Understanding Causal Pathways for Occupationally Related Low Back Disorders

Abstract

Extended Abstract Low back pain has been a leading cause of disability worldwide for nearly two decades (Hartvigsen et al 2018). In a study of US health care spending between 1996 through 2013, low back and neck pain was the health care condition with the highest increase in spending (Dieleman et. al. 2016). Continued increases in health care costs due to low back pain are not sustainable. Therefore, we need to develop better low back disorder prevention plans or tools. In order to prevent occupational low back disorders several tools (ie. NIOSH lifting guide, 3DSSPP, Snook Tables, Lumbar Motion Monitor risk model, REBA, LiFFT) have been developed to quantify the biomechanical or physical exposure risk. There are a multitude of risk factors for low back disorders including psychological, psychosocial, and personal factors none of which are included in the available ergonomics tools (Ferguson and Marras, 1997). The goal of this panel is to promote discussion of the biopsychosocial risk factors that lead to low back disorders and disability. Health care providers suggest that patient advocacy should include preventing prolonged work loss (Nguyen and Randolph, 2007) yet one of the most common personal risk factors of low back pain is previous history of low back pain. The prevention tools above do not include any personal risk factors regarding an individual’s low back health status or any other personal risk factor. Should a new low back injury prevention tool include some personal risk factors for previous low back injury or some other personal risk factor? What about a smoking status risk factor or since sitting is the new smoking what about a sitting risk factor? What about psychosocial factors such as supervisor support or co-worker support? What new tools might we need? What stakeholders to do we need or want at the table in order to develop a tool that will actually be effective and who will the users be? The National Institute of Occupational Safety and Health funded several field studies in the 2000s to examine biomechanical exposure as risk factors of low back disorders. Several of the panelists had studies in the group. A consortium was formed to pool data where possible to increase statistical power to measure these more complex relationships. The common surveillance questionnaire measures of low back disorder included varying degrees of low back disorder severity. The surveillance measures in order from least severe to most severe were 1) any low back pain, 2) seeking medical care due to low back pain and 3) self-reported lost time due to low back pain in the past year. The panelists will be asked to address how the role of their specific topic may change as a function of the various surveillance measures. What does a new tool being developed really need to prevent (low back pain, seeking medical care, self-reported lost time, low back disability)? We will have each panel member discuss causality from several different multidimensional perspectives and will have an open debate/discussion. We will also allow time for audience perspectives Panelist Roles Dr. Jay Kapellusch will be discussing the role of psychophysics and the NIOSH lifting equation. Dr. Matthew S. Thiese will be examining the role of psychosocial risk factors. Dr. Kermit Davis will address interventions. Dr. Sean Gallagher will be probing specific physical injury mechanisms. Dr. William S. Marras will be presenting the multidimensional causal pathway for low back disorders.