Self-report measure of low back-related biomechanical exposures: clinical validation

Challenges of Measuring Self-Reported Exposure to Occupational Biomechanical Risk Factors Amongst People with Low Literacy Engaged in Manual Labour: Findings from a Cross-Cultural Adaptation and Psychometric Investigation in an African Population with Chronic Low Back Pain

PURPOSE

Occupational biomechanical factors are implicated in the aetiology and progression of low back pain (LBP). This study cross-culturally adapted and psychometrically investigated the Occupational Risk Factor Questionnaire (ORFQ) in a low literate Nigerian Igbo population with chronic LBP.

METHODS

Forward and back translation of the original ORFQ by clinical and non-clinical translators was followed by an expert committee review. The adapted ORFQ was pre-tested amongst rural Nigerian adults with chronic LBP using cognitive think-aloud interviewing. Internal consistency (Cronbach's alpha) and test-retest reliability (unweighted and linear weighted k statistic for item-by-item agreement, and intra-class correlation coefficient-ICC) were investigated amongst 50 rural and urban Nigerian dwellers with chronic LBP. Spearman's correlation and regression analyses were conducted with the Igbo-ORFQ, and measures of disability [World Health Organisation Disability Assessment Schedule (WHODAS 2.0), Roland Morris Disability Questionnaire (RMDQ), Back performance scale (BPS)], pain intensity [Eleven-point box scale (BS-11)] and social support [Multidimensional Scale of Perceived Social Support (MSPSS)], to test construct validity with 200 rural Nigerian dwellers with chronic LBP.

RESULTS

Cross-cultural adaptation highlighted difficulty conceptualising and concretising exposure to biomechanical risk factors. Item-by-item agreement, internal consistency (α = 0.84) and intraclass correlation coefficient (ICC = 0.83) were good. Some unexpected direction of associations between the biomechanical components of the Igbo-ORFQ, and disability, pain intensity, and social support prohibits establishment of construct validity.

CONCLUSION

Prospective studies comparing the Igbo-ORFQ to other measures of exposure to occupational biomechanical risk factors are required to establish the construct validity of the Igbo-ORFQ.

The problem with "ergonomics injuries": What can ergonomists do?

Effects of psychosocial hazards on risk of musculoskeletal disorders (MSDs) are often very substantial, but workplace risk management practices focus largely on biomechanical hazards, as do the risk assessment methods used by ergonomists. Translation of research evidence into more effective workplace practices demands a more holistic risk management framework that encompasses both types of hazard. In this context, we evaluate the validity of different MSD risk assessment methods for different purposes, focusing particularly on requirements for routine workplace risk management. These include choice of fit-for-purpose assessment methods, prioritisation of hazards that are most affecting risk, and control actions as high as possible in the risk control hierarchy. Ergonomists could facilitate more effective workplace risk management by promoting: awareness of the need for change; improvements to guidance from OHS regulators; research on MSD-related workplace management issues; and professional development programs on this topic for ergonomists and other OHS practitioners.

Job requirements and physical demands (JRPD) questionnaire: cross-cultural adaptation and psychometric evaluation in Iranian Army personnel with chronic low back pain

BACKGROUND

Biomechanical risk factors have been identified as the main predisposing factor of chronic low back pain (CLBP), especially in Army personnel. The Job Requirements and Physical Demands (JRPD) questionnaire has been developed to assess the biomechanical exposures related to CLBP. Examining the biomechanical risk factors could prevent CLBP. This study aimed to translate and cross-culturally adapt the JRPD into Persian and assess its psychometric properties among Iranian male Army personnel with CLBP.

METHODS

In this cross-sectional study, the content validation of the JRPD was assessed after translating to Persian. The Persian JRPD was administered to 198 male Army personnel with CLBP, with an interval of 7 days, to assess test-retest reliability, including Cronbach's α, intraclass correlation coefficients (ICC), standard error of measurement (SEM), and minimal detectable change at 95% confidence interval (MDC_95%). Scores of the Persian JRPD were correlated with the scores of visual analog scale (VAS), Borg's category-ratio (CR10) scale, general health questionnaire-28 (GHQ-28), and physical functioning (PF₁ and PF₂) subscale of the 12-item short-form health survey (SF-12) to assess convergent validity using Spearman correlation for a priori hypotheses.

