Exposure Response Relationships for Low Back Pain from Pooled Data

Details

• Personal Author:
  Ferguson SA ; Hegmann KT ; Kapellusch J ; Lu M-L ; Malloy E ; Marras WS ; Merryweather AS ; Thiese MS
• Description:
  Low Back Pain (LBP), and related outcomes are burdensome occupational MSDs for workers and employers. Prior studies have examined risk factors but only limited information is available about quantified exposure-response relationships for LBP and its related outcomes of seeking care for LBP (SC-LBP) and lost time due to LBP (LT-LBP). There is scientific disagreement about whether or not biomechanical exposures are independent risk factors for LBP. Previously collected data were pooled from three research sites. Workers from 82 facilities representing 21 predominantly manufacturing and warehousing industries in six US states were included. Demographic, psychosocial, and health outcomes data were collected on each worker. Workers were followed for up to 4.5 years. Occupational physical exposures were measured for each task performed by each worker. A total of 1,976 workers provided data. Complete data were available and successfully pooled for 1,650 (83.5%). Many workers (395) performed multi-task jobs (i.e., job-rotation). A large majority of the cohort was male (75%) and white (68%). Mean age was 35.5 +/- 11.3 years, and mean BMI was 28.0 +/- 6.0. Lift/Lower activities were quantified using the Revised NIOSH Lifting Equation (RNLE) with summary measures at the sub-task, task, and job levels. Sub-tasks were individual lifts/lowers (quantified with peak RNLE Frequency Independent Lifting Index), tasks were collections of sub-tasks performed as a set (quantified with the peak RNLE Composite Lifting Index), and jobs were collections of tasks performed in a workday (quantified with the RNLE Cumulative Lifting Index). Independent lifting parameters such as peak weight, peak reach and peak twisting were also analyzed. Exposure-response relationships were developed for prevalence of LBP outcomes using logistic regression and developed for incidence of LBP outcomes using proportional hazards regression. Continuous analyses were performed with linear splines used to account for nonlinear exposure-response. The RNLE was consistently associated with prevalence and incidence of LBP, SC-LBP, and LTLBP at the peak sub-task, peak task, and job-levels. Peak task exposure was most strongly associated with prevalence and peak sub-task most strongly associated with incidence. In addition, peak reaching and peak twisting were consistently and strongly associated with incidence of all three LBP outcomes. Increased age was associated with prevalence of LBP but not SC-LBP or LT-LBP. Conversely, increased age was protective for incidence of LBP. Gender and BMI were not associated. Psychosocial factors such as coworker support and job satisfaction were associated with prevalence of all three outcomes but not incidence. Lifetime history of LBP was associated with prevalence and incidence of outcomes. In prevalence analyses LBP history appeared to confound the effects of physical exposure and reduced the ORs of the RNLE measures by 40 to 50%. Overall, evidence is provided that biomechanical exposures are independent risk factors for LBP and related outcomes. The findings of this study should help inform future LBP research and intervention strategies. Continuous exposure-response relationships provide a basis for companies to develop exposure policies. The RNLE provides a foundation for detailed job design, evaluation, and decision making. Associations with individual parameters of lifts/lowers provide a basis for simple surveillance strategies. [Description provided by NIOSH]
• Subjects:
  Age Factors Biomechanical Phenomena Manufacturing And Industrial Facilities Musculoskeletal Diseases Musculoskeletal System Occupational Health Risk Assessment Risk Factors Safety
• Keywords:
  Age Factors Biomechanics Lifting Low Back Pain Manual Materials Handling Manufacturing MSD Musculoskeletal Disorders Psychosocial Factors Risk Factors Warehousing

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• Series:
  Grant Final Reports
• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Final Grant Report
• Place as Subject:
  District of Columbia ; Ohio ; OSHA Region 3 ; OSHA Region 5 ; OSHA Region 8 ; Utah ; Wisconsin
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OEP - Office of Extramural Programs
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-47
• NIOSHTIC Number:
  nn:20063039
• NTIS Accession Number:
  PB2022-100488
• Citation:
  Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, R01-OH-010916, 2020 Nov; :1-47
• Federal Fiscal Year:
  2021
• NORA Priority Area:
  Manufacturing ; Services
• Performing Organization:
  University of Wisconsin, Milwaukee
• Peer Reviewed:
  False
• Start Date:
  20150901
• Source Full Name:
  National Institute for Occupational Safety and Health
• End Date:
  20180831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:5a4850504f2718f84454e1d487359e0bee429d9cabc0a6af8a310895d3f4ecb8e0b43a9cc768e4f8947c5caea0d961fe65e088d8a89f2db4e9d45d157d42a14a
• Download URL:
  https://stacks.cdc.gov/view/cdc/219063/cdc_219063_DS1.pdf
• File Type:
  [PDF - 927.35 KB ]