An update of a systematic review of controlled clinical trials on the primary prevention of back pain at the workplace

OBJECTIVE: To update the evidence on the effectiveness of lumbar supports, education and exercise in the primary prevention of low back pain at the workplace. METHODS: A computerized search for controlled clinical trials published between 1997 and 2002 was conducted, and the methodological quality of the studies was assessed using a criteria list. The available evidence was graded with a rating system for the level of evidence. Effect sizes of individual studies were combined if the studies were sufficiently similar. RESULTS: Five new papers were identified for the update. These trials were added to the previously available trials (n = 11). The methodological quality of most studies was low. Since three of four RCTs on lumbar supports reported no effect, there is no evidence for the effectiveness of lumbar supports. No evidence for education could be found either, since all six RCTs showed negative results. The four RCTs on exercise consistently reported a positive effect, indicating limited evidence for the effectiveness of exercise. CONCLUSION: There is no evidence for the effectiveness of lumbar supports or education in the primary prevention of low back pain at the workplace. There is limited evidence for the efficacy of exercise, and the effect that can be obtained is moderate. There is still a need for methodologically sound studies and studies on the cost-effectiveness of exercise. Also the possible effect of lumbar supports in the treatment of back pain needs further investigation.     

A systematic review of the effectiveness of health promotion interventions in the workplace

The aim of this study was to identify and critically review evaluations of the effectiveness of health promotion programmes in the workplace. In line with guidelines for 'good practice' within the literature on workplace health promotion, this study aimed to assess the extent to which evaluated interventions considered employees' expressed needs or involved employee-employer partnerships. Overall, 110 outcome evaluations were located. Only a quarter of these reported that interventions were implemented in response to the explicit needs and/or views of the employees and very few involved partnerships. Most of the programmes targeted individual behaviour and supportive organizational change was limited. The majority of the outcome evaluations were not sufficiently rigorous to make a strong case for the effectiveness of workplace health promotion. However, some pointers to success were identified. It was concluded that there seems to be a wide disparity between what counts as 'good practice' within workplace health promotion and what is reported in the evaluation of effectiveness literature. This is not to say that 'good practice' does not exist, but that either such programmes are not rigorously evaluated for their effectiveness and/or that many of the evaluation findings remain outside the public domain.     

Low back pain among Iranian industrial workers

BACKGROUND: Most epidemiological data concerning low back pain (LBP) are from high-income countries and there is very little information about LBP in the working population in developing countries. OBJECTIVES: To determine the prevalence of LBP in Iranian industrial workers. To explore associations between LBP and physical and psychosocial factors at work, as well as lifestyle factors. METHODS: Cross-sectional study of the largest car-manufacturing group in Iran. The prevalence of LBP, work exposures and lifestyle factors were recorded using the standardized Nordic questionnaire for analysis of musculoskeletal symptoms. Demographic data and lifestyle factors (age, sex, education, weight, work experience, smoking and fitness training) were also collected. RESULTS: Of the 18,031 employees, 78% participated. The majority of subjects in this study population were young males (<30 years) and a small proportion was female (4%). The 1-year prevalence of self-reported LBP in this Iranian industrial population was 21% (20% males and 27% females). The prevalence rate of absence due to LBP was 5% per annum. The multiple logistic regression models indicated that the following remained risk indicators for LBP in the previous 12 months: increasing age, no regular exercise, heavy lifting, repetitive work and monotonous work. CONCLUSION: LPB is a common problem in the working population even in a developing country. Age and gender as well as certain work-related physical and psychosocial factors influenced the prevalence of LBP but the differences between different categories of workers were small.     

Interventions to prevent back pain and back injury in nurses: a systematic review

A systematic literature review was undertaken to assess the effectiveness of interventions that aim to prevent back pain and back injury in nurses. Ten relevant databases were searched; these were examined and reference lists checked. Two reviewers applied selection criteria, assessed methodological quality and extracted data from trials. A qualitative synthesis of evidence was undertaken and sensitivity analyses performed. Eight randomised controlled trials and eight non-randomised controlled trials met eligibility criteria. Overall, study quality was poor, with only one trial classified as high quality. There was no strong evidence regarding the efficacy of any interventions aiming to prevent back pain and injury in nurses. The review identified moderate level evidence from multiple trials that manual handling training in isolation is not effective and multidimensional interventions are effective in preventing back pain and injury in nurses. Single trials provided moderate evidence that stress management programs do not prevent back pain and limited evidence that lumbar supports are effective in preventing back injury in nurses. There is conflicting evidence regarding the efficacy of exercise interventions and the provision of manual handling equipment and training. This review highlights the need for high quality randomised controlled studies to examine the effectiveness of interventions to prevent back pain and injury in nursing populations. Implications for future research are discussed.     

