From: Risk factors for low back pain in active military personnel: a systematic review
Risk factor | Study | Outcomes and key findings |
---|---|---|
Physical factors (consistent associations) | ||
History of LBP | Monnier et al. (2019) | Incident LBP: Back pain within 6 months prior to course start (ref: no): Yes1: HR 2.47 (1.41; 4.31)* Incident LBP limiting work ability: Back pain within 6 months prior to course start (ref: no): Yes2: HR 3.58 (1.44; 8.90)* |
Roy and Lopez (2013) | Brigade Support Battalion: History of LBP (ref: no): Yes: OR 5.03 (1.61; 15.72)* Brigade Special Troops Battalion: History of LBP (ref: no): Yes: OR 8.91 (1.71; 46.46)* Infantry Battalions: History of LBP (ref: no): Yes: OR 2.20 (1.2; 4.04)* | |
Previous injury | Taanila et al. (2012) | Sports injury during last month (ref: no): Yes3: HR 1.7 (1.0; 2.8)* |
Seay et al. (2017) | Lower extremity injury4 (ref: no lower extremity injury): HR 1.70 (1.66; 1.74)* Pooled TR 0.90 (0.90; 0.91)* Males with lower extremity injury4 (ref: males with no lower extremity injury): HR 1.76 (1.72; 1.80)* Pooled TR 0.90 (0.89; 0.90)* Females with lower extremity injury4 (ref: females with no lower extremity injury): HR 1.43 (1.36; 1.50)* Pooled TR 0.93 (0.92; 0.94)* | |
Time spent on physical training | Monnier et al. (2019) | Incident LBP limiting work ability: Physical training sessions per week (ref: > 2): ≤ 22: HR 2.96 (1.19; 7.39)* |
Roy and Lopez (2013) | Brigade Special Troops Battalion: Strength training (ref: less): More: OR 0.88 (0.78; 0.99)* | |
Physical factors (non-associations, single study) | ||
Body mass index | Taanila et al. (2012) | BMI (ref: normal 18.5 ≤ BMI < 25.0): Underweight BMI < 18.53: HR 0.2 (0.0; 1.3) Pre-obese 25.0 ≤ BMI ≤ 30.03: HR 0.9 (0.6; 1.3) Obese BMI ≥ 30.03: HR 1.4 (0.8; 2.4) |
Waist circumference | Taanila et al. (2012) | WC (ref: normal 80 ≤ WC < 94): Thin WC < 803: HR 0.8 (0.5; 1.4) Increased 94 ≤ WC < 1023: HR 1.3 (0.8; 2.0) High WC ≥ 1023: HR 1.3 (0.7; 2.4) |
Self-assessed health | Taanila et al. (2012) | Self-assessed health (ref: good or very good): Average or inferior3: HR 1.1 (0.8; 1.6) |
Chronic disease | Taanila et al. (2012) | Chronic disease (ref: no): Yes3: HR 1.2 (0.8; 1.7) |
Regular medications | Taanila et al. (2012) | Regular medication (ref: no): Yes3: HR 1.4 (0.9; 2.3) |
Orthopedic surgery | Taanila et al. (2012) | Orthopedic surgery (ref: never): Yes3: HR 1.6 (0.9; 2.6) |
Chronic impairment due to prior MSK injury | Taanila et al. (2012) | Chronic impairment or disability because of prior MSK injury (ref: no): Yes3: HR 1.4 (0.9; 2.2) |
Self-assessed physical fitness | Taanila et al. (2012) | Self-assessed physical fitness (ref: good or very good): Average or inferior3: HR 1.3 (0.8; 1.9) |
Physical factors (inconsistent associations) | ||
Poor performance on physical fitness tests | Monnier et al. (2019) | Incident LBP: Pull-up (number of repetitions) (ref: ≥ 4): ≤ 35: HR 1.87 (1.17; 3.01)* |
Taanila et al. (2012) | Pull-up test (consecutive repeats without time limit) (ref: excellent ≥ 14): Good ≥ 103: HR 1.6 (0.8; 3.1) Fair ≥ 63: HR 1.3 (0.7; 2.5) Poor < 63: HR 1.2 (0.7; 2.3) Standing long jump test (two attempts, best result observed) (ref: excellent ≥ 240 m): Good ≥ 220 m3: HR 0.9 (0.5; 1.5) Fair ≥ 200 m3: HR 1.1 (0.7; 1.7) Poor < 200 m3: HR 0.9 (0.5; 1.5) Sit-up test (repeats/60 s) (ref: excellent ≥ 48): Good ≥ 403: HR 1.5 (0.8; 2.8) Fair ≥ 323: HR 1.4 (0.8; 2.4) Poor < 323: HR 1.7 (0.9; 3.0) Push-up test (repeats/60 