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Occupational Medicine Advance Access originally published online on June 22, 2006
Occupational Medicine 2006 56(7):447-454; doi:10.1093/occmed/kql056
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© The Author 2006. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Low back pain and occupation among Irish health service workers

C. Cunningham1, T. Flynn2 and C. Blake1

1 School of Physiotherapy and Performance Science, Health Sciences Centre, University College Dublin, Dublin 4, Ireland
2 Department of Physiotherapy, St Vincents University Hospital, Dublin, Ireland

Correspondence to: C. Cunningham, School of Physiotherapy and Performance Science, Health Sciences Centre, University College Dublin, Dublin 4, Ireland. e-mail: caitriona.g.cunningham{at}ucd.ie


   Abstract
Top
 Abstract
Introduction
 Methods
 Results
 Discussion
 Conflicts of interest
 References
 
Background The health services sector has been identified as a high-risk work sector for low back pain (LBP) and related absenteeism.

Aims To establish levels and predictors of LBP prevalence and associated sick leave among health service workers. To identify if levels of LBP or related absenteeism differ between occupational groups.

Methods A postal survey using a standardized questionnaire and disproportionate random sampling of occupational groups was conducted at a single Dublin hospital. Overall hospital LBP prevalence and sickness absence were calculated using weighted analysis methods. Univariate analysis included the use of Chi-square, Fisher's exact and Mann–Whitney tests. Multivariate logistic regression techniques were used to explore for independent predictors of lifetime LBP prevalence and LBP-related sickness absence.

Results An overall response rate of 62% (n = 246) was achieved. Lifetime, annual and point prevalence rates for the hospital employees were calculated at 46, 30 and 15.5%, respectively. No significant difference in prevalence was found between occupational groups but sick leave did differ with the highest level among general support and nursing staff. Multivariate analysis confirmed that occupation was an independent predictor for LBP-related sick leave (P < 0.05).

Conclusions LBP prevalence rates did not differ significantly between occupational groups but occupation was found to be an independent predictor of LBP-related sick leave. Involvement in manual handling did not predict either LBP or related sick leave.

Keywords      Health service workers; low back pain; occupational; sickness absence


   Introduction
Top
 Abstract
 Introduction
Methods
 Results
 Discussion
 Conflicts of interest
 References
 
Low back pain (LBP) is an important public health problem in all industrialized nations. It is associated with major costs, in terms of health resource usage and worker disability and absenteeism [1] and is one of the most common causes of sick leave in the Western world [2,3].

General population studies give varying estimates of LBP lifetime and point prevalence which range from 50 to 85% and 14 to 28%, respectively [4–8]. As case definitions and study methodologies differ, it is difficult to generalize about populations or to apply the results to differing populations. In addition, it is recognized that identifying risk factors for such a highly prevalent disorder is difficult [9].

LBP is acknowledged as a common cause of disability and related sickness absenteeism is commonly used as a disability indicator. It is estimated that in 1994–95, 116 million production days were lost in the United Kingdom due to LBP-related work incapacity [1]. Equivalent figures are not available for Ireland which has very limited sickness absenteeism data. The Health and Safety Authority (Ireland) does record all work injury-related sickness absences of ≥3 days duration [10]. However, no national record of non-work injury-related back absenteeism exists in Ireland.

Problems with recording of sickness absence are not, however, unique to Ireland. Diverse sickness absence indices are used in different work settings and countries with data usually based on local organizational or welfare systems. Reasons for sickness absence are not always clearly recorded and work loss data are unlikely to capture the full extent of the sickness absence problem with shorter absences often remaining unrecorded. This lack of accurate baseline data, combined with the difficulty of comparing sickness absence data between organizations or work sectors leads to difficulties in measuring the efficacy of strategies aimed at reducing sick leave.

