Identifying factors associated with physical therapy use versus non-use among injured workers with back pain in Washington State.

BACKGROUND: There is little information about predictors of physical therapy (PT) use among injured workers with back pain. The primary objective of this study is to investigate the associations between PT use and baseline factors not routinely captured in workers' compensation (WC) data. METHODS: We conducted a secondary analysis using the Washington State Workers' Compensation Disability Risk Identification Study Cohort, which combines self-reported surveys with claims data from the Washington State Department of Labor and Industries State Fund. Workers with an accepted or provisional WC claim for back injury between June 2002 and April 2004 were eligible. Baseline factors for PT use were selected from six domains (socio-demographic, pain and function, psychosocial, clinical, health behaviors, and employment-related). The outcome was a binary measure for PT use within 1 year of injury. Bivariate and multivariable logistic regression models were conducted to evaluate the associations between PT use and baseline factors. RESULTS: Among the 1370 eligible study participants, we identified 673 (49%) who received at least one PT service. Baseline factors from five of the six domains (all but health behaviors) were associated with PT use, including gender, income, pain and function measures, injury severity rating, catastrophizing, recovery expectations, fear avoidance, mental health score, body mass index, first provider seen for injury, previous injury, and several work-related factors. CONCLUSION: We identify baseline factors that are associated with PT use, which may be useful in addressing disparities in access to care for injured workers with back pain in a WC system.

Epidemiology of musculoskeletal injury in professional and amateur golfers: a systematic review and meta-analysis.

OBJECTIVE: To determine the prevalence and incidence of musculoskeletal injury in amateur and professional golfers, and to identify common injury sites and factors associated with increased injury frequency. DESIGN: Systematic epidemiological review and meta-analysis. DATA SOURCES: PubMed (Medline), Embase, the Cochrane Library and SPORTDiscus were searched in September 2023. ELIGIBILITY CRITERIA: Studies published in the English language reporting the incidence or prevalence of musculoskeletal injuries in golfers at all anatomical sites. RESULTS: 20 studies (9221 golfers, 71.9% male, 28.1% female) were included, with mean age 46.8 years. Lifetime injury prevalence was significantly greater in professional golfers (73.5% (95% CI: 47.3% to 93.0%)) than amateur golfers (56.6% (95% CI: 47.4% to 65.5%); relative risk (RR)=1.50, p<0.001). Professional golfers had a significantly greater lifetime prevalence of hand and wrist (RR=3.33, p<0.001) and lower back injury (RR=3.05, p<0.001). Soft tissue injuries were most common, and diagnoses were typically non-specific. Injury frequency was not associated with age or sex. Two studies reported a greater injury risk in amateur golfers playing more than three and four rounds per week. CONCLUSION: Over half of golfers are at risk of sustaining a musculoskeletal injury during their lifetime. Risks and patterns of injury differ between professional and amateur golfers, with professionals significantly more likely to develop lower back, and hand and wrist injuries. A recent international consensus statement on the reporting of injury and illness in golf should aid consistency in future research assessing the epidemiology of specific diagnoses, informing golf injury prevention and management strategies. PROSPERO REGISTRATION NUMBER: CRD42023408738.

Agricultural Injuries: Risk Factors and Severity by Affected Body Part among US (Midwest) Farmers.

