853839

research-article2019
WHSXXX10.1177/2165079919853839Workplace Health & SafetyWorkplace Health & Safety

vol. XX  ■  no. X Workplace Health & Safety

Research Article

Occupational Characteristics of Low Back Pain

Among Standing Workers in a Japanese
Manufacturing Company
Gen Inoue, MD, PhD1 , Kentaro Uchida, PhD1, Masayuki Miyagi, MD, PhD1, Wataru Saito, MD, PhD1,
Toshiyuki Nakazawa, MD, PhD1, Takayuki Imura, MD1, Eiki Shirasawa, MD1, Tsutomu Akazawa, MD, PhD2 ,
Sumihisa Orita, MD, PhD3, Kazuhide Inage, MD, PhD3, Masashi Takaso, MD, PhD1, and Seiji Ohtori, MD, PhD2

Abstract: Low back pain (LBP) is a major public health
problem that adversely affects the quality of life (QOL) of
workers. The etiology of LBP is considered to be multi-
factorial with individual, physical, and psychosocial factors
contributing to its development and persistence. Although
prevention of LBP in workers in the workplace is very
important, only a small number of studies have assessed
the risk factors and epidemiology of LBP among Japanese
factory workers who stand as part of their job. This cross-
sectional study investigated the prevalence of LBP in
691 factory employees who conducted their work while
standing. Health-related QOL was evaluated using the
Roland-Morris Disability Questionnaire (RDQ) to quantify
the severity of LBP with the aim of identifying risk factors
for LBP among workers who stand as part of their work in
an electronics manufacturing company. We observed that
the prevalence of LBP lasting for at least 48 hours within a
week was 20.0% among participants, with female employees
and those with a prior history of LBP having a significantly
increased risk of developing LBP. The distribution of the
RDQ score showed a negative regression curve among the
employees, which was different from the normal distribution
pattern reported previously in Japanese patients with LBP.
These findings suggest that prolonged standing among
factory workers poses an increased risk for LBP.
Keywords: chronic illnesses, health promotion,
occupational hazards, research, generation, workforce
Introduction
Low back pain (LBP) is a serious public health issue. In
addition to negatively impacting the well-being and quality of
life (QOL) of workers, it also contributes markedly to the global
disease burden due, in part to the difficulty with diagnosing and
treating the condition (Dagenais, Caro, & Haldeman, 2008;
Kikuchi, 2017). In an estimate of the global disease burden
between 1990 and 2010, the World Health Organization found
that musculoskeletal disorder sufferers were deprived of a mean
6.8 disability-adjusted life years. Low back pain is also
associated with close to 50% of musculoskeletal disorders and
was the most frequent condition among 289 diseases within the
Asia Pacific region (Murray et al., 2012; Vos et al., 2012).
The development and persistence of LBP are thought to be
associated with multiple factors, including individual, physical,
and psychosocial factors. Studies to date have found that LBP
was associated with middle age (45 to 64 years), being female,
lower educational status, obesity, smoking, sleep deprivation,
extended periods of driving, and prolonged time of computer
use (Chen, Chang, Chang, & Christiani, 2005; Dionne et al.,
1995; Juul-Kristensen, Søgaard, Strøyer, & Jensen, 2004; Kopec,
Sayre, & Esdaile, 2004; Shiri et al., 2013; van de Water, Eadie, &
Hurley, 2011). Psychosocial factors including stress and
depressive symptoms may also increase the risk of LBP
(Andersson, 1999; Hoogendoorn, van Poppel, Bongers, Koes, &
Bouter, 2000). A systematic review of 18 prospective cohort
studies reported conflicting findings between LBP and
numerous factors including engaging in sports and exercise
during leisure time, full body vibration during work, heavy
physical work, and postures involving bending and/or twisting
of the trunk while working (Bakker, Verhagen, van Trijffel,
Lucas, & Koes, 2009). Several studies have reported prolonged
standing as a risk factor for LBP due to increased trunk or
gluteal muscle activity, and a higher load on the lumbar spine
(Andersen, Haahr, & Frost, 2007; Coenen, Parry, et al., 2017;
Coenen, Willenberg, et al., 2016; Fewster, Gallagher, Howarth, &
Callaghan, 2017; Gregory, Brown, & Callaghan, 2008; Gregory &
Callaghan, 2008; Macfarlane et al., 1997). In contrast, some

