ArticleLiterature Review

Sitting Posture During Occupational Driving Causes Low Back Pain; Evidence-Based Position or Dogma? A Systematic Review

September 2019
Human Factors The Journal of the Human Factors and Ergonomics Society 63(3):001872081987173

DOI:10.1177/0018720819871730

Authors:

Kelly-Ann Bowles

Monash University (Australia)

Terry Haines

Monash University (Australia)

Objective In this review, we determine if there is evidence to demonstrate a relationship between occupational driving posture and low back pain. Background The burden of low back pain is increasing. An understanding of this relationship is required to enable the development of recommendations for clinicians and policy-makers for the driving industry. Method Five databases were searched up to March 12, 2018. Study quality was assessed using the National Heart, Lung, and Blood Institute’s Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, followed by a GRADE analysis to consider the evidence as a whole. A narrative, critical synthesis was completed that considered the methods by which driving posture and low back pain were measured and analyzed. Results There were 653 articles identified, with seven eligible for review. Four articles identified an association between occupational driving posture and low back pain, yet this was based on the use of measurement tools lacking validity. Although a relationship may exist, the specific driving postures associated with low back pain and the strength of this relationship have not been confirmed. Conclusion Future research needs to employ validated and reliable, real-time qualitative methods for measuring occupational driving posture to advance our understanding of this relationship. Application Clinical and policy recommendations regarding driving posture and low back pain should be used with caution, as they are guided by evidence incorporating bias. Future studies are required to confirm the specific postures assumed while occupational driving and their relationship with low back pain, before recommendations can be made.

Actividad física como tratamiento del dolor crónico de espalda baja no específico: revisión sistemática.

Article

Full-text available

Dec 2022

El dolor de espalda baja (LBP) es una de las discapacidades que más afecta a la población adulta (70%) hoy en día. En la actualidad se le ha dado demasiada importancia a los factores biomecánicos y su preocupación hacia ellos, como es por ejemplo mantener una correcta higiene postural, sin atender tanto a otros factores como es el contexto ambiental de la persona y condiciones económicas. En este trabajo de revisión se ha tratado de revisar a fondo las causas, tratamiento y readaptación, del dolor crónico no específico en espalda baja que precisamente se corresponde con el 85% de los casos de dolor de espalda baja. Las bases de datos utilizadas para la búsqueda de información fueron Scopus, Sportdiscus, Pubmed y diferentes revistas gran impacto según Web of Science. La evidencia actual sugiere que debe ser evaluada y tratada desde un enfoque más integrador como es el modelo biopsicosocial, llevado a cabo por un equipo multidisciplinar, donde el paciente forme parte activa del proceso de readaptación, en el que tendrá tanta importancia evaluar los diferentes factores que han causado su aparición y tratamiento, como su prevención. Por ello, en este trabajo se propone una intervención basada en un programa de ejercicio físico adaptado e individualizado a las condiciones del sujeto, así como una intervención educacional sobre las causas y evolución de dicha discapacidad, evitando generar comportamiento kinesiofóbicos desencadenantes en un comportamiento sedentario.

Lumbar Flexion During Driving: Establishing a Methodology for Characterising Real-Time Posture Data Collected by Innovative Technology

Article

Dec 2021

Objective To determine a methodology for the analysis of real-time driving posture data in the low back pain population. Background The strength of the relationship between driving posture and low back pain is yet to be defined due to the lack of studies in the field using validated and repeatable posture measurement tools. Reliable and validated real-time measurement tools are now available, yet reliable methods of analysis of these data are yet to be established. Method Ten occupational drivers completed a typical work shift while wearing an inertial motion sensor system (dorsaVi ViMove). Real-time lumbar flexion data were extracted, with test–retest reliability of mean lumbar flexion, peak lumbar flexion, and standard deviation of lumbar flexion analysed at different times across a work shift, and in different sections within a drive. Results Mean lumbar flexion was highly repeatable over numerous drives in one day, with greater test–retest reliability if the first five minutes of driving data were excluded. Peak lumbar flexion had acceptable test-retest reliability over numerous drives in one day, while standard deviation of lumbar flexion was not a repeatable measure. Conclusion Mean lumbar flexion was a reliable outcome for characterising driving posture in drivers with low back pain. Peak lumbar flexion may be used if appropriate to the individual study. Standard deviation of lumbar flexion is not a reliable posture outcome. Application This paper provides a reliable methodology for analysis of real-time driving posture data in occupational drivers with low back pain.

The Vehicle Seating Intervention Trial: Cross-Over Randomized Controlled Trial to Evaluate the Impact of 2 Car Seat Configurations on Spinal Posture

Article

Oct 2023

Driving posture can lead to musculoskeletal pain. Most work focuses on the lower back; therefore, we know little about automobile seat design and neck posture. This study evaluated an automobile driver seat that individualized upper back support to improve head and neck posture. Specifically, we examined the system’s impact on anterior head translation with secondary outcomes of spine posture and perceptions of comfort/well-being compared with a control. Forty participants were block randomized to experience either the activated or deactivated version of the same seating system first. Participants completed two 30-minute simulated driving trials, separated by washout, with continuous measures of anterior head translation, spine posture, and pelvis orientation. Perceptions of comfort/well-being were assessed by survey and open-ended questions immediately following each condition. Small, but statistically significant decreases in anterior head translation and posterior pelvic tilt occurred with the activated seat system. Participants reported lower satisfaction with the activated seat system. Order of the 2 seat conditions affected differences in pelvis orientation and participant perceptions of comfort/well-being. An anthropometric-based seat system targeting upper back support can significantly affect head and pelvic posture but not satisfaction during simulated driving. Future work should examine long-term impacts of these posture changes on health outcomes.

No Evidence for the Biomechanical and Pathophysiological Explanatory Models of Musculoskeletal Diseases According to Liebscher & Bracht

Article

Full-text available

Feb 2022
Z ORTHOP UNFALLCHIR

Article 746591 S (2022) International Publication Trends in Low Back Pain Research: A Bibliometric and Visualization Analysis

Article

Full-text available

Mar 2022

Background: Although there is a growing research base on low back pain, the bibliometric literature related to it is deficient. The aim of this study was to conduct a bibliometric and visualization analysis of low back pain and to provide a broad view of the current trends in LBP research and a potential guide in this discipline. Methods: The authors searched the Web of Science to extract publications regarding low back pain, and found a total of 12,249 publications during a period of 22 years, among which 12,242 were eligible. We classified and analyzed publications such as total citations, average citations per item, H-index, research types, countries/regions, institutions, and journals using standard bibliometric indicators. Bibliometric approaches (VOSviewer1.6.13 and CiteSpace 5.8.3) were also available for gathering information and explore the trends of research. Results: Conspicuously, over the past 22 years, an increasing number of scholars have specialized in the research of LBP, exerting the boom in articles. The largest number of document type was that of articles. Under modern conditions, regional distinction existed in the research of low back pain and developed countries preceded others. Research individuals and institutions were preoccupied by respective aspects. Visualization analysis provided objective information for potential collaborators and cooperative institutions. Furthermore, most burst keywords varied during different periods. Conclusions: The map of research on LBP obtained by our analysis is expected to help researchers to efficiently and effectively explore LBP.

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

Article

Full-text available

Aug 2023

Unlabelled: 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.

Driving the prevention of low back pain in police officers: A systematic review

Article

Jun 2023

LAY SUMMARY Police officers are exposed to multiple risks that increase the prevalence of low back pain. Few interventions have been tailored to help with prevention of low back pain. This systematic literature review aimed to analyse interventions done with civilian or military police officers for this ongoing problem and to identify solutions to help alleviate low back pain in this population. Approaches in the literature regarding police officers and low back pain included an analysis of equipment in patrol vehicles, equipment worn by police officers, and individual factors, such as physical condition and mental state. Findings show multiple methods that can be used to further study low back pain among police officers and reduce its burden.

