This population-based cohort study investigated the association between a lifetime history of a work-related low back injury, in those who had recovered to have no or mild low back pain, and the development of troublesome low back pain (LBP). A secondary analysis explored the possible effects of misclassification of the exposure by examining the association between a lifetime history of having taken time off work or performed light duties at work because of a work-related low back injury. Current evidence from cross-sectional studies suggests that individuals with a history of a work-related low back injury are more likely to experience future LBP. However, there is a need to examine this association prospectively in a large population-based cohort with adequate control of known confounders.
We formed a cohort of 810 randomly sampled Saskatchewan adults with no or mild LBP in September 1995. At baseline, participants were asked if they had ever injured their low back at work. The secondary analysis asked if they had ever had to take time off work or perform light duties at work because of a work-related low back injury. Prospective follow-up 6 and 12 months later, asked about the presence of troublesome LBP (grade II–IV) on the Chronic Pain Grade Questionnaire. Multivariable Cox proportional hazards regression analysis was used to estimate these associations while controlling for known confounders.
The proportion followed up at 6 and 12 months was 76 and 65 %, respectively. We found an association between a history of work-related low back injury and the onset of troublesome LBP after controlling for gender (adjusted HRR = 2.24; 95 % CI 1.41–3.56). When covariates that may also be mediators of the association were added to the model, the effect estimate was attenuated (adjusted HRR = 1.37; 95 % CI 1.41–3.56). We found a similar association between a lifetime history of having taken time off work or had to work light duties at work because of a work-related low back injury, adjusted for gender (adjusted HRR = 2.31; 95 % CI 1.39–3.85) which was also diluted by the further adjustment for covariates that may also be mediators of the association (adjusted HRR = 1.80; 95 % CI 1.08–3.01).
Our study suggests that a history of work-related low back injury or taking time off work or having to perform light duties at work due to a work-related low back injury may be a risk factor for the development of troublesome LBP. Residual confounding may account for some of the observed associations, but this was less in the group who took time off work or had to work light duties due to a work-related low back injury.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M et al (2012) Years lived with disability (YLD’s) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380:2163–2196
Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD et al (2012) Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regoins, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380:2197–2223
Hoy D, March L, Brooks P, Woolf A, Blyth F et al (2010) Measuring the global burden of low back pain. Best Pract Res Clin Rheumatol 24:155–165
Hoy D, Bain C, Williams G, March L, Brooks P et al (2012) A systematic review of the global prevalence of low back pain. Arthritis Rheum 64(6):2028–2037
Cassidy JD, Côté P, Carroll LJ, Kristman V (2005) Incidence and course of low back pain episodes in the general population. Spine 30(24):2817–2823
Hayden JA, Dunn KM, van der Windt DA, Shaw WS (2010) What is the prognosis of back pain? Best Practice & Research Clinical Rheumatology 24:167–179
Itz CJ, Geurts JW, van Kleef M, Nelemans P (2012) Clinical course of non-specific low back pain: a systematic review of prospective cohort studies set in primary care. Eur J Pain 17(1):5–15
Nolet PS, Kristman VL, Côté P, Carroll LJ, Cassidy JD (2015) Is low back pain associated with worse health—related quality of life six month later? Eur Spine J 24:458–466
Hoy D, Brooks P, Blyth F, Buchbinder R (2010) The epidemiology of low back pain. Best Pract Res Clin Rheumatol 24:769–781
Taylor JB, Goode AP, George SZ, Cook CE (2014) Incidence and risk factors for first-time incident low back pain: a systematic review and meta-analysis. Spine J 14(10):2299–2319
