Safety and Health at Work

Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency (산업안전보건연구원)
권호 표지
DOI QR코드

DOI QR Code

Importance of an Integrated Assessment of Functional Disability and Work Ability in Workers Affected by Low Back Pain

  • Fabrizio Russo (Research Unit of Orthopaedic and Trauma Surgery, Campus Bio-Medico University Hospital Foundation) ;
  • Cristina Di Tecco (Italian Workers' Compensation Authority (INAIL), Department of Occupational and Environmental Medicine, Epidemiology and Hygiene) ;
  • Simone Russo (Italian Workers' Compensation Authority (INAIL), Department of Occupational and Environmental Medicine, Epidemiology and Hygiene) ;
  • Giorgia Petrucci (Research Unit of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome) ;
  • Gianluca Vadala (Research Unit of Orthopaedic and Trauma Surgery, Campus Bio-Medico University Hospital Foundation) ;
  • Vincenzo Denaro (Research Unit of Orthopaedic and Trauma Surgery, Campus Bio-Medico University Hospital Foundation) ;
  • Sergio Iavicoli (Ministry of Health, Directorate for Communication and International Affairs)
  • Received : 2023.02.16
  • Accepted : 2023.11.05
  • Published : 2024.03.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background: This study examines the relationship between functional disability and work ability in workers affected by low back pain (LBP) through an analysis of correlations between the Oswestry Disability Index (ODI) and Work Ability Index (WAI). The role of personal and work factors on functional disability/work ability levels has also been studied. LBP is the most common musculoskeletal problem and a major disabling health problem worldwide. Its etiology is multifactorial. Multidisciplinary approaches may help reduce the burden of pain and disability and improve job continuity and reintegration at work. Methods: A cohort of 264 patients affected by LBP from an Italian outpatient clinic were included in a clinical diagnostic/therapeutic trial aiming at rehabilitation and return to work through an integrated investigation protocol. Data were collected during the first medical examination using anamnestic and clinical tools. The final sample is composed of 252 patients, 57.1% man, 44.0 % blue collars, 46.4% with the high school degree, 45.6% married. Results: WAI and ODI reported a negative and fair correlation (r = -0.454; p = .000). Workers with acute LBP symptoms have a higher probability of severe disability than those with chronic LBP symptoms. White collars without depressive symptoms reported higher work ability - even in chronic disability conditions-than those with depressive symptoms. Conclusion: The study found that ODI and WAI have a convergent validity and this suggests that the two tools measure capture distinctive aspects of disability related to personal, environmental, and occupational characteristics. The most important and modifiable prognostic factors found for ODI and WAI were depressive symptoms, workday absence, and intensity of back pain. The study also found a mild association between age and ODI. The study's findings highlight the importance of using a multidisciplinary approach to manage and prevent disability due to LBP.

Keywords

Acknowledgement

This research was funded by the Research Grants (BRIC-2018 ID3 and BRIC-2021 ID4) of the Italian Workers' Compensation Authority (INAIL).

