Contribution of occupational factors to the incidence and persistence of chronic low back pain among workers: results from the longitudinal VISAT study

Global, Regional, and National Change Patterns in the Incidence of Low Back Pain From 1990 to 2019 and Its Predicted Level in the Next Decade

Objectives: To analyze and describe the spatiotemporal trends of Low back pain (LBP) burdens from 1990 to 2019 and anticipate the following decade's incidence. Methods: Using data from the Global Burden of Disease (GBD) 2019 Study, we described net drifts, local drifts, age effects, and period cohort effects in incidence and forecasted incidence rates and cases by sex from 2020 to 2029 using the Nordpred R package. Results: LBP remained the leading cause of the musculoskeletal disease burden globally and across all socio-demographic index (SDI) regions. China is the top country. For recent periods, high-SDI countries faced unfavorable or worsening risks. The relative risk of incidence showed improving trends over time and in successively younger birth cohorts amongst low-middle-, middle- and high-middle-SDI countries. Additionally, the age-standardized incidence rates (ASIR) of LBP in both sexes globally showed a decreasing trend, but the incident cases would increase from 223 to 253 million overall in the next decade. Conclusion: As the population ages, incident cases will rise but ASIR will fall. To minimise LBP, public awareness and disease prevention and control are needed.

Body Mass Index and Its Influence on Chronic Low Back Pain in the Spanish Population: A Secondary Analysis from the European Health Survey (2020)

Risk factors such as obesity and a sedentary lifestyle contribute to the development of chronic low back pain.

PURPOSE

To describe how body mass index (BMI) influences the prevalence of chronic low back pain in the general Spanish population and assess this influence given other factors as sex, age, physical occupational demands, and recreational physical activity.

METHODS

An analytical cross-sectional design was performed based on secondary data from the European Health Survey in Spain (2020). Data on age, gender, physical occupational demands, physical activity, BMI, and presence of chronic low back pain were extracted.

RESULTS

A total of 19,716 (52.2% women) subjects with a median age of 53 years old were analyzed. Of these, 18.3% had chronic low back pain, 39% were overweight, and 16.1% were obese. The adjusted generalized linear model showed that being obese increased the odds of chronic low back pain by 1.719 times (p < 0.001). Being a woman increased the odds by 1.683 times (p < 0.001). Performing occupational tasks requiring high physical demands increased the odds by 1.403 times (p < 0.001). Performing physical activity in leisure time several times a week decreased the odds by 0.598 times (p < 0.001). For every additional year of age, the odds of chronic low back pain increased by 3.3% (p < 0.001).

CONCLUSIONS

Obesity is related with the presence of chronic low back pain in the general Spanish population. This association persists, being the more relevant factor, after adjusting the association of BMI and chronic low back pain with other factors such as sex, age, physical occupational demands, and recreational physical activity.

Physical and psychological strain in upper Austrian elementary school teachers - an observational study

Musculoskeletal disorders (MSDs) are the main cause of pain leading to high economic burden and psychosocial disadvantages. In addition, psychological stress impacts the overall health as well as the quality of life. Elementary school teachers clearly are a cohort with a high risk of MSDs and stress. The 'BelaPrim' study was conducted to determine the physical and psychological conditions of elementary school teachers in Upper Austria and to investigate the influence of physical and psychological parameters on MSDs. Physical and mental strain was determined with the Nordic Musculoskeletal Questionnaire (NMQ) and the 11-item short version of a German work-related behaviour and experience assessment (AVEM), respectively. Despite a high prevalence of MSDs, high scores were found on personality dimensions. Furthermore, qualitative results indicated the need of administrative/pedagogical support. A linear regression model showed that body height (+), work engagement (+), and emotions (-) are predictors for the occurrence of back pain.Practitioner summary: Despite a high proportion of physical complaints, Upper Austrian elementary school teachers show good mental health. Body height, a high work engagement, and low level of emotions are predictors for the occurrence of back pain. Health initiatives for elementary schools should have a multifactorial view to improve teachers' health.Abbreviations: BA: professional ambition; BE: willingness to spend; VB: striving for perfection PE: ability to distance; DF: tendency to resign in case of failure; RT: offensive problem-solving: OP; inner calm and balance; IR: experiencing success at work; EE: life satisfaction; LZ and SU: experiencing social support.

