Men and Women's Occupational Activities and the Risk of Developing Osteoarthritis of the Knee, Hip, or Hands: A Systematic Review and Recommendations for Future Research
Abstract:Objective
To systematically review the evidence for an increased risk of osteoarthritis in the hip, knee, hand, wrist, finger, ankle, foot, shoulder, neck, and spine related to diverse occupational activities of men and women and to examine dose‐response information related to the frequency, intensity, and duration of work exposures and the risk of osteoarthritis (OA).
Methods
Established guidelines for systematic reviews in occupational health and safety studies were followed. MEDLINE, Embase, CINAHL, and Coc… Show more
“…A possible selection bias might exist as participants with jobs with the highest odds of knee OA were likely to be recruited and have their data reported. Compared to previous systematic reviews of occupations and knee OA , our study is the most comprehensive in including an increased number of relevant occupational exposures and sample size.…”
Section: Discussionmentioning
confidence: 99%
“…The underlying mechanistic links between occupations and knee OA are believed to be biomechanical, with excessive knee forces generated during strenuous work tasks . Several studies have identified frequent workplace kneeling, squatting, and heavy lifting as risk factors for development and progression of knee OA . However, few studies have quantitatively synthesized the evidence , and no systematic review has compared the disease outcomes according to specific job titles.Prevalence of knee osteoarthritis (OA) has been associated with work‐related repetitive joint movements and excess knee load, but little is known of the relationship between specific job titles and risk of knee OA, especially light‐to-moderate physically demanding occupations.Increased odds of knee OA were found in agriculture workers, construction workers, miners, service workers, houseworkers, and cleaners, who typically perform high levels of lifting, kneeling, climbing, squatting, and standing, compared to individuals with sedentary occupations.This evidence could help inform workplace regulators and insurers by identifying individuals who are frequently involved in specific work activities and may be susceptible to joint disorders; it could also help identify targeted industrial sectors that might need tailored prevention strategies for knee OA.…”
Objective
To assess the association between occupational exposures and knee osteoarthritis (OA).
Methods
We systematically searched for observational studies that examined the relationship between occupational exposures and knee OA and total knee replacement. Four databases were searched up to October 1, 2019. Two reviewers independently assessed study quality using the Newcastle‐Ottawa Scale and evidence quality using the Grading of Recommendations Assessment, Development and Evaluation approach. Subgroup meta‐analyses were conducted for important study characteristics and each type of occupational exposure. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated for the meta‐analysis using random‐effects models.
Results
Eighty eligible studies were identified including 25 case–control (n = 20,505 total participants), 36 cross‐sectional (n = 139,463 total participants), and 19 cohort studies (n = 16,824,492 total participants). A synthesis of 71 studies suggested increased odds of knee OA (OR 1.52 [95% CI 1.37–1.69]) by combining different physically demanding jobs and occupational activities as compared to sedentary occupations and/or low‐exposure groups. Odds of knee OA were greater in males and in industry‐based studies and studies assessing lifetime occupational exposures. There were 9 specific job titles that were associated with knee OA, including farmer, builder, metal worker, and floor layer. Occupational lifting, kneeling, climbing, squatting, and standing were all associated with higher odds of knee OA as compared to the odds of knee OA in sedentary workers.
Conclusion
Strenuous, physically demanding occupations and occupational activities were associated with increased odds of knee OA as supported by moderate‐quality evidence. Specifically, agricultural and construction sectors, which typically involve heavy lifting, frequent climbing, prolonged kneeling, squatting, and standing, carried increased odds of knee OA.
“…A possible selection bias might exist as participants with jobs with the highest odds of knee OA were likely to be recruited and have their data reported. Compared to previous systematic reviews of occupations and knee OA , our study is the most comprehensive in including an increased number of relevant occupational exposures and sample size.…”
Section: Discussionmentioning
confidence: 99%
“…The underlying mechanistic links between occupations and knee OA are believed to be biomechanical, with excessive knee forces generated during strenuous work tasks . Several studies have identified frequent workplace kneeling, squatting, and heavy lifting as risk factors for development and progression of knee OA . However, few studies have quantitatively synthesized the evidence , and no systematic review has compared the disease outcomes according to specific job titles.Prevalence of knee osteoarthritis (OA) has been associated with work‐related repetitive joint movements and excess knee load, but little is known of the relationship between specific job titles and risk of knee OA, especially light‐to-moderate physically demanding occupations.Increased odds of knee OA were found in agriculture workers, construction workers, miners, service workers, houseworkers, and cleaners, who typically perform high levels of lifting, kneeling, climbing, squatting, and standing, compared to individuals with sedentary occupations.This evidence could help inform workplace regulators and insurers by identifying individuals who are frequently involved in specific work activities and may be susceptible to joint disorders; it could also help identify targeted industrial sectors that might need tailored prevention strategies for knee OA.…”
Objective
To assess the association between occupational exposures and knee osteoarthritis (OA).