Although it is often impossible to distinguish LBP ‘caused’ by work from pain of other origin, attribution of LBP to work is very common [11,12]. Many studies have explored LBP in relation to specific occupational groups and have identified the health services sector as a workplace with a high risk for LBP [13–19]. This is reflected in the Health and Safety Authority (Ireland) annual report, 2003 [10] which indicates that back injuries accounted for 32% of all non-fatal work injuries within the health and social services sector, whereas the mean proportion for all work sectors is 26%. Research regarding LBP prevalence, risk factors and consequences among health service workers has, however, tended to focus on single occupational groups only and studies have largely concentrated on the nursing profession [20–25]. Some studies compare nursing with the general population [26], while others group all health service workers together for comparison with non-health sector workers [13]. Few studies compare groups of health service workers. Thus, it is difficult to identify whether certain health sector occupations are actually associated with a higher risk of LBP or any greater levels of LBP-related sick leave.

The primary aim of this study was therefore to establish levels and predictors of LBP prevalence and associated sick leave among health service workers at a single health services site in Ireland. In particular, this study aimed to identify whether specific health service occupations had any greater levels of LBP or related absenteeism.


   Methods
Top
 Abstract
 Introduction
 Methods
Results
 Discussion
 Conflicts of interest
 References
 
A postal survey using a standardized questionnaire and random sampling of hospital employees was conducted. Ethical approval for this study was obtained from the relevant hospital ethics committee. A complete staff list (n = 2337) was obtained from the human resources department at the research site. This was stratified according to the Department of Health and Children (Ireland) occupational clusters (Administration, Medical, General Support, Nursing and Allied Health Professionals). In order to ensure representation of all occupational groups in the study sample, a disproportional sample (n = 400) of hospital employees was taken using the statistical package for the social sciences (SPSS v 11) to generate equal size, random samples of 80 from each occupational group.

A self-administered study questionnaire was designed with discrete sections to gather the following data:

(i) sociodemographic and occupational data;
(ii) point, annual and lifetime LBP prevalence;
(iii) LBP-related sick leave;
(iv) attribution of LBP to a work incident;
(v) beliefs about LBP and
(vi) psychosocial aspects of work: (job satisfaction, social support and mental stress).

The Nordic pain questionnaire definition of LBP:

By low back pain is meant ache, pain or discomfort in the lower back whether or not it extends from there to one or both legs

was utilized and accompanied by a mannequin diagram to define the low back region [27]. Questions relating to LBP prevalence were worded according to the Saskatchewan Health and Back Pain Survey [4]. Respondents were asked to report on significant episodes of LBP which were defined as ‘LBP lasting 24 h or more’ as used in previous prevalence studies [5–8]. Workers were asked to identify whether or not they attributed their LBP onset to a specific incident and to specify if such an incident was work related or not.

Ferrie et al. [28] demonstrated good agreement between self-reported and recorded number of sickness absenteeism days for a recall period of 12 months.

Thus, for this study, workers were asked whether or not they had taken LBP-related sick leave and to quantify the number of LBP-related sick leave days taken in the previous 12 months.

Manual handlers were identified using self-reports of whether or not work involved patient or manual handling. The questionnaire also incorporated the Back Beliefs Questionnaire (BBQ) and the Psychosocial Aspects of Work Questionnaire (PAWQ) [29].

The BBQ is an instrument which is designed to measure an individual's beliefs about LBP and can be used whether or not there is a history of LBP. Its primary objective is to investigate beliefs about various inevitable aspects of the future as a consequence of LBP. The scale comprises nine inevitability statements (along with five statements used as distractors) and respondents are required to indicate their level of agreement with the statements on a five-point scale. Higher scores indicate a more positive attitude towards LBP and the maximum score possible on the BBQ is 45. The validity, test–retest reliability and internal consistency of the BBQ have been established [29].

