Association of Exposures to Seated Postures With Immediate Increases in Back Pain: A Systematic Review of Studies With Objectively Measured Sitting Time

have determined sitting time by self-report and/or LBP by recall following exposure. Given known problems with recall and the validity of estimated sitting time, we conducted a systematic review of studies using objectively measured sitting time to determine if sitting time is associated with immediate LBP in adults. Methods: Four databases (PubMed, EMBASE, SPORTDiscus and CINAHL) were searched from inception to September 1, 2018. Randomized controlled trials, cohort and cross-sectional studies, where objectively measured sitting time was temporally matched with a measure of LBP in adults, were included. Studies without a control session conducted on a separate day were excluded. Screening, full text review, data extraction and risk of bias assessment (QUIPS) of included papers were performed independently by two reviewers, with a third available to resolve disagreements. Results: In total, 609 articles were identified, 361 titles/abstracts were screened,75 full-text articles were assessed for eligibility and 10 met the inclusion criteria. All but one reported sitting time to be associated with immediate increase in LBP. Six of these reported clinically relevant pain levels (n=330). Half of the included studies were rated as having low risk of bias and the remaining as moderate risk of bias. Conclusion: Prolonged sitting increases immediate reporting of LBP in adults; however, no conclusion between sitting and clinical episodes of LBP can be made. Future prospective studies should match objectively measured sitting with temporally related pain measurements to determine whether prolonged sitting can trigger a clinical episode of LBP