Treatment and ergonomics training of work-related lower back pain and body posture problems for nurses

Efficacy of an Omaha system-based remote ergonomic intervention program on self-reported work-related musculoskeletal disorders (WMSDs) - A randomized controlled study

Purpose

Heavy biomechanical loadings at workplaces may lead to high risks of work-related musculoskeletal disorders. This study aimed to explore the efficacy of an Omaha System-based remote ergonomic intervention program on self-reported work-related musculoskeletal disorders among frontline nurses.

Materials and methods

From July to October 2020, 94 nurses with self-reported pain in one of the three body parts, i.e., neck, shoulder, and low back, were selected and were randomly divided into two groups. The intervention group received a newly developed remote program, where the control group received general information and guidance on health and life. Program outcome was evaluated by a quick exposure check approach.

Results

After 6 weeks, the intervention group exhibited significantly less stress in the low back, neck, and shoulder/forearms, compared to the control group (p < 0.05). In addition, the occurrence of awkward postures, such as extreme trunk flexion or twisting, was also significantly reduced (p < 0.05).

Conclusions

The newly developed Omaha System-based remote intervention program may be a valid alternative to traditional programs for frontline nurses during the COVID-19 pandemic, reducing biomechanical loadings and awkward postures during daily nursing operations.

Comparison of the Effects of Body Mechanics Education Methods on Pain, Disability, and Quality of Life: A Randomized Controlled Study

BACKGROUND

Educating patients undergoing surgery for LDH is important to maintain the proper performance of body mechanics.

PURPOSE

The study compared the effects of standard, brochure-based, and video-based education on postoperative pain, disability, and the quality of life in patients undergoing surgery for lumbar disc herniation.

DESIGN

This was a randomized controlled study.

SETTINGS

The study was conducted in the Department of Neurosurgery of a training and research hospital in Turkey.

PARTICIPANTS/SUBJECTS

Sixty patients (n = 20 control, n = 20 video, n = 20 brochure) undergoing surgery for LDH who volunteered to participate.

METHODS

The study was carried out between 15 January and 30 July 2017. The data were collected preoperatively and postoperatively using the Patients' Characteristics Form, Oswestry Disability Index (ODI), Short-Form McGill Pain Questionnaire (SF-MPQ), Physical Functioning and Bodily Pain subscales of the Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36) and the Survey of Patient Satisfaction with Clinical Education and Materials.

RESULTS

All three groups were similar in terms of socio-demographic and clinical characteristics. Preoperative scores obtained from the ODI, SF-MPQ, and the two subscales of the SF-36 were not significantly different. However, there was a statistically significant difference between the video group (81.5 ± 24.3) and the control group (67.7 ± 18.6) in terms of the Physical Functioning subscale of the SF-36 in the postoperative period (p< .05).

CONCLUSIONS

Preoperative education on body mechanics increases the physical functioning of patients with LDH and facilitates the integration of information into their daily activities.

Telerehabilitation for a Non-specific Low Back Pain: A Case Report

One of the most common conditions that affect activities of daily living and make them significantly more difficult to perform is low back pain (LBP). As a result, it is essential to treat LBP at an early stage. Particularly in geographically remote areas where there is a shortage of medical professionals and a lack of rehabilitation services, telerehabilitation is considered a potential alternative. Hence, this case report represents the impact of telerehabilitation on LBP in a 32-year-old female corporate worker who presented to the out-patient department of physiotherapy with the chief complaints of LBP for the last three months with difficulty in performing activities, and being unable to sit for prolonged period of time. The physiotherapeutic rehabilitation was virtually administered through online sessions through the cloud-based application as the patient was not able to visit the outpatient department on a regular basis. Post-intervention results demonstrated increased range of motion and flexibility, reduced pain, increased muscle strength, reduced disability and kinesiophobia, and improved quality of life. Hence, it can be concluded that telerehabilitation offers a novel solution to increase access to rehabilitation services.

Occupational low back pain prevention capacity of nurses in China: A multicenter cross-sectional study

Introduction

Nurses have a high prevalence of occupational low back pain, especially since the outbreak of the COVID-19 pandemic, which has increased the nurses' workloads. It has brought a huge burden on nurses and their professional development. Nurses' occupational low back pain prevention capacity is the logical starting point and core of interventions to prevent its occurrence. To date, there is no study investigating it with a scientific scale. Therefore, a multicenter cross-sectional study was conducted to explore the current status of nurses' capacity in occupational low back pain prevention and its influencing factors in China.

Methods

Using a two-stage, purposive and convenience mixed sampling method, 1331 nurses from 8 hospitals across 5 provinces (Hubei, Zhejiang, Shandong, Henan, and Sichuan) in the southern, western, northern, and central areas of mainland China were involved in this study. The demographic questionnaire and occupational low back pain prevention behavior questionnaire were used for data collection. The descriptive analysis, univariate analysis, and multiple stepwise linear regression were used for data analysis.

Results

The results showed that the occupational low back pain prevention behavior questionnaire score was 89.00 (80.00, 103.00) [M (Q1, Q3)], which indicated that nurses' ability was at a moderate level. Participation in prevention training before, perceived stress at work, and working hours per week were predictors for nurses' occupational low back pain prevention capacity.

Discussion

To improve nurses' prevention ability, nursing managers should organize various training programs, strengthen regulations to reduce nurses' workload and stress, provide a healthy workplace, and offer incentives to motivate nurses.

Home Exercise Programs Are Infrequently Prescribed in Trials of Supervised Exercise for Individuals With Low Back Pain: A Scoping Review of 292 Randomized Controlled Trials

OBJECTIVES: To (1) determine how often home exercise programs (HEPs) are prescribed in supervised exercise trials for low back pain (LBP) and (2) describe characteristics of the HEP programs (design, purpose, dose, and adherence). DESIGN: Scoping review. LITERATURE SEARCH: PubMed, CINAHL, and Ovid MEDLINE were searched from January 1, 2010, to August 17, 2021. STUDY SELECTION CRITERIA: Randomized controlled trials that included adults with LBP who received exercise interventions. DATA SYNTHESIS: The presence or absence of a prescribed HEP and any details of the HEP including design, dose, and adherence were extracted and summarized. RESULTS: Of 2689 potentially relevant trials, 292 were eligible for inclusion. Ninety-four trials (32%) included a HEP. The most commonly prescribed home exercises were core stability, trunk strengthening, and motor control exercises. There was great variation in the frequency and duration with which HEPs were prescribed. Adherence to HEPs was measured in fewer than half of the trials, and the methods for measuring adherence were inconsistent. Adherence to HEPs ranged from 29% to 82% in the 21 trials that reported adherence. CONCLUSION: Home exercise programs are not regularly prescribed in supervised exercise trials for LBP. There was considerable variation in prescribing HEPs and monitoring exercise adherence in trials of exercise-based treatments for adults with LBP. There is no consistent method used to measure participants' adherence to HEPs, and adherence percentages vary widely. J Orthop Sports Phys Ther 2023;53(3):120-142. Epub: 16 January 2023. doi:10.2519/jospt.2023.11448.

