Manual material handling advice and assistive devices for preventing and treating back pain in workers

Quantifying how functional and structural personal factors influence biomechanical exposures in paramedic lifting tasks

It is unknown how structural (sex, stature, body mass) and functional (strength, flexibility) personal factors influence lifting strategy in paramedic work. We explored whether variance in peak low back forces and kinematic coordination patterns could be explained by structural and functional personal factors in paramedic lifting tasks. Seventy-two participants performed backboard and stretcher lifts. Peak low back forces normalised to body mass, as well as kinematic coordination patterns, were calculated as dependent variables. Being female, stronger, shorter, having higher body mass, and/or having greater lower body range of motion (ROM) were all independently associated with lower normalised low back forces across backboard and stretcher lifting. Females and stronger individuals seemed to define a movement objective to consistently minimise compressive forces, while individuals with greater hip ROM consistently minimised anteroposterior shear forces. The efficacy of improving strength and hip ROM to reduce low back forces in paramedic lifting should be investigated.Practitioner summary: Females, stronger individuals, and individuals with greater hip range of motion consistently exhibited lower normalised low back forces in paramedic lifting. Improving strength and hip range of motion via training is a potential proactive ergonomics approach to reduce peak low back forces in paramedic lifting tasks.

A Rapid Review on the Effectiveness and Use of Wearable Biofeedback Motion Capture Systems in Ergonomics to Mitigate Adverse Postures and Movements of the Upper Body

Work-related diseases and disorders remain a significant global health concern, necessitating multifaceted measures for mitigation. One potential measure is work technique training utilizing augmented feedback through wearable motion capture systems. However, there exists a research gap regarding its current effectiveness in both real work environments and controlled settings, as well as its ability to reduce postural exposure and retention effects over short, medium, and long durations. A rapid review was conducted, utilizing two databases and three previous literature reviews to identify relevant studies published within the last twenty years, including recent literature up to the end of 2023. Sixteen studies met the inclusion criteria, of which 14 were of high or moderate quality. These studies were summarized descriptively, and the strength of evidence was assessed. Among the included studies, six were rated as high quality, while eight were considered moderate quality. Notably, the reporting of participation rates, blinding of assessors, and a-priori power calculations were infrequently performed. Four studies were conducted in real work environments, while ten were conducted in controlled settings. Vibration feedback was the most common feedback type utilized (n = 9), followed by auditory (n = 7) and visual feedback (n = 1). All studies employed corrective feedback initiated by the system. In controlled environments, evidence regarding the effectiveness of augmented feedback from wearable motion capture systems to reduce postural exposure ranged from strong evidence to no evidence, depending on the time elapsed after feedback administration. Conversely, for studies conducted in real work environments, the evidence ranged from very limited evidence to no evidence. Future reach needs are identified and discussed.

Systematic Review of Workplace Interventions to Support Young Workers' Safety, Work Environment and Health

PURPOSE

This systematic review investigates the effectiveness of workplace interventions to support young workers' work environment, safety and health.

METHODS

A systematic search was conducted in bibliographic databases including PubMed, Web of Science Core Collection and PsycInfo for English or Scandinavian articles published from 2007 to 2022. The PICO strategy guided the assessment of study relevance and the bibliographical search for randomized controlled trials (RCTs) and non-RCTs in which (1) participants were young workers (mean age: 15-29), (2) interventions were initiated and/or carried out at the workplace, (3) a comparison group was included, and (4) an outcome measure related to work environment, safety and health was reported. We categorized each included study using the intervention classification framework. The quality assessment and evidence synthesis adhered to the guidelines developed by the Institute for Work & Health (Toronto, Canada).

RESULTS

A total of 33 high and medium quality studies showed a moderate level of evidence for no benefit of 'Mental training' on stress. We found limited evidence of a positive effect of the following intervention types: 'Attitude and belief' on mental health problems, 'Behavior based' on anxiety, and 'Multifaceted' on hand eczema. We found limited evidence for no benefit of the following intervention types: 'Mental training' on mental health problems, and 'Physiological modifications' on musculoskeletal disorders. The remaining intervention types showed mixed or insufficient evidence.

CONCLUSIONS

Except for a moderate level of evidence for no benefit of 'Mental training' on stress, the evidence synthesis recommends, that there is not enough evidence from the scientific literature to guide current practices. The results emphasizes a strong need for high quality interventions specifically aiming at increasing or maintaining young workers' work environment, safety and health. Included studies focused mainly on individual measures, highlighting the need for studies investigating possible preventive measures at the group or organizational level.

Pain Control Beliefs Predict Premature Withdrawal From the Labor Market in Workers With Persistent Pain: Prospective Cohort Study With 11-Year Register Follow-up

While a range of work-related psychosocial factors has been associated with various pain disorders and early retirement, less is known about pain cognitions and their influence on premature exit from the labor market. Therefore, as a primary objective, this study investigates associations between pain control beliefs and risk of disability pension among Danish eldercare workers. In 2005, 2257 female eldercare workers with low-back and/or neck/shoulder pain>90 days within the previous 12 months, replied to a survey and were followed for 11 years in a national register of social transfer payments. Using Cox regression, we estimated the risk of disability pension during follow-up from experiencing different levels of "pain control" and "pain influence," controlling for pain intensity and other relevant confounders. In the fully adjusted model for pain control with "high" as reference, hazard ratios of 1.30 (95% CI 1.03-1.64) and 2.09 (95% CI 1.45-3.01) are observed for "moderate" and "low," respectively, while the metric of pain influence shows hazard ratios of 1.43 (95% CI 1.11-1.87) and 2.10 (1.53-2.89), respectively. Pain control beliefs are associated with disability pension among eldercare workers with persistent pain. These results highlight the importance of evaluating not only bodily manifestations of pain, but also individual pain-related cognitions that may influence the experience of pain. PERSPECTIVE: This article addresses the complex experience of pain within an organizational context. We introduce the metrics of "pain control" and "pain influence" among workers with persistent pain, showing that the psychometric properties of these measures are prospectively associated with premature exit from the labor market.

Using a Back Exoskeleton During Industrial and Functional Tasks-Effects on Muscle Activity, Posture, Performance, Usability, and Wearer Discomfort in a Laboratory Trial

OBJECTIVE

To investigate the effect of using a passive back-support exoskeleton (Laevo V2.56) on muscle activity, posture, heart rate, performance, usability, and wearer comfort during a course of three industrial tasks (COU; exoskeleton worn, turned-on), stair climbing test (SCT; exoskeleton worn, turned-off), timed-up-and-go test (TUG; exoskeleton worn, turned-off) compared to no exoskeleton.

BACKGROUND

Back-support exoskeletons have the potential to reduce work-related physical demands.

METHODS

Thirty-six men participated. Activity of erector spinae (ES), biceps femoris (BF), rectus abdominis (RA), vastus lateralis (VL), gastrocnemius medialis (GM), trapezius descendens (TD) was recorded by electromyography; posture by trunk, hip, knee flexion angles; heart rate by electrocardiography; performance by time-to-task accomplishment (s) and perceived task difficulty (100-mm visual analogue scale; VAS); usability by the System Usability Scale (SUS) and all items belonging to domains skepticism and user-friendliness of the Technology Usage Inventory; wearer comfort by the 100-mm VAS.

RESULTS

During parts of COU, using the exoskeleton decreased ES and BF activity and trunk flexion, and increased RA, GM, and TD activity, knee and hip flexion. Wearing the exoskeleton increased time-to-task accomplishment of SCT, TUG, and COU and perceived difficulty of SCT and TUG. Average SUS was 75.4, skepticism 11.5/28.0, user-friendliness 18.0/21.0, wearer comfort 31.1 mm.