DOI: 10.1177/2165079919853839. From 1Kitasato University School of Medicine, 2St. Marianna University School of Medicine, and 3Chiba University. Address correspondence to: Gen Inoue, MD,
https://doi.org/

PhD, Department of Orthopaedic Surgery, Kitasato University, School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan; email: ginoue@kitasato-u.ac.jp.
For reprints and permissions queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav.
Copyright © 2019 The Author(s)

1
Workplace Health & Safety
Applying Research to Practice
We carried out this study to clarify whether prolonged
standing was associated with LBP in Japanese
employees in the workplace of an electronics
manufacturing company. 20.0% of employees reported
LBP lasting for 48 hours or more within the past week,
and being female and having a past history of LBP were
significant risk factors for LBP. To reduce the
occurrence of LBP, responsible person for employees’
health care should note that environmental maintenance
to prevent prolonged standing during their workplace is
important.
studies have demonstrated no significant associations between
prolonged standing and LBP (Harkness, Macfarlane, Nahit,
Silman, & McBeth, 2003; Yip, 2004). To date, no studies have
been carried out in workers at an electronics manufacturing
company in Japan, in which workers are consistently exposed
to prolonged standing. This cross-sectional study aimed to
examine the prevalence of LBP in employees at an electronics
manufacturing factory in Japan who conduct their work while
standing.
Materials and Methods
We carried out a cross-sectional survey of employees at an
electronics manufacturing factory (TDK Corporation) in Japan.
This private factory, one of biggest electrical companies in
Japan, manufactures and assembles electric parts such as
capacitors, sensors, batteries, and other components. Our study
was approved by our institution’s institutional review board for
observation and epidemiological studies at Chiba University.
Informed consent was obtained from all participants.
Study Participants
The TDK factory, in the Kanto region of Japan, and its
subsidiary companies conduct annual general health checkups,
which include standard internal medical counseling and
physical assessments. For the present study, all eligible
employees among the 2,025 employed at this TDK factory
completed a general checkup and survey on LBP within a few
days of their annual general checkup. According to the Japanese
Labor Standards Law, all employees work 8 hours per day and a
total of 40 hours per week, and have a 45- to 60-minute break
every day. We checked the employees’ schedule and recorded
their standing time during the workday. Employees who
satisfied the following criteria were included in the analysis: (a)
standing for more than 70% of their work day; and (b)
conducting at least one of the following work activities in the
standing position as part of their daily work including
continuous arm movements, lifting, some rotation of the trunk,
and/or heavy lifting. These tasks were ascertained through self-
report from the worker. Data on demographic variables such as
2
Mon 2019
age, sex, height, and body mass index (BMI) expressed as
kilograms (kg) per meters2 (m2) were collected during the
checkup. Data on the details of the individual’s work, and
whether it involved heavy lifting of >20 kilograms (kg) were
also collected. In addition, we collected data on other possible
risk factors for LBP, such as how often workers engaged in
regular exercise, current or former smoking status, past history
of continuous LBP for 1 week or more, and past history of
lumbar spine surgery. Regarding exercise, the participants were
asked to report whether they undertook a modest to
competitive amount of physical activity such as jogging, tennis,
swimming, gymnastics, and/or soccer for at least 30 minutes per
day (Björck-van et al., 2008). Positive smoking status included
smoking five cigarettes or more every day for 1 month or more
(Deyo & Bass, 1989).
LBP Measurement
Each employee was asked whether they had experienced
LBP lasting 48 hours or more within the week prior to their
general health checkup. LBP was defined as pain located in the
region between the costal margin and inferior gluteal folds
(Krismer & van Tulder, 2007). Only participants with LBP who
attended the annual screening and met our inclusion criteria
were asked to complete the Roland-Morris Disability
Questionnaire (RDQ). RDQ is an established scale used to
assess the severity of LBP and allows patients to answer
questions about the disability they experienced during usual
daily activities as a result of LBP. The questionnaire includes 24
items about disability that may occur during daily activities such
as standing, walking, sitting, lying, dressing, sleeping, and
working. Each item in the RDQ can be answered as either “Yes”
or “No.” The RDQ score is calculated as the total number of
positive responses, with the scores ranging between 0 and 24,
with a higher score indicating greater disability (Roland &
Morris, 1983). The Japanese version of the RDQ has been
validated in a study by Suzukamo et al. (2003) with Japanese
patients with LBP.
Data Analysis
Statistical analysis was performed using SPSS Software,
version 25 (IBM, Armonk, NY, USA). The unpaired t test was
used to analyze mean values between the two groups and the
χ2 test to examine proportions for categorical data. The
prevalence of LBP was assessed by gender, age (≤29, 30-39,
40-49, or ≥50 years), height (<165 cm or ≥165 cm), and BMI
(<18.5, 18.5-25, or ≥25 kg/m2) strata. The prevalence of LBP
was also compared in groups involved with or without heavy
lifting, past history of LBP, past history of lumbar spinal surgery,
and smoking status and exercise habits. Univariate analysis was
performed for each factor, and the odds ratio (OR) and 95%
confidence intervals (CI) were calculated, with factors with P
values <.15 used for inclusion of variables in the multivariate
logistic regression models. The distribution of the RDQ scores
and its regression curve were determined in the study cohort for
vol. XX  ■  no. X Workplace Health & Safety

