Background: Low back pain is a debilitating condition with poor patient outcomes despite the use of a wide variety of diagnostic and treatment modalities. A lack of objective metrics to support clinical decision-making may be a reason for these poor outcomes. This study aimed to compare patient recovery following lumbar fusion surgery using an objective motion-based metric (functional performance) and subjective patient-reported outcomes for pain, disability and kinesophobia. Methods: A prospective observational study was conducted on 121 patients that received a lumbar fusion surgery. A wearable motion system was used to quantify three-dimensional multi-planar lumbar motion and benchmark each patient's lumbar function prior to surgery and post-operatively at follow-up time points for up to 2 years. Patient recovery profiles after surgery were evaluated using the acquired functional motion data and compared to patient-reported outcomes. Findings: Our results found significant improvement after surgery in objective functional performance as well as patient-reported pain, disability, and kinesophobia. However, we found a delayed response in the objective metric, with meaningful improvement occurring only 6 months after fusion surgery. In contrast, we found sig-nificant improvement in all subjective scores as early as 6 weeks post-surgery. Interpretation: Objective motion-based metric provides a unique perspective to assessing patient's functional recovery. While it is associated with dimensions of pain, disability and fear avoidance, it is also distinct and assesses a uniquely different dimension of functional health. This information can form the basis for the use of objective metrics to gauge patient recovery after lumbar fusion surgery.

Objective: Assessment of possible relationships between work-related psychosocial measures and self-reported low back pain (LBP) outcomes in a large pooled dataset of 1929 participants from 82 facilities in the United States. Methods: Pooled data from three prospective cohort studies were used to calculate odds ratios (OR) and 95% confidence intervals (95% CI) for relationships between psychosocial factors and the LBP outcomes. Personal and occupational confounders were controlled for in adjusted Logistic regression models. Results: Supervisor support and job satisfaction were significantly (P < 0.05) related to all three LBP outcomes. Other psychosocial factors were significantly (P < 0.05) associated with at least one of the LBP outcomes. Adjusted ORs ranged from approximately 1.50 to 3.50 for most associations. Conclusions: There is a significant relationship between work-related psychosocial measures and LBP outcomes.

Study Design Observational Study Objective The primary objective was to determine if there were differences in spine structure measures between experimental postures and standard supine posture MRIs. Methods Thirty-four low back pain patients were included. MRI was taken in 6 experimental postures. The dependent measures includes sagittal view anterior (ADH), middle and posterior disc heights, thecal sac width, left/right foraminal height (FH). In the axial view: disc width, left and right foraminal height. Measures were done L3/L4, L4/L5 and L5/S1. Each subject served as their own control. Spine measurements in the experimental posture were compared to the same measures in the standard supine posture. Results 94% inter-observer reliability was seen. In the sagittal and axial view, 55 of the 108 and 11 of the 18 measures were significantly different. In sagittal view: a) ADH was significantly smaller in the sitting flexed posture by 2.50 mm +/- 0.63 compared to the supine posture; b) ADH in sitting neutral posture was significantly smaller than the standard posture by 1.97 mm +/- 0.86; c) sitting flexed posture showed that bilateral FH measures were significantly different; d) Bilateral FH was larger in the sitting neutral posture compared to the standard supine posture by 0.87 mm +/- 0.17. Conclusions This research quantifies the differences in spine structure measures that occur in various experimental postures. The additional information gathered from an upright MRI may correlate with symptoms leading to an accurate diagnosis and assist in future spine research.

Low back pain (LBP) is a common health problem and a major cause of lost productivity in workplaces. Manual materials handling (MMH) jobs have traditionally been regarded as risk factor for LBP. Compared to two-handed lifting, one-handed lifting has received little attention in both epidemiological and biomechanical research. In addition, one frequent complaint of the revised NIOSH lifting equation (RNLE) has been the lack of capability to directly evaluate one-handed lifting. Modifications have been proposed by the European Union, however their efficacy and influence have not yet been evaluated. This cross-sectional study provided objective survey of the MMH jobs, especially the one-handed lifting performed in manufacturing industry and investigated the outcomes of three proposed methods to address one-handed lifting using RNLE approach. Preliminary results suggest that workers with some one-handed lifting are associated with higher physical exposure. However, the increase was more significant among those who perform primarily one-handed lifting.