Chair squat performance as a potential predictor of nurses' physical capabilities in ergonomic patient transfers

Muscle activation and movements performed during occupational work can lead to musculoskeletal disorders, one of the nursing profession's most significant health hazards. However, physical activity like exercise training tailored to the exposure and physical ability offers health prevention and rehabilitation. Professional nursing associations have advised squat training to promote occupational health because it strengthens lower limb and back muscles. Given that squatting is a fundamental part of many daily activities and various actions in caregiving processes, we hypothesized that chair squat performance is a potential predictor of nurses' physical capabilities to perform occupational tasks. We conducted kinetic and electromyographic assessments of 289 chair squat repetitions and compared them to ergonomic patient transfer tasks. In this task, nurses transferred a supine patient to a lateral position in a care bed using similar movement characteristics of the squat task. This cross-sectional pilot study provides initial insights into nurses' kinetic and muscle activation patterns of health-enhancing and compensational strategies. Highly asymmetric movements corresponded to distinct extremes in lower limb and spine muscle activity data-e.g., increased activity of the rectus femoris indicates increased hip flexion, including postural sway and, therefore, high torsional forces affecting the sacroiliac joints. The potential of the chair squat performance as a predictor of nurses' physical capabilities in ergonomic patient transfers was quantified by a 2 × 2 contingency table resulting in an accuracy rate of 73%.

Ergonomics in Spine Surgery

As physician burnout and wellness become increasingly recognized as vital themes for the medical community to address, the topic of chronic work-related conditions in surgeons must be further evaluated. While improving ergonomics and occupational health have been long emphasized in the executive and business worlds, particularly in relation to company morale and productivity, information within the surgical community remains relatively scarce. Chronic peripheral nerve compression syndromes, hand osteoarthritis, cervicalgia and back pain, as well as other repetitive musculoskeletal ailments affect many spinal surgeons. The use of ergonomic training programs, an operating microscope or exoscope, powered instruments for pedicle screw placement, pneumatic Kerrison punches and ultrasonic osteotomes, as well as utilizing multiple surgeons or microbreaks for larger cases comprise several methods by which spinal surgeons can potentially improve workspace health. As such, it is worthwhile exploring these areas to potentially improve operating room ergonomics and overall surgeon longevity.

Knowledge, Attitudes, and Practices Regarding Ergonomic Hazards Among Healthcare Workers in a Saudi Government Hospital

Background

Musculoskeletal disorders (MSDs) affecting healthcare workers (HCWs) must be considered and addressed as a serious issue. Thus, it is important to incorporate ergonomics into clinical practice to prevent MSDs. The objectives of this study were to investigate HCWs’ knowledge, attitudes, and practices regarding ergonomics in a large governmental healthcare facility.

Methods

A cross-sectional study was conducted in which the participants were interviewed to complete a validated four-section questionnaire (demographic data, knowledge, attitudes, and practice information related to ergonomics). The questionnaire was newly self-developed based on a literature review and was pilot tested after development.

Results

This study included 273 HCWs. Their average knowledge score regarding ergonomics was 2.6, or “fair to good.” Overall, the participants reported good attitude scores, with a total average score of 1 and 2, or “agree to strongly agree.” The findings also indicated that appropriate ergonomics practices were often not implemented, as the average practice score was 1 to 2, or “always to sometimes engaging in bad practice.” The risk factors of being Saudi, being a woman, and having low academic achievement were associated with poor knowledge, attitudes, and practices related to ergonomics among HCWs.

Conclusion

This study showed that the majority of the participants had fair knowledge and good attitudes toward ergonomics at work while practicing. However, the practice of ergonomics at work was not implemented. It is important to apply ergonomics at work to prevent MSDs; therefore, ergonomic principles should be included in the undergraduate health curriculum for all HCWs, with emphasis on practicing ergonomics in their routine clinical work.

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The comparison of percutaneous kyphoplasty and vertebroplasty for the management of stage III Kummell disease without neurological symptoms

Purpose

To compare the clinical and radiological outcomes of percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP) in the treatment of stage III Kummell disease without neurological deficit.

Methods

This retrospective study involved 41 patients with stage III Kummell disease without neurological deficit who underwent PKP or PVP from January 2018 to December 2019. Demographic data and clinical characteristics were comparable between these two groups before surgery. Operation time, volume of injected bone cement, intraoperative blood loss and time of hospital stay were analyzed. Visual analog scale (VAS) scoring and Oswestry disability index (ODI) scoring were assessed for each patient before and after operation. Radiographic follow-up was assessed by the height of anterior (Ha), the height of middle (Hm), Cobb’s angle, and Vertebral wedge ratio (VWR). The preoperative and postoperative recovery values of these data were used for comparison.

Results

The two groups showed no significant difference in demographic features (p > 0.05). What’s more, the operation time, intraoperative blood loss, and time of hospital stay revealed no sharp statistical distinctions either (p > 0.05), except PKP used more bone cement than PVP (7.4 ± 1.7 mL vs 4.7 ± 1.4 mL, p < 0.05). Radiographic data, such as the Ha improvement ratio (35.1 ± 10.2% vs 16.2 ± 9.4%), the Hm improvement ratio (41.8 ± 11.3% vs 22.4 ± 9.0%), the Cobb’s angle improvement (10.0 ± 4.3° vs 3.5 ± 2.1°) and the VWR improvement ratio (30.0 ± 10.6% vs 12.7 ± 12.0%), were all better in PKP group than that in PVP group (p < 0.05). There were no statistical differences in the improvement of VAS and ODI 1-day after the surgery between these two groups (p > 0.05). However, at the final follow-up, VAS and ODI in PKP group were better than that in PVP (p < 0.05). Cement leakage, one of the most common complications, was less common in the PKP group than that in the PVP group (14.3% vs 45.0%, p < 0.05). And there was 1 case of adjacent vertebral fractures in both PKP and PVP (4.8% vs 5.0%, p > 0.05), which showed no statistical difference, and there were no severe complications recorded.