CONCLUSION

Using the exoskeleton modified muscle activity and posture depending on the task applied, slightly impaired performance, and was evaluated mildly uncomfortable.

APPLICATION

These outcomes require investigating the effects of this passive back-supporting exoskeleton in longitudinal studies with longer operating times, providing better insights for guiding their application in real work settings.

Effectiveness and usability of real-time vibrotactile feedback training to reduce postural exposure in real manual sorting work

Vibrotactile feedback training may be used as a complementary strategy to reduce time in demanding postures in manual handling. This study evaluated the short- and medium-term effects of concurrent posture-correction vibrotactile feedback training on trunk inclination exposure in real manual sorting work. Fifteen warehouse workers completed the training and the follow-up sessions. Trunk inclination angles were recorded using the ambulatory Smart Workwear System. Questionnaires were used for assessing system usability, perceived physical exertion, and work ability. The results showed reduced time in trunk inclination >30°, >45°, and >60°, and reductions in the 90th, 95th, and 99th percentile trunk inclination angles, when receiving feedback and immediately after feedback withdrawal. No significant reduction was retained after one and three weeks. The wearer's comfort was scored high, and the feedback did not increase the perceived cognitive demands. No significant effects attributed to changed trunk inclination exposure were observed for perceived physical exertion or work ability. The training program has the potential of contributing to reduced trunk inclination exposure in the short term. Future studies are needed to evaluate if improvements in the feedback training can transfer the short-term results to retained median- and long-term effects.Practitioner summary: A two-day training program with concurrent posture-correction vibrotactile feedback can contribute to reduced exposure of trunk inclination in real manual sorting work in the short term. More research is needed on how to design the feedback training programs in order to be effective in the long term.

Does intra-lumbar flexion during lifting differ in manual workers with and without a history of low back pain? A cross-sectional laboratory study

Advice to limit or avoid a flexed lumbar curvature during lifting is widely promoted to reduce the risk of low back pain (LBP), yet there is very limited evidence to support this relationship. To provide higher quality evidence this study compared intra-lumbar flexion in manual workers with (n = 21) and without a history of LBP (n = 21) during a repeated lifting task. In contrast to common expectations, the LBP group demonstrated less peak absolute intra-lumbar flexion during lifting than the noLBP group [adjusted difference -3.7° (95%CI -6.9 to -0.6)]. The LBP group was also further from the end of range intra-lumbar flexion and did not use more intra-lumbar range of motion during any lift condition (both symmetrical and asymmetrical lifts and different box loads). Peak absolute intra-lumbar flexion was more variable in the LBP group during lifting and both groups increased their peak absolute intra-lumbar flexion over the lift repetitions. This high-quality capture of intra-lumbar spine flexion during repeated lifting in a clinically relevant cohort questions dominant safe lifting advice.Practitioner summary: Lifting remains a common trigger for low back pain (LBP). This study demonstrated that people with LBP, lift with less intra-lumbar flexion than those without LBP. Providing the best quality in-vivo laboratory evidence, that greater intra-lumbar flexion is not associated with LBP in manual workers, raising questions about lifting advice.

An investigation of implicit bias about bending and lifting

OBJECTIVES

Previous studies in a high-income country have demonstrated that people with and without low back pain (LBP) have an implicit bias that bending and lifting with a flexed lumbar spine is dangerous. These studies present two key limitations: use of a single group per study; people who recovered from back pain were not studied. Our aims were to evaluate: implicit biases between back posture and safety related to bending and lifting in people who are pain-free, have a history of LBP or have current LBP in a middle-income country, and to explore correlations between implicit and explicit measures within groups.

METHODS

Exploratory cross-sectional study including 174 participants (63 pain-free, 57 with history of LBP and 54 with current LBP). Implicit biases between back posture and safety related to bending and lifting were assessed with the Implicit Association Test (IAT). Participants completed paper-based (Bending Safety Belief [BSB]) and online questionnaires (Tampa Scale of Kinesiophobia; Back Pain Attitudes Questionnaire).

RESULTS

Participants displayed significant implicit bias between images of round-back bending and lifting and words representing "danger" (IATD-SCORE: Pain-free group: 0.56 (IQR=0.31-0.91; 95% CI [0.47, 0.68]); history of LBP group: 0.57 (IQR=0.34-0.84; 95% CI [0.47, 0.67]); current LBP group: 0.56 (IQR=0.24-0.80; 95% CI [0.39, 0.64])). Explicit measures revealed participants hold unhelpful beliefs about the back, perceiving round-back bending and lifting as dangerous (BSBthermometer: Pain-free group: 8 (IQR=7-10; 95% CI [7.5, 8.5]); history of LBP group: 8 (IQR=7-10; 95% CI [7.5, 9.0]); current LBP group: 8.5 (IQR=6.75-10; [7.5, 9.0])). There was no correlation between implicit and explicit measures within the groups.

CONCLUSIONS

In a middle-income country, people with and without LBP, and those who recovered from LBP have an implicit bias that round-back bending and lifting is dangerous.

The Importance of Lifting Height and Load Mass for Muscular Workload during Supermarket Stocking: Cross-Sectional Field Study

High physical work demands increase the risk of musculoskeletal disorders and sickness absence. Supermarket work involves a high amount of manual material handling. Identifying specific ergonomic risk factors is an important part of occupational health and safety efforts in the supermarket sector. In this cross-sectional field study among 64 supermarket workers, we used electromyography during the workday to determine the influence of lifting height and load mass on muscular workload of the low-back and neck/shoulder muscles during un-restricted manual material handling (grocery stocking). We found a significant effect of load mass, i.e., higher loads associated with higher muscular workload in the low-back and neck/shoulder muscles. We demonstrated a significant interaction between start and end position, i.e., lifts performed from 'Low' start positions to 'High' end positions demonstrated the highest low-back muscular workload, whereas 'High' positions were associated with increased neck/shoulder workload. In conclusion, lifting higher loads and lifting goods from low to high positions (low-back) and at high positions (neck/shoulder) are associated with higher muscular workload. These results can be used to guide highly warranted preventive initiatives to reduce the physical workload during supermarket work.

Can Hip-Knee Line Angle Distinguish the Size of Pelvic Incidence?-Development of Quick Noninvasive Assessment Tool for Pelvic Incidence Classification

This study aimed to explore effective measurement angles for pelvic incidence (PI) classification and to develop a quick, noninvasive assessment tool for PI classification. We defined five variation types of hip–knee line (HKL) angles and tested the discrimination ability of the receiver operating characteristic (ROC) analysis using 125 photographs of upright standing posture from the right lateral side. ROC analysis revealed an applicable HKL angle defined by the line connecting the most raised part of the buttock and the central point of the knee and the midthigh line. The acceptable cut-off points for discriminating small or large PIs in terms of HKL angle were 18.5° for small PI (sensitivity, 0.91; specificity, 0.79) and 21.5° for large PI discrimination (sensitivity, 0.74; specificity, 0.72). In addition, we devised a quick noninvasive assessment tool for PI classification using the cut-offs of the HKL angle with a view to practical application. The results of intra- and inter-rater reliability ensured a substantial/moderate level of the tool (Cohen’s kappa coefficient, 0.79; Fleiss’s kappa coefficient, 0.50–0.54). These results revealed that the HKL angle can distinguish the size of the PI with a high/moderate discrimination ability. Furthermore, the tool indicated acceptable inter-/intra-rater reliability for practical applications.

