A Path Analysis of the Effects of Biopsychosocial Factors on the Onset of Nonspecific Low Back Pain in Office Workers.

OBJECTIVE: The purpose of this study was to develop a conceptual model for the association between various biopsychosocial factors and nonspecific low back pain (LBP) in a sample of office workers. METHODS: A 1-year prospective cohort study of 669 healthy office workers was conducted. At baseline, a self-administered questionnaire and standardized physical examination were employed to gather biopsychosocial data. Follow-up data were collected every month for the incidence of LBP. A regression model was built to analyze factors predicting the onset of LBP. Path analysis was performed to examine direct and indirect associations between identified risk factors and LBP. RESULTS: The onset of LBP was predicted by history of LBP, frequency of rest breaks, and psychological demand, measured by the Job Content Questionnaire. All 3 factors directly related to LBP; history of LBP was the strongest effector on the onset of LBP. History of LBP and frequency of rest breaks had indirect effects on LBP that were mediated through psychological demand, and frequency of rest breaks was the most influential effector on psychological demand. CONCLUSIONS: Three risk factors were identified to predict onset LBP, including history of LBP, frequency of rest breaks, and psychological demand. Each factor had direct effects on the development of LBP. Also, history of LBP and frequency of rest breaks had indirect effects on LBP that were mediated through psychological demand.

Predictors for chronic neck and low back pain in office workers: a 1-year prospective cohort study.

OBJECTIVE: All occupations expose workers to varied and unique conditions. The nature of work has been recognized as influencing the health of workers. Whether predictors for chronic neck and low back pain would be occupation-specific is unknown. This study aimed to identify predictors for chronic neck and low back pain in a cohort of office workers. METHODS: A prospective study was carried out among 669 healthy office workers. At baseline, risk factors were assessed using a questionnaire and standardized physical examination. A symptomatic case was defined as an individual who reported pain greater than 30 mm on a 100-mm VAS, and chronic pain was defined as experiencing ongoing neck or low back pain for greater than 3 months over the past 6 months. Two regression models were built to analyze the risk factors for developing chronic neck and low back pain. RESULTS: Of the sample, 17 and 27% of office workers who reported a new onset of neck or low back pain developed chronicity, respectively. Predictors for chronic neck pain were high body mass index, frequent neck extension during the work day, high initial pain intensity, and high psychological job demands. The development of chronic low back pain was associated with history of low back pain and high initial pain intensity. CONCLUSIONS: The findings suggest that predictors for chronic musculoskeletal pain in a subpopulation may be a subset of predictors identified in a general population or occupation specific. Successful management to prevent chronic musculoskeletal pain may also need to consider the patient's occupation.

A screening tool for non-specific low back pain with disability in office workers: a 1-year prospective cohort study.

BACKGROUND: Having a screening tool with reasonable predictive ability is essential in providing information about an individual's risk of developing a disease, allowing an examination to be conducted with limited personnel and time, and selecting the relevant individuals for therapeutic research. This study aimed to produce a screening tool to identify office workers at risk of developing non-specific low back pain (LBP) with disability, and to evaluate the tool's predictive power. METHODS: At baseline, 615 healthy office workers filled out a self-administered questionnaire and underwent physical examination to gather potential risk factors. The incidence of LBP was collected every month thereafter. Disability level was assessed using the Roland-Morris Disability Questionnaire (RMDQ). The minimum RMDQ score for categorization as LBP was 3. Logistic regression was used to select significant factors to build a risk score. The coefficients from the logistic regression model were used to develop the components of a screening tool. RESULTS: Over the 1-year follow-up, 8.8 % of participants reported incident LBP with disability. The screening tool for non-specific low back pain with disability in office workers comprised two items that contributed to the total score: previous history of LBP and psychological demand (assessed by the Job Content Questionnaire). The score range of the screening tool was 12 to 69. With a cut-off score of 53, the sensitivity was 65 % and the specificity was 68 %. The positive and negative predictive values were 16 and 95 %, respectively. The area under the receiver-operating characteristic curve was 0.76. CONCLUSIONS: A screening tool for non-specific low back pain with disability in office workers was developed and appears to have reasonable sensitivity, specificity, positive predictive values, and negative predictive values. Further validation and impact studies of the screening tool in a new population of office workers are suggested.

Contribution of biopsychosocial risk factors to nonspecific neck pain in office workers: A path analysis model.