comparison with the general population. In addition, the mean

Table 1.  Demographic Characteristics of Factory Employees RDQ scores were examined across demographic and
(n = 691) occupational study variables.

Variables   Results
Total 691 A total of 691 of 694 employees (570 males, 121 females)
met the criteria for standing 70% of the time at work. Table 1
Age (years) category, n (%) summarizes the employees’ baseline characteristics. The
  ≤29 120 (17.4) employees had a mean age of 40.1 years (range, 15–68 years);
most were in their 30s (n = 264, 38.2%), followed by those in
 30-39 264 (38.2) their 40s (n = 144, 20.8%), with their mean height and BMI
being 167.5 cm and 23.0 kg/m2, respectively. Heavy lifting >20
 40-49 144 (20.8)
kg was carried out by 45.2% of employees. In total, 24.9% (n =
  ≥50 163 (23.6) 172/691) of employees had previously experienced LBP lasting
for 1 week or more, and 0.9% (n = 6/691) of employees had a
Sex, n, (%) past history of lumbar spinal surgery. For smoking status, 61.9%
(n = 428/691) of employees have never smoked, 2.7% (n =
 Female 121 (17.5)
19/691) were former smokers, and 35.3% (n = 244/691) were
 Male 570 (82.5) currently smoking. Regarding exercise, 27.9% (n = 193/691)
exercised 1 to 4 days/week, and 1.9% (n = 13/691) exercised 5
Age (years; M ± SD) 40.1 ± 11.6 to 7 days/week. In total, 70.2% of employees (75.2% of females
and 69% of males) failed to exercise at least once a week.
Height (cm; M ± SD) 167.5 ± 8.0

