WORK ACCIDENTS
Back Injuries

Data on work accidents and back injuries

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Over 40 recent articles provided evidence regarding the relationship between low-back disorder and the five physical workplace factors that were considered in this review. These included (1) heavy physical work, (2) lifting and forceful movements, (3) bending and twisting (awkward postures), (4) whole-body vibration (WBV), and (5) static work postures. Many of the studies addressed multiple work-related factors. All articles that addressed a particular workplace factor contributed to the information used to draw conclusions about that risk factor, regardless of whether results were positive or negative.

The review provided evidence for a positive relationship between back disorder and heavy physical work, although risk estimates were more moderate than for lifting/forceful movements, awkward postures, and WBV. This was perhaps due to subjective and imprecise characterization of exposures. Evidence for dose-response was equivocal for this risk factor.

There is strong evidence that low-back disorders are associated with work-related lifting and forceful movements. Of 18 epidemiologic studies that were reviewed, 13 were consistent in demonstrating positive relationships. Those using subjective measures of exposure showed a range of risk estimates from 1.2 to 5.2, and those using more objective assessments had odds ratios (ORs) ranging from 2.2 to 11. Studies using objective measures to examine specific lifting activities generally demonstrated risk estimates above three and found dose-response relationships between exposures and outcomes. For the most part, higher ORs were observed in high-exposure populations (e.g., one high-risk group averaged 226 lifts per hour with a mean load weight of 88 newtons [N]) . Most of the investigations reviewed for this document adjusted for potential covariates in analyses; nevertheless, some of the relatively high ORs that were observed were unlikely to be caused by confounding or other effects of lifestyle covariates. Several studies suggested that both lifting and awkward postures were important contributors to the risk of low-back disorder. The observed relationships are consistent with biomechanical and other laboratory evidence regarding the effects of lifting and dynamic motion on back tissues.

The review provided evidence that work-related awkward postures are associated with low-back disorders. Results were consistent in showing positive associations, with several risk estimates above three. Exposure-response relationships were demonstrated. Many of the studies adjusted for potential covariates and a few examined the simultaneous effects of other work-related physical factors. Again, it appeared that lifting and awkward postures both contribute to risk of low-back disorder.

There is strong evidence of an association between exposure to WBV and low-back disorder. Of 19 studies reviewed for this document, 15 studies were consistent in demonstrating positive associations, with risk estimates ranging from 1.2 to 5.7 for those using subjective exposure measures, and from 1.4 to 39.5 for those using objective assessment methods. Most of the studies that examined relationships in high-exposure groups using detailed quantitative exposure measures found strong positive associations and exposure-response relationships between WBV and low back disorders. These relationships were observed after adjusting for covariates.

Both experimental and epidemiologic evidence suggest that WBV may act in combination with other work-related factors, such as prolonged sitting, lifting, and awkward postures, to cause increased risk of back disorder. It is possible that effects of WBV may depend on the source of exposure (type of vehicle).

With regard to static work postures and low-back disorder, results from the studies that were reviewed provided insufficient evidence that a relationship exists. Few investigations examined effects of static work postures, and exposure characterizations were limited.

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see also:

Vibration Syndrome Work Accidents: Hand-Arm Vibration Syndrome - Musculoskeletal Disorders
Vibration Syndrome - Musculoskeletal Disorders: Evidence for Work Accidents

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