Hincapié CA, Cassidy JD, Côté P (2008) Is a history of work-related low back injury associated with prevalent low back pain and depression in the general population? BMC Musculoskeletal Disord 9:22
Hurwitz EL, Morgenstern H (1997) Correlates of back problems and back-related disability in the United States. J Clin Epidemiol 50(6):669–681
Tomita S, Arphorn S, Muto T, Koetkhlai K, Naing SS et al (2010) Prevalence and risk factors of low back pain among Thai and Myanmar migrant seafood processing factory workers in Samut Sakorn province. Thailand. Ind Health 48:283–291
Nolet PS, Côté P, Cassidy JD, Carroll LJ (2011) The association between a lifetime history of a work-related neck injury and future neck pain: a population based cohort study. J Manipulative Physiol Ther 34(6):348–355
Carroll LJ, Cassidy JD, Côté P (2000) The Saskatchewan Health and Back Pain Survey: the prevalence and factors associated with depressive symptomatology in Saskatchewan adults. Can J Public Health 91:459–464
von Korff M, Ormel J, Keefe FJ, Dworkin SF (1992) Grading the severity of chronic pain. Pain 50:133–149
Elliott AM, Smith BH, Smith WC, Chambers WA (2000) Changes in chronic pain severity over time: the Chronic Pain Grade as a valid measure. Pain 88:303–308
Ware JE Jr, Snow KK, Kosinski M et al (1993) SF-36 Health Survey: Manual and Interpretation Guide. The Health Institute, New England Medical Center, Boston
Brazier JE, Harper R, Jones NM, O’Cathain A, Thomas KJ, Usherwood T, Westlake L (1992) Validating the SF-36 health survey questionnaire: new outcome measure for primary care. Br Med J 305(6846):160–164
Beaton DC, Hogg-Johnson S, Bombardier C (1997) Evaluating changes in health status: reliability and responsiveness of five generic health status measures in workers with musculoskeletal disorders. J Clin Epidemiol 50(1):79–93
Ware JE, Gandek B (1998) Overview of the SF-36 health survey and the International Quality of Life Assessment (IQOLA) Project. J Clin Epidemiol 51(11):903–912
Ware JE (2000) SF-36 health survey update. Spine 25(24):3130–3139
Nolet PS, Côté P, Cassidy JD, Carroll LJ (2010) The association between a lifetime history of a neck injury in a motor vehicle collision and future neck pain: a population-based cohort study. Eur Spine J 19(6):972–981
Vermeulen S (2006). Assessing the performance of a self-report comorbidity scale. MSc Thesis, Unpublished manuscript, University of Alberta
Radloff LS (1997) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401
Beekman AT, Deeg DJ, Van Limbeek J, Braam AW, De Vries MZ, Tilburg W (1997) Criterion Validity of the Center for Epidemiologic Studies Depression Scale (CES-D): results from a community-based sample of older participants in the Netherlands. Psychol Med 27(1):231–235
Boyd JH, Weissman MM, Thompson WD, Myers JK (1982) Screening for depression in a community sample. Arch Gen Psychiatry 39(10):1195–2000
Devins GM, Orme CM, Costello CG, Minik YM, Frizzell B, Stam HJ, Pullin WM (1988) Measuring depressive symptoms in illness populations: psychiatric properties of the Center for Epidemiological Studies Depression (CES-D) Scale. Psychol Health 2:139–156
Rothman KJ (2002) Epidemiology: an introduction. Oxford University Press, New York
IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp
Cassidy JD, Carroll LJ, Côté P (1998) The Saskatchewan Health and Back Pain Survey, the prevalence of low back pain and related disability in Saskatchewan Adults. Spine 21(17):1860–1867
Schisterman EF, Cole SR, Platt RW (2009) Overadjustment bias and unnecessary adjustment in epidemiologic studies. Epidemiology 20:488–495
The authors would like to acknowledge the Chiropractors’ Association of Saskatchewan for funding the Saskatchewan Health and Back Pain Survey and the assistance of Saskatchewan Health in sampling the Saskatchewan population.
Conflict of interest
About this article
Cite this article
Nolet, P.S., Kristman, V.L., Côté, P. et al. The association between a lifetime history of work-related low back injury and future low back pain: a population-based cohort study. Eur Spine J 25, 1242–1250 (2016). https://doi.org/10.1007/s00586-015-4151-3
- Low back pain
- Occupational injuries
- Risk factors
- Cohort studies