The PAWQ is comprised of 15 items and includes three subscales which reflect attitudes towards three specific aspects of work: job satisfaction, social support and mental stress. Again respondents are required to indicate their level of agreement with a number of statements on a scale of 1–5. The maximum scores possible are 25 for job satisfaction, 20 for mental stress and 20 on the social support scale with higher scores indicating greater job satisfaction, social support or higher levels of stress. The reliability of the PAWQ has been established [29].

The study questionnaire was piloted on a group of 30 health service workers at the hospital and was reviewed for content validity and reader acceptability.

Questionnaires were then coded and distributed to the random sample of 400 workers, using the internal postal system at the research site. A cover letter, assuring respondents of confidentiality, accompanied the questionnaire. Reminder letters were sent to all non-respondents after 2 weeks.

Data were entered onto the statistical package for the social sciences (SPSS v 11). Nominal, ordinal and binary data were analysed using descriptive statistics. Based on the LBP prevalence and sickness absenteeism levels found in each occupational group, weighted analysis methods were used to calculate overall hospital LBP prevalence and sickness absence. Thus, the overall hospital figures reflect any occupational group differences in levels of LBP or related sick leave. In addition to the occupational group classification of workers, respondents were classified as manual handlers or non-manual handlers based on their self-rating. Classification of this working population into the age categories of <40 years and >40 years was conducted to examine the relationship between age and LBP. Univariate analysis was used to examine for the associations between occupation, manual handling, attribution of LBP to a work incident, age, sex, back beliefs, psychosocial aspects of work and (i) lifetime LBP prevalence and (ii) associated sick leave. Chi-square and Fisher's exact tests were used for categorical data and Mann–Whitney tests for BBQ and PAWQ scores.

Data were further analysed using multivariate logistic regression techniques to explore for independent predictors of lifetime LBP prevalence and related sickness absence.


   Results
Top
 Abstract
 Introduction
 Methods
 Results
Discussion
 Conflicts of interest
 References
 
A total of 400 questionnaires were distributed and an overall response rate of 62% (n = 246) was achieved.

Of the respondents, 71% (n = 175) were female and 29% (n = 71) male. The age range of respondents was from 19 to 66 years with a median age of 34 years. The profile of respondents in each occupational group is outlined in Table 1.


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  		Table 1. Profile of respondents (n = 246)

 
Lifetime, annual and point LBP prevalence rates for the hospital employees were calculated at 46, 30 and 15.5%, respectively, and on comparison of occupational groups no significant difference in LBP prevalence was found (Table 2).


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  		Table 2. Point, annual and lifetime prevalence of LBP among hospital workers (n = 246)

 
Further analysis explored for factors associated with lifetime LBP prevalence. A significantly higher lifetime LBP prevalence was found among the older (>40 years) age group. Despite an emphasis in the literature on manual handling as a risk factor for LBP, lifetime LBP prevalence was actually higher (P < 0.05) among non-manual handlers. No other factors (sex, BBQ or PAWQ scores) were found to be associated with lifetime prevalence.

On proceeding to multivariate analysis, belonging to the older (>40 years) age category emerged as the only significant predictor (P < 0.05) of lifetime LBP prevalence. Those in the older age group had 2.7 times higher odds of having a history of LBP in their lifetime than those aged <40 years (Table 3).


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  		Table 3. Lifetime prevalence of LBP among hospital workers (n = 246)—predictors of lifetime LBP prevalence

 
The indices of sickness absence used in this study were the number of staff taking sick leave, the number of days sick leave per employee and the total number of sick leave days for the organization in the previous year. Twenty-one respondents had taken LBP-related sick leave in the previous year representing 32% of those who had experienced LBP in that same period. The number of days taken by individual staff members with LBP ranged between 1 and 50 with a median of 5 days per staff member. The most frequent LBP-related sick leave duration was 2 days and one-third of those taking sick leave reported a sick leave duration of less than the 3-day threshold for sick certification.

Based on the proportions of each occupational group who took sick leave and using weighted analysis methods it is estimated that 11% (n = 249) of all hospital employees had taken LBP-related sick leave in the previous year. This would lead to a loss of 1876 working days which is the equivalent of 375 working weeks.

