Prevention of Low Back Pain

A Systematic Review and Meta-analysis
IMPORTANCE: Existing guidelines and systematic reviews lack clear recommendations for prevention of low back pain (LBP).
OBJECTIVE: To investigate the effectiveness of interventions for prevention of LBP.
DATA SOURCES: MEDLINE, EMBASE, Physiotherapy Evidence Database Scale, and Cochrane Central Register of Controlled Trials from inception to November 22, 2014.
STUDY SELECTION: Randomized clinical trials of prevention strategies for nonspecific LBP.
DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data and assessed the risk of bias. The Physiotherapy Evidence Database Scale was used to evaluate the risk-of-bias. The Grading of Recommendations Assessment, Development, and Evaluation system was used to describe the quality of evidence.
MAIN OUTCOMES AND MEASURES: The primary outcome measure was an episode of LBP, and the secondary outcome measure was an episode of sick leave associated with LBP. We calculated relative risks (RRs) and 95% CIs using random-effects models.
RESULTS: The literature search identified 6133 potentially eligible studies; of these, 23 published reports (on 21 different randomized clinical trials including 30?850 unique participants) met the inclusion criteria. With results presented as RRs (95% CIs), there was moderate-quality evidence that exercise combined with education reduces the risk of an episode of LBP (0.55 [0.41-0.74]) and low-quality evidence of no effect on sick leave (0.74 [0.44-1.26]). Low- to very low-quality evidence suggested that exercise alone may reduce the risk of both an LBP episode (0.65 [0.50-0.86]) and use of sick leave (0.22 [0.06-0.76]). For education alone, there was moderate- to very low-quality evidence of no effect on LBP (1.03 [0.83-1.27]) or sick leave (0.87 [0.47-1.60]). There was low- to very low-quality evidence that back belts do not reduce the risk of LBP episodes (1.01 [0.71-1.44]) or sick leave (0.87 [0.47-1.60]). There was low-quality evidence of no protective effect of shoe insoles on LBP (1.01 [0.74-1.40]).
CONCLUSION AND RELEVANCE: The current evidence suggests that exercise alone or in combination with education is effective for preventing LBP. Other interventions, including education alone, back belts, and shoe insoles, do not appear to prevent LBP. Whether education, training, or ergonomic adjustments prevent sick leave is uncertain because the quality of evidence is low.

Source: Steffens D, Maher CG, Pereira LS, Stevens ML2, Oliveira VC, Chapple M, Teixeira-Salmela LF, Hancock MJ. JAMA Intern Med. 2016 Feb 1; 176 (2): 199-208.

Social support modifies association between forward bending of the trunk and low-back pain

Cross-sectional field study of blue-collar workers
Objectives: This study aimed to investigate the association between forward bending of the trunk and low-back pain intensity (LBPi) among blue-collar workers in Denmark as well as whether the level of social support modifies the association.
Methods: In total, 457 workers were included in the study. The forward bending of ≥30° was computed from accelerometer recordings for several consecutive days during work, categorized into long (highest tertile) and short–moderate (remaining tertiles) duration. LBPi was measured on a 0–10 scale and categorized into low (≤5) and high (>5) pain. Self-reported social support was categorized into low, moderate, and high levels. Multi-adjusted logistic regressions estimated the association between forward bending and LBPi and the effect modification by social support.
Results: Forward bending and LBPi were not significantly associated but modified by social support. Workers with low social support and long duration of forward bending had higher likelihood of high LBPi [odds ratio (OR) 2.97, 95% confidence interval (95% CI) 1.11–7.95] compared to workers with high social support and long duration of forward bending. Among workers with low social support, workers with long duration of forward bending had higher likelihood of high LBPi (OR 3.28, 95% CI 0.99–10.90) compared to workers with short–moderate duration of forward bending. Among workers with high social support, workers with short duration of forward bending had reduced likelihood of high LBPi (OR 0.39, 95% CI 0.16–0.95) compared to workers with short–moderate duration of forward bending.
Conclusions: Social support modifies the association between objectively measured forward bending and LBPi among blue-collar workers.