Low Back Pain and Upper-Extremity Musculoskeletal Disorders in French Postal Workers Driving Light-Duty Vehicles for Mail and Parcel Delivery

Article

Full-text available

Jan 2023
Int J Environ Res Publ Health

Occupational driving of light-duty vehicles (LDVs) became increasingly important in parcel delivery faced with the explosive growth of e-commerce. Since musculoskeletal disorders (MSDs) represent the most reported driving-related health problem, we aimed to analyze the risk of low back pain (LBP) and upper-extremity musculoskeletal disorders (UEMSDs) associated with driving LDVs for parcel delivery. In 306 postal workers exposed to driving and 100 unexposed workers, information on occupational driving, physical/psychosocial constraints, and work organization were collected via a questionnaire. MSDs were assessed using the Nordic Questionnaire, 14 additional questions regarding LBP, and a standardized clinical examination for UEMSDs. Statistical modeling consisted of multivariable logistic regression for UEMSDs and the item response theory approach for LBP. UEMSDs were associated with the distance of rural rounds and inversely associated with urban/mixed delivery rounds. Handling heavy loads was associated with LBP, and high physical demands during delivery rounds were related to MSDs. Karasek dimensions and mobbing actions were associated with MSDs. Work recognition, driving training, using an automatic gearbox, and the utilization of additional staff during peak periods were inversely associated with MSDs. Our results suggest that the distance driven in rural settings and high physical demands were associated with MSDs, while some organizational factors could protect from MSDs.

ERGONOMICS OF AUTOMATIC TRANSMISSION VEHICLE ON WORK -RELATED MUSCULOSKELETAL DISORDER AMONG ACADEMIC AND NON-ACADEMIC STAFF OF LAGOS STATE UNIVERSITY

Article

Full-text available

Apr 2022

The study is examined the ergonomic of automatic transmission vehicle on work-related musculoskeletal disorder among academic and non-academic staff of Lagos State University. The ergonomic effects of automatic transmission vehicles on employee while driving to and from work. Employees that are frequently exposed to long period of standing position when performing work-related functions such as lecturing, laboratory experiment and the sitting position during research, administrative function and even some laboratory experiment like the academic. This can then be compared to employees that are mostly exposed to more sitting position within the same system, non-academics for a robust comparative analysis. The study aimed to examine how the effect of driving automated transmission vehicle on workplace-related musculoskeletal disorders among academic and to investigate the effect of driving automated transmission vehicle on workplace-related musculoskeletal disorders among non-academics in Lagos State University. This study adopted descriptive research design. The population of the study comprise the entire 557 Academic and 1423 non-academic staffs in Ojo campus. Though, the population should be only staffs that drives personally automated transmission vehicles to office, but at the initial stage it was difficult to determine such staffs. It was adequately noted from the questionnaires filled. A sample of 234 and 312 were drawn from the population of academic and non-academic staff respectively using Yamane (1969 as cited by Anokye, 2020). The reliability of the research instrument was assessed using the Cronbach's Alpha coefficient while the validity was assessed using content and face validities. The study found that, there is a weak positive relationship between that driving automated transmission vehicle and workplace-related musculoskeletal disorders among academics in Lagos State University (R = 0.076). This implies that driving automated transmission vehicles do not significantly affect workplace-related musculoskeletal disorders among academics in Lagos State University, that driving automated transmission vehicles explains about (R= 0.032) of workplace-related musculoskeletal disorders among non-academic members of staff of Lagos State University and the more they drive automated transmission vehicles, the more non-academic members of staff of Lagos State University experience workplace-related musculoskeletal disorders, (Beta = 0.178). This study concluded that a slightly increase in the impact of driving ATV on WMSD among non-academics when compared to the academics, this is not significant enough to show that the external work of driving ATV and, therefore, recommended that the management in academic systems should strategically focus their policy more on the workplace environment to reduce WMSDs.

ERGONOMICS AND PERFORMANCE OF ACADEMIC STAFF IN SELECTED TERTIARY INSTITUTION IN LAGOS STATE. Article

Article

Full-text available

Apr 2022

International Publication Trends in Low Back Pain Research: A Bibliometric and Visualization Analysis

Article

Full-text available

Mar 2022

A vision for the future of wearable sensors in spine care and its challenges: narrative review

Article

Jan 2021

Objective: This review aimed to: (I) provide a brief overview of some topical areas of current literature regarding applications of wearable sensors in the management of low back pain (LBP); (II) present a vision for a future comprehensive system that integrates wearable sensors to measure multiple parameters in the real world that contributes data to guide treatment selection (aided by artificial intelligence), uses wearables to aid treatment support, adherence and outcome monitoring, and interrogates the response of the individual patient to the prescribed treatment to guide future decision support for other individuals who present with LBP; and (III) consider the challenges that will need to be overcome to make such a system a reality. Background: Advances in wearable sensor technologies are opening new opportunities for the assessment and management of spinal conditions. Although evidence of improvements in outcomes for individuals with LBP from the use of sensors is limited, there is enormous future potential. Methods: Narrative review and literature synthesis. Conclusions: Substantial research is underway by groups internationally to develop and test elements of this system, to design innovative new sensors that enable recording of new data in new ways, and to fuse data from multiple sources to provide rich information about an individual's experience of LBP. Together this system, incorporating data from wearable sensors has potential to personalise care in ways that were hitherto thought impossible. The potential is high but will require concerted effort to develop and ultimately will need to be feasible and more effective than existing management.

The Impact of Social Support and Pregnancy on Subjective Well-Being: A Systematic Review

Article

Full-text available

Sep 2021

Background: Subjective well-being (SWB) has a protective role in mental health maintenance and is prone to change during short stressful moments, such as pregnancy. Longstanding research suggests that social support (SS) from the partner and family members of pregnant women directly or indirectly acts as a buffer against negative mental outcomes. For happier pregnancies, it is important to understand how SS and pregnancy affect the SWB. Objective: This review aims to examine the extended association of being pregnant and SS on the SWB of pregnant women. Methods: A systematic review was conducted in PubMed, ScienceDirect, and Google Scholar. Articles published in peer-reviewed journals were included regardless of the year and if they had assessed the impact of at least one SWB or SS outcome among healthy pregnant women. The tools of the National Heart, Lung, and Blood Institute were used for quality assessment. Results: Thirty-four studies that assessed the domains of SWB measurements, such as happiness, quality of life (QoL), life satisfaction, positive and negative effects, and well-being, were included and its association with either pregnancy or SS was summarized. Variable results, such as life satisfaction, happiness, and mental component of QoL, were found to be high during pregnancy, but positive emotion and physical components of QoL had decreased. Almost universally, SS during pregnancy was found to have a positive association with all measurements of SWB. Conclusion: This study had found that, despite some arising trends, pregnancy itself does not necessarily have similar impacts on SWB across healthy pregnant women. However, SS had a significant effect on SWB.

Low Back Pain and Associated Factors Among Auto Mechanics in two Suburbs of Accra, Ghana -A Cross-Sectional Study

Article

Jun 2021

Background: Universally, work-related illness and injury continue to be of great concern because it is the principal cause of surge in work productivity. It is estimated to cost nearly $2.8 trillion (4%) of annual Gross Domestic Product (GDP) due to sickness absence, lost workday, worker's compensation and daily production interruption. Amongst these work-related illness and injuries, musculoskeletal pain is rife. It is projected to constitute about 32% of work-related injuries. Musculoskeletal pain affects most body parts of the individual. It may affect the neck, shoulders, back, thighs, elbow, wrists, or legs. Leading amongst these is the low back accounting for over 60% of all musculoskeletal pain. Low back pain is almost ubiquitous amongst all class of professionals. Methods: The study employed a cross-sectional study design with a quantitative approach to determine the factors influencing the risk of developing low back pain amongst auto mechanics. Participants were selected using multistage random sampling. Fisher's exact test and Logistic regression were employed to test association and predict the likelihood to experience low back pain. Results: Of the192 total Auto Mechanics who participated in the two communities (Korle Gonno and Mamprobi), 80% were "Apprentices", 11.5% were "Masters", and the remaining 9.9% are "Coworkers". The prevalence of Low Back Pain (LBP) among the studied respondents was high (92.1%). However, the back pain intensity level shows that 21.9% of respondents have Minimal disability, 62.0% have Moderate disability, and 9.4% have severe disability, while 6.8% of the participants are crippled. The study realized that factors influencing the risk of developing LBP include job support, the level of knowledge, and the position held in the job. Conclusion: The prevalence of LBP amongst study participants was high, with most of the studied participants experiencing moderate disability. Nevertheless, majority of them had adequate knowledge of body mechanic techniques. Job support, Job Position and Knowledge were found to significantly influence the determination of the condition among study recruits.

