Abstract
Low back pain and symptoms are major contributors to ambulatory visits, economic burden, and reduced readiness among military personnel and employers in the civilian workplace as well. While a link between low back pain and biomechanical exposures has been established, efficient surveillance methods of such exposures are still needed. Furthermore, the utility of self-report measures for biomechanical exposures has not been examined extensively. The present cross-sectional study analyzed questionnaire data from US Army soldiers (n = 279) working in previously identified occupational specialties that were associated with high risk for low back pain and/or low back pain disability. Demographic characteristics, physical workload, health behaviors, and psychosocial factors were assessed in addition to self-reported workplace biomechanical exposures using the Job Related Physical Demands (JRPDs). Outcomes included self-reported low back pain severity, low back symptoms, functional limitations, and general physical health. The results indicated that the self-report measure of biomechanical exposure had a high degree of internal consistency (Cronbach alpha, 0.95). The JRPD index correlated with low back symptoms, pain intensity, function, and perceived work load using the Borg scale. Regression analyses indicated statistically significant associations between the JRPD and back pain specific pain severity and physical function, but not for general physical health (SF-12) after controlling for age, gender, educational level, job type, and reported exercise and work stress. Specifically, higher JRPD scores (representing greater biomechanical exposure) were associated with higher levels of pain intensity and functional limitations. Higher JRPD scores were found to place an individual at a greater likelihood for being a case with low back pain within the past 12 months (OR = 1.01 per point increase in scale-95%; range 38–152; CI = 1.00–1.02, p ≤ 0.05). While future longitudinal studies of the JRPD determining the predictive validity of the measure are needed, the present study provides evidence of the utility of the JRPD for assessing biomechanical exposures associated with low back pain within high-risk jobs. The findings suggest that the JRPD may assist with surveillance efforts and be useful as a process and/or outcome measure in research related to occupational rehabilitation.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Peake J. Reflections on Injuries in the military: The hidden epidemic. Am J Prev Med 2000; 18(3S): 4–5.
Berkowitz M, Feuerstein M, Lopez M, Peck A. Occupational back disability in US army personnel. Mil Med 1999; 164: 412–418.
U.S. Department of Defense Injury Surveillance and Prevention Work Group. Atlas of injuries in the US Armed Forces. Mil Med 1999; 164: 8 entire supplement.
Feuerstein M, Berkowitz SM, Peck CA. Musculoskeletal-related disability in U.S. Army personnel: Prevalence, gender, and military occupational specialties. J Occup Environ Med. 1997; 39: 68–78.
Jones H, Perrotta D, Canhan-Chervak M, Nee M, Brundage J. Injuries in the military: A review and commentary focused on Prevention. Am J Prev Med 2000; 18(3S): 71–84.
Huang G, Feuerstein M, Arroyo F. Back and upper extremity disorders among enlisted U.S. marines: Burden and individual risk factors. Mil Med 2001; 166: 1007–1017.
US Department of Health and Human Services. Musculoskeletal disorders and workplace factors: A critical review of epidemiological evidence for work related musculoskeletal disorders of the neck, upper extremities and low back. NIOSH Publication No. 97–141. Cincinnati, OH: National Institute for Occupational Safety and Health, 1997.
Burdorf A, Rossignol M, Fathallah FA, Snook SH, Herrick RF. Challenges in assessing risk factors in epidemiologic studies on back disorders. Am J Ind Med 1997; 32: 142–152.
National Research Council and Institute of Medicine. Musculoskeletal disorders and the workplace, ppESI. Washington, DC: National Academy Press, 2001.
Feuerstein M, Berkowitz S, Haufler A, Lopez M, Huang G. Working with low back pain: Workplace individual psychosocial determinants of limited duty and lost time. Am J Ind Med 2001; 40: 627–638.
Shelerud R. Epidemiology of occupational low back pain. J Occup Med: State of the Art Reviews 1998; 13: 1–22.
Burdorf A, Govaert G, Elders L. Postural load and back pain of workers in the manufacturing of prefabricated concrete elements. Ergonomics 1991; 34: 909–918.
Hildebrandt VH. Back pain in the working population: Prevalence rates in Dutch trades and professions. Ergonomics 1995; 38: 1283–1298.
Punnett L, Fine L, Keyserling W, Herrin G, Chaffin D. Back disorders and nonneutral trunk postures of automobile assembly workers. Scand J Work Environ Health 1991; 17: 337–346.
Spielholz P, Silverstein B, Morgan M, Checkoway H, Kaufman J. Comparison of self-report, video observation and direct measurement methods for upper extremity musculoskeletal disorder physical risk factors. Ergonomics 2001; 44: 588–613.
Hagberg M. Exposure variables in ergonomic epidemiology. Am J Ind Med 1992; 21: 91–100.
Kilbom A. Assessment of physical exposure in relation to work-related musculoskeletal disorders-what information can be obtained from systematic observations. Scand J Work Environ Health 1994; 20(Special Issue): 30–45.
Kirwan B, Ainsworth LK. A guide to task analysis. London: Taylor and Francis, 1992.
Burdorf A. Exposure assessment of risk factors for disorders of the back in occupational epidemiology. Scand J Work Environ Health 1992; 18: 1–9.
Van der Beek A, Frings-dresen M. Assessment of mechanical exposure in ergonomic epidemiology. Occup Environ Med 1998; 55: 291–299.
Wells R, Norman P, Andrews D. Assessment of physical workload in epidemiologic studies: Common measurement metrics for exposure assessment. Ergonomics 1997; 40: 51–61.
