Dose-response relations between occupational exposures to physical and psychosocial factors and the risk of low back pain
Dose-response relations between occupational exposures to physical and psychosocial factors and the risk of low back pain
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DOI：
10.1136/oem.2003.012245
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发表时间：
2004-12-01
影响因子：
4.9
通讯作者：
Burdorf, A
中科院分区：
文献类型：
--
作者：
Jansen, JP;Morgenstern, H;Burdorf, A
目的：为了评估职业暴露的身体和心理社会因素和风险的腰背痛。方法：一个队列的523名受试者，在疗养院和老人院工作，前瞻性地随访了一年。通过在工作场所的定量观察，对不同职业的身体负荷进行了评估。在基线和一年时，通过问卷调查收集有关腰痛和其他因素的信息。使用两种腰痛发生率的结局指标：随访期间任何持续至少几小时的新发疼痛（LBP）;以及随访期间任何干扰日常活动的新发致残性疼痛（LBP/ D）。分层回归分析与样条函数被用来估计dose-response relationships.Results：LBP的风险是不相关的物理因素，控制混杂因素，但这种结果与年龄呈负相关，弱，但不精确，与两个心理社会因素-低决策权威和高工作要求。与此相反，LBP/ D的风险与年龄呈正相关，与心理社会因素无关。躯干屈曲超过45度与LBP/ D的风险单调相关;相对于每周30分钟，每周屈曲1小时45分钟（第90百分位数）的估计相对风险为3.18（95%CI 1.13至9.00）。分层估计的效果是更稳定的最大似然estimation.Conclusion：职业暴露于躯干屈曲超过45度似乎是一个危险因素，在养老院和老年人之家在荷兰的人与残疾腰背痛。
Aims: To assess dose-response relations between occupational exposures to physical and psychosocial factors and the risk of low back pain.Methods: A cohort of 523 subjects, working in nursing homes and homes for the elderly, was followed prospectively for one year. Physical load for different occupations was assessed by quantitative observations at the workplace. Information on low back pain and other factors was gathered with questionnaires administered at baseline and at one year. Two outcome measures of low back pain incidence were used: any new episode of pain lasting for at least a few hours during follow up (LBP); and any new episode of disabling pain that interfered with daily activities during follow up (LBP/ D). Hierarchical regression analysis with a spline function was used to estimate dose-response relations.Results: The risk of LBP was not associated with physical factors, controlling for confounders; but this outcome was inversely associated with age and weakly, though imprecisely, associated with two psychosocial factors - low decision authority and high work demands. In contrast, the risk of LBP/ D was positively associated with age and not associated with the psychosocial factors. Trunk flexion over 45 degrees was monotonically associated with the risk of LBP/ D; the estimated relative risk was 3.18 (95% CI 1.13 to 9.00) for 1 hour and 45 minutes of bending per week (90th centile), relative to 30 minutes per week. The hierarchical estimates of effect were more stable than were the maximum likelihood estimates.Conclusion: Occupational exposure to trunk flexion over 45 degrees appears to be a risk factor for low back pain with disability among persons employed in nursing homes and homes for the elderly in the Netherlands.