Lumbar spine movement profiles uniquely characterize postural variation during simulated prolonged driving

Article

Aug 2022

Prolonged driving has been linked to the development of low back pain. Methods to examine time varying postural changes of the lumbar spine during driving have been scarcely investigated. Distinguishing postural variation as movement patterns such as lumbar shifts and fidgets may provide novel insight, which may otherwise be lost with analyses that parameterize variation as a single value. This investigation aimed to identify if lumbar spine shifts or fidgets typically occur in automotive sitting and if differences occur across sex or time. An additional objective was to investigate the extent these movement patterns can capture variation across time. Forty participants (18 F, 22 M) performed a one hour driving simulation. Number, duration and amplitude of shifts and fidgets as well as the mean and standard deviation (SD) of lumbar angle were calculated. Reported discomfort and pain were also recorded. Shifts and fidgets occurred in the absence of discomfort or pain and did not vary on average across time or sex (p > 0.05). Movement patterns characterized variation with a higher resolution compared to lumbar angle SD. Identifying lumbar shifts and fidgets provide an increased potential to understand individual time varying postural responses during driving, including the development of low back discomfort or pain.

Quantifying the lumbar spine movements of surgeons during surgical lists in a teaching hospital

Article

Full-text available

Sep 2018

Background Low back pain (LBP) is a common occupational musculoskeletal complaint among health professionals. No research has quantified lumbar movement patterns in the surgical workplace, identifying ‘at risk’ behaviours with objective measures. This project aimed to identify lumbar movement patterns and change in LBP of surgeons and surgical trainees during a surgical list. Methods Surgeons or surgical trainees were recruited in a tertiary metropolitan hospital. Low back movements were quantified in real time via a monitoring system. This measured three‐dimensional movement, velocity, acceleration and orientation to gravity during a typical theatre session. Pre‐ and post‐surgery LBP, or low back injury measures of functional disability were quantified using the Oswestry disability index. Mean (standard deviation) and median (interquartile range) low back movement patterns were described. A Wilcoxon signed‐rank test determined differences in LBP recorded from beginning to end of recording periods. Results Participants (n = 28) recorded data for a mean (standard deviation) of 6.1 (2.2) h. On average, 27.7 lumbar flexion events were recorded per monitoring session, with flexion movements held for >30 s an average of 5.6 times. Many of the flexion events were considered low range (between 20° and 40°) with an average of 19.1 events per session. Orthopaedic trainees recorded the highest average of lumbar and sustained lumbar flexions per hour (4.13 times). LBP significantly increased over the work day (z = −2.53, P = 0.012). Conclusion This study provides a base for the understanding of low back movement patterns during surgery. This data may be useful in helping surgeons to identify their ‘high risk’ movements and prevent low back symptoms.

Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Article

Full-text available

Sep 2017

Background: As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016. Methods: We estimated prevalence and incidence for 328 diseases and injuries and 2982 sequelae, their non-fatal consequences. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between incidence, prevalence, remission, and cause of death rates for each condition. For some causes, we used alternative modelling strategies if incidence or prevalence needed to be derived from other data. YLDs were estimated as the product of prevalence and a disability weight for all mutually exclusive sequelae, corrected for comorbidity and aggregated to cause level. We updated the Socio-demographic Index (SDI), a summary indicator of income per capita, years of schooling, and total fertility rate. GBD 2016 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings: Globally, low back pain, migraine, age-related and other hearing loss, iron-deficiency anaemia, and major depressive disorder were the five leading causes of YLDs in 2016, contributing 57·6 million (95% uncertainty interval [UI] 40·8–75·9 million [7·2%, 6·0–8·3]), 45·1 million (29·0–62·8 million [5·6%, 4·0–7·2]), 36·3 million (25·3–50·9 million [4·5%, 3·8–5·3]), 34·7 million (23·0–49·6 million [4·3%, 3·5–5·2]), and 34·1 million (23·5–46·0 million [4·2%, 3·2–5·3]) of total YLDs, respectively. Age-standardised rates of YLDs for all causes combined decreased between 1990 and 2016 by 2·7% (95% UI 2·3–3·1). Despite mostly stagnant age-standardised rates, the absolute number of YLDs from non-communicable diseases has been growing rapidly across all SDI quintiles, partly because of population growth, but also the ageing of populations. The largest absolute increases in total numbers of YLDs globally were between the ages of 40 and 69 years. Age-standardised YLD rates for all conditions combined were 10·4% (95% UI 9·0–11·8) higher in women than in men. Iron-deficiency anaemia, migraine, Alzheimer's disease and other dementias, major depressive disorder, anxiety, and all musculoskeletal disorders apart from gout were the main conditions contributing to higher YLD rates in women. Men had higher age-standardised rates of substance use disorders, diabetes, cardiovascular diseases, cancers, and all injuries apart from sexual violence. Globally, we noted much less geographical variation in disability than has been documented for premature mortality. In 2016, there was a less than two times difference in age-standardised YLD rates for all causes between the location with the lowest rate (China, 9201 YLDs per 100 000, 95% UI 6862–11943) and highest rate (Yemen, 14 774 YLDs per 100 000, 11 018–19 228). Interpretation: The decrease in death rates since 1990 for most causes has not been matched by a similar decline in age-standardised YLD rates. For many large causes, YLD rates have either been stagnant or have increased for some causes, such as diabetes. As populations are ageing, and the prevalence of disabling disease generally increases steeply with age, health systems will face increasing demand for services that are generally costlier than the interventions that have led to declines in mortality in childhood or for the major causes of mortality in adults. Up-to-date information about the trends of disease and how this varies between countries is essential to plan for an adequate health-system response.

Cost-effectiveness of using a motion-sensor biofeedback treatment approach for the management of sub-acute or chronic low back pain: Economic evaluation alongside a randomised trial

Article

Full-text available

Jan 2017
BMC MUSCULOSKEL DIS

Background Low back pain is a common and costly condition internationally. There is high need to identify effective and economically efficient means for managing this problem. This study aimed to explore the cost-effectiveness of a novel motion-sensor biofeedback treatment approach in addition to guidelines-based care compared to guidelines-based care alone, from a societal perspective over a 12 month time horizon. Method This was an incremental cost-effectiveness analysis conducted concurrently with a pilot, cluster randomized controlled trial. Health care resource use was collected using daily diaries and patient-self report at 3, 6 and 12 month follow-up assessments. Productivity was measured using industry classifications and participant self-reporting of ability to do their normal work with their present pain. Clinical effect was measured using the Patient Global Impression of Change measured at the 12 month follow-up assessment. Data were compared between groups using linear regression clustered by recruitment site. Bootstrap resampling was used to generate a visual representation of the 95% confidence interval for the incremental cost-effectiveness estimate. Two, one-way sensitivity analyses were undertaken to examine the robustness of findings to key assumptions. ResultThere were n = 38 participants in the intervention group who completed the 12 month assessment and n = 45 in the control. The intervention group had greater use of trial-related medical and therapy resources [$477 per participant (95% CI: $447, $508)], but lower use of non-trial medical and therapy resources [$-53 per participant (95% CI: $-105, $-0)], and a greater improvement in productivity [$-5123 per participant (95% CI: $-10,174, $-72)]. Overall, the intervention dominated with a saving of $478,100 and an additional 41 participants self-rating as being very or much improved compared to the control. There was >99% confidence in this finding of dominance in both the primary and sensitivity analyses. Conclusions The motion-sensor biofeedback treatment approach in addition to guidelines- based care appears to be both more clinically effective and economically efficient than guidelines- based care alone. This approach appears to be a viable means to manage low back pain and further research in this area should be a priority. Trial registrationThe randomised trial this research was based upon was prospectively registered on March 25th 2009 with the Australian New Zealand Clinical Trials Registry: ACTRN12609000157279.

Effect of physical and psychosocial factors on occupational low back pain

Article

Full-text available

Oct 2012

Background: Musculoskeletal pain, in particular low back pain, is one of the most common occupational health problems and accounts for a large number of workers' compensational days and disability in modern industrialised societies. It is believed that occupational musculoskeletal pain is caused by multiple factors, generally categorised into physical, psychosocial and lifestyle ones. Aims: The aim of this review was to evaluate role of psychosocial and physical risk factors in work-related low back pain in the light of current literature. Methods and material: The method of this review evaluated both research and review studies in national and international literature which about role of psychosocial and physical risk factors in work-related low back pain. Results: Various physical factors mechanical impacts have been found to be associated with pain in different body regions. Heavy physical work, heavy or frequent manuel operations, repeated rotation of the trunk, whole body vibration and prolonged sitting were positively associated with low back pain. Psychosocial factors at work have also been shown to play important roles in the development of low back pain. Factors such as work demands, decision latitude, symptoms of stress and social support have been reported as important psychosocial factors at work. However, the causal and independent contribution of the work enviroment on the incidence of low back pain is stil debated, especially with regard to psychosocial factors. Conclusion: A number of researchers have been examined the evidence for psychosocial factors at work as risk factors for back pain in recent years. It is recommended to be addressed psychosocial factors as physical factors as for management of work related low back pain.