Wiktorin C, Karlqvist L, Winkel J. Validity of self-reported exposures to work postures and manual materials handling. Scand J Work Environ Health 1993; 19: 208–214.
Burdorf A. Comparison of methods for the assessment of postural load on the back. Scand J Work Environ Health 1991; 17: 425–429.
Marcotte A, Barker R, Joyce M, Miller N, Klinenberg EJ, Cogburn CD, Goddard DE. Preventing work-related musculoskeletal illnesses through ergonomics: The Air Force PREMIER Program. Volume 2: Job requirements and physical demands survey methodology guide (field version). Brooks Air Force Base, TX: Occupational and Environmental Directorate, 1997.
Huang G, Feuerstein M, Kop W, Schor K, Arroyo F. Individual and combined impacts of biomechanical and work organization factors in work-related musculoskeletal symptoms. Am J Ind Med 2003; 495–506.
Dane D, Feuerstein M, Huang G, Dimberg L, Ali D, Lincoln A. Measurement properties of a self-report index of ergonomic exposures for use in an office work environment. J Occup Environ Med 2002; 44: 73–81.
Bernard B, Sauter S, Fine L, Petersen M, Hales T. Job task and psychological risk factors for work-related musculoskeletal disorders among newspaper employees. Scand J Work Environ Health 1994; 20: 417–426.
Baron S, Hales T, Hurrell J. Evaluation of symptom surveys for occupational musculoskeletal disorders. Am J Ind Med 1996; 29: 609–617.
Hunting KL, Welch LS, Cuccherini BA, Seiger LA. Musculoskeletal symptoms among electricians. Am J Ind Med 1994; 25: 149–163.
U.S. Army Center for Health Promotion and Preventive Medicine. HRA comparative analysis. Internal Report, 1994.
Borg G. Psychological scaling with application in physical work and the perception of exertion. Scand J Work Environ Health 1990; 16(Suppl 1): 55–58.
Holmstrom EB, Lindell J, Moritz U. Low back and neck/shoulder pain in construction workers: Occupational workload and psychosocial risk factors. Part 1: Relationship to low back pain. Spine 1992; 17(6): 663–71.
Eston RG, Williams JG. Reliability of ratings of perceived effort regulation of exercise intensity. Br J Sports Med 1988; 22: 153–155.
Ware JE, Kosinski M, Keller SD. A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Med Care 1996; 34: 220–233.
Ware JE, Sherbourne CD. The MOST 36-item Short-Form Health Survey (SF-36). Med Care 1992; 30: 473–483.
Feuerstein M, Huang GD, Haufler AJ, Miller JK. Development of a screen for predicting clinical outcomes in patients with work-related upper extremity disorders. J Occup Environ Med 2000; 42: 749–761.
Bessette L, Sangha O, Kuntz KM, Keller, RB, Lew RA, Fossel AH, Katz JN. Comparative responsiveness of generic versus disease specific weighted versus unweighted health status measures in carpal tunnel syndrome. Med Care 1998; 36: 491–502.
Hazard RG, Haugh LD, Reid S, Preble JB, McDonald L. Early prediction of chronic disability after occupational low back injury. Spine 1996; 21: 945–951.
Nunnally J, Bernstein I. Psychometric theory, 3rd edn. New York: McGraw-Hill, 1994.
Hosmer DW, Lemeshow S. Applied logistic regression. New York: Wiley, 2000.
Hoogendoorn WE, van Poppel MN, Bongers PM, Koes BW, Bouter LM. Physical load during work and leisure time as risk factors for back pain. Scand J Work Environ Health 1999; 25(5): 387–403.
Bongers P, Hulshof C, Dijkstra L, Boshuizen H. Back pain and exposure to whole-body vibration in helicopter pilots. Ergonomics 1990; 33: 1007–1026.
Riihimaki H, Viikari-Juntura E, Moneta G, Kuha J, Videman T, Tola S. Incidence of sciatic pain among machine operating, dynamic physical work, and sedentary work. A three-year follow-up. Spine 1994; 19(2): 138–142.
Engstrom T, Hanse JJ, Kadefors R. Musculoskeletal symptoms due to technical preconditions in long cycle time work in an automobile assembly plant: A study of prevalence and relation to psychosocial factors and physical exposure. Appl Ergon 1999; 30(5): 443–453.
Dehlin O, Berg S. Back symptoms and psychological perception of work. A study among nursing aides in a geriatric hospital. Scand J Rehabil Med 1977; 9(2): 61–65.
van Poppel MN, Koes BW, Deville W, Smid T, Bouter LM. Risk factors for back pain incidence in industry: A prospective study. Pain 1998; 77(1): 81–86.
Thomas E, Silman AJ, Croft PR, Papgeorgiou AC, Jayson MIV, Macfarlene GJ. Predicting who develops chronic low back pain in primary care: A prospective study. Br Med J 1999; 318(7199): 1662–1667.
Jones BH, Bovee MW, Harris JM, Cowan DN. Intrinsic risk factors for exercise-related injuries among male and female army trainees. Am J Sports Med 1993; 21: 705–710.
U.S. Department of Labor. Lost work-time injuries and illnesses: Characteristics and resulting time away from work. Washington, DC: Bureau of Labor and Statistics, 2000. Available from http://stats.bls.gov/oshahome.htm.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Daniels, C., Huang, G.D., Feuerstein, M. et al. Self-Report Measure of Low Back-Related Biomechanical Exposures: Clinical Validation. J Occup Rehabil 15, 113–128 (2005). https://doi.org/10.1007/s10926-005-1214-z
Issue Date:
DOI: https://doi.org/10.1007/s10926-005-1214-z