Ulrike Ott

Prevalence of low back pain by anatomic location and intensity in an occupational population

BackgroundLow Back Pain (LBP) is a common and costly problem, with variation in prevalence. Epidemiological reports of rating of pain intensity and location within the low back area are rare. The objective is to describe LBP in a large, multi-center, occupational cohort detailing both point and 1-month period prevalence of LBP by location and intensity measures at baseline.MethodsIn this cross-sectional report from a prospective cohort study, 828 participants were workers enrolled from 30 facilities performing a variety of manual material handling tasks. All participants underwent a structured interview detailing pain rating and location. Symptoms in the lower extremities, demographic and other data were collected. Body mass indices were measured. Outcomes are pain rating (0–10) in five defined lumbar back areas (i) LBP in the past month and (ii) LBP on the day of enrollment. Pain ratings were reported on a 0–10 scale and subsequently collapsed with ratings of 1–3, 4–6 and 7–10 classified as low, medium and high respectively.Results172 (20.8%) and 364 (44.0%) of the 828 participants reported pain on the day of enrollment or within the past month, respectively. The most common area of LBP was in the immediate paraspinal area with 130 (75.6%) participants with point prevalence LBP and 278 (77.4%) with 1-month period prevalence reported having LBP in the immediate paraspinal area. Among those 364 reporting 1-month period prevalence pain, ratings varied widely with 116 (31.9%) reporting ratings classified as low, 170 (46.7%) medium and 78 (21.4%) providing high pain ratings in any location. Among the 278 reporting 1-month period prevalence pain in the immediate paraspinal area, 89 (32.0%) reported ratings classified as low, 129 (46.4%), medium and 60 (21.6%) high pain ratings.ConclusionsPain ratings varied widely, however less variability was seen in pain location, with immediate paraspinal region being the most common. Variations may suggest different etiological factors related to LBP. Aggregation of different locations of pain or different intensities of pain into one binary classification of LBP may result in loss of information which may potentially be useful in prevention or treatment of LBP.

Long haul truck drivers’ views on the barriers and facilitators to healthy eating and physical activity: A qualitative study

Purpose – The purpose of this paper is to explore truck drivers’ views toward diet, physical activity, and health care access to inform the development of a weight loss intervention. Design/methodology/approach – The authors conducted four focus groups via teleconference (one) or in person (three). Each focus group included eight to ten truck drivers. Sessions were digitally recorded and transcribed. The authors used thematic analysis of the participant responses to develop themes and subthemes. Findings – Truck drivers desired good health, however, many knowledge gaps were identified. Drivers were aware of some healthy foods, but lacked knowledge of appropriate energy intake and healthy weight. Drivers expressed many barriers to eating healthy food and engaging in physical activity on the road. Participants suggested strategies and resources to improve their diet and increase physical activity. Research limitations/implications – This qualitative study included a convenience sample of 30 long-haul truck ...

Factors Associated With Truck Crashes in a Large Cross Section of Commercial Motor Vehicle Drivers.

Objective: This large, cross-sectional study calculated prevalence of disorders and assessed factors associated with self-reported lifetime crashes. Methods: Truck drivers (n = 797) completed computerized questionnaires reporting crashes, demographics, psychosocial factors, and other elements, as well as had taken measurements (eg, height, weight, serum, and blood pressure). Results: Most drivers were male (n = 685, 85.9%), and the mean body mass index was 32.9 ± 7.5 kg/m2 with 493 (61.9%) being obese. Many drivers (n = 326, 39.9%) experienced at least one, with 132 (16.6%) having multiple, lifetime, reportable crashes. Many factors were associated with crashes, including increasing age, increasing truck driving experience, male sex, alcohol, low back pain, heart disease, and feeling tense. The most consistent associations with crashes were pulse pressure, cell phone use, and feeling physically exhausted after work. Conclusions: Modifiable factors associated with self-reported crashes were identified. These suggest targeted interventions may reduce risks of crashes.

ACOEM practice guidelines: elbow disorders.

Objective: The American College of Occupational and Environmental Medicine has updated the treatment guidelines in its Elbow Disorders chapter through revision processes begun in 2006. This abbreviated version of that chapter highlights some of the evidence and recommendations developed. Methods: Comprehensive systematic literature reviews were accomplished with article abstraction, critiquing, grading, evidence table compilation, and guideline finalization by a multidisciplinary expert panel and extensive peer-review to develop evidence-based guidance. Consensus recommendations were formulated when evidence was lacking and often relied on analogy to other disorders for which evidence exists. A total of 108 high- or moderate-quality trials were identified for elbow disorders. Results: Guidance has been developed for 13 major diagnoses and includes 270 specific recommendations. Conclusion: Quality evidence is now available to guide treatment for elbow disorders, particularly for lateral epicondylalgia.

