Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Ave., Ottawa, ON K1Y 4E9, Canada.
Spine J. 2010 Jan;10(1):89-99. doi: 10.1016/j.spinee.2009.09.003. Epub 2009 Nov 11.
Low back pain (LBP) is a prevalent and costly musculoskeletal disorder that often occurs in the working-age population. Although numerous physical activities have been implicated in its complex etiology, determining causation remains challenging and requires a methodologically rigorous approach.
To conduct a systematic review of the scientific literature focused on establishing a causal relationship between awkward occupational postures and LBP.
Systematic review of the literature using MEDLINE, EMBASE, CINAHL, Cochrane Library, and Occupational Safety and Health database, gray literature, hand-searching occupational health journals, reference lists of included studies, and experts. Evaluation of methodological quality using a modified Newcastle-Ottawa Scale for observational studies. Summary levels of evidence for each of the Bradford Hill criteria for causality for each category of awkward occupational posture and type of LBP.
Studies reporting an association between awkward occupational postures and LBP.
Numerical association between different levels of exposure to awkward occupational postures and the presence or severity of LBP.
A systematic review was performed to identify, evaluate, and summarize the literature related to establishing a causal relationship, according to Bradford Hill criteria, between awkward occupational postures and LBP.
This search yielded 2,766 citations. Eight high-quality studies reported on awkward occupational postures and LBP. Three were case-control studies, one was cross-sectional, and four were prospective cohort studies. There was strong evidence for consistency of no association between awkward occupational postures and LBP, with only two studies demonstrating significant associations in most of their risk estimates compared with six studies reported mainly nonsignificant associations. Two studies assessed dose response, with one study demonstrating a nonsignificant dose-response trend. Three studies were able to assess temporality, but all demonstrated nonsignificant risk estimates. Biological plausibility was discussed by two studies. There was no available evidence to assess the experiment criterion for causality.
There was strong evidence from six high-quality studies that there was no association between awkward postures and LBP. Similarly, there was strong evidence from three high-quality studies that there was no temporal relationship. Moreover, subgroup analyses identified only a handful of studies that demonstrated only weak associations and no evidence for other aspects of causality in certain specific subcategories. It is therefore unlikely that awkward occupational postures are independently causative of LBP in the populations of workers studied.
下背痛（LBP）是一种普遍且昂贵的肌肉骨骼疾病，常发生于工作年龄段人群。尽管有许多身体活动与该病的复杂病因有关，但确定因果关系仍具有挑战性，需要采用方法严谨的方法。
对科学文献进行系统综述，以确定工作中不舒适的姿势与 LBP 之间的因果关系。
使用 MEDLINE、EMBASE、CINAHL、Cochrane 图书馆和职业安全与健康数据库、灰色文献、职业健康杂志的手工检索、纳入研究的参考文献列表和专家，对文献进行系统综述。使用改良的 Newcastle-Ottawa 量表对观察性研究进行方法学质量评估。对每种不舒适的职业姿势类别和 LBP 类型的因果关系的 Bradford Hill 标准的每个因果标准进行证据总结水平评估。
报告不舒适的职业姿势与 LBP 之间存在关联的研究。
不同程度暴露于不舒适的职业姿势与 LBP 的存在或严重程度之间的数值关联。
根据 Bradford Hill 标准，进行系统综述以确定、评估和总结与工作中不舒适的姿势和 LBP 之间建立因果关系的文献。
此次搜索产生了 2766 条引文。8 项高质量研究报告了不舒适的职业姿势和 LBP 之间的关系。其中 3 项为病例对照研究，1 项为横断面研究，4 项为前瞻性队列研究。在没有关联方面，一致性证据很强，只有两项研究在大多数风险估计中显示出显著关联，而 6 项研究报告的主要是非显著关联。两项研究评估了剂量反应，其中一项研究显示出非显著的剂量反应趋势。三项研究能够评估时间关系，但所有研究都显示出非显著的风险估计。两项研究讨论了生物学上的合理性。没有可用于评估因果关系的实验标准的证据。
6 项高质量研究提供了强有力的证据表明，不舒适的姿势与 LBP 之间没有关联。同样，3 项高质量研究提供了强有力的证据表明，两者之间没有时间关系。此外，亚组分析仅确定了少数几项仅显示出微弱关联且在某些特定子类别中没有因果关系其他方面证据的研究。因此，在研究的工人人群中，不舒适的职业姿势不太可能独立导致 LBP。
