are necessary for a better understanding of the risk factors of chronic back pain.

Identification of risk factors for new-onset sciatica in Japanese workers: findings from the Japan epidemiological research of Occupation-related Back pain study

STUDY DESIGN

Two-year, prospective cohort data collected for the Japan epidemiological research of Occupation-related Back pain study were used for the analysis.

OBJECTIVE

To identify potential risk factors for the development of new-onset sciatica in initially symptom-free Japanese workers with no history of sciatica.

SUMMARY OF BACKGROUND DATA

Although the associations between individual and occupational factors and cases of new-onset sciatica are established, the effect of psychosocial factors on the development of sciatica has still not been adequately clarified.

METHODS

In total, 5310 participants responded to a self-administered baseline questionnaire (response rate: 86.5%). Furthermore, 3194 (60.2%) completed both 1- and 2-year follow-up questionnaires. The baseline questionnaire assessed individual characteristics, ergonomic work demands, and work-related psychosocial factors. The outcome of interest was new-onset sciatica with or without low back pain during the 2-year follow-up period. Incidence was calculated for participants who reported no low back pain in the preceding year and no history of lumbar radicular pain (sciatica) at baseline. Logistical regression assessed risk factors associated with new-onset sciatica.

RESULTS

Of 765 eligible participants, 141 (18.4%) reported a new episode of sciatica during the 2-year follow-up. In crude analysis, significant associations were found between new-onset sciatica and age and obesity. In adjusted analysis, significant associations were found for obesity and mental workload in a qualitative aspect after controlling for age and sex. Consequently, in multivariate analysis with all the potential risk factors, age and obesity remained statistically significant (odds ratios: 1.59, 95% confidence interval: 1.01-2.52; odds ratios: 1.77, 95% confidence interval: 1.17-2.68, respectively).

CONCLUSION

In previously asymptomatic Japanese workers, the risk of developing new-onset sciatica is mediated by individual factors. Our findings suggest that the management of obesity may prevent new-onset sciatica.

LEVEL OF EVIDENCE

3.

Work-related musculoskeletal disorders and ergonomic risk factors in early intervention educators

BACKGROUND

Early intervention educators who serve children with special needs often suffer from physical strains. The objectives of this study were to investigate the prevalence of work-related musculoskeletal disorders in this population, and to evaluate the relationship between work-related musculoskeletal disorders and personal/ergonomic risk factors.

METHODS

A self-designed questionnaire consisting three domains (demographics/prevalence of work-related musculoskeletal disorders/ergonomic risk factors) was delivered to educators who work in early intervention institutions.

RESULTS

Ninety-four percent of early intervention educators suffered from musculoskeletal disorders. Logistic regression revealed that some work-related ergonomic factors were highly associated with symptoms on lower back, shoulder and neck, with odds ratios ranging from 0.321 to 4.256.

CONCLUSION

High prevalence of work-related musculoskeletal disorders impacts this occupation negatively. Further regulations to the institutions regarding workplace health promotion and environment modification, as well as training to the employees for body mechanics, should be implemented to prevent injury occurrence.

Potential risk factors for new onset of back pain disability in Japanese workers: findings from the Japan epidemiological research of occupation-related back pain study

STUDY DESIGN

Two-year, prospective cohort data from the Japan epidemiological research of occupation-related back pain study were used for this analysis.

OBJECTIVE

To examine the association between a new onset of low back pain (LBP) with disability and potential risk factors among initially symptom-free Japanese workers.

SUMMARY OF BACKGROUND DATA

Despite strong evidence that psychosocial issues may influence LBP onset among symptom-free persons, these and other LBP risk factors have not been well investigated in the Japanese workplace.

METHODS

Of 5310 participants responding to a self-administered baseline questionnaire (response rate: 86.5%), 3194 (60.2%) completed both 1- and 2-year follow-up questionnaires. The baseline questionnaire assessed individual characteristics, ergonomic work demands, and work-related psychosocial factors. The outcome of interest was new-onset LBP with disability during the follow-up period. Incidence was calculated for the participants who reported no LBP during the past year at baseline. Logistic regression was used to explore risk factors associated with new-onset LBP with disability.

RESULTS

Of 836 participants who were symptom-free during the preceding year, 33 (3.9%) reported LBP with disability during the 2-year follow-up. In univariate analyses, "history of LBP," "frequent lifting," "interpersonal stress at workplace," and "monotonous tasks" were all significant predictors of LBP incidence. All of these factors remained statistically significant or almost significant in the multivariate analysis adjusting for the other variables as well as age and sex: adjusted odds ratio (OR) and 95% confidence interval (95% CI) for history of LBP (OR: 3.25, 95% CI: 1.53-6.91), frequent lifting (OR: 3.77, 95% CI: 1.16-12.3), interpersonal stress at workplace (OR: 2.42, 95% CI: 1.08-5.43), and monotonous tasks (OR: 2.21, 95% CI: 0.99-4.94).