Residents of Mountainous Areas Have a Higher Low Back Pain Prevalence Than Flat Areas of Chongqing, China: A Cross-Sectional Study

Background and Purpose

Epidemiological studies on low back pain in residents living in mountainous areas are scarce. The study was aimed at investigating the prevalence and associated factors of low back pain in Chongqing, relatively impoverished mountainous areas of China.

Materials and Methods

This was a cross-sectional study conducted at selected community or village health service centers in Chongqing over a 2-month period (May 2021 to June 2021), which included adults of Chongqing aged >18 years with or without low back pain (N=1820) chosen by stratified, cluster-sampling. Associated factors of low back pain including sociodemographic characteristics, lifestyle, and occupational features were collected, along with medical history, Oswestry Disability Questionnaire (ODI), and Numerical Rating Scale (NRS) of patients with low back pain, and carried out for at least 20 minutes per respondent. Univariate and multivariate logistic regression models were utilized for statistical analysis.

Results

Overall, 30.5% of 1704 respondents presented with low back pain, with 26.3% living in flat areas and 35.6% in mountainous areas. The associated factors of low back pain were mountainous area residence (OR 1.4, 95% CI 1.1-1.8), advanced age (OR 1.8, 95% CI 1.3-2.5 for those aged 45-59 years, OR 2.3, 95% CI 1.6-3.4 for those aged 60-74 years, and OR 2.1, 95% CI 1.2-3.6 for those aged ≥75 years), married or remarried (OR 1.9, 95% CI 1.1-3.2), divorced or widowed (OR 2.7, 95% CI 14-5.4), moderate labor intensity (OR 1.4, 95% CI 1.1-1.8), frequent stoop (OR 1.6, 95% CI 1.1-2.4), and depressed mood (OR 1.6, 95% CI 1.2-2.1). Residents in the mountainous areas had a higher score on Oswestry Disability Questionnaire (8.3 [SD 6.3] vs 6.2 [SD 4.3]) than those in flat areas.

Conclusion

Mountainous areas in Chongqing had higher prevalence of low back pain as 35.6%, compared with 26.3% in flat areas, with more severe dysfunction in low back pain patients. Multifactorial analysis found that the factors associated with low back pain in Chongqing residents included mountain residence, labor intensity, stoop, psychological factors and frequency of exercise.

Exposure to environmental occupational constraints and all-cause mortality: Results for men and women from a 20-year follow-up prospective cohort, the VISAT study. Be aware of shift-night workers!

Objective

To determine the predictive value of the large panel of occupational constraints (OC) on all-cause mortality with a 20-year follow-up, in general population of workers.

Methods

In VISAT prospective cohort study, 3,138 workers (1,605 men; 1,533 women) were recruited during the periodic work health visits conducted by occupational physicians. OC (physical, organizational, psychological and employment categories) were collected through self-questionnaires. Exposure durations of each OC were divided by tertile distribution. Cox-regression models were performed to analyze the associations between all-cause mortality and each OC first separately and simultaneously in a single model.

Results

The mortality rates were higher among exposed participants to most of OC compared to those unexposed. Being exposed and longer exposure increased the risks of all-cause mortality for exposures to carrying heavy loads, loud noise, working more than 48 h/week, starting its first job before 18 years old although these risks became non-significant after adjustments for cardiovascular risk factors. Shift work and night work confirmed a high risk of mortality whatever the adjustments and notably when the other occupational exposures were taking into account, with, respectively: HR: 1.38 (1.01-1.91) and 1.44 (1.06-1.95). After adjustments being exposed more than 13 years to a work requiring getting-up before 5:00 a.m. and more than 16 years in rotating shift work significantly increased the risk of mortality by one and a half.

Conclusion

The links between each OC and all-cause mortality and the role of individual factors were stressed. For night-shift workers, it is urgent to implement preventive strategies at the workplace.

Modifiable lifestyle-related prognostic factors for the onset of chronic spinal pain: A systematic review of longitudinal studies

BACKGROUND

Stratified approaches to spinal pain that address psychosocial risk factors reduce long-term disability to a moderate extent. Identifying and managing other risk factors might help improve outcomes.

OBJECTIVE

This systematic review of longitudinal studies aimed to evaluate possible associations between the onset of chronic spinal pain (including low back, back and neck pain) and putative modifiable lifestyle-related risk or protective factors.

