LOW BACK PAIN: PHYSICAL AND PSYCHOSOCIAL JOB FACTORS

本项目旨在前瞻性地研究身体和心理社会工作因素在职业性下腰痛(LBP)发展中的作用，分五个连续的阶段：(1)残疾前症状阶段，(2)残疾前正式伤害报告阶段，和(3)三个残疾阶段--急性、亚急性和慢性--根据损失的工作时间的增加来定义。假设身体和心理社会工作因素在所有五个阶段都是LBP的独立预测因素，并且它们的相对影响大小在不同阶段有所不同。主要目标是确定特定阶段的风险因素概况，特别关注心理社会和生物力学风险因素的相对影响。长期目标是为工作场所干预措施的设计提供有用的信息，这种干预措施结合了组织和人体工程学的工作重新设计，以防止腰部受伤和工作残疾。该项目结合了两个现有数据集的资源-旧金山城市交通运营商的两个预期队列(n=1,449，n=1,640)。这两项纵向研究为工人赔偿数据提供了3至5年的跟踪，以便研究残疾进程的每个阶段，包括慢性残疾阶段(超过90天休假)，这一阶段占与工伤有关的下腰伤相关费用的80%。这两项研究都提供了关于工作相关、社会人口、伤害、医疗法律和经济因素的可比信息。初步分析将考察身体和心理社会工作因素的独立和综合影响，包括心理和身体工作需求、工作控制、工作压力和工作中的社会支持。此外，将使用由独立观察员用创新的工作分析工具测量的关于工作压力的独特数据，与自我报告的措施进行一致性分析，以评估大型职业性下腰痛流行病学研究中使用的调查工具的预测有效性。

This project seeks to prospectively examine the role of physical and psychosocial job factors in the development of occupational low back pain (LBP) during five successive phases: (1) the pre- disability symptom phase, (2) the pre-disability formal injury report phase, and (3) three disability phases - acute, subacute, and chronic - defined by increasing durations of lost work time. It is hypothesized that both physical and psychosocial job factors are independent predictors of LBP at all five phases and that their relative effect sizes change across phases. The main objective is to determine phase-specific risk factor profiles with particular focus on the relative impact of psychosocial and biomechanical risk factors. The long-term goal is to yield useful information for the design of workplace interventions which combine organizational and ergonomic job redesign to prevent low back injuries and work disability. This project combines the resources of two existing data sets - two prospective cohorts of San Francisco urban transit operators (n = 1,449, n = 1,640). These two longitudinal studies provide workers' compensation data with 3 to 5 years of follow-up, allowing for the study of each phase of the disability process, including the chronic disability phase (greater than 90 days off work), which accounts for 80 percent of the costs associated with work-related low back injuries. Both studies provide comparable information on job-related, sociodemographic, injury, medico- legal, and economic factors. Primary analyses will examine the independent and combined effects of physical and psychosocial job factors, including psychological and physical job demands, job control, job strain and social support at work. In addition, unique data on job stress, measured by independent observers with an innovative job analysis instrument, will be used for agreement analyses with self-reported measures to evaluate the predictive validity of survey instruments used in large epidemiological studies of occupational LBP.