The efficacy of interventions for low back pain in nurses: A systematic review

Association between high fear-avoidance beliefs about physical activity and chronic disabling low back pain in nurses in Japan

Background

High prevalence of low back pain (LBP) in nurses has been reported globally. Ergonomic factors and work-related psychosocial factors have been focused on as risk factors. However, evidence on the role of fear-avoidance beliefs (FABs) concerning LBP in nurses is lacking. This study examined LBP prevalence and the association between FABs and chronic disabling LBP that interfered with work and lasted ≥ 3 months.

Methods

Female nurses (N = 3066; mean age = 35.8 ± 10.6 years) from 12 hospitals in Japan participated. A self-reported questionnaire was used to collect information on sociodemographics, LBP, work-related factors, and psychological distress. FABs about physical activity were assessed using a subscale from the FAB Questionnaire (score range = 0–24). The participants were asked to choose one of four statements regarding their LBP in the past 4 weeks: 1) I did not have LBP, 2) I had LBP without work difficulty, 3) I had LBP with work difficulty but without requiring absence from work, and 4) I had LBP requiring absence from work. If the participant had LBP in the past 4 weeks, it was also inquired if the LBP had lasted for ≥ 3 months. Chronic disabling LBP was defined as experiencing LBP with work difficulty in the past 4 weeks which had lasted for ≥ 3 months. In the nurses who had experienced any LBP in the past 4 weeks, we examined the association between FABs and experiencing chronic disabling LBP using multiple logistic regression models adjusting for pain intensity, age, body mass index, smoking status, psychological distress, hospital department, weekly work hours, night shift work, and the12 hospitals where the participants worked.

Results

Four-week and one-year LBP prevalence were 58.7 and 75.9%, respectively. High FABs (≥ 15) were associated with chronic disabling LBP (adjusted odds ratio = 1.76, 95% confidence interval [1.21–2.57], p = 0.003).

Conclusions

LBP is common among nurses in Japan. FABs about physical activity might be a potential target for LBP management in nurses.

Trial registration

UMIN-CTR UMIN000018087. Registered: June 25, 2015.

Factors associated with disabling low back pain among nursing personnel at a medical centre in Japan: a comparative cross-sectional survey

OBJECTIVES

Low back pain (LBP) is a common cause of disability among nursing personnel. Although many studies regarding the risk factors for LBP among nursing staff have focused on the physical load at work, multidimensional assessments of risk factors are essential to identify appropriate preventive strategies. We aimed to investigate the association of multidimensional factors (individual, physical, psychological and occupational) with disabling LBP among nursing personnel in Japan.

DESIGN

Observational study with comparative cross-sectional design.

SETTING

Data were collected using the self-administered questionnaire at a tertiary medical centre.

PARTICIPANTS

After excluding participants with missing variables, 718 nursing personnel were included in the analysis.

OUTCOME MEASURES

A self-administered questionnaire assessed individual characteristics, rotating night shift data, severity of LBP, previous episode of LBP, sleep problem, kinesiophobia (Tampa Scale for Kinesiophobia), depressive condition (K6), physical flexibility and frequency of lifting at work. A logistic regression model was used to evaluate the factors associated with disabling LBP (LBP interfering with work) among nursing personnel.

RESULTS

Of all participants, 110 (15.3%) reported having disabling LBP. The multivariable logistic regression analysis after adjustment for several confounding factors showed that kinesiophobia (highest tertile, adjusted OR (aOR): 6.13, 95% CI : 3.34 to 11.27), previous episode of LBP (aOR: 4.31, 95% CI: 1.50 to 12.41) and insomnia (aOR: 1.66, 95% CI: 1.05 to 2.62) were significantly associated with disabling LBP.

CONCLUSIONS

The present study indicated that kinesiophobia, a previous episode of LBP, and sleep problems were associated with disabling LBP among nursing personnel. In the future, workplace interventions considering assessments of these factors may reduce the incidence of disabling LBP in nursing staff, although further prospective studies are needed.

