Occupational low back pain: Recovery curves and factors associated with disability

Review of the literature shows significant variation in the rates of recovery from an episode of low back pain (LBP). Two hundred and seven workers filing a “First Report of Injury” form with the Vermont Department of Labor and Industry were contacted 3 months post-injury to determine time until first return-to-work, work status, lost workdays, and factors such as pain intensity and satisfaction with health care. Overall, 69.4% of the workers had first returned to work within 1 week, 85.9% within 1 month, and 93.7% by 3 months. Three months post-injury, 8.7% of these workers were not working (disabled) due to their LBP. On a scale of 0–10, the disabled reported substantially more pain in the past few days (p=.0001) and a higher level of “worst pain since injury” (p=.004). Those disabled were less likely to feel they had received the right treatment for their LBP (p=.05). Researchers and clinicians need a clear understanding of recovery curves to assess the effectiveness of any interventions.     

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.     

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.     

Exposure of Paris taxi drivers to automobile air pollutants within their vehicles

OBJECTIVES—To study the exposure of Parisian taxi drivers to automobile air pollutants during their professional activity.
METHODS—A cross sectional study was carried out from 27 January to 27 March 1997, with measurements performed in the vehicles of 29 randomly selected drivers. Carbon monoxide (CO) content was measured over an 8 hour period by a CO portable monitor. The fine suspended particles were measured according to the black smoke index (BS), with a flow controlled portable pump provided with a cellulose filter. The nitrogen oxides, NO and NO₂ were measured with a passive sampler.
RESULTS—These drivers are exposed during their professional activity to relatively high concentrations of pollutants (mean, median (SD) 3.8, 2 (1.7) ppm for CO, 168, 164 (53) µg/m³ for BS, 625, 598 (224) µg/m³ for NO, and 139, 131 (43) µg/m³ for NO₂.) For CO the concentrations were clearly lower than the threshold values recommended by the World Health Organisation. The situation is less satisfactory for the other pollutants, especially for the BS index. All concentrations of pollutants recorded were noticeably higher than concentrations in air recorded by the ambient Parisian air monitoring network and were close to, or slightly exceeded, the concentrations measured at the fixed stations close to automobile traffic. Pollutant concentrations were also influenced greatly by weather conditions.
CONCLUSION—This first French study conducted in taxi drivers shows that they are highly exposed to automobile pollutants. The results would justify a medical follow up of this occupational group.


Keywords: taxi drivers; exposure assessment     

Factors associated with HIV testing among male motorbike taxi drivers in urban Vietnam

Using the Attitude-Skills-Knowledge (ASK) model, this study examined the prevalence of, and factors associated with, human immunodeficiency virus (HIV) testing among male motorbike taxi drivers (MMTDs). In a cross-sectional design, using quantitative approaches, 291 MMTDs were recruited from 135 sites across 13 districts in Hanoi, Vietnam, for a face-to-face interview. Applying the ASK model modified as a central theory, logistic regression was used to identify determinants of HIV testing. Although many MMTDs engaged in multiple risk behaviours for HIV, only 20.6% had been tested for HIV during the past 12 months. The tested model included one factor of the ASK model, HIV prevention knowledge (adjusted odds ratio [AOR] = 4.76; 95% confidence interval [CI] = 2.12–10.7) and five additional factors: being married (AOR = 3.13; 95% CI = 1.25–4.78), preferring sex with men or with both men and women (AOR = 8.72; 95% CI = 1.48–51.5), having lower number of lifetime sex partners (AOR = 0.66; 95% CI = 0.49–0.88), higher number of past year sex partners (AOR = 2.97: 95% CI = 1.21–7.31) and discussing condom use when having sex with partners (AOR = 0.08; 95% CI = 0.01–7.31). This modified ASK model provided better fit than the ASK model, as it explained more variance in HIV testing (47 vs. 29.8%). Recognising factors associated with HIV testing among MMTDs enables us to create suitable public health intervention strategies.     

Occupational risk factors for low back pain among drivers of three-wheelers in Sri Lanka

Abstract

Background:

Approximately 5% of all households in Sri Lanka operate a three-wheeler as their primary source of income. However, very little is known about the occupational health risks associated with driving these vehicles.

