Objective: The purpose of this study was to conduct a systematic review of studies to determine whether sitting time measured objectively (by laboratory controlled time trial, direct observation, or wearable sensor) is associated with the immediate increase in low back pain (LBP) (determined by pain scale rating) in people >18 years of age.
Methods: Four databases (PubMed, EMBASE, SPORTDiscus, and Cumulative Index to Nursing and Allied Health Literature) were searched from inception to September 1, 2018. Randomized controlled trials and cohort and cross-sectional studies, where objectively measured sitting time was temporally matched with a measure of LBP in adults, were included. Studies without a control session conducted on a separate day were excluded. Screening, full-text review, data extraction, and risk of bias assessment (Quality In Prognosis Studies) of included papers were performed independently by 2 reviewers, with a third available to resolve disagreements.
Results: In total, 609 articles were identified, 361 titles/abstracts were screened,75 full-text articles were assessed for eligibility, and 10 met the inclusion criteria. All but 1 reported sitting time to be associated with an immediate increase in LBP. Six of these reported clinically relevant pain levels (n = 330). Half of the included studies were rated as having a low risk of bias and the remaining were rated as having a moderate risk of bias.
Conclusion: Prolonged sitting increases immediate reporting of LBP in adults; however, no conclusion between sitting and clinical episodes of LBP can be made. Based upon these findings, we recommend that future prospective studies should match objectively measured sitting with temporally related pain measurements to determine whether prolonged sitting can trigger a clinical episode of LBP.
Keywords: Low Back Pain, Sitting Position, Sedentary Behavior, Time Factors, Occupational Diseases, Accelerometry, Actigraphy, Pain Measurement; Risk Factors.
Author affiliations: DEDC: Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada; KdL: Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, New South Wales, Australia; MF: Division of Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada; AB: Centre for Biomechanics Research, AECC University College, Bournemouth, United Kingdom; AYLW: Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China; MSJ: Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Musculoskeletal Disorders and Physical Workload, The National Research Centre for the Working Environment, Copenhagen, Denmark; MLF: Institute of Bone and Joint Research, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; MS: Health Science Library, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada; GNK: Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada; JA: Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia; JH: Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark.
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