Occupational health guidelines for the management of low back pain at work: evidence review

There is increasing demand for evidence-based health care. Back pain is one of the most common and difficult occupational health problems, but there has been no readily available evidence base or guidance on management. There are well-established clinical guidelines for the management of low back pain, but these provide limited guidance on the occupational aspects. Occupational Health Guidelines for the Management of Low Back Pain at Work were launched by the Faculty of Occupational Medicine in March 2000. These are the first national occupational health guidelines in the UK and, as far as we are aware, the first truly evidence-linked occupational health guidelines for back pain in the world. They were based on an extensive, systematic review of the scientific literature predominantly from occupational settings or concerning occupational outcomes. The full evidence review is on the Faculty web site (www.facoccmed.ac.uk), but an abridged version is presented here to aid its dissemination.     

Low back pain and occupation among Irish health service workers

BACKGROUND: The health services sector has been identified as a high-risk work sector for low back pain (LBP) and related absenteeism. AIMS: To establish levels and predictors of LBP prevalence and associated sick leave among health service workers. To identify if levels of LBP or related absenteeism differ between occupational groups. METHODS: A postal survey using a standardized questionnaire and disproportionate random sampling of occupational groups was conducted at a single Dublin hospital. Overall hospital LBP prevalence and sickness absence were calculated using weighted analysis methods. Univariate analysis included the use of Chi-square, Fisher's exact and Mann-Whitney tests. Multivariate logistic regression techniques were used to explore for independent predictors of lifetime LBP prevalence and LBP-related sickness absence. RESULTS: An overall response rate of 62% (n = 246) was achieved. Lifetime, annual and point prevalence rates for the hospital employees were calculated at 46, 30 and 15.5%, respectively. No significant difference in prevalence was found between occupational groups but sick leave did differ with the highest level among general support and nursing staff. Multivariate analysis confirmed that occupation was an independent predictor for LBP-related sick leave (P < 0.05). CONCLUSIONS: LBP prevalence rates did not differ significantly between occupational groups but occupation was found to be an independent predictor of LBP-related sick leave. Involvement in manual handling did not predict either LBP or related sick leave.     

Determinants of occupational disability following a low back injury: a critical review of the literature

The aim of this research was to determine prognostic indicators of work disability in occupational back pain as reported in the literature, by systematically searching the research literature, assessing the methodological quality of the research, and synthesizing the findings into a concise summary. An article was considered eligible for review if research participants had an injury of the back, the article was based on original research, published in English, and involved a cohort with back pain less than 6 months post injury with at least one follow up assessment. Each article was independently reviewed by two blinded reviewers using 19 appraisal criteria for methodological quality of prognostic studies. Nineteen studies met the methodological standard to be included. Time since onset, demographic factors, functional disability, psychological distress, pain reports, previous episodes, and work environment were identified as important prognostic factors. Most studies compartmentalized the factors they considered. What is needed is a comprehensive multivariate biopsychosocial job-related model of work disability.     

Patient–professional partnerships and chronic back pain self‐management: a qualitative systematic review and synthesis

Chronic back pain is common, and its self‐management may be a lifelong task for many patients. While health professionals can provide a service or support for pain, only patients can actually experience it. It is likely that optimum self‐management of chronic back pain may only be achieved when patients and professionals develop effective partnerships which integrate their complementary knowledge and skills. However, at present, there is no evidence to explain how such partnerships can influence patients' self‐management ability. This review aimed to explore the influence of patient–professional partnerships on patients' ability to self‐manage chronic back pain, and to identify key factors within these partnerships that may influence self‐management. A systematic review was undertaken, aiming to retrieve relevant studies using any research method. Five databases were searched for papers published between 1980 and 2014, including Cochrane Library, CINAHL, Medline, EMBASE and PsycINFO. Eligible studies were those reporting on patients being supported by professionals to self‐manage chronic back pain; patients being actively involved for self‐managing chronic back pain; and the influence of patient–professional partnerships on self‐management of chronic back pain. Included studies were critically appraised for quality, and findings were extracted and analysed thematically. A total of 738 studies were screened, producing 10 studies for inclusion, all of which happened to use qualitative methods. Seven themes were identified: communication, mutual understanding, roles of health professionals, information delivery, patients' involvement, individualised care and healthcare service. These themes were developed into a model suggesting how factors within patient–professional partnerships influence self‐management. Review findings suggest that a partnership between patients and professionals supports patients' self‐management ability, and effective communication is a fundamental factor underpinning their partnerships in care. It also calls for the development of individualised healthcare services offering self‐referral or telephone consultation to patients with chronic conditions.     

