{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T16:47:09Z","timestamp":1782146829219,"version":"3.54.5"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The aim of this systematic overview was to summarize and synthesize systematic reviews (SRs) with meta-analyses of the association between occupational mechanical exposures and low-back and lower-body musculoskeletal disorders (MSDs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A protocol was registered in PROSPERO and a systematic literature search was conducted in PubMed, Web of Science, Embase, and CINAHL. Systematic reviews were considered eligible if they included occupational mechanical exposures and provided weighted measures of association in relation to specific MSDs. Data were extracted from each SR, including databases searched, exposure, outcome, effect estimates, and quality of evidence of the association. The methodological quality of each SR was assessed using AMSTAR 2.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The screening of 1,756 articles resulted in the inclusion of 17 SRs with meta-analyses covering 7 MSDs: chronic low back pain (n = 1), lumbar spine degeneration (n = 2), lumbosacral radiculopathy (n = 1), hip osteoarthritis (n = 7), inguinal hernia (n = 1), meniscal lesions (n = 1), knee osteoarthritis (n = 4), and knee and\/or hip osteoarthritis (n = 1). Methodological quality assessment using the AMSTAR 2 tool revealed high confidence in 5 SRs, while 4 were rated as low and 8 as critically low confidence. The weighted odds ratios (OR) from the meta-analyses generally ranged between 1.3 and 2.8, although substantial heterogeneity was observed. Among the included SRs, 50% graded the certainty of evidence, and among these 60% graded it as low or very low.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This overview demonstrates that most occupational mechanical exposures show directionally consistent associations (OR &amp;gt;1) with an increased risk of developing lower-body MSDs. However, as the quality of evidence was generally graded as low, the true effect may be substantially different from the reported estimates. Future research should prioritize prospective studies and objective exposure assessments to strengthen the quality of evidence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/annweh\/wxag045","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T11:21:17Z","timestamp":1780917677000},"source":"Crossref","is-referenced-by-count":0,"title":["The association between occupational mechanical exposures and low-back and lower-body musculoskeletal disorders: an overview of systematic reviews"],"prefix":"10.1093","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6806-0371","authenticated-orcid":false,"given":"Alexander","family":"Jahn","sequence":"first","affiliation":[{"name":"Department of Occupational and Environmental Medicine, Danish Ramazzini Centre, Aarhus University Hospital , Palle Juul-Jensens Boulevard 99, Aarhus 8200 ,","place":["Denmark"]},{"name":"Department of Clinical Medicine, Aarhus University , Palle Juul-Jensens Boulevard 99, Aarhus 8200 ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6251-0310","authenticated-orcid":false,"given":"Claus","family":"Kj\u00e6rgaard","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, Aalborg University , Selma Lagerl\u00f8fs Vej 249, Gistrup 9260 ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0085-333X","authenticated-orcid":false,"given":"Bradley","family":"Evanoff","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Washington University in St.Louis , 660 South Euclid Avenue, St. Louis, MO 63130 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0070-6916","authenticated-orcid":false,"given":"Frederik Kronvold","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Department of Occupational and Environmental Medicine, Danish Ramazzini Centre, Aarhus University Hospital , Palle Juul-Jensens Boulevard 99, Aarhus 8200 ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6028-3186","authenticated-orcid":false,"given":"Alexis","family":"Descatha","sequence":"additional","affiliation":[{"name":"Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en sant\u00e9, environnement et travail) - UMR_S 1085, IRSET-ESTER, SFR ICAT, CAPTV, Prevention , 28 rue Amsler, 49000 