References

  1. Vadala G, Russo F, Ambrosio L, Papalia R, Denaro V. Mesenchymal stem cells for intervertebral disc regeneration. J Biol Regul Homeost Agents 2016;30(4 Suppl 1):173-9. 
  2. Wu A, March L, Zheng X, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Transl Med 2017;8(6):299. https://doi.org/10.21037/atm.2020.02.175. 
  3. Russo F, Di Tecco C, Fontana L, et al. Prevalence of work related musculoskeletal disorders in Italian workers: is there an underestimation of the related occupational risk factors? BMC Musculoskelet Disord 2020;21(1):738. https://doi.org/10.1186/s12891-020-03742-z. 
  4. Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380(9859):2197-223. https://doi.org/10.1016/S0140-6736(12)61689-4. 
  5. Kongsted A, Kent P, Axen I, Downie AS, Dunn KM. What have we learned from ten years of trajectory research in low back pain? BMC Musculoskelet Disord 2016;17:220. https://doi.org/10.1186/s12891-016-1071-2. 
  6. Russo F, Ambrosio L, Ngo K, et al. The role of type I diabetes in intervertebral disc degeneration. Spine 2019;44(17):1177-85. https://doi.org/10.1097/BRS.0000000000003054. 
  7. Russo F, De Salvatore S, Ambrosio L, et al. Does workers' compensation status affect outcomes after lumbar spine surgery? A systematic review and metaanalysis. Int J Environ Res Public Health 2018;18(11). https://doi.org/10.3390/ijerph18116165. 
  8. Gianola S, Andreano A, Castellini G, Moja L, Valsecchi MG. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: the need to present minimal important differences units in meta-analyses. Health Qual Life Outcome. 2018;16(1):91. https://doi.org/10.1186/s12955-018-0924. 
  9. Wong AYL, Karppinen J, Samartzis D. Low back pain in older adults: risk factors, management options and future directions. Scoliosis Spinal Disord 2017;12:14. https://doi.org/10.1186/s13013-017-0121-3. 
  10. Vadala G, Russo F, De Salvatore S, et al. Physical activity for the treatment of chronic low back pain in elderly patients: a systematic review. J Clin Med 2020;9(4). https://doi.org/10.3390/jcm9041023. 
  11. Vadala G, Russo F, Ambrosio L, Di Martino A, Papalia R, Denaro V. Biotechnologies and biomaterials in spine surgery. J Biol Regul Homeost Agents 2015;29(4 Suppl. l):137-47. PMID: 26652500. 
  12. C Menezes Costa L, Maher CG, Hancock MJ, McAuley JH, Herbert RD, Costa LO. The prognosis of acute and persistent low-back pain: a meta-analysis. CMAJ 2012 Aug 7;184(11):E613-24. https://doi.org/10.1503/cmaj.111271. 
  13. Fukuura Y, Shigematsu Y. The work ability of people with mental illnesses: a conceptual analysis. Int J Environ Res Public Health 2021 Sep 28;18(19):10172. https://doi.org/10.3390/ijerph181910172. PMID: 34639474; PMCID: PMC8508570. 
  14. Petrucci G, Papalia GF, Russo F, et al. Psychological approaches for the integrative care of chronic low back pain: a systematic review and metanalysis. Int J Environ Res Public Health 2021;19(1). https://doi.org/10.3390/ijerph19010060. 
  15. Russo F, Papalia GF, Vadala G, et al. The effects of workplace interventions on low back pain in workers: a systematic review and meta-analysis. Int J Environ Res Public Health 2021;18(23). https://doi.org/10.3390/ijerph182312614. 
  16. Leveille SG, Zhang Y, McMullen W, Kelly-Hayes M, Felson DT. Sex differences in musculoskeletal pain in older adults. Pain 2005;116(3):332-8. https://doi.org/10.1016/j.pain.2005.05.002. 
  17. Maughan EF, Lewis JS. Outcome measures in chronic low back pain. Eur Spine J 2010;19(9):1484-94. https://doi.org/10.1007/s00586-010-1353-6. 
  18. Ilmarinen J. Work ability-a comprehensive concept for occupational health research and prevention. Scand J Work Environ Health 2009;35(1):1-5. https://doi.org/10.5271/sjweh.1304. 
  19. Ilmarinen J. From work ability research to implementation. Int J Environ Res Public Health 2019;16(16). https://doi.org/10.3390/ijerph16162882. 
  20. Morschhauser MSR. Healthy work in an ageing Europe. Strategies and instruments for prolonging working life. European network for workplace health promotion. Essen (Germany): Federal Association of Company Health Insurance Funds (BKK Bundesverband) ENWHP-Secretariat; 2006. 72 p. 
  21. Cuomo A, Cascella M, Vittori A, et al. Chronic low back pain as a biopsychosocial disease: time to change our point of view. J Anesth Analg Crit Care 2021;1:7. https://doi.org/10.1186/s44158-021-00010-x. 