Conclusions

For stage III Kummell disease, both PKP and PVP can relieve pain effectively. Moreover, PKP can obtain more satisfactory reduction effects and less cement leakage than PVP. We suggested that PKP was more suitable for stage III Kummell disease without neurological deficit compared to PVP from a vertebral reduction point of view.

Utilization rates of Active Release Techniques® in the workplace: A descriptive study

BACKGROUND: Workplace safety is a necessary and frequent topic of discussion for researchers, employers, and workers. It is estimated that annual losses caused by work-related injuries cost the United States $140 to $145 billion. Specifically, work-related musculoskeletal disorders (WMSD) have risen from just over 10% to 50% of the total claims from 1952 to 1996, accounting for more than 345,00 days lost and more than $57 million in WSIB costs in 2015. Novel approaches to managing WMSDs, such as Active Release Techniques®, need to be explored to ensure the ongoing health of workers. OBJECTIVE: This descriptive study provides the details of the 697,002 onsite treatments across 448 sites in North America between 2014–2018 provided by Active Release Techniques® Corporate Solutions (ARTCS) practitioners. The objective was to calculate the total number of treatments, cost per closed case, percent improvement, and the number of cases referred to worker’s compensation. METHODS: All charting was done on the ARTCS EMR portal. The lead author was given a spreadsheet of the results sanitized of all identifying data in order to perform the aforementioned calculations. RESULTS: From 2014 to 2018, ARTCS providers opened 199,077 new cases, with an average cost to the employer of $306.69 USD per case and an average percent improvement in pain (VNPS) of 87.2%. The most frequently treated areas were the shoulder (32,574 cases), hip (6,633 cases), and low back (27,873 cases), respectively. A total of 48,946 cases were work-related pain/discomfort, of which 1,110 (2.27%) went on to worker’s compensation. CONCLUSION: ARTCS in the workplace has shown a positive trend in terms of reducing pain intensity. The cost was low as compared to worker’s compensation claims, as was the rate of cases (2.27%) referred to worker’s compensation. Additional studies, including prospective data collection and a control group, are warranted to substantiate this.

Providing physical relief for nurses by collaborative robotics

Manual patient handling is one of the most significant challenges leading to musculoskeletal burden among healthcare workers. Traditional working techniques could be enhanced by innovations that can be individually adapted to the physical capacity of nurses. We evaluated the use of a robotic system providing physical relief by collaboratively assisting nurses in manual patient handling tasks. By quantifying kinetic and muscle activity data, it was possible to distinguish two kinds of movement patterns. Highly asymmetric postures and movements corresponded to distinct extremes in lower limb and spine muscle activity data. The use of collaborative robotics significantly reduced maximum force exertion in the caregiving process by up to 51%. Lateral flexion and torsion of the trunk were reduced by up to 54% and 87%, respectively, leading to a significant reduction in mean spine muscle activity of up to 55%. These findings indicate the feasibility of collaborative robot-assisted patient handling and emphasize the need for future individual intervention programs to prevent physical burden in care.

The Effects on Turkish Ice Cream Employees' Musculoskeletal Pain of Physical Activity and Ergonomy Programme in Workplace

ABSTRACTObjective. This study aimed to investigate the effects of physical activity and ergonomy programme (PAEIP) on employees' musculoskeletal pain. Methods. The sampling group included 120 employees met the criteria and were randomly assigned to the intervention group (N = 57) and the control group (N = 63). Visual Analog Scale (VAS), Nordic Musculoskeletal Survey, Rapid Upper Limb Assessment (RULA) were used for collecting data. Results. When pre-test and post-test pain scores of intervention group were compared, the average post-test scores were significantly lower in neck, shoulder, wrist and low back regions than the pre-test scores. When the intervention and control groups' RULA score compared, in the intervention group whereas proportion of employees found in "acceptable posture" level was 0 percent in pre-test, it was 5.3 percent in the post-test, and in the same group, proportion of employees in "further investigation and change may be needed" level was 31.6% in the pre-test, this rate increased to 61.4% in the post-test. Conclusion. As a result, PAEIP has been found effective in reducing the ergonomic risks associated with upper extremities and rate or intensity of musculoskeletal pain.

What Do We Know About Interventions to Prevent Low Back Injury and Pain Among Nurses and Nursing Students? A Scoping Review

STUDY BACKGROUND

Back injuries are common among nurses worldwide with lifetime prevalence of lower back pain ranging from 35% to 80%, making nursing a profession at great risk for back injuries.

PURPOSE

This systematic scoping review explored and mapped existing evidence regarding the prevention of low back injury and pain among nurses and nursing students.

METHODS

Using a scoping review methodology, six databases were searched initially in September 2017 and updated June 2020. Studies investigating interventions designed to reduce back injuries and pain among regulated nurses and student nurses, published in peer-review journals and written in English, were eligible for inclusion in this review. Quantitative, qualitative, and mixed methods studies of regulated nurses, nursing students, and nursing aides were included. Two independent reviewers screened, critically analysed studies using a quality appraisal tool, extracted data, and performed quality appraisals.

RESULTS

Two searches yielded 3,079 abstracts and after title, abstract and screening, our final synthesis was based on 48 research studies.

CONCLUSIONS

Forty years of research has demonstrated improvements in quality over time, the efficacy of interventions to prevent back injury and pain remains unclear, given the lack of high-quality studies. Further research, using multi-dimensional approaches and rigorous study designs, are needed.

Decreasing thoracic hyperkyphosis - Which treatments are most effective? A systematic literature review and meta-analysis

BACKGROUND

A variety of treatments aim to reduce thoracic hyperkyphosis in adults, thereby improving posture and reducing possible complications.

OBJECTIVE

To investigate the effectiveness of treatments to reduce thoracic hyperkyphosis.

DESIGN

Systematic review and meta-analysis.

METHODS

MEDLINE, EMBASE, CINAHL, and CENTRAL were searched from inception to March 2021. Two authors independently selected randomised controlled trials assessing the effectiveness of treatments to reduce thoracic hyperkyphosis in adults. Raw data on mean change in thoracic kyphosis were extracted and standardised mean differences (SMD) calculated. Meta-analysis was performed on studies homogenous for study population and intervention. Strength of evidence was assessed using GRADE.