A frozen wasteland of endless winter does not sound very susceptible to change. Despite this common description of Arctic landscapes, northern North America is quite vulnerable and can change dramatically. Climate change, whether natural or human-caused, is imminent. Anticipating the direction and magnitude of change requires knowledge of natural climatic fluctuations as well as the impacts of human activity. Of all the recent climate change issues, the potential for global warming due to enhanced greenhouse gases has received the most attention. The challenge in understanding regional response to climate change is to downscale the large climatic patterns simulated in the General circulation models to spatial and temporal resolutions that are meaningful. It is uncertain how the marine/Arctic air mass boundary will respond to climate change. If Arctic and subarctic temperature inversions become less frequent, the associated high atmospheric pressure should diminish.

Low back pain (LBP) is a common and costly problem throughout the United States. To achieve a greater understanding of the occupational risk factors, the National Institute for Occupational Safety and Health (NIOSH) funded a low back health effects consortium, which performed several surveillance studies throughout the United States. This study combines data from the consortium research groups resulting in a data set with nearly 2000 workers in various regions of the country. The purpose of this paper is to examine prevalence and personal risk factors of low back health effects among these workers. There were three common questions regarding history of low back health effects in the past 12 months including 1) have you had LBP lasting 7 days, 2) have you sought medical care for LBP, and 3) have you taken time off work due to LBP. The questionnaire included demographic questions. There were five data collections institutions or sites including NIOSH, Ohio State University, University of Wisconsin-Milwaukee, Texas A&M University, and University of Utah. The 12-month period prevalence of low back pain lasting 7 days, seeking medical care, and lost time due to LBP were 25, 14 and 10%, respectively. There were no statistically significant differences in gender, age or weight between cases and non-cases for any prevalence measure. The height of workers was significantly greater in the cases compared to non-cases for all three prevalence definitions. There were significant differences among the sites on the prevalence of seeking medical care for LBP and lost time due to LBP. The Ohio State University had significantly higher prevalence rates for seeking medical care and lost time due to LBP than University of Wisconsin, University of Utah, or Texas A&M University. LBP, the least severe low back health effect studied, had the highest prevalence (25%) and lost time due to LBP, the most severe low back health effect studied, had the lowest prevalence (10%) among nearly 2000 US manual material handling workers. There was a significant site or regional influence in prevalence rates for seeking medical care and lost time due to LBP.

Low back pain (LBP) is the leading cause of disability worldwide. Unfortunately, there is no gold standard for objectively quantifying low back function. The clinical lumbar motion monitor (CLMM), a wearable technology, has been developed to provide an objective measure of low back function. The evaluation for the patient is like playing a video game with their back. For health care practitioners the CLMM provides three metrics including overall impairment, structural/muscular and test reliability (do we have good data). This study had two goals. 1) To evaluate the ease of use for the patients. 2) To evaluate how the health care practitioners were able to use the results. Sixty-six low back pain patients were evaluated in the study and 18 health care practitioners were interviewed after receiving CLMM results on their patients. The patients were given a survey immediately after evaluation completion. The practitioners participated in a phone survey after all patient evaluations were completed. Ninety-two percent of the patients either agreed or strongly agreed that the monitor was comfortable and 98% either agreed or strongly agreed that the instructions were clear. One hundred percent of the health care practitioners agreed the test reliability metric was informative and provided a new perspective to their clinical impression. Overall LBP patients were satisfied with the evaluation and health care practitioners thought the results added to their clinical impression. The CLMM technology provides an objective quantitative measure of low back function that may change the way health care practitioners treat LBP patients.