METHODS

This systematic review of longitudinal studies published during the last 2 decades followed PRISMA guidelines. Two reviewers screened Medline, Scopus, Pedro, Cochrane Library, Psycinfo, Science Direct, PTSDpubs and Google Scholar for relevant studies. The QUIPS tool was used to assess the risk of bias. A qualitative meta-synthesis of relevant factors was performed.

RESULTS

Of 3716 unique records, 14 studies met the inclusion criteria (10 with low risk of bias and 4 moderate risk of bias). The highest bias observed was attrition. For chronic low back pain, we found moderate evidence for the involvement of high body weight, waist circumference, and hip circumference and conflicting evidence for high body mass index (BMI), smoking, and physical activity. For chronic neck pain, we found strong evidence for high BMI in women, moderate evidence for sleep disorders in women and conflicting evidence for high BMI in men and physical activity. For chronic back pain, we found limited evidence for gardening/yard work in men and more than one adult at home. Effect sizes were small.

CONCLUSIONS

Several modifiable lifestyle-related factors were identified. Evidence is still sparse and there is a need for more studies. PROSPERO database registration: Ref 172,112 CRD42020172112.

Prevalence and Related Factors of Low Back Pain in the General Elderly Population: A Japanese Cross-Sectional Study Randomly Sampled from a Basic Resident Registry

Low back pain (LBP) is one of the main etiologies of disability in daily life. In the face of LBP increases in super-aged societies, there are serious concerns of escalating medical costs and deteriorations in the social economy. It is therefore important to identify the factors associated with LBP for prompt preventative and therapeutic measures. This study investigated the prevalence of LBP and the impact of subject-specific factors on LBP development in Japanese community-dwelling older adults. We established eight groups based on age (50's, 60's, 70's, and 80's) and gender after random sampling from a resident registry. A total of 411 participants (201 male and 210 female) were enrolled for a whole-spine lateral radiographic examination and dual-energy X-ray absorptiometry. All subjects were evaluated for the presence and degree of LBP. We analyzed the impact of clinical factors on LBP using multivariate analysis. Fifty-three (12.9%) participants (23 (11.4%) male and 30 (14.3%) female) were found to have LBP. The prevalence of LBP tended to increase with age, and similar results were found between genders. In univariate analysis, the subject-related factors of the sagittal vertebral axis, pelvic incidence minus lumbar lordosis (PI-LL) mismatch, and aging had significant associations with LBP. PI-LL mismatch was a significant independent factor in multivariate analysis. In conclusion, this study identified LBP prevalence and subject-specific factors on a general population basis. Multivariate analysis revealed PI-LL mismatch as an independent factor associated with LBP in the healthy community-dwelling elderly.

Prognostic factors for pain chronicity in low back pain: a systematic review

Supplemental Digital Content is Available in the Text.

Several prognostic factors are related to low back pain chronicity, and these should be taken into account when planning more comprehensive models in its prevention.

Low back pain is the leading cause for years lived in disability. Most people with acute low back pain improve rapidly, but 4% to 25% of patients become chronic. Since the previous systematic reviews on the subject, a large number of new studies have been conducted. The objective of this article was to review the evidence of the prognostic factors behind nonspecific chronic low back pain. A systematic literature search was performed without date limitation from the MEDLINE, Cochrane library, and Medic databases. Specific inclusion criteria were used, and risk factors before the onset of chronic symptoms were searched. Study quality was assessed by 2 independent reviewers. One hundred eleven full articles were read for potential inclusion, and 25 articles met all the inclusion criteria. One study was rated as good quality, 19 studies were rated as fair quality, and 5 articles were rated as poor quality. Higher pain intensity, higher body weight, carrying heavy loads at work, difficult working positions, and depression were the most frequently observed risk factors for chronic low back pain. Maladaptive behavior strategies, general anxiety, functional limitation during the episode, smoking, and particularly physical work were also explicitly predictive of chronicity. According to this systematic review, several prognostic factors from the biomechanical, psychological and psychosocial point of view are significant for chronicity in low back pain.

Risk and Prognostic Factors of Low Back Pain: Repeated Population-based Cohort Study in Sweden

STUDY DESIGN

Prospective longitudinal cohort study.