RESULTS

The Persian JRPD had good content validity evidenced by the higher content validity index (> 0.70). The questionnaire had a significant positive negligible to weak correlation with the VAS (rho = 0.27; p < 0.001), Borg's CR10 scale (rho = 0.19; p = 0.009), and the total score of GHQ-28 and its domains (rho ≤0.34; p < 0.05); and significant negative weak correlation with PF₂ (rho = - 0.27; p < 0.001) and significant negative moderate correlation with PF₁ (rho = - 0.35; p < 0.001), thus confirming the priori hypotheses (89%, 8/9). The internal consistency and ICC (α = 0.91; ICC = 0.80) were highly adequate, with SEM and MDC_95% of 7.91 and 21.3 respectively.

CONCLUSIONS

The JRPD was successfully adapted into Persian and had adequate psychometric properties in terms of content and convergent validity, internal consistency, and test-retest reliability. The questionnaire is found useable to assess the CLBP-related biomechanical exposures in Iranian male Army personnel.

Caring-Related Chronic Low Back Pain and Associated Factors among Mothers of Children with Cerebral Palsy

BACKGROUND

Literature indicated some risk factors for low back pain; however, there is insufficient knowledge on the effect of caring-related physical activities and individual characteristics on Chronic Low Back Pain (CLBP) in mothers of children with Cerebral Palsy (CP).

OBJECTIVE

The main aim of the current study was to determine the association between caring-related physical activities, Body Mass Index (BMI), education level, and CLBP in mothers of children with CP.

DESIGN

Case-control observational study. Setting. Pediatric rehabilitation clinics. Participants. Mothers of children with CP. Main Outcome Measures. Measures is comprised of a self-administered questionnaire that included the demographic characteristics items, pain visual analog scale, and three items of the job-related physical demands questionnaire. The logistic regression model served to assess the association.

RESULTS

The control group included 81 healthy mothers, with a mean (SD) age of 39 (8.45) years, and the case group contained 90 mothers who suffered from CLBP, with a mean (SD) age of 37 (8.64) years. Performing lifting movements (OR 13.73, β = 2.62, p < .001), BMI (OR 11.85, β = 2.47, p = .011), repetitive bending (OR 7.67, β = 2.04, p = .010), forward-flexion (OR 6.71, β = 1.91, p = .033), and level of education (OR .21, β = -1.53, p = .020), in descending order of odds ratios, were found to be significant predictors of the CLBP in mothers of children with CP.

CONCLUSION

Avoiding caring-related harmful physical activities, maintaining body weight within a healthy range, and increasing knowledge for accurate lifting/handling techniques can be helpful to prevent the CLBP in mothers of children with CP.

Effects of Ergomotor Intervention on Improving Occupational Health in Workers with Work-Related Neck-Shoulder Pain

(1) Background: Work-related neck and shoulder pain (WRNSP) are common problems, and past occupational research has focused on ergonomic interventions such as adjusting workstations while physiotherapists have traditionally focused on teaching exercises to improve posture and movement control in the clinical setting. The current study aimed to integrate these two approaches and evaluate the immediate and long-term effects of such interventions on occupational exposure outcomes. (2) Methods: A total of 101 patients diagnosed with WRNSP were randomized into 2 groups: Control (CO) group (n = 50) and ergomotor (EM) group (n = 51). Participants in the control group had 12 weeks of usual care (conventional physiotherapy) while participants in the EM group received an integrated program with tailor-made motor control training and ergonomic advice for 12 weeks. (3) Results: Both groups achieved significant improvement in pain and functional outcomes at post-intervention. The EM group also reported significantly improved scores in terms of perceived exertion in the job-related physical demands (JRPD) and the short form workstyle questionnaires compared to the control group. (4) Conclusions: The results suggest that ergomotor intervention may be more effective in producing favorable occupational health outcomes compared to conventional physiotherapy.