RESULTS

Twenty-eight studies were included, with five meta-analyses performed. Low to moderate-quality evidence found structured exercise programs of three-months duration or less effective in reducing thoracic hyperkyphosis in younger (SMD -2.8; 95%CI -4.3 to -1.3) and older populations (SMD -0.3; 95%CI -0.6 to 0.0). Low-quality evidence found bracing for three months or more effective in older participants (SMD -1.0, 95%CI -1.3 to -0.7). A single study demonstrated the effectiveness of multimodal care in younger participants. The available evidence suggests multimodal care, structured exercise programs over three months duration, and taping in older adults, and biofeedback and muscle stimulation in younger adults, are ineffective in reducing thoracic hyperkyphosis.

CONCLUSION

Low to moderate-quality evidence indicates that structured exercise programs are effective to reduce thoracic hyperkyphosis. Low-quality evidence indicates that bracing is effective to reduce thoracic hyperkphosis in older adults.

Low Back Pain-Behavior Correction by Providing Haptic Feedbacks: A Preliminary Investigation

The activities performed by nurses in their daily activities involve frequent forward bending and awkward back postures. These movements contribute to the prevalence and development of low back pain (LBP). In previous studies, it has been shown that modifying their posture by education and training in proper lifting techniques decreases the prevalence of LBP. However, this education and training needs to be implemented daily. Hence, implementing the use of a wearable device to monitor the back posture with haptic feedback would be of importance to prevent LBP. This paper proposes a wearable device to monitor the back posture of the user and provide feedback when the participant is performing a possible hurtful movement. In this study, a group of participants was asked to wear the device while performing three of the most common activities performed by nurses. The study was divided into three sessions: In the first session, the participants performed the activities without feedback (baseline). During the second session, the participants received feedback from the wearable device (training) while performing the three tasks. Finally, for the third session, the participants performed the three tasks again, but the haptic feedback was turned off (validation). We found an improvement in the posture of more than 40% for the pitch (lateral bending) and roll (forward/backward bending) axes and 7% for the yaw (twisting) axis when comparing to the results from session 1 and session 2. The comparison between session 1 and session 3 showed an overall improvement of more than 50% for the pitch (lateral bending) and roll (forward/backward bending) axes and more than 20% for the yaw axis. These results hinted at the impact of the haptic feedback on the participants to correct their posture.

Exercise therapy for chronic low back pain

BACKGROUND

Low back pain has been the leading cause of disability globally for at least the past three decades and results in enormous direct healthcare and lost productivity costs.

OBJECTIVES

The primary objective of this systematic review is to assess the impact of exercise treatment on pain and functional limitations in adults with chronic non-specific low back pain compared to no treatment, usual care, placebo and other conservative treatments.

SEARCH METHODS

We searched CENTRAL (which includes the Cochrane Back and Neck trials register), MEDLINE, Embase, CINAHL, PsycINFO, PEDro, SPORTDiscus, and trials registries (ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform), and conducted citation searching of relevant systematic reviews to identify additional studies. The review includes data for trials identified in searches up to 27 April 2018. All eligible trials have been identified through searches to 7 December 2020, but have not yet been extracted; these trials will be integrated in the next update.

SELECTION CRITERIA

We included randomised controlled trials that assessed exercise treatment compared to no treatment, usual care, placebo or other conservative treatment on the outcomes of pain or functional limitations for a population of adult participants with chronic non-specific low back pain of more than 12 weeks' duration.

DATA COLLECTION AND ANALYSIS

Two authors screened and assessed studies independently, with consensus. We extracted outcome data using electronic databases; pain and functional limitations outcomes were re-scaled to 0 to 100 points for meta-analyses where 0 is no pain or functional limitations. We assessed risk of bias using the Cochrane risk of bias (RoB) tool and used GRADE to evaluate the overall certainty of the evidence. When required, we contacted study authors to obtain missing data. To interpret meta-analysis results, we considered a 15-point difference in pain and a 10-point difference in functional limitations outcomes to be clinically important for the primary comparison of exercise versus no treatment, usual care or placebo.

MAIN RESULTS

We included 249 trials of exercise treatment, including studies conducted in Europe (122 studies), Asia (38 studies), North America (33 studies), and the Middle East (24 studies). Sixty-one per cent of studies (151 trials) examined the effectiveness of two or more different types of exercise treatment, and 57% (142 trials) compared exercise treatment to a non-exercise comparison treatment. Study participants had a mean age of 43.7 years and, on average, 59% of study populations were female. Most of the trials were judged to be at risk of bias, including 79% at risk of performance bias due to difficulty blinding exercise treatments. We found moderate-certainty evidence that exercise treatment is more effective for treatment of chronic low back pain compared to no treatment, usual care or placebo comparisons for pain outcomes at earliest follow-up (MD -15.2, 95% CI -18.3 to -12.2), a clinically important difference. Certainty of evidence was downgraded mainly due to heterogeneity. For the same comparison, there was moderate-certainty evidence for functional limitations outcomes (MD -6.8 (95% CI -8.3 to -5.3); this finding did not meet our prespecified threshold for minimal clinically important difference. Certainty of evidence was downgraded mainly due to some evidence of publication bias.  Compared to all other investigated conservative treatments, exercise treatment was found to have improved pain (MD -9.1, 95% CI -12.6 to -5.6) and functional limitations outcomes (MD -4.1, 95% CI -6.0 to -2.2). These effects did not meet our prespecified threshold for clinically important difference. Subgroup analysis of pain outcomes suggested that exercise treatment is probably more effective than education alone (MD -12.2, 95% CI -19.4 to -5.0) or non-exercise physical therapy (MD -10.4, 95% CI -15.2 to -5.6), but with no differences observed for manual therapy (MD 1.0, 95% CI -3.1 to 5.1). In studies that reported adverse effects (86 studies), one or more adverse effects were reported in 37 of 112 exercise groups (33%) and 12 of 42 comparison groups (29%). Twelve included studies reported measuring adverse effects in a systematic way, with a median of 0.14 (IQR 0.01 to 0.57) per participant in the exercise groups (mostly minor harms, e.g. muscle soreness), and 0.12 (IQR 0.02 to 0.32) in comparison groups.