The effect of changing movement and posture using motion-sensor biofeedback, versus guidelines-based care, on the clinical outcomes of people with sub-acute or chronic low back pain-a multicentre, cluster-randomised, placebo-controlled, pilot trial

Article

Full-text available

May 2015
BMC MUSCULOSKEL DIS

The aims of this pilot trial were to (i) test the hypothesis that modifying patterns of painful lumbo-pelvic movement using motion-sensor biofeedback in people with low back pain would lead to reduced pain and activity limitation compared with guidelines-based care, and (ii) facilitate sample size calculations for a fully powered trial. A multicentre (8 clinics), cluster-randomised, placebo-controlled pilot trial compared two groups of patients seeking medical or physiotherapy primary care for sub-acute and chronic back pain. It was powered for longitudinal analysis, but not for adjusted single-time point comparisons. The intervention group (n = 58) received modification of movement patterns augmented by motion-sensor movement biofeedback (ViMove, dorsaVi.com) plus guidelines-based medical or physiotherapy care. The control group (n = 54) received a placebo (wearing the motion-sensors without biofeedback) plus guidelines-based medical or physiotherapy care. Primary outcomes were self-reported pain intensity (VAS) and activity limitation (Roland Morris Disability Questionnaire (RMDQ), Patient Specific Functional Scale (PSFS)), all on 0-100 scales. Both groups received 6-8 treatment sessions. Outcomes were measured seven times during 10-weeks of treatment and at 12, 26 and 52 week follow-up, with 17.0 % dropout. Patients were not informed of group allocation or the study hypothesis. Across one-year, there were significant between-group differences favouring the intervention group [generalized linear model coefficient (95 % CI): group effect RMDQ -7.1 (95 % CI-12.6;-1.6), PSFS -10.3 (-16.6; -3.9), QVAS -7.7 (-13.0; -2.4); and group by time effect differences (per 100 days) RMDQ -3.5 (-5.2; -2.2), PSFS -4.7 (-7.0; -2.5), QVAS -4.8 (-6.1; -3.5)], all p < 0.001. Risk ratios between groups of probability of improving by >30 % at 12-months = RMDQ 2.4 (95 % CI 1.5; 4.1), PSFS 2.5 (1.5; 4.0), QVAS 3.3 (1.8; 5.9). The only device-related side-effects involved transient skin irritation from tape used to mount motion sensors. Individualised movement retraining using motion-sensor biofeedback resulted in significant and sustained improvements in pain and activity limitation that persisted after treatment finished. This pilot trial also refined the procedures and sample size requirements for a fully powered RCT. This trial (Australian New Zealand Clinical Trials Registry NCT01572779) was equally funded by dorsaVi P/L and the Victorian State Government.

Effectiveness of Simulation for Improvement in Self-Efficacy Among Novice Nurses: A Meta-Analysis

Article

Full-text available

Nov 2014

The influence of simulation on self-efficacy for novice nurses has been reported inconsistently in the literature. Effect sizes across studies were synthesized using random-effects meta-analyses. Simulation improved self-efficacy in one-group, pretest-posttest studies (Hedge's g = 1.21, 95% CI [0.63, 1.78]; p < 0.001). Simulation also was favored over control teaching interventions in improving self-efficacy in studies with experimental designs (Hedge's g = 0.27, 95% CI [0.1, 0.44]; p = 0.002). In nonexperimental designs, consistent conclusions about the influence of simulation were tempered by significant between-study differences in effects. Simulation is effective at increasing self-efficacy among novice nurses, compared with traditional control groups. [J Nurs Educ. 2014;53(11):607-614.].

The global burden of low back pain: Estimates from the Global Burden of Disease 2010 study

Article

Full-text available

Mar 2014
ANN RHEUM DIS

To estimate the global burden of low back pain (LBP). LBP was defined as pain in the area on the posterior aspect of the body from the lower margin of the twelfth ribs to the lower glutaeal folds with or without pain referred into one or both lower limbs that lasts for at least one day. Systematic reviews were performed of the prevalence, incidence, remission, duration, and mortality risk of LBP. Four levels of severity were identified for LBP with and without leg pain, each with their own disability weights. The disability weights were applied to prevalence values to derive the overall disability of LBP expressed as years lived with disability (YLDs). As there is no mortality from LBP, YLDs are the same as disability-adjusted life years (DALYs). Out of all 291 conditions studied in the Global Burden of Disease 2010 Study, LBP ranked highest in terms of disability (YLDs), and sixth in terms of overall burden (DALYs). The global point prevalence of LBP was 9.4% (95% CI 9.0 to 9.8). DALYs increased from 58.2 million (M) (95% CI 39.9M to 78.1M) in 1990 to 83.0M (95% CI 56.6M to 111.9M) in 2010. Prevalence and burden increased with age. LBP causes more global disability than any other condition. With the ageing population, there is an urgent need for further research to better understand LBP across different settings.

A Reliability Study of the New Back Strain Monitor Based on Clinical Trials

Article

Full-text available

Feb 2008

A new Back Strain Monitor (BSM) device has been developed in order to measure, record and analyze movements of the lower back. The purpose of this study was to examine the inter-tester and the intra-tester reliability of the movement measurements given by the BSM accelerometers, and compare it with the reliability of two other conventional measurement methods: the Double Inclinometer method (DI) and the Modified-Modified Schober (MMS) method. The clinical studies included 23 participants (16 males, 7 females) with no recent history of lower back pain, who wore the device during a combination of different anatomical movements (flexion, extension, left lateral flexion and right lateral flexion of the lumber spine). The tests were conducted by three therapists (testers). The reliability results for the BSM accelerometers clearly outperform the results obtained for the DI and the MMS methods. The inter-tester reliability gives the Intra-Class Correlation (ICC) value of 0.95 for the BSM flexion, 0.89 for the DI flexion and 0.74 for the MMS. The intra-tester reliability gives the ICC value of 0.99 for BSM flexion, 0.94 for DI flexion and 0.77 for the MMS. The BSM accelerometers were highly reliable in assessing back movements, measuring these movements with less error than the DI and MMS methods.

Self-Reported Low Back Symptoms in Urban Bus Drivers Exposed to Whole-Body Vibration

Article

Full-text available

Oct 1992

The prevalence of self-reported low back symptoms was investigated by a postal questionnaire in a group of 234 urban bus drivers exposed to whole-body vibration and postural stress and in a control group of 125 maintenance workers employed at the same bus municipal company. The average vertical whole-body vibration magnitude measured on the seat pan of the buses was 0.4 m/s2. After controlling for potential confounders, the prevalence odds ratios for the bus drivers compared to the controls significantly exceeded 1 for several types of low back symptoms (leg pain, acute low back pain, low back pain). The occurrence of low back symptoms increased with increasing whole-body vibration exposure expressed in terms of total (lifetime) vibration dose (years m2/s4), equivalent vibration magnitude (m/s2), and duration of exposure (years of service). The highest prevalence of disc protrusion was found among the bus drivers with more severe whole-body vibration exposure. Frequent awkward postures at work were also related to some types of low back symptoms. It is concluded that bus driving is associated with an increased risk for low back troubles. This excess risk may be due to both whole-body vibration exposure and prolonged sitting in a constrained posture. The findings of this study also indicated that among the bus drivers low back symptoms occurred at whole-body vibration exposure levels that were lower than the health-based exposure limits proposed by the International Standard ISO 2631/1.

Positive and negative evidence of risk factors for back disorders

Article

Full-text available

Sep 1997

The scientific literature on work-related back disorders was reviewed to identify consistent risk factors and to determine the strength of the association between the two. Thirty-five publications were selected with quantitative information. Lifting or carrying loads, whole-body vibration, and frequent bending and twisting proved to be the physical load risk factors consistently associated with work-related back disorders. Job dissatisfaction and low job decision latitude proved to be important, but the evidence was not consistent across different studies and study designs. The epidemiologic studies illustrated the importance of several confounders, especially age, smoking habits, and education. In this review, gender, height, weight, exercise, and marital status were consistently not associated with back disorders in occupational populations.