BMI (kg/m2; M ± SD) 23.0 ± 3.3 Prevalence and Risk Factors for LBP
Heavy lifting during work, n (%) Of the 691 employees, 138 (20.0%) indicated that they had
experienced continuous LBP for 48 hours or more within the
 Yes 312 (45.2) week before their general health checkup. Table 2 shows the
comparison of demographic variables between employees
 No 379 (54.8)
with and without LBP. The prevalence of LBP was highest in
Past history of LBP, n (%) employees aged 50 years or older (28.2%), followed by those
aged 40 to 49 years (22.2%). The incidence increased gradually
 Yes 172 (24.9) in higher age stratum. Females had a higher incidence of LBP
 No 519 (75.1) than males, although this difference was not statistically
significant (25.6% vs. 18.8%, p = .06). Employees who
Past history of lumbar spinal surgery, n (%) performed heavy lifting (23.4% vs. 17.2%), or had a past
 Yes 6 (0.9) history of either LBP (47.7% vs. 10.8%) or lumbar spine
surgery (66.7% vs. 19.6%) had a significantly higher incidence
 No 685 (99.1) compared with employees without these experiences (p <
.05). There was no significant difference in the prevalence of
Smoking status, n (%)
LBP according to height or BMI stratum. The prevalence was
  Never smoked 428 (61.9) also not different in employees with different smoking status
or exercise habits.
  Former smoker 19 (2.7)
The risk factors for the development of LBP in the
  Current smoker 244 (35.3) employees using univariate and multivariate analysis are
presented in Table 3. The univariate analysis showed that
Exercise habits, n (%) being at least 40 years of age (OR = 1.84), performing heavy
 None 485 (70.2) lifting >20 kg (OR = 1.47), and a previous history of either
LBP (OR = 7.53) or lumbar spinal surgery (OR = 8.22) were
  1-4 days/week 193 (27.9) significant risk factors for developing LBP in the previous
week (all p < .05). Although being female (OR = 1.49) was
  5-7 days/week 13 (1.9)
not a significant factor, it was included in subsequent
Note. BMI = body mass index; LBP = low back pain. multivariate logistic regression analysis. The results of this
multivariate analysis found female sex (OR = 2.13) and a

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Workplace Health & Safety Mon 2019

Table 2.  A Comparison of the Demographic Characteristics Between Employees With and Without Low Back Pain

LBP Total
No Yes
 
  n (%) n (%) n p value
Total 553 (80.0) 138 (20.0) 691  
Age (years) <.01

  ≤29 103 (85.8) 17 (14.2) 120  

 30-39 221 (83.7) 43 (16.3) 264  

 40-49 112 (77.8) 32 (22.2) 144  

  ≥50 117 (71.7) 46 (28.2) 163  

Sex .06
 Female 90 (74.4) 31 (25.6) 121  
 Male 463 (81.2) 107 (18.8) 570  
Height (cm) .30

  <165 165 (78.6) 45 (21.4) 210  

  ≥165 388 (80.7) 93 (19.3) 481  

BMI (kg/m2) .38

  <18.5 25 (89.3) 3 (10.7) 28  

 18.5-25 406 (79.1) 107 (20.9) 513  

  ≥25 122 (81.3) 28 (18.7) 150  

Heavy lifting <.05

 Yes 239 (76.6) 73(23.4) 312  
 No 314 (82.8) 65 (17.2) 379  
Past history of LBP <.001
 Yes 90 (52.3) 82 (47.7) 172  
 No 463 (89.2) 56 (10.8) 519  
Past history of lumbar .02
spinal surgery
 Yes 2 (33.3) 4 (66.7) 6  
 No 551 (80.4) 134 (19.6) 685  
Smoking status .90
  Never smoked 342 (79.9) 86 (20.1) 428  
  Former smoker 16 (84.2) 3 (15.8) 19  
  Current smoker 195 (79.9) 49 (20.1) 244  