Objectives:

The aim of this study was to assess occupational risk factors, including the number of hours worked associated with the 4-week prevalence of low back pain (LBP) among drivers of three-wheelers.

Methods:

Questionnaires were administered to 200 full-time drivers of three-wheelers from the Galle District in Sri Lanka. Occupational, psychological, socio-demographic, lifestyle, and anthropometric variables were collected. Univariate and multivariate analysis were used to investigate the correlation between occupational risk factors of the prevalence of LBP.

Results:

15·5% of respondents reported experiencing LBP in the previous 4 months. Univariate analysis revealed that the number of hours worked per week, feeling pressure to compete with other drivers, and perceived stress scale scores were significantly associated with the 4-week prevalence of LBP. Multivariate analysis found that the number of hours worked per week and engine type were significantly associated with LBP.

Conclusions:

LBP is common among drivers of three-wheelers in Sri Lanka. Long work hours and two-stroke engines were significantly associated with LBP. Results from this study point towards a role for educational, behavioral health, and policy interventions to help prevent and reduce LBP among these drivers.     

Occupational risk factors for low back pain among drivers of three-wheelers in Sri Lanka

Background:

Approximately 5% of all households in Sri Lanka operate a three-wheeler as their primary source of income. However, very little is known about the occupational health risks associated with driving these vehicles.

Objectives:

The aim of this study was to assess occupational risk factors, including the number of hours worked associated with the 4-week prevalence of low back pain (LBP) among drivers of three-wheelers.

Methods:

Questionnaires were administered to 200 full-time drivers of three-wheelers from the Galle District in Sri Lanka. Occupational, psychological, socio-demographic, lifestyle, and anthropometric variables were collected. Univariate and multivariate analysis were used to investigate the correlation between occupational risk factors of the prevalence of LBP.

Results:

15.5% of respondents reported experiencing LBP in the previous 4 months. Univariate analysis revealed that the number of hours worked per week, feeling pressure to compete with other drivers, and perceived stress scale scores were significantly associated with the 4-week prevalence of LBP. Multivariate analysis found that the number of hours worked per week and engine type were significantly associated with LBP.

Conclusions:

LBP is common among drivers of three-wheelers in Sri Lanka. Long work hours and two-stroke engines were significantly associated with LBP. Results from this study point towards a role for educational, behavioral health, and policy interventions to help prevent and reduce LBP among these drivers.     

Medical assessment for licensing of taxi drivers by Scottish Local Authorities

In the UK, licensing of taxi drivers is dealt with by localgovernment authorities. In Scotland, before the recent reorganizationof local government, taxi licensing was under the jurisdictionof District Councils, so a telephone survey was conducted ofall 52 mainland Scottish District Councils to ascertain theprocedures which were being employed in assessing medical fitnessto drive a taxi, for which there is no national standard. Medicalenquiries relevant to fitness to drive were being made by 41(79%) of local authorities, but in 38 (73%) this was limitedto a single question about health. No enquiry regarding healthstatus was being made by 11 (21%) District Councils (all serving< 100,000 population size). Only three Scottish DistrictCouncils conducted a routine medical examination of all applicants.Thirteen of the 15 large (> 100,000 population size), and20 of the 21 medium-sized (50,000–100,000) Scottish DistrictCouncils carried out medical examinations either when a relevantmedical disorder was declared by the applicant, or when theapplicant was above a defined age (which varied between localauthorities). The small local authorities (population < 50,000)examined only those applicants who declared medical disorders.This survey has shown considerable variation and limitationsin the approach of the previously existing Scottish DistrictCouncils to the assessment of medical fitness to drive of applicantsfor taxi licences. It is suggested that national standards andguidelines are required for medical fitness to drive in relationto taxi licensing.     

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.     