The data of employees with a lifetime history of LBP (n = 132) were analysed and a significant difference between occupational groups, in the proportion of LBP-related sick leave (P < 0.05) was found. The highest level of sick leave was among nurses and general support staff (Table 4).


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  		Table 4. Predictors of LBP-related sickness absence among hospital workers with a history of LBP (n = 132)

 
Multivariate analysis confirmed that older age and occupation were independent predictors for LBP-related sick leave (P < 0.05). The odds of general support workers and nurses taking sick leave were 8.4 and 6.5 times higher, respectively, than those of other workers within the hospital. None of the other variables explored was found to have a significant association with sick leave (Table 4).


   Discussion
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
Conflicts of interest
 References
 
Lifetime, annual and point prevalence rates for the hospital employees were calculated at 46, 30 and 15.5%, respectively. These prevalence rates are at the lower end of the ranges found in previous general population studies [4–8] suggesting that LBP prevalence among health service workers is no greater than that of the general population. This is consistent with the findings of Leighton and Reilly [26] who found no difference in LBP prevalence between age- and gender-matched nursing and non-nursing groups despite the fact that nursing is generally regarded as a high-risk occupation for LBP.

For this study group, neither occupation nor involvement in manual handling was found to predict LBP. This is perhaps counterintuitive given the reports of many previous authors.

However, the evidence regarding physical workload as a risk factor for LBP is not conclusive [30]. Indeed, the lack of predictors for LBP found here may simply reflect the view that LBP is endemic [11,12].

LBP-related sickness absence clearly represents a major cost to this organization which is likely to be replicated in other Irish health service organizations. It is however difficult to say how the health sector compares with other work sectors as data on sickness absence within Ireland are generally very limited. The most commonly reported sick leave duration for this organization was 2 days, an absence which does not necessitate medical certification. Recording certified days only means that this organization underestimates its LBP-related sick leave with the data of one-third of the staff who took LBP-related sick leave remaining unrecorded.

Although a greater proportion of men took LBP-related sick leave sex was not found to be a significant predictor of LBP-related sick leave. Indeed, higher work absence is generally found among women [31] but in studies specific to LBP-related absenteeism, results vary regarding the gender most likely to take sick leave [32–35]. For this study group, being younger was found to predict sick leave which differs with previous findings [31]. The occupational group differences in sickness absenteeism levels found here are consistent with previous research findings which showed that the threshold for taking sick leave is high among doctors [36,37] and low among nurses [38].

The differing levels of lifting and manual handling associated with the various occupations could reasonably have been expected to explain this difference but such involvement in manual handling was not found to be predictive of sick leave in this cohort.

Although the overall response rate for this study was reasonably good at 62%, the numbers in some subgroups were small and the results of this study should be interpreted with this in mind. In particular, the number of doctors who responded was low at 26% (n = 21). As with all workers surveyed, reminders were sent to doctors. However, from this organization's data it is known that doctors rarely avail themselves of back services or take sick leave and one can only speculate that many of the doctors may therefore have believed that the survey had little relevance to them.

The findings of this study contrast with previous studies which showed that manual work, high physical workload and frequent handling of heavy objects lead to higher levels of LBP-related sick leave [39,40]. However, previous authors have indicated that disability due to LBP depends more on complex individual and work-related psychosocial factors than on the physical demands of work [30] and Linton [41] concluded that psychological work factors play a significant role in future LBP problems.

Although job satisfaction, social support and job stress have previously been identified as sick leave predictors [40,42–46] this was not the case for this study population.

Qualitative research methods may, however, prove more useful in identifying the occupation specific, psychosocial factors which lead to LBP-related sick leave among health service workers.

As LBP was found to be common, irrespective of occupation, back management strategies need to switch their focus from primary prevention of LBP to reducing disability as highlighted by previous authors [11,12,30,47].

