The Boeing prospective study and beyond

Study Design. The Boeing prospective study was reviewed. The Boeing prospec tive study, comprising two articles, was a large field study that explored why workers would or would not report occupational back pain problems. Objectives. The most immediate objective was to determine the extent to whi ch conclusions drawn from the Boeing prospective study withstand critical e xamination. The ultimate purpose of this review was to develop guidelines f or field studies of back pain in industry. Summary of Background Data. For more than a century, researchers have noted great variability among individuals in the reporting of back pain, but the explanations posed for this variability have been inconsistent. Because fi ndings gain credibility roughly to the extent that they bear on the world o utside the laboratory, field studies in particular hold great potential for clarifying the underlying explanation for individual variability in back p ain reporting. The Boeing prospective study was a large and ambitious field study that examined this issue. Methods. The Boeing prospective study was examined through the lens of rese arch conducted since it was published. The review used both the methodologi cal and substantive literature. Results. The Boeing prospective study, based on a minority of workers origi nally solicited to participate in it (33-41%), accounted for 7% of the vari ation in why workers would or would not report a back pain problem. A numbe r of issues that may have biased its results toward the null are examined. Conclusions. The highlighting of the Boeing prospective study's limitations may be instructive not so much to criticize this one particular study but, rather, to anticipate problems that in general may be encountered in field studies of back pain in industry. Looking beyond the Boeing prospective st udy, the following guidelines for the conduct of such studies may be propos ed: 1) Study designs should be based on explanations from which testable hy potheses may be derived; 2) Subgroups within the more general category of " back pain" should be delineated; 3) Both occupational exposures and psychos ocial factors should be entered into the analysis; 4) Factors not apparent at the workplace should be considered; 5. Abstracts of articles should be c arefully crafted.