Improving Working Conditions to Promote Worker Safety, Health, and Wellbeing for Low-Wage Workers: The Workplace Organizational Health Study

This paper addresses a significant gap in the literature by describing a study that tests the feasibility and efficacy of an organizational intervention to improve working conditions, safety, and wellbeing for low-wage food service workers. The Workplace Organizational Health Study tests the hypothesis that an intervention targeting the work organization and environment will result in improvements in workers' musculoskeletal disorders and wellbeing. This ongoing study is being conducted in collaboration with a large food service company. Formative evaluation was used to prioritize outcomes, assess working conditions, and define essential intervention elements. The theory-driven intervention is being evaluated in a proof-of-concept trial, conducted to demonstrate feasibility and potential efficacy using a cluster randomized design. Ten worksites were randomly assigned to intervention or control conditions. The 13-month intervention uses a comprehensive systems approach to improve workplace policies and practices. Using principles of participatory engagement, the intervention targets safety and ergonomics; work intensity; and job enrichment. The evaluation will provide a preliminary assessment of estimates of the intervention effect on targeted outcomes and inform understanding of the intervention implementation across worksites. This study is expected to provide insights on methods to improve working conditions in support of the safety and wellbeing of low-wage workers.

The prospective effects of workplace violence on physicians' job satisfaction and turnover intentions: the buffering effect of job control

Background

Health care professionals, including physicians, are at high risk of encountering workplace violence. At the same time physician turnover is an increasing problem that threatens the functioning of the health care sector worldwide. The present study examined the prospective associations of work-related physical violence and bullying with physicians’ turnover intentions and job satisfaction. In addition, we tested whether job control would modify these associations.

Methods

The present study was a 4-year longitudinal survey study, with data gathered in 2006 and 2010.The present sample included 1515 (61% women) Finnish physicians aged 25–63 years at baseline. Analyses of covariance (ANCOVA) were conducted while adjusting for gender, age, baseline levels, specialisation status, and employment sector.

Results

The results of covariance analyses showed that physical violence led to increased physician turnover intentions and that both bullying and physical violence led to reduced physician job satisfaction even after adjustments. We also found that opportunities for job control were able to alleviate the increase in turnover intentions resulting from bullying.

Conclusions

Our results suggest that workplace violence is an extensive problem in the health care sector and may lead to increased turnover and job dissatisfaction. Thus, health care organisations should approach this problem through different means, for example, by giving health care employees more opportunities to control their own work.

Predictors of low back pain in physically active conscripts with special emphasis on muscular fitness

BACKGROUND CONTEXT

Association between low physical fitness and low back pain (LBP) is contradictory in previous studies.

PURPOSE

The objective of the present prospective cohort study was to investigate the predictive associations of various intrinsic risk factors in young conscripts for LBP, with special attention to physical fitness.

STUDY DESIGN

A prospective cohort study.

PATIENT SAMPLE

A representative sample of Finnish male conscripts. In Finland, military service is compulsory for male citizens and 90% of young men enter into the service.

OUTCOME MEASURES

Incidence of LBP and recurrent LBP prompting a visit at the garrison health clinic during 6-month military training.

METHODS

Four successive cohorts of 18- to 28-year-old male conscripts (N=982) were followed for 6 months. Conscripts with incidence of LBP were identified and treated at the garrison clinic. Predictive associations between intrinsic risk factors and LBP were examined using multivariate Cox proportional hazard models.

RESULTS

The cumulative incidence of LBP was 16%, the incidence rate being 1.2 (95% confidence interval [CI], 1.0-1.4) per 1,000 person-days. Conscripts with low educational level had increased risk for incidence of LBP (hazard ratio [HR], 1.6; 95% CI, 1.1-2.3). Conscripts with low dynamic trunk muscle endurance and low aerobic endurance simultaneously (ie, having coimpairment) at baseline also had an increased risk for incidence of LBP. The strongest risk factor was coimpairment of trunk muscular endurance in tests of back lift and push-up (HR, 2.8; 95% CI, 1.4-5.9).