OBJECTIVE

To determine the associations for workload and health-related factors with incident and recurrent low back pain (LBP), and to determine the mediating role of health-related factors in associations between physical workload factors and incident LBP.

SUMMARY OF BACKGROUND DATA

It is not known whether the risk factors for the development of LBP are also prognostic factors for recurrence of LBP and whether the associations between physical workload and incident LBP are mediated by health-related factors. We used data from the Swedish Longitudinal Occupational Survey of Health study. Those responding to any two subsequent surveys in 2010 to 2016 were included for the main analyses (N = 17,962). Information on occupational lifting, working in twisted positions, weight/height, smoking, physical activity, depressive symptoms, and sleep problems were self-reported. Incident LBP was defined as pain limiting daily activities in the preceding three months in participants free from LBP at baseline. Recurrent LBP was defined as having LBP both at baseline and follow-up. For the mediation analyses, those responding to three subsequent surveys were included (N = 3516).

METHODS

Main associations were determined using generalized estimating equation models for repeated measures data. Mediation was examined with counterfactual mediation analysis.

RESULTS

All risk factors at baseline but smoking and physical activity were associated with incident LBP after adjustment for confounders. The strongest associations were observed for working in twisted positions (risk ratio  = 1.52, 95% CI 1.37, 1.70) and occupational lifting (risk ratio  = 1.52, 95% CI 1.32, 1.74). These associations were not mediated by health-related factors. The studied factors did not have meaningful effects on recurrent LBP.

CONCLUSION

The findings suggest that workload and health-related factors have stronger effects on the development than on the recurrence or progression of LBP, and that health-related factors do not mediate associations between workload factors and incident LBP.

LEVEL OF EVIDENCE

3.

The Prevalence of Occupational Risk Factors and Occupational Diseases in Kerman, Iran

Background and aims: Many workers face significant hazardous workplace exposures, especially in developing countries. The objective of this study was to investigate the prevalence of occupational risk factors and common occupational diseases in Kerman. Methods: This study was based on data from occupational risk factor and disease monitoring systems available at Kerman Province Health Center during 2011-2015. These data are gathered semiannually by occupational hygienists based on standard checklists provided by the Ministry of Health and Medical Education and these checklists include exposures and diseases related to the workplace. Results: Based on the results, 292 (3.7%), 281 (3.58%), 261 (3.32%), and 115 (1.47%) cases were found regarding occupational hearing loss, respiratory conditions, work-related back pain, and musculoskeletal disorders, respectively, which were related to different occupational exposures diagnosed in Kerman during 2011-2015. Moreover, dust, work tools, wrong body position during work, and noise were the most common risk factors in this respect. Conclusion: Overall, occupational hazards are considered as an important health issue in Kerman. Therefore, it is necessary to control exposure to these risk factors in order to prevent occupational diseases

Is occupational or leisure physical activity associated with low back pain? Insights from a cross-sectional study of 1059 participants

BACKGROUND

Low back pain is a highly prevalent and disabling musculoskeletal disorder. Physical activity is widely used as a prevention strategy for numerous musculoskeletal disorders; however, there is still conflicting evidence as to whether physical activity is a protective or risk factor for low back pain or whether activity levels differ between people with and without low back pain.

OBJECTIVE

To investigate the association between low back pain and different types (occupational and leisure) and intensities (moderate and vigorous) of physical activity.

METHODS

This is cross-sectional observational study. We included in this study a total of 1059 individuals recruited from a Spanish twin registry with data available on low back pain.

OUTCOME

Self-reported leisure and occupational physical activity were the explanatory variables. The low back pain outcome used in this study was recurrent low back pain.

RESULTS

Our results indicate that leisure physical activity is associated with a lower prevalence of recurrent low back pain. In contrast, occupational physical activity, such as carrying, lifting heavy weight while inclined, awkward postures (e.g. bending, twisting, squatting, and kneeling) are associated with a higher prevalence of recurrent low back pain. There was no statistically significant association between other occupational physical activities, such as sitting or standing, and low back pain.

CONCLUSION

Leisure and occupational physical activity are likely to have an opposed impact on low back pain. While leisure physical activity appears to be protective, occupational physical activity appears to be harmful to low back pain. Future longitudinal studies should assist in formulating guidelines addressing specific types and intensity of physical activity aimed at effectively preventing low back pain.

