Inpatient hospital care for back disorders in relation to industry and occupation in Finland

Global and regional estimates of clinical and economic burden of low back pain in high-income countries: a systematic review and meta-analysis

Introduction

Low back pain (LBP) is a common health problem, and the leading cause of activity limitation and work absence among people of all ages and socioeconomic strata. This study aimed to analyse the clinical and economic burden of LBP in high income countries (HICs) via systematic review and meta-analysis.

Methods

A literature search was carried out on PubMed, Medline, CINAHL, PsycINFO, AMED, and Scopus databases was from inception to March 15th, 2023. Studies that assessed the clinical and economic burden of LBP in HICs and published in English language were reviewed. The methodological quality of the included studies was assessed using the Newcastle-Ottawa quality assessment scale (NOS) for cohort studies. Two reviewers, using a predefined data extraction form, independently extracted data. Meta-analyses were conducted for clinical and economic outcomes.

Results

The search identified 4,081 potentially relevant articles. Twenty-one studies that met the eligibility criteria were included and reviewed in this systematic review and meta-analysis. The included studies were from the regions of America (n = 5); Europe (n = 12), and the Western Pacific (n = 4). The average annual direct and indirect costs estimate per population for LBP ranged from € 2.3 billion to € 2.6 billion; and € 0.24 billion to $8.15 billion, respectively. In the random effects meta-analysis, the pooled annual rate of hospitalization for LBP was 3.2% (95% confidence interval 0.6%-5.7%). The pooled direct costs and total costs of LBP per patients were USD 9,231 (95% confidence interval -7,126.71-25,588.9) and USD 10,143.1 (95% confidence interval 6,083.59-14,202.6), respectively.

Discussion

Low back pain led to high clinical and economic burden in HICs that varied significantly across the geographical contexts. The results of our analysis can be used by clinicians, and policymakers to better allocate resources for prevention and management strategies for LBP to improve health outcomes and reduce the substantial burden associated with the condition.

Systematic review registration

https://www.crd.york.ac.uk/prospero/#recordDetails?, PROSPERO [CRD42020196335].

Factory and construction work is associated with an increased risk of severe lumbar spinal stenosis on MRI: A case control analysis within the wakayama spine study

BACKGROUND

To explore the association of MRI-diagnosed severe lumbar spinal stenosis with occupation.

METHODS

Occupational data were collected by questionnaire and all participants underwent spine MRI scans using the same protocol. Central lumbar spinal stenosis (LSS) was graded qualitatively. Those with severe LSS (>two-thirds narrowing) were compared with the controls with lesser degrees of stenosis or no stenosis.

RESULTS

Data were available for 722 subjects, mean age 70.1 years. 239 (33%) cases with severe LSS were identified. Factory/construction workers had an almost four-fold increased risk of severe LSS after adjustment for age, sex, smoking, and walking speed amongst those aged <75 years (OR 3.97, 95%CI 1.46-10.85). Severe LSS was also associated with squatting ≥1 h/day (OR 1.76, 95%CI 1.01-3.07) but this association became non-significant after adjustment.

CONCLUSION

Further research is needed but this study adds more evidence that occupational factors are associated with an increased risk and/or severity of degenerative disease of the lumbar spine.

Trunk and upper arm postures in paper mill work

The aim of this study was to assess postures and movements of the trunk and upper arm during paper mill work, and to determine the extent to which they differ depending on method of assessment. For each of 28 paper mill workers, postures and movements were assessed during three full shifts using inclinometer registration and observation from video. Summary metrics for each shift, e.g., 10^th, 50^th, and 90^th posture percentile, were averaged across shifts and across workers. In addition, the standard deviation between workers, and the standard deviation between shifts within worker were computed. The results showed that trunk and arm postures during paper mill work were similar to other occupations involving manual materials handling, but the velocities of arm movements were lower. While postures determined by inclinometry and observation were similar on a group level, substantial differences were found between results obtained by the two methods for individual workers, particularly for extreme postures. Thus, measurements by either method on individuals or small groups should be interpreted with caution.

Evaluation of daily outpatient multidisciplinary rehabilitative treatment of patients with musculoskeletal, neurological and traumatic disorders in a municipality outpatient setting

BACKGROUND AND OBJECTIVE

Musculoskeletal, neurological, and traumatic injuries are a considerably increasing problem. There is a lack of studies evaluating the results of outpatient rehabilitative treatment of patients with the abovementioned diseases. The aim of this study was to determine the effectiveness of daily outpatient multidisciplinary rehabilitation.