Source: Villumsen M, Holtermann A, Samani A, Madeleine P, Jørgensen MB. Scand J Work Environ Health, 2016.

Biomechanical risk assessment during field loading of hydraulic stretchers into ambulances

The process of loading a stretcher into an ambulance is known to cause a high incidence of back injuries among paramedics. This study aimed to assess the forces at L5/S1 during real-life stretcher loading activities and to determine the variables that contribute significantly to these forces. Analyses involved 58 paramedics (111 shifts) and 175 stretcher loading activities. Estimates of compression and shear forces at L5/S1 were calculated using the 3DSSPP program. Seventy-one percent of loading activities exceeded the safe loading level of 3.4 kN compression force at L5/S1 (mean: 3.9 kN, min–max: 2.1–7.0 kN). About 92% of the variance can be predicted from a combination of several variables, notably hand load (mean: 0.72 kN/number of paramedics) and back sagittal flexion (mean: 32°). Recommendations to reduce the risk of back injuries are proposed with regard to stretcher and ambulance loading design as well as training in stretcher lifting for paramedics.

Source: Prairie, Jérôme, Plamondon, André, Hegg-Deloye, Sandrine, Larouche, Dominique, & Corbeil, Philippe. (2016). Industrial Journal of Industrial Ergonomics, 54, 1-9.

Association Between Cardiovascular Risk Factors and Carpal Tunnel Syndrome in Pooled Occupational Cohorts

Objective: The aim of the study was to ascertain if cardiovascular (CVD) risk factors are carpal tunnel syndrome (CTS) risk factors.
Methods: Analysis of pooled baseline data from two large prospective cohort studies (n?=?1824) assessed the relationships between a modified Framingham Heart Study CVD risk score both CTS and abnormal nerve conduction study prevalence. Quantified job exposures, personal and psychosocial confounders were statistically controlled. Odds ratio and 95% confidence intervals were calculated for individual risk scores.
Results: There was a strong relationship between CVD risk score and both CTS and abnormal nerve conduction study after adjustment for confounders, with odds ratios as high as 4.16 and 7.35, respectively. Dose responses were also observed.
Conclusions: In this workplace population, there is a strong association between CVD risk scores and both CTS and abnormal nerve conduction study that persisted after controlling for confounders. These data suggest a potentially modifiable disease mechanism.

Source: Hegmann, Kurt T.; Thiese, Matthew Steven; Kapellusch, Jay; Merryweather, Andrew S.; Bao, Stephen; Silverstein, Barbara; Wood, Eric M.; Kendall, Richard; Wertsch, Jacqueline; Foster, James; Garg, Arun; Drury, David L. Journal of Occupational & Environmental Medicine: January 2016, Volume 58, Issue 1, p. 87-93.

The Consequence of Combined Pain and Stress on Work Ability in Female Laboratory Technicians

A Cross-Sectional Study
Musculoskeletal pain and stress-related disorders are leading causes of impaired work ability, sickness absences and disability pensions. However, knowledge about the combined detrimental effect of pain and stress on work ability is lacking. This study investigates the association between pain in the neck-shoulders, perceived stress, and work ability. In a cross-sectional survey at a large pharmaceutical company in Denmark 473 female laboratory technicians replied to questions about stress (Perceived Stress Scale), musculoskeletal pain intensity (scale 0–10) of the neck and shoulders, and work ability (Work Ability Index). General linear models tested the association between variables. In the multi-adjusted model, stress (p < 0.001) and pain (p < 0.001) had independent main effects on the work ability index score, and there was no significant stress by pain interaction (p = 0.32). Work ability decreased gradually with both increased stress and pain. Workers with low stress and low pain had the highest Work Ability Index score (44.6 (95% CI 43.9–45.3)) and workers with high stress and high pain had the lowest score (32.7 (95% CI 30.6–34.9)). This cross-sectional study indicates that increased stress and musculoskeletal pain are independently associated with lower work ability in female laboratory technicians.

Source: Jay K, Friborg MK, Sjøgaard G, et al. International Journal of Environmental Research and Public Health, 2015; 12 (12): p. 15834-42.