Risk factors for low back pain among office workers in Ibadan,Southwest Nigeria

BACKGROUND: Low back pain is the most common musculo-skeletal problem in the workplace. Data from low-income countries are scant. OBJECTIVES: To determine the prevalence and risk factors for low back pain among office workers in Ibadan, Nigeria. METHODS: A cross-sectional study design was utilized. Questionnaires were distributed among office workers in the civil service in Ibadan, Nigeria. RESULTS: Eight hundred and forty questionnaires were analysed, with a response rate of 66%. The 12 month prevalence of low back pain was 38% and the point prevalence was 20%. Low back pain was significantly associated with senior staff grade and smoking. Severity of low back pain was associated with sitting for >3 h. Only 16 respondents (5%) reported sickness absence due to back pain in the previous year. A total of 75 days were lost, a mean of 4.7 days per year. CONCLUSIONS: The occurrence of low back pain in this study is comparable with that reported in studies from more industrialized countries, but does not constitute a major cause of sickness absence in this group of workers.     

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.     

Interrelations of risk factors and low back pain in scaffolders

OBJECTIVES—To assess with a cross sectional study the interrelations between physical, psychosocial, and individual risk factors and different end points of low back pain.
METHODS—In total, 229 scaffolders and 59 supervisors completed a questionnaire about manual handling of materials, awkward back posture, strenuous arm position, perceived exertion, psychosocial load, need for recovery, and general health. Physical load at the worksite was also measured with many frequent observations. Interrelations between risk factors and their relation with four end points of low back pain were investigated.
RESULTS—Interrelations were strong among self reported determinants of physical load but showed an inverted trend for both age and total working experience, which could indicate the presence of a healthy worker effect. Weak relations existed between variables of psychosocial and physical load. The multivariate analyses showed a significant relation between high manual handling of materials, moderate perceived general health, high job demands, and low back pain in the past 12 months. Chronic low back pain was significantly correlated with high perceived exertion and moderate perceived general health. Severe low back pain was significantly correlated with awkward back postures, high need for recovery, and high job demands. Finally, low back pain with perceived disability was significantly related to strenuous shoulder positions and moderate perceived general health. All end points of low back pain were consistently associated with physical load whereas psychosocial aspects showed a more diverse pattern.
CONCLUSIONS—The findings of this study suggest that work related risk factors may vary according to different definitions of low back pain. Distinct patterns of risk factors might enhance different expressions of it. Scaffolders are a group at high risk of developing persistent forms of low back pain.


Keywords: interrelations; low back pain; risk factors     

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.     

济南市出租车司机颈肩痛影响因素分析

目的了解山东省济南市出租车司机颈肩痛（NSP）的患病率及其影响因素。方法2013年7月-2013年12月,采用整群随机抽样方法随机抽取济南市出租车司机719人为研究对象,分析NSP的患病率及其危险因素。结果出租车司机NSP患病率为35.05%（252/719）;多因素 logistic 回归分析结果显示,夜班（OR=2.157,95%CI=1.405~3.313）、吸烟（OR=1.824,95%CI=1.227~2.712）、工龄≥5年（OR=1.666,95%CI=1.031~2.691）、兼职（OR=1.599,95%CI=1.122~2.279）是NSP患病的危险因素,受教育程度高中及以上（OR=0.454,95%CI=0.302~0.683）、睡眠时间≥8 h/d（OR=0.446,95%CI=0.274~0.725）是NSP患病的保护因素。结论出租车司机NSP的患病率较高,夜班、吸烟、长工龄、兼职易引发NSP。     

电解铝厂工人职业性下背痛危险因素探讨

目的　探讨电解铝厂工人职业性下背痛患病情况及其危险因素。方法　采用横断面调查问卷对铝厂工人及对照组的下背痛有关危险因素逐一询问,并依据病史及症状作出下背痛的临床诊断。结果　电解铝厂工人职业性下背痛患病率４５－４ ％ ,不同车间工人患病率差异未见显著性,但均高于对照组（１６－４ ％ ） 。Ｌｏｇｉｓｔｉｃ 回归分析提示下背痛患病与性别、年龄、身高、文化程度、婚烟状况、子女数、吸烟、饮酒、工作紧张感、疲劳感、既往疾病史及劳动姿势有关。结论　提示改善作业方式及有关社会心理状况、降低工作和家庭劳动负荷以及杜绝不良生活习惯是减低下背痛患病率的重要途径。     

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.