Extended Abstract Low back pain has been a leading cause of disability worldwide for nearly two decades (Hartvigsen et al 2018). In a study of US health care spending between 1996 through 2013, low back and neck pain was the health care condition with the highest increase in spending (Dieleman et. al. 2016). Continued increases in health care costs due to low back pain are not sustainable. Therefore, we need to develop better low back disorder prevention plans or tools. In order to prevent occupational low back disorders several tools (ie. NIOSH lifting guide, 3DSSPP, Snook Tables, Lumbar Motion Monitor risk model, REBA, LiFFT) have been developed to quantify the biomechanical or physical exposure risk. There are a multitude of risk factors for low back disorders including psychological, psychosocial, and personal factors none of which are included in the available ergonomics tools (Ferguson and Marras, 1997). The goal of this panel is to promote discussion of the biopsychosocial risk factors that lead to low back disorders and disability. Health care providers suggest that patient advocacy should include preventing prolonged work loss (Nguyen and Randolph, 2007) yet one of the most common personal risk factors of low back pain is previous history of low back pain. The prevention tools above do not include any personal risk factors regarding an individual’s low back health status or any other personal risk factor. Should a new low back injury prevention tool include some personal risk factors for previous low back injury or some other personal risk factor? What about a smoking status risk factor or since sitting is the new smoking what about a sitting risk factor? What about psychosocial factors such as supervisor support or co-worker support? What new tools might we need? What stakeholders to do we need or want at the table in order to develop a tool that will actually be effective and who will the users be? The National Institute of Occupational Safety and Health funded several field studies in the 2000s to examine biomechanical exposure as risk factors of low back disorders. Several of the panelists had studies in the group. A consortium was formed to pool data where possible to increase statistical power to measure these more complex relationships. The common surveillance questionnaire measures of low back disorder included varying degrees of low back disorder severity. The surveillance measures in order from least severe to most severe were 1) any low back pain, 2) seeking medical care due to low back pain and 3) self-reported lost time due to low back pain in the past year. The panelists will be asked to address how the role of their specific topic may change as a function of the various surveillance measures. What does a new tool being developed really need to prevent (low back pain, seeking medical care, self-reported lost time, low back disability)? We will have each panel member discuss causality from several different multidimensional perspectives and will have an open debate/discussion. We will also allow time for audience perspectives Panelist Roles Dr. Jay Kapellusch will be discussing the role of psychophysics and the NIOSH lifting equation. Dr. Matthew S. Thiese will be examining the role of psychosocial risk factors. Dr. Kermit Davis will address interventions. Dr. Sean Gallagher will be probing specific physical injury mechanisms. Dr. William S. Marras will be presenting the multidimensional causal pathway for low back disorders.

Low back pain (LBP) is a common health problem and a major cause of lost productivity in workplaces. Lifting and lowering (LL) activities have traditionally been regarded as risk factor for LBP. In the literature, very little data have been reported describing industrial workers’ exposures to measured job physical demands using comprehensive and quantitative method, such as the revised NIOSH lifting equation (RNLE). This study pooled physical exposure data for the RNLE commonly collected in three independent LBP prospective studies. In total, over one million subtasks (i.e., lifting/lowering activities) were included in this pooled study. Examination of the pooled dataset revealed an increased data distribution of the physical job demands quantified by the RNLE. Research using the pooled dataset will improve the overall statistical power and help address the weaknesses identified in previous studies.

PURPOSE:The purpose of this study was to assess low back functional health among a group of nurses with a history of low back pain symptoms in a university hospital using a direct measure of low back functional performance and compare to traditional low back disability and pain questionnaires.METHODS:Fifty-two nurses and patient care associates volunteered for the study. The clinical lumbar motion monitor (LMM) was used to directly measure low back functional performance. The participants performed a series of standard tasks involving trunk flexion and extension at different asymmetries. The LMM measures the motion signature of the participant (range of motion, velocity and acceleration) in all three planes of the body. The clinical LMM evaluation documented objective assessment of low back function normalized for age and gender. The Oswestry Disability Index (ODI) was used to evaluate self-reported disability and the McGill Pain Questionnaire visual analog scale assessed pain symptom.RESULTS:The average functional performance probability was 0.49 with a standard deviation of 0.29, indicating that on average the functional performance was impaired. The average ODI score was 13.4 with a standard deviation of 11.6. The correlation between the functional performance probability and ODI was 0.046 (not statistically significant).CONCLUSIONS:The clinical LMM functional performance measure provides a direct measure of trunk function. The low correlation between the ODI and clinical LMM functional performance probability indicates that the direct functional performance measure adds another component to our understanding of low back health or impairment that traditional questionnaires lack.