Work-Related Burdens and Requirements for Health Promotion Programs for Nursing Staff in Different Care Settings: A Cross-Sectional Study

Nursing staff in all settings have multiple work-related problems due to patient handling and occupational stressors, which result in high stress levels and low back pain. In this context the importance of health promotion becomes apparent. The aim of this study is to analyse whether nursing staff (in elderly care, hospitals, home care, or trainees) show different levels of work-related burdens and whether they require individualized components in health promotion programs. N = 242 German nurses were included in a quantitative survey (Health survey, Screening Scale (SSCS) of Trier Inventory for Chronic Stress, Slesina). The differences were tested using Chi²-Tests, Kruskal–Wallis Test and one-way ANOVA. Nurses differed in stress loads and were chronically stressed (F₍₃₂₃₆₎ = 5.775, p = 0.001). Nurses in home care showed the highest SSCS-values with time pressure as the most important straining factor. The physical strains also placed a particular burden on nurses in home care, whereas they still reported higher physical well-being in contrast to nurses in elderly care (Chi² = 24.734, p < 0.001). Nurses in elderly care and home care preferred strength training whereas nurses in hospitals and trainees favoured endurance training. Targeted programs are desirable for the reduction of work-related burdens. While nurses in elderly care and home care need a combination of ergonomic and strength training, all nurses require additional stress management. Planning should take into account barriers like perceived additional time consumption. Therefore, health promotion programs for all settings should be implemented during working time at the work setting and should consider the working schedule.

Evaluation of implicit associations between back posture and safety of bending and lifting in people without pain

Background and aims Despite lack of support from recent in vivo studies, bending and lifting (especially with a round-back posture) are perceived as dangerous to the back. In light of this view, it has been proposed that pain-free people may hold a common implicit belief that is congruent with the idea that bending and lifting with a round-back represents danger to a person's back, however this has not been evaluated. The aims of this study were: (1) to evaluate implicit associations between back posture and safety related to bending and lifting in pain-free people; (2) to explore correlations between the implicit measure and explicit measures of back beliefs, fear of movement and safety of bending; (3) to investigate self-reported qualitative appraisal of safe lifting. Methods Exploratory cross-sectional study including 67 pain-free participants (no pain, or average pain ≤3/10 for less than one week over the previous 12 months) (52% male), who completed an online survey containing demographic data and self-reported measures of: fear of movement (Tampa Scale for Kinesiophobia for General population - TSK-G), back beliefs (Back Pain Attitudes Questionnaire BackPAQ), and bending beliefs (Bending Safety Belief - BSB - a pictorial scale with images of a person bending/lifting with round and straight back postures). Implicit associations between back posture and safety related to bending and lifting were evaluated with the Implicit Association Test (IAT). A qualitative assessment of descriptions of safe lifting was performed. Results An implicit association between "danger" and "round-back" bending/lifting was evident in all participants (IATD-score=0.65 (SD=0.45; 95% CI [0.54, 0.76]). Participants' profile indicated high fear of movement, unhelpful back beliefs, and perceived danger to round-back bending and lifting (BSBThermometer: 5.2 (SD=3.8; 95% CI [4.26, 6.13] range -10 to 10; t(67)=11.09, p<0.001). There was a moderate correlation between IAT and BSBThermometer (r=0.38, 95% CI [0.16, 0.62]). There were weaker and non-statistically significant correlations between IAT and TSK-G (r=0.28, 95% CI [-0.02, 0.47]), and between IAT and BackPAQDanger (r=0.21, 95% CI [-0.03, 0.45]). Qualitative assessment of safe lifting descriptions indicated that keeping a "straight back" and "squatting" when lifting were the most common themes. Conclusions Pain-free people displayed an implicit bias towards bending and lifting with a "round-back" as dangerous. Our findings support the idea that pain-free people may have a pre-existing belief about lifting, that the back is in danger when rounded. Research to evaluate the relationship between this implicit bias and lifting behaviour is indicated. Implications The findings of this study may have implications for ergonomic guidelines and public health information related to bending and lifting back postures. Additionally, clinicians may need to be aware of this common belief, as this may be reflected in how a person responds when they experience pain.