CONCLUSION

Both ergonomic and work-related psychosocial factors may predict the development of LBP with disability among previously asymptomatic Japanese workers. Thus, workplace interventions aimed at reducing the incidence of LBP should focus on both ergonomic and psychosocial stress.

A systematic review of musculoskeletal disorders among school teachers

BACKGROUND

Musculoskeletal disorders (MSD) represent one of the most common and most expensive occupational health problems in both developed and developing countries. School teachers represent an occupational group among which there appears to be a high prevalence of MSD. Given that causes of MSD have been described as multi-factorial and prevalence rates vary between body sites and location of study, the objective of this systematic review was to investigate the prevalence and risk factors for MSD among teaching staff.

METHODS

The study involved an extensive search of MEDLINE and EMBASE databases in 2011. All studies which reported on the prevalence and/or risk factors for MSD in the teaching profession were initially selected for inclusion. Reference lists of articles identified in the original search were then examined for additional publications. Of the 80 articles initially located, a final group of 33 met the inclusion criteria and were examined in detail.

RESULTS

This review suggests that the prevalence of self-reported MSD among school teachers ranges between 39% and 95%. The most prevalent body sites appear to be the back, neck and upper limbs. Nursery school teachers appear to be more likely to report suffering from low back pain. Factors such as gender, age, length of employment and awkward posture have been associated with higher MSD prevalence rates.

CONCLUSION

Overall, this study suggests that school teachers are at a high risk of MSD. Further research, preferably longitudinal, is required to more thoroughly investigate the issue of MSD among teachers, with a greater emphasis on the possible wider use of ergonomic principles. This would represent a major step forward in the prevention of MSD among teachers, especially if easy to implement control measures could be recommended.

Development of a risk score for low back pain in office workers--a cross-sectional study

Background

Low back pain (LBP) is common among office workers and is the most common cause of work-related disability in people under 45 years of age. The aetiology of LBP is widely accepted to be multi-factorial. Prognostic research into office workers at risk of developing LBP has received limited attention. The aims of this study were to develop a risk score to identify office workers likely to have LBP and to evaluate its predictive power.

Methods

397 office workers filled out a self-administered questionnaire and underwent physical examination. The questionnaire gathered data on individual, work-related physical and psychosocial data as well as the presence of low back pain in the previous 4 weeks. The physical examination included measurement of body weight, height, waist circumference, hamstrings length, spinal scoliosis, spinal curve, Backache Index and lumbar stability. Logistic regression was used to select significant factors associated with LBP to build a risk score. The coefficients from the logistic regression model were transformed into the components of a risk score.

Results

The model included six items: previous history of working as an office worker, years of work experience, continuous standing for >2 hrs/d, frequency of forward bending during work day, chair having lumbar support and Backache Index outcome. The risk score for LBP in office workers (The Back pain Risk score for Office Workers: The BROW) was built with a risk score ranging from 0 to 9. A cut-off score of ≥4 had a sensitivity of 80% and a specificity of 58%. The positive predictive value and negative predictive values were 70% each.

Conclusions

The BROW is easy and quick to administer. It appears to have reasonable sensitivity, specificity, positive predictive value and negative predictive values for the cut-off point of ≥4. The BROW is a promising tool for use to identify office workers in need of early interventions. Further prospective study is needed to validate the predictive performance of the BROW.

Causal assessment of workplace manual handling or assisting patients and low back pain: results of a systematic review

BACKGROUND CONTEXT

Low back pain (LBP) is a common musculoskeletal disorder associated with a considerable social and economic burden within the working-age population. Despite an unclear etiology, numerous physical activities are suspected of leading to LBP. Declaring a causal relationship between occupational activities and LBP remains challenging and requires a methodologically rigorous approach.

PURPOSE

To conduct a systematic review focused on assessing the potentially causal relationship between workplace manual handling or assisting patients and LBP.

STUDY DESIGN

Systematic review of the literature.

SAMPLES

Studies reporting an association between workplace manual handling or assisting patients and LBP.

OUTCOME MEASURES

Numerical association between different levels of exposure to manual handling or assisting patients, and the presence or severity of LBP.

METHODS

A systematic review was conducted using Medline, EMBASE, CINAHL, Cochrane Library, and Occupational Safety and Health database, gray literature, hand-searching occupational health journals, reference lists of included studies, and content experts. The methodological quality of each study was assessed using a modified Newcastle-Ottawa Scale (NOS) for observational studies. The overall level of evidence supporting various Bradford-Hill criteria for causality for each category of manual handling or assisting patients and type of LBP was then evaluated. Studies were deemed of higher quality if they received a score of five or more on the modified NOS and used appropriate statistical analysis methods.