Deliberate Practice and Motor Learning Principles to Underpin the Design of Training Interventions for Improving Lifting Movement in the Occupational Sector: A Perspective and a Pilot Study on the Role of Augmented Feedback

Spine posture during repetitive lifting is one of the main risk factors for low-back injuries in the occupational sector. It is thus critical to design appropriate intervention strategies for training workers to improve their posture, reducing load on the spine during lifting. The main approach to train safe lifting to workers has been educational; however, systematic reviews and meta-analyses have shown that this approach does not improve lifting movement nor reduces the risk of low back injury. One of the main limitations of this approach lies in the amount, quality and context of practice of the lifting movement. In this article, first we argue for integrating psychologically-grounded perspectives of practice design in the development of training interventions for safe lifting. Principles from deliberate practice and motor learning are combined and integrated. Given the complexity of lifting, a training intervention should occur in the workplace and invite workers to repeatedly practice/perform the lifting movement with the clear goal of improving their lifting-related body posture. Augmented feedback has a central role in creating the suitable condition for achieving such intervention. Second, we focus on spine bending as risk factor and present a pilot study examining the benefits and boundary conditions of different feedback modalities for reducing bending during lifting. The results showed how feedback modalities meet differently key requirements of deliberate practice conditions, i.e., feedback has to be informative, individualized and actionable. Following the proposed approach, psychology will gain an active role in the development of training interventions, contributing to finding solutions for a reduction of risk factors for workers.

A pilot study to assess a risk of a high-risk group of low back pain membership in workers who perform the manual material handling tasks

BACKGROUND

We conducted this experimental study to estimate a risk of a high-risk group of low back pain (LBP) membership in workers who perform the manual material handling (MMH) tasks in an actual workplace setting.

METHODS

The subjects include healthy workers who were engaged in 12 MMH tasks at 6 manufacturing companies. We assessed the dynamic motion of trunk or lumbar spine using an industrial lumbar motion monitor (BioDynamics Laboratory of Ohio State University). The subjects were evaluated for the age, gender, years of working and anthropometric measurements (e.g., height, weight, shoulder height, elbow height, iliac height, leg length, trunk length, trunk circumference, iliac width, iliac depth, xiphoid width and xiphoid depth). Moreover, they were also evaluated for a risk of a high-risk group of LBP membership based on lift frequency, average twisting velocity, maximum moment, maximum sagittal flexion and maximum lateral velocity.

RESULTS

The subjects who were engaged in a packaging at a detergent manufacturing company are at the greatest risk of LBP (63.76%). This was followed by packaging at a leather product manufacturing company (57.06%), packaging at a non-metallic casting material manufacturing company (57.03%), manual injection at a non-metallic casting material manufacturing company (52.00%), toggling at a leather product manufacturing company (46.09%), non-metallic casting material manufacturing company (42.88%), rolling at a non-metallic mineral product manufacturing company (42.12%), shooting at a non-metallic casting material manufacturing company (40.99%), vacuum processes at a leather product manufacturing company (35.00%), looping at a general industrial machinery manufacturing company (33.93%), setting at a leather product manufacturing company (30.22%) and packaging at a general metal product manufacturing company (22.02%).

CONCLUSIONS

Our approach indicates that there is a risk of a high-risk group of LBP membership in workers who perform the MMH tasks.

Low Back Pain

Low back pain is a common problem that is the leading cause of disability and is associated with high costs. Evaluation focuses on identification of risk factors indicating a serious underlying condition and increased risk for persistent disabling symptoms in order to guide selective use of diagnostic testing (including imaging) and treatments. Nonpharmacologic therapies, including exercise and psychosocial management, are preferred for most patients with low back pain and may be supplemented with adjunctive drug therapies. Surgery and interventional procedures are options in a minority of patients who do not respond to standard treatments.

Fear-avoidance beliefs are associated with reduced lumbar spine flexion during object lifting in pain-free adults

ABSTRACT

There is a long-held belief that physical activities such as lifting with a flexed spine is generally harmful for the back and can cause low back pain (LBP), potentially reinforcing fear-avoidance beliefs underlying pain-related fear. In patients with chronic LBP, pain-related fear has been shown to be associated with reduced lumbar range of motion during lifting, suggesting a protective response to pain. However, despite short-term beneficial effects for tissue health, recent evidence suggests that maintaining a protective trunk movement strategy may also pose a risk for (persistent) LBP due to possible pronociceptive consequences of altered spinal motion, potentially leading to increased loading on lumbar tissues. Yet, it is unknown if similar protective movement strategies already exist in pain-free individuals, which would yield potential insights into the role of fear-avoidance beliefs in motor behavior in the absence of pain. Therefore, the aim of this study is to test whether fear-avoidance beliefs influence spinal motion during lifting in a healthy cohort of pain-free adults without a history of chronic pain. The study subjects (N = 57) filled out several pain-related fear questionnaires and were asked to perform a lifting task (5kg-box). High-resolution spinal kinematics were assessed using an optical motion capturing system. Time-sensitive analyses were performed based on statistical parametric mapping. The results demonstrated time-specific and negative relationships between self-report measures of pain-related fear and lumbar spine flexion angles during lifting, indicating potential unfavorable interactions between psychological factors and spinal motion during lifting in pain-free subjects.

Changes in physiotherapy students' beliefs and attitudes about low back pain through pre-registration training

BACKGROUND

Implementation of best-practice care for patients with low back pain (LBP) is an important issue. Physiotherapists' who hold unhelpful beliefs are less likely to adhere to guidelines and may negatively influence their patients' beliefs. Pre-registration education is critical in moving towards a biopsychosocial model of care. This study aimed to investigate the changes in 2nd year physiotherapy students' beliefs about LBP after a module on spinal pain management and determine whether these changes were maintained at the end of academic training.

METHODS

During three consecutive calendar years, this longitudinal cohort study assessed physiotherapy students' beliefs with the Back Pain Attitudes Questionnaires (Back-PAQ) in their 1st year, before and after their 2nd year spinal management learning module, and at the end of academic training (3rd year). Unpaired t-tests were conducted to explore changes in Back-PAQ score.

RESULTS

The mean response rate after the spinal management module was 90% (128/143 students). The mean (± SD) Back-PAQ score was 87.73 (± 14.21) before and 60.79 (± 11.44) after the module, representing a mean difference of - 26.95 (95%CI - 30.09 to - 23.80, p < 0.001). Beliefs were further improved at the end of 3rd year (- 7.16, 95%CI - 10.50 to - 3.81, p < 0.001).

CONCLUSIONS

A spinal management learning module considerably improved physiotherapy students' beliefs about back pain. Specifically, unhelpful beliefs about the back being vulnerable and in need of protection were substantially decreased after the module. Improvements were maintained at the end of academic training one-year later. Future research should investigate whether modifying students' beliefs leads to improved clinical practice in their first years of practice.

A Systematic Review of Workplace Interventions to Rehabilitate Musculoskeletal Disorders Among Employees with Physical Demanding Work

Purpose This systematic review investigates the effectiveness of workplace interventions to rehabilitate musculoskeletal disorders (MSDs) among employees with physically demanding work. Methods A systematic search was conducted in bibliographic databases including PubMed and Web of Science Core Collection for English articles published from 1998 to 2018. The PICO strategy guided the assessment of study relevance and the bibliographical search for randomized controlled trials (RCTs) and non-RCTs in which (1) participants were adult workers with physically demanding work and MSD (including specific and non-specific MSD and musculoskeletal pain, symptoms, and discomfort), (2) interventions were initiated and/or carried out at the workplace, (3) a comparison group was included, and (4) a measure of MSD was reported (including musculoskeletal pain, symptoms, prevalence or discomfort). The quality assessment and evidence synthesis adhered to the guidelines developed by the Institute for Work & Health (Toronto, Canada) focusing on developing practical recommendations for stakeholders. Relevant stakeholders were engaged in the review process. Results Level of evidence from 54 high and medium quality studies showed moderate evidence of a positive effect of physical exercise. Within this domain, there was strong evidence of a positive effect of workplace strength training. There was limited evidence for ergonomics and strong evidence for no benefit of participatory ergonomics, multifaceted interventions, and stress management. No intervention domains were associated with "negative effects". Conclusions The evidence synthesis recommends that implementing strength training at the workplace can reduce MSD among workers with physically demanding work. In regard to workplace ergonomics, there was not enough evidence from the scientific literature to guide current practices. Based on the scientific literature, participatory ergonomics and multifaceted workplace interventions seem to have no beneficial effect on reducing MSD among this group of workers. As these interventional domains were very heterogeneous, it should also be recognized that general conclusions about their effectiveness should be done with care.Systematic review registration PROSPERO CRD42018116752 ( https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=116752 ).