AUTHORS' CONCLUSIONS

We found moderate-certainty evidence that exercise is probably effective for treatment of chronic low back pain compared to no treatment, usual care or placebo for pain. The observed treatment effect for the exercise compared to no treatment, usual care or placebo comparisons is small for functional limitations, not meeting our threshold for minimal clinically important difference. We also found exercise to have improved pain (low-certainty evidence) and functional limitations outcomes (moderate-certainty evidence) compared to other conservative treatments; however, these effects were small and not clinically important when considering all comparisons together. Subgroup analysis suggested that exercise treatment is probably more effective than advice or education alone, or electrotherapy, but with no differences observed for manual therapy treatments.

Influence of Work-Related Safety and Health Guidelines on Knowledge and Prevalence of Occupational Back Pain among Rehabilitation Nurses in Saudi Arabia: A 6-Month Follow-Up Study

Background: Nurses are frequently involved in different types of patient handling activities in different departments of the hospitals. Mishandling the patients causes accumulative stress on their spine that results in occupational back pain (OBP), substantial morbidity, and incurred cost. Objectives: This study aimed to observe the influence of work-related safety and health guidelines on knowledge and prevalence of occupational back pain among rehabilitation nurses in Saudi Arabia. Methodology: This cohort study was conducted with the inclusion of a total of 116-registered rehabilitation nurses (97-female, 19-male, mean age = 39.6-years) from different regions of Saudi Arabia. After the invitation, these nurses attended an ergonomic workshop focusing on work-related safety and patient handling guidelines, risk assessment, and control of OBP. A self-administered questionnaire was used to assess the knowledge, risk, and prevalence of OBP at baseline and 6-months follow-up. Results: The perceived knowledge score significantly improved (95% CI; t = 4.691; p < 0.001; Cohen’s d = 0.72) at 6-month follow-up (mean ± SD = 81.6 ± 18.2) from its baseline score (mean ± SD = 68.2 ± 19.2). Likewise, the prevalence score of OBP markedly reduced from 71.5% (baseline) to 65.0% (6-month follow-up). Conclusion: The level of knowledge highly improved and the prevalence of OBP markedly reduced within a span of 6-month among rehabilitation nurses in Saudi Arabia after attending an ergonomic workshop. Importantly, the nurses learned and geared up themselves for practicing the safe patient handling guidelines to avoid occupational back pain in the future. Therefore, rehabilitation nurses should update their knowledge and awareness about occupational safety and health guidelines, risk assessments, and control of OBP at a regular interval for increasing the knowledge and reducing the prevalence of OBP among them.

Interventions to promote physical and mental health of nurses in elderly care: A systematic review

This systematic review focuses on the current evidence on interventions to promote physical and mental health in elderly care nurses. The literature was identified through the electronic databases Medline, PsycINFO and CINAHL using a combination of synonyms of the terms "elderly care nurses", "physical activity", "stress management", "occupational stress", "musculoskeletal diseases" and "incapacity to work". The search was performed in January 2020 and repeated in November 2020. N = 6 randomized controlled studies were included investigating the effect of physical activity interventions, cognitive-behavioral interventions, organizational interventions and multicomponent interventions on physical and mental health in elderly care nurses. Both, the content of the interventions and the used outcome measures were heterogeneous. Four of the included studies had a high quality. They scored same or higher than seven (out of a maximum quality score of 14) with low risks of performance and attrition bias. Results suggest that cognitive-behavioral and multicomponent interventions seem to have an influence on physical and mental health factors such as job satisfaction, burnout, mental health symptoms and neck complaints. This systematic review demonstrated the potential of health promotion programs in elderly care nurses. Nevertheless, high quality randomized controlled trials are needed. Further research should consider the bottom-up approach for planning programs as well as recommended and standardized outcome measures and interventions.

Assessment of health-related quality of life and patient's knowledge in chronic non-specific low back pain

BACKGROUND

Chronic non-specific low back pain syndrome (cnsLBP) is a severe health problem in developed countries, which has an important effect on patients' quality of life and is highly determined by socio-demographic factors and low back pain specific knowledge. We examined patients' health-related quality of life according to the results of the Short Form Health Survey (SF-36), low back pain knowledge (LBPKQ) and the social determinants of the participants.

METHODS

We carried out our research in the first half of 2015 in Southern Transdanubia, Hungary. The examination included 1155 respondents living with chronic non-specific low back pain. The confidence interval of 95% was used, and the level of. significance was p < 0.05 using SPSS 22.0 software.

RESULTS

The SF-36 questionnaire is suitable for the examination of patients' health-related quality of life (Cronbach's Alpha> 0.76), as the LBPKQ's Cronbach's Alpha was 0.726 also, which showed good validity. Longer-term disease meant a lower health-related quality of life (p < 0.05). A greater decrease of function (Roland Morris scores (RM)) accounts for a lower HRQoL and higher knowledge level. We found significant differences in LBPKQ scores according to sociodemographic parameters. The general health status was positively correlated with LBPKQ (p = 0.024) adjusted for demographic and pain and functional status.

CONCLUSION

The negative effect of the symptoms on patients' quality of life is proved, which is determined by different socio-demographic parameters furthermore by knowledge. Above all could be useful information for professionals to adopt the right interventions.

Effectiveness of workplace intervention strategies in lower back pain prevention: a review

The aim of this study was to identify effective work place intervention strategies for the prevention of low back pain (LBP). The study focused on interventions to two major groups: personal interventions and technical interventions. Data basis were searched for with inclusion criteria: study design based on randomised controlled trial; outcome measures including non-specific LBP occurrence expressed by prevalence or intensity; intervention met the definition of the technical and/or personal (physical exercises, behavioural training, educational) intervention programme. Eighteen papers were selected for full analysis. The diversification of quantitative indicators of differences between control and intervention groups were carried out using Cohen's d index. The results of analysis showed strong differences in effects among intervention strategies, as well as among different cases within similar intervention strategies. LBP severity before intervention and the length of intervention were discussed as potentially influencing factors. The results of the analysis suggest that the most effective strategies for LBP prevention include technical modifications of the workstand and education based on practical training. Behavioural and physical training seems to be of lesser importance. LBP severity before intervention and the time when the measurements of outcome measures take place play an important role in the effectiveness of intervention.

