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.     

Predicting the long term course of low back pain and its consequences for sickness absence and associated work disability

Background

Low back pain is characterised by a dynamic pattern of episodes and recovery but little is known about the long term course of back pain due to lack of cohort studies with sufficiently long follow up periods.

Methods

A cohort of 523 workers in nursing homes and homes for the elderly was followed for two years. Physical load was measured by observations at the workplace. Psychosocial factors at work, individual characteristics, and low back pain were determined by questionnaire once a year. The effect of work load on low back pain and the transition of low back pain into sickness absence was calculated with logistic regression analysis. A Markov model was used to construct a hypothetical cohort of workers with follow up of 40 years (40 cycles of 1 year) with transitional probabilities between no complaints, low back pain, and sickness due to low back pain. Permanent disability was used as end state of health.

Results

The transitional probability from no complaints to low back pain varied between p = 0.25 and p = 0.29, from low back pain to sickness absence between p = 0.09 and p = 0.25, and recurrence of sickness absence varied between p = 0.27 and p = 0.50, depending on the level of physical load. During a 40 year career, total sickness absence due to low back pain was approximately 140 weeks (6.6%) among workers with high physical load and about 30 weeks (1.4%) among those with low physical load.

Conclusion

The Markov approach illustrated the potential impact of physical load on (permanent) disability due to low back pain among workers with exposure to physical load. These consequences may go unnoticed in cohort studies with follow up periods of a few years.     

An evaluation of low back pain among female brick field workers of West Bengal,India

Objectives

The purpose of the study was to determine the prevalence of low back pain (LBP) among brick field workers and to explore attributed causes of LBP, investigate the relationship between LBP and psychophysical and psychosocial factors and measure the impact of LBP.

Methods

A modified Nordic Musculoskeletal Disorder Questionnaire along with Body Part Discomfort scale were administered to brick field workers (N = 148). Working posture of the participants was assessed using Rapid Entire Body Assessment (REBA) method.

Results

The study showed that 70 % of the female workers reported LBP due to awkward working posture for prolonged period of time. This was mainly reported by brick moulders. 45 % reported LBP due to manual material handling (MMH) and 40 % due to awkward lifting of heavy objects (brick). The study shows that the LBP is more prevalent (OR 1.59 and 95 % CI 0.411–6.207). 78 % of the female workers want the job rotation to relieve from their job monotony.

Conclusions

LBP occurred among female workers due to awkward posture, repetitive work and MMH. This study also stated that psychosocial cause of LBP is inadequacy income, monotony work, job dissatisfaction. Working posture analysis REBA suggests that all the working postures are high-risk level.     

Chronic back pain and work disability: Vocational outcomes following multidisciplinary rehabilitation

Studies indicate that work disabled chronic back pain patients out of work for longer than three months have a reduced probability of returning to work. The escalating personal and economic costs (indemnity and health care) associated with such long term disability have facilitated efforts at multiple levels to prevent and more effectively manage work disability. Multidisciplinary rehabilitation (MDR) targeted at return to work represents one such approach. The approach is based upon a multidimensional conceptualization of work disability and integrates medical, physical, psychological, educational and vocational interventions to increase physical function, reduce pain, increase stress coping skills and facilitate return to work. Seven outpatient multidisciplinary rehabilitation outcome studies for chronic back pain were identified that met the following selection criteria: 1) diagnosis of back pain, low back pain, spinal disorder (specific and nonspecific diagnosis), 2) chronic back pain of either longer than three months since injury or longer than three months absence from work, 3) use of an outpatient multidisciplinary rehabilitation approach that included some combination of medical management, physical conditioning, pain and stress management, vocational counseling/placement and education regarding back safety and health, and 4) work reentry was the primary focus of outcome. These were reviewed to determine the effectiveness of MDR in terms of return to work outcome. Analyses revealed that an average of 71 percent of work disabled chronic back pain patients who completed a multidisciplinary rehabilitation program were working or involved in vocational rehabilitation efforts at 12 month follow-up in contrast to an average of 44 percent in corresponding comparison groups. While these studies suggest the clinical utility of a multidisciplinary approach as compared to usual care in facilitating return to work for chronic back pain patients, the literature was characterized by several methodological limitations including the absence of randomization in the majority of studies, use of insurance company denials as control groups, heterogenous samples in terms of duration of work disability, job availability at discharge, extent of impairment and disability, age and duration of pain disorder, lack of specification as to exact treatment delivered in the control or usual care groups and varying definitions of return to work outcome. Research on predictors of return to work outcome following MDR were identified and included variables in five categories: demographics, medical history, physical findings, pain and psychological characteristics. The literature provides support for the use of integrated approaches that target the medical, physical, ergonomic and psychosocial factors that can exacerbate and/or maintain work disability. Future research should address current methodological limitations in the literature and focus on: 1) identifying critical treatment components of such approaches, 2) developing innovative screening methods to identify high risk cases to facilitate earlier more targeted efforts to assist such individuals, and 3) consider variations in the staging of various combinations of interventions in an effort to develop more cost-effective variations in the multidisciplinary approach.     