A Clinical Trial on Weight Loss among Truck Drivers

Background: The high prevalence of obesity among commercial truck drivers may be related to sedentary nature of the job, lack of healthy eating choices, and lack of exercise. There may be a link between obesity and crash risk, therefore an intervention to reduce obesity in this population is needed. Objective: To assess feasibility of a 12-week weight loss intervention for truck drivers with a weight loss goal of 10% of initial body weight. Methods: Drivers were selected based on age (≥21 years) and body mass index (≥30 kg/m2). The drivers participated in a before-after clinical trial. The intervention included a 12-week program that provided information on healthy diet and increasing exercise, and telephone-based coaching using SMART goals. Outcomes included change from baseline in reported energy intake, measured weight, waist, hip, and neck circumference, blood pressure, and point of care capillary blood lipids and hemoglobin A1c. Exit interviews were conducted to gain insight into driver opinions on the program features and usefulness. This study was registered with the NIH Clinical Trials Registry, number NCT02348983. Results: 12 of 13 drivers completed the study. Weight loss was statistically significant (p=0.03). Reported energy (p=0.005), total fat consumption (p=0.04), and saturated fat consumption (p=0.02) intake were also lower after the 12-week intervention. Drivers attributed their weight loss to health coaching and suggested a longer intervention so that they could reach their goal and become accustomed to the changes. Conclusion: This weight loss intervention is feasible for this difficult population. Additional research is needed to compare this intervention with a control group.

The association between cardiovascular disease risk factors and motor vehicle crashes among professional truck drivers

Objective: This study assesses relationships between the Framingham cardiovascular disease risk (CVD risk) score and prevalence of US Department of Transportation (DOT)-reportable crashes in commercial motor vehicle (CMV) drivers, after controlling for potential confounders. Methods: Data were analyzed from CMV drivers (N = 797) in a large cross-sectional study. CVD risk was calculated for each driver. Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) between CVD risk and DOT-reportable crashes were calculated. Results: Drivers in the two highest CVD risk groups had significantly higher likelihood of crash (OR = 2.08, 95% CI = 1.20 to 3.63 and OR = 1.99, 95% CI = 1.05 to 3.77, respectively) after adjusting for confounders. There was a significant trend of increasing prevalence of crashes with an increasing CVD risk score (P = 0.0298). Conclusion: Drivers with a high CVD risk had a higher likelihood of a crash after controlling for confounders.

Two industrial cohorts: Baseline characteristics and factors associated with obesity

Objective: To describe demographic and health characteristics, and factors associated with obesity among production workers. Methods: This cross-sectional study analyzed baseline data from two occupational cohorts. Regression modeling was used to assess associations between worker characteristics and obesity. Results: A total of 1974 subjects were included in these analyses. The mean body mass index was 29.5 kg/m2 (SD = 6.5). Having smoked in the past and currently smoking decreased the odds of being obese in the WISTAH Distal Upper Extremity cohort, whereas those feeling depressed had increased odds of being obese. Being a Pacific Islander/Native Hawaiian and married increased the odds of obesity in the BackWorks Low Back Pain cohort. Conclusions: Factors associated with obesity differed substantially between the two cohorts. Recognizing factors associated with obesity in specific work settings may provide opportunities for optimizing preventive workplace interventions.

Stages of weight change among an occupational cohort

Objective: To assess the readiness to change dietary intake and body weight among production workers. We also ascertained differences between self-perceived and measured body mass index. Methods: This cross-sectional study queried physical activity, psychosocial factors, fruit and vegetable intake, and readiness to change based on the transtheoretical model. Results: Sixty-three (28%) workers were overweight, and 114 (50%) were obese. Obese workers were in the following stages of weight change: precontemplation (4%), contemplation (45%), preparation (13%), action (21%), and (17%) maintenance. Ten percent of overweight workers erroneously reported their body mass index to be normal. Conclusions: About half of overweight/obese workers were in the precontemplation or contemplation stages for healthy dietary changes or weight loss. Recognizing the stages of change with regard to weight and the self-perception of weight status may help tailor workplace health promotion programs.

Opioids and safety-sensitive work.

E xtrapolation of data has been used for decades to perform quantitative occupational and environmental risk assessments. Extrapolation has been used to develop nearly every one of the hundreds of occupational chemical, physical, and biological exposure standards in the United States and the rest of the world. Such standards have reduced burdens of occupational injuries, illnesses, and diseases. Industrial hygienists, epidemiologists, and toxicologists have developed criteria for these processes including extrapolation such as “(1) a stable positive association with an adverse health outcome; (2) high overall study quality; (3) no substantial confounding; (4) quantitative exposure assessment for individuals; and (5) evidence of a dose– response relationship” to serve as a basis for extrapolation.1 The US Environmental Protection Agency also regularly extrapolates data.2 It is worth noting that, in contrast with the recent American College of Occupational and Environmental Medicine opioid practice guideline,3 most occupational and environmental risk analyses have relied primarily on animal models. Thus, the extrapolation used in the American College of Occupational and Environmental Medicine guideline on safety sensitive work should be substantially less controversial because it uses human population studies rather than animal studies on the effects of opioids. Dr Swotinsky has suggested that one should only use direct studies of each occupation or task to provide guidance for safe work. His position is that guidance developed from extrapolating 12 large, consistent epidemiological studies of driving activities to nondriving activities that also are safetysensitive jobs is insufficient; the recommendation not to drive under the influence of opioids should only apply to driving. What he did not state is that the available studies are largely of private drivers. One could therefore take the additional position that

Association between wrist ratio and carpal tunnel syndrome: Effect modification by body mass index

Previous studies have reported higher wrist ratios (WR) related to carpal tunnel syndrome (CTS) but have not assessed effect modification by obesity and may have inadequately controlled for confounders.