MATERIALS AND METHODS

This observational study enrolled 223 adult people undergoing outpatient rehabilitation performed in a municipality outpatient clinic during 14 days. The functional assessment of disability was performed by using the Barthel index (BI), functional performance was estimated by the modified Keitel functional test (MKFT), and pain perception was evaluated by the visual analogue scale (VAS). The mean scores of the tests were compared before and after outpatient multidisciplinary rehabilitation.

RESULTS

Significantly reduced disability and pain perception as well as increased functional performance were documented after outpatient rehabilitation. The mean scores of BI, MKFT, and VAS before and after rehabilitation did not differ significantly among patients ranked to each cluster of diseases. Increased functional performance of patients had a moderate-to-weak association with decreased disability and pain perception. The positive changes in health status considering disability, functional performance, and pain perception were documented after 14-day rehabilitation.

CONCLUSIONS

Multidisciplinary outpatient rehabilitation can be considered as effective treatment. However, it is necessary to implement specific, well-adapted consuming assessment instruments in order to evaluate the outcomes of daily multidisciplinary outpatient rehabilitative treatment.

Is the interleukin-6 haplotype a prognostic factor for sciatica?

AIMS

We have shown in a cross-sectional setting that an IL6 haplotype (GGGA) is associated with intervertebral disc disease (IDD) characterized by sciatica. The aim of this study was to evaluate the prognostic role of the GGGA haplotype in IDD.

METHODS

DNA from 153 sciatica patients who participated in a randomized controlled trial of periradicular infiltration was analysed for IL6 variations rs1800797 (-596A>G), rs1800796 (-572G>C), rs1800795 (-174G>C), and rs13306435 (+15T>A). The patients recorded back and leg pain intensity and duration, disability by Oswestry Index and back-related sickness absence over a three-year follow-up. Repeated measures and univariate analysis of variance with adjustment for age, gender and physical work load were used in statistical analyses for the last two-years of the follow-up.

RESULTS

The prevalence of the GGGA haplotype was 9% (14/153). Subjects with the GGGA haplotype did not differ from those without the haplotype with respect to pain intensity, or disability score, but days with back and leg pain and days on sick leave were significantly higher among subjects with the IL6 haplotype after adjustment for occupation (p=0.006, 0.001 and 0.002, respectively). An interaction between the IL6 haplotype and physical work load was significant for the duration of back and leg pain and sick leave (p=0.038, 0.011 and 0.006, respectively).

CONCLUSIONS

This is the first observation of any prognostic genotype among sciatica patients. The IL6 haplotype GGGA predicted the number of days with back or leg pain and also sickness absence. Subjects with the IL6 haplotype may be more vulnerable when doing physically demanding jobs.

How consistently distributed are the socioeconomic differences in severe back morbidity by age and gender? A population based study of hospitalisation among Finnish employees

AIMS

To study the socioeconomic distribution of severe back morbidity by age and gender, and to examine to what extent the differences in back morbidity between socioeconomic groups are particularly related to manual work in different age groups.

METHODS

Hospital admissions in 1996 for back disorders of 25-64 year old men (3123 of a total 743,961) and women (3043 of 773,936) from the Finnish Hospital Discharge Register were linked with demographic and socioeconomic data from the 1995 population census. Poisson regression analysis was used to calculate the rate ratios for back related hospitalisation by occupational class and education. The distribution of cases according to occupational status and education was presented in relation to the whole occupationally active workforce by age and gender.

RESULTS

Blue-collar (manual) workers had a higher risk of being hospitalised because of back disorders compared with white-collar employees (non-manual) in all age groups among both genders. Manual work versus non-manual work was associated with a 1.3 to 1.4-fold risk (95% CI 1.0 to 1.8) among women and a 1.3 to 1.6-fold risk (95% CI 1.1 to 2.2) among men. The risk of hospitalisation was further inversely associated with educational level within manual and non-manual work in all other age groups except in those aged 55-64 years. Gender related differences were much smaller compared with the socioeconomic ones.