Physical exposure during patient transfer and risk of back injury & low-back pain: prospective cohort study

BACKGROUND

Work-related musculoskeletal disorders (MSDs) are common among healthcare workers. Because frequent patient transfer has been associated with increased risk of MSDs, we aim to quantify the physical load associated with commonly-used assistive devices and to investigate associations between accumulated physical exposure and risk of MSDs.

METHODS

By applying an exposure matrix based on objective measurements of electromyography and trunk flexion on a large (n = 1285) prospective cohort, intensity of low-back pain (LBP) and odds of back injury at 1-year follow-up were modelled using linear models and logistic regressions, respectively. The cohort was divided into groups according to physical exposure; i.e. low (1st quartile), moderate (2nd and 3rd quartiles) and high (4th quartile) exposure.

RESULTS

Exposure profiles are provided for 9 groups of assistive devices, with ceiling lifts and intelligent beds eliciting the lowest physical exposure. In the fully-adjusted model, we report differences in LBP intensity at follow-up between the low and moderate exposure groups (p = 0.0085). No difference was found between the moderate and high exposure groups (p = 0.2967). Likewise, we find no associations between physical exposure and odds of back injury at 1-year follow-up, with a prevalence of 11, 13 and 11% for the three groups, respectively.

CONCLUSIONS

Low physical exposure during patient transfer was prospectively associated with lower intensity of LBP. Consistent use of assistive devices associated with low physical exposure, namely ceiling-lifts and intelligent beds, may play a role in reducing the incidence of MSDs among healthcare workers.

A Wearable Sensor System for Physical Ergonomics Interventions Using Haptic Feedback

Work-related musculoskeletal disorders are a major concern globally affecting societies, companies, and individuals. To address this, a new sensor-based system is presented: the Smart Workwear System, aimed at facilitating preventive measures by supporting risk assessments, work design, and work technique training. The system has a module-based platform that enables flexibility of sensor-type utilization, depending on the specific application. A module of the Smart Workwear System that utilizes haptic feedback for work technique training is further presented and evaluated in simulated mail sorting on sixteen novice participants for its potential to reduce adverse arm movements and postures in repetitive manual handling. Upper-arm postures were recorded, using an inertial measurement unit (IMU), perceived pain/discomfort with the Borg CR10-scale, and user experience with a semi-structured interview. This study shows that the use of haptic feedback for work technique training has the potential to significantly reduce the time in adverse upper-arm postures after short periods of training. The haptic feedback was experienced positive and usable by the participants and was effective in supporting learning of how to improve postures and movements. It is concluded that this type of sensorized system, using haptic feedback training, is promising for the future, especially when organizations are introducing newly employed staff, when teaching ergonomics to employees in physically demanding jobs, and when performing ergonomics interventions.

Evidence-based occupational health and safety interventions: a comprehensive overview of reviews

OBJECTIVES

Occupational injuries and diseases are a huge public health problem and cause extensive suffering and loss of productivity. Nevertheless, many occupational health and safety (OHS) guidelines are still not based on the best available evidence. In the last decade, numerous systematic reviews on behavioural, relational and mixed interventions to reduce occupational injuries and diseases have been carried out, but a comprehensive synopsis is yet missing. The aim of this overview of reviews is to provide a comprehensive basis to inform evidence-based decision-making about interventions in the field of OHS.

METHODS

We conducted an overview of reviews. We searched MEDLINE (Ovid), the Cochrane Library (Wiley), epistemonikos.org and Scopus (Elsevier) for relevant systematic reviews published between January 2008 and June 2018. Two authors independently screened abstracts and full-text publications and determined the risk of bias of the included systematic reviews with the ROBIS (Risk of Bias in Systematic Reviews) tool.

RESULTS

We screened 2287 abstracts and 200 full-texts for eligibility. Finally, we included 25 systematic reviews with a low risk of bias for data synthesis and analysis. We identified systematic reviews on the prevention of occupational injuries, musculoskeletal, skin and lung diseases, occupational hearing impairment and interventions without specific target diseases. Several interventions led to consistently positive results on individual diseases; other interventions did not show any effects, or the studies are contradictory. We provide detailed results on all included interventions.

DISCUSSION

To our knowledge, this is the first comprehensive overview of behavioural, relational and mixed interventions and their effectiveness in preventing occupational injuries and diseases. It provides policymakers with an important basis for making evidence-based decisions on interventions in this field.

PROSPERO REGISTRATION NUMBER

CRD42018100341.

Are there differences in lifting technique between those with and without low back pain? A systematic review

Background and aims

To systemically review the literature to compare freestyle lifting technique, by muscle activity and kinematics, between people with and without low back pain (LBP).

Methods

Five databases were searched along with manual searches of retrieved articles by a single reviewer. Studies were included if they compared a freestyle lifting activity between participants with and without LBP. Data were extracted by two reviewers, and studies were appraised using the CASP tool for case-control studies.

Results

Nine studies were eligible. Heterogeneity did not allow for meta-analysis. Most studies (n = 8 studies) reported that people with LBP lift differently to pain-free controls. Specifically, people with LBP lift more slowly (n = 6 studies), use their legs more than their back especially when initiating lifting (n = 3 studies), and jerk less during lifting (n = 1 studies). Furthermore, the four larger studies involving people with more severe LBP also showed that people with LBP lift with less spinal range of motion and greater trunk muscle activity for a longer period.

Conclusions

People with LBP move slower, stiffer, and with a deeper knee bend than pain-free people during freestyle lifting tasks. Interestingly, such a lifting style mirrors how people, with and without LBP, are often told how to lift during manual handling training. The cross-sectional nature of the comparisons does not allow for causation to be determined.

Implications

The changes described may show embodiment of cautious movement, and the drive to protect the back. There may be value in exploring whether adopting a lifting style closer to that of pain-free people could help reduce LBP.

Systematic Reviews in Occupational Health and Safety: where are we and where should we go?

Systematic Reviews have been introduced to improve the synthesis of available evidence and to reduce bias in the conclusions about a body of evidence. Nowadays, Systematic Review is an established method also in the Occupational Safety and Health (OSH) field. It is the Cochrane Work Review Group that facilitates authors to produce Cochrane reviews of intervention topics in this area. A variety of guidelines used Cochrane Work reviews for underpinning their recommendations. Due to the comprehensive search and reproducibility of the methods of a systematic review, it turned out that systematic reviews can be powerful in changing beliefs. For example, studies published in the eighties advocated the use of back schools. Nowadays, we know that the total body of evidence has changed the traditional view that training in lifting techniques could prevent back pain. ‘Sitting is the new smoking’ is an eye catching nicely alliterating motto, but it is of course highly overstated. The findings of a Cochrane review of the effects of interventions to decrease sitting at work showed that sitting time can be reduced by a bit less than two hours per day by providing sit-stand desks plus education. However, it is unclear if this is sufficient to counter the effects of sitting. A wealth of evidence on OSH interventions has been collected by international collaboration in the Cochrane Work Review Group. This can be extended to systematic reviews of the effects of exposure of workers to assess to which risks of adverse health effects they are exposed.