Effects of driving on low back pain

BACKGROUND: Many previous studies have demonstrated that driving a car is a risk factor for low back pain (LBP). We have frequent contact with medical representatives who often drive cars for business, and have noticed that many of them suffer from LBP. AIMS: To investigate how driving affected the occurrence of LBP in medical representatives. METHODS: Questionnaire survey of all medical representatives working in Mie Prefecture (Japan). RESULTS: A total of 551 medical representatives replied (92%). We divided the subjects into Group A (with LBP) and Group B (without LBP). There was no significant difference in mean age, height, weight or duration of continuous employment between the two groups. Mean total mileage was 342 539 km in Group A and 251 945 km in Group B (P < 0.05). There was no significant difference in estimated daily mileage or estimated daily driving time between the two groups. As for backrest inclination, most of the respondents in Group A chose 105 degrees and the majority in Group B chose 120 degrees (P < 0.001). CONCLUSION: The total mileage was significantly higher in Group A than in Group B. We considered that the risk for LBP increased as the lumbar spine load accumulated day by day while driving a car almost every day without a holiday.     

Smoking, heavy physical work and low back pain: a four-year prospective study.

Data from a community-based four-year prospective study were used to test the hypothesis that heavy physical work is a stronger predictor of low back pain in smokers than in non-smokers. Of 708 working responders without low back pain during the entire year prior to 1990, 562 (79%) completed a questionnaire four years later in 1994. A job involving heavy lifting and much standing in 1990 was a strong predictor of low back pain in smokers four years later [odds ratio (OR) = 5.53, 95% confidence interval (CI) = 1.93-15.84, p < 0.01) after having adjusted for other job characteristics, demographic factors, emotional symptoms, physical exercise and musculoskeletal pain elsewhere. In non-smokers, having a job with heavy lifting and much standing was not associated with low back pain. One explanation may be that smoking leads to reduced perfusion and malnutrition of tissues in or around the spine and causes these tissues to respond inefficiently to mechanical stress.     

Occupational risk factors for shoulder pain: a systematic review

OBJECTIVES—To systematically evaluate the available evidence on occupational risk factors of shoulder pain.
METHODS—Relevant reports were identified by a systematic search of Medline, Embase, Psychlit, Cinahl, and Current Contents. The quality of the methods of all selected publications was assessed by two independent reviewers using a standardised checklist. Details were extracted on the study population, exposures (physical load and psychosocial work environment), and results for the association between exposure variables and shoulder pain.
RESULTS—29 Studies were included in the review; three case-control studies and 26 cross sectional designs. The median method score was 60% of the maximum attainable score. Potential risk factors related to physical load and included heavy work load, awkward postures, repetitive movements, vibration, and duration of employment. Consistent findings were found for repetitive movements, vibration, and duration of employment (odds ratio (OR) 1.4-46 in studies with method scores  60%). Nearly all studies that assessed psychosocial risk factors reported at least one positive association with shoulder pain, but the results were not consistent across studies for either high psychological demands, poor control at work, poor social support, or job dissatisfaction. Studies with a method score 60% reported ORs between 1.3 and 4.0. Substantial heterogeneity across studies for methods used for exposure assessment and data analysis impeded statistical pooling of results.
CONCLUSIONS—It seems likely that shoulder pain is the result of many factors, including physical load and the psychosocial work environment. The available evidence was not consistent across studies, however, and the associations were generally not strong. Future longitudinal research should evaluate the relative importance of each individual risk factor and the role of potential confounding variables—such as exposure during leisure time—to set priorities for the prevention of shoulder pain in occupational settings.


Keywords: systematic review; shoulder pain; risk factors     

Prevalence of low back pain among staff in a rural hospital in Nigeria

A cross-sectional study was carried out in a rural hospital in south-western Nigeria to determine the prevalence of low back pain among its staff. The questionnaire administered to staff sought information on social and demographic characteristics, job history, smoking status, frequency and severity of low back pain and factors predisposing to low back pain. Seventy-four out of a total of 80 workers participated in the study. The prevalence of low back pain among staff was 46%. The highest prevalence of back pain (69%) was recorded among nursing staff, followed by secretaries/administrative staff (55%) and cleaners/aides (47%). Heavy physical work (45%), poor posture (20%) and prolonged standing or sitting (20%) were the most frequent activities reported to be associated with low back pain among these workers. The prevalence of low back pain among these workers is comparable to that of workers in high income countries. Health education on posture and correct lifting techniques can be introduced to reduce the burden of low back pain among these workers.     