Overdiagnosis and overtreatment of low back pain: Long-term effects

Low back pain and subsequent disability remain a concern in terms of both cost and impact upon industry let alone the adverse effects on the patients involved. The causes of low back pain remain elusive. There has been extensive focus on the intervertebral disc with treatment ranging from passive modalities to multiple surgery. Current experience suggests that misinformation, inadequate patient examination, medication abuse, over use of passive modalities, focus on pain rather than function and excessive reliance on radiological imaging and specialist referrals are contributing factors. Indeed, one is drawn to the conclusion that low back disability may well be an iatrogenic disorder in many cases.     

Prevalence of chronic head, neck and low back pain and associated factors in women residing in the Autonomous Region of Madrid (Spain)

Objective

To compare the prevalence of chronic headache (CH), chronic neck pain (CNP) and chronic low back pain (CLBP) in the autonomous region of Madrid by analyzing gender differences and to determine the factors associated with each pain location in women in 2007.

Methods

We analyzed data obtained from adults aged 16 years or older (n = 12,190) who participated in the 2007 Madrid Regional Health Survey. This survey includes data from personal interviews conducted in a representative population residing in family dwellings in Madrid. The presence CH, CNP, and CLBP was analyzed. Sociodemographic features, self-perceived health status, lifestyle habits, psychological distress, drug consumption, use of healthcare services, the search for alternative solutions, and comorbid diseases were analyzed by using logistic regression models.

Results

The prevalence of CH, CNP and CLBP was significantly higher (P<0.001) in women (7.3%, 8.4%, 14.1%, respectively) than in men (2.2%, 3.2%, 7.8%, respectively). In women, CH, CNP and CBLP were significantly associated with having ≥3 chronic diseases (OR 7.1, 8.5, 5.8, respectively), and with the use of analgesics and drugs for inflammation (OR: 3.5, 1.95, 2.5, respectively). In the bivariate analysis, the factors associated with pain in distinct body locations differed between men and women.

Conclusions

This study found that CH, CNP and CLBP are a major public health problem in women in central Spain. Women have a higher overall prevalence of chronic pain than men. Chronic pain was associated with a higher use of analgesics and healthcare services.     

某汽车公司铸造厂工人腰背痛的危险因素分析

目的 通过横断面流行病学记查,寻找汽车铸造厂作业工人腰背痛的主要危险因素,为此类疾患的预防提供科学依据.方法 在某汽车公司铸造厂对1340名工人进行腰背痛和劳动负荷问卷调查,利用logistic回归进行危险因素分析.结果 铸造厂工人的腰背痛年患病率为58.9%,其中铸造、物流和造型工种工人腰背痛年患病率较高,分别为64.6%、64.6%和62.5%.以不适体位搬举、大幅度弯腰、弯腰与转身并存及搬运重物这些负荷因素导致患腰背痛危险性最高,其OR值分别为2.085、1.961、1.967和1.956.各个危险因素在不同工种中的分布不同.多元logistic同归分析表明,搬运重物、不适体位搬举、大幅度弯腰、弯腰与转身并存及工龄和性别均被选人模型.结论 手工搬运重物、不良劳动姿势或二者同时存在是导致腰背痛的首要危险因素,应从这方面入手,加强工效学干预研究,减少此类疾患.