CONCLUSIONS

Socioeconomic differences in back morbidity leading to hospitalisation were consistent by age and gender. The results suggest that not only the physical strenuousness of work, but also other causes of severe back disorders are clustered around a subject's socioeconomic status, indicated by formal education. This may have implications for prevention and the planning of rehabilitation.

Co-occurrence of musculoskeletal pain among female kitchen workers

OBJECTIVES

The co-occurrence of musculoskeletal pain symptoms in seven body sites and their combinations among women in kitchen work were studied.

METHODS

Data on musculoskeletal pain during the past 3 months in the neck, shoulders, forearms/hands, low back, hips, knees and ankles/feet were gathered by questionnaire from 495 female workers (mean age 45 years) in connection with an ergonomic intervention study in municipal kitchens of four cities in Finland. Altogether 122 kitchens (60% of those eligible) participated in the study. The response rate in the participating kitchens was 98%.

RESULTS

The 3-month prevalence of any musculoskeletal pain was 87%, the most common sites being the neck (71%), low back (50%) and forearms/hands (49%). About 73% of the subjects had pain in at least two, 36% in four or more, and 10% in 6-7 sites. In pair wise comparisons, e.g. neck pain was associated with pain in other sites with prevalence ratios (PR) varying from 1.3 to 1.6, and ankle or foot pain with ratios between 1.9 and 2.4. The seven pain symptoms occurred in more than 80 different combinations. When the co-occurrence of pain was studied in three larger anatomical areas, i.e. any pain in the axial (neck and low back), upper limb and lower limb areas, subjects reporting concurrent pain in all three were the largest category (36% of the respondents). Altogether 53% of the workers reported pain in at least the axial and upper limb areas, and 48% in at least the axial and lower limb areas.

CONCLUSIONS

Widespread co-occurrence of musculoskeletal pain symptoms was common among female kitchen workers with slight predominance in the upper body.

Low back pain, work absenteeism, chronic back disorders, and clinical findings in the low back as predictors of hospitalization due to low back disorders: a 28-year follow-up of industrial employees

STUDY DESIGN

Prospective cohort study.

OBJECTIVE

To study symptoms, chronic disorders, and clinical findings in the low back, and work absenteeism, as predictors of hospitalization.

SUMMARY OF BACKGROUND DATA

Socioeconomic and lifestyle factors are associated with back-related hospitalization, but the significance in the working normal population of low back symptoms and clinical findings are not known.

METHODS

The cohort (n = 902) was drawn in 1973 from among employees in the metal industry (n = 2,653). The data were collected by questionnaire and a structured clinical assessment by a physiotherapist. Weight was measured. A sum score of local and radiating low back symptoms (frequency during the past year on a 4-point Likert scale) was categorized as no/yes and no/infrequent/frequent. Local and radiating symptoms were considered also separately. The data were linked with those from the Finnish Hospital Discharge Register during 1973 to 2000. Logistic regression and the Cox proportional hazard models were used.

RESULTS

As compared with persons without low back pain, those with frequent or radiating low back pain had an increased risk of hospitalization due to low back disorders (hazard rate ratio (HRR), 3.0; 95% confidence interval (CI), 1.4-6.5, and 3.7; 1.8-7.7, respectively) after adjustment for age, gender, and occupational class. Similarly, clinical findings (HRR, 2.4; 95% CI, 1.3-4.7), back-related absenteeism (HRR, 3.3; 95% CI, 1.6-6.7), and chronic low back disorders (HRR, 2.8; 95% CI, 1.5-5.4) predicted hospitalization. The associations persisted when further adjusted for smoking, body mass index, and distress symptoms at baseline.

CONCLUSION

Frequent or radiating low back symptoms, chronic low back disorders, back-related work absenteeism, and having clinical findings in the low back predicted inpatient hospital care for low back disorders.

Occupational exposures and inpatient hospital care for lumbar intervertebral disc disorders among Finns

BACKGROUND

Low back disorders are among the most common health problems in industrialized societies. We examined the relationship between occupational exposures and severe lumbar intervertebral disc disorders (LIDD).

METHODS

Information on inpatient care for LIDD (ICD-10: M51.1-51.9) in Finnish hospitals during 1996 was linked with the 1995 Population Census, and based on occupational title with the Finnish Job Exposure Matrix and the Occupational Lifestyle Matrix. There were 3,863 individuals hospitalized due to LIDD among occupationally active Finns. Poisson regression analyses were made with the total occupationally active population as reference.