Evaluation of a functional restoration programme in chronic low back pain

BACKGROUND: Persistent low back pain is a major health and socio-economic problem in the UK. Evidence-based guidelines have been produced to inform management strategies for this significant health issue. This study reports the outcome of a tertiary intervention functional restoration programme (FRP) in manual workers of a water utility company, consistent with UK guidelines. OBJECTIVES: To evaluate whether a FRP could achieve a sustainable improvement in back health, a sustainable return to full duties and a cost reduction. METHOD: Participants were assessed at start, end, 12 and 24 months post-programme. RESULTS: Eighty-nine employees completed the FRP; 78 returned to normal duties, nine to restricted duties and two left the employer shortly after. Overall, there were significant improvements in psychological status, perceived pain, disability and work capability. Improvements were sustained for 24 months. Sickness absence and the need for post-treatment work restrictions decreased. Reductions in ill-health retirements and compensation claims for low back pain were reduced. CONCLUSION: The findings support the effectiveness of a tertiary intervention FRP for workers with persistent low back pain.     

Psychological and occupational predictive factors for back pain among employees of a university hospital in southern Spain

OBJECTIVES: To identify the individual and occupational factors that are predictors for low back pain among the employees of a university hospital in southern Spain. METHODS: A transverse study was conducted in which the population used was the hospital employees who volunteered to participate. The information was obtained by using a questionnaire, which included demographic and anthropometric variables, habits, characteristics of the work done, and of any pain experienced. The mental health condition of subjects was measured using the GHQ-28, using a score of > or = 6 as the cut-off point. To study the variables associated with pain, crude odds ratios (ORs) were calculated (+/- 95% CI) and adjusted according to a logistic regression model. RESULTS: One thousand one hundred and four subjects participated in the study but only 890 of these completed the questionnaire in full (rate of response, 35.7% of total employees). The population studied was notable for the high proportion of women, for subjects > 41 years of age, and subjects who undertook little or no physical exercise. In addition, according to the GHQ-28 test, 29.9% of the total were 'probable psychiatric cases'. The crude ORs were high in all the occupational categories in comparison with the doctors, with the exception of the maintenance, cleaning, and catering group. They were also higher among women, among subjects with poor mental health, and among women with one or more children. The adjusted ORs showed that having a GHQ-28 score of > or = 6, and belonging to the auxiliary technician category, were independent risk factors for suffering low back pain. Being older than 41 years and in temporary employment were protective variables. CONCLUSIONS: The presence of probable mental illness is the variable most strongly associated with the presence of low back pain in the population studied. Its diagnostic confirmation and appropriate treatment could contribute to reducing the prevalence of vertebral pains in this occupational group.     

Formal education and back pain: a review

OBJECTIVES: To summarise the scientific evidence on the relation between educational status and measures of the frequency and the consequences of back pain and of the outcomes of interventions among back pain patients, and to outline possible mechanisms that could explain such an association if found. DESIGN: Sixty four articles published between 1966 and 2000 that documented the association of formal education with back pain were reviewed. MAIN RESULTS: Overall, the current available evidence points indirectly to a stronger association of low education with longer duration and/or higher recurrence of back pain than to an association with onset. The many reports of an association of low education with adverse consequences of back pain also suggest that the course of a back pain episode is less favourable among persons with low educational attainment. Mechanisms that could explain these associations include variations in behavioural and environmental risk factors by educational status, differences in occupational factors, compromised "health stock" among people with low education, differences in access to and utilisation of health services, and adaptation to stress. Although lower education was not associated with the outcomes of interventions in major studies, it is difficult, in light of the current limited available evidence, to draw firm conclusions on this association. CONCLUSION: Scientific evidence supports the hypothesis that less well educated people are more likely to be affected by disabling back pain. Further study of this association may help advance our understanding of back pain as well as understanding of the relation between socioeconomic status and disease as a general phenomenon.     