Assessment of the ergonomic risk from saddle and conventional seats in dentistry: A systematic review and meta-analysis

Objective

This study aimed to verify whether the saddle seat provides lower ergonomic risk than conventional seats in dentistry.

Methods

This review followed the PRISMA statement and a protocol was created and registered in PROSPERO (CRD42017074918). Six electronic databases were searched as primary study sources. The "grey literature" was included to prevent selection and publication biases. The risk of bias among the studies included was assessed with the Joanna Briggs Institute Critical Appraisal Tool for Systematic Reviews. Meta-analysis was performed to estimate the effect of seat type on the ergonomic risk score in dentistry. The heterogeneity among studies was assessed using I² statistics.

Results

The search resulted in 3147 records, from which two were considered eligible for this review. Both studies were conducted with a total of 150 second-year dental students who were starting their laboratory activities using phantom heads. Saddle seats were associated with a significantly lower ergonomic risk than conventional seats [right side (mean difference = -3.18; 95% CI = -4.96, -1.40; p < 0.001) and left side (mean difference = -3.12; 95% CI = -4.56, -1.68; p < 0.001)], indicating posture improvement.

Conclusion

The two eligible studies for this review provide moderate evidence that saddle seats provided lower ergonomic risk than conventional seats in the examined population of dental students.

Impact of occupational environmental stressors on blood pressure changes and on incident cases of hypertension: a 5-year follow-up from the VISAT study

BACKGROUND

The role of occupational stressors (OS) on blood pressure (BP) is often suspected, but asserting its impact remains uncertain. Our goal was to evaluate their impact on BP increase and on incident cases of hypertension over a 5-year period.

METHODS

One thousand, one hundred and fifty-six men and women from the French prospective VISAT study were followed up over five-years (T1 to T2). Exposures to a large panel of OS (physical, organizational, psychosocial and employment categories) were collected. Linear and logistic regressions were used to assess associations between OS and T2-T1 SBP difference and incident cases of hypertension. They were performed to determine the role of OS first considered separately, then in combination, in crude and adjusted models for main cardiovascular risk factors (gender, age, education, BMI, lifestyle habits and medical history).

RESULTS

For initial SBP level < 130 mmHg, carrying loads, intense noise exposure, working more than 48 h/week, active and high strain tended to be associated with an SBP difference increase, while job recognition was associated with a decrease. After adjustment, only significant associations with job strain and job recognition persisted. For initial SBP level ≥ 130 mmHg, being exposed to an active job strain was positively associated with T2-T1 SBP difference only in unadjusted model. Considering all the OS, the recognition of completed tasks had a major protective role. No impact of OS on incident cases of hypertension was observed.

CONCLUSION

Associations between OS and SBP were observed mainly when initial SBP is within the normal range, and are mainly explained by cardiovascular factors, requiring physician's particular attention to people exposed to these OS. VISAT study is registered in "LE PORTAIL EPIDEMIOLOGIE - FRANCE- AVIESAN -ID 3666".

Acupuncture and Neural Mechanism in the Management of Low Back Pain-An Update

Within the last 10 years, the percentage of low back pain (LBP) prevalence increased by 18%. The management and high cost of LBP put a tremendous burden on the healthcare system. Many risk factors have been identified, such as lifestyle, trauma, degeneration, postural impairment, and occupational related factors; however, as high as 95% of the cases of LBP are non-specific. Currently, LBP is treated pharmacologically. Approximately 25 to 30% of the patients develop serious side effects, such as drowsiness and drug addiction. Spinal surgery often does not result in a massive improvement of pain relief. Therefore, complementary approaches are being integrated into the rehabilitation programs. These include chiropractic therapy, physiotherapy, massage, exercise, herbal medicine and acupuncture. Acupuncture for LBP is one of the most commonly used non-pharmacological pain-relieving techniques. This is due to its low adverse effects and cost-effectiveness. Currently, many randomized controlled trials and clinical research studies have produced promising results. In this article, the causes and incidence of LBP on global health care are reviewed. The importance of treatment by acupuncture is considered. The efforts to reveal the link between acupuncture points and anatomical features and the neurological mechanisms that lead to acupuncture-induced analgesic effect are reviewed.