Abstract：

Objective To study the main risk factors of low back pain of workers in a foundry factory of the automobile company using cross sectional epidemiological investigation, and to provide scientific base for preventing the disorder. Methods The low back pain and work loads of 1340 workers in a foundry factory of the automobile company were investigated using questionnaire, and logistic regression analysis was used to analyze the risk factors. Results The one-year morbidity of low back pain in workers was 58.9%the morbidities of low back pain in workers engaged in foundry, transportation and modeling were 64.6 %, 64.6 % and 62.5 %, respectively. The lifting with squat postures, bending trunk heavily, bending trunk with twisting and moving the heave objects were found to be the most dominant risk factors for low-back pain, the OR values were 2.085, 1.961, 1.967 and 1.956, respectively. The distributions of risk factors were different among the different jobs. The logistic regression analysis showed that moving the heave objects, lifting with squat postures, bending trunk heavily, bending trunk with twisting existed simultaneously, also the work years and gender were the risk factors. Conclusion The manual moving heave objects, awkward working posture or both were the most important risk factors for low-back pain. The intervene ergonomic study should be performed in future to reduce the morbidity of low-back pain.     

Industrial back belts and low back pain: Mechanisms and outcomes

The recent increased utilization of industrial back belts as personal protective equipment in the workplace has generated considerable controversy among occupational health and safety professionals in the United States. The purpose of this article is to review the literature regarding proposed mechanisms of action of these devices and studies related to outcome of belt utilization in the prevention of low back pain and disability in the workplace. At the present time, neither the suspected mechanisms of action nor the efficacy of these devices in the primary, secondary, and tertiary prevention of work-related low back pain has been adequately demonstrated in clinical trials. As a result, generally accepted guidelines regarding the safe use of belts in the occupational setting have not been established. Based on this review it is recommended that further well-controlled, prospective, randomized clinical trials are necessary to evaluate the effectiveness of these devices as personal protective equipment. During the interim, the decision to prescribe belts to employees in the workplace should be at the discretion of an adequately trained occupational health care provider. These devices should not be provided as an alternative to appropriate administrative and/or engineering controls.     

Perceived effort and low back pain in non-emergency ambulance workers: Implications for rehabilitation

Introduction: This study aims to explore factors associated with low back pain (LBP) that required treatment from health care provider among non-emergency ambulance transfer workers. Method: A cross-sectional study was conducted to 38 workers of a major hospital in Hong Kong. The influences of four categories of risk factors (personal, physical, psychosocial, and exposure factors) in the prevalence of LBP were investigated by objective measurement and self-reported questionnaires. A modified Nordic musculoskeletal symptoms survey and sick leave record were used to document the prevalence of LBP. Univariate analyses followed by multiple logistic regression analyses were used to explore the risk factors associated with LBP cases. Results: The results revealed that LBP was associated with age (OR=0.75, CI=0.56–1.00, P < 0.05), perceived effort (OR=7.95, CI=1.46–43.27, P < 0.05), job satisfaction (OR=4.18 CI=1.42–12.33, P < 0.01), and flexor peak torque at 120°/s (OR=1.09 CI= 0.99–1.19, P=0.07). Conclusion: This study suggests that workers’ perceived exertion has an valuable role in assessing risk at this workplace. A high perceived exertion at work can signal the need for work adjustment or modification to avoid progression of low back disorder to persistent pain or intense pain. The effects of work adjustment or modification in affected workers needs to be systematically investigated.     

护理人员下背痛调查及其影响因素的初步探讨

目的探讨护理作业人员职业性下背痛现患状况及其影响因素。方法采用现况调查的方法对某市规模相近的3所医院的486名护士进行问卷调查,内容包括下背痛患病率及其可能相关影响因素。结果护理作业人员下背痛患病率高达60.3%,多元Logistic回归分析提示:工龄、弯腰时间、工作疲劳感、轮班频率等因素与下背痛有关。结论下背痛是护理人员常见疾患,其患病危险因素来自多个方面。     

木材装饰贴面作业女工腰背痛分析

目的研究木材装饰贴面作业女工的腰背痛及其原因。方法对某地木材装饰贴面加工作业中3种主要工种的女工进行问卷调查、腰部检查和弯腰状态分析。结果选板、修补和贴面3个工种女工疲劳主诉率分别为68．8％、66．7％和59．0％，最易疲劳部位是腰背。选板和修补工的腰背痛发生率明显高于贴面工，分别是53．8％、58．7％和30．1％；棘间和腰大肌压痛与腰背痛结果一致。姿势分析结果表明，选板和修补工最大弯腰幅度（80°）大于贴面工（60°），且日弯腰次数[分别为（4396±817）、（1696±286）次]和日弯腰时间[分别为（6．5±0．6）、（6．2±1．3）h]也明显高于贴面工[分别为（1094±476）次、（4．5±0.9）h]，差异均有统计学意义（P〈0．05）。结论装饰贴面女工因现有作业方式而普遍存在弯腰姿势，尤以选板和修补工种突出，可能是其腰背痛高发的主要原因。     