OBJECTIVE:The objective was to assess the role of cumulative spine loading measures in the development of a clinically meaningful decline in low-back function.BACKGROUND:Cumulative spine loading has been a suspected risk factor for low-back pain for many years, yet the measures that characterize risk have not been well delineated.METHODS:A total of 56 cumulative exposure measures were collected in a prospective field study of distribution center workers. An individual's risk for a clinically meaningful decline in low-back function (true cases) was explored with daily, weekly, and job tenure cumulative exposure measures using univariate and multivariate statistical modeling techniques. True noncases were individuals with no decline in low-back function.RESULTS:An individual's risk for a clinically meaningful decline in low-back function (true cases) was predicted well versus true noncases (sensitivity/specificity = 72%/73%) using initial low-back function (p(n)), cumulative rest time, cumulative load exposure, job satisfaction, and worker age.CONCLUSIONS:Cumulative rest time was identified as an important component for predicting an individual's risk for a clinically meaningful decline in low-back function.APPLICATION:This information can be used to assess cumulative spine loading risk and may help establish guidelines to minimize the risk of a clinically meaningful decline in low-back function.

OBJECTIVE:The objective is to quantify differences in physical exposures for those who stayed on a job (survivor) versus those who left the job (turnover).BACKGROUND:It has been suggested that high physical job demands lead to greater turnover and that turnover rates may supplement low-back disorder incidence rates in passive surveillance systems.METHOD:A prospective study with 811 participants was conducted. The physical exposure of distribution center work was quantified using a moment monitor. A total of 68 quantitative physical exposure measures in three categories (load, position, and timing) were examined. Low-back health function was quantified using the lumbar motion monitor at baseline and 6-month follow-up.RESULTS:There were 365 turnover employees within the 6-month follow-up period and 446 "survivors" who remained on the same job, of which 126 survivors had a clinically meaningful decline in low-back functional performance (cases) and 320 survivors did not have a meaningful decline in low-back functional performance (noncases). Of the job exposure measures, 6% were significantly different between turnover and cases compared to 69% between turnover and noncases. Turnover employees had significantly greater exposure compared to noncases.CONCLUSION:Turnover employees had similar physical job exposures to workers who remained on the job and had a clinically meaningful decline in low-back functional performance. Thus, ergonomists and HR should be aware that high turnover jobs appear to have similar physical exposure as those jobs that put workers at risk for a decline in low-back functional performance.

OBJECTIVE:The objective of this study was to quantify shoulder muscle fatigue during repetitive exertions similar to motions found in automobile assembly tasks.BACKGROUND:Shoulder musculoskeletal disorders (MSDs) are a common and costly problem in automotive manufacturing.METHOD:Ten subjects participated in the study. There were three independent variables: shoulder angle, frequency, and force. There were two types of dependent measures: percentage change in near-infrared spectroscopy (NIRS) measures and change in electromyography (EMG) median frequency. The anterior deltoid and trapezius muscles were measured for both NIRS and EMG. Also, EMG was collected on the middle deltoid and biceps muscles.RESULTS:The results showed that oxygenated hemoglobin decreased significantly due to the main effects (shoulder angle, frequency, and force). The percentage change in oxygenated hemoglobin had a significant interaction attributable to force and repetition for the anterior deltoid muscle, indicating that as repetition increased, the magnitude of the differences between the forces increased. The interaction of repetition and shoulder angle was also significant for the percentage change in oxygenated hemoglobin. The median frequency decreased significantly for the main effects; however, no interactions were statistically significant.CONCLUSIONS:There was significant shoulder muscle fatigue as a function of shoulder angle, task frequency, and force level. Furthermore, percentage change in oxygenated hemoglobin had two statistically significant interactions, enhancing our understanding of these risk factors.APPLICATION:Ergonomists should examine interactions of force and repetition as well as shoulder angle and repetition when evaluating the risk of shoulder MSDs.

Purpose The purpose of the study was to determine thresholds for low back kinematic measures for the amount of functional recovery necessary to reduce the risk of recurrent pain symptoms or lost time. Methods Low back kinematic ability measures were collected at baseline when the workers returned to work for full duty. The range of motion, velocity, and acceleration were collected using the lumbar motion monitor. Results Follow-up data was collected on 196 of the 206 workers. Workers with sagittal extension velocity of < 40 deg./s at baseline were twice as likely to report recurrent low back pain symptoms. Workers with sagittal flexion velocity < 34 deg./s were 3 times more likely to report lost time. Conclusions Kinematic functional performance measures may be used as recovery criteria in low back pain patients to minimize recurrence risk.

