Foppa I, Noack R H
Division of Health Research, University of Berne, Switzerland.
Soc Sci Med. 1996 Oct;43(7):1119-26. doi: 10.1016/0277-9536(96)00032-9.
Back pain causes a considerable loss of working days as well as health care costs and therefore represents a major public health problem in industrialized countries. Psychosocial factors have received increasing attention from researchers studying the causal factors of non-specific back pain. However, most studies focus on few dimensions, like individual or work-related factors. We studied the simultaneous association of various factors representing psychosocial, behavioral, and health-related dimensions to self-reported back pain. Data from the Berne Workplace Health Project on 850 employed men and women was analyzed. Back pain was operationalized by a dichotomized variable (having suffered moderately to severely from back pain in the preceding four weeks). The theoretical model guiding the underlying project was a general demand-resource model. Variables that--according to that model--were hypothesized to be related to back pain as well as more specific factors--like physical work load--were analyzed by stepwise logistic regression analysis. In men, there was a statistical trend (P < 0.1) for several work-related factors (low job discretion, high job demands, low job satisfaction). In women, dissatisfaction with salary was the only work-related factor associated with back pain. There was no significant association between private context factors, like poor social network or high demands/low control, and back pain. Only in men, the likelihood of back pain increased with age, while only in women, back pain was associated with emotional problems (individual factors). Among the behavioral factors, smoking was associated to back pain in men, while in women none of the behavioral factors was significant. In both men and women reporting more than two functional symptoms and a history of intestinal problems were associated to back pain. All of our findings were in the expected direction, i.e., it was invariably unfavorable categories of explanatory variables that were associated with higher prevalence of back pain. However, most associations seem to be quite unspecific. There is a need for theoretically guided research aiming at the development of a more complex process model of back pain.
背痛会导致大量工作日的损失以及医疗保健成本的增加，因此在工业化国家中是一个重大的公共卫生问题。心理社会因素在研究非特异性背痛病因的研究人员中受到了越来越多的关注。然而，大多数研究只关注几个维度，如个人因素或与工作相关的因素。我们研究了代表心理社会、行为和健康相关维度的各种因素与自我报告的背痛之间的同时关联。对来自伯尔尼工作场所健康项目的850名在职男女的数据进行了分析。背痛通过一个二分变量来操作化（在前四周内曾患有中度至重度背痛）。指导该基础项目的理论模型是一个一般需求-资源模型。根据该模型假设与背痛相关的变量以及更具体的因素，如体力工作负荷，通过逐步逻辑回归分析进行了分析。在男性中，几个与工作相关的因素（工作自主权低、工作要求高、工作满意度低）存在统计学趋势（P < 0.1）。在女性中，对薪资的不满是与背痛相关的唯一工作相关因素。私人背景因素，如社交网络差或高要求/低控制，与背痛之间没有显著关联。只有在男性中，背痛的可能性随年龄增加，而只有在女性中，背痛与情绪问题（个人因素）相关。在行为因素中，吸烟与男性的背痛相关，而在女性中，没有一个行为因素是显著的。在报告有两种以上功能症状和肠道问题病史的男性和女性中，都与背痛相关。我们所有的发现都在预期的方向上，即与背痛患病率较高相关的总是解释变量的不利类别。然而，大多数关联似乎都相当不具体。需要进行理论指导的研究，以开发一个更复杂的背痛过程模型。
