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The effect of lifting during work on low back pain: a health impact assessment based on a meta-analysis
  1. Pieter Coenen1,
  2. Vincent Gouttebarge2,
  3. Aafje S A M van der Burght3,
  4. Jaap H van Dieën1,
  5. Monique H W Frings-Dresen2,
  6. Allard J van der Beek4,
  7. Alex Burdorf5
  1. 1Faculty of Human Movement Sciences, MOVE Research Institute Amsterdam, VU University, Amsterdam, The Netherlands
  2. 2Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  3. 3Health Council of the Netherlands, The Hague, The Netherlands
  4. 4Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
  5. 5Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
  1. Correspondence to Professor Alex Burdorf, Department of Public Health, Erasmus MC, Rotterdam 2040 CA, The Netherlands; a.burdorf{at}


Lifting at work is considered an important risk factor for low back pain (LBP). However, contradictory findings have been reported, partly because frequency, duration and intensity (ie, the weight of the load) of lifting have not been systematically considered. This has hampered developments of threshold values for lifting. The aims of this study were: to assess the effect of lifting during work (quantified in duration, frequency or intensity) on the incidence of LBP and to quantify the impact of these relationships on the occurrence of LBP in occupational populations exposed to lifting. We searched in PubMed and for longitudinal studies assessing the effect of occupational lifting on LBP incidence. For each study, the exposure–response slope of the association was estimated by loglinear regression analysis. When possible, a meta-analysis on these slopes was conducted. In a health impact assessment, the effects of the pooled exposure–response relationships on LBP incidence was assessed. Eight longitudinal studies were included. Pooled estimates resulted in ORs of 1.11 (1.05 to 1.18) per 10 kg lifted and 1.09 (1.03 to 1.15) per 10 lifts/day. Duration of lifting could not be pooled. Using these ORs, we estimated that lifting loads over 25 kg and lifting at a frequency of over 25 lifts/day will increase the annual incidence of LBP by 4.32% and 3.50%, respectively, compared to the incidence of not being exposed to lifting. Intensity and frequency of lifting significantly predict the occurrence of LBP. Exposure–response relationships show that lifting heavy loads may have a substantial impact on musculoskeletal health of the working population. This information may direct the development of occupational lifting guidelines and workplace design for LBP prevention.

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