Sickness absenteeism from work is an important indicator of LBP-related disability. Successful management of health-related lost labour time requires accurate measurement of lost productivity caused by health conditions in the workplace [48]. Standardizing methods of sickness absence recording within and between various work sectors will allow the efficacy of various strategies to be compared. The next step is the development and implementation of appropriate strategies aimed at reducing LBP-related sick leave.

The results of this study suggest that manual handling does not increase the likelihood of LBP pain or related sick leave. Thus, it would seem that manual handling training is not warranted. Arguably, though it is this provision of manual handling training for health service workers in Ireland which is reducing the risks of LBP among manual handlers.

However, Hignett's [49] systematic literature review, regarding the efficacy of interventions aimed at reducing patient handling-related work injuries, found strong evidence that techniques-based training has no impact on working practices or injury rates.

Only through controlled worksite studies could the value of manual handling training be conclusively evaluated but it is likely that such research would prove difficult in the context of current legislation which requires training for all staff who may be at risk of injury, be they patient handlers or not.

Thus, manual handling skills training may remain the most appropriate first step in a process which also focuses on imparting back care information, implementation of skills in working practice and risk assessment.

However, the results of this study do indicate that occupation-specific risk factors other than manual handling exist and need to be identified.


   Conflicts of interest
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 Conflicts of interest
References
 
None declared.


   References
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 Conflicts of interest
 References
 

  1. Maniadakis N, Gray A. The economic burden of back pain in the UK. Pain 2000;84:95–103.[CrossRef][Web of Science][Medline]

  2. Reiso H, Nygard JF, Jorgensen GS et al. Back to work: predictors of return to work among patients with back disorders certified as sick. Spine 2003;28:1468–1473.[CrossRef][Web of Science][Medline]

  3. Tellnes G, Svendsen KO, Bruusgaard D et al. Incidence of sickness certification. Proposal for use as a health status indicator. Scand J Prim Health Care 1989;7:11–17.

  4. Cassidy JD, Carroll LJ, Cote P. The Saskatchewan health and back pain survey. Spine 1998;23:1860–1866.[CrossRef][Web of Science][Medline]

  5. Biering-Sorensen F. Low back trouble in a general population of 30–40–50 year old males and females: study design, representativeness and basic results. Dan Med Bull 1982;29:289–299.[Web of Science][Medline]

  6. Papageorgiou AC, Croft PR, Ferry S et al. Estimating the prevalence of low back pain in the general population: evidence from the South Manchester back pain survey. Spine 1995;20:1889–1894.[Web of Science][Medline]

  7. Walsh K, Cruddas M, Coggon D. Low back pain in eight areas of Britain. J Epidemiol Community Health 1992;46:227–230.[Abstract/Free Full Text]

  8. Hillman M, Wright A, Rajaratnam G et al. Prevalence of low back pain in the community: implication for service provision in Bradford, United Kingdom. J Epidemiol Community Health 1996;50:347–352.[Abstract/Free Full Text]

  9. Troup JDG, Edwards FC. Manual Handling and Lifting: An Information and Literature Review with Special Reference to the Back. London: Health & Safety Executive, HMSO, 1985.

  10. Health and Safety Authority. Annual Report 2003. Ireland: Health and Safety Authority Publications. ISBN 1-84496-043-9.

  11. Burton AK. Spine update-back injury and work loss. Spine 1997;22:2575–2580.[CrossRef][Web of Science][Medline]

  12. Frank JW, Kerr MS, Brooker AS et al. Disability resulting from occupational low back pain. Spine 1996;21:2908–2917.[CrossRef][Web of Science][Medline]

  13. Xu Y, Bach E, Orhede E. Occupation and risk for the occurrence of low back pain (LBP) in Danish employees. Occup Med (Lond) 1996;46:131–136.