CONCLUSIONS

The increased risk for LBP was observed among young men who had a low educational level and poor fitness level in both muscular and aerobic performance.

Comparison of risk factors for shoulder pain and rotator cuff syndrome in the working population

BACKGROUND

To compare risk factors for shoulder pain without and with rotator cuff syndrome (RCS).

METHODS

A total of 3,710 workers of a French region were randomly included in the cross-sectional study between 2002 and 2005. Personal and occupational risk factors were assessed during a physical examination and by a self-administered questionnaire. Multinomial logistic modeling was used for the following outcomes: no shoulder pain and no RCS (reference), shoulder pain without RCS (called "shoulder pain") and RCS, separately for men and women.

RESULTS

The prevalence rates of "shoulder pain" for men and women were 28.0% and 31.1%, respectively, and the prevalence rates of RCS were 6.6% and 8.5%, respectively. In men, "shoulder pain" and RCS were associated with age, high-perceived physical exertion, and arm abduction. Automatic work pace and low supervisor support were associated with "shoulder pain," and high psychological demand and low skill discretion with RCS. In women, "shoulder pain" and RCS were associated with age, repetitiveness of tasks, and low supervisor support. High perceived physical exertion and exposure to cold temperatures were associated with "shoulder pain."

CONCLUSIONS

Age was more strongly associated with RCS than with shoulder pain without RCS for both genders. Biomechanical and psychosocial factors were associated with "shoulder pain" and RCS and differed between genders.

Effects of individual and work-related factors on incidence of shoulder pain in a large working population

OBJECTIVES

The aim of this study was to assess the effects of individual and work-related factors on the incidence of shoulder pain in a large French working population.

METHODS

A total of 3,710 workers of a French region were randomly included in a cross-sectional study between 2002 and 2005. They completed a self-administered questionnaire about musculoskeletal symptoms, individual factors and exposure to work constraints. In 2007, 2,332 responded to a follow-up questionnaire. The Nordic questionnaire was used both times to assess shoulder pain during the preceding 7 days. Associations between incident shoulder pain and individual and work-related factors at baseline were studied by multivariate logistic regression for both genders.

RESULTS

A total of 946 men and 709 women without shoulder pain at baseline were eligible for the analyses. At follow-up, 105 men (11.1%) and 145 women (20.5%) reported shoulder pain. For men, age (OR 3.3, 95% CI, 1.7-6.5 for ≥50 yr), working with arms above the shoulder (1.5; 1.0-2.3) and high perceived physical exertion (1.6; 1.0-2.5) increased the risk of incident shoulder pain. For women, the factors associated with incident shoulder pain were age (2.9; 1.5-5.8 for ≥50 yr), obesity (2.5; 1.4-4.5), temporary employment (2.1; 1.1-3.7), high perceived physical exertion (2.2; 1.4-3.5) and low decision latitude (1.6; 1.0-2.3).

CONCLUSION

Age was the strongest predictor of incident shoulder pain in both genders. BMI and biomechanical and psychosocial factors were also identified as risk factors, whereas no factor related to work organization remained in the final models.

Low back pain among personal care workers in an old age home: work-related and individual factors

This cross-sectional study explored the work-related and individual factors that contributed to the occurrence of low back pain and affected activities of 36 personal care workers at an old age home in Hong Kong. The study was divided into four parts: (1) a questionnaire documenting workload exposure factors; (2) a musculoskeletal symptoms survey documenting the prevalence of low back pain in this group of workers; (3) a worksite evaluation focusing on personal care workers' work postures and the work environment; and (4) an evaluation of physical fitness and lifting capacities of personal care workers. Univariate followed by multiple logistic regression analyses were used to identify the risk factors associated with low back pain that affected work activities. The results revealed that low back pain was associated with the perceived physical demands of cleaning tasks (odds ratio [OR] = 7.28, 95% confidence interval [CI] = 1.35-39.35, p < .05), perceived demands of awkward sustained back (OR = 4.46, CI = 0.86-22.97, p = .074) and neck (OR = 0.18, CI = 0.04-0.81, p < .05) postures, and thermal stress at work (OR = 49.80, CI = 0.70-3541.79, p = .072). The results of the current study indicated that the work environment contributed to low back pain at work. Workers perceived that exertion in workplaces has a role in assessing workplace risk. To avoid progression of low back pain in the workplace, work adjustment or modification should be considered when workers report high levels of perceived exertion at work.