Effectiveness of workplace interventions in rehabilitating musculoskeletal disorders and preventing its consequences among workers with physical and sedentary employment: systematic review protocol

BACKGROUND

Musculoskeletal disorders (MSDs) are the leading cause of work disability and sickness absence worldwide. The prevalence of MSDs increases with age, consequently challenging sustainable employability among the growing ageing workforce. Knowledge of feasible and efficient workplace-based interventions to rehabilitate MSD or prevent its consequences is therefore warranted. This systematic review will evaluate the effectiveness of workplace-based interventions on MSDs and its consequences among adult workers with physical and sedentary work tasks, respectively.

METHODS

We will search the following bibliographic databases: PubMed (including the database 'MEDLINE') and Web of Science Core Collection (including the databases 'Science Citation Index Expanded', 'Social Sciences Citation Index' and 'Arts & Humanities Citation Index'). Manual searches will also be performed. We will include randomised controlled trials (RCTs) and non-RCTs reported in English in which (1) participants are adult workers with MSD, (2) interventions are aiming at rehabilitating pain symptoms of MSD or preventing the consequences of MSD and (3) interventions are initiated and/or carried out at the workplace. The review will adhere to the 'Preferred Reporting Items for Systematic reviews and Meta-Analyses' (PRISMA) guidelines for reporting systematic reviews and the Institute for Work and Health (IWH) guidelines for workplace-based interventions. For the primary evaluation of the review, the quality assessment and evidence synthesis will conform to the IWH guidelines. Secondary evaluation will include a meta-analysis (unless the included studies do not allow this due to heterogeneity) and employ the risk of bias domains recommended by Cochrane along with the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach on the studies with pain intensity as an outcome.

DISCUSSION

This systematic review will provide knowledge on effective workplace-based interventions among physical and sedentary workers with MSD. RCTs are considered the most powerful experimental design in clinical trials, but solely including these may be too restrictive to understand effective workplace-based interventions where randomised and carefully controlled trials (RCTs) are not always possible. In order to maximize practical relevance, the selection process will, therefore, include both RCTs and non-RCTs and the quality assessment and evidence synthesis will conform to IWH guidelines focusing on developing practical guidelines for stakeholders. The result of this work will form the basis for industry-specific evidence-based recommendations on effective workplace-based interventions for rehabilitation of MSDs and its consequences that will later be operationalised into concrete and user-friendly practical tools for workplaces.

SYSTEMATIC REVIEW REGISTRATION

International Prospective Register of Systematic Reviews (PROSPERO) number CRD42018116752 .

Support System for the Assessment and Intervention During the Manual Material Handling Training at the Workplace: Contributions From the Systematic Observation

Efficacy of classical manual material handling (MMH) training interventions on back pain prevention at the workplace has been called into question. The way that observation (self-observation or hetero-observation) is used in other areas to create feedback addressed to modify motor activities can justify innovative components for these interventions. However, their implementation and evaluation cannot be done without tackling the methodological challenge of developing a reliable observational instrument to measure manual handling practice during the training process. The aims of this study were: (1) justify and develop an hetero-observation (H-O) instrument to assess changes in the worker behavioral patterns with a level of analysis convenient to derive a parallel version for the systematic self-observation (S-O) during training on MMH; (2) provide evidence on the inter-rater reliability of the H-O instrument; (3) provide evidence on the usability of the S-O instrument and its perceived usefulness; and (4) provide evidence on the benefits that can be derived with the use of the H-O instrument to create feedback based on T-pattern and polar coordinate analysis. A mixed method approach mainly grounded on systematic observation was used. A convenience sample composed by blue-collar workers participated in the study. Based on literature review and expert opinion, the H-O instrument proposed was composed by six dimensions (feet, knee joints, back, elbow joints, load position, and interaction between back tilt and displacement) plus a structural dimension which defined MMH phases. The inter-rater reliability of this instrument was almost perfect for all dimensions using a tolerance level of 2 s (the range of time-unit kappa was from 0.93 to 0.97 and the range of event-based kappa was from 0.82 to 0.9). The usability and usefulness of the S-O instrument was highly valued by workers. Regarding the way to use hetero-observations to create feedback, the paper shows the great potential of T-pattern and polar coordinate analysis. The observational instruments developed combined with these techniques make it possible to characterize the body positions adopted during manual handling performance, and this is crucial to create feedback on performance instead of only feedback on results.

Outcomes of safe patient handling and mobilization programs: A meta-analysis

BACKGROUND

Variability in patient care settings and the range of patient handling tasks present challenges in developing and evaluating safe patient handling and mobilization (SPHM) programs.

OBJECTIVE

We performed a systematic meta-analysis of SPHM program evaluations.

METHODS

Systematic literature review identified published SPHM program evaluations. Injury Rate Ratios (IRR), pre- to post-intervention, were used to estimate intervention effects and to examine the influence of patient care level, program components, and follow-up time using meta-regression.

RESULTS

27 articles reported evaluations from 44 sites. Combined effect estimate for all SPHM programs was 0.44 (95% CI 0.36, 0.54), reflecting substantial injury reductions after program implementation. While specific program components were not associated with greater effectiveness, longer follow-up duration was associated with greater injury rate reduction (p = 0.01) and intervention effects varied by level of care (p = 0.01), with the greatest effect in intensive care unit interventions (IRR 0.14; 95% CI 0.07, 0.30).

CONCLUSIONS

SPHM programs appear to be highly effective in reducing injuries. More research is needed to identify the most effective interventions for different patient care levels.

Do Technical Aids for Patient Handling Prevent Musculoskeletal Complaints in Health Care Workers?-A Systematic Review of Intervention Studies

The physical load ensuing from the repositioning and moving of patients puts health care workers at risk of musculoskeletal complaints. Technical equipment developed to aid with patient handling should reduce physical strain and workload; however, the efficacy of these aids in preventing musculoskeletal disorders and complaints is still unclear. A systematic review of controlled intervention studies was conducted to examine if the risk of musculoskeletal complaints and disorders is reduced by technical patient handling equipment. MEDLINE®/PubMed®, EMBASE®, Allied and Complementary Medicine Database (AMED), and Cumulative Index of Nursing and Allied Health Literature (CINAHL®) were searched using terms for nursing, caregiving, technical aids, musculoskeletal injuries, and complaints. Randomized controlled trials and controlled before-after studies of interventions including technical patient handling equipment were included. The titles and abstracts of 9554 publications and 97 full-texts were screened by two reviewers. The qualitative synthesis included one randomized controlled trial (RCT) and ten controlled before-after studies. A meta-analysis of four studies resulted in a pooled risk ratio for musculoskeletal injury claims (post-intervention) of 0.78 (95% confidence interval 0.68-0.90). Overall, the methodological quality of the studies was poor and the results often based on administrative injury claim data, introducing potential selection bias. Interventions with technical patient handling aids appear to prevent musculoskeletal complaints, but the certainty of the evidence according to GRADE approach ranged from low to very low.

Implementation of an ergonomics intervention in a Swedish flight baggage handling company-A process evaluation

Objective

To conduct a process evaluation of the implementation of an ergonomics training program aimed at increasing the use of loading assist devices in flight baggage handling.

Methods

Feasibility related to the process items recruitment, reach, context, dose delivered (training time and content); dose received (participants’ engagement); satisfaction with training; intermediate outcomes (skills, confidence and behaviors); and barriers and facilitators of the training intervention were assessed by qualitative and quantitative methods.

Results

Implementation proved successful regarding dose delivered, dose received and satisfaction. Confidence among participants in the training program in using and talking about devices, observed use of devices among colleagues, and internal feedback on work behavior increased significantly (p<0.01). Main facilitators were self-efficacy, motivation, and perceived utility of training among the trainees. Barriers included lack of peer support, opportunities to observe and practice behaviors, and follow-up activities; as well as staff reduction and job insecurity.