Associations between Wage System and Risk Factors for Musculoskeletal Disorders among Construction Workers

Piece rate and performance based wage systems are common in the construction industry. Construction workers are known to have an increased risk of pain and musculoskeletal disorders (MSD). In this cross-sectional questionnaire study, we examined the association between wage system and (1) physical exertion, (2) time pressure, (3) pain, and (4) fatigue. The participants comprised 456 male Danish construction workers working on one of three different wage systems: group based performance wage, individually based performance wage, and time based wage system. The statistical analyses indicated differences between the wage systems in relation to physical exertion () and time pressure () but not to pain or fatigue. Workers on group based performance wage scored higher (i.e., worse) than workers on individual performance based wage and workers with an hourly/monthly wage. In conclusion, group performance based wage was associated with higher levels of physical exertion and time pressure. Accordingly, group performance based wage can be viewed as a factor that has the potential to complicate prevention of MSD among construction workers. Since performance based wage systems are common in many countries across the world, more attention should be paid to the health effects of these types of payment.

Source: Ajslev JZ, Persson R, Andersen LL. Pain Research and Treatment, 2015. 

Motor control exercise for chronic non-specific low-back pain

Non-specific low back pain (LBP) is a common condition. It is reported to be a major health and socioeconomic problem associated with work absenteeism, disability and high costs for patients and society. Exercise is a modestly effective treatment for chronic LBP. However, current evidence suggests that no single form of exercise is superior to another. Among the most commonly used exercise interventions is motor control exercise (MCE). MCE intervention focuses on the activation of the deep trunk muscles and targets the restoration of control and co-ordination of these muscles, progressing to more complex and functional tasks integrating the activation of deep and global trunk muscles. While there are previous systematic reviews of the effectiveness of MCE, recently published trials justify an updated systematic review.

Source: Saragiotto BT, Maher CG, Yamato TP, Costa LOP, Menezes Costa LC, Ostelo RWJG, Macedo LG. Cochrane Database of Systematic Reviews 2016, Issue 1.

Effets de la posture de travail sur les patrons musculaires de la région lombaire lors d’une tâche répétitive

En Amérique du Nord, la posture debout prolongée est largement utilisée dans les entreprises, alors que dans d'autres régions du monde, le travail s'effectue plutôt à partir de la position assise. Le travail en station debout prolongée a déjà été associé à divers symptômes comme la douleur lombaire et la fatigue généralisée. Des études récentes ont démontré une association entre la douleur lombaire en posture debout prolongée et des patrons de coactivation (activation coordonnée de paires de muscles) des muscles de la région lombo-pelvienne. Cependant, ces patrons n'ont jamais été mesurés pour d'autres postures de travail, ou lorsque la posture debout était accompagnée de gestes répétitifs des membres supérieurs.


Santé, prévention de la pénibilité et parcours professionnel

Les 33es Journées nationales du bâtiment et des travaux publiques (BTP), organisées conjointement par l'AMCO-BTP de Limoges (Association médicale du Centre-Ouest) et le GNMST-BTP (Groupement national multidisciplinaire de santé au travail dans le BTP), avec le soutien de l'Organisme professionnel de prévention du BTP (OPPBTP), se sont déroulées à Limoges du 27 au 29 mai 2015 sur le thème de la pénibilité et de ses conséquences sur l'épaule et le rachis. De nombreuses démarches de prévention ont été mises en place par les services de santé au travail du BTP en partenariat avec les entreprises pour en limiter les conséquences. Certaines de ces actions ont été exposées au cours de ces 33es Journées.

Source: Références en santé au travail, No 144, Décembre 2015.

Quelle prévention des TMS dans l’activité de l’encadrement de proximité en sous-traitance interne?

