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Meta-Analysis
. 2023 Oct 1;49(7):453-465.
doi: 10.5271/sjweh.4114. Epub 2023 Aug 15.

Occupational mechanical exposures as risk factor for chronic low-back pain: a systematic review and meta-analysis

Alexander Jahn  1 , Johan Hviid Andersen, David Høyrup Christiansen, Andreas Seidler, Annett Dalbøge
Affiliations
Meta-Analysis

Occupational mechanical exposures as risk factor for chronic low-back pain: a systematic review and meta-analysis

Alexander Jahn et al. Scand J Work Environ Health. .

Abstract

Objectives: The association between occupational mechanical exposures and low-back pain (LBP) has been studied in several systematic reviews. However, no systematic review addressing chronic LBP exists. The aim of this systematic review and meta-analysis was to examine the association between occupational mechanical exposures and chronic LBP.

Methods: The study was registered in PROSPERO. We used an existing systematic review to identify articles published before January 2014. For studies published between January 2014 and September 2022, a systematic literature search was conducted in six databases. Two authors independently excluded articles, extracted data, and assessed risk of bias and level of evidence (GRADE). Meta-analyses were conducted using random-effects models comparing highest versus lowest exposure group with sensitivity analyses based on study quality (low/moderate versus high risk of bias), study design (cohort versus case-control), and outcome definition (non-specific LBP versus specific chronic LBP).

Results: Twenty-six articles were included. Highest pooled odd ratios (OR) were found for combined mechanical exposures [OR 2.2, 95% confidence interval (CI) 1.4-3.6], lifting/carrying loads (OR 1.7, 95% CI 1.4-2.2), and non-neutral postures (OR 1.5, 95% CI 1.2-1.9). For the remaining mechanical exposures (ie, whole-body vibrations, standing/walking, and sitting), OR ranged between 1.0 and 1.4. In the sensitivity analyses, generally, higher pooled OR were found in low/moderate risk of bias studies, case-control studies, and studies of specific chronic LBP.

Conclusions: Moderate evidence of an association was found for lifting/carrying loads, non-neutral postures, and combined mechanical exposures. Low or very low evidence was found for whole-body vibrations, standing/walking, and sitting. Studies using standardized exposure definition, metric, and technical measurements are highly warranted.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart of the literature search and exclusion of articles.
Figure 2
Figure 2
Forest plot of the association between lifting/carrying loads and chronic lower back pain (LBP). [ASBEOP=Age, Sex, BMI, Education, Other mechanical exposures, and Physical activity in leisure time. + Others = adjustments of other confounding variables besides ASBEOP; NS=not stated; kg=kilograms; MMH=manual materials handling; N/h=newton hour; H=hour.]
*Cases with lumbar disc herniation.
**Cases with lumbar disc narrowing.
^ In brackets, numbers of exposed persons with chronic LBP and numbers of exposed references is provided.
Figure 3
Figure 3
Forest plot of the association between non-neutral postures and chronic LBP. [ASBEOP=Age, Sex, BMI, Education, Other mechanical exposures, and Physical activity in leisure time. + Others = adjustments of other confounding variables besides ASBEOP; NS=not stated; kg=kilograms.]
*Cases with lumbar disc herniation.
**Cases with lumbar disc narrowing.
^ In brackets, numbers of exposed persons with chronic LBP and numbers of exposed references is provided.
^^ In brackets, numbers of unexposed persons with chronic LBP and numbers of unexposed references is provided. If only on number is provided, it was not possible to distinguish between, e.g., exposed persons with chronic LBP and exposed references.
^^ In brackets, numbers of unexposed persons with chronic LBP and numbers of unexposed references is provided. If only on number is provided, it was not possible to distinguish between, e.g., exposed persons with chronic LBP and exposed references.
Figure 4
Figure 4
Forest plot of the association between whole-body vibrations and chronic LBP. [ASBEOP=Age, Sex, BMI, Education, Other mechanical exposures, and Physical activity in leisure time. + Others = adjustments of other confounding variables besides ASBEOP; NS=not stated; N/h=newton hours; JEM=job-exposure matrix; WBV=whole-body vibration.]
*Cases with lumbar disc herniation.
**Cases with lumbar disc narrowing.
^ In brackets, numbers of exposed persons with chronic LBP and numbers of exposed references is provided.
^^ In brackets, numbers of unexposed persons with chronic LBP and numbers of unexposed references is provided. If only on number is provided, it was not possible to distinguish between, e.g., exposed persons with chronic LBP and exposed references.
Figure 5
Figure 5
Forest plot of the association between standing or walking and chronic LBP. [ASBEOP=Age, Sex, BMI, Education, Other mechanical exposures, and Physical activity in leisure time. + Others = adjustments of other confounding variables besides ASBEOP; NS=not stated.]
*Cases with lumbar disc herniation.
**Cases with lumbar disc narrowing.
^ In brackets, numbers of exposed persons with chronic LBP and numbers of exposed references is provided.
^^ In brackets, numbers of unexposed persons with chronic LBP and numbers of unexposed references is provided. If only on number is provided, it was not possible to distinguish between, e.g., exposed persons with chronic LBP and exposed references.
Figure 6
Figure 6
Forest plot of the association between sitting and chronic LBP. [ASBEOP=Age, Sex, BMI, Education, Other mechanical exposures, and Physical activity in leisure time. + Others = adjustments of other confounding variables besides ASBEOP; NS=not stated; H=hours.]
*Cases with lumbar disc herniation.
**Cases with lumbar disc narrowing.
^ In brackets, numbers of exposed persons with chronic LBP and numbers of exposed references is provided.
^^ In brackets, numbers of unexposed persons with chronic LBP and numbers of unexposed references is provided. If only on number is provided, it was not possible to distinguish between, e.g., exposed persons with chronic LBP and exposed references.
Figure 7
Figure 7
Association between combined mechanical exposures and chronic LBP. [ASBEOP=Age, Sex, BMI, Education, Other mechanical exposures, and Physical activity in leisure time. + Others = adjustments of other confounding variables besides ASBEOP; NS=not stated; MMH=manual materials handling.]
*Cases with lumbar disc herniation.
**Cases with lumbar disc narrowing.
^ In brackets, numbers of exposed persons with chronic LBP and numbers of exposed references is provided.
^^ In brackets, numbers of unexposed persons with chronic LBP and numbers of unexposed references is provided. If only on number is provided, it was not possible to distinguish between, e.g., exposed persons with chronic LBP and exposed references.
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References

    1. Ricci JA, Stewart WF, Chee E, Leotta C, Foley K, Hochberg MC. Back pain exacerbations and lost productive time costs in United States workers. Spine 2006. Dec;31(26):3052–60. 10.1097/01.brs.0000249521.61813.aa - DOI - PubMed
    1. Stewart WF, Ricci JA, Chee E, Morganstein D, Lipton R. Lost productive time and cost due to common pain conditions in the US workforce. JAMA 2003. Nov;290(18):2443–54. 10.1001/jama.290.18.2443 - DOI - PubMed
    1. Hoy D, Bain C, Williams G, March L, Brooks P, Blyth Fet al. A systematic review of the global prevalence of low back pain. Arthritis Rheum 2012. Jun;64(6):2028–37. 10.1002/art.34347 - DOI - PubMed
    1. Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay Set al. ; Lancet Low Back Pain Series Working Group . What low back pain is and why we need to pay attention. Lancet 2018. Jun;391(10137):2356–67. 10.1016/S0140-6736(18)30480-X - DOI - PubMed
    1. Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet 2017. Feb;389(10070):736–47. 10.1016/S0140-6736(16)30970-9 - DOI - PubMed