(continued)
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vol. XX  ■  no. X
Table 2.  (continued)
LBP
No
  n (%)
Exercise habits
 None 394 (81.2)
  1-4 days/week 149 (77.2)
  5-7 days/week 10 (76.9)
Note. Values in bold indicate statistical significance with p < 0.05. LBP = low back pain; BMI = body mass index.
previous history of LBP (OR = 7.42) were significant risk
factors for developing LBP.
RDQ Among LBP Workers Only
The mean RDQ score was 4.10 (SD, 4.15; range, 1–21) in
the 138 employees with LBP. Figures 1 shows the distribution
of RDQ scores, the trend line of which demonstrated a negative
regression curve, indicating there existed more employees with
modest LBP and few employee showed severe LBP with RDQ
score ≥17. There was a significant difference in RDQ scores
between employees who did and did not conduct heavy lifting
as part of their usual work duties (M ± SD, 5.0 ± 4.6 vs. 3.2 ±
3.3, p = .01) (Table 4). In contrast, there was no statistically
significant difference in RDQ scores stratified according to sex,
age, height, BMI, and previous history of LBP and lumbar spine
surgery.
Discussion
This cross-sectional study examined the prevalence,
possible risk factors, and characteristics of LBP in employees
who conducted their work while standing at an electronics
manufacturing organization in Japan. Among these
employees, one fifth reported experiencing LBP within the
week before their general health checkup. The 20%
prevalence of LBP within a week of the checkup in the
present study is lower than the 35.7% reported for the
general Japanese population (Fujii & Matsudaira, 2013). A
nationwide epidemiological survey of 11,507 randomly
selected Japanese people aged 18 years or older
demonstrated an approximately 25% prevalence of LBP
within a week of their checkup (Nakamura, Nishiwaki,
Ushida, & Toyama, 2011). The discrepancy between the
prevalence of LBP in our study and previous reports suggests
that our results may not be generalizable because our sample
was confined to factory employees whose work did not
involve extreme or awkward postures or exposure to full
body vibration, which were previously reported as risk
factors for LBP (Coenen, Willenberg, et al., 2016).
Workplace Health & Safety
Total
Yes
n (%) n p value
.48
91 (18.8) 485  
44 (22.8) 193  
3 (23.1) 13  
Recent studies have demonstrated that spending extended
periods standing has an effect on the development of LBP
(Coenen, Parry, et al., 2017; Coenen, Willenberg, et al., 2016;
Fewster et al., 2017). Kopec et al. showed that men who stood
as part of their usual daily activities were at greater risk of LBP
(Kopec et al., 2004). Macfarlane et al. (1997) also showed that
women who stood more than 2 hours per day were at greater
risk of developing LBP. In contrast, a number of studies have
demonstrated negative correlations between standing
mechanical loads and LBP incidence (Harkness et al., 2003; Yip,
2004). The association should be evaluated in greater detail in
future studies.
Our findings agree with a number of reports that showed
female sex was a significant risk factor for LBP, especially
chronic LBP, among the general population and certain types of
employees (Spyropoulos et al., 2007; Tomita et al., 2010).
However, a 2-year prospective study by Matsudaira et al.
demonstrated that female Japanese employees had a lower
prevalence of LBP among initially symptom-free employees
(OR = 0.79) (Matsudaira et al., 2012). The discrepancies in
these findings may have arisen from the use of different
definitions for LBP between studies. LBP prevalence may be
higher in females because of differences in either the subset of
the population selected for our study or work activities between
sexes. In addition, a previous study showed that most
employees who experience an episode of LBP will have a
recurrence within 1 year (Von Korff, Deyo, Cherkin, & Barlow,
1993). The result of our multivariate analysis that a prior
episode of LBP is a risk factor for recurrence is consistent with
previous findings (Papageorgiou et al., 1996).
Our univariate analysis showed aged 40 years or older
were also at significant risk factor for LBP. In a study of
11,507 individuals in the general Japanese population,
Nakamura et al. reported 16.5% and 15.0% LBP prevalence at
age <40 and ≥40 years, respectively (Nakamura et al., 2011).
In addition, the Japanese nationwide Research on
Osteoarthritis/osteoporosis Against Disability (ROAD) cohort
study reported that the incidence of LBP in the general
population was independent of age stratum (Muraki et al.,
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Workplace Health & Safety Mon 2019

Table 3.  Univariate and Multivariate Analyses of Risk Factors for the Development of LBP

Univariate analysis Multivariate analysis

OR 95% CI p value OR 95% CI P value

Sex
 Female 1.49 [0.94, 2.36] .10 2.13 [1.27, 3.60]  
 Male 1.00 1.00  
Age (years)

  <39 1.00 1.00  

  ≥40 1.84 [1.26, 1.68] .002 1.36 [0.90, 2.06] .15

Height (cm)

  <165 1.00  

  ≥165 0.88 [0.59, 1.31] .54  

BMI (kg/m2)

  <18.5 1.00  

 18.5-25 2.20 [0.65, 7.41] .24  

  ≥25 1.91 [0.54, 6.78] .42  

Heavy lifting
 Yes 1.47 [1.02, 2.13] .045 1.26 [0.83, 1.91] .28
 No 1.00 1.00  
Past history of LBP
 Yes 7.53 [5.01, 11.3] <.001 7.42 [4.83, 11.4] <.001
 No 1.00 1.00  
Past history of lumbar spinal surgery
 Yes 8.22 [1.49, 45.4] .02 3.26 [0.47, 22.4] .23
 No 1.00 1.00  
Smoking status
  Never smoked 1.00  
  Former smoker 0.75 [0.21, 2.62] .78  
  Current smoker 1.00 [0.68, 1.48] 1.00  
Exercise habits
 None 1.00  
  1-4 days/week 1.28 [0.85, 1.92] .24  
  5-7 days/week 1.30 [0.35, 4.82] .72  

Note. LBP = low back pain; OR = odds ratio; CI = confidence interval; BMI = body mass index.