RESULTS

This search yielded 2,766 citations, and 32 studies met the eligibility criteria. Three high-quality studies reported on manual handling and LBP, including two prospective cohorts and one cross-sectional design. None demonstrated a significant association in most of their multivariate risk estimates. One study was able to assess dose-response and temporality, but its results did not support these criteria. Only one study discussed the biological plausibility of this association. Four high-quality studies evaluated assisting patients and LBP, including two case-controls, one cross-sectional, and one prospective cohort design. These studies were consistent in reporting no significant association. Two studies demonstrated a nonsignificant dose-response trend, and two studies discussed the biological plausibility of this association. No studies were able to demonstrate the temporality or experiment criteria.

CONCLUSIONS

The studies reviewed did not support a causal association between workplace manual handling or assisting patients and LBP in a Bradford-Hill framework. Conflicting evidence in specific subcategories of assisting patients was identified, suggesting that tasks such as assisting patients with ambulation may possibly contribute to LBP. It appears unlikely that workplace manual handling or assisting patients is independently causative of LBP in the populations of workers studied.

Menstrual disorders and their influence on low back pain among Japanese nurses

An increasing body of evidence now suggests that menstrual disorders may influence the development of Low Back Pain (LBP) among women of reproductive age. To investigate this issue in Japan, we conducted a large cross-sectional survey of female nurses from a university teaching hospital during 2008. Nurses reported a wide range of symptoms both prior to and during menstruation, including breast tenderness, stomach pain, light headedness and fatigue. Around three-quarters had experienced at least one episode of LBP in the previous 12-months, with most symptoms lasting one week or less. Increasing body weight was correlated with an increased risk of LBP affecting their daily activities (OR: 12.94, 95%CI: 1.54-116.56). Having three or more children was correlated with a reduced risk of experiencing LBP (OR: 0.13, 95%CI: 0.01-0.97). Nurses who reported breast tenderness prior to menstruation were twice as likely to suffer LBP (OR: 2.09, 95%CI: 1.20-3.73), while those who reported breast tenderness during menstruation were almost twice as likely to suffer LBP that interfered with their daily activities (OR: 1.85, 95%CI: 1.06-3.32). Overall, our study suggests that reproductive symptoms and menstrual disorders may influence the development of LBP among Japanese nurses, although the magnitude of this effect appears to be less than that reported in some previous research.

Prevalence and risk factors for low back pain among professional cooks working in school lunch services

BACKGROUND

The prevalence of self-reported low back pain among professional cooks was estimated to examine the effects of daily life conditions, job-related factors, and psychological factors on this disorder.

METHODS

Data was collected using a mailed self-administered questionnaire.

RESULTS

Of 7100 cooks, 5835 (82%) replied to the questionnaire, including 1010 men and 4825 women. The mean age was 41.4 for men and 47.5 for women. The prevalence of low back pain during a 1-month period was 72.2% among men and 74.7% among women, with no significant differences between groups. By logistic regression analyses, factors significantly associated with the prevalence of low back pain in 1 month were female gender (prevalence ratio [PR] 1.32; 95% CI, 1.03-1.68), current smoking (PR 1.57; 95% CI, 1.24-1.98), and past smoking (PR 1.35; 95% CI, 1.01-1.79). As for job-related factors, the number of cooked lunches per person (PR 1.28; 95% CI, 1.05-1.56), breaks in the morning session (PR 1.33; 95% CI, 1.13-1.56), kitchen environment (PR 1.09; 95%, CI, 1.03-1.15), and height of cooking equipment (PR 1.13; 95% CI, 1.08-1.19) were associated with the prevalence of low back pain. As for psychological factors, job satisfaction (PR 1.22; 95% CI, 1.03-1.45), stress at work (PR 1.68; 95% CI, 1.42-1.99), financial constraints (PR 1.23; 95% CI, 1.03-1.47), health-related stress (PR 1.31; 95% CI, 1.08-1.59) and worries about the future (PR 1.24; 95% CI, 1.01-1.52) were similarly associated.

CONCLUSION

Daily life conditions, job-related factors, and psychological factors are associated with the occurrence of low back pain. It is important to take comprehensive preventive measures to address a range of work and life conditions that can be improved to decrease the incidence of low back pain for professional cooks.

Job stressors and job stress among teachers engaged in nursing activity

Teachers and staff members engaged in nursing activity experience more stress than other workers. However, it is unknown whether teachers engaged in nursing activity in schools for handicapped children experience even greater stress. This study evaluated job stressors and job stress among such teachers using a cross-sectional study design. The subjects were all 1,461 teachers from all 19 prefectural schools for handicapped children in Shizuoka Prefecture, Japan. We used a brief job stress questionnaire for the survey and 831 teachers completed the questionnaire. Job stressors among teachers engaged in nursing activity were compared with those among teachers not engaged in nursing activity. Job stress among such teachers was estimated by the score for total health risk, and was compared with the score in the Japanese general population. Male and female teachers engaged in nursing activity had a significantly higher level of job stressors for physical work load and job control compared with those not engaged in nursing activity. The scores for total health risk among male and female teachers engaged in nursing activity were 102 points and 98 points, respectively. These scores were not markedly above 100 points which is the mean score in the Japanese general population.