Krause N, Ragland D R, Fisher J M, Syme S L
Division of Epidemiology, School of Public Health, University of California, Berkeley, USA.
Spine (Phila Pa 1976). 1998 Dec 1;23(23):2507-16. doi: 10.1097/00007632-199812010-00005.
Five-year prospective cohort study of 1449 transit operators.
To investigate psychosocial job factors as predictors of work-related spinal injuries, controlling for current and past physical workload.
The association between psychosocial job factors and spinal disorders may be confounded by physical workload. A 1991 prospective study of Boeing workers found psychosocial but not physical factors to be associated with spinal injuries. However, data on physical workload were limited. Recent cross-sectional studies of transit drivers showed both physical and psychosocial factors to be independently associated with back and neck pain. This study was designed to test these findings prospectively.
Spinal injuries were ascertained from workers' compensation records, employment history from company records, and psychosocial factors from questionnaires. Logistic regression models adjusted for age, gender, height, weight, vehicle type, and current and past physical workload.
During follow-up, 320 drivers reported a first spinal injury. Spinal injury was predicted by psychological job demands (odds ratio [OR], 1.50; 95% confidence interval [CI], 1.33-1.95); job dissatisfaction (OR, 1.56; 95% CI, 1.09-2.23); and the frequency of job problems (OR, 1.52; 95% CI, 1.02-2.26). Marginally significant associations were found for low supervisor support (OR, 1.30; 95% CI, 0.99-1.72) and female gender (OR, 1.49; 95% CI, 0.95-2.32). Compared with full-time work, part-time work was associated with a 2.7-fold reduced risk for spinal injury (OR, 0.37; 95% CI, 0.15-0.93). Cable car crews performing the heaviest physical labor had a threefold increased risk of spinal injury compared with bus drivers (OR, 3.04; 95% CI, 1.85-5.00).
Physical workload and psychosocial job factors both independently predict spinal injury in transit vehicle operators.
对1449名公交司机进行为期五年的前瞻性队列研究。
研究心理社会工作因素作为与工作相关脊柱损伤预测指标的情况，同时控制当前和过去的体力工作负荷。
心理社会工作因素与脊柱疾病之间的关联可能会受到体力工作负荷的干扰。1991年对波音公司员工的一项前瞻性研究发现，心理社会因素而非体力因素与脊柱损伤有关。然而，有关体力工作负荷的数据有限。近期对公交司机的横断面研究表明，体力因素和心理社会因素均与背部和颈部疼痛独立相关。本研究旨在对这些发现进行前瞻性检验。
从工伤赔偿记录中确定脊柱损伤情况，从公司记录中获取就业历史，通过问卷调查获取心理社会因素。采用逻辑回归模型对年龄、性别、身高、体重、车辆类型以及当前和过去的体力工作负荷进行校正。
在随访期间，320名司机报告了首次脊柱损伤。脊柱损伤的预测因素包括心理工作需求（比值比[OR]，1.50；95%置信区间[CI]，1.33 - 1.95）、工作不满意（OR，1.56；95% CI，1.09 - 2.23）以及工作问题发生频率（OR，1.52；95% CI，1.02 - 2.26）。发现低主管支持（OR，1.30；95% CI，0.99 - 1.72）和女性性别（OR，1.49；95% CI，0.95 - 2.32）存在边缘显著关联。与全职工作相比，兼职工作与脊柱损伤风险降低2.7倍相关（OR，0.37；95% CI，0.15 - 0.93）。与公交司机相比，从事体力劳动最繁重的缆车工作人员脊柱损伤风险增加了两倍（OR，3.04；95% CI，1.85 - 5.00）。
体力工作负荷和心理社会工作因素均能独立预测公交车辆驾驶员的脊柱损伤。