Task and postural factors are related to back pain in helicopter pilots

Article

Full-text available

Sep 2002
AVIAT SPACE ENVIR MD

A previous survey by Shear et al. revealed a high prevalence of back pain in Royal Navy helicopter aircrew, compared with controls. It was recommended that a second survey be undertaken, taking account of flying tasks and cockpit ergonomics. This was the purpose of the present investigation. A questionnaire containing items on back pain and posture was circulated to all 246 acting pilots, with returns of 75%. The questionnaire sought information on pain in both the flying pilot and co-pilot/instructor roles. The 12-mo prevalence of back pain was 80%. Task-related back pain was greatest in instrument flying (72%) and least in the co-pilot and instructor roles (24%). Self-ratings of posture indicated that forward flexed trunk postures predominated in the flying roles and were most extreme in instrument flying. In non-flying roles, symmetrical, reclining postures were more often reported. No demographic or psychosocial variables were significantly related to back pain prevalence or disability. Much of the back pain experienced by helicopter pilots appears to be due to the posture needed to operate the cyclic and collective controls. In instrument flying, it is suggested that the visual demands of scanning the displays may exacerbate the pain by causing the pilot to lean further forward.

Grading quality of evidence and strength of recommendationGRADE Working GroupBMJ20043281490149742852515205295

Article

Full-text available

Jul 2004
Br Med J

Users of clinical practice guidelines and other recommendations need to know how much confidence they can place in the recommendations. Systematic and explicit methods of making judgments can reduce errors and improve communication. We have developed a system for grading the quality of evidence and the strength of recommendations that can be applied across a wide range of interventions and contexts. In this article we present a summary of our approach from the perspective of a guideline user. Judgments about the strength of a recommendation require consideration of the balance between benefits and harms, the quality of the evidence, translation of the evidence into specific circumstances, and the certainty of the baseline risk. It is also important to consider costs (resource utilisation) before making a recommendation. Inconsistencies among systems for grading the quality of evidence and the strength of recommendations reduce their potential to facilitate critical appraisal and improve communication of these judgments. Our system for guiding these complex judgments balances the need for simplicity with the need for full and transparent consideration of all important issues.

Low-back disorders in agricultural tractor drivers exposed to whole-body vibration and postural stress

Article

Full-text available

Sep 1994
APPL ERGON

The occurrence of low-back pain (LBP) was investigated in a population of 1155 tractor drivers exposed to whole-body vibration (WBV) and postural stress (response rate 91.2%) and in a control group of 220 office workers (response rate 92.2%). The subjects were questioned about several types of low-back symptom (LBP, sciatic pain, acute LBP, transient and chronic LBP) and various work- and individual-related risk factors, by using a standardized questionnaire. Vibration measurements were performed on a representative sample of the vehicles driven by the tractor drivers in the last ten years. Vibration magnitude and duration of exposure were used to calculate a vibration dose for each tractor driver. Perceived postural load was assessed in terms of frequency and/or duration of awkward postures at work. The prevalence of LBP was found to be greater in the tractor drivers than in the controls. After controlling for potential confounders by logistic modelling, low-back disorders were found to be significantly associated with both vibration dose and postural load. Back accidents and age were also significant predictors for LBP. Quantitative regression analysis indicated that vibration exposure and postural load were independent contributors to the increased risk for LBP according to a multiplicative model. The exposure levels for WBV recently recommended by a proposal of European Directive on physical agents seem to be more adequate to prevent long-term health effects on the lower back than the exposure limits suggested by the International Standard ISO 2631/1.

Association between sitting and occupational LBP

Article

Full-text available

Mar 2007

Low back pain (LBP) has been identified as one of the most costly disorders among the worldwide working population. Sitting has been associated with risk of developing LBP. The purpose of this literature review is to assemble and describe evidence of research on the association between sitting and the presence of LBP. The systematic literature review was restricted to those occupations that require sitting for more than half of working time and where workers have physical co-exposure factors such as whole body vibration (WBV) and/or awkward postures. Twenty-five studies were carefully selected and critically reviewed, and a model was developed to describe the relationships between these factors. Sitting alone was not associated with the risk of developing LBP. However, when the co-exposure factors of WBV and awkward postures were added to the analysis, the risk of LBP increased fourfold. The occupational group that showed the strongest association with LBP was Helicopter Pilots (OR=9.0, 90% CI 4.9-16.4). For all studied occupations, the odds ratio (OR) increased when WBV and/or awkward postures were analyzed as co-exposure factors. WBV while sitting was also independently associated with non-specific LBP and sciatica. Vibration dose, as well as vibration magnitude and duration of exposure, were associated with LBP in all occupations. Exposure duration was associated with LBP to a greater extent than vibration magnitude. However, for the presence of sciatica, this difference was not found. Awkward posture was also independently associated with the presence of LBP and/or sciatica. The risk effect of prolonged sitting increased significantly when the factors of WBV and awkward postures were combined. Sitting by itself does not increase the risk of LBP. However, sitting for more than half a workday, in combination with WBV and/or awkward postures, does increase the likelihood of having LBP and/or sciatica, and it is the combination of those risk factors, which leads to the greatest increase in LBP.

Effects of driving on low back pain

Article

Full-text available

Oct 2006

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. To investigate how driving affected the occurrence of LBP in medical representatives. Questionnaire survey of all medical representatives working in Mie Prefecture (Japan). 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). 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.

City bus driving and low back pain: A study of the exposures to posture demands, manual materials handling and whole-body vibration

Article

Full-text available

Feb 2007
APPL ERGON

A cross-sectional study was conducted to investigate worker exposure to posture demands, manual materials handling (MMH) and whole body vibration as risks for low back pain (LBP). Using validated questionnaire, information about driving experience, driving (sitting) posture MMH, and health history was obtained from 80 city bus drivers. Twelve drivers were observed during their service route driving (at least one complete round trip) and vibration measurements were obtained at the seat and according to the recommendations of ISO 2631 (1997), for three models of bus (a mini-bus, a single-decker bus, a double-decker bus). The results showed that city bus drivers spend about 60% of the daily work time actually driving, often with the torso straight or unsupported, perform occasional and light MMH, and experience discomforting shock/jerking vibration events. Transient and mild LBP (not likely to interfere with work or customary levels of activity) was found to be prevalent among the drivers and a need for ergonomic evaluation of the drivers' seat was suggested.

The Association between Risk Factors and Low Back Pain among Commercial Vehicle Drivers in Peninsular Malaysia: A Preliminary Result

Article

Full-text available

May 2007

To determine the risk factors associated with complain of low back pain. A cross sectional study was done from June 2004 until August 2005. Seven hundred and sixty commercial vehicle drivers from 11 bus companies in central, northern and eastern regions in Malaysia participated in this study. Modified Nordic questionnaire was used to determine the prevalence of low back pain; Maestro human vibration meter was used to measure the personal R.M.S values of lateral, anterior-posterior and vertical axes. Modified Owas was used to assess the awkward posture of the driver torso namely, bending forward movement, leaning, sitting straight and twisting. Profile of Mood States (POMS) was used to evaluate the mood states of bus drivers with complain of low back pain. A high prevalence of low back pain (60.4%) among Malaysian commercial vehicle drivers was found. Logistic regression analysis controlling for age, income, education level and non occupational activities revealed that the following factors were related to low back pain: Tension-anxiety [1.080, 95% CI 1.041-1.121], depression dejection [1.047, 95% CI 1.023-1.072], anger-hostility [1.053, 95% CI 1.027-1.081], fatigue [1.132, 95% CI 1.089-1.177] and confusion [1.114, 95% CI 1.061-1.169] of POMS, length of employment [1.001, 95% CI 1.0-1.003], steering wheel adjustment [1.521, 95% CI 1.101-2.101], perception of exposing to vibration [1.943, 95% CI 1.389-2.719]. In conclusion, combinations of risks lead to high increase of low back pain complain among Malaysian bus drivers.

Article

Full-text available

Jul 2007

Fall risk screening tools are frequently used as a part of falls prevention programs in hospitals. Design-related bias in evaluations of tool predictive accuracy could lead to overoptimistic results, which would then contribute to program failure in practice. A systematic review was undertaken. Two blind reviewers assessed the methodology of relevant publications into a four-point classification system adapted from multiple sources. The association between study design classification and reported results was examined using linear regression with clustering based on screening tool and robust variance estimates with point estimates of Youden Index (= sensitivity + specificity - 1) as the dependent variable. Meta-analysis was then performed pooling data from prospective studies. Thirty-five publications met inclusion criteria, containing 51 evaluations of fall risk screening tools. Twenty evaluations were classified as retrospective validation evaluations, 11 as prospective (temporal) validation evaluations, and 20 as prospective (external) validation evaluations. Retrospective evaluations had significantly higher Youden Indices (point estimate [95% confidence interval]: 0.22 [0.11, 0.33]). Pooled Youden Indices from prospective evaluations demonstrated the STRATIFY, Morse Falls Scale, and nursing staff clinical judgment to have comparable accuracy. Practitioners should exercise caution in comparing validity of fall risk assessment tools where the evaluation has been limited to retrospective classifications of methodology. Heterogeneity between studies indicates that the Morse Falls Scale and STRATIFY may still be useful in particular settings, but that widespread adoption of either is unlikely to generate benefits significantly greater than that of nursing staff clinical judgment.