Conclusions

In identifying important barriers and facilitators for a successful outcome, this study can help supporting the effectiveness of future interventions. Our results suggest that barriers caused by organizational changes may likely be alleviated by recruiting motivated trainees and securing strong organizational support for the implementation.

Pain-related factors associated with lost work days in nurses with low back pain: A cross-sectional study

Background and aims

Chronic low back pain is known to contribute to lost work days (LWDs) in nurses. However, there is a limited understanding of the factors that moderate the impact of low back pain (LBP) on LWDs – in particular factors that are modifiable and that could therefore be the treatment targets of interventions designed to help nurses more effectively manage LBP.

This study aims to identify pain-related factors that are associated with LWDs in nurses with LBP, in order to inform the development of interventions that could reduce LBP-related work dysfunction and improve patient care.

Methods

A cross sectional study was conducted on 111 female nurses who were asked to answer questions regarding demographic information, work history, presence or absence of LBP, number of LWDs due to illness, and a number of factors that could potentially be related to LWDs including: (1) average and worst pain intensity; (2) the temporal pattern of LBP (constant versus intermittent); (3) pain aggravating factors (lifting, bending, walking, and standing); and (4) pain alleviating factors (medications, rest, exercise).

Results

Sixty-five percent (n = 72) of the sample reported LBP. Constancy of pain and having a LBP problem that was alleviated by rest were significantly associated with the number of LWDs, while maximum and average LBP intensity were only weakly associated.

Conclusion

The findings provide important new information regarding whatis (and of equal importance) what is not associated with LWDs in nurses with LBP.

Implications

To effectively reduce LBP-related work disability, interventions may need to teach nurses how to better manage constant pain and remain active despite pain, rather than focus on pain reduction. Research to examine the potential efficacy of such treatment approaches for nurses with LBP is warranted.

Occupational injuries of teachers and educational staff at special schools with multiple and severely handicapped children in Rhineland-Palatinate (Germany): results of a cross-sectional study

OBJECTIVES

The present study aimed to describe the prevalence, type, and influencing factors of occupational injuries of staff working at special schools with multiple and severely handicapped pupils in Southwestern Germany.

METHODS

This cross-sectional study was carried out between August 2010 and August 2012 at 13 special schools with focus on motoric and/or holistic development of handicapped pupils in Rhineland-Palatinate (Germany). Participants were interviewed using a written questionnaire.

RESULTS

There were 395 participants (response proportion: 59.7%) in our study, with 390 being eligible for statistical analysis. Respondents were on average 45 years old and mainly female (86.9%). The 12-month injury prevalence was 16.9%. Joint dislocations, sprains, and torn ligaments (41.6%) were the main types of injuries. Pupils (59.8%) and auxiliary equipment (12.2%) were identified as the main causes of injury by the respondents. Multivariable logistic regression analysis showed that washing pupils (using auxiliary equipment) (aOR, 3.93; 95% CI, 1.66-9.31) and daily physical strain due to unexpected conduct of pupils (aOR, 3.70; 95% CI, 1.20-11.37) were the main influencing factors for an occupational injury.

CONCLUSIONS

Almost one in five persons suffered an occupational injury in the previous 12 months. Nursing activities, including close contact with pupils, were identified as the most important factors for an injury. In order to prevent injuries at special schools, a multifaceted approach is necessary. This includes sufficient supply of auxiliary devices including proper technical maintenance. Furthermore, regular participation in training for manual handling of heavy loads and schooling on the technical use of auxiliary devices should be encouraged.

Back pain: Prevention and management in the workplace

Despite all the efforts in studying work-related risk factors for low back pain (LBP), interventions targeting these risk factors to prevent LBP have no proven cost-effectiveness. Even with adequate implementation strategies for these interventions on group level, these did not result in the reduction of incident LBP. Physical exercise, however, does have a primary preventive effect on LBP. For secondary prevention, it seems that there are more opportunities to cost-effectively intervene in reducing the risk of long-term sickness absence due to LBP. Starting at the earliest moment possible with proper assessment of risk factors for long-term sickness absence related to the individual, the underlying mechanisms of the LBP, and also factors related to the workplace by a well-trained clinician, may increase the potential of effective return to work (RTW) management. More research on how to overcome barriers in the uptake of these effective interventions in relation to policy-specific environments, and with regard to proper financing of RTW management is necessary.

Prevention of occupational Back Pain

This paper reviews scientific research on occupational back pain and focuses on prevention of this problem. It discusses some of the challenges of translating the evidence of this multi-factorial condition into policy. Medical science is currently unable to clearly distinguish between back pain caused by work and that possibly due to other causes but which affects the individual's capacity to work. Back pain affects the vast majority of people at some point in their lives and is very costly to both the health care system and the industry. Evidence suggests that heavy lifting, driving, and vibration of the whole body are linked to occupational back pain. Once the risk factors for occupational back pain are identified, an otherwise chronic and disabling condition can be prevented in the majority of patients. As explained in this article, three levels of prevention for occupational back pain have been reported as effective. Failure to implement preventive measures may lead to a high incidence of occupational back pain.

Time trends in musculoskeletal disorders attributed to work exposures in Ontario using three independent data sources, 2004-2011

Objective

Work-related musculoskeletal disorders (MSDs) are the leading cause of work disability in the developed economies. The objective of this study was to describe trends in the incidence of MSDs attributed to work exposures in Ontario over the period 2004–2011.

Methods

An observational study of work-related morbidity obtained from three independent sources for a complete population of approximately six million occupationally active adults aged 15–64 in the largest Canadian province. We implemented a conceptually concordant case definition for work-related non-traumatic MSDs in three population-based data sources: emergency department encounter records, lost-time workers’ compensation claims and representative samples of Ontario workers participating in consecutive waves of a national health interview survey.

Results

Over the 8-year observation period, the annual per cent change (APC) in the incidence of work-related MSDs was −3.4% (95% CI −4.9% to −1.9%) in emergency departments’ administrative records, −7.2% (−8.5% to −5.8%) in lost-time workers’ compensation claims and −5.3% (−7.2% to −3.5%) among participants in the national health interview survey. Corresponding APC measures for all other work-related conditions were −5.4% (−6.6% to −4.2%), −6.0% (−6.7% to −5.3%) and −5.3% (−7.8% to −2.8%), respectively. Incidence rate declines were substantial in the economic recession following the 2008 global financial crisis.

Conclusions

The three independent population-based data sources used in this study documented an important reduction in the incidence of work-related morbidity attributed to non-traumatic MSDs. The results of this study are consistent with an interpretation that the burden of non-traumatic MSDs arising from work exposures is declining among working-age adults.

The effect of different lumbar belt designs on the lumbopelvic rhythm in healthy subjects

Background

Research suggests that in some patients with low back pain, lumbar belts (LB) may derive secondary prophylactic benefits. It remains to be determined, however, which patients are most likely to benefit from prophylactic LB use, and which LB design is optimal for this purpose. The objective of this study was to determine the effect of different lumbar belts designs on range of motion and lumbopelvic rhythm.

Methods

Healthy subjects (10 males; 10 females) performed five standing lumbar flexion/extension cycles, with knees straight, during a control (no belt) and four lumbar belt experimental conditions (extensible, with and without dorsal and ventral panels; non-extensible). Motion of the pelvis and lumbar spine was measured with 3D angular inertial sensors.

Results

The results suggest that adding dorsal and ventral panels to an extensible LB produces the largest lumbar spine restrictions among the four tested lumbar belt designs, which in turn also altered the lumbopelvic rhythm. On a more exploratory basis, some sex differences were seen and the sex × experimental condition interaction just failed to reach significance.