Un cas dans le secteur de la découpe de viande
Cet article vise à documenter, à partir d'un cas, comment un encadrant de proximité exerçant en sous-traitance interne dans le secteur de la découpe de viande peut participer à la conception d'une organisation du travail favorable à la prévention des TMS des opérateurs encadrés. Le recueil de données porte sur le travail de régulation de l'encadrant de proximité et ses déterminants. La méthodologie mobilise principalement des entretiens, des observations et des autoconfrontations. Nos résultats tendent à montrer que l'encadrant de proximité parvient, dans un contexte contraint et par des régulations opératives, à desserrer certaines contraintes de l'organisation du travail des opérateurs encadrés. Ces régulations portent sur la répartition des personnes en activité et la participation de l'encadrant aux activités de découpe de viande. Dans le contexte de sous-traitance, ces régulations, davantage mises en exergue du côté des logiques de performance, participent indirectement à des logiques de préservation de la santé difficilement visibles a priori.

Source: Aude Cuny-Guerrier, Sandrine Caroly, Fabien Coutarel et Agnès Aublet-Cuvelier. PISTES, 2015, 17-2.

Multi-position ergonomic computer workstation design to increase comfort of computer work

This paper presents a new design of computer workstation that is aimed at increasing the comfort of a user working for long periods at a computer. As we have become a society that spends a lot of time working on computers, the computer workstation needs to provide comfort to users. Discomfort and an improper position can negatively affect overall health and productivity. A new type of ergonomic computer workstation, which allows users to sit in multiple working positions, is proposed in order to provide better comfort to people who spend a long time sitting at their workstations. We have designed and developed a new multi-position ergonomic computer workstation which has 19 degrees of freedom and which can accommodate from 5th to 95th percentile human size. Four types of working position (upright, lean-back, zero-gravity and lean-forward) are preset by choosing different angular positions of the workstation parts. Positions of the workstation parts can be changed by controlling the actuators. These four positions were used to evaluate the comfort of the workstation. Subjective and objective evaluations, including comparison of the prototype and standard computer setup, were carried out using human subjects and ergonomic principles. Results showed that the new workstation is much more comfortable, supporting the body in a balanced way. Users have the freedom to stretch and relax in different working positions before they feel any noticeable discomfort; as a result, it lets users work for a longer period without strain, thus resulting in higher productivity.

Source: Workineh, Sisay A., & Yamaura, Hiroshi. (2016). International Journal of Industrial Ergonomics, 53, 1-9.

Effectiveness of workplace interventions in the prevention of upper extremity musculoskeletal disorders and symptoms

An update of the evidence
The burden of disabling musculoskeletal pain and injuries (musculoskeletal disorders, MSDs) arising from work-related causes in many workplaces remains substantial. There is little consensus on the most appropriate interventions for MSDs. Our objective was to update a systematic review of workplace-based interventions for preventing and managing upper extremity MSD (UEMSD). We followed a systematic review process developed by the Institute for Work & Health and an adapted best evidence synthesis. 6 electronic databases were searched (January 2008 until April 2013 inclusive) yielding 9909 non-duplicate references. 26 high-quality and medium-quality studies relevant to our research question were combined with 35 from the original review to synthesise the evidence on 30 different intervention categories. There was strong evidence for one intervention category, resistance training, leading to the recommendation: Implementing a workplace-based resistance training exercise programme can help prevent and manage UEMSD and symptoms. The synthesis also revealed moderate evidence for stretching programmes, mouse use feedback and forearm supports in preventing UEMSD or symptoms. There was also moderate evidence for no benefit for EMG biofeedback, job stress management training, and office workstation adjustment for UEMSD and symptoms. Messages are proposed for both these and other intervention categories.

Source: D Van Eerd, C Munhall, E Irvin, D Rempel, S Brewer, A J van der Beek, J T Dennerlein, J Tullar, K Skivington, C Pinion, B Amick. Occup Environ Med, 2015. 