s) (ref: excellent ≥ 38): Good ≥ 303: HR 1.3 (0.8; 2.1) Fair ≥ 223: HR 1.2 (0.8; 1.9) Poor < 223: HR 1.6 (1.0; 2.6) Back-lift test (repeats/60 s) (ref: excellent ≥ 60): Good ≥ 503: HR 1.2 (0.8; 1.9) Fair ≥ 403: HR 1.2 (0.7; 1.8) Poor < 403: HR 1.6 (0.9; 2.8) Combination of push-up and Cooper test (ref: excellent): Good3: HR 1.4 (0.8; 2.3) Fair3: HR 1.5 (0.8; 2.5) Poor3: HR 2.1 (1.1; 4.2)* Combination of back lift and Cooper test (ref: excellent): Good3: HR 1.3 (0.8; 2.1) Fair3: HR 1.5 (0.9; 2.5) Poor3: HR 2.4 (1.1; 5.4)* Combination of sit-up and push-up test (ref: excellent): Good3: HR 1.5 (0.8; 2.8) Fair3: HR 1.6 (0.9; 3.0) Poor3: HR 2.2 (1.1; 4.5)* Combination of push-up and back lift test (ref: excellent): Good3: HR 1.4 (0.8; 2.2) Fair3: HR 1.3 (0.8; 2.0) Poor3: HR 2.8 (1.4; 5.9)* | |
Height | Monnier et al. (2019) | Incident LBP: Body height (ref: > 1.80 m): ≤ 1.80m1: HR 1.98 (1.19; 3.29)* Incident LBP limiting work ability: Body height (ref: > 1.80 m): ≤ 1.80m2: HR 4.48 (2.01; 9.97)* |
Taanila et al. (2012) | Height (cm) (ref: shortest quartile ≤ 176): Second quartile 177–1803: HR 1.2 (0.7; 1.8) Third quartile 181–1853: HR 0.9 (0.5; 1.4) Tallest quartile ≥ 1853: HR 1.1 (0.7; 1.8) | |
Sociodemographic factors (consistent associations) | ||
Female | MacGregor et al. (2012) | Sex (ref: male): Female6: OR 1.94 (1.61; 2.34)* |
Knox et al. (2014) | Sex# (ref: male): Female7: IRR 1.45 (1.39; 1.52)* | |
Sociodemographic factors (associations, single study) | ||
‘Single’ marital status | Knox et al. (2014) | Marital status# (ref: married): Single8: IRR 0.87 (0.84; 0.91)* Other8: IRR 1.01 (0.91; 1.12) |
Lower education level | Taanila et al. (2012) | Level of education (ref: higher—secondary school graduates, polytechnic, university student): Lower—comprehensive or vocational school)3: HR 1.6 (1.1; 2.3)* Degrees achieved in school (ref: high): Low or average3: HR 1.5 (1.0; 2.2)* |
Sociodemographic factors (non-associations) | ||
Father’s occupation | Taanila et al. (2012) | Father’s occupation (ref: not physical): Physical3: HR 1.2 (0.8; 1.9) Unemployed or retired3: HR 1.4 (0.9; 2.2) |
Urbanisation level of place of residence | Taanila et al. (2012) | Urbanisation level of place of residence (ref: countryside): Small population centre3: HR 1.1 (0.6; 2.0) Midsize town or city3: HR 1.0 (0.6; 1.7) Bigger city3: HR 1.2 (CI 0.7; 2.0) |
Smoking habits | Taanila et al. (2012) | Smoking habits (ref: never regularly): Smoked regularly3: HR 1.1 (0.8; 1.6) |
Use of alcohol | Taanila et al. (2012) | Use of alcohol (ref: < 1 time/month): 1–2 times/week3: HR 0.8 (0.5; 1.2) ≥ 3 times/week3: HR 0.6 (0.3; 1.2) |
Frequency of drunkenness before military service | Taanila et al. (2012) | Frequency of drunkenness before military service (ref: < 1 time/week): ≥ 1 time/week3: HR 0.7 (0.5; 1.1) |
Agreeing that soldiers need good physical fitness | Taanila et al. (2012) | Agrees that soldier needs good physical fitness (ref: yes): No3: HR 1.0 ( 0.7; 1.4) |
Amount of time spent on sweating exercises | Taanila et al. (2012) | Sweating exercise (brisk leisure time sport) (ref: ≥ 3 times/week): 1–2 times/week3: HR 0.7 (0.5; 1.1) Only leisured exercise3: HR 1.3 (0.8; 2.1) No physical exercise3: HR 1.0 (0.6; 1.7) |
Participation in individual aerobic sports | Taanila et al. (2012) | Participates in individual aerobic sports (ref: yes, at least sometimes): No3: HR 1.1 ( 0.7; 1.5) |
Belonging to a sports club | Taanila et al. (2012) | Belongs to a sports club (ref: yes, active member): No3: HR 1.1 ( 0.7; 1.8) |