Low Back Pain among Personal Care Workers in an Old Age Home

This cross-sectional study explored the work-related and individual factors that contributed to the occurrence of low back pain and affected activities of 36 personal care workers at an old age home in Hong Kong. The study was divided into four parts: (1) a questionnaire documenting workload exposure factors; (2) a musculoskeletal symptoms survey documenting the prevalence of low back pain in this group of workers; (3) a worksite evaluation focusing on personal care workers' work postures and the work environment; and (4) an evaluation of physical fitness and lifting capacities of personal care workers. Univariate followed by multiple logistic regression analyses were used to identify the risk factors associated with low back pain that affected work activities. The results revealed that low back pain was associated with the perceived physical demands of cleaning tasks (odds ratio [OR] = 7.28, 95% confidence interval [CI] = 1.35–39.35, p < .05), perceived demands of awkward sustained back (OR = 4.46, CI = 0.86–22.97, p = .074) and neck (OR = 0.18, CI = 0.04–0.81, p < .05) postures, and thermal stress at work (OR = 49.80, CI = 0.70–3541.79, p = .072). The results of the current study indicated that the work environment contributed to low back pain at work. Workers perceived that exertion in workplaces has a role in assessing workplace risk. To avoid progression of low back pain in the workplace, work adjustment or modification should be considered when workers report high levels of perceived exertion at work.

Addressing occupational factors in the management of low back pain: implications for physical therapist practice

There is mounting evidence that occupational factors influence the extent of sickness absence following an episode of low back pain, but there have been limited efforts to integrate the identification and management of occupational factors into the routine practice of physical therapists. Systematic reviews suggest that a client's report of heavy physical demands, inability to modify job tasks, work stress, lack of organizational support, job dissatisfaction, poor expectations for resuming usual work, and fear of reinjury are indications of significant barriers to returning to work. Recommended strategies for evaluating and addressing occupational factors are explored with respect to the physical therapist's role in client assessment, development of activity and lifestyle recommendations, therapeutic exercise, communication with other providers, and summary reports. Primary recommendations include: (1) administration of self-report questionnaires to assess a client's perspective of physical job demands, (2) client-centered interviewing to highlight individual return-to-work concerns, (3) early discussions with clients about possible job modifications, and (4) incorporation of clients' workplace concerns in progress reports and summaries. These strategies may improve low back pain outcomes by encouraging effective communication with key stakeholders and by developing clients' ability to resolve obstacles to returning to work.

A coronary heart disease risk score based on patient-reported information

To develop a simple, patient self-report-based coronary heart disease (CHD) risk score for adults without previously diagnosed CHD (Personal Heart Early Assessment Risk Tool [HEART] score), the Atherosclerosis Risk In Communities (ARIC) Study, a prospective cohort of subjects aged 45 to 64 years at baseline, was used to develop a measure for 10-year risk of CHD (n = 14,343). Variables evaluated for inclusion were age, history of diabetes mellitus, history of hypercholesterolemia, history of hypertension, family history of CHD, smoking, physical activity, and body mass index. The 10-year risk of CHD events was defined as myocardial infarction, fatal CHD, or cardiac procedure. The new measure was compared with the Framingham Risk Score (FRS) and European Systematic Coronary Risk Evaluation (SCORE). The Personal HEART score for men included age, diabetes, hypertension, hypercholesterolemia, smoking, physical activity, and family history. In men, the area under the receiver-operator characteristic curve for predicting 10-year CHD for the Personal HEART score (0.65) was significantly different from that for the FRS (0.69, p = 0.03), but not for the European SCORE (0.62, p = 0.12). The Personal HEART score for women included age, diabetes, hypertension, hypercholesterolemia, smoking, and body mass index. The area under the curve for the Personal HEART score (0.79) for women was not significantly different from that for the FRS (0.81, p = 0.42) and performed better than the European SCORE (0.69, p = 0.01). In conclusion, the Personal HEART score identifies 10-year risk for CHD based on self-report data, is similar in predictive ability to the FRS and European SCORE, and has the potential for easy self-assessment.