OBJECTIVES: Statistics from the United States Bureau of Labor Statistics indicate that agriculture consistently ranks as the most hazardous industry in the US. To identify specific targets for prevention, we investigated injury risk factor profiles separately for each injured body site. We also characterized the severity of agricultural injuries by injured body site using the type of medical care and lost work time due to injury. METHODS: We used the Central States Center for Agricultural Safety and Health (CS-CASH) surveillance data for 2018 to perform descriptive statistics and regression modeling. RESULTS: We found that 12% (513/4351) of the participants experienced one or more injuries in the previous 12 months. Compared to female operators, male operators had 3.53 (95% CI: 1.17-10.68) times higher odds of back injury. Operators in livestock production had 2.77 times (95% CI:1.12-6.82), 2.28 times (95% CI:1.25-4.14), and 1.69 times (95% CI:1.10-2.59) higher odds of injury to the chest/trunk, finger, and leg/knee/hip, respectively, compared to operators in crop or mixed production. After adjusting for age and gender, operators who worked full time (vs. part-time) on the farm/ranch had 2.11 times (95% CI:1.03-4.34) higher odds of back injury. Arm/shoulder and leg/knee/hip injuries were more frequent in older age groups. CONCLUSIONS: Prevention measures should be tailored considering specifically livestock producers with emphasis on trainings on proper livestock handling, such as being gentle, establishing routine, keeping distance, and avoiding sudden and loud noise when handling animals. Applying these techniques avoid startling the animals and reduce the risk of injuries.

Comparisons of Trunk Motions and Low Back Injury Risk between Alternative Hotel Room Cleaning Methods.

Hotel room cleaners frequently report job-related pain, with high rates of work-related musculoskeletal disorder injuries established for this group of workers. Surprisingly, there is limited published research documenting the impact of interventions to reduce ergonomic-related injury risks specific to hotel room cleaners' job tasks. In this study focused on hotel bathroom-cleaning and furniture-dusting tasks, twelve experienced hotel room cleaners used their standard method and a risk-reduction method-a tool with a handle that could extend, to perform these tasks. The female study participants' average age was 45.3 (SD 8.7) years with an average of 10 years of work experience as cleaners (range: 0.8-26.0 years). Trunk kinematics and a low back injury risk assessment were measured using the Lumbar Motion Monitor. All study metrics were significantly reduced when cleaning tasks involved use of adjustable, long-handled tools (p < 0.05). This study demonstrated that commonly available cleaning and dusting tools with extendable handles can significantly reduce low back injury risk among hotel room cleaners and potentially reduce injury risk to other body parts known to be the site of musculoskeletal disorders in this workforce. The study findings suggest that cleaning or housekeeping jobs in other industries where these same tasks are performed could benefit from use of extended-handle tools like those investigated here.

Prevalence and Risk Factors for Musculoskeletal Back Injury Among U.S. Army Personnel.

INTRODUCTION: Physical and medical readiness have emerged as a top priority in the army over the last decade. With this emphasis on deployment readiness, it is important to understand key risk factors attributed to common medical problems that arise in our soldiers, including low back pain. The purpose of this study is to elucidate demographic and lifestyle risk factors which would result in seeking medical care for musculoskeletal low back pain among active duty army personnel. MATERIALS AND METHODS: A cross-sectional retrospective study investigating all active duty soldiers between October 1, 2016 and September 30, 2018 was performed using the existing Military Health System Data Repository to retrospectively review administrative claims data. Our study queried 39 unique International Classification of Disease codes, 10th Revision codes for low back pain to determine a positive case. We compared those with and without back pain across all variables using a chi-square analysis in SAS. Multivariate logistic analysis was performed to adjust for confounding within any single proposed risk factor and the six other proposed risk factors. RESULTS: Six hundred fifty seven thousand and six thirty soldiers met inclusion criteria; 228,184 of whom had a medical encounter for low back pain (34.7%). All of the proposed risk factors included statistically significant unadjusted and adjusted odds ratios (ORs) with age conferring the greatest risk in soldiers aged 50-59 with an OR of 2.89 (2.73-3.05) compared to those aged 20-29. Obesity-adjusted OR was 1.77 (1.74-1.80) compared to those who were normal weight. Senior Enlisted status-adjusted OR was 1.34 (1.32-1.36). Females were 66% more likely to have low back pain compared to males with an OR of 1.66 (1.63-1.68). CONCLUSION: Disease burden for low back pain tends to be high in the U.S. Army with 34.7% of service members experiencing low back pain. Older age, obesity, and being an enlisted, female service member are risk factors for these musculoskeletal injuries, which is in agreement with previously reported literature on the topic. To mitigate the burden of low back pain, policies and incentives to encourage healthy body mass index and lifestyle are needed. The results of this work inform future studies aimed at further delineating the risk factors found in this study.