Angers ,","place":["France"]},{"name":"Indiana University School of Public Health , Bloomington, IN ,","place":["United States"]},{"name":"Donald and Barbara Zucker School of Medicine, Hofstra Univ Northwell Health , Hampstead, NY 11549 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1638-8276","authenticated-orcid":false,"given":"Johan Hviid","family":"Andersen","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, Aarhus University , Palle Juul-Jensens Boulevard 99, Aarhus 8200 ,","place":["Denmark"]},{"name":"Department of Occupational Medicine, Danish Ramazzini Centre, University Research Clinic, Goedstrup Hospital , Hospitalsparken 15, Herning 7400 ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8657-1688","authenticated-orcid":false,"given":"Annett","family":"Dalb\u00f8ge","sequence":"additional","affiliation":[{"name":"Department of Occupational and Environmental Medicine, Danish Ramazzini Centre, Aarhus University Hospital , Palle Juul-Jensens Boulevard 99, Aarhus 8200 ,","place":["Denmark"]},{"name":"Department of Clinical Medicine, Aarhus University , Palle Juul-Jensens Boulevard 99, Aarhus 8200 ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"key":"2026062211490626400_wxag045-B1","doi-asserted-by":"publisher","first-page":"1042","DOI":"10.1186\/s12891-021-04900-7","article-title":"Occupational risk factors for meniscal lesions: a systematic review and meta-analysis","volume":"22","author":"Bahns","year":"2021","journal-title":"BMC Musculoskelet Disord"},{"key":"2026062211490626400_wxag045-B2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjmed-2021-000071","article-title":"Conducting umbrella reviews","volume":"1","author":"Belbasis","year":"2022","journal-title":"BMJ Med"},{"key":"2026062211490626400_wxag045-B3","doi-asserted-by":"publisher","first-page":"581","DOI":"10.3238\/arztebl.2017.0581","article-title":"Occupational strain as a risk for hip osteoarthritis","volume":"114","author":"Bergmann","year":"2017","journal-title":"Dtsch Arztebl Int"},{"key":"2026062211490626400_wxag045-B4","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1002\/jrsm.1557","article-title":"Graphical representation of overlap for OVErviews: GROOVE tool","volume":"13","author":"Bracchiglione","year":"2022","journal-title":"Res Synth Methods"},{"key":"2026062211490626400_wxag045-B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.apergo.2020.103097","article-title":"Risk factors for development of lower limb osteoarthritis in physically demanding occupations: a systematic review and meta-analysis","volume":"86","author":"Canetti","year":"2020","journal-title":"Appl Ergon"},{"key":"2026062211490626400_wxag045-B6","doi-asserted-by":"publisher","first-page":"3","DOI":"10.12997\/jla.2023.12.1.3","article-title":"Introduction to Umbrella reviews as a useful evidence-based practice","volume":"12","author":"Choi","year":"2023","journal-title":"J Lipid Atheroscler"},{"key":"2026062211490626400_wxag045-B7","doi-asserted-by":"publisher","first-page":"2006","DOI":"10.1016\/S0140-6736(20)32340-0","article-title":"Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"396","author":"Cieza","year":"2021","journal-title":"Lancet"},{"key":"2026062211490626400_wxag045-B8","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1002\/ajim.20750","article-title":"Risk factors for work-related musculoskeletal disorders: a systematic review of recent longitudinal studies","volume":"53","author":"da Costa","year":"2010","journal-title":"Am J Ind Med"},{"key":"2026062211490626400_wxag045-B9","volume-title":"Work-related musculoskeletal disorders: prevalence, costs and demographics in the EU","author":"de Kok","year":"2019"},{"key":"2026062211490626400_wxag045-B10","doi-asserted-by":"publisher","first-page":"996","DOI":"10.1093\/eurjcn\/zvaf012","article-title":"Umbrella reviews: a methodological guide","volume":"24","author":"Fernandez","year":"2025","journal-title":"Eur J Cardiovasc Nurs"},{"key":"2026062211490626400_wxag045-B11","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2022-070849","article-title":"Reporting guideline for overviews of reviews of healthcare interventions: development of the PRIOR statement","volume":"378","author":"Gates","year":"2022","journal-title":"BMJ"},{"key":"2026062211490626400_wxag045-B12","doi-asserted-by":"publisher","first-page":"2356","DOI":"10.1016\/S0140-6736(18)30480-X","article-title":"What