Document Detail

Causal assessment of awkward occupational postures and low back pain: results of a systematic review.
MedLine Citation:
PMID:  19910263     Owner:  NLM     Status:  MEDLINE    
BACKGROUND CONTEXT: Low back pain (LBP) is a prevalent and costly musculoskeletal disorder that often occurs in the working-age population. Although numerous physical activities have been implicated in its complex etiology, determining causation remains challenging and requires a methodologically rigorous approach.
PURPOSE: To conduct a systematic review of the scientific literature focused on establishing a causal relationship between awkward occupational postures and LBP.
STUDY DESIGN: Systematic review of the literature using MEDLINE, EMBASE, CINAHL, Cochrane Library, and Occupational Safety and Health database, gray literature, hand-searching occupational health journals, reference lists of included studies, and experts. Evaluation of methodological quality using a modified Newcastle-Ottawa Scale for observational studies. Summary levels of evidence for each of the Bradford Hill criteria for causality for each category of awkward occupational posture and type of LBP.
SAMPLE: Studies reporting an association between awkward occupational postures and LBP.
OUTCOME MEASURES: Numerical association between different levels of exposure to awkward occupational postures and the presence or severity of LBP.
METHODS: A systematic review was performed to identify, evaluate, and summarize the literature related to establishing a causal relationship, according to Bradford Hill criteria, between awkward occupational postures and LBP.
RESULTS: This search yielded 2,766 citations. Eight high-quality studies reported on awkward occupational postures and LBP. Three were case-control studies, one was cross-sectional, and four were prospective cohort studies. There was strong evidence for consistency of no association between awkward occupational postures and LBP, with only two studies demonstrating significant associations in most of their risk estimates compared with six studies reported mainly nonsignificant associations. Two studies assessed dose response, with one study demonstrating a nonsignificant dose-response trend. Three studies were able to assess temporality, but all demonstrated nonsignificant risk estimates. Biological plausibility was discussed by two studies. There was no available evidence to assess the experiment criterion for causality.
CONCLUSIONS: There was strong evidence from six high-quality studies that there was no association between awkward postures and LBP. Similarly, there was strong evidence from three high-quality studies that there was no temporal relationship. Moreover, subgroup analyses identified only a handful of studies that demonstrated only weak associations and no evidence for other aspects of causality in certain specific subcategories. It is therefore unlikely that awkward occupational postures are independently causative of LBP in the populations of workers studied.
Darren M Roffey; Eugene K Wai; Paul Bishop; Brian K Kwon; Simon Dagenais
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Publication Detail:
Type:  Journal Article; Review     Date:  2009-11-11
Journal Detail:
Title:  The spine journal : official journal of the North American Spine Society     Volume:  10     ISSN:  1878-1632     ISO Abbreviation:  Spine J     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-02-04     Completed Date:  2010-04-22     Revised Date:  2011-09-20    
Medline Journal Info:
Nlm Unique ID:  101130732     Medline TA:  Spine J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  89-99     Citation Subset:  IM    
Copyright Information:
Copyright 2010 Elsevier Inc. All rights reserved.
Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Ave., Ottawa, ON K1Y 4E9, Canada.
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MeSH Terms
Low Back Pain / etiology*,  physiopathology*
Occupational Diseases / etiology*,  physiopathology*
Posture / physiology*
Comment In:
Spine J. 2011 Jul;11(7):690-1; author reply 691-2   [PMID:  21821202 ]
Spine J. 2010 Oct;10(10):944; author reply 944-5   [PMID:  20869009 ]
Spine J. 2010 Jan;10(1):73-5   [PMID:  20129240 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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