These are closest to what we
might think of as possible causes of back pain. Still others may be ”pantechnicon”
variables, e. This started from the
concept that increasing or cumulative exposure Opportunity details upon programs harm 93
but additionally causal mechanisms, e.
We should also ask - risk of what? In this chapter
we are mainly concerned with risk factors for the
onset of back pain.
Risk factors for low back trouble and the
- incapacity 0 Ei
Figure 6. 6. Over
the next seven chapters we will consider the wide
range of factors that are linked to the various consequences
of back pain: chronic pain and disability,
sickness absence, and health care use. However, it seems to make
more sense to think of them as influences on back
pain after it has occurred.
Proof guide or maybe perception usually takes cast in stone specifications
(Bombardier et a1 1994, Rothman. g. However the others may just be ”pantechnicon”
causes, e. , a few foot orthotics
must have coming from all time. For complex statistical
reasons that we need not go into here, this
usually requires an odds ratio (OR) or relative
risk (RR) of >3-4. , certain physical
demands of work. 1
relationship between them. , sexual, who get challenging
biologic, mental, or even sociable points that
get even more examine.
Adams et a1 (2002) considered various risk factors
for back trouble and possible relationships
0 reversibility: stopping exposure to the hazard
Low back mcJ-=hl
trouble - rlrk factom
gender traits I
t i’ Fitness, age, Psychohcia1
Figure 6. , asbestos and
mesothelioma. , gender, which contain complex
biologic, psychological, and social issues that
require further analysis. ” Weak effects may be
statistically significant but are unlikely to be
clinically important. g. Figure 6. g. 2 expands on
the possible consequences of back pain, and shows
the dose-response gradient. It is difficult to demonstrate with
a common condition like back pain
reduces the risk. 2 The dose-response gradient: increased
exposure produces increased risk and impact. g.
Risk factors for back pain 93
and causal mechanisms, e. 1). Reproduced with permission
from Adarns et al (2002).
0 consistency in different studies
0 biologic plausibility: does it fit our theoretic
understanding? This may be difficult for a
condition like non-specific back pain where we
do not really understand the pathology!
0 temporal sequence of exposure and effect:
which can only be shown in a longitudinal
0 dose-response gradient: greater or cumulative
exposure to the hazard increases the risk
0 specificity: it is usually only possible to
demonstrate this with an uncommon exposure
and an uncommon condition, e. Thus back pain that develops
some time after stopping work is unlikely to be
caused by that job.
Proof of cause and effect requires strict criteria
(Bombardier et a1 1994, Rothman & Greenland
0 strength of association: sometimes described as
the “effect size. g. These
are sometimes described as risk factors for these
between them (Fig.