The role of whole body vibration, posture and manual materials handling as risk factors for low back pain in occupational drivers

Article

Full-text available

Apr 2008

It seems evident that occupational drivers have an increased risk of developing back pain. Not only are they exposed to whole body vibration (vibration), their work often includes exposure to several other risk factors for low back pain (LBP), particularly the seated posture (posture) and manual materials handling (MMH). Excessive demands on posture are likely to be aggravated by vibration and vice versa, and the risks may be further compounded when MMH is performed. This study investigated the relative role of vibration, posture and MMH as risk factors for LBP and the stated hypothesis was that the risks for LBP in drivers are the combined effect of vibration, posture and/or MMH. The findings showed that interaction effects due to posture and one or both of vibration and MMH, rather than the individual exposure effects, are the main contributors for precipitation of LBP.

The Environment and Disease: Association or Causation?

Article

May 1965
Proc Roy Soc Med

Austin Bradford Hill

Article

Sep 2019

Article

Mar 2019

The environment and disease: Association or causation

Article

Jan 1966

A. Bradford-Hill

Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement

Article

Jul 2009
PLOS MED

Moher D, Liberati A, Tetzlaff J, Altman DG Group PPreferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339: b2535

Article

Aug 2009

David Moher

Recruitment of Discrete Regions of the Psoas Major and Quadratus Lumborum Muscles Is Changed in Specific Sitting Postures in Individuals With Recurrent Low Back Pain

Article

Oct 2013
J ORTHOP SPORT PHYS

Study design: Cross-sectional controlled laboratory study. Objectives: To investigate potential changes in the function of discrete regions of the psoas major (PM) and quadratus lumborum (QL) with changes in spinal curvatures and hip positions in sitting, in people with recurrent low back pain (LBP). Background: Although the PM and QL contribute to control of spinal curvature in sitting, whether activity of these muscles is changed in individuals with LBP is unknown. Methods: Ten volunteers with recurrent LBP (pain free at the time of testing) and 9 pain-free individuals in a comparison group participated. Participants with LBP were grouped into those with high and low erector spinae (ES) electromyographic (EMG) signal amplitude, recorded when sitting with a lumbar lordosis. Data were recorded as participants assumed 3 sitting postures. Fine-wire electrodes were inserted with ultrasound guidance into fascicles of the PM arising from the transverse process and vertebral body, and the anterior and posterior layers of the QL. Results: When data from those with recurrent LBP were analyzed as 1 group, PM and QL EMG signal amplitudes did not differ between groups in any of the sitting postures. However, when subgrouped, those with low ES EMG had greater EMG signal amplitude of the PM vertebral body and QL posterior layer in flat posture and greater EMG signal amplitude of the QL posterior layer in short lordotic posture, compared to those in the pain-free group. For the group with high ES EMG, the PM transverse process and PM vertebral body EMG was less than that of the other LBP group in short lordotic posture. Conclusion: The findings suggest a redistribution of activity between muscles that have a potential extensor moment in individuals with LBP. The modification of EMG of discrete fascicles of the PM and QL was related to changes in ES EMG signal amplitude recorded in sitting.

Design and validation of an ambulatory inertial system for 3-D measurements of low back movements

Article

Dec 2011

In studies of human movement, inertial sensors (accelerometers and gyroscopes) are gaining attention as a promising alternative to laboratory-constrained video capture systems. Kinematics of various body parts and joints can be quantified by attaching inertial sensors at points of interest and integrating the observed acceleration and angular velocity signals. It is broadly accepted that this measurement procedure is significantly influenced by cumulative errors arising from sensor noise, non-linearities, asymmetries, sensitivity variations and bias drifts. In addition, it is also known that linear acceleration superimposed to the gravity acceleration introduces errors when calculating tilt angles. Recently, newer techniques using sensor fusion methods have shown error reduction in orientation measurements, but require additional hardware and consume more energy. In this paper, we assess the accuracy of a low-power wireless inertial system (ViMove) that measures Low Back (lumbar spine) orientation in three dimensions. The system consists of two inertial units (sensor), with each sensor containing one tri-axis accelerometer and one single-axis gyroscope. We investigate the accuracy of 1D, 2D and 3D simultaneous movements by means of root mean square error (RMSE) computed in comparison with NDI Optotrak, an optical tracking system. The RMSE achieved for one dimensional movements in the Flexion, Lateral Flexion and Twist planes were 1.0°, 0.5° and 2.4° respectively, and 2.1°, 2.4° and 4.6° for three dimensional movements.

Trunk posture

Article

Dec 2001
INT J IND ERGONOM

It has been recently reported that both dynamic movement characteristics, as well as the duration of postures adopted during work, are important in the development of low back pain (LBP). This paper presents a video-based posture assessment method capable of measuring trunk angles and angular velocities in industrial workplaces. The inter-observer reliability, system accuracy, and the relationship of the measured exposures to the reporting of low back pain are reported. The video analysis workstation consisted of a desktop computer equipped with digital video capture and playback technology, a VCR, and a computer game type joystick. The operator could then use a joystick to track trunk flexion and lateral bending during computer-controlled video playback. The joystick buttons were used for binary input of twisting. The inter-observer reliability for peak flexion and percentage of time spent in posture category variables were excellent (ICC>0.8). Lower reliability levels were observed for peak and average velocity and movement related variables. The video analysis system time series data showed very high correlation to the criterion optoelectronic imaging system (r=0.92). Root mean square errors averaged 5.8° for the amplitude probability distribution function data. Trunk flexion variables including peak level, peak velocity, average velocity indicators, and percent time in flexion category indicators all showed significant differences between cases and controls in the epidemiological study. A model consisting of the measures peak trunk flexion, percent time in lateral bend and average lateral bending velocity emerged after multivariable analysis for relationship to low back pain.

An Epidemiological Study of Low Back Pain in Professional Drivers

Article

Dec 2006
J SOUND VIB

The prevalence of low back pain (LBP) was investigated in 598 Italian professional drivers exposed to whole-body vibration (WBV) and ergonomic risk factors (drivers of earth moving machines, fork-lift truck drivers, truck drivers, bus drivers). The control group consisted of a small sample of 30 fire inspectors not exposed to WBV. Personal, occupational and health histories were collected by means of a structured questionnaire. Vibration measurements were performed on representative samples of the machines and vehicles used by the driver groups. From the vibration magnitudes and exposure durations, alternative measures of vibration dose were estimated for each subject. Daily vibration exposure, expressed in terms of 8-h energy-equivalent frequency-weighted acceleration, A(8), averaged 0.28–0.61 (range 0.10–1.18) m s−2 rms in the driver groups. Duration of exposure to WBV ranged between 1 and 41 years. The 7-day and 12-month prevalence of LBP was greater in the driver groups than in the controls. In the professional drivers, the occurrence of 12-month LBP, high intensity of LBP (Von Korff pain scale score ⩾5), and LBP disability (Roland & Morris disability scale score ⩾12) significantly increased with increasing cumulative vibration exposure. Even though several alternative measures of vibration exposure were associated with LBP outcomes, nevertheless a more regular trend of association with LBP was found for vibration dose expressed as ∑aviti (m s−2 h), in which the frequency-weighted acceleration, av, and lifetime exposure duration, t, were given equal weight. In multivariate data analysis, individual characteristics (e.g. age, body mass index) and a physical load index (derived from combining manual materials handling and awkward postures) were significantly associated with LBP outcomes, while psychosocial work factors (e.g. job decision, job support) showed a marginal relation to LBP. This study tends to confirm that professional driving in industry is associated with an increased risk of work-related LBP. Exposure to WBV and physical loading factors at work are important components of the multifactorial origin of LBP in professional drivers.