low back pain is and why we need to pay attention","volume":"391","author":"Hartvigsen","year":"2018","journal-title":"Lancet"},{"key":"2026062211490626400_wxag045-B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2020.106349","article-title":"The effect of occupational exposure to ergonomic risk factors on osteoarthritis of hip or knee and selected other musculoskeletal diseases: a systematic review and meta-analysis from the WHO\/ILO Joint Estimates of the Work-related Burden of Disease and Injury","volume":"150","author":"Hulshof","year":"2021","journal-title":"Environ Int"},{"key":"2026062211490626400_wxag045-B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2020.106157","article-title":"The prevalence of occupational exposure to ergonomic risk factors: a systematic review and meta-analysis from the WHO\/ILO Joint Estimates of the Work-related Burden of Disease and Injury","volume":"146","author":"Hulshof","year":"2021","journal-title":"Environ Int"},{"key":"2026062211490626400_wxag045-B15","doi-asserted-by":"publisher","first-page":"453","DOI":"10.5271\/sjweh.4114","article-title":"Occupational mechanical exposures as risk factor for chronic low-back pain: a systematic review and meta-analysis","volume":"49","author":"Jahn","year":"2023","journal-title":"Scand J Work Environ Health"},{"key":"2026062211490626400_wxag045-B16","doi-asserted-by":"publisher","first-page":"244","DOI":"10.5271\/sjweh.4152","article-title":"Hip osteoarthritis and occupational mechanical exposures: a systematic review and meta-analysis","volume":"50","author":"Jahn","year":"2024","journal-title":"Scand J Work Environ Health"},{"key":"2026062211490626400_wxag045-B17","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1212\/01.wnl.0000544322.26939.09","article-title":"Work-relatedness of lumbosacral radiculopathy syndrome: review and dose-response meta-analysis","volume":"91","author":"Kuijer","year":"2018","journal-title":"Neurology"},{"key":"2026062211490626400_wxag045-B18","doi-asserted-by":"publisher","first-page":"943","DOI":"10.1007\/s10029-020-02236-0","article-title":"Work-relatedness of inguinal hernia: a systematic review including meta-analysis and GRADE","volume":"24","author":"Kuijer","year":"2020","journal-title":"Hernia"},{"key":"2026062211490626400_wxag045-B19","doi-asserted-by":"publisher","first-page":"691","DOI":"10.3233\/BMR-181350","article-title":"The association between whole body vibration exposure and spine degeneration on imaging: a systematic review","volume":"35","author":"Macedo","year":"2022","journal-title":"J Back Musculoskelet Rehabil"},{"key":"2026062211490626400_wxag045-B20","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1186\/s12891-019-2835-2","article-title":"The association between occupational loading and spine degeneration on imaging\u2014a systematic review and meta-analysis","volume":"20","author":"Macedo","year":"2019","journal-title":"BMC Musculoskelet Disord"},{"key":"2026062211490626400_wxag045-B21","doi-asserted-by":"publisher","first-page":"829","DOI":"10.1016\/j.joca.2011.02.016","article-title":"Occupational risk factors for osteoarthritis of the knee: a meta-analysis","volume":"19","author":"McWilliams","year":"2011","journal-title":"Osteoarthritis Cartilage"},{"key":"2026062211490626400_wxag045-B22","volume-title":"Cochrane handbook for systematic reviews of interventions version 6.5.","author":"Pollock","year":"2024"},{"key":"2026062211490626400_wxag045-B23","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.jelekin.2003.09.015","article-title":"Work-related musculoskeletal disorders: the epidemiologic evidence and the debate","volume":"14","author":"Punnett","year":"2004","journal-title":"J Electromyogr Kinesiol"},{"key":"2026062211490626400_wxag045-B24","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0269009","article-title":"Methodological approaches for assessing certainty of the evidence in umbrella reviews: a scoping review","volume":"17","author":"Sadoyu","year":"2022","journal-title":"PLoS One"},{"key":"2026062211490626400_wxag045-B25","doi-asserted-by":"publisher","DOI":"10.1002\/1348-9585.12103","article-title":"Risk factors for development of lower limb osteoarthritis in physically