Bias and Power in Group-Based Epidemiologic Studies of Low-Back Pain Exposure and Outcome - Effects of Study Size and Exposure Measurement Efforts

被引:6
作者
Coenen, Pieter [1 ,3 ]
Mathiassen, Svend Erik [4 ]
Kingma, Idsart [2 ,3 ]
Boot, Cecile R. L. [3 ,5 ]
Bongers, Paulien M. [3 ,6 ]
van Dieen, Jaap H. [2 ,7 ]
机构
[1] Curtin Univ, Sch Physiotherapy & Exercise Sci, Perth, WA, Australia
[2] Vrije Univ Amsterdam, Fac Human Movement Sci, MOVE Res Inst Amsterdam, NL-1081 BT Amsterdam, Netherlands
[3] Res Ctr Phys Act Work & Hlth, Body Work, Amsterdam, Netherlands
[4] Univ Gavle, Ctr Musculoskeletal Res, Dept Occupat & Publ Hlth Sci, SE-80176 Gavle, Sweden
[5] Vrije Univ Amsterdam, Med Ctr, EMGO Inst Hlth & Care Res, Dept Publ & Occupat Hlth, NL-1081 BT Amsterdam, Netherlands
[6] TNO Healthy Living, NL-2316 ZL Leiden, Netherlands
[7] King Abdulaziz Univ, Jeddah 21589, Saudi Arabia
基金
瑞典研究理事会;
关键词
epidemiology; ergonomics; exposure; exposure assessment; group-based measurement strategy; low-back pain; musculoskeletal injury; precision; UPPER ARM ELEVATION; PROSPECTIVE COHORT; RISK-FACTORS; MEASUREMENT ERROR; OCCUPATIONAL EPIDEMIOLOGY; MUSCULOSKELETAL DISORDERS; ERGONOMIC EPIDEMIOLOGY; ASSESSMENT STRATEGIES; MECHANICAL EXPOSURE; RESPONSE RELATIONS;
D O I
10.1093/annhyg/meu102
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Objectives: Exposure-outcome studies, for instance on work-related low-back pain (LBP), often classify workers into groups for which exposures are estimated from measurements on a sample of workers within or outside the specific study. The present study investigated the influence on bias and power in exposure-outcome associations of the sizes of the total study population and the sample used to estimate exposures. Methods: At baseline, lifting, trunk flexion, and trunk rotation were observed for 371 of 1131 workers allocated to 19 a-priori defined occupational groups. LBP (dichotomous) was reported by all workers during 3 years of follow-up. All three exposures were associated with LBP in this parent study (P < 0.01). All 21 combinations of n = 10, 20, 30 workers per group with an outcome, and k = 1, 2, 3, 5, 10, 15, 20 workers actually being observed were investigated using bootstrapping, repeating each combination 10 000 times. Odds ratios (OR) with P values were determined for each of these virtual studies. Average OR and statistical power (P < 0.05 and P < 0.01) was determined from the bootstrap distributions at each (n, k) combination. Results: For lifting and flexed trunk, studies including n = 20 workers, with k = 5 observed, led to an almost unbiased OR and a power >0.80 (P level = 0.05). A similar performance required n = 30 workers for rotated trunk. Small numbers of observed workers (k) resulted in biased OR, while power was, in general, more sensitive to the total number of workers (n). Conclusions: In epidemiologic studies using a group-based exposure assessment strategy, statistical performance may be sufficient if outcome is obtained from a reasonably large number of workers, even if exposure is estimated from only few workers per group.
引用
收藏
页码:439 / 454
页数:16
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