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vol. XX  ■  no. X Workplace Health & Safety

Figure 1.  The distribution of the RDQ scores in all the employees.
Note. RDQ = Roland-Morris Disability Questionnaire.

Table 4.  A Comparison of Employees’ Demographics by the Mean RDQ Scores

RDQ score (M ± SD) p value

Total (n = 138) 4.1 ± 4.2  

Sex .60
 Female 4.5 ± 4.9  

 Male 4.0 ± 3.9  

Age (years) .64

  ≤39 3.8 ± 4.2  

  ≥40 4.3 ± 4.2  

Height (cm) .58

  <165 3.8 ± 4.0  

  ≥165 4.2 ± 4.3  

BMI (kg/m2)

  <18.5 2.0 ± 1.0 .58

 18.5-25 4.0 ± 4.1  

  ≥25 4.9 ± 4.7 0.32

Heavy lifting .01

 Yes 5.0 ± 4.6  

 No 3.2 ± 3.3  

(continued)

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Workplace Health & Safety
Table 4.  (continued)
RDQ score (M ± SD)
Past history of LBP
 Yes
 No
Past history of lumbar spinal surgery
 Yes
 No
Smoking status
  Never smoked
  Former smoker
  Current smoker
Exercise habits
 None
  1-4 days/week
  5-7 days/week
Note. RDQ = Roland-Morris Disability Questionnaire.
2012). However, the correlation between age and LBP remains
controversial among Japanese employees, suggesting that the
prevalence among various age strata may be affected by
differences in occupation or working environment
(Kawaguchi et al., 2017; Matsudaira et al., 2011). Our
univariate analysis also demonstrated that previous lumbar
spine surgery was a risk factor for LBP. Even cases in which
lumbar surgery was successful may also experience LBP due
to soft tissue injury, diminished spinal stability, or spinal
stenosis (Ragab & Deshazo, 2008).
We also examined the potential correlation between LBP and
height, BMI, smoking, and exercise. Past reports including a
meta-analysis have shown that being overweight is a risk factor
for LBP (Heuch, Hagen, Heuch, Nygaard, & Zwart, 2010; Shiri
et al., 2013). In addition, smoking can induce lumbar disk
degeneration and subsequently LBP (Magora, 1972; Wang et al.,
2012). However, we did not observe a significant correlation
between these factors and LBP. Only 29.8% of the participants
surveyed in this study exercised at least once a week,
suggesting that these employees were primarily sedentary.
However, reviews suggest that sports and exercise may not be
associated with LBP (Bakker et al., 2009; Heneweer, Staes,
Aufdemkampe, van Rijn, & Vanhees, 2011).
8
Mon 2019
p value
.69
4.2 ± 3.9  
3.9 ± 4.5  
.16
7.0 ± 5.0  
4.0 ± 4.1  
4.4 ± 4.3  
7.7 ± 7.4 .76
3.4 ± 3.6 .44
4.4 ± 4.6  
3.4 ± 3.0 .58
5.0 ± 6.1 .82
The RDQ revealed that the average RDQ score among the
138 employees with LBP was 4.1, which was lower than that
observed in a previous validation study in which 214 patients
with LBP reported a mean of RDQ = 9.1 (Suzukamo et al.,
2003). These findings suggest that the severity of LBP in our
study population was not sufficient to require clinical treatment.
However, this RDQ score is comparable with that reported in
our previous study in 201 employees from the same factory
who conducted their work while sitting (mean RDQ = 4.0;
SD, 4.2; range, 1–22) (Inoue et al., 2015). The score in this
earlier study could have been relatively lower because there
was a maximum 10-day interval between the day the employee
felt LBP and the recording of LBP. The distribution of RDQ
scores among all employees in our study produced negative
regression curves. This trend differed from the almost normal
distribution observed for the general population (Suzukamo
et al., 2003), indicating that working while in a standing position
is far from a normal daily work activity. However, we did not
investigate the ergonomics of the working or standing
environment.
The present study had several limitations. First, we did not
examine the ergonomic factors that may affect employees who
conduct their work while standing. Work environments can be