Implementation of a Classroom Program of Physiotherapy among Spanish Adolescents with Back Pain: A Collaborative Study

Background: The prevalence of back pain in adolescents is steadily increasing, with negative repercussions on students’ social and academic life. This study sought to improve the ergonomics and musculoskeletal health of adolescents in secondary school by implementing physiotherapy actions within the educational context. Methods: A qualitative collaborative action research approach was used, comprising 49 students, 9 teachers, 11 family members, and 9 physiotherapists. Workshops on ergonomics, stretching, and massage were held. Visual materials were developed to support the assimilation of the information given at the workshops. Data collection included field notes, reflexive diaries, in-depth interviews, and discussion groups. The data were analyzed using the Atlas.ti 6.0 program (Scientific Software Development GmbH, Berlin, Germany). Results: The presence of a physiotherapist in the school context facilitates the acquisition of healthy postural habits. All the adolescents perceived a decrease in back pain after undergoing the program. Conclusions: physiotherapy activities offer students new tools to decrease their back pain and improve their health.

Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of low back pain

BACKGROUND CONTEXT

The North American Spine Society's (NASS) Evidence Based Clinical Guideline for the Diagnosis and Treatment of Low Back Pain features evidence-based recommendations for diagnosing and treating adult patients with nonspecific low back pain. The guideline is intended to reflect contemporary treatment concepts for nonspecific low back pain as reflected in the highest quality clinical literature available on this subject as of February 2016.

PURPOSE

The purpose of the guideline is to provide an evidence-based educational tool to assist spine specialists when making clinical decisions for adult patients with nonspecific low back pain. This article provides a brief summary of the evidence-based guideline recommendations for diagnosing and treating patients with this condition.

STUDY DESIGN

This is a guideline summary review.

METHODS

This guideline is the product of the Low Back Pain Work Group of NASS' Evidence-Based Clinical Guideline Development Committee. The methods used to develop this guideline are detailed in the complete guideline and technical report available on the NASS website. In brief, a multidisciplinary work group of spine care specialists convened to identify clinical questions to address in the guideline. The literature search strategy was developed in consultation with medical librarians. Upon completion of the systematic literature search, evidence relevant to the clinical questions posed in the guideline was reviewed. Work group members utilized NASS evidentiary table templates to summarize study conclusions, identify study strengths and weaknesses, and assign levels of evidence. Work group members participated in webcasts and in-person recommendation meetings to update and formulate evidence-based recommendations and incorporate expert opinion when necessary. The draft guideline was submitted to an internal and external peer review process and ultimately approved by the NASS Board of Directors.

RESULTS

Eighty-two clinical questions were addressed, and the answers are summarized in this article. The respective recommendations were graded according to the levels of evidence of the supporting literature.

CONCLUSIONS

The evidence-based clinical guideline has been created using techniques of evidence-based medicine and best available evidence to aid practitioners in the diagnosis and treatment of adult patients with nonspecific low back pain. The entire guideline document, including the evidentiary tables, literature search parameters, literature attrition flowchart, suggestions for future research, and all of the references, is available electronically on the NASS website at https://www.spine.org/ResearchClinicalCare/QualityImprovement/ClinicalGuidelines.aspx.

Wearable Device to Monitor Back Movements Using an Inductive Textile Sensor

Low back pain (LBP) is the most common work-related musculoskeletal disorder among healthcare workers and is directly related to long hours of working in twisted/bent postures or with awkward trunk movements. It has already been established that providing relevant feedback helps individuals to maintain better body posture during the activities of daily living. With the goal of preventing LBP through objective monitoring of back posture, this paper proposes a wireless, comfortable, and compact textile-based wearable platform to track trunk movements when the user bends forward. The smart garment developed for this purpose was prototyped with an inductive sensor formed by sewing a copper wire into an elastic fabric in a zigzag pattern. The results of an extensive simulation study showed that this unique design increases the inductance value of the sensor, and, consequently, improves its resolution. Furthermore, experimental evaluation on a healthy participant confirmed that the proposed wearable system with the suggested sensor design can easily detect forward bending movements. The evaluation scenario was then extended to also include twisting and lateral bending of the trunk, and it was observed that the proposed design can successfully discriminate such movements from forward bending of the trunk. Results of the magnetic interference test showed that, most notably, moving a cellphone towards the unworn prototype affects sensor readings, however, manipulating a cellphone, when wearing the prototype, did not affect the capability of the sensor in detecting forward bends. The proposed platform is a promising step toward developing wearable systems to monitor back posture in order to prevent or treat LBP.

A systematic review on self-management education campaigns for back pain

BACKGROUND

Evidence-based clinical practice guidelines on back pain recommend early management and use of approaches that emphasise self-management, psychological and physical therapies. Lately, mass media campaigns, addressing misconceptions about back pain, have been conducted in developed countries.

OBJECTIVES

This study retrieved and synthesised the contents of back pain messages and described the outcomes and effectiveness of the media campaigns.

METHOD

Seventeen key words and 10 electronic databases were used to conduct a search between February and July 2018. Authors screened titles, abstracts and full-text articles independently to identify eligible studies. Data were reported using narratives because of heterogeneity in the outcomes.

RESULTS

Appraisal of articles was done using the Physiotherapy Evidence Database scale for randomised controlled trials (RCT) (one) or the Joanna Briggs Institute checklist for non-RCT (four). The campaigns were conducted in the general population in Australia, Canada, Norway, the Netherlands and Scotland. The message 'stay as active as possible' increased participants' awareness and influenced their health beliefs and healthcare utilisation behaviours resulting in reductions in sick leave days, work disability, healthcare utilisation and claims.

CONCLUSION

The back pain campaign message 'stay as active as possible' increased participants' awareness and influenced their health beliefs and healthcare utilisation behaviours. Even though the campaigns were done in high-income countries, their contents and methods are transferable to developing countries. However, their implementation must be tailored and efficient and cost-effective methods need to be explored.

CLINICAL IMPLICATIONS

Providing information on back pain can contribute to significant changes in sickness behaviours and beliefs.

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

Background

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

Methods

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

Results

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

Conclusion

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

Electronic supplementary material

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

Evaluation of the efficacy and safety of herbal medicine for treating work-related chronic low back pain: A study protocol for a multicenter, randomized, controlled, clinical trial

INTRODUCTION

In Korea, low back pain (LBP) which is occupation-related symptom is one of the major health issues owing to rapid industrialization. Even traditional Korean medicine has the long history in pain treatment, there still has been lack of supporting evidence on herbal prescription itself. Sogyeonghwalhyeol-tang, a Korean herbal medicine prescription, has been suggested as a medication for treating chronic LBP as well as work-related pains.