Back injuries in Major League Baseball.

BACKGROUND: There is a scarcity of epidemiological studies on back injuries in Major League Baseball (MLB). In our study, we explore all back related injuries in MLB from 2010 to 2016 (inclusive) with the aim to help better understand these injuries, assess their risks, and improve their prevention policies. METHODS: The transaction lists from the MLB website were screened for back injuries from 2010 through 2016. Only players who were placed on the disabled list (DL) for one or more days due to back-related injury were included in our study. Our database included the player's position, team, injury location, injury type, days spent on the DL and month of injury occurrence. RESULTS: Two hundred fifty-four back injuries, an equivalent of 7% of all injuries, were recorded between 2010 and 2016 (inclusive). These injuries increased from 2010 to 2016. Back related injuries were found to place players on the disabled list for around 54 days. Injuries were recorded mostly during April, and strain was significantly greater than any other type of injury (P value <0.001). CONCLUSIONS: Back injuries are prevalent in the MLB. Better understanding of the trends and patterns of these injuries will help in establishing better prevention policies.

Injuries and illnesses among competitive Norwegian rhythmic gymnasts during preseason: a prospective cohort study of prevalence, incidence and risk factors.

OBJECTIVES: Rhythmic gymnastics is an Olympic sport that demands high training volume from early age. We investigated the extent of, and risk factors for, injuries among competitive Norwegian rhythmic gymnasts. METHODS: One hundred and seven of 133 (80.5%) female rhythmic gymnasts (mean age: 14.5 years (SD 1.6), mean body mass index: 18.9 (SD 2.2)) participated. All gymnasts completed a baseline questionnaire and the 'Triad-Specific Self-Report Questionnaire'. Injuries, illnesses and training hours were recorded prospectively for 15 weeks during preseason using the 'Oslo Sports Trauma Research Center Questionnaire on Health Problems' (OSTRC-H2). RESULTS: Response rate to OSTRC-H2 was 97%. Mean overuse and acute injury prevalence were 37% (95% CI: 36% to 39%) and 5% (95% CI: 4% to 6%), respectively. Incidence was 4.2 overuse injuries (95% CI: 3.6 to 4.9) and 1.0 acute injuries (95% CI: 0.5 to 1.6) per gymnast per year. Overuse injuries in knees, lower back and hip/groin represented the greatest burdens. Previous injury increased the odds of injury (OR 30.38, (95% CI: 5.04 to 183.25)), while increased age (OR 0.61 per year, (95% CI: 0.39 to 0.97)) and presence of menarche (OR: 0.20, (95% CI: 0.06 to 0.71)) reduced the odds of all injuries and substantial injuries, respectively. CONCLUSIONS: Overuse injuries were common among Norwegian rhythmic gymnasts. Younger gymnasts had higher all-injury risk. Gymnasts who were not menstruating had higher substantial injury risk. Injury prevention interventions should start at an early age and focus on preventing knee, lower back and hip/groin injuries.

Common Injuries in Whitewater Rafting, Kayaking, Canoeing, and Stand-Up Paddle Boarding.

Paddle sports continue to be popular forms of outdoor recreation in the United States and around the world. This includes not only the more traditional sports of rafting, kayaking, and canoeing but also the newer and growing sport of stand-up paddle boarding. Because these sports are based in an aquatic environment, and frequently whitewater, there are unique, significant risks of injury. Overall, injuries in paddling sports are mostly musculoskeletal and are both acute and chronic in nature. Some injuries, such as environmental and head injuries, are especially problematic because they can lead to serious morbidity and mortality, most importantly drowning. This review describes the epidemiology, type, and location of injuries across paddle sports. It not only focuses on whitewater injuries but also includes information on injuries sustained in other aquatic paddling environments.

Orthopedic Injuries in Professional Surfers: A Retrospective Study at a Single Orthopedic Center.

