Association between objectively measured physical behaviour and neck‐ and/or low back pain: A systematic review

Abstract

Background and objective Clinical guidelines recommend physical activity to manage neck pain (NP) and low back pain (LBP). However, studies used to support these guidelines are based on self‐reports of physical behaviour, which are prone to bias and misclassification. This systematic review aimed to investigate associations between objectively measured physical behaviour and the risk or prognosis of NP and/or LBP. Databases and data treatment Literature searches were performed in MEDLINE, Embase and Scopus from their inception until 18 January 2019. We considered prospective cohort studies for eligibility. Article selection, data extraction and critical appraisal were carried out by independent reviewers. Results were stratified on activity/sedentariness. Results Ten articles out of 897 unique records identified met the inclusion criteria, of which eight studied working populations with mainly blue‐collar workers. The overall results indicate that increased sitting time at work reduces the risk of NP and LBP while increased physical activity during work and/or leisure increases the risk of these conditions among blue‐collar workers; however, associations were weak. Physical activity was not associated with prognosis of LBP (no studies investigated prognosis of NP). Most of the included articles have methodological shortcomings. Conclusions This review indicates that, among blue‐collar workers, increased sitting at work may protect against NP and LBP while increased physical activity during work and/or leisure may increase this risk. There was no evidence supporting physical activity as a prognostic factor for LBP. Findings should be interpreted with caution due to the weak associations and few available studies with methodological shortcomings. Significance Based on prospective cohort studies with objectively measured physical behaviour, this review questions the common notion that increased physical activity is associated with reduced risk or better prognosis of NP and/or LBP. We found that, among blue‐collar workers, increased sitting time at work reduces the risk of NP and LBP, whereas physical activity somewhat increases the risk. Despite methodological shortcomings, there was consistency in the direction of the results, although high‐quality articles reported the weakest associations. Systematic review registration: PROSPERO CRD42018100765

Work-Time Compositions of Physical Behaviors and Trajectories of Sick Leave Due to Musculoskeletal Pain

“…Thus, sitting may be needed to allow rest and recovery, and prevent aggravated symptoms that contribute to sick-leave spells [38]. This would corroborate previous prospective studies using device-worn measurements indicating a negative association between sitting time and MSP in blue-collar workers [12]. To account for the possibility of this association merely occurring because of sitting being inversely related to physical activity, we adjusted for relative time spent in standing, LIPA, and MVPA, along with other relevant covariates.…”

“…Sick leave due to MSP is of multifactorial origin and a variety of possible occupational determinants of future sick leave due to MSP have been identified-for example, high physical work demands and poor psychosocial working conditions [4][5][6][7][8][9]. Time spent in daily physical behaviors such as sitting, standing, and physical activity has profound physiological and psychological effects that may extend to the onset and progression of MSP [10][11][12] and the ability to remain at work [13][14][15][16]. Overall, very few studies have addressed physical behaviors at work in relation to sick leave specifically due to MSP [17].…”

Clinical predictive modelling of post-surgical recovery in individuals with cervical radiculopathy: a machine learning approach

“…It is clinically more intuitive that better physical function is related to better prognosis, given that enhanced function is the aim of many therapeutic efforts. In the wider musculoskeletal literature, there have been reports of paradoxical relationships between physical function and pain, such as: (1) greater spine mobility predicting poorer recovery in back pain 38 , (2) greater physical activity levels increasing the risk of spinal pain onset 39 , and (3) greater hip internal rotation mobility, as one factor, increasing the responsiveness to manual therapy in back pain 40 . The predictors selected in the present study should not be interpreted causally but be restricted to the predictive framework.…”

Is hard physical work in the early working life associated with back pain later in life? A cross-sectional study among 5700 older workers

“…In fact, a recent systematic review found increased sitting time at work to associate with less intense LBP among physical workers. 39 Besides, hard physical work during early life is bringing workers closer to a musculoskeletal pain threshold that is associated with an increased risk of sickness absence due to LBP. Andersen and coworkers found female eldercare workers to be at elevated risk of sickness absence due to LBP when their pain intensity was 5.0 on the 0-9 NRS.…”