OBJECTIVE

This study aims to evaluate the clinical efficacy and safety of herbal medicine, Sogyeonghwalhyeol-tang on work-related chronic LBP patients.

METHOD

This trial is designed as a multicenter, randomized, controlled, clinical trial. Seventy-two participants who have chief complaint of LBP in Korean medicine rehabilitation center will be randomly assigned to ether Sogyeonghwalhyeol-tang group or placebo group with a ratio of 1:1. They will receive assigned drugs in 4 weeks and follow-up for 2 weeks.

DISCUSSION

The result of this study will provide the valuable information for efficacy and safety of Sogyeonghwalhyeol-tang for patients with work-related chronic LBP.

The Back College for nurses - an evaluation of intermediate effects

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Abstracts of low back pain trials are poorly reported, contain spin of information and are inconsistent with the full text: An overview study

OBJECTIVE

To investigate trials abstracts evaluating treatments for low back pain with regards to completeness of reporting, spin (i.e., interpretation of study results that overemphasizes the beneficial effects of the intervention), and inconsistencies in data with the full text.

DATA SOURCES

The search was performed on Physiotherapy Evidence Database (PEDro) in February 2016.

STUDY SELECTION

This is an overview study of a random sample of 200 low back pain trials published between 2010 and 2015. The languages of publication were restricted to English, Spanish and Portuguese.

DATA EXTRACTION

Completeness of reporting was assessed using the CONSORT for Abstracts checklist (CONSORT-A). Spin was assessed using a SPIN-checklist. Consistency between abstract and full text were assessed by applying the assessment tools to both the abstract and full text of each trial and calculating inconsistencies in the summary score (paired t test) and agreement in the classification of each item (Kappa statistics). Methodological quality was analyzed using the total PEDro score.

DATA SYNTHESIS

The mean number of fully reported items for abstracts using the CONSORT-A was 5.1 (SD 2.4) out of 15 points and the mean number of items with spin was 4.9 (SD 2.6) out of 7 points. Abstract and full text scores were statistically inconsistent (P=0.01). There was slight to moderate agreement between items of the CONSORT-A in the abstracts and full text (mean Kappa 0.20 SD 0.13) and fair to moderate agreement for items of the SPIN-checklist (mean Kappa 0.47 SD 0.09).

CONCLUSIONS

The abstracts were incomplete, with spin and inconsistent with the full text. We advise health care professionals to avoid making clinical decisions based solely upon abstracts. Journal editors, reviewers and authors are jointly responsible for improving abstracts, which could be guided by amended editorial policies.

The management of work-related musculoskeletal injuries in an occupational health setting: the role of the physical therapist

With the emergence of work-related musculoskeletal disorders and the associated high cost of injured workers, physical therapists are in a unique position to help employers manage these concerns through multidisciplinary injury prevention programs, education, ergonomics, on-site treatment, and return to work programs. The purpose of this paper, through a review of the literature, is to describe the effect that workplace injuries have on employees and the economic burden on employers. Furthermore, this paper will highlight the effectiveness a physical therapist can have in the occupational health setting as part of a multidisciplinary team on ergonomics, employee health, prevention of work-related musculoskeletal disorders, return to work programs, and on-site treatment interventions, such as therapeutic exercise and manual intervention. This review of the literature suggests that participation in ergonomics and on-site physical therapy treatment in the workplace (e.g., education, exercise, manual intervention) has a positive effect on decreasing work-related musculoskeletal disorders, decreasing costs associated with these injuries, increasing work productivity, and decreasing absenteeism and improving presenteeism amongst workers. It is important to ensure that payers, employers, and employees are aware of the crucial role physical therapists can play in occupational health. Physical therapists also need to advocate for their role in occupational health and offer expert care to workers in a nontraditional manner.

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

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

Effectiveness of Massage Therapy and Abdominal Hypopressive Gymnastics in Nonspecific Chronic Low Back Pain: A Randomized Controlled Pilot Study

Background

There are a great number of interventions in physiotherapy, but with little evidence of their effectiveness in chronic low back pain. Therefore, this study assesses effectiveness of Massage Therapy and Abdominal Hypopressive Gymnastics and the combination of both to decrease pain and lumbar disability while increasing joint mobility and quality of life in patients with chronic nonspecific low back pain.

Methods

A randomized, single-blinded, controlled, clinical trial with sample (n = 27) was comprised of patients between 20 and 65 years, diagnosed with pain of mechanical origin characterized by having a duration of at least 12 weeks and no serious complications. Each group received 8 interventions of 30 minutes.

Results

Friedman ANOVA test obtained statistically significant differences of Oswestry, NRS, and Schober variables (p < 0.05) in the three measurements (pretest, posttest 1, and posttest 2), in each individual group. ANOVA Kruskal-Wallis test was used for comparison between groups, and Oswestry Disability values were significantly higher (p = 0.024) in the group receiving both treatments.

Conclusion

Both individual groups reduce pain levels, improve disability, and increase the flexibility of the lumbar spine. The combination therapy provides greater benefits in terms of lumbar disability. This study is registered on March 8, 2016, with NCT02721914.

Back School programme for nurses has reduced low back pain levels: A randomised controlled trial

AIMS AND OBJECTIVES

(i) To examine patient lifting techniques used by nurses, and (ii) to evaluate an effectiveness of the Spine Care for Nurses programme in chronic nonspecific low back pain syndrome reduction and the execution of proper patient lifting techniques.

BACKGROUND

Millions of nurses around the world suffer from occupational-related chronic nonspecific low back pain (chronic nonspecific low back pain syndrome). Generally, low back pain in nurses is a result of increased pressure on the spine and can be associated with improperly conducted patient lifting techniques.

METHODS

A randomised controlled trial was conducted among 137 nurses with chronic nonspecific low back pain syndrome. Participants were randomised into an experimental and control group (experimental group n = 67, control group n = 70). Nurses in the experimental group attended the Spine Care for Nurses programme for 3 months. The programme consisted of didactic education, spine-strengthening exercises and education on safe patient handling techniques. The control group only received a brief written lifestyle guidance. The Zebris WinSpine Triple Lumbar examination was used to analyse nurses' patient lifting techniques (horizontal and vertical lifting). The lumbar pain intensity was measured with a 0-100 visual analogue scale.