BACKGROUND: Literature regarding surfing injuries is scarce and most studies report a high number of minor injuries. Recent literature suggests that musculoskeletal injuries are more common than previously reported. In the mid 2000s, competitive surfing has seen an increase in aerial maneuvers, as they have become more highly rewarded by the judging panel, which may be contributing to a change in injury patterns. Our goal was to evaluate orthopedic injuries in professional surfers. HYPOTHESIS: Orthopedic injuries in professional surfers are diverse and have evolved with skill and technology. STUDY DESIGN: Retrospective observational study. LEVEL OF EVIDENCE: Level 4 Case Series. METHODS: Medical records of professional surfers from a single orthopedic center between 1991 and 2016 were reviewed. Injuries sustained while surfing and chronic injuries related to surfing were included. Site of injury, diagnosis, and treatment were recorded along with demographic data. RESULTS: In total, 163 injuries in 86 athletes were recorded. The median injury age was 28.5 years (range 12-62 years) and 92.6% of patients were male. The most frequently injured body parts were the knee (28.2%), ankle (22.1%), and shoulder (19%). Most knee injuries were of the medial collateral ligament at 49%, with 75% of ankle injuries being sprains, and in shoulder, 48% had instability, 42% had a rotator cuff tear, and 35% had a superior anterior-posterior labral tear. Lower extremity injuries primarily affected the surfers' back leg (72.5%). In all, 34.6% of all injuries required surgical intervention and involved shoulder injuries most the time. CONCLUSIONS: The most common orthopedic injuries in professional surfers involve the knee, ankle, shoulder, hip, and back. Surfers' rear extremities were preferentially injured which is the extremity responsible for power and torque. Shoulder injuries increased the probability of an operative intervention. Last, overuse injuries (femoral-acetabular impingement, rotator cuffs) occurred in the older surf population compared with more acute injuries (ankle sprains/fractures, anterior cruciate ligament tears) which is also consistent with time to surgery.

Effects of Nordic Hamstring Exercise on Hamstring Injuries in High School Soccer Players: A Randomized Controlled Trial.

We evaluated a range of physical characteristics related to hamstring injuries, as well as the Nordic Hamstring Exercise compliance rate, and whether this influenced the rate hamstring injury. Subjects comprised 259 male soccer players from seven high schools randomly clustered into two groups, a Nordic Hamstring Exercise group and a control group. Training and match time were logged, as well as details of hamstring injury, and subsequent time lost to hamstring injury recorded over a period of 27 weeks. The Nordic Hamstring Exercise compliance rate, injury rate per 10000 playing hours and time-lost-to-sport-injury rate were calculated. The relative risk and hamstring injury severity were also calculated. The hamstring injury rate was 1.04/10 000 h in the control group and 0.88/10 000 h in the intervention group. The relative risk for hamstring injury was 1.14. The time-lost to injury rate was 1116.3/10 000 h in the control group and 113.7/10 000 h in the intervention group; with relative risk 9.81. The Nordic Hamstring Exercise in high school soccer players significantly reduced hamstring injury severity compared to a control intervention. Our results indicate that the time-lost to injury rate should be taken into account when analyzing the severity of hamstring injury.

Retrospective Study of Risk Factors and the Prevalence of Injuries in HIFT.

The aim of this study was to investigate the risk factors and the incidence of injuries in high-intensity functional training (HIFT) practitioners. A survey was administered to 213 HIFT practitioners. Participants reported the number of injuries, the location of the injuries, and training exposure during the preceding six months and answered questions regarding potential risk factors for injury. We found there were 7.1 injuries for every 1000 hours of training. In addition, we found that individuals with experience in the modality (>2 years) were 3.77 times more likely to be affected by injury when compared with beginner individuals (<6 months) (CI95%=1.59-8.92; p=0.003). When the analysis was performed only for the competitive level, we found that practitioners competing at the national level were 5.69 times more likely to experience an injury than competitors who do not compete (CI95%=1.10-29.54; p=0.038). We also found that the injuries mainly affect the shoulder and lumbar regions. It was possible to conclude that subjects with a higher level of experience in the modality are more likely to be affected by injuries and that the shoulder and lumbar areas are most likely to be injured during HIFT.

