Schenk Peter, Läubli Thomas, Hodler Juerg, Klipstein Andreas
Center for Organisational and Occupational Health Sciences (ZOA), ETH Zurich, Leonhardstrasse 25a, 8092, Zurich, Switzerland.
Eur Spine J. 2007 Nov;16(11):1789-98. doi: 10.1007/s00586-007-0346-6. Epub 2007 Jul 5.
The aim of the present study was to explore if (a) recurrent low back pain (LBP) has different symptomatologies in cases from occupations with predominantly sitting postures compared to cases from occupations involving dynamic postures and frequent lifting and (b) if in the two occupational groups, different factors were associated with the presence of recurrent LBP. Hundred and eleven female subjects aged between 45 and 62 years with a long-standing occupation either in administrative or nursing professions, with and without recurrent LBP were examined. An extensive evaluation of six areas of interest (pain and disability, clinical examination, functional tests, MR examination, physical and psychosocial workplace factors) was performed. The variables from the six areas of interest were analyzed for their potential to discriminate between the four groups of subjects (administrative worker and nurses with and without recurrent LBP) by canonical discriminant analysis. As expected, the self-evaluation of physical and psychosocial workplace factors showed significant differences between the two occupational groups, which holds true for cases as well as for controls (P < 0.01). The functional tests revealed a tendency for rather good capacity in nurses with LBP and a decreased capacity in administrative personnel with LBP (P = 0.049). Neither self completed pain and disability questionnaires nor clinical examination or MR imaging revealed any significant difference between LBP cases from sedentary and non-sedentary occupations. When comparing LBP cases and controls within the two occupational groups, the functional tests revealed significant differences (P = 0.0001) yet only in administrative personnel. The clinical examination on the other hand only discriminated between LBP cases and controls in the nurses group (P < 0.0001). Neither MRI imaging nor self reported physical and psychosocial workplace factors discriminated between LBP cases and controls from both occupational groups. Although we used a battery of tests that have broad application in clinical and epidemiological studies of LBP, a clear difference in the pattern of symptoms between LBP cases from nursing and hospital administration personnel could not be ascertained. We conclude that there is no evidence for different mechanisms leading to non-specific, recurrent LBP in the two occupations, and thus no generalizable recommendations for the prevention and therapy of non-specific LBP in the two professions can be given.
(a)与从事动态姿势及频繁搬运工作的职业相比,以久坐姿势为主的职业中,复发性腰痛(LBP)的症状是否不同;以及(b)在这两个职业群体中,复发性LBP的存在是否与不同因素相关。对111名年龄在45至62岁之间、长期从事行政或护理职业、有或无复发性LBP的女性受试者进行了检查。对六个感兴趣的领域(疼痛与残疾、临床检查、功能测试、磁共振成像检查、身体及心理社会工作场所因素)进行了全面评估。通过典型判别分析,分析了六个感兴趣领域的变量区分四组受试者(有和无复发性LBP的行政工作人员和护士)的潜力。正如预期的那样,身体及心理社会工作场所因素的自我评价在两个职业群体之间显示出显著差异,病例组和对照组均如此(P < 0.01)。功能测试显示,患有LBP的护士能力倾向于较好,而患有LBP的行政人员能力有所下降(P = 0.049)。自我填写的疼痛与残疾问卷、临床检查或磁共振成像均未显示久坐和非久坐职业的LBP病例之间存在任何显著差异。在比较两个职业群体中的LBP病例和对照组时,功能测试显示存在显著差异(P = 0.0001),但仅在行政人员中如此。另一方面,临床检查仅在护士组中区分了LBP病例和对照组(P < 0.0001)。磁共振成像以及自我报告的身体及心理社会工作场所因素均未区分两个职业群体中的LBP病例和对照组。尽管我们使用了一系列在LBP临床和流行病学研究中广泛应用的测试,但仍无法确定护理人员和医院行政人员的LBP病例在症状模式上存在明显差异。我们得出结论,没有证据表明这两种职业中导致非特异性复发性LBP的机制不同,因此无法给出针对这两种职业中非特异性LBP预防和治疗的通用建议。