Sitting Posture During Occupational Driving Causes Low Back Pain; Evidence-Based Position or Dogma? A Systematic Review.

OBJECTIVE: In this review, we determine if there is evidence to demonstrate a relationship between occupational driving posture and low back pain. BACKGROUND: The burden of low back pain is increasing. An understanding of this relationship is required to enable the development of recommendations for clinicians and policy-makers for the driving industry. METHOD: Five databases were searched up to March 12, 2018. Study quality was assessed using the National Heart, Lung, and Blood Institute's Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, followed by a GRADE analysis to consider the evidence as a whole. A narrative, critical synthesis was completed that considered the methods by which driving posture and low back pain were measured and analyzed. RESULTS: There were 653 articles identified, with seven eligible for review. Four articles identified an association between occupational driving posture and low back pain, yet this was based on the use of measurement tools lacking validity. Although a relationship may exist, the specific driving postures associated with low back pain and the strength of this relationship have not been confirmed. CONCLUSION: Future research needs to employ validated and reliable, real-time qualitative methods for measuring occupational driving posture to advance our understanding of this relationship. APPLICATION: Clinical and policy recommendations regarding driving posture and low back pain should be used with caution, as they are guided by evidence incorporating bias. Future studies are required to confirm the specific postures assumed while occupational driving and their relationship with low back pain, before recommendations can be made.