MRI Bone Marrow Edema Signal Intensity: A Reliable and Valid Measure of Lumbar Bone Stress Injury in Elite Junior Fast Bowlers.

STUDY DESIGN: Comparative reliability and prospective validity. OBJECTIVE: First, to evaluate the reliability of four methods of assessing magnetic resonance imaging (MRI) bone marrow edema (BMO) of the posterior vertebral arch of the lumbar vertebrae of elite junior fast bowlers. Second, to evaluate the validity of the most reliable method for the early detection of lumbar bone stress injury. SUMMARY OF BACKGROUND DATA: MRI has demonstrated utility in identifying BMO in lumbar vertebrae. Methods to grade the severity of BMO may provide valuable insight to inform clinical management, particularly in elite athletes where detection of early-stage bone stress may prevent progression to more severe and costly bone stress injury. METHODS: Sixty-five male elite junior fast bowlers had repeat MRI scans during a cricket season. A subset of 19 bowlers' images were reassessed by experienced musculoskeletal radiologists to determine intra- and inter-rater reliability. All images were aligned with independent medical records of lower back symptoms and diagnosed bone stress injuries to establish the relationship of BMO and lumbar bone stress injury. RESULTS: Clinical detection of abnormal BMO, whether the pars region of the vertebra was considered in its entirety or subdivided into regions, had fair-to-moderate inter-rater reliability, and fair-to-almost perfect intra-rater reliability. Measurement of BMO signal intensity using an imaging software tool had excellent intra-rater and inter-rater reliability (ICC = 0.848, 0.837). BMO signal intensity was positively associated with subsequent LBSI (P < 0.001), and differentiated between asymptomatic and symptomatic bowlers (P < 0.001). CONCLUSION: Measurement of BMO signal intensity using an imaging software tool proved a reliable and valid measure of the severity of lumbar bone stress injury in elite junior fast bowlers. LEVEL OF EVIDENCE: 2.

Musculoskeletal Injury in Paddle Sport Athletes.

INTRODUCTION: Kayak racing has been an Olympic sport since 1936. The sport is evolving with the introduction of ocean skis and stand-up-paddle boards (SUP). Musculoskeletal injury incidence surveys have been conducted for ultra-marathon events, but no data have been published for other racing formats. OBJECTIVE: To identify and compare the rates and types of injuries sustained by paddling athletes as a function of discipline and training parameters in Sprint, Marathon, Ultra-Marathon, and Ocean events. METHODS: Competitors from 6 kayak and/or ocean surf-ski races in Australia were surveyed. Before each race, competitors were asked to complete a questionnaire. The questionnaire investigated paddling-related injuries over the previous 5 years, athlete morphology, flexibility, equipment and its setup, training volume, and environment. RESULTS: Five hundred eighty-three competitors were surveyed. Disciplines included 173 racing-kayak (K1), 202 touring-kayak, 146 ocean-skis, 42 SUP, and 20 other. The top 5 paddling-related injuries were shoulder (31%), low back (23.5%), wrist (16.5%), neck (13.7%), and elbow (11.0%). The highest percentage of injury was found in K1 paddlers for shoulder (40.5%), SUP for low back (33.3%), and ocean-ski for wrist (22.6%). After controlling for on-water training hours, the relative risk (RR) of wrist injury was significantly increased in ocean-ski paddlers (1.86) and in paddlers with decreased flexibility (1.53-1.83). Relative risk of shoulder and low-back injury was significantly increased in athletes with lower training volumes (1.82-2.07). Younger athletes had lower RR of wrist and shoulder injury (0.58-0.62).

Physical and Psychosocial Work Environmental Risk Factors for Back Injury among Healthcare Workers: Prospective Cohort Study.

