Combined effect of back pain and stress on work ability

Occup Med (Lond). 2015 Mar;65(2):147-53. doi: 10.1093/occmed/kqu190. Epub 2015 Jan 29.


Background: Back pain and occupational stress are known risk factors for absenteeism and presenteeism. In addition, the relationship between back pain (BP) and psychosocial stressors has been examined in numerous studies.

Aims: To examine the prevalence of BP and perceived stress among employees of different occupational status and to investigate their combined impact on work ability.

Methods: A comprehensive survey combining questionnaire data and medical examination offered in one division of a major chemical company in Germany. Self-rated health and work ability were assessed using the Work Ability Index (WAI). A synergy index was used to assess a potential interaction between both exposures under an additive model.

Results: Of 867 voluntary participants, 653 returned complete questionnaires on BP and job stress perception. Although occupational stressors were perceived differently, there was no difference in the prevalence of BP between the occupational groups. Back pain and stress perception are correlated with each other and both are negatively associated with work ability. After adjustment for occupational status, demographic and lifestyle factors, we found a synergy effect of BP and stress perception with a modest to strong impact on declining WAI.

Conclusions: Corporate health promotion interventions to reduce the impact of BP and stress perception on work ability should target both physical and psychological dimensions. Such interventions may be initiated in the context of regular (occupational) medical examinations.

Keywords: Back pain; Work Ability Index (WAI).; combined effect; corporate health promotion; cross-sectional study; stress perception; synergy index.

MeSH terms

  • Absenteeism
  • Adult
  • Back Pain / epidemiology*
  • Back Pain / etiology
  • Back Pain / psychology
  • Cross-Sectional Studies
  • Female
  • Germany / epidemiology
  • Humans
  • Male
  • Occupational Diseases / epidemiology*
  • Occupational Diseases / physiopathology
  • Occupational Diseases / psychology
  • Occupational Health*
  • Prevalence
  • Risk Factors
  • Stress, Psychological / epidemiology*
  • Stress, Psychological / etiology
  • Stress, Psychological / psychology
  • Surveys and Questionnaires
  • Work Capacity Evaluation*