  14. Cooper JE, Tate RB, Yassi A. Components of initial and residual disability after back injury in nurses. Spine 1998;23:2118–2122.[CrossRef][Web of Science][Medline]

  15. Smedley J, Egger P, Cooper C et al. Manual handling activities and risk of low back pain in nurses. Occup Environ Med 1995;52:160–163.[Abstract/Free Full Text]

  16. Goldman RH, Jarrard MR, Rokho K et al. Prioritising back injury risk in hospital employees: application and comparison of different injury rates. J Occup Environ Med 2000;42:645–652.[Web of Science][Medline]

  17. Yassi A, Khokhar J, Tate R et al. The epidemiology of back injuries in nurses at a large Canadian tertiary care hospital: implications for prevention. Occup Med (Lond) 1995;45:215–220.

  18. Rossi A, Marinon G, Barbieri L et al. Backache from exertion in health personnel of the Istituti Ortopedici Rizzoliu in Bologna. A case control study of the injury phenomenon in the 10 year-period of 1987–1996. Epidemiol Prev 1999;23:98–104.[Medline]

  19. Anderson VP, Bernard BP, Burt SE et al. Musculoskeletal Disorders (MSDs) and Workplace Factors. A Critical Review of Epidemiologic Evidence for Work Related Musculoskeletal Disorders of the Neck, Upper Extremity and Low Back. http://www.cdc.gov/niosh/erg (April 2006, date last accessed).

  20. Turnball N, Dornan J, Fletcher B, Wilson S. Prevalence of spinal pain among the staff of a district health authority. Occup Med (Lond) 1992;42:143–148.

  21. Engels JA, van der Guilden JWJ, Senden TF, van't Hof B. Work related risk factors for musculoskeletal complaints in the nursing profession: results of a questionnaire survey. Occup Environ Med 1996;53:636–641.[Abstract/Free Full Text]

  22. Cohen-Mansfield J, Culpepper WJ, Carter P. Nursing staff back injuries: prevalence and costs in long-term care facilities. AAOHN J 1996;44:9–17.[Medline]

  23. Klaber Moffat J, Hughes G, Griffiths P. A longitudinal study of low back pain in student nurses. Int J Nurs Stud 1993;30:151–161.

  24. Stubbs DA, Buckle PW, Hudson MP et al. Back pain in the nursing profession-epidemiology and pilot methodology. Ergonomics 1983;26:755–765.[Medline]

  25. Maul I, Laubli T, Klipstein A. Course of low back pain among nurses: a longitudinal study across eight years. Occup Environ Med 2003;60:497–503.[Abstract/Free Full Text]

  26. Leighton DJ, Reilly T. Epidemiological aspects of back pain: the incidence and prevalence of back pain in nurses compared to the general population. Occup Med (Lond) 1995;45:263–267.

  27. Kuorinka I, Jonsson B, Kilbom A et al. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon 1987;18:233–237.[Medline]

  28. Ferrie JE, Kivimaki M, Head J, Shipley MJ, Vahtera J, Marmot MG. A comparison of self-reported sickness absence with absences recorded in employers' registers: evidence from the Whitehall 11 study. Occup Environ Med 2005;62:74–79.[Abstract/Free Full Text]

  29. Symonds TL, Burton AK, Tillotson KM, Main CJ. Do attitudes and beliefs influence work loss due to low back trouble? Occup Med (Lond) 1996;46:25–32.

  30. Waddell G, Burton K. Occupational Health Guidelines for the Management of Low Back Pain at Work. Evidence Review and Recommendations. Faculty of Occupational Medicine of the Royal College of Physicians Publications, 2000.