The incidence of occupational back injury in the healthcare sector remains high despite decades of efforts to reduce such injuries. This prospective cohort study investigated the risk factors for back injury during patient transfer. Healthcare workers (n = 2080) from 314 departments at 17 hospitals in Denmark replied to repeated questionnaires sent every 14 days for one year. Using repeated-measures binomial logistic regression, controlling for education, work, lifestyle, and health, the odds for back injury (i.e., sudden onset episodes) were modeled. On the basis of 482 back injury events, a higher number of patient transfers was an important risk factor, with odds ratio (OR) 3.58 (95% confidence interval (CI) 2.51-5.10) for 1-4 transfers per day, OR 7.60 (5.14-11.22) for 5-8 transfers per day, and OR 8.03 (5.26-12.27) for 9 or more transfers per day (reference: less than 1 per day). The lack of necessary assistive devices was a common phenomenon during back injury events, with the top four lacking devices being sliding sheets (30%), intelligent beds (19%), walking aids (18%), and ceiling lifts (13%). For the psychosocial factors, poor collaboration between and support from colleagues increased the risk for back injury, with OR 3.16 (1.85-5.39). In conclusion, reducing the physical burden in terms of number of daily patient transfers, providing the necessary assistive devices, and cultivating good collaboration between colleagues are important factors in preventing occupational back injuries among healthcare workers.

Significant Decreasing Trend in Back Injuries in a Multiemployer Environment: A Follow-Up Study.

BACKGROUND: A significant decrease in back injury claims was observed in a single employer. OBJECTIVE: The aim of this study was to validate whether back injury claims are decreasing in a multiemployer environment within a non-monopolistic state and quantify the risk of delayed return-to-work and adverse cost of injured workers with back injuries. METHODS: Thirty-six thousand four hundred sixty-three claims from 1998 to 2015 were analyzed with descriptive statistics and multivariate logistic and Cox-Proportional Hazards models. RESULTS: Back injury claims decreased three-fold (5.02 to 1.60 per 1000 employees) and were more likely to have claim costs over $100,000 (odds ratio = 2.41) and delayed return-to-work (hazard ratio = 1.16). CONCLUSION: Back injury claims are decreasing in a multiemployer environment within a non-monopolistic state.

Joint contribution of rotation of the back and repetitive movements to disability pension using job exposure matrix data.

BACKGROUND: Heavy physical effort at work has been linked with disability pension, but the contribution of other ergonomic job exposures is less studied. We studied the independent and joint contributions of long-term exposure to (i) rotation of the back and (ii) repetitive movements to disability pension, particularly due to musculoskeletal disorders. METHODS: Exposures were measured with the Helsinki Health Study Job Exposure Matrix during 1996-2005 and linked to register data on employees of the City of Helsinki, Finland (n = 18 585). Outcomes were followed up during 2006-2015. Competing risk survival analyses were performed and synergy indices computed, adjusting for sociodemographic factors. RESULTS: Long-term exposure to rotation of the back was associated with disability pension due to any cause [age and sex-adjusted subhazard ratio (SHR) 2.39, 95% confidence interval (CI) 1.73-3.30], and specifically disability pension due to musculoskeletal disorders (SHR = 3.39, 95% CI 1.52-7.56) when compared to employees exposed to neither of the two exposures. Repetitive movements alone did not increase the risk of disability pension (all-cause SHR = 1.08, 95% CI 0.84-1.38, musculoskeletal SHR = 1.65, 95% CI 0.91-2.97). Employees with exposure to both rotation of the back and repetitive movements had the highest risk of disability pension due to musculoskeletal disorders (SHR = 5.98, 95% CI 3.85-9.28), but the interaction between exposures was additive rather than synergistic. Adjustment for education diluted the associations by 42-108%. CONCLUSION: Long-term exposure to awkward work postures increased the risk of disability pension. Educational inequalities largely account for differences in occupational exposures.

Role of computed tomography tractography in evaluation of back/flank stab wounds.

