title: Associations of occupational standing with musculoskeletal symptoms: a systematic review with meta-analysis.
abstract: OBJECTIVE
  Given the high exposure to occupational standing in specific occupations, and recent initiatives to encourage intermittent standing among white-collar workers, a better understanding of the potential health consequences of occupational standing is required. We aimed to review and quantify the epidemiological evidence on associations of occupational standing with musculoskeletal symptoms.
  
  
  METHODS
  A systematic review was performed. Data from included articles were extracted and described, and meta-analyses conducted when data were sufficiently homogeneous.
  
  
  METHODS
  Electronic databases were systematically searched.
  
  
  METHODS
  Peer-reviewed articles on occupational standing and musculoskeletal symptoms from epidemiological studies were identified.
  
  
  RESULTS
  Of the 11 750 articles screened, 50 articles reporting 49 studies were included (45 cross-sectional and 5 longitudinal; n=88 158 participants) describing the associations of occupational standing with musculoskeletal symptoms, including low-back (39 articles), lower extremity (14 articles) and upper extremity (18 articles) symptoms. In the meta-analysis, 'substantial' (>4 hours/workday) occupational standing was associated with the occurrence of low-back symptoms (pooled OR (95% CI) 1.31 (1.10 to 1.56)). Evidence on lower and upper extremity symptoms was too heterogeneous for meta-analyses. The majority of included studies reported statistically significant detrimental associations of occupational standing with lower extremity, but not with upper extremity symptoms.
  
  
  CONCLUSIONS
  The evidence suggests that substantial occupational standing is associated with the occurrence of low-back and (inconclusively) lower extremity symptoms, but there may not be such an association with upper extremity symptoms. However, these conclusions are tentative as only limited evidence was found from high-quality, longitudinal studies with fully adjusted models using objective measures of standing.
authors.affiliation: School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia.
authors.forename: Pieter
authors.initials: P
authors.lastname: Coenen
authors.affiliation: Centre for International Health, Burnet Institute, Melbourne, Victoria, Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Willenberg
authors.affiliation: School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia.
authors.forename: Sharon
authors.initials: S
authors.lastname: Parry
authors.affiliation: Monash Health, Melbourne, Victoria, Australia.
authors.forename: Joyce W
authors.initials: JW
authors.lastname: Shi
authors.affiliation: Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Lorena
authors.initials: L
authors.lastname: Romero
authors.affiliation: Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.
authors.forename: Diana M
authors.initials: DM
authors.lastname: Blackwood
authors.affiliation: Musculoskeletal Division, Sydney Medical School, The George Institute for Global Health, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Maher
authors.affiliation: School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia.|School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.|Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
authors.forename: Genevieve N
authors.initials: GN
authors.lastname: Healy
authors.affiliation: School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.|Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.|School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.|School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia.|Department of Medicine, Monash University, Melbourne, Victoria, Australia.|School of Sport Science, Exercise and Health, The University of Western Australia, Perth, Western Australia, Australia.|Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia.
authors.forename: David W
authors.initials: DW
authors.lastname: Dunstan
authors.affiliation: School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia.
authors.forename: Leon M
authors.initials: LM
authors.lastname: Straker
mesh_terms: D016021:Epidemiologic Studies; D006801:Humans; D017116:Low Back Pain / Q000453:epidemiology; D035002:Lower Extremity / Q000503:physiopathology; D009140:Musculoskeletal Diseases / Q000453:epidemiology*; D064887:Observational Studies as Topic; D009784:Occupational Diseases / Q000453:epidemiology*; D011187:Posture; D034941:Upper Extremity / Q000503:physiopathology
keywords: Lower back; Lower limb; Meta-analysis; Review; Work