Conclusions

LB may provide some biomechanical benefit for patients with low back disorders, based on the protection that may be provided against soft tissue creep-based injury mechanisms. More comprehensive assessment of different LB designs, with additional psychological and neuromuscular measurement outcomes, however, must first be conducted in order to produce sound recommendations for LB use. Future research should also to take sex into account, with sufficient statistical power to clearly refute or confirm the observed trends.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2474-15-307) contains supplementary material, which is available to authorized users.

Upper body and lower limbs musculoskeletal symptoms and health inequalities in Europe: an analysis of cross-sectional data

BACKGROUND

Musculoskeletal disorders are the most frequent occupational diseases in Europe. However, their multifactorial aetiology poses several challenges concerning not only the estimation of relative prevalence rates across occupational groups but also how the co-occurrence of known risk factors might differ between disorders of the upper and lower limbs. Against this background, the following objectives are pursued: (1) to estimate the relative odds and prevalence rates of self-reported disorders of the upper limbs and/or shoulders and neck (upper body) and the lower limbs for major ISCO-88 occupational groups, (2) to evaluate to what extent the associations between known risk factors differ for musculoskeletal disorders of the upper body and the lower limbs.

METHODS

Statistical analysis of cross-sectional data from the European Working Conditions Survey 1995-2010. The probability of reporting upper body and lower limbs pain in the survey sample 2010 is estimated by mixed logistic regression models using the Markov chain Monte Carlo Sampler. Independent variables include some known physical and psychosocial risk factors.

RESULTS

Concerning the first objective, an excess risk of reporting musculoskeketal disorders of the upper body was observed among craft workers (ISCO 7), machine operators (ISCO 8) and workers in elementary occupations (ISCO 9). Concerning musculoskeletal disorders of the lower limbs, service and sales workers (ISCO 5) and workers in ISCO groups 7, 8 and 9 reported symptoms more frequently. Regarding the second objective, similar association patterns were observed for upper body and lower limbs symptoms. Major physical risk factors associated with both symptom types were very frequent exposure to tiring positions, carrying heavy loads and performing repetitive tasks. Standing appears to be an important risk factor for lower limbs symptoms only.

CONCLUSIONS

Results suggest that the unequal burden of exposure has not changed substantially across occupational groups since 1995, and that there is urgent need of delivering and evaluating the effects of specific interventions targeting workers at high risk of developing musculoskeletal disorders.

An Evidence-Based Multidisciplinary Practice Guideline to Reduce the Workload due to Lifting for Preventing Work-Related Low Back Pain

We developed an evidence-based practice guideline to support occupational safety and health (OSH) professionals in assessing the risk due to lifting and in selecting effective preventive measures for low back pain (LBP) in the Netherlands. The guideline was developed at the request of the Dutch government by a project team of experts and OSH professionals in lifting and work-related LBP. The recommendations for risk assessment were based on the quality of instruments to assess the risk on LBP due to lifting. Recommendations for interventions were based on a systematic review of the effects of worker- and work directed interventions to reduce back load due to lifting. The quality of the evidence was rated as strong (A), moderate (B), limited (C) or based on consensus (D). Finally, eight experts and twenty-four OSH professionals commented on and evaluated the content and the feasibility of the preliminary guideline. For risk assessment we recommend loads heavier than 25 kg always to be considered a risk for LBP while loads less than 3 kg do not pose a risk. For loads between 3-25 kg, risk assessment shall be performed using the Manual handling Assessment Charts (MAC)-Tool or National Institute for Occupational Safety and Health (NIOSH) lifting equation. Effective work oriented interventions are patient lifting devices (Level A) and lifting devices for goods (Level C), optimizing working height (Level A) and reducing load mass (Level C). Ineffective work oriented preventive measures are regulations to ban lifting without proper alternatives (Level D). We do not recommend worker-oriented interventions but consider personal lift assist devices as promising (Level C). Ineffective worker-oriented preventive measures are training in lifting technique (Level A), use of back-belts (Level A) and pre-employment medical examinations (Level A). This multidisciplinary evidence-based practice guideline gives clear criteria whether an employee is at risk for LBP while lifting and provides an easy-reference for (in)effective risk reduction measures based on scientific evidence, experience, and consensus among OSH experts and practitioners.

Cross-sectional survey of attitudes and beliefs about back pain in New Zealand

OBJECTIVES

To explore the prevalence of attitudes and beliefs about back pain in New Zealand and compare certain beliefs based on back pain history or health professional exposure.

DESIGN

Population-based cross-sectional survey.

SETTING

Postal survey.

PARTICIPANTS

New Zealand residents and citizens aged 18 years and above. 1000 participants were randomly selected from the New Zealand Electoral Roll. Participants listed on the Electoral Roll with an overseas postal address were excluded. 602 valid responses were received.

MEASURES

Attitudes and beliefs about back pain were measured with the Back Pain Attitudes Questionnaire (Back-PAQ). The interaction between attitudes and beliefs and (1) back pain experience and (2) health professional exposure was investigated.

RESULTS

The lifetime prevalence of back pain was reported as 87% (95% CI 84% to 90%), and the point prevalence as 27% (95% CI 24% to 31%). Negative views about the back and back pain were prevalent, in particular the need to protect the back to prevent injury. People with current back pain had more negative overall scores, particularly related to back pain prognosis. There was uncertainty about links between pain and injury and appropriate physical activity levels during an episode of back pain. Respondents had more positive views about activity if they had consulted a health professional about back pain. The beliefs of New Zealanders appeared to be broadly similar to those of other Western populations.

CONCLUSIONS

A large proportion of respondents believed that they needed to protect their back to prevent injury; we theorise that this belief may result in reduced confidence to use the back and contribute to fear avoidance. Uncertainty regarding what is a safe level of activity during an episode of back pain may limit participation. People experiencing back pain may benefit from more targeted information about the positive prognosis. The provision of clear guidance about levels of activity may enable confident participation in an active recovery.

Lifting strategies of expert and novice workers during a repetitive palletizing task

Thirty manual material handlers (15 experts and 15 novices) were invited to perform series of box transfers under conditions similar to those of large distribution centers. The objective of the present study was to verify whether multiple box transfers leading to fatigue would also lead to differences between expert and novice workers in joint motions and in back loading variables (L5/S1 moments). The task consisted in transferring 24 15-kg boxes from one pallet to another (4 layers of boxes; 6 boxes/layer: 3 in the front row, 3 in the back) at a self-determined pace and then at an imposed pace of 9 lifts/min for a total of 240 lifts. The underlying idea was to set a challenging task that would force the experts to use their skills. Full-body 3D kinematic data were collected as well as external foot forces. A dynamic 3D linked segment model was used to estimate the net moments at L5/S1. The results clearly show that the experts bent their lumbar spine less (10° less) and were closer (4 cm) to the box than novice workers. Knee flexions were similar in both groups except when the box was lifted from ground level (expert ≈ 71°, novice ≈ 48°). The peak resultant moment was not statistically different (expert = 168 Nm, novice = 184 Nm) although experts had lower values on average than novices when lifting heights (and deposit heights) of the boxes increased. Therefore, experts differed from novice workers mostly in the posture-related variables. These differences are especially important to consider when the box is located on the ground, as the back posture and back loading are then at their greatest magnitude and could have a major impact on the distribution of internal forces on the spine.

Interventions to reduce injuries when transferring patients: a critical appraisal of reviews and a realist synthesis

OBJECTIVES

There has been extensive investment in programmes to reduce injuries among health care staff caused by moving and handling patients or residents. Given conflicting evidence regarding the effectiveness of such programmes, the present paper conducted a critical appraisal of systematic reviews assessing the effectiveness of interventions in reducing back pain and injuries among healthcare staff. A realist synthesis was conducted on a second set of reports to identify best practices for moving and handling programmes.

