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Figure 1.6 A conceptual framework for the development of WRLBD (reprinted from NRC-IOM,
psychosocial aspects of work, and especially with exposures to physical heavy work including
lifting heavy loads (Hagberg et al., 1995; Mathers, Stevens, and Mascarenhas, 2009; NIOSH, 1981,
1997; NRC-IOM, 2001; Op de Beek and Hermans, 2000).
Table 1.1 provides the occupational risk factors that are associated with LBP and their scientific
evidence. According to the Global Health Risk (GHR) report (2009), physical risk factors with
strong scientific evidence that are reported at Table 1.1 are also considered by WHO, under
the term ergonomic stressors, as the major causes of WRLBP worldwide. Hence, according to
WHO (Mathers, Stevens, and Mascarenhas, 2009), the following biomechanical risk factors are
recognized as global risk factors for disease burden because of the considerable global work
disability and work absenteeism that LBP provokes, and because of the economic and productivity
loss: (I) lifting and carrying heavy loads, (II) demanding physical work, (III) frequent bending,
and (IV) twisting and awkward postures.
However, there are epidemiological studies where occupational mechanical factors, included the
global risk factors, were reported as non-causative factors of LBP (Roffey et al., 2010a,b,c,d,e;
Wai et al., 2010a,b,c), and systematic reviews where occupational mechanical risks associated
with lifting, bending and other body actions have been reported as not effective to prevent LBP
(Balagué et al., 2012). The epidemiological approach to MSD (observational studies) has been
criticized that due to the multifactorial nature of occupational risk factors is not able to identify
single causal factors on LBP (Dagenais et al., 2012; Kuijer et al., 2012; Marras, 2000; Marras et al.,
1995). Therefore, it can be said that these studies have only recognised the strong interaction