Causal assessment of occupational standing or walking 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.2009.12.023

« Previous Next »The Spine Journal
Volume 10, Issue 3 , Pages 262-272, March 2010

Causal assessment of occupational standing or walking and low back pain: results of a systematic review

Darren M. Roffey, PhD
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Ave., Ottawa, ON K1Y 4E9, Canada
Eugene K. Wai, MD, MSc, CIP, FRCSC
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Ave., Ottawa, ON K1Y 4E9, Canada
- Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, 1053 Carling Ave., Ottawa, Ontario, K1Y 4E9, Canada
- Corresponding author. Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, 1053 Carling Ave., Ottawa, ON K1Y 4E9, Canada. Tel.: (613) 7985555 ext 19138; fax: (613) 7614944.
Paul Bishop, DC, MD, PhD
- Department of Orthopaedics, University of British Columbia, 3114-910 West 10th Ave., Vancouver, BC V5Z 4E3, Canada
- UBC Combined Neurosurgical and Orthopaedic Spine Program, D6 Heather Pavilion, 2733 Heather Street, Vancouver, BC V5Z 3J5, Canada
- Vancouver Hospital Spine Program and Acute Spinal Cord Injury Unit, D6 Heather Pavilion, 2733 Heather Street, Vancouver, BC V5Z 3J5, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Blusson Spinal Cord Center, 818 West 10th Ave., Vancouver, BC V5Z IM9, Canada
Brian K. Kwon, MD, PhD, FRCSC
- UBC Combined Neurosurgical and Orthopaedic Spine Program, D6 Heather Pavilion, 2733 Heather Street, Vancouver, BC V5Z 3J5, Canada
- Vancouver Hospital Spine Program and Acute Spinal Cord Injury Unit, D6 Heather Pavilion, 2733 Heather Street, Vancouver, BC V5Z 3J5, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Blusson Spinal Cord Center, 818 West 10th Ave., Vancouver, BC V5Z IM9, Canada
Simon Dagenais, DC, PhD
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Ave., Ottawa, ON K1Y 4E9, Canada
- Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, 1053 Carling Ave., Ottawa, Ontario, K1Y 4E9, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, Room 3105-451 Smyth Rd, Ottawa, ON K1H 8M5, Canada

Received 4 August 2009; received in revised form 6 November 2009; accepted 25 December 2009.

Abstract

Background context

Low back pain (LBP) is a widespread musculoskeletal condition that frequently occurs in the working-age population. Numerous occupational physical activities have been implicated in its etiology.

Purpose

To conduct a systematic review establishing a causal relationship between occupational standing or walking and LBP.

Study design

Systematic review of the literature.

Sample

Studies reporting an association between occupational standing or walking and LBP.

Outcome measures

Numerical association between exposure to standing or walking and the presence 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 for causality, between occupational standing or walking and LBP. A search was conducted using MEDLINE, Embase, CINAHL, Cochrane Library, and Occupational Safety and Health database, gray literature, hand-searching occupational health journals, reference lists of included studies, and expert knowledge. Evaluation of methodological quality was performed using a modified Newcastle-Ottawa Scale.

Results

This search yielded 2,766 citations. Eighteen studies met the inclusion criteria. Five were high-quality studies related to standing, and two were high-quality studies related to walking. For occupational standing and LBP, there was moderate to strong evidence against the association criterion, the only study examining dose response did not support this criterion, four studies examining temporality failed to support this criterion, and only one study discussed the biological plausibility criterion. For occupational walking and LBP, there was moderate evidence against a causal relationship with respect to the association, temporality, dose response, and biological plausibility criteria. No studies assessed the experiment criterion for these activities.

Conclusions

A summary of existing studies was not able to find any high-quality studies that satisfied more than two of the Bradford-Hill causation criteria for occupational standing or walking and LBP. Based on the evidence reviewed, it is unlikely that occupational standing or walking is independently causative of LBP in the populations of workers studied.

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