Spinal troubles in sewage workers: epidemiological data and work disability due to low back pain.

OBJECTIVES: To determine the prevalence of spinal troubles (i.e., neck, upper back and low back pain) in a population of sewage workers, and to establish the effect of sociodemographic, work-related, physical, and psychosocial factors on the reported work disability due to low back pain (LBP) during the previous 12 months. METHODS: Data from 255 sewage workers were obtained by standardized questionnaire, structured interview, and standardized physical examination. Data on the prevalence of neck, upper back and low back pain were obtained with the use of the Nordic Questionnaire. The level of disability was assessed from a modified Low-Back Outcome Scale. Work history included physical factors and job perception based on a modified Work APGAR Score. Other questionnaires recorded the psychosocial aspects of the work environment. In addition, we compared the risk factors between sewage workers who had been prevented from doing their normal work, at any time during the preceding 12 months, as a result of LBP (n = 92), and those without any history of work disability during the previous 12 months (n = 157). RESULTS: The 12-month prevalence rates of neck, upper back and low back pain were 52.4%, 54.8%, and 72.8%, respectively. The prevalence of spinal troubles increased with age. Work disability during the preceding 12 months due to LBP was significantly positively associated with age, disability, the weekly duration of stooping and lifting 5 years previously and higher abnormal illness-behavior scores (odds ratio between 1.26 and 0.94). Moreover, when adjusted for age, the results showed that the subjects in the work disability group were more likely to report higher pain intensities, decreased participation in sports activities, higher levels of physical impairment, the belief that their LBP was related to the physical demands of their job, and a lack of drive (P < 0.05). CONCLUSIONS: This study revealed a high incidence of spinal troubles among sewage workers. In a multidisciplinary approach, we demonstrated that not one factor alone but a combination of sociodemographic, work-related and psychosocial factors have shown associations with work disabilities due to LBP. Additional studies evaluating the relative importance of individual risk factors are warranted.

Spinal posture during stooped walking under vertical space constraints.

STUDY DESIGN: Simultaneous spine kinematic variables in sewage workers were quantified using a two-dimensional video-based gait analysis system. OBJECTIVES: To identify patterns of spinal posture in a population of sewage workers pushing waste matter through tunnels while walking stooped under various height constraints. SUMMARY OF BACKGROUND DATA: Working with stooped postures is one of several occupational risk factors that have been associated with spinal disorders. However, the specific changes in spinal posture during stooped walking under various height constraints have not been documented. METHODS: A video-based gait analysis system was used to measure spinal posture in 22 sewage workers. Angles of the cervical, thoracic, and lumbar spine in the sagittal plane were assessed during walking with five levels of height constraint, from upright walking to stooped walking under a headroom restriction of 105 cm. Correlations among gait parameters, demographic data, and clinical results were determined. Linear regression analysis was performed to examine which variables have the largest impact on the posture resulting from a given vertical height constraint when age and body height are held constant. RESULTS: Mean angular values changed significantly with increasing headroom restrictions, with increases in cervical and thoracic extension as well as lumbar flexion. The cervical and thoracic angles were best correlated with height constraint, followed by lumbar angle and stride length. The inverse relation between cervical and thoracic angle during upright walking increased with increasing vertical space constraints, whereas the relation between the thoracic and lumbar angles decreased. Subjects with decreased abdominal muscle strength adopted a significantly more kyphotic thoracic posture when walking under headroom constraints than subjects with normal abdominal muscle strength. CONCLUSIONS: Combined walking and pushing under vertical space constraints was associated not only with the expected increased flexion of the lumbar spine, but also with greater extension (i.e., reduced kyphosis) of the thoracic spine.

Combined exercise and motivation program: effect on the compliance and level of disability of patients with chronic low back pain: a randomized controlled trial.

OBJECTIVE: To assess the effect of a combined exercise and motivation program on the compliance and level of disability of patients with chronic and recurrent low back pain. DESIGN: A double-blind prospective randomized controlled trial. SETTING: Physical therapy outpatient department, tertiary care. PATIENTS: Ninety-three low back pain patients were randomly assigned to either a standard exercise program (n = 49) or a combined exercise and motivation program (n = 44). INTERVENTIONS: Patients were prescribed 10 physical therapy sessions and were advised to continue exercising after treatment termination. The motivation program consisted of five compliance-enhancing interventions. Follow-up assessments were performed at 3 1/2 weeks, 4 months, and 12 months. MAIN OUTCOME MEASURES: Disability (low back outcome score), pain intensity, physical impairment (modified Waddell score, fingertip-to-floor distance, abdominal muscle strength), working ability, motivation, and compliance. RESULTS: The patients in the motivation group were significantly more likely to attend their exercise therapy appointments (p = .0005). Four and 12 months after study entry there was a significant difference in favor of the motivation group with regard to the disability score (p = .004) and pain intensity (p < or = .026). At 4 months, there was a significant advantage for the motivation group in the fingertip-to-floor distance (p = .01) and in abdominal muscle strength (p = .018). No significant differences were found in motivation scores, self-reported compliance with long-term exercise, and modified Waddell score. In terms of working ability, there was a trend favoring the combined exercise and motivation program. CONCLUSION: The combined exercise and motivation program increased the rate of attendance at scheduled physical therapy sessions, ie, short-term compliance, and reduced disability and pain levels by the 12-month follow-up. However, there was no difference between the motivation and control groups with regard to long-term exercise compliance.