Cumulative occupational lumbar load and lumbar disc disease – results of a German multi-center case-control study (EPILIFT)

Background The to date evidence for a dose-response relationship between physical workload and the development of lumbar disc diseases is limited. We therefore investigated the possible etiologic relevance of cumulative occupational lumbar load to lumbar disc diseases in a multi-center case-control study. Methods In four study regions in Germany (Frankfurt/Main, Freiburg, Halle/Saale, Regensburg), patients seeking medical care for pain associated with clinically and radiologically verified lumbar disc herniation (286 males, 278 females) or symptomatic lumbar disc narrowing (145 males, 206 females) were prospectively recruited. Population control subjects (453 males and 448 females) were drawn from the regional population registers. Cases and control subjects were between 25 and 70 years of age. In a structured personal interview, a complete occupational history was elicited to identify subjects with certain minimum workloads. On the basis of job task-specific supplementary surveys performed by technical experts, the situational lumbar load represented by the compressive force at the lumbosacral disc was determined via biomechanical model calculations for any working situation with object handling and load-intensive postures during the total working life. For this analysis, all manual handling of objects of about 5 kilograms or more and postures with trunk inclination of 20 degrees or more are included in the calculation of cumulative lumbar load. Confounder selection was based on biologic plausibility and on the change-in-estimate criterion. Odds ratios (OR) and 95% confidence intervals (CI) were calculated separately for men and women using unconditional logistic regression analysis, adjusted for age, region, and unemployment as major life event (in males) or psychosocial strain at work (in females), respectively. To further elucidate the contribution of past physical workload to the development of lumbar disc diseases, we performed lag-time analyses. Results We found a positive dose-response relationship between cumulative occupational lumbar load and lumbar disc herniation as well as lumbar disc narrowing among men and women. Even past lumbar load seems to contribute to the risk of lumbar disc disease. Conclusions According to our study, cumulative physical workload is related to lumbar disc diseases among men and women

Epidemiological Evidence for Work Load as a Risk Factor for Osteoarthritis of the Hip: A Systematic Review

Osteoarthritis of the hip (OA) is a common degenerative disorder of the joint cartilage that presents a major public health problem worldwide. While intrinsic risk factors (e.g, body mass and morphology) have been identified, external risk factors are not well understood. In this systematic review, the evidence for workload as a risk factor for hip OA is summarized and used to derive recommendations for prevention and further research.Epidemiological studies on workload or occupation and osteoarthritis of the hip were identified through database and bibliography searches. Using pre-defined quality criteria, 30 studies were selected for critical evaluation; six of these provided quantitative exposure data.Study results were too heterogeneous to develop pooled risk estimates by specific work activities. The weight of evidence favors a graded association between long-term exposure to heavy lifting and risk of hip OA. Long-term exposure to standing at work might also increase the risk of hip OA.It is not possible to estimate a quantitative dose-response relationship between workload and hip OA using existing data, but there is enough evidence available to identify job-related heavy lifting and standing as hazards, and thus to begin developing recommendations for preventing hip OA by limiting the amount and duration of these activities. Future research to identify specific risk factors for work-related hip OA should focus on implementing rigorous study methods with quantitative exposure measures and objective diagnostic criteria

Messdatenbasierte Gefährdungsbeurteilung

<jats:title>Zusammenfassung</jats:title><jats:sec> <jats:title>Hintergrund</jats:title> <jats:p>Beobachtungsbasierte Methoden zur Gefährdungsbeurteilung physischer Belastungen im Bereich der oberen Extremität können durch subjektive Erfahrungen der Untersuchenden beeinflusst werden. Darüber hinaus ist eine Quantifizierung biomechanischer Belastungen, wie Zeitverläufe von Gelenkwinkeln, Winkelgeschwindigkeiten oder Kräften durch Beobachtungen, schwer möglich. Zur objektiven Quantifizierung von Expositionen im Rahmen von spezifischen Gefährdungsbeurteilungen eignen sich daher vor allem messtechnische Methoden, wobei die Auswahl der entsprechenden Methode herausfordernd sein kann.</jats:p> </jats:sec><jats:sec> <jats:title>Zielsetzung</jats:title> <jats:p>Dieser Artikel soll Arbeitsschutzfachleute dabei unterstützen, aus der Bandbreite der unterschiedlichen Verfahren die geeignete messtechnische Methode für eine vorliegende Expositionssituation zu identifizieren.</jats:p> </jats:sec><jats:sec> <jats:title>Methoden</jats:title> <jats:p>Ausgehend von einer Literaturübersicht wurden Messmethoden für die obere Extremität in Anlehnung an ein etabliertes Kategoriensystem hinsichtlich ihrer Komplexität klassifiziert. Zusätzlich werden Anwendungsbeispiele für alle Kategorien skizziert.</jats:p> </jats:sec><jats:sec> <jats:title>Ergebnisse</jats:title> <jats:p>Dieser Artikel liefert eine Übersicht und Klassifizierung von unterschiedlichen messtechnischen Erfassungs- und Bewertungsmethoden arbeitsbezogener Muskel-Skelett-Belastungen, die in 3 Kategorien von einfach bis komplex eingeteilt werden.</jats:p> </jats:sec><jats:sec> <jats:title>Diskussion</jats:title> <jats:p>Vereinfachte Sensorik in Kombination mit spezifischen Bewertungsansätzen kann zukünftig die objektive Gefährdungsbeurteilung physischer Belastungen unterstützen.</jats:p> </jats:sec&gt