demanding occupations: a narrative umbrella review","volume":"62","author":"Schram","year":"2020","journal-title":"J Occup Health"},{"key":"2026062211490626400_wxag045-B26","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1186\/s12891-018-2085-8","article-title":"Dose-response relationship between cumulative physical workload and osteoarthritis of the hip\u2014a meta-analysis applying an external reference population for exposure assignment","volume":"19","author":"Seidler","year":"2018","journal-title":"BMC Musculoskelet Disord"},{"key":"2026062211490626400_wxag045-B27","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j4008","article-title":"AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both","volume":"358","author":"Shea","year":"2017","journal-title":"BMJ"},{"key":"2026062211490626400_wxag045-B28","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph16193681","article-title":"Exposure\u2013response relationship and doubling risk doses\u2014a systematic review of occupational workload and osteoarthritis of the hip","volume":"16","author":"Sun","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"2026062211490626400_wxag045-B29","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph16030322","article-title":"Hip osteoarthritis and physical workload: influence of study quality on risk estimations\u2014a meta-analysis of epidemiological findings","volume":"16","author":"Sun","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"2026062211490626400_wxag045-B30","doi-asserted-by":"publisher","first-page":"109312","DOI":"10.1016\/j.jbiomech.2019.08.006","article-title":"No consensus on causality of spine postures or physical exposure and low back pain: a systematic review of systematic reviews","volume":"102","author":"Swain","year":"2020","journal-title":"J Biomech"},{"key":"2026062211490626400_wxag045-B31","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1186\/s12995-022-00358-y","article-title":"Influence of physically demanding occupations on the development of osteoarthritis of the hip: a systematic review","volume":"17","author":"Unverzagt","year":"2022","journal-title":"J Occup Med Toxicol"},{"key":"2026062211490626400_wxag045-B32","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1016\/j.shaw.2017.02.001","article-title":"Occupational exposure to knee loading and the risk of osteoarthritis of the knee: a systematic review and a dose-response meta-analysis","volume":"8","author":"Verbeek","year":"2017","journal-title":"Saf Health Work."},{"key":"2026062211490626400_wxag045-B33","doi-asserted-by":"publisher","first-page":"1213","DOI":"10.1002\/acr.24333","article-title":"Occupational risk in knee osteoarthritis: a systematic review and meta-analysis of observational studies","volume":"72","author":"Wang","year":"2020","journal-title":"Arthritis Care Res."},{"key":"2026062211490626400_wxag045-B34","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1186\/s12916-018-1151-2","article-title":"Musculoskeletal conditions may increase the risk of chronic disease: a systematic review and meta-analysis of cohort studies","volume":"16","author":"Williams","year":"2018","journal-title":"BMC Med"},{"key":"2026062211490626400_wxag045-B35","volume-title":"ICD-10: international statistical classification of diseases and related health problems: tenth revision","author":"World Health Organization","year":"2004","edition":"2nd ed"}],"container-title":["Annals of Work Exposures and Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/annweh\/article-pdf\/70\/5\/wxag045\/68575697\/wxag045.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/annweh\/article-pdf\/70\/5\/wxag045\/68575697\/wxag045.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T15:49:15Z","timestamp":1782143355000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/annweh\/article\/doi\/10.1093\/annweh\/wxag045\/8713233"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,3]]},"references-count":35,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,6,3]]}},"URL":"https:\/\/doi.org\/10.1093\/annweh\/wxag045","relation":{},"ISSN":["2398-7308","2398-7316"],"issn-type":[{"value":"2398-7308","type":"print"},{"value":"2398-7316","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,7]]},"published":{"date-parts":[[2026,6,3]]},"article-number":"wxag045"}}