vol. XX  ■  no. X
adapted to improve employees’ postures such as adjusting the
height of workbenches or providing options for back support to
decrease overuse and tiredness of the back muscles. Both these
strategies have been reported to help prevent the development
or aggravation of LBP (Larivière, Gagnon, Gravel, & Bertrand
Arsenault, 2008). Specifically, due to limited resources, we did
not conduct a detailed examination of the workplace or
equipment design, both of which could be associated with LBP
(Driessen et al., 2011; Gilson, Suppini, Ryde, Brown, & Brown,
2012; Radas et al., 2013). Adjusting awkward postures can
decrease LBP risk (Keyserling, Punnet, & Fine, 1998). Although
the employees in this study were not exposed to continuous
awkward postures, a further more detailed analysis of posture
may help to improve methods for preventing. Second, we
cannot conclude that LBP was related only to work. The design
of the current study makes it difficult to determine whether LBP
was related to work or nonwork, and therefore the onset of LBP
can be affected by both lifestyle and work style. Third, while we
evaluated demographic and physical factors, we did not
examine psychosocial factors associated with LBP. Many studies
have highlighted the significance of discerning the psychosocial
characteristics of LBP (Andersson, 1999; Hoogendoorn et al.,
2000; Matsudaira, Konishi, Miyoshi, Isomura, & Inuzuka, 2014).
However, despite these limitations we consider that our results
from one of the biggest companies in Japan can help to
improve the working environment and prevent the occurrence
of LBP in standing workers.
In summary, one fifth of our participants reported LBP
lasting for 48 hours or more within the past week. Female sex
and a history of LBP were significant risk factors for LBP in
Japanese employees who conduct their work while standing.
The mean RDQ score was relatively low with the distribution
showing a negative regression. Further studies are required to
assess posture and ergonomic factors to develop strategies to
reduce LBP prevalence in employees and to minimize the
psychosocial burden of LBP.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
ORCID iDs
Gen Inoue https://orcid.org/0000-0001-6500-9004
Tsutomu Akazawa https://orcid.org/0000-0003-2348-0994
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Author Biographies
Gen Inoue, MD, PhD, is an associate professor of orthopaedic
surgery, Kitasato University School of Medicine.
Kentaro Uchida, PhD, is a senior lecturer of orthopaedic surgery,
Kitasato University School of Medicine.
Masayuki Miyagi, MD, PhD, is a senior lecturer of orthopaedic
surgery, Kitasato University School of Medicine.
Wataru Saito, MD, PhD, is a senior lecturer of orthopaedic
surgery, Kitasato University School of Medicine.
Toshiyuki Nakazawa, MD, PhD, is a clinical associate professor
of orthopaedic surgery, Kitasato University School of Medicine.
Takayuki Imura, MD, is a clinical senior lecturer of orthopaedic
surgery, Kitasato University School of Medicine.
Workplace Health & Safety
Eiki Shirasawa, MD, is an assistant professor of orthopaedic
surgery, Kitasato University School of Medicine.
Tsutomu Akazawa, MD, PhD, is a clinical professor of
orthopaedic surgery, St. Marianna University School of Medicine.
Sumihisa Orita, MD, PhD, is a research associate professor in
Center for Advanced Joint Function and Reconstructive Spine
Surgery, Graduate School of Medicine, Chiba University.
Kazuhide Inage, MD, PhD, is an assistant professor of orthopaedic
surgery, Graduate School of Medicine, Chiba University.
Masashi Takaso, MD, PhD, is a professor of orthopaedic surgery,
Kitasato University School of Medicine.
Seiji Ohtori, MD, PhD, is a professor of orthopaedic surgery,
Graduate School of Medicine, Chiba University.
11