Occupational factors associated with low back pain in urban taxi drivers

BACKGROUND: Urban taxi drivers differ from other professional drivers in their exposures to physical and psychosocial hazards in the work environment. Epidemiological data on low back pain (LBP) of this occupational group are very scarce. AIMS: To examine LBP in taxi drivers and its association with prolonged driving and other occupational factors. METHODS: We analyzed the cross-sectional data from the Taxi Drivers' Health Study. Standardized instruments were used to collect information on personal factors, work-related physical and psychosocial factors and driving time profiles. LBP prevalence was assessed using the modified Nordic Musculoskeletal Questionnaire. Multiple logistic regression models were employed for statistical analyses. RESULTS: Of 1242 drivers, 51% reported LBP in the past 12 months, significantly (P < 0.001) higher than other professional drivers (33%) in Taiwan. After adjusting for the effects of demographic characteristics, lifestyle factors, anthropometric measures and socioeconomic positions, we found that driving time >4 h/day [prevalence odds ratio (POR) 1.78; 95% CI 1.02-3.10], frequent bending/twisting activities while driving (adjusted OR 1.86; 95% CI 1.15-2.99), self-perceived job stress (POR 1.75; 95% CI 1.20-2.55), job dissatisfaction (POR 1.44; 95% CI 1.05-1.98) and registration type were the major occupational factors significantly associated with higher LBP prevalence in taxi drivers. CONCLUSIONS: We have identified that long driving time and several physical and psychosocial factors are associated with high prevalence of LBP in taxi drivers. This should be further investigated in prospective studies. Future studies are needed to examine the potential adverse effects of prolonged exposure to low levels of whole-body vibration.     

Risk factors for first-ever low back pain among workers in their first employment

BACKGROUND: Low back pain has been estimated to be the most costly ailment of people of working age. Both work characteristics and individual factors have been identified as risk factors. The first interaction between work characteristics and individual factors occurs when workers start in their first job. AIMS: To investigate work-related risk factors for first-ever low back pain in young workers in their first employment. METHODS: A cross-sectional analysis was performed on 278 young workers in their first employment and without a history of low back pain prior to working. Work-related physical factors, psychosocial work characteristics, individual variables and first-ever low back pain were queried by means of a questionnaire. RESULTS: About half of the workers who developed low back pain after job start did so in the first year of employment. An increased risk was observed for (i) long periods of seated work [relative risk (RR) = 3.2, 95% confidence interval (CI) = 1.6-6.4]; (ii) more than 12 flexion or rotation movements of the trunk per hour (RR = 3.0, 95%CI = 1.4-6.4); and (iii) more than 3 years seniority in a job involving lifting more than 25 kg at least once an hour (RR = 3.7, 95%CI = 1.4-9.4). As to psychosocial work characteristics, first-ever low back pain was associated with a combination of low psychological job demands and low supervisor support. CONCLUSION: Work-related physical factors and psychosocial work characteristics should be considered as risk factors for first-ever low back pain. First-ever episodes of low back pain are common in the first year of employment. This may reflect a lack of work experience or training.     

Low back pain and risk factors among Taxi drivers in Turkey: a cross-sectional study

Background: Taxi drivers have an increased risk of low back pain due to both physical and occupational conditions. This study aims to determine the prevalence of low back pain and occupational risk factors among taxi drivers working in Izmir, Turkey. Methods: This study was conducted with 447 taxi drivers at randomly selected taxi stands between April and September 2021. The questionnaire included demographic, individual, and work-related questions; the Nordic Musculoskeletal Questionnaire; and the Back Pain Functional Scale (BPFS). Results: The prevalence of low back pain in the last year was 49.7%. In multivariate logistic regression analyses, the risk factors for low back pain included having a body mass index of25-29.9 kg/m² (OR= 1.67, 95% CI 1.01-2.76) or >30 kg/m² (OR= 2.15, 95% CI 1.19-3.87), no physical activity (OR= 1.66, 95% CI1.06-2.62), years of work >10 (OR= 3.23, 95% CI1.89-5.53), no weekly rest period (OR= 3.11, 95% CI 1.42-6.81), having no lumbar support on the driver''s seat (OR=1.67, 95% CI 1.05-2.66), or undecisive job satisfaction (OR= 2.07, 95% CI 1.17-3.66). Being undecided about job satisfaction (OR= 2.34, 95% CI 1.15-4.92) and not having physical activity (OR= 2.10 CI 1.08-4.08) were found to be risk factors for reduced BPFS scores. Conclusion: A strong correlation was found between the frequency of low back pain and the BPFS score and occupational factors. Early detection and management of low back pain are critical to avoid increased low back pain and related injuries among taxi drivers.