The relationship between psychosocial work characteristics and low back pain: underlying methodological issues

Objective. To evaluate the current epidemiological evidence linking psychos ocial work characteristics with low back pain. Background. Psychosocial work characteristics have been widely evaluated as potential risk factors for low back injury. However, studies with differen t study populations and using various types of measures have had conflictin g results. Methods. This review is the most extensive to date, reviewing 66 articles t hat have provided empirical evidence about the relationship between psychos ocial work characteristics and initial reporting of lower back pain. The st udies are reviewed with an emphasis on certain methodological issues: contr olling for potential confounding; timing of the data collection; and measur ement of the exposures and outcomes. Results. The results of this review suggest that controlling for potential confounding from occupational biomechanical demands had a large influence o n the associations found between psychosocial work characteristics and lowe r back pain. In addition, the use of accurate and reliable measures for the occupational exposures (biomechanical and psychosocial) and the lower back pain outcomes appears to influence the strength of the associations found between psychosocial work characteristics and lower back pain. Conclusion, Given the methodological concerns discussed in this review, it is difficult to draw strong causal inferences from this literature. However , it does appear that psychosocial characteristics are related to some lowe r back pain outcomes, and that employees' reactions to psychosocial work ch aracteristics (e.g., job dissatisfaction and job stress) are more consisten tly related to lower back pain than are the psychosocial work characteristi cs themselves (e.g., work overload, lack of influence over work, quality of relationships with coworkers). Relevance This review attempts to identify and address methodological issues in the l iterature evaluating the relationship between psychosocial work characteris tics and lower back pain. Implications for future research are presented. ( C) 2000 Elsevier Science Ltd. All rights reserved.