title: Dose-response relations between occupational exposures to physical and psychosocial factors and the risk of low back pain.
abstract: OBJECTIVE
  To assess dose-response relations between occupational exposures to physical and psychosocial factors and the risk of low back pain.
  
  
  METHODS
  A cohort of 523 subjects, working in nursing homes and homes for the elderly, was followed prospectively for one year. Physical load for different occupations was assessed by quantitative observations at the workplace. Information on low back pain and other factors was gathered with questionnaires administered at baseline and at one year. Two outcome measures of low back pain incidence were used: any new episode of pain lasting for at least a few hours during follow up (LBP); and any new episode of disabling pain that interfered with daily activities during follow up (LBP/D). Hierarchical regression analysis with a spline function was used to estimate dose-response relations.
  
  
  RESULTS
  The risk of LBP was not associated with physical factors, controlling for confounders; but this outcome was inversely associated with age and weakly, though imprecisely, associated with two psychosocial factors--low decision authority and high work demands. In contrast, the risk of LBP/D was positively associated with age and not associated with the psychosocial factors. Trunk flexion over 45 degrees was monotonically associated with the risk of LBP/D; the estimated relative risk was 3.18 (95% CI 1.13 to 9.00) for 1 hour and 45 minutes of bending per week (90th centile), relative to 30 minutes per week. The hierarchical estimates of effect were more stable than were the maximum likelihood estimates.
  
  
  CONCLUSIONS
  Occupational exposure to trunk flexion over 45 degrees appears to be a risk factor for low back pain with disability among persons employed in nursing homes and homes for the elderly in the Netherlands.
authors.affiliation: Department of Public Health, Faculty of Medicine and Health Sciences, Erasmus University, PO Box 1738, 3000 DR Rotterdam, Netherlands.
authors.forename: J P
authors.initials: JP
authors.lastname: Jansen
authors.forename: H
authors.initials: H
authors.lastname: Morgenstern
authors.forename: A
authors.initials: A
authors.lastname: Burdorf
mesh_terms: D000368:Aged; D004812:Epidemiologic Methods; D006707:Homes for the Aged; D006801:Humans; D007389:Internal-External Control; D017770:Lifting / Q000009:adverse effects; D017116:Low Back Pain / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009735:Nursing Homes; D009784:Occupational Diseases / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D016273:Occupational Exposure / Q000009:adverse effects; D018570:Risk Assessment / Q000379:methods; D016526:Workload / Q000706:statistics & numerical data