Low-Back Pain Disorders as Occupational Diseases in the Czech Republic and 22 European Countries: Comparison of National Systems, Related Diagnoses and Evaluation Criteria

By Lastovková, Andrea; Nakládalová, Marie et al. | Central European Journal of Public Health, September 1, 2015 | Go to article overview

Low-Back Pain Disorders as Occupational Diseases in the Czech Republic and 22 European Countries: Comparison of National Systems, Related Diagnoses and Evaluation Criteria


Lastovková, Andrea, Nakládalová, Marie, Fenclová, Zdenka, Urban, Pavel, Gad'ourek, Petr, Lebeda, Tomás, Ehler, Edvard, Ridzon, Petr, Hlávková, Jana, Boriková, Alena, Kuijer, P. Paul F. M., Bátora, Igor, Scholz-Odermatt, Stefan M., Moldovan, Horatiu, Godderis, Lode, Leijon, Ola, Campo, Giuseppe, Vanecková, Manuela, Bonneterre, Vincent, Stikova, Elisaveta Jasna, Pelclová, Daniela, Central European Journal of Public Health


INTRODUCTION

Regular physical activity including sport is considered a positive factor contributing to a higher quality of life and reduction of obesity (1, 2). On the other hand, excessive physical workload still occurring in many occupations leads to frequent musculoskeletal disorders and neurological damage of the upper extremities (3, 4). The spine belongs to the most frequently overloaded parts of the body during different work operations. Lifetime prevalence of low-back pain diseases (LBPD) across the general population worldwide is very high, reaching 84% (5), which makes the determination of the occupational cause of LBPD very difficult. According to data from the Institute of Health Information and Statistics of the Czech Republic, musculoskeletal diseases (MSD) accounted for almost 20% of work disability cases in the year 2012 and represented the second most frequent cause after respiratory diseases. The mean duration of sick leave due to this diagnosis was 67.7 days. Among all MSD, dorsopathies, particularly of the lumbar part of the back, were most common. Craftsmen, serviceman and non-qualified workers were most often affected (6).

This situation is quite similar across Europe. In Germany, with a population of almost 82 million, MSD caused 23.3% of the sick leaves in 2010 with approximately 26,000 new disability pensions which resulted in a loss of production corresponding to euro9.1 billion (7). It has been proven that factors such as lifestyle, social factors, residence location, and type of workload have an impact on health condition and prevalence of diseases, including LBPD (8, 9).

Employees working as nurses, hospital attendance, craftsmen, fishermen, warehousemen, etc. are daily exposed to heavy-weight lifting usually in unfavourable work postures which may cause damage to the vertebral column. Harmful effects of physical overload or whole-body vibrations affect mainly the lumbar intervertebral discs, which are getting narrower. Secondary changes such as subchondral sclerosis and osteophytes appear later and overload of the intervertebral joints results in early arthrosis. In this vulnerable area herniation of the disc and radicular syndrome are frequent (10).

According to an EU Report from 2013 (11), 22 out of 29 countries, covered by the study, consider risk prevention as their priority. Specifically, in 16 countries a priority in the prevention of the diseases is given to musculoskeletal disorders. These are Belgium, Cyprus, Denmark, Estonia, Finland, France, Germany, Hungary, Iceland, Italy, Netherlands, Norway, Poland, Portugal, Spain, and the United Kingdom. Musculoskeletal diseases have become a research priority in 10 of those countries, namely Belgium, Denmark, Estonia, Finland, France, Germany, Netherlands, Norway, Poland, and Sweden.

To be recognized as an occupational disease, a condition or sickness is required to meet certain medical and legal criteria. The problem of definition of such criteria is directly related to the reliability of a medical expert's assessment and conclusions (12). Certain discrepancies between the legal and medical concepts of occupational disease are practically inevitable, which brings another problem of admissibility of medical criteria, i.e. its compliance with the legal requirements (13).

The main reason why setting the criteria and compensation of LBPD as occupational diseases is rather difficult is the fact that the prevalence of LBPD in the general population is high. Lötters et al. (14) performed a meta-analysis of 40 studies and compared the prevalence of non-specific low-back pain in an unexposed population versus a population exposed to several risk factors. They found that the unexposed population under 35 years had 22% probability of having LBPD, people between 35 and 45 years 30% and people over 45 years 34%. The pooled odds ratio (OR) was 1.51 (95% CI 1.31-1.74) for manual materials handling, 1.68 (95% CI 1.41-2.01) for frequent bending or twisting, 1. …

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