Methods
We systematically searched for observational studies that examined the relationship between occupational exposures and knee OA and total knee replacement. Four databases were searched up to October 1, 2019. Two reviewers independently assessed study quality using the Newcastle‐Ottawa Scale and evidence quality using the Grading of Recommendations Assessment, Development and Evaluation approach. Subgroup meta‐analyses were conducted for important study characteristics and each type of occupational exposure. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated for the meta‐analysis using random‐effects models.
Results
Eighty eligible studies were identified including 25 case–control (n = 20,505 total participants), 36 cross‐sectional (n = 139,463 total participants), and 19 cohort studies (n = 16,824,492 total participants). A synthesis of 71 studies suggested increased odds of knee OA (OR 1.52 [95% CI 1.37–1.69]) by combining different physically demanding jobs and occupational activities as compared to sedentary occupations and/or low‐exposure groups. Odds of knee OA were greater in males and in industry‐based studies and studies assessing lifetime occupational exposures. There were 9 specific job titles that were associated with knee OA, including farmer, builder, metal worker, and floor layer. Occupational lifting, kneeling, climbing, squatting, and standing were all associated with higher odds of knee OA as compared to the odds of knee OA in sedentary workers.
Conclusion
Strenuous, physically demanding occupations and occupational activities were associated with increased odds of knee OA as supported by moderate‐quality evidence. Specifically, agricultural and construction sectors, which typically involve heavy lifting, frequent climbing, prolonged kneeling, squatting, and standing, carried increased odds of knee OA.
“…Another review showed that cumulative physical workloads were associated with hip osteoarthritis in men; this review showed mixed evidence for physical demands and knee osteoarthritis, hip osteoarthritis and osteoarthritis in multiple other joints. 58 For high versus low OPA, there was an statistically significant increased risk of insomnia (OR 2.76, 95% CI 1.71 to 4.45), 61 with pooled results from four cross-sectional and three cohort studies, and high heterogeneity.…”
ObjectivePhysical activity (PA) has substantial benefits across a range of health outcomes. There is uncertainty about the PA-specific health effects, and in particular, the occupational domain. In this umbrella review, we synthesised available evidence on the associations between occupational PA (OPA) and health-related outcomes (including cancer, all-cause mortality and cardiovascular disease). This work informed the development of WHO’s guidelines on PA and sedentary behaviour (2020).DesignUmbrella review of systematic reviews.Data sourceWe performed a literature search in PubMed, Web of Science, Embase, CINAHL and Sportdiscuss from database inception to 2 December 2019.Eligibility criteria for selecting studiesWe included systematic reviews if they contained a quantitative assessment of OPA and its relationship with at least one health-related outcome.ResultsWe summarised the evidence of 17 reviews covering 23 unique health-related outcomes. We graded most evidence as low or very low, or moderate quality. We found health benefits for those engaging in high versus low OPA for multiple cancer outcomes (including colon and prostate), ischaemic stroke, coronary heart disease and mental health (ie, mental well-being and life satisfaction). High OPA was associated with unfavourable health outcomes for all-cause mortality in men, mental ill health (ie, depression and anxiety), osteoarthritis, and sleep quality and duration.ConclusionsWe found favourable associations for most health-related outcomes with high OPA levels, but we also found some evidence for unfavourable associations due to high OPA levels. At this point, there is a need for better quality evidence to provide a unequivocal statement on the health effects of OPA.
“…Although moderate physical activity is encouraged to improve one's general health, repetition or incorrect execution of movements is the prevailing cause of OA in both young and older adults ( 56 , 64 , 107 ). From a comprehensive review of recent studies, common occupational activities such as sitting (hip and knee OA), lifting (knee OA), driving (knee OA), and squat (lower limb OA) have been associated with increased risk of OA ( 108 , 109 ). These activities, if repeated, could be detrimental to the joint, as a study calculated the risk of developing localized OA to be twice as likely in individuals with occupations demanding repetitive physical activities compared to the average population ( 110 ).…”
Section: Applications Of Msc Therapies In Oamentioning
Mesenchymal stem cell (MSC) therapies have been used as cell-based treatments for decades, owing to their anti-inflammatory, immunomodulatory, and regenerative properties. With high expectations, many ongoing clinical trials are investigating the safety and efficacy of MSC therapies to treat arthritic diseases. Studies on osteoarthritis (OA) have shown positive clinical outcomes, with improved joint function, pain level, and quality of life. In addition, few clinical MSC trials conducted on rheumatoid arthritis (RA) patients have also displayed some optimistic outlook. The largely positive outcomes in clinical trials without severe side effects establish MSCs as promising tools for arthritis treatment. However, further research is required to investigate its applicability in clinical settings. This review discusses the most recent advances in clinical studies on MSC therapies for OA and RA.
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