Perceived effort and low back pain in non-emergency ambulance workers: implications for rehabilitation

INTRODUCTION

This study aims to explore factors associated with low back pain (LBP) that required treatment from health care provider among non-emergency ambulance transfer workers.

METHOD

A cross-sectional study was conducted to 38 workers of a major hospital in Hong Kong. The influences of four categories of risk factors (personal, physical, psychosocial, and exposure factors) in the prevalence of LBP were investigated by objective measurement and self-reported questionnaires. A modified Nordic musculoskeletal symptoms survey and sick leave record were used to document the prevalence of LBP. Univariate analyses followed by multiple logistic regression analyses were used to explore the risk factors associated with LBP cases.

RESULTS

The results revealed that LBP was associated with age (OR=0.75, CI=0.56-1.00, P < 0.05), perceived effort (OR=7.95, CI=1.46-43.27, P < 0.05), job satisfaction (OR=4.18 CI=1.42-12.33, P < 0.01), and flexor peak torque at 120 degrees /s (OR=1.09 CI= 0.99-1.19, P=0.07).

CONCLUSION

This study suggests that workers' perceived exertion has an valuable role in assessing risk at this workplace. A high perceived exertion at work can signal the need for work adjustment or modification to avoid progression of low back disorder to persistent pain or intense pain. The effects of work adjustment or modification in affected workers needs to be systematically investigated.

How Do Job Stress and Ergonomic Factors Impact Clinic Visits in Acute Low Back Pain? A Prospective Study

OBJECTIVE

We sought to identify whether ergonomic factors, job stress, health behavior, and emotional distress are prospectively related to return visits for acute back pain.

METHODS

A total of 368 U.S. Army soldiers completed a baseline survey of health and work factors at their first visit for back pain. Multivariable regression and structural equation modeling were used to describe the relationships among ergonomic exposure, job stress, smoking, and emotional distress and their ability to predict repeat clinic visits.

RESULTS

The path analysis indicated that higher levels of ergonomic exposures were directly related to increased job stress (beta = 0.29). Higher levels of job stress were directly related to higher levels of general distress (beta = -35). General distress (beta = -0.70) and smoking (beta = 0.67) were directly linked to clinic visits.

CONCLUSIONS

Efforts to directly impact emotional distress or indirectly reduce distress by intervening at the levels of ergonomic risks and psychosocial workplace stress should prove useful in the management of acute low back pain.

Amantadine Sulfate Reduces Experimental Sensitization and Pain in Chronic Back Pain Patients

We investigated if established psychophysical measures of enhanced experimental sensitization in chronic musculoskeletal pain can be reduced by adjuvant treatment with a N-methyl-d-aspartate receptor antagonist, amantadine sulfate, and whether a reduction in sensitization might be accompanied by a concurrent improvement in clinical pain. Sensitization was evaluated by an experimental tonic heat model of short-term sensitization with concurrent subjective and behavioral psychophysical scaling. Twenty-six patients with chronic back pain were included in the randomized, double-blind, placebo-controlled study and received daily dosages of either placebo or 100 mg of amantadine sulfate during a 1-wk treatment. Participants completed quantitative sensory testing of pain thresholds and experimental sensitization before and after treatment and clinical pain ratings before, during, and after treatment. Experimental sensitization and clinical pain were reduced in patients receiving verum. Initially, experimental sensitization was enhanced in patients, with early sensitization at nonpainful intensities of contact heat and enhanced sensitization at painful intensities, as shown previously. After 1 wk of treatment, experimental sensitization was reduced with amantadine sulfate but not with placebo. We conclude that adjuvant chronic pain treatment with N-methyl-d-aspartate receptor antagonists might be beneficial for chronic pain if enhanced sensitization is involved and that the quantitative sensory test of temporal summation may be used to verify this.