Neuromuscular exercise reduces low back pain intensity and improves physical functioning in nursing duties among female healthcare workers; secondary analysis of a randomised controlled trial

Background

Low back pain (LBP) is common among healthcare workers, whose work is physically strenuous and thus demands certain levels of physical fitness and spinal control. Exercise is the most frequently recommended treatment for LBP. However, exercise interventions targeted at sub-acute or recurrent patients are scarce compared to those targeted at chronic LBP patients. Our objective was to examine the effects of 6 months of neuromuscular exercise on pain, lumbar movement control, fitness, and work-related factors at 6- and 12-months’ follow-up among female healthcare personnel with sub-acute or recurrent low back pain (LBP) and physically demanding work.

Methods

A total of 219 healthcare workers aged 30–55 years with non-specific LBP were originally allocated to four groups (exercise, counselling, combined exercise and counselling, control). The present study is a secondary analysis comparing exercisers (n = 110) vs non-exercisers (n = 109). Exercise was performed twice a week (60 min) in three progressive stages focusing on controlling the neutral spine posture. The primary outcome was intensity of LBP. Secondary outcomes included pain interfering with work, lumbar movement control, fitness components, and work-related measurements. Between-group differences were analysed with a generalised linear mixed model according to the intention-to-treat principle. Per-protocol analysis compared the more exercised to the less exercised and non-exercisers.

Results

The mean exercise attendance was 26.3 (SD 12.2) of targeted 48 sessions over 24 weeks, 53% exercising 1–2 times a week, with 80% (n = 176) and 72% (n = 157) participating in 6- and in 12-month follow-up measurements, respectively. The exercise intervention reduced pain (p = 0.047), and pain interfering with work (p = 0.046); improved lumbar movement control (p = 0.042), abdominal strength (p = 0.033) and physical functioning in heavy nursing duties (p = 0.007); but had no effect on other fitness and work-related measurements when compared to not exercising. High exercise compliance resulted in less pain and better lumbar movement control and walking test results.

Conclusion

Neuromuscular exercise was effective in reducing pain and improving lumbar movement control, abdominal strength, and physical functioning in nursing duties compared to not exercising.

Electronic supplementary material

The online version of this article (10.1186/s12891-019-2678-x) contains supplementary material, which is available to authorized users.

The Back College for nurses - an evaluation of intermediate effects

BACKGROUND

Nursing staff and care workers run an increased risk of work related musculoskeletal disorders such as low back pain. The Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW) offers its insured persons the opportunity to participate in a three-week Back College with the aim of preventing them having to abandon their profession due to back problems. The aim of the study was to record the effectiveness and sustainability of the Back College on an intermediate basis (6 months).

METHODS

As part of a single-group pre-post measurement on three survey dates - at the start (T0) and end (T1) of rehabilitation and 6 months later (T2) - in 2013 all participants in the Back College at three locations were surveyed using a standard questionnaire. Wilcoxon signed-rank tests were performed to evaluate statistically significant changes.

RESULTS

For measurement dates T0 to T2 we had 570 complete datasets (response rate 70.81%). There was a significant decrease in reported back pain and the general state of health and quality of life index improved. Participants' emotional strain decreased and they showed an improved understanding of illness as well as of having acquired knowledge-based abilities and skills for dealing with the disease. After training, they recorded back-friendly behaviour in everyday life and opportunities to relieve strain on the spinal column were utilised at work more often. Participants' subjective assessment of their ability to work (Work Ability Index) improved.

CONCLUSION

The present study proved the intermediate effectiveness of the Back College curriculum. Whether these effects remain stable in the long term will be tested on the subsequent measurement date (T3, after 24 months).

Influence of isostretching on patients with chronic low back pain. A randomized controlled trial

Objective: This study investigated the influence of isostretching on patients with chronic low back pain. Methods: It was a randomized, controlled trial with concealed allocation, intention-to-treat analysis, and blind assessment. Fifty-four patients with chronic low back pain were randomized to an experimental group and a control group. The experimental group performed isostretching twice a week for 45 days, while the control group remained on the waiting list for physical therapy. Patients were submitted to evaluations at baseline, after 20 and 45 days of treatment with regard to pain, quality of life, functional capacity, and satisfaction. Results: The experimental group exhibited statistically significant improvements in comparison to the control group with regard to pain (p = .003), functional capacity (p = .026), patient satisfaction (p < .001), and quality of life as determined by the functional capacity (p = .012), physical aspects (p = .011) and pain (p = .006) subscales of the SF-36. The experimental group used a significantly lesser amount of pain medication than the control group (p = .03). Conclusion: Isostretching was effective in reducing pain and in improving function, patient satisfaction and some aspects of quality of life in patients with chronic low back pain.

