Does occupational forward bending of the back increase long-term sickness absence risk? A 4-year prospective register-based study using device-measured compositional data analysis

Objective Forward bending of the back is common in many jobs and a risk factor for sickness absence. However, this knowledge is based on self-reported forward bending that is generally imprecise. Thus, we aimed to investigate the dose-response relation between device-measured forward bending at work and prospective register-based risk of long-term sickness absence (LTSA). Methods At baseline, 944 workers (93% from blue-collar jobs) wore accelerometers on their upper back and thigh over 1-6 workdays to measure worktime with forward bending (>30° and >60°) and body positions. The first event of LTSA (>6 consecutive weeks) over a 4-year follow-up were retrieved from a national register. Compositional Cox proportional hazard analyses were used to model the association between worktime with forward bending of the back in an upright body position and LTSA adjusted for age, sex, body mass index (BMI), occupational lifting/ carrying, type of work, and, in an additional step, for leisure time physical activity (PA) on workdays. Results During a mean worktime of 457 minutes/day, the workers on average spent 40 and 10 minutes on forward bending >30° and >60° in the upright position, respectively. Five more minutes forward bending >30° and >60° at work were associated with a 4% [95% confidence interval (CI) 1.01-1.07] and 8% (95% CI 1.01-1.16) higher LTSA risk, respectively. Adjustment for leisure-time PA did not influence the results. Conclusion We found a dose-response association between device-measured forward bending of the back and prospective LTSA risk. This knowledge can be integrated into available feasible methods to measure forward bending of the back for improved workplace risk assessment and prevention.