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Literature review found no link between occupational carrying and low back pain
Wai EK. Spine J. doi:10.1016/j.spinee.2010.03.027.
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A systematic literature review did not find any high-quality studies that established a causal link between occupational carrying and low back pain, indicating that it is unlikely that occupational carrying is an independent cause of low back pain (LBP) in the population studied.
Using the Bradford-Hill framework, Eugene K. Wai, MD, MSc, FRCSC, University of Ottawa, Ontario, Canada, and colleagues performed a systematic literature review. They searched the literature using Medline, Embase, CINAHL, Cochrane Library, the Occupational Safety and Health (OSH-ROM) database, gray literature (eg. studies published in non-peer-reviewed journals), hand-searching occupational health journals, reference lists of included studies and content experts.
To evaluate study quality, they used a modified version of the Newcastle-Ottawa Scale. They evaluated levels of evidence supporting specific Bradford-Hill Criteria for different categories of carrying and types of LBP outcomes.
The researchers’ search yielded 2,766 citations. In all, they found 9 high-quality studies — 4 case-control and 5 prospective cohort studies — that reported on occupational carrying and LBP. All 9 studies reported strong and consistent evidence against a statistical link between carrying and LBP. Three studies assessed dose-response; only 1 reported a dose-response trend that was not statistically significant. Five studies assessed temporality, although none had results that supported this aspect of causality. No studies discussed the biological plausibility of carrying and LBP, the authors wrote. None of the research devised studies that measured the exposure to carrying and level of LBP before and after implementing a strategy focused on reducing carrying in the workplace.