Effectiveness of the back school program on the low back pain and functional disability of Iranian nurse

Low back pain (LBP) as a recurrent and costly health problem and one of the leading causes of disability, is common in nurses. It can have adverse effects on the quality of life of nurses and quality of care of patients. The aim of the study was to evaluate the effectiveness of Back School program on the LBP and functional disability of Iranian nurses. A quasi-experimental methodological design was utilized for this study. Participants were nurses with back pain who participated in the Back School program workshop and completed a self-report visual analogue scales and Roland–Morris Disability questionnaire that measuring LBP and functional disability. Data were analyzed descriptively and comparisons in LBP and functional disability made between groups with t-test for pre-intervention and analysis of covariance for after intervention. Sixty-four participants (16 males, 48 females) completed this survey. The study participants’ mean age was 38.9 ± 8.1 years in intervention group and 38.1 ± 8.2 in control group. There were no significant differences in terms of pain (P = 0.575) and disability scores (P = 0.844) before intervention. Although, the intervention led to a decrease in the functional ability and LBP scores of the nurses (P<0.001) in the intervention group compared with that in the control group. Overall, Back School program as an educational strategy can reduce the LBP and functional disability in nurses. This program can be suitable for preventing of pain and functional disability among nurses working in hospital settings.

Educational intervention for promoting stretching exercise behavior among a sample of Iranian office employees: applying the Health Promotion Model

INTRODUCTION

Health Promotion Model (HPM) is one comprehensive model by which health behavior predicting factors could be determined.

PURPOSE

This study aimed to investigate the effects of a designed interventional program based on HPM on promoting stretching exercise (SE) behavior among office employees.

PATIENTS AND METHODS

This interventional designed study was carried out on 87 office employees who were working in the three health networks affiliated to Shahid Beheshti University of Medical Sciences in Tehran, Iran. These participants were randomly divided into intervention group (N=44) who complied with educational program based on HPM and control group (N=43) who did not receive the program. The data were collected through a demographic questionnaire and a researcher-made questionnaire based on HPM at three times of baseline, 3- and 6-month follow-ups and analyzed using SPSS version 19.

RESULTS

Totally, 40 office employees with mean age of (37.70±7.40) in intervention and 37 ones with mean age of (35.97±7.34) in control group were assessed. At baseline, both groups were the same regarding the HPM constructs of perceived barriers, perceived self-efficacy, commitment to plan, and interpersonal influences (P>0.05). However, following intervention, there was a significant difference between two groups during 6-month follow-up in all these predictor factors (P<0.0001). Furthermore, the mean score of SE behavior in intervention group (22.43±6.50) was significantly better than the control group (15.45±0.93) (P<0.001). The pain severity also in intervention group (1±1.22) also was significantly less than control group (2±2.03) after 6-month follow-up (P<0.001).

CONCLUSION

The SE educational programs applied in this study were effective for promoting SE among office employees.

Effectiveness of a multifactorial ergonomic intervention and exercise conditioning kinesiology program for subsequent work related musculoskeletal disorder prevention

BACKGROUND

Health care workers are known to be at high risk for occupational musculoskeletal disorders and injuries. Many different intervention strategies have been implemented in order to reduce the risk of injury to health care workers, however not many have been proven to be effective. A continuing care establishment in Ottawa, Canada, implemented a multidimensional kinesiology intervention program for injured employees.

OBJECTIVE

To evaluate the effectiveness of the kinesiology intervention program on reducing subsequent rates for the nursing personnel and analyze the impact of age, position (RN, RPN, PCA) and sex on subsequent injuries.