Musculoskeletal disorder risk was assessed during automotive assembly processes. The risk associated with current assembly processes was compared to using a cantilever chair intervention. Spine loads and normalized shoulder muscle activity were evaluated during assembly in eight regions of the vehicle. Eight interior cabin regions of the vehicle were classified by reach distance, height from vehicle floor and front to back. The cantilever chair intervention tool was most effective in the far reach regions regardless of the height. In the front far reach regions both spine loads and normalized shoulder muscle activity levels were reduced. In the middle and close reach regions spine loads were reduced, however, shoulder muscle activity was not, thus an additional intervention would be necessary to reduce shoulder risk. In the back far reach region, spine loads were not significantly different between the current and cantilever chair conditions. Thus, the effectiveness of the cantilever chair was dependent on the region of the vehicle.

Background: Biomechanical, psychosocial and individual risk factors for low back disorder have been studied extensively however few researchers have examined all three risk factors. The objective of this was to develop a low back disorder risk model in furniture distribution workers using biomechanical, psychosocial and individual risk factors.Methods: This was a prospective study with a six month follow-up time. There were 454 subjects at 9 furniture distribution facilities enrolled in the study. Biomechanical exposure was evaluated using the American Conference of Governmental Industrial Hygienists (2001) lifting threshold limit values for low back injury risk. Psychosocial and individual risk factors were evaluated via questionnaires. Low back health functional status was measured using the lumbar motion monitor. Low back disorder cases were defined as a loss of low back functional performance of -0.14 or more.Findings: There were 92 cases of meaningful loss in low back functional performance and 185 non cases. A multivariate logistic regression model included baseline functional performance probability, facility, perceived workload, intermediated reach distance number of exertions above threshold limit values, job tenure manual material handling, and age combined to provide a model sensitivity of 68.5% and specificity of 71.9%.Interpretation: The results of this study indicate which biomechanical, individual and psychosocial risk factors are important as well as how much of each risk factor is too much resulting in increased risk of low back disorder among furniture distribution workers. (C) 2011 Elsevier Ltd. All rights reserved.

.................................................................................................................... ii Acknowledgments................................................................................................... iv Vita ............................................................................................................................ v List of Tables ......................................................................................................... viii List of Figures .......................................................................................................... ix Introduction ............................................................................................................... 1 Methods............................................ .............................................................................. 4 Approach .......................................... .......................................................................... 4 Subjects ................................................................................................................ 5 Experimental Design ............................................................................................ 6 Spine Load Predictions......................................................................................... 9 Apparatus ........................................................................................................... 11 Procedure ............................................................................................................ 12 Data Processing ................................................................................................. 12 Results .................................................................................................................... 13 Models ................................................................................................................. 13

Using our ultrasound-based “Moment Monitor,” exposures to biomechanical low back disorder risk factors were quantified in 195 volunteers who worked in 50 different distribution center jobs. Low back injury rates, determined from a retrospective examination of each company's Occupational Safety and Health Administration (OSHA) 300 records over the 3-year period immediately prior to data collection, were used to classify each job's back injury risk level. The analyses focused on the factors differentiating the high-risk jobs (those having had 12 or more back injuries/200,000 hr of exposure) from the low-risk jobs (those defined as having no back injuries in the preceding 3 years). Univariate analyses indicated that measures of load moment exposure and force application could distinguish between high (n = 15) and low (n = 15) back injury risk distribution center jobs. A three-factor multiple logistic regression model capable of predicting high-risk jobs with very good sensitivity (87%) and specificity (73%) indicated that risk could be assessed using the mean across the sampled lifts of the peak forward and or lateral bending dynamic load moments that occurred during each lift, the mean of the peak push/pull forces across the sampled lifts, and the mean duration of the non-load exposure periods. A surrogate model, one that does not require the Moment Monitor equipment to assess a job's back injury risk, was identified although with some compromise in model sensitivity relative to the original model.

This panel presents near-infrared spectroscopy (NIRS) theory and its principles, and applicability of NIRS on a variety of muscle and cerebral regions during activities that demand considerable physical and mental effort. Five presentations will cover: (1) theoretical basis of NIRS; (2) NIRS-derived hemodynamic measurements in shoulder muscles during repetitive tasks; (3) development of NIRS for use in evaluating long term standing fatigue; (4) monitoring training-related changes in prefrontal cortex activation with functional NIRS; and (5) simultaneous evaluation of physical and mental work.