A meta-analysis of the association between physical demands of domestic labor and back pain among women.

BACKGROUND

Back pain (BP) is among the most common musculoskeletal problems globally and is a leading contributor to disability among adults. Millions of women especially those in low-income settings, engage in strenuous domestic activities that may increase their risk of BP. The purpose of this meta-analysis was to estimate the association between physically demanding domestic labor (PDDL) which is characterized as intensity, frequency, duration of work and biomechanical risk factors of work and BP among women.

METHODS

Five databases were searched for records published from January 1991 to March 2020; and results from 11studies were included in the meta-analysis. A random effects model and the generic inverse-variance method was used to estimate the pooled odds ratio (OR), 95% confidence interval (CI), and the degree of heterogeneity among studies (I). Stratified and sensitivity analyses were conducted to identify the influence of outliers and identify the sources of heterogeneity.

RESULTS

Exposure to high PDDL was significantly associated with BP (OR = 1.63; 95% CI 1.30, 2.04; I = 70%). The odds of back pain were highest among the following groups: women performing domestic labor in non-neutral postures (OR = 2.30; 95% CI = 1.75-3.04; I = 0%; N = 4 studies) and among women from low- and middle-income countries (OR = 1.98; 95% CI = 1.58-2.49; I = 29%; N = 5 studies). We found no evidence of publication bias (Egger's test p-value = 0.15).

CONCLUSIONS

PDDL may significantly increase a woman's risk of experiencing BP, but larger prospective studies are needed to further investigate the association. Presenting data on how domestic work affects the musculoskeletal health of women will be important in designing future interventions (behavioral, infrastructural, and ergonomic) that can reduce the burdens from domestic labor.