RESULTS

In a multivariate analysis in women, accident risk, job control, and three-shift work were associated with hospitalization, together with age, education, personal income, and average body mass index (BMI) by occupation. In men, accident risk and job control were associated with hospital admissions, allowing for age, education, and income.

CONCLUSIONS

Accident risk and job control increased the risk of hospitalization for LIDD in both sexes. Three-shift work and BMI were also predictive of hospital admission among women.

Psychosocial factors at work as predictors of hospitalization for back disorders: a 28-year follow-up of industrial employees

STUDY DESIGN

A prospective cohort study.

OBJECTIVES

To study the association of psychosocial factors at work with severe back disorders leading to hospitalization.

SUMMARY OF BACKGROUND DATA

Some psychosocial factors at work have been related to back pain, but little is known about their predictive role in severe back disorders.

METHODS

Psychosocial factors at work were studied by questionnaire and interview in 1973 among a cohort of 902 metal industry employees. Information on hospital admissions for back disorders from the Finnish Hospital Discharge Register in 1973-2000 was linked to the data. Cox proportional hazards regression was used to estimate the time between the assessment of risk factors and the first hospital admission for intervertebral disc disorders (36 cases) and other back disorders (47 cases).

RESULTS

In a model including psychosocial factors and potential confounders, low job control versus high control was associated with a 3.2-fold risk (95% confidence interval, 1.3-7.8) of hospitalization for back disorders other than those of the intervertebral disc. The corresponding rate ratio for low versus high supervisor support was 2.9 (95% confidence interval, 1.3-6.3). Job demands, coworker support, and distress were not independently associated with these disorders. The result did not change when patients with chronic back disorder at baseline were excluded from the analysis. There was no association between psychosocial factors at work and hospitalizations for intervertebral disc disorders.

CONCLUSION

Low job control and low supervisor support seem to increase the risk of hospitalization for back disorders other than intervertebral disc disorders.

Ergonomic Pain--Part 2: Differential Diagnosis and Management Considerations

Work-related musculoskeletal disorders (MSDs) can produce ergonomic pain in several different regions of the body, including the shoulder, elbow, wrist and hand, lumbar spine, knee, and ankle/foot. Each family of disorders is distinctive in presentation and requires diagnosis-specific interventions. Because of the complex nature of these disorders, management approaches may not always eliminate symptoms and or completely restore patient function to a level found prior to symptom onset. As a consequence, ergonomic measures should be implemented to reduce the overload on tissue and contribute to patient recovery. However, functional limits may persist and the clinician must make further decisions regarding a person's functional status in the chronic stages of the patient's care.

Smoking and overweight as predictors of hospitalization for back disorders

STUDY DESIGN

A prospective cohort study.

OBJECTIVE

To study the relationship of smoking and overweight with severe back disorders leading to hospitalization.

SUMMARY OF BACKGROUND DATA

Many epidemiological studies have shown an association between smoking or overweight and back pain, but the results are still equivocal. Longitudinal studies are few.

METHODS

A cohort of metal industry employees (n = 902) was studied for lifestyle, work history, and health in 1973 by questionnaire and interview. The weight of the subjects was measured and body mass index (kg/m2) was calculated. Based on intensity and duration, smoking was categorized as: never smoked (reference), stopped smoking, smoked <or=9 or >9 pack-years. Information on hospital admissions from 1973 to 2000 from the Finnish Hospital Discharge Register was linked to the data. Seventy-five individuals had been admitted to hospital because of back disorders. Intervertebral disc disorders and other common back disorders were analyzed separately. Cox proportional hazards regression was used to estimate the time between the assessment of potential risk factors and the first hospitalization for a back disorder.

RESULTS

The rate ratio of heavy smokers (>9 pack-years) for hospitalization because of intervertebral disc disorders was 3.4 (95% confidence interval 1.3-9.0) as compared with never-smokers, allowing for other risk factors. Accordingly, the rate ratio of body mass index >27.5 kg/m2 was 2.7 (1.1-6.45) as compared with people with normal weight. The results retained when patients with chronic back disease at baseline were excluded from the analyses. Other back-related diagnoses of hospitalization were not consistently associated with smoking or overweight.

CONCLUSION

Heavy smoking and overweight predicted hospitalization for intervertebral disc disorders.