  22. Li C, Friedman B, Conwell Y, Fiscella K. Validity of the Patient Health Questionnaire 2 (PHQ-2) in identifying major depression in older people. J Am Geriatr Soc 2007;55(4):596-602. https://doi.org/10.1111/j.1532-5415.2007.01103.x. 
  23. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary care evaluation of mental disorders. Patient health questionnaire. JAMA 1999;282(18):1737-44. https://doi.org/10.1001/jama.282.18.1737. 
  24. Fairbank JC, Couper J, Davies JB, O'Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy 1980;66(8):271-3.  https://doi.org/10.1037/t04205-000
  25. Tonosu J, Takeshita K, Hara N, et al. The normative score and the cut-off value of the Oswestry Disability Index (ODI). Eur Spine J 2012;21(8):1596-602. https://doi.org/10.1007/s00586-012-2173-7. 
  26. Akoglu H. User's guide to correlation coefficients. Turk J Emerg Med 2018;18(3):91-3. https://doi.org/10.1016/j.tjem.2018.08.001. 
  27. Carlson KD, Herdman AO. Understanding the impact of convergent validity on research results. Organizational Res Methods 2012;15(1):17-32. https://doi.org/10.1177/1094428110392383. 
  28. Roland M, Fairbank J. The Roland-Morris disability questionnaire and the Oswestry disability questionnaire. Spine 2000;25(24):3115-24. https://doi.org/10.1097/00007632-200012150-00006. 
  29. da CMCL, Maher CG, Hancock MJ, McAuley JH, Herbert RD, Costa LO. The prognosis of acute and persistent low-back pain: a meta-analysis. CMAJ 2012;184(11):E613-24. https://doi.org/10.1503/cmaj.111271. 
  30. Doualla M, Aminde J, Aminde LN, et al. Factors influencing disability in patients with chronic low back pain attending a tertiary hospital in sub-Saharan Africa. BMC Musculoskelet Disord 2019;20(1):25. https://doi.org/10.1186/s12891-019-2403-9. 
  31. Di Iorio A, Abate M, Guralnik JM, et al. From chronic low back pain to disability, a multifactorial mediated pathway: the InCHIANTI study. Spine 2007;32(26):E809-15. https://doi.org/10.1097/BRS.0b013e31815cd422. 
  32. Disease GBD. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Injury I, Prevalence C. Lancet 2018;392(10159):1789-858. https://doi.org/10.1016/S0140-6736(18)32279-7. 
  33. Nygaard PP, Skovlund SV, Sundstrup E, Andersen LL. Is low-back pain a limiting factor for senior workers with high physical work demands? A cross-sectional study. BMC Musculoskelet Disord 2020;21(1):622. https://doi.org/10.1186/s12891-020-03643-1. 
  34. Rashid M, Kristofferzon ML, Heiden M, Nilsson A. Factors related to work ability and well-being among women on sick leave due to long-term pain in the neck/shoulders and/or back: a cross-sectional study. BMC Public Health 2018;18(1):672. https://doi.org/10.1186/s12889-018-5580-9. 
  35. Menzel NN. Psychosocial factors in musculoskeletal disorders. Crit Care Nurs Clin North Am 2007;19(2):145-53. https://doi.org/10.1016/j.ccell.2007.02.006. 
  36. Ng YM, Voo P, Maakip I. Psychosocial factors, depression, and musculoskeletal disorders among teachers. BMC Public Health 2019;19(1):234. https://doi.org/10.1186/s12889-019-6553-3. 
  37. Uronen L, Heimonen J, Puukka P, Martimo KP, Hartiala J, Salantera S. Health check documentation of psychosocial factors using the WAI. Occup Med (Lond) 2017;67(2):151-4. https://doi.org/10.1093/occmed/kqw117. 
  38. van den Berg TI, Alavinia SM, Bredt FJ, Lindeboom D, Elders LA, Burdorf A. The influence of psychosocial factors at work and life style on health and work ability among professional workers. Int Arch Occup Environ Health 2008;81(8):1029-36. https://doi.org/10.1007/s00420-007-0296-7. 
  39. Koolhaas W, van der Klink JJ, de Boer MR, Groothoff JW, Brouwer S. Chronic health conditions and work ability in the ageing workforce: the impact of work conditions, psychosocial factors and perceived health. Int Arch Occup Environ Health 2014;87(4):433-43. https://doi.org/10.1007/s00420-013-0882-9. 
  40. Mazloumi A, Rostamabadi A, Nasl Saraji G, Rahimi Foroushani A. Work ability index (WAI) and its association with psychosocial factors in one of the petrochemical industries in Iran. J Occup Health 2012;54(2):112-8. https://doi.org/10.1539/joh.11-0150-oa. 
  41. Davidson M, Keating JL. A comparison of five low back disability questionnaires: reliability and responsiveness. Phys Ther 2002;82(1):8-24. https://doi.org/10.1093/ptj/82.1.8.