Guidelines for whole-body vibration health surveillance

Article

May 2002

There is strong epidemiological evidence that occupational exposure to WBV is associated with an increased risk of low back pain (LBP), sciatic pain, and degenerative changes in the spinal system, including lumbar intervertebral disc disorders. A prototype health surveillance scheme for WBV is presented in this paper. Surveillance is the collection, analysis, and dissemination of data for the purpose of prevention. The aims are to assess health status and diagnose vibration-induced disorders at an early stage, to inform the workers on the potential risk associated with vibration exposure, to give preventive advice to employers and employees and to control whether preventive measures which have been taken, were successful. It is suggested that a pre-placement health examination should be o!ered to each worker who will be exposed to WBV so as to make the worker aware of the hazards, to obtain baseline health data, and to identify medical conditions that may increase the risk due to WBV. The case history should focus on personal history, work history, and leisure activities involving driving of vehicles. The personal medical history should detail back pain complaints, disorders in the spine, any injuries or surgery to the musculoskeletal system. A physical examination on the lower back should be performed on workers who have experienced LBP symptoms over the past 12 months. The pre-placement examination should be followed by periodic health re-assessment with a regular interval according to the legislation of the country. It is suggested that periodic medical examination should be made available at least every 2 years to all workers who are exposed to WBV. Any change in vibration exposure at the workplace should be reported by the employer. If an increase in vibration exposure or a change in health status have occurred, the medical re-examination should be o!ered at shorter intervals at the discretion of the attending physician. There should be a periodic medical examination, which includes recording any change in exposure to WBV. The "ndings for the individual should be compared with previous examinations. Group data should also be compiled periodically. Medical removal may be considered along with re-placement in working practices without exposure to WBV. This paper presents opinions on health surveillance for whole-body vibration developed within a working group of partners funded on a European Community Network BIOMED2 concerted action BMH4-CT98-3251: Research network on detection and prevention of injuries due tooccupational vibration exposures). The health surveillance protocol and the draft questionnaire with explanation comments are presented for wider consideration by the science community and others before being considered appropriate for implementation.

Low back pain in drivers: The relative role of whole-body vibration, posture and manual materials handling

Article

Dec 2006

A cross-sectional study was conducted to investigate the relative role of whole-body vibration (WBV), posture and manual materials handling (MMH) as risk factors for low back pain (LBP). Using a validated questionnaire, information about health history, posture and MMH performed was obtained from 394 workers who drove vehicles as part of their job (according to seven predefined occupational groups) and 59 who did not. The intention was to reflect a wide range of exposures with the lower end of the exposure spectrum defined as that of non-manual workers who do not drive as part of their job. Based on the questionnaire responses and direct measurements of vibration exposure, personal aggregate measures of exposure were computed for each of the respondents, i.e., total vibration dose (TVD), posture score (PS) and manual handling score (MHS). Odds ratios (and 95% confidence intervals) for back pain were obtained from logistics regression models and log-linear backward elimination analysis was performed. The findings showed that ‘combined exposure’ due to posture and one or both of vibration and MMH, rather than the individual exposure to one of the three factors (WBV, posture, MMH) is the main contributor of the increased prevalence of LBP.

Trunk posture:: reliability, accuracy, and risk estimates for low back pain from a video based assessment method

Article

Dec 2001
INT J IND ERGONOM

The hierarchy of evidence: Levels and grades of recommendation

Article

Jan 2007

Is ‘ideal’ sitting posture real? Measurement of spinal curves in four sitting postures

Article

Oct 2008

There is a lack of quantitative evidence for spinal postures that are advocated as 'ideal' in clinical ergonomics for sitting. This study quantified surface spinal curves and examined whether subjects could imitate clinically 'ideal' directions of spinal curve at thoraco-lumbar and lumbar regions: (i) flat - at both regions (ii) long lordosis - lordotic at both regions (iii) short lordosis - thoracic kyphosis and lumbar lordosis. Ten healthy male subjects had 3-D motion sensors adhered to the skin so that sagittal spinal curves were represented by angles at thoracic (lines between T1-T5 and T5-T10), thoraco-lumbar (T5-T10 and T10-L3) and lumbar regions (T10-L3 and L3-S2). Subjects attempted to imitate pictures of spinal curves for the flat, long lordosis, short lordosis and a slumped posture, and were then given feedback/manual facilitation to achieve the postures. Repeated measures analysis of variance was used to compare spinal angles between posture and facilitation conditions. Results show that although subjects imitated postures with the same curve direction at thoraco-lumbar and lumbar regions (slumped, flat or long lordosis), they required feedback/manual facilitation to differentiate the regional curves for the short lordosis posture. Further study is needed to determine whether the clinically proposed 'ideal' postures provide clinical advantages.

A Comparison of the Effects of Two Sitting Postures on Back and Referred Pain

Article

Nov 1991

This study compared the effects of sitting with portable supports in either a kyphotic or lordotic posture on low-back and referred pain. Two hundred ten patients with low-back and/or referred pain were randomly assigned to either a kyphotic posture or lordotic posture group. The kyphotic and lordotic postures were facilitated by the use of a flat foam cushion or lumbar roll, respectively. Pain location, back pain, and leg pain intensity were assessed over a 24-48-hour period under both standardized clinical settings and general sitting environments. When sitting with a lordotic posture, back and leg pain were significantly reduced and referred pain shifted towards the low back. This study demonstrates that in general sitting environments a lumbar roll results in: 1) reductions in back and leg pain; and 2) centralization of pain. These findings do not apply to patients with stenosis or spondylolisthesis, whose symptoms may be aggravated by use of a lumbar roll.

The well-built clinical question: A key to evidence-based decisions

Article

Nov 1995

Physical Workload and Ergonomic Factors Associated With Prevalence of Back and Neck Pain in Urban Transit Operators

Article

Oct 1997

Back and neck pain was studied cross-sectionally in 1,449 urban transit drivers by linking medical data, self-reported ergonomic factors, and company records on job history. The goal was to examine the relation between physical workload, ergonomic factors, and the prevalence of back and neck pain. Researchers, to date, have not found an independent effect of ergonomic factors on back and neck pain while accounting for the effects of past and current physical workload. Self-reported ergonomic factors, vehicle type, physical workload (measured as duration of driving), height, weight, age, and gender were analyzed in relation to back and neck pain, using multivariable logistic regression models. Physical workload showed a positive dose-response relation with back and neck pain after controlling for vehicle type, height, weight, age, and gender. The odds ratio for 10 years of driving was 3.43. Additional adjustment for ergonomic factors decreased this odds ratio to 2.55. Six out of seven ergonomic factors were significantly related to the prevalence of back and neck pain after adjustment for age, gender, height, weight, and physical workload. Problems with adjusting the seat had the largest effect (odds ratio = 3.52). Women had back and neck pain twice as frequently as men. The results support the hypothesis of a causal role of physical workload for the development of back and neck pain. Ergonomic factors partially mediated the risk of back and neck pain associated with driving, suggesting a potential for prevention of back and neck pain by ergonomic redesign of transit vehicles. Elevated risks for back and neck pain for female drivers were not explained by anthropometric and ergonomic factors.

Evaluation and management of occupational low back disorders

Article

Feb 2000

Eckardt Johanning

This clinical practice review of occupational low back disorders describes work-related risk factors, occupational history, physical evaluation, clinical tests, diagnosis, care, and prevention. It is part of a quality assurance (QA) and quality improvement (QI) effort to establish exemplary occupational practice standards. It emphasizes the involvement of occupational medicine physicians in exposure assessment, care of injured workers, and disease prevention. Important occupational risk factors such as lifting, awkward body posture and vibration, in addition to psychosocial, socio-economic and other factors are summarized. The focus is on mechanical back disorders. Return-to-work, rehabilitation and prevention strategies are discussed as part of integrated disability management involving the injured worker, the primary care provider, employers and other relevant parties.

Factors contributing to low back pain among professional drivers: A review of current literature and possible ergonomic controls

Article

Feb 2002
Work

Jane Lyons

It is suggested that professional drivers are at an increased risk for low back pain and injury due to a variety of factors such as whole body vibration, prolonged sitting, awkward postures, lifting and carrying, and psychosocial issues. Ergonomics can play an important role in the reduction of risk of injury to the professional driver by implementing modifications to the work place (engineering controls), changes in administrative and management practice (administrative controls), and education of the worker (work practice controls). A review of the literature of the etiology of low back pain and injury among professional drivers is presented, and possible ergonomic controls have been recommended.