Participation in competitive sports | Taanila et al. (2012) | Participates in competitive sports (ref: yes): No3: HR 1.1 ( 0.7; 1.7) |
Last degree in school sports | Taanila et al. (2012) | Last degree in school sports (ref: good or excellent): Poor or fair3: HR 0.8 (0.5; 1.3) |
Race | Knox et al. (2014) | Race# (ref: other): Black9: IRR 1.07 (1.00; 1.14) White9: IRR 1.06 (1.00; 1.13) |
Sociodemographic factors (inconsistent associations) | ||
Age | Knox et al. (2014) | Age# (ref: 30–39): < 2010: IRR 1.24 (1.15; 1.36)* 20–2910: IRR 0.96 (0.91; 1.01) > 4010: IRR 1.23 (1.0; 1.38) |
Ernat et al. (2012) | Infantrymen stratified by age (ref: control): < 2011: IRR 0.61 (0.59; 0.63)* 20–2911: IRR 0.66 (0.65; 0.67)* 30–3911: IRR 0.86 (0.83; 0.88)* > 4011: IRR 0.91 (0.86; 0.97)* | |
Taanila et al. (2012) | Age (ref: 18–20): 21–283: HR 1.8 (1.0; 3.4) | |
MacGregor et al. (2012) | Age (ref: 18–24): ≥ 256: OR 1.13 (0.94, 1.36) | |
Occupational factors (consistent associations) | ||
Lower rank | Knox et al. (2014) | Rank# (ref: senior E5–E9): Junior E1–E412: IRR 1.60 (1.52; 1.70)* |
MacGregor et al. (2012) | Rank (ref: junior E1–E3): Midlevel E4–E56: OR 0.73 (0.64; 0.83)* Senior E6–E96: OR 0.98 (0.76; 1.26) | |
Occupational factors (associations, single study) | ||
Blast injury | MacGregor et al. (2012) | Blast injury (ref: no): Yes6: OR 2.29 (1.64; 3.19)* |
Job duties | Roy and Lopez (2013) | Brigade Support Battalion: Lifting objects (ref: < 30 lbs): > 30 lbs: OR 1.30 (1.06; 1.60)* Brigade Special Troops Battalion: Body armour (ref: no): Yes: OR 1.23 (1.03; 1.47)* Reconnaissance, Surveillance, and Target Acquisition Squadron: Body armour (ref: no): Yes: OR 1.30 (1.11; 1.53)* Infantry Battalions: Body armour (ref: no): Yes: OR 1.14 (1.07; 1.21)* |
Service type | Knox et al. (2014) | Military service# (ref: Marine): Army13: IRR 2.74 (2.60; 2.89)* Air Force13: IRR 1.98 (1.84; 2.14)* |
Occupational factors (non-associations, single study) | ||
Location of deployment | MacGregor et al. (2012) | Location country (ref: Iraq): Kuwait6: OR 1.11 (1.00; 1.24) |
Time deployed | MacGregor et al. (2012) | Time deployed (ref: 1–7 months): > 7 months6: OR 1.06 (0.95; 1.19) |
Occupational factors (inconsistent associations) | ||
Military occupations | MacGregor et al. (2012) | Occupation (ref: administrative/other): Communications/intelligence1: OR 0.82 (0.64; 1.06) Infantry6: OR 0.86 (0.73; 1.02) Service/supply6: OR 1.33 (1.12; 1.59)* Electrical/mechanical/craftsworker1: OR 1.31 (1.12; 1.53)* |
Taanila et al. (2012) | Company (ref: anti-tank): Signal3: HR 1.4 (0.9; 2.3) Mortar3: HR 1.0 ( 0.5; 1.8) Engineer3: HR 2.0 (CI 1.2; 3.3)* | |
Ernat et al. (2012) | Infantrymen11 (ref: control): IRR 0.69 (95% CI 0.68; 0.70)* Infantrymen stratified by age (ref: control): < 2011: IRR 0.61 (0.59; 0.63)* 20–2911: IRR 0.66 (0.65; 0.67)* 30–3911: IRR 0.86 (0.83; 0.88)* > 4011: IRR 0.91 (0.86; 0.97)* Infantrymen stratified by rank (ref: control): Junior: Unadjusted IRR 0.59 (no CI provided) Senior: Unadjusted IRR 0.80 (no CI provided) Infantrymen stratified by branches of service (ref: control): Army: Unadjusted IRR 0.70 (no CI provided) Marine: Unadjusted IRR 0.59 (no CI provided) | |
Driving | Knox et al. (2014) | Military vehicle operator14 (ref: other occupations): IRR 1.15 (1.13; 1.17)* |
Zack et al. (2018) | Occupational categories (ref: administrative): Car drivers: RR 1.0 (0.79; 1.28) Truck drivers: RR 0.49 (0.40; 0.60)* |