Looking upstream to understand low back pain and return to work: Psychosocial factors as the product of system issues

Low back pain (LBP) is the most common and expensive musculoskeletal (MSK) disorder in industrialized countries. There is evidence that personal and occupational psychosocial variables play a more important role than spinal pathology or the physical demands of the job. However, it is unclear which psychosocial variables are most important. The objective of this study is to understand which psychosocial variables are deemed most important to various workplace stakeholders involved in the process of returning a worker with LBP to work. Nine focus groups were convened with injured workers, small and large employers, unions, health and safety associations, physicians and non-physician clinicians, return to work coordinators and compensation board representatives in Ontario, Canada. A qualitative grounded theory approach was applied to explore, from their perspectives, important psychosocial factors that prevent the promotion of early and safe return to work (RTW) for individuals with LBP. While the study began by asking questions related to the various psychosocial factors and their association to LBP and RTW, it took an interesting turn. The majority of study participants described how psychosocial factors were the product of larger systemic/organizational issues. Rather than focusing solely on individual psychosocial factors, respondents described how the context of a much larger system, and the complex interplay between the many different components of that system, contributes directly or indirectly to the treatment of LBP and RTW. It is the interrelationships between these systems that determine the process of returning an injured worker with LBP back to work. Although it is important to understand how psychosocial factors affect RTW, organizational structures within our social context seem to play a role in shaping how all stakeholders see and emotionally respond to LBP and RTW, as well as the degree to which they can envision taking action on them. We need to consider moving beyond a psychosocial conceptualization of LBP and RTW into a sociopolitical and economic conceptualization. This reconceptualization provides insight into the “upstream factors” associated with LBP and RTW.     

ICU病房护理人员职业相关腰背痛及其危险因素

目的探讨ICU病房护理人员职业相关腰背痛（OLBP）的发生情况及相关的危险因素。方法以某市5家综合性医院ICU病房护士为观察组，普通病房护士为对照组进行横断面调查，发放OLBP问卷调查，并对其中一家医院ICU病房进行现场录像，采用Win OWAS和Bless Pro2．0软件做姿势负荷和生物力学负荷计算。结果ICU病房护士OLBP现患率（87％）、发作频率（每月1次以上者占48％）以及因OLBP误工率（7％）与对照组（分别为60％、32％、2％）比较均明显升高，差异有统计学意义（P〈0．01，P〈0．05）。ICU病房护士典型护理操作危险姿势发生频率依次为观察引流（99％）、在床上搬抬患者（90％）、静脉操作（75％）、吸痰（75％）、调整输液量（6％）；调整输液量、吸痰、静脉操作、观察引流量、在床上搬抬患者的腰椎间盘压力（Fc）比值为100：155：199：301：418。结论ICU病房护士OLBP患病率高，高频率弯腰、扭转姿势和在床上搬抬患者是主要的危险因素。     

深圳市中学生日常行为习惯与其肩颈腰背健康状况的关系

目的 探讨深圳市中学生日常行为习惯与其肩颈、腰背健康的相关性,为更好地预防中学生肩颈、腰背症状提供理论依据。方法 采取分层整群抽样方法,抽取深圳市10个区10所中学的3 952名学生进行脊柱健康状况及日常行为习惯的问卷调查,调查数据采用SPSS 23.0软件进行分析。结果 深圳市中学生中有肩颈症状和腰背症状的分别为20.3%和15.2%;有肩颈症状的女生（25.3%）多于男生（16.2%）,高中生（24.5%）多于初中生（15.5%）,住校生（24.4%）多于非住校生（17.6%）;有腰背症状的女生（17.9%）多于男生（13.0%）,差异均有统计学意义（P<0.05）。多因素logistic结果分析显示,性别、学校类型、午休趴在桌子上睡觉、因学习或玩电脑熬夜、自评学习压力、持续长时间做作业、玩手机、看电视和使用电脑与学生肩颈症状相关（P<0.05）;性别、午休趴在桌子上睡觉、因学习或玩电脑熬夜、自评学习压力、持续长时间做作业、玩手机、看电视与学生腰背症状相关（P<0.05）。结论 深圳市中学生肩颈、腰背症状不容忽视,学习压力、长时间静坐行为和不良的睡眠习惯均对脊柱健康有影响。     

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.