Investigation of work-related disorders in truck drivers using RULA method

Article

Aug 2003
APPL ERGON

A high incidence of spinal disorders is observed in professional drivers; in particular, back and neck pain result in high rates of morbidity and low retirement age. A sample of 77 drivers, of rubbish-collection vehicles who sit in a standard posture and of road-washing vehicles, who drive with the neck and trunk flexed, bent and twisted, was studied using RULA, a method for the evaluation of the exposure to risk factors associated with work-related upper-limb disorders. Results showed a significant association between trunk and neck scores and all self-reported pains, aches or discomforts in the trunk or neck regions in all subjects. In particular, the neck score was significant in both postures, reflecting high loading of the neck. Significantly different posture scores were also recorded for drivers using an adjustable vs. a non-adjustable seat. In this first RULA study of the working posture of professional truck drivers, the method proved to be a suitable tool for the rapid evaluation of the loading of neck and trunk.

Low Back Pain in Australian Adults: The Economic Burden

Article

Feb 2003

This paper reports the results of a "cost-of-illness" study of low back pain (LBP) in Australian adults. It estimates the direct cost of LBP in 2001 to be AU dollars 1.02 billion. Approximately 71% of this amount is for treatment by chiropractors, general practitioners, massage therapists, physiotherapists and acupuncturists. However, the direct costs are minor compared to the indirect costs of AU dollars 8.15 billion giving a total cost of AU dollars 9.17 billion. LBP in Australian adults represents a massive health problem with a significant economic burden. This burden is so great that it has compelling and urgent ramifications for health policy, planning and research. This study identifies that research should concentrate on both direct but particularly the indirect costs including cost-effective management regimes that encourage an early return to duties.

Driver's back pain and its prevention

Article

Jan 1979
APPL ERGON

J. D. G. Troup

There is evidence that those who spend more than half their working lives driving are three times more likely to suffer back trouble than the rest of the population. The causes have not been clearly defined. Sitting is a source of postural, spinal stress which can be disabling for those who have had serious back and sciatic pain. The muscular exertion of driving also adds to spinal stress. In many commercial vehicles, the driver is subjected to vibration at the natural frequency of the human trunk: and the resulting 'vibrocreep' may contribute further to the pattern of spinal stress. In addition, the transmission of road-shocks increases the muscular effort of driving as well as loading the spine. The capacity of the spine to resist such jerks is not fully understood, but it is believed that the mechanical 'conditioning' of the spine increases its susceptibility to minor injury which, if repeated, leads to an early onset of degeneration. The solution is to design a seat to support the back in a posture which minimises spinal stress, and to isolate the seat from the effects of vibration and road-shock.

Standardized Nordic Questionnaires For The Analysis Of Musculoskeletal Symptoms

Article

Oct 1987
APPL ERGON

Standardised questionnaires for the analysis of musculoskeletal symptoms in an ergonomic or occupational health context are presented. The questions are forced choice variants and may be either self-administered or used in interviews. They concentrate on symptoms most often encountered in an occupational setting. The reliability of the questionnaires has been shown to be acceptable. Specific characteristics of work strain are reflected in the frequency of responses to the questionnaires.

Epidemiology of back disorders: Prevalence, risk factors, and prognosis

Article

Apr 2005

This article reviews some of the advances that have taken place in understanding back disorders, with a particular emphasis on low back pain, as this area has been most represented in the literature in the preceding year (September 2003 to September 2004). Epidemiological studies continue to provide insights into the prevalence of back pain and have identified many individual, psychosocial, and occupational risk factors for its onset. Psychological factors have an important role in the transition from acute to chronic pain and related disability. Recent advances show that there is a significant genetic effect on severe low back pain in the community. Data emerging from candidate gene studies show an association between lumbar disc disease and mutations of genes encoding the alpha-2 and alpha-3 subunits of collagen IX. Back pain is among the most common conditions for which patients seek medical care. Interventions based on behavioral and cognitive principles and exercise programs are effective in improving disability in chronic back pain. Although progress has been made in understanding the role of genetic mutations in disorders such as lumbar disc disease, further investigation of the interaction between genetic and environmental factors such as physical stress is needed.

Occupational factors associated with low back pain in urban taxi drivers

Article

Nov 2005

Urban taxi drivers differ from other professional drivers in their exposures to physical and psychosocial hazards in the work environment. Epidemiological data on low back pain (LBP) of this occupational group are very scarce. To examine LBP in taxi drivers and its association with prolonged driving and other occupational factors. We analyzed the cross-sectional data from the Taxi Drivers' Health Study. Standardized instruments were used to collect information on personal factors, work-related physical and psychosocial factors and driving time profiles. LBP prevalence was assessed using the modified Nordic Musculoskeletal Questionnaire. Multiple logistic regression models were employed for statistical analyses. Of 1242 drivers, 51% reported LBP in the past 12 months, significantly (P < 0.001) higher than other professional drivers (33%) in Taiwan. After adjusting for the effects of demographic characteristics, lifestyle factors, anthropometric measures and socioeconomic positions, we found that driving time >4 h/day [prevalence odds ratio (POR) 1.78; 95% CI 1.02-3.10], frequent bending/twisting activities while driving (adjusted OR 1.86; 95% CI 1.15-2.99), self-perceived job stress (POR 1.75; 95% CI 1.20-2.55), job dissatisfaction (POR 1.44; 95% CI 1.05-1.98) and registration type were the major occupational factors significantly associated with higher LBP prevalence in taxi drivers. We have identified that long driving time and several physical and psychosocial factors are associated with high prevalence of LBP in taxi drivers. This should be further investigated in prospective studies. Future studies are needed to examine the potential adverse effects of prolonged exposure to low levels of whole-body vibration.

Differences in Sitting Postures are Associated With Nonspecific Chronic Low Back Pain Disorders When Patients Are Subclassified

Article

Mar 2006
SPINE

A comparative study. To investigate sitting postures of asymptomatic individuals and nonspecific chronic low back pain (NS-CLBP) patients (pooled and subclassified) and evaluate the importance of subclassification. Currently, little evidence exists to support the hypothesis that CLBP patients sit differently from pain-free controls. Although classifying NS-CLBP patients into homogeneous subgroups has been previously emphasized, no attempts have been made to consider such groupings when examining seated posture. Three angles (sacral tilt, lower lumbar, and upper lumbar) were measured during "usual" and "slumped" sitting in 33 NS-CLBP patients and 34 asymptomatic subjects using an electromagnetic measurement device. Before testing, NS-CLBP patients were subclassified by two blinded clinicians. Twenty patients were classified with a flexion motor control impairment and 13 with an active extension motor control impairment. No differences were found between control and NS-CLBP (pooled) patients during usual sitting. In contrast, analyses based on subclassification revealed that patients classified with an active extension pattern sat more lordotic at the symptomatic lower lumbar spine, whereas patients with a flexion pattern sat more kyphotic, when compared with healthy controls (F = 19.7; df1 = 2, df2 = 63, P < 0.001). Further, NS-CLBP patients had less ability to change their posture when asked to slump from usual sitting (t = 4.2, df = 65; P < 0.001). Differences in usual sitting posture were only revealed when NS-CLBP patients were subclassified. This highlights the importance of subclassifying NS-CLBP patients.

Grading quality of evidence and strength of recommendations

Jan 2004
Br Med J
1490-1494

Grade Working Group. (2004). Grading quality of evidence and strength of recommendations. British Medical Journal, 328(7454), 1490-1494.

Report of investigations 9684: Practical ergonomic principles

Jan 2011

S M Moore
J Torma-Krajewski
L J Steiner

Moore, S. M., Torma-Krajewski, J., & Steiner, L. J. (2011). Report of investigations 9684: Practical ergonomic principles.

Driver's back pain and its prevention: A review of the postural, vibratory and muscular factors, together with the problem of transmitted road-shock

Jan 1978
APPL ERGON
207-214

J D G Troup

Troup, J. D. G. (1978). Driver's back pain and its prevention: A review of the postural, vibratory and muscular factors, together with the problem of transmitted road-shock. Applied Ergonomics, 9, 207-214.

National Institute for Occupational Safety and Health. National Heart, Lung, and Blood Institute

Jan 2014

P A Pittsburgh

Pittsburgh, PA: National Institute for Occupational Safety and Health. National Heart, Lung, and Blood Institute. (2014). Quality assessment tool for observational cohort and cross-sectional studies. Retrieved from https://www.nhlbi.nih.gov/health-topics/studyquality-assessment-tools

Sitting Posture During Occupational Driving Causes Low Back Pain; Evidence-Based Position or Dogma? A Systematic Review

Abstract

No full-text available

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