OBJECTIVE: The etiology of nonspecific neck pain is widely accepted to be multifactorial. Each risk factor has not only direct effects on neck pain but may also exert effects indirectly through other risk factors. This study aimed to test this hypothesized model in office workers. METHODS: A one-year prospective cohort study of 559 healthy office workers was conducted. At baseline, a self-administered questionnaire and standardized physical examination were employed to gather biopsychosocial data. Follow-up data were collected every month for the incidence of neck pain. A regression model was built to analyze factors predicting the onset of neck pain. Path analysis was performed to examine direct and indirect associations between identified risk factors and neck pain. RESULTS: The onset of neck pain was predicted by female gender, having a history of neck pain, monitor position not being level with the eyes, and frequently perceived muscular tension, of which perceived muscular tension was the strongest effector on the onset of neck pain. Gender, history of neck pain, and monitor height had indirect effects on neck pain that were mediated through perceived muscular tension. History of neck pain was the most influential effector on perceived muscular tension. CONCLUSIONS: The results of this study support the hypothesis that each risk factors may contribute to the development of neck pain both directly and indirectly. The combination of risk factors necessary to cause neck pain is likely occupation specific. Perceived muscular tension is hypothesized to be an early sign of musculoskeletal symptoms.

Development of a neck pain risk score for predicting nonspecific neck pain with disability in office workers: a 1-year prospective cohort study.

OBJECTIVE: The purpose of this study was to develop a neck pain risk score for office workers (NROW) to identify office workers at risk for developing nonspecific neck pain with disability. METHODS: A 1-year prospective cohort study of 559 healthy office workers was conducted. At baseline, risk factors were assessed using questionnaires and standardized physical examination. The incidence of neck pain was collected every month thereafter. Disability level was evaluated using the neck disability index. Logistic regression was used to select significant factors to build a risk score. The coefficients from the logistic regression model were transformed into the components of a risk score. RESULTS: Among 535 (96%) participants who were followed up for 1 year, 23% reported incident neck pain with disability (≥5). After adjusting for confounders, the onset of neck pain with disability was significantly associated with history of neck pain, chair adjustability, and perceived muscular tension. Thus, the NROW comprises 3 questions about history of neck pain, chair adjustability, and perceived muscular tension. The NROW had scores ranging from 0 to 4. A cut-off score of at least 2 had a sensitivity of 82% and specificity of 48%. The positive and negative predictive values were 29% and 91%, respectively. The area under the receiver operating characteristic curve was 0.75. CONCLUSION: The risk score for nonspecific neck pain with disability in office workers was developed, and it contained 3 items with scores ranging from 0 to 4. This study shows that the score appears to have reasonable sensitivity, specificity, positive predictive value, and negative predictive values for the cut-off point of at least 2.

Risk factors for the onset of nonspecific low back pain in office workers: a systematic review of prospective cohort studies.

OBJECTIVE: The purpose of this study was to systematically review prospective cohort studies to identify risk factors for the onset of low back pain (LBP) in office workers. METHODS: Online searches were conducted on PubMed, CINAHL Plus with full text, ScienceDirect, PEDro, ProQuest, and Scopus databases from 1980 to November 2011 using the following keywords: low back pain paired with risk or prognostic factors and office or computer or visual display unit (VDU) or visual display terminal (VDT). The methodological quality of each study was assessed using a 21-item checklist, which was divided into 2 parts: the internal validity (11 items) and descriptive quality (10 items) of studies. Strength of evidence for risk factors associated with the development of nonspecific LBP was assessed by defining 5 levels of evidence based on the number of studies and the quality score of studies. RESULTS: Eighteen full-text articles were identified, and 15 were excluded. A total of 3 articles were judged to meet the selection criteria and were included in the methodological quality assessment. Risk factors were divided into 3 groups: individual, work-related physical, and work-related psychosocial risk factors. There was strong evidence that history of LBP is a predictor of the onset of LBP. Limited evidence was found that the combination of postural risk factors and job strain is associated with the onset of LBP. CONCLUSION: After review of 3 high-quality prospective studies on the association between risk factors and the onset of nonspecific LBP in office workers, few risk factors were found to predict the onset of LBP in office workers.

Office workers' risk factors for the development of non-specific neck pain: a systematic review of prospective cohort studies.

The purpose of this study was to systematically review prospective cohort studies to gain insights into risk factors for the development of non-specific neck pain in office workers as well as to assess the strength of evidence. Publications were systematically searched from 1980 - March 2011 in several databases. The following key words were used: neck pain paired with risk or prognostic factors and office or computer or visual display unit or visual display terminal. Relevant studies were retrieved and assessed for methodological quality by two independent reviewers. The strength of the evidence was based on methodological quality and consistency of the results. Five high-quality and two low-quality prospective cohort studies investigating the predictive value of 47 individual, work-related physical and work-related psychosocial factors for the onset of non-specific neck pain in office workers were included in this review. Strong evidence was found for female gender and previous history of neck complaints to be predictors of the onset of neck pain. Interestingly, for a large number of factors that have been mentioned in the literature as risk factors for neck pain, such as high physical leisure activity, low social support, and high psychosocial stress, we found no predictive value for future neck pain in office workers. Literature with respect to the development of non-specific neck pain in office workers is scant. Only female gender and previous history of neck complaints have been identified as risk factors that predict the onset of neck pain.