DESIGN

A critical appraisal of systematic reviews and a realist synthesis to identify best practices for moving and handling programmes.

DATA SOURCES

A literature search of five databases (Medline, EMBASE, CINAHL, PsycINFO and ScienceDirect) located 150 reports assessing programme outcomes published in refereed journals between 2000 and 2013.

REVIEW METHODS

The critical appraisal included six systematic reviews. The realist synthesis included 47 studies that provided descriptive information about programme mechanisms.

RESULTS

Five of the six systematic reviews covered interventions involving either staff training or training and equipment supply. One review covered multi-component interventions. All concluded that training staff by itself was ineffective. There were differing conclusions regarding the effectiveness of training and equipment interventions and multi-component programmes. The reviews provided little information about the content of programme components. The realist synthesis noted the need for management commitment and support, and six core programme components; a policy requiring safe transfer practices, ergonomic assessment of spaces where people are transferred, transfer equipment including lifts, specific risk assessment protocols, adequate training of all care staff, and coordinators coaches or resource staff. These programme components are likely to be synergistic; omitting one component weakens the impact of the other components.

CONCLUSIONS

Five systematic reviews provided little information regarding the core components of effective programmes. Given the absence of experimental trials for multi-component programmes, the best available evidence for the effectiveness of multi-component programmes is from pre-post studies and large-scale surveys. The realist synthesis provided detailed information about the core components for effective programmes. Further studies, which include qualitative data, are needed to provide evidence about the specific mechanisms through which components contribute to effective patient handling programmes.

The enduring impact of what clinicians say to people with low back pain

PURPOSE

The purpose of this study was to explore the formation and impact of attitudes and beliefs among people experiencing acute and chronic low back pain.

METHODS

Semistructured qualitative interviews were conducted with 12 participants with acute low back pain (less than 6 weeks' duration) and 11 participants with chronic low back pain (more than 3 months' duration) from 1 geographical region within New Zealand. Data were analyzed using an Interpretive Description framework.

RESULTS

Participants' underlying beliefs about low back pain were influenced by a range of sources. Participants experiencing acute low back pain faced considerable uncertainty and consequently sought more information and understanding. Although participants searched the Internet and looked to family and friends, health care professionals had the strongest influence upon their attitudes and beliefs. Clinicians influenced their patients' understanding of the source and meaning of symptoms, as well as their prognostic expectations. Such information and advice could continue to influence the beliefs of patients for many years. Many messages from clinicians were interpreted as meaning the back needed to be protected. These messages could result in increased vigilance, worry, guilt when adherence was inadequate, or frustration when protection strategies failed. Clinicians could also provide reassurance, which increased confidence, and advice, which positively influenced the approach to movement and activity.

CONCLUSIONS

Health care professionals have a considerable and enduring influence upon the attitudes and beliefs of people with low back pain. It is important that this opportunity is used to positively influence attitudes and beliefs.

Essential Occupational Safety and Health Interventions for Low- and Middle-income Countries: An Overview of the Evidence

There is still a considerable burden of occupational diseases and injuries in the world. It is not well known which interventions can effectively reduce the exposures at work that cause this burden. The objective of this article is to summarize evidence from systematic reviews of interventions to prevent occupational diseases and injuries. We included systematic reviews of interventions to reduce the incidence of work-related cancer, dust-related diseases, occupational asthma, chronic obstructive pulmonary disease, noiseinduced hearing loss, back pain, and occupational injuries. We searched Medline and Embase with predefined search strategies to locate systematic reviews of these interventions. We found 23 systematic reviews of which the results are also applicable to low- and middle income countries. Effective measures to reduce exposure leading to work-related cancer, dust-related diseases, asthma, chronic obstructive pulmonary disease, noise, and injuries are available. However, better implementation of these measures is needed. Regulation, enforcement of regulation, and incentives for employers are effective interventions to achieve this goal. There is evidence that feedback and rewards for workers help in reducing occupational injuries. There is no evidence in many studies that back pain can be prevented. Personal protective equipment technically has the potential to reduce exposure but this is difficult to put into effect. There is no evidence in the studies regarding the effectiveness of education and training, preventive drugs, or health examinations. There is evidence that the implementation of technical measures enforced by regulation can prevent occupational diseases and injuries. For other interventions such as education or health examinations, there is no evidence that supports their effectiveness. More systematic reviews are needed in the area of injury prevention.

Effectiveness of preventive back educational interventions for low back pain: a critical review of randomized controlled clinical trials

PURPOSE

A systematic search was conducted to study the efficiency of preventive educational interventions mainly focused on a biomechanical/biomedical model.

METHODS

The PubMed electronic database and the Cochrane Library were searched based on a combination of keywords related to low back pain (LBP) and posture education. Only randomized controlled trial (RCT) studying the efficiency on outcomes directly related to LBP of a preventive intervention programme mainly based on education of proper care of the back for subjects not seeking treatment were included. References of the articles meeting these inclusion criteria were also checked to identify other potential citations. Besides, a methodological study assessment of the included RCTs was performed.

RESULTS

Nine studies, all conducted at the workplace were included in this review. Their mean quality level was low (5.1/12) and among the four studies with a huge sample size (n > 400 subjects), only one had an acceptable methodological quality score (6/12). The education interventions differed widely from one study to another. No significant differences between the control and education groups were found at the follow-up in eight out of the nine studies on the incidence of back pain, disability and sick leave.

CONCLUSIONS

The results of the RCTs included in this review suggest that educational interventions mainly focused on a biomechanical/biomedical model are not effective in preventing LBP. However, taking into account the methodological quality level of the RCTs as well as the very short and heterogeneous interventions often proposed, additional high-quality studies with a longer education period are needed to conclude that such interventions are inefficient.

A prospective cohort study on musculoskeletal risk factors for long-term sickness absence among healthcare workers in eldercare

PURPOSE

The socioeconomic burden of sickness absence from musculoskeletal disorders is considerable. However, knowledge about the risk of sickness absence from pain in different body regions among specific job groups is needed to more efficiently target preventative strategies. This study estimates the risk of long-term sickness absence (LTSA) from pain in different body regions among healthcare workers.

METHODS

Prospective cohort study among 8,952 Danish healthcare workers responding to a questionnaire in 2004-2005 and followed for 1 year in a national register of social transfer payments (DREAM). Using Cox regression hazard ratio (HR) analysis controlled for age, gender, BMI, smoking, seniority, leisure physical activity and psychosocial working conditions, we modeled risk estimates of sub-chronic (1-30 days last year) and chronic pain (>30 days last year) in the low back, neck/shoulder and knees for onset of LTSA (receiving sickness absence compensation for at least eight consecutive weeks) during one-year follow-up.

RESULTS

At baseline, the prevalence of chronic pain was 23% (low back), 28% (neck/shoulder) and 12% (knees). During follow-up, the 12-month prevalence of LTSA was 6.3%. Chronic pains in the low back (HR 1.47 [95% CI 1.17-1.85]), neck/shoulder (HR 1.60 [95% CI 1.27-2.02]) and knees (HR 1.92 [95% CI 1.52-2.42]) were significant risk factors for LTSA. However, only chronic neck/shoulder (HR 1.41 [95% CI 1.09-1.82]) and knee pain (HR 1.69 [95% CI 1.32-2.16]) remained significant with mutual adjustment for all three musculoskeletal pain regions.

CONCLUSION

Musculoskeletal pain is a risk factor for LTSA among healthcare workers. Future research among healthcare workers in eldercare should include the management of neck/shoulder and knee pain in addition to the management of back pain.