Systematic review of biochemical biomarkers for neck and upper-extremity musculoskeletal disorders

Objective: This study systematically summarizes biochemical biomarker research in non-traumatic musculoskeletal disorders (MSD). Two research questions guided the review: (i) Are there biochemical markers associated with neck and upper-extremity MSD? and (ii) Are there biochemical markers associated with the severity of neck and upper-extremity MSD?
Methods: A literature search was conducted in PubMed and SCOPUS, and 87 studies met primary inclusion criteria. Following a quality screen, data were extracted from 44 articles of sufficient quality.
Results: Most of the 87 studies were cross-sectional and utilized convenience samples of patients as both cases and controls. A response rate was explicitly stated in only 11 (13%) studies. Less than half of the studies controlled for potential confounding through restriction or in the analysis. Most sufficient-quality studies were conducted in older populations (mean age in one or more analysis group >50 years). In sufficient-quality articles, 82% demonstrated at least one statistically significant association between the MSD and biomarker(s) studied. Evidence suggested that: (i) the collagen-repair marker TIMP-1 is decreased in fibro proliferative disorders, (ii) 5-HT (serotonin) is increased in trapezius myalgia, and (iii) triglycerides are increased in a variety of MSD. Only 5 studies showed an association between a biochemical marker and MSD severity.
Conclusion: While some MSD biomarkers were identified, limitations in the articles examined included possible selection bias, confounding, spectrum effect (potentially heterogeneous biomarker associations in populations according to symptom severity or duration), and insufficient attention to comorbid conditions. A list of recommendations for future studies is provided.

Source: Gold JE, Hallman DM, Hellström F, Björklund M, Crenshaw AG, Djupsjobacka M, Heiden M, Mathiassen SE, Piligian G, Barbe MF. Scand J Work Environ Health, 2015.

Tarification à l’expérience, incidence des troubles musculo-squelettiques et arrêts de travail

Dans un grand nombre de pays, l'assurance des risques professionnels est financée par les entreprises qui versent des contributions modulées selon leur sinistralité
passée. En France, pour une entreprise de plus de 10 salariés, plus le nombre et la gravité des accidents et maladies professionnels sont importants, plus le montant de sa contribution sera élevée. Ce mode de tarification devrait contribuer à sensibiliser les employeurs à l'intérêt de développer des démarches préventives (primaires ou secondaires), afin de réduire leur coût d'assurance, et ainsi contribuer à minimiser le coût social des accidents du travail et maladies professionnels. À partir d'une expérience naturelle observée en 2007 dans le contexte français, nous étudions l'influence d'une augmentation exogène de la contribution des entreprises au coût des troubles musculo - squelettiques (TMS) sur l'incidence de ces maladies et les arrêts de travail associés. Nous estimons un modèle de différence-de-différences, à partir des données administratives de tarification des risques professionnels pour la période 2004-2010. Selon nos résultats, cette augmentation a entraîné une diminution substantielle de l'incidence des TMS, du nombre de jours d'arrêt de travail et du montant des indemnités journalières associés.


Association between objectively measured sitting time and neck–shoulder pain among blue-collar workers

Objectives: Prolonged sitting has been suggested as a risk factor for neck–shoulder pain (NSP). Using a cross-sectional design, we investigated the extent to which objectively measured time sitting is associated with NSP among blue-collar workers.
Methods: Sitting time was measured during multiple working days on male (n = 118) and female (n = 84) blue-collar workers (n = 202) using triaxial accelerometers (Actigraph) placed on the thigh and trunk. Workers were categorized into having, on average, a low, moderate or high sitting time, with mean values (SD between subjects) of 4.9 (1.0), 7.3 (0.5) and 9.6 (1.1) h in total per day. Workers rated their largest NSP intensity during the previous month on a numerical scale (0–9) and were subsequently dichotomized into a low and high NSP intensity group (ratings 0–4 and >4, respectively). Logistic regression analyses adjusted for several individual, and work-related factors were used to investigate the association between average sitting time per day (work, leisure and total) and NSP intensity.
Results: For total sitting time, workers in the high sitting category were more likely (adjusted OR 2.97, CI 1.25–7.03) to report high NSP intensity than those who sat moderately (reference category). Low sitting during work was associated with a reduced NSP intensity, but only for males (adjusted OR 0.26 CI 0.07–0.96). No significant association was found between sitting during leisure and NSP intensity.
Conclusion: These findings suggest an association between sitting time, in total per day and specifically during work, and NSP intensity among blue-collar workers. We encourage studying the structure and explanation of this association further in prospective studies on larger populations.

Source: Latza U, Rossnagel K, Hannerz H, et al. International Archives of Occupational and Environmental Health 2015;88(8):1087-97.

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