A literature review of low back disorder surveillance measures and risk factors.

OBJECTIVE: The goal of this literature review was to gain insight into low back disorder risk factors via a critical examination of the surveillance measures and analysis techniques employed in existing literature. DESIGN: Fifty-seven original articles were evaluated and categorized as a function of their surveillance measures. BACKGROUND: There have been a plethora of articles concerning the causes of low back disorder, yet no specific risk factors are consistently associated with the development of these disorders. It was hypothesized that different low back surveillance measures and variations in risk factor (dependent variable) measurements have led to the inconsistencies in the literature. METHODS: Five low back disorder surveillance measures and five risk factor categories were defined for this review. Each article was classified on several criteria including: surveillance measures, risk factors, statistical methods, population and type of study. Summary statistics were calculated for the percentage of positive findings as a function of surveillance measure and risk factor category. RESULTS: The most consistently defined surveillance measure was incidence of low back disorder, with 82% of those investigating it as claims from medical records or Occupational Safety and Health Administration records. The combination of surveillance measures and risk factor influenced the outcome of investigations. Ninety-one percent of the direct or video methods of measuring exposure risk factor influenced outcome. Psychosocial measures had positive findings in 70% of the studies examining lost time. Finally, statistical methodology was critical in the outcome of these investigations. CONCLUSIONS: The surveillance measure of incidence had more positive findings, with exposure risk factors and the surveillance measures indicating more advanced stages of low back disorder such as lost time had more positive findings with psychosocial risk factors. Thus, as low back disorders progress to disability, the psychosocial risk factors play a more prominent role. RELEVANCE: In order to prevent low back disorders we must first understand the plethora of epidemiological literature. This literature review provides new insight on the critical issues that have contributed to the results of previous research.