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a causal link between injury or disease and disability. Taking into considerations the previous
criticisms, the last GBD study has improved the “disability weights” values (Hoy et al., 2010).
Moreover, it is reported that “disability weights” are very consistent among different cultural
environments (Salomon et al., 2013).
WRLBP causes considerable morbidity and it is a major cause of work absenteeism, resulting in
economic and productivity loss. According to the rationale of disability adjusted life year (DALY),
the so far prevention policies of WRMSD were not effective to reduce work disability (Institute for
Health Metrics and Evaluation, 2013b). The Institute for Health Metrics and Evaluation (2013b)
argues, that demographic changes, longevity and prior health policies changed the global view
of health loss. The risk factors for health loss shifted from communicable to non-communicable
diseases and from fatality to disability, whereas the objective consists to live longer, free of disease
and with less disability (Institute for Health Metrics and Evaluation, 2013b).
Work-Related Risk Factors and Causality for Low Back Pain
Figure 1.6 shows the conceptual framework of physiological pathways and factors that potentially
contribute to the development of WRLBD as adopted by EU-OSHA and NRC-IOM. It is centered
on the load-tolerance relationship (Radwin, Marras, and Lavender, 2002), whereas “load” was
defined as the physical stresses acting on the body, or on anatomical structure within the body,
and are developed by (I) mechanical loads of kinetic and kinematic origin, (II) heat loss and
(III) transmission of vibrations, resulted either from the external environment or internally from
the neuromusculoskeletal system, and “tolerance” was defined as the capacity of physiological
and physical responses of the tissues to the loading (Radwin, Marras, and Lavender, 2002).
The conceptual model can be devided into two periods following nomenclature of previous
generic exposure-outcome models (Armstrong et al., 1993; Hagberg et al., 1995), (A) the
prepathogenesis period, which includes the workplace features and the individuals risk factors,
and (B) the pathogenesis period, which comprises the pathophysiology (biomechanical loading
and internal tolerances) and the outcomes (pain, discomfort, impairment, disability).
Work-Related Risk Factors for Low Back Pain
According to the conceptual model of Fig. 1.6, at the prepathogenesis period, the worker is exposed
to risk factors that are induced by the work environment and which may trigger a pathological
condition. The occupational risk factors that are potentially precursors of triggering a pathological
condition resulting to MSD are divided into physical, psychosocial, organizational and individual
factors. The prepathogenesis period is a conceptual scheme of the invloved pathways to LBP
based on epidemiological and critical analyses evidence. Many epidemiological studies have been
performed in order to identify occupational factors that are associated either negatively or positively
with the development of WRMSD. Critical reviews of the epidemiologic evidence associated with
WRMSD and pattern of evidence analyses performed from different organizations, authoritative
agencies and national institutes (WHO, EU-OSHA, NRC-IOM, NIOSH, etc.) reported that there
is a strong evidence of work-relatedness of LBP that supports its relation with the physical and