  31. Allebeck P, Mastekaasa A. Risk factors for sick leave-general studies. Scand J Public Health 2004;32(Suppl. 63):49–108.[Abstract/Free Full Text]

  32. Feuerstein M, Berkowitz SM, Haufler AJ, Loez MS, Huang GD. Working with low back pain: workplace and individual psychosocial determinants of limited duty and lost time. Am J Ind Med 2001;40:627–638.[CrossRef][Web of Science][Medline]

  33. Abenheim L, Suissa S. Importance and economic burden of occupational back pain: a study of 2,500 cases representative of Quebec. J Occup Med 1987;29:670–674.[Web of Science][Medline]

  34. Sandanger I, Nygard JF, Brage S, Tellnes G. Relation between health problems and sickness absence: gender and age differences—a comparison of low back pain, psychiatric disorders and injuries. Scand J Public Health 2000;28:244–252.[CrossRef][Web of Science][Medline]

  35. Klein BP, Jensen RC, Sanderson LM. Assessment of workers' compensation claims for back strains/sprains. J Occup Med 1984;26:443–448.[CrossRef][Web of Science][Medline]

  36. Kivimaki M, Sutinen R, Elovainio M et al. Sickness absence in hospital physicians: 2 year follow up study on determinants. Occup Environ Med 2001;58:361–366.[Abstract/Free Full Text]

  37. Mc Kevitt C, Myfanwy M, Dundas R, Holland WW. Sickness absence and ‘working through’ illness: a comparison of two occupational groups. J Public Health Med 1997;19:295–300.[Abstract/Free Full Text]

  38. Health & Safety Executive. Self Reported Work Related Illness in 1995—Results from a Household Survey. HSE, 1995.

  39. Muller CF, Monrad T, Biering Sorensen F. The influence of previous low back trouble, general health and working conditions on future sick listing because of low back trouble. Spine 1999;24:1562–1570.[CrossRef][Web of Science][Medline]

  40. Hoogendorn WE, Bongers PM, de Vet HC, Ariens GSA, van Merchelen W, Bouter LM. High physical workload and low job satisfaction increase the risk of sickness absence due to low back pain; results of a prospective cohort study. Occup Environ Med 2003;59:323–328.

  41. Linton SJ. Occupational psychological factors increase the risk for back pain: a systematic review. J Occup Rehabil 2001;11:53–66.[CrossRef][Web of Science][Medline]

  42. Melchior M, Niedhammer I, Berkman LF, Goldberg M. Do psychosocial work factors and social relations exert independent effects on sickness absence? A six year prospective study of the Gazel cohort. J Epidemiol Community Health 2003;57:285–293.[Abstract/Free Full Text]

  43. Bourbonnais R, Mondor M. Job strain and sickness absence among nurses in the province of Quebec. Am J Ind Med 2001;39:194–202.[CrossRef][Web of Science][Medline]

  44. Eriksen W, Bruusgaard D, Knardahl S. Work factors as predictors of sickness absence attributed to airway infections; a three month prospective study of nurses' aides. Occup Environ Med 2003;60:271–278.[Abstract/Free Full Text]

  45. Moreau M, Valente F, Mak R et al. Occupational stress and incidence if sick leave in the Belgian workforce: the Belstress study. J Epidemiol Community Health 2004;58:507–516.[Abstract/Free Full Text]

  46. Nieuwenhuijsen K, Verbeek JHAM, de Boer AGEM, Blonk RWB, van Dijk FJH. Supervisory behaviour as a predictor of return to work in employees absent from work due to mental health problems. Occup Environ Med 2004;61:817–823.[Abstract/Free Full Text]

  47. Fransen M, Woodward M, Norton R, Coggan C, Dave M, Sheridan N. Factors associated with the transition from acute to chronic occupational back pain. Spine 2002;27:92–98.[CrossRef][Web of Science][Medline]

  48. Stewart WF, Ricci JA, Leotta C. Health related lost productive time (LPT): recall interval and bias in LPT estimates. J Occup Environ Med 2004;46(6 Suppl.):s12–s22.

  49. Hignett S. Intervention strategies to reduce musculoskeletal injuries associated with handling patients: a systematic review. Occup Environ Med 2003;60:E6.


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