METHODS

The number of recorded work related musculoskeletal disorders (WRMSD) for each patient care worker was counted from 2007-2011. The control group included injured employees that were not referred to the kinesiologists, or who chose not to participate in the program. The intervention group included injured employees that were referred to the kinesiology service and followed their treatment program.

RESULTS

The intervention group showed a statistically significant reduction of subsequent acute cases when compared to the control group. Nevertheless there was no significant impact regarding age, position or sex on subsequent acute cases.

CONCLUSION

The kinesiology intervention program within the health care facility was effective at reducing subsequent WRMSD rates within the nursing personnel.

Effectiveness and cost-effectiveness of neuromuscular exercise and back care counseling in female healthcare workers with recurrent non-specific low back pain: a blinded four-arm randomized controlled trial

Background

Registered healthcare workers worldwide have a high prevalence of work-related musculoskeletal disorders, particularly of the back. Multidisciplinary interventions among these workers have improved fear avoidance beliefs, but not low back pain (LBP) and related sickness absences, cost-effectiveness studies are scarce. Our purpose was to investigate the effectiveness and cost-effectiveness of three intervention-arms (combined neuromuscular exercise and back care counselling or either alone) compared with non-treatment.

Methods

We randomly assigned female healthcare workers with recurrent non-specific LBP to one of four study-arms: Combined neuromuscular exercise and back care counseling; Exercise; Counseling; and no intervention Control. We assessed the effectiveness of the interventions on intensity of LBP, pain interfering with work and fear avoidance beliefs against the Control, and calculated the incremental cost-effectiveness ratios for sickness absence and QALY.

Results

We conducted three sub-studies in consecutive years of 2011, 2012, and 2013 to reach an adequate sample size. All together 219 women were randomized within each sub-study, of whom 74 and 68% had adequate questionnaire data at 6 and 12 months, respectively. No adverse events occurred. Compliance rates varied between intervention-arms. After 12 months, the Combined-arm showed reduced intensity of LBP (p = 0.006; effect size 0.70, confidence interval 0.23 to 1.17) and pain interfering with work (p = 0.011) compared with the Control-arm. Work-related fear of pain was reduced in both the Combined- (p = 0.003) and Exercise-arm (p = 0.002). Physical activity-related fear was reduced only in the Exercise-arm (p = 0.008). During the study period (0–12 months) mean total costs were lowest in the Combined-arm (€476 vs. €1062–€1992, p < 0.001) as were the mean number of sickness absence days (0.15 vs. 2.29–4.17, p = 0.025). None of the intervention-arms was cost-effective for sickness absence. There was 85% probability of exercise-arm being cost-effective if willing to pay €3550 for QALY gained.

Conclusions

Exercise once a week for 6 months combined with five sessions of back care counseling after working hours in real-life settings effectively reduced the intensity of LBP, work interference due to LBP, and fear of pain, but was not cost-effective.

Trial registration

ClinicalTrials.gov, NCT01465698 November 7, 2011 (prospective).

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6293-9) contains supplementary material, which is available to authorized users.

Wearable Monitoring Devices for Biomechanical Risk Assessment at Work: Current Status and Future Challenges-A Systematic Review

Background: In order to reduce the risk of work-related musculoskeletal disorders (WMSDs) several methods have been developed, accepted by the international literature and used in the workplace. The purpose of this systematic review was to describe recent implementations of wearable sensors for quantitative instrumental-based biomechanical risk assessments in prevention of WMSDs. Methods: Articles written until 7 May 2018 were selected from PubMed, Scopus, Google Scholar and Web of Science using specific keywords. Results: Instrumental approaches based on inertial measurement units and sEMG sensors have been used for direct evaluations to classify lifting tasks into low and high risk categories. Wearable sensors have also been used for direct instrumental evaluations in handling of low loads at high frequency activities by using the local myoelectric manifestation of muscle fatigue estimation. In the field of the rating of standard methods, on-body wireless sensors network-based approaches for real-time ergonomic assessment in industrial manufacturing have been proposed. Conclusions: Few studies foresee the use of wearable technologies for biomechanical risk assessment although the requirement to obtain increasingly quantitative evaluations, the recent miniaturization process and the need to follow a constantly evolving manual handling scenario is prompting their use.