BACKGROUND: The clinical approach to back/flank wounds has evolved over the years. The aim of this study was to discuss the potential of computed tomography tractography in patients with a stab wound to the back or flank. METHODS: A total of 25 stable patients with stab wounds confined to the back/flank region were enrolled in this retrospective study. After initial resuscitation and physical examination, tractography was performed at the site of the stab wound. The patients subsequently underwent computed tomography with intravenous contrast. RESULTS: Computed tomography tractography helped avoid a laparotomy in 15 (60%) patients and accurately revealed a peritoneal breach in 10 (40%) patients. No missed injuries were reported in the conservatively followed patients. CONCLUSION: The addition of tractography to computed tomography is a safe, fast, and cost- and time-effective technique to evaluate back/flank stab wounds.

Injury-related hospital admission of female firefighters in South Korea.

Purpose. The main objective of this study was to ascertain whether injury-related hospital admission in all South Korea female firefighters is greater than that in the general population. Methods. To perform this comparison, the standardized admission ratios (SARs) and their 95% confidence intervals (CIs) were calculated by person-years and mortality computation software. Results. Compared to the general population, the SARs for overall injury (SAR = 1.57, 95% CI [1.24, 1.96]) and for injury to the lower back (SAR = 2.78, 95% CI [1.81, 4.07]) in the female firefighters were significantly higher. The SARs for injury to the knee (SAR = 2.48, 95% CI [1.18, 4.55]) in emergency medical services (EMS) workers were significantly higher than those in the general population. Conclusions. Our study shows that the SARs of overall injury and injury to the lower back in female firefighters and knee injury in the EMS were significantly higher than those in the general population. Further studies are needed to protect the lower back of firefighters and the knees of EMS.

The association between awkward working posture and low back disorders in farmers: a systematic review.

BACKGROUND: Low back disorders (LBD) are the most common musculoskeletal problem among farmers, with higher prevalence than other occupations. Although studies of the general population have shown an association between LBD and awkward working posture, farmers have unique work context and exposures that may modify this relationship. This review aimed to 1) identify published research studies investigating posture as a risk factor for LBD in farmers/agricultural workers, and 2) determine the strength of the relationship between postural exposure and LBD risk of bias assessment. METHOD: Comprehensive electronic searches of Medline, Web of Science, CINAHL, SCOPUS, PubMed, and EMBASE were carried out with combined conceptual groups of search terms for 'farming' and 'LBD.' After screening, data were extracted to summarize the study design, sample characteristics, exposure assessment methods, LBD risk factors, demographic information, data collection methods, farm commodities, job context, and sampling strategy. Data were synthesized to determine the weight of evidence for awkward working posture as a risk factor for LBD among farmers. RESULTS: Nine studies were included in this review. All studies used self-report; there were no field-based studies including direct measurement of awkward posture. There was diversity in exposure definition, exposure assessment, LBD definition, worker characteristics, and analytical approaches. There was evidence to support association between awkward working posture and LBD among farmers. CONCLUSION: Despite the diversity, the weight of evidence supported a relationship between awkward posture and LBD. Well-designed epidemiological studies with quantitative physical workload assessments, consistent and valid LBD definitions, and longitudinal designs are recommended to clarify the relationship between awkward posture and LBD.

Significant Decreasing Trend in Low Back Injuries in a Beverage Company.

BACKGROUND: Work-related injuries in the U.S. have steadily declined over the past three decades. OBJECTIVE: The aim of this study was to compare trends of the most frequently injured body parts from a beverage company over an 8-year study period (2008 to 2015). METHOD: Work-related injury claims with more than 3 days of missed work (N = 20,203) were classified into body part groups, including low back, knee, shoulder, and all other(s). Descriptive statistics and linear models were used to evaluate trends over time. RESULTS: The total number of injuries decreased from 6.57 per 100 to 3.79 per 100 employees from 2008 to 2015. Proportion of low back injuries decreased from 22.0% to 15.4% (P < 0.001) over the study period. Proportionally, knee(s), shoulder(s), and all other injuries increased, but the changes did not reach statistical significance. CONCLUSION: Low back injuries decreased at a faster rate than knee, shoulder, and all other injuries.