Causal assessment of occupational sitting and low back pain: results of a systematic review

Roffey, Darren M.; Wai, Eugene K.; Bishop, Paul; Kwon, Brian K.; Dagenais, Simon

doi:10.1016/j.spinee.2009.12.005

« Previous Next »The Spine Journal
Volume 10, Issue 3 , Pages 252-261, March 2010

Causal assessment of occupational sitting and low back pain: results of a systematic review

Darren M. Roffey, PhD
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Eugene K. Wai, MD, MSc, CIP, FRCSC
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
- Corresponding author. Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, 1053 Carling Ave., Ottawa, Ontario K1Y 4E9, Canada. Tel.: (613) 798-5555 ext 19138; fax: (613) 761-4944.
Paul Bishop, DC, MD, PhD
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
- UBC Combined Neurosurgical and Orthopaedic Spine Program, Vancouver, British Columbia, Canada
- Vancouver Hospital Spine Program and Acute Spinal Cord Injury Unit, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
Brian K. Kwon, MD, PhD, FRCSC
- UBC Combined Neurosurgical and Orthopaedic Spine Program, Vancouver, British Columbia, Canada
- Vancouver Hospital Spine Program and Acute Spinal Cord Injury Unit, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
Simon Dagenais, DC, PhD
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada

Received 29 July 2009; accepted 2 December 2009. published online 25 January 2010.

Abstract

Background context

Low back pain (LBP) is a common and disabling musculoskeletal disorder that often occurs in a working-age population. Determining the precise causation of LBP remains difficult. Any attempt to implicate a specific occupational activity in the genesis of LBP requires a methodologically rigorous approach.

Purpose

To conduct a systematic review of the scientific literature focused on evaluating the causal relationship between occupational sitting and LBP.

Study design

Systematic review of the literature using Medline, EMBASE, CINAHL, Cochrane Library, Occupational Safety and Health database, grey literature, hand-searching occupational health journals, reference lists of included studies, and content experts. Evaluation of study quality using a modified version of the Newcastle-Ottawa Scale. Summary levels of evidence supporting Bradford-Hill criteria for different categories of sitting and types of LBP.

Samples

Studies reporting an association between occupational sitting and LBP.

Outcome measures

Numerical association between different levels of exposure to occupational sitting and the presence or severity of LBP.

Methods

A systematic review was performed to identify, evaluate, and summarize the literature related to establishing a causal relationship, according to Bradford-Hill criteria, between occupational sitting and LBP.

Results

This search yielded 2,766 citations. Twenty-four studies met the inclusion/exclusion criteria and five were high-quality studies, including two case-controls and three prospective cohorts. Strong, consistent evidence was found for no association between occupational sitting and LBP. A moderate level of evidence was found for the absence of any dose-response trend. Risk estimates evaluating temporality were not statistically significant. Biological plausibility was not discussed in these studies. No evidence was available to assess the experiment criterion.

Conclusions

This review failed to uncover high-quality studies to support any of the Bradford-Hill criteria to establish causality between occupational sitting and LBP. Strong and consistent evidence did not support criteria for association, temporality, and dose response. Based on these results, it is unlikely that occupational sitting is independently causative of LBP in the populations of workers studied.

Keywords: Occupational health, Low back pain, Sitting, Causality, Etiology, Systematic review