RESULTS

The pre-intervention average chronic nonspecific low back pain syndrome intensity score on visual analogue scale decreased from 49.3 to the postintervention score of 7.5. The correct execution of vertical lifting techniques in the experimental group increased from 8.91%-97.01% (control group: 8.57% pre-intervention test and postintervention test 11.42%). The horizontal patient lifting technique pre-intervention increased from 10.44%-100% correct execution in the experimental group (control group: pre-intervention test 10.00% and postintervention test 11.42%).

CONCLUSION

The Spine Care for Nurses programme significantly reduced chronic nonspecific low back pain syndrome and increased the number of properly executed horizontal and vertical patient lifting techniques in nurses.

RELEVANCE TO CLINICAL PRACTICE

We recommend that healthcare organisations should consider the implementation of regular Spine Care for Nurses programmes as successful low back injury prevention programmes.

Back Schools for chronic non-specific low back pain

BACKGROUND

Many people with low back pain (LBP) become frequent users of healthcare services in their attempt to find treatments that minimise the severity of their symptoms. Back School consists of a therapeutic programme given to groups of people that includes both education and exercise. However, the content of Back School has changed over time and appears to vary widely today. This review is an update of a Cochrane review of randomised controlled trials (RCTs) evaluating the effectiveness of Back School. We split the Cochrane review into two reviews, one focusing on acute and subacute LBP, and one on chronic LBP.

OBJECTIVES

The objective of this systematic review was to determine the effect of Back School on pain and disability for adults with chronic non-specific LBP; we included adverse events as a secondary outcome. In trials that solely recruited workers, we also examined the effect on work status.

SEARCH METHODS

We searched for trials in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, two other databases and two trials registers to 15 November 2016. We also searched the reference lists of eligible papers and consulted experts in the field of LBP management to identify any potentially relevant studies we may have missed. We placed no limitations on language or date of publication.

SELECTION CRITERIA

We included only RCTs and quasi-RCTs evaluating pain, disability, and/or work status as outcomes. The primary outcomes for this update were pain and disability, and the secondary outcomes were work status and adverse events.

DATA COLLECTION AND ANALYSIS

Two review authors independently performed the 'Risk of bias' assessment of the included studies using the 'Risk of bias' assessment tool recommended by The Cochrane Collaboration. We summarised the results for the short-, intermediate-, and long-term follow-ups. We evaluated the overall quality of evidence using the GRADE approach.

MAIN RESULTS

For the outcome pain, at short-term follow-up, we found very low-quality evidence that Back School is more effective than no treatment (mean difference (MD) -6.10, 95% confidence interval (CI) -10.18 to -2.01). However, we found very low-quality evidence that there is no significant difference between Back School and no treatment at intermediate-term (MD -4.34, 95% CI -14.37 to 5.68) or long-term follow-up (MD -12.16, 95% CI -29.14 to 4.83). There was very low-quality evidence that Back School reduces pain at short-term follow-up compared to medical care (MD -10.16, 95% CI -19.11 to -1.22). Very low-quality evidence showed there to be no significant difference between Back School and medical care at intermediate-term (MD -9.65, 95% CI -22.46 to 3.15) or long-term follow-up (MD -5.71, 95% CI -20.27 to 8.84). We found very low-quality evidence that Back School is no more effective than passive physiotherapy at short-term (MD 1.96, 95% CI -9.51 to 13.43), intermediate-term (MD -16.89, 95% CI -66.56 to 32.79), or long-term follow-up (MD -12.86, 95% CI -61.22 to 35.50). There was very low-quality evidence that Back School is no better than exercise at short- term follow-up (MD -2.06, 95% CI -14.58 to 10.45). There was low-quality evidence that Back School is no better than exercise at intermediate-term (MD -4.46, 95% CI -19.44 to 10.52) and long-term follow-up (MD 4.58, 95% CI -0.20 to 9.36).For the outcome disability, we found very low-quality evidence that Back School is no more effective than no treatment at intermediate-term (MD -5.92, 95% CI -12.08 to 0.23) and long-term follow-up (MD -7.36, 95% CI -22.05 to 7.34); medical care at short-term (MD -1.19, 95% CI -7.02 to 4.64) and long-term follow-up (MD -0.40, 95% CI -7.33 to 6.53); passive physiotherapy at short-term (MD 2.57, 95% CI -15.88 to 21.01) and intermediate-term follow-up (MD 6.88, 95% CI -4.86 to 18.63); and exercise at short-term (MD -1.65, 95% CI -8.66 to 5.37), intermediate-term (MD 1.57, 95% CI -3.86 to 7.00), and long-term follow-up (MD 4.54, 95% CI -4.44 to 13.52). We found very low-quality evidence of a small difference between Back School and no treatment at short-term follow-up (MD -3.38, 95% CI -6.70 to -0.05) and medical care at intermediate-term follow-up (MD -6.34, 95% CI -10.89 to -1.79). Still, at long-term follow-up there was very low-quality evidence that passive physiotherapy is better than Back School (MD 9.60, 95% CI 3.65 to 15.54).Few studies measured adverse effects. The results were reported as means without standard deviations or group size was not reported. Due to this lack of information, we were unable to statistically pool the adverse events data. Work status was not reported.

AUTHORS' CONCLUSIONS

Due to the low- to very low-quality of the evidence for all treatment comparisons, outcomes, and follow-up periods investigated, it is uncertain if Back School is effective for chronic low back pain. Although the quality of the evidence was mostly very low, the results showed no difference or a trivial effect in favour of Back School. There are myriad potential variants on the Back School approach regarding the employment of different exercises and educational methods. While current evidence does not warrant their use, future variants on Back School may have different effects and will need to be studied in future RCTs and reviews.

Back schools for acute and subacute non-specific low-back pain

BACKGROUND

Since the introduction of the Swedish back school in 1969, back schools have frequently been used for treating people with low-back pain (LBP). However, the content of back schools has changed and appears to vary widely today. In this review we defined back school as a therapeutic programme given to groups of people, which includes both education and exercise. This is an update of a Cochrane review first published in 1999, and updated in 2004. For this review update, we split the review into two distinct reviews which separated acute from chronic LBP.

OBJECTIVES

To assess the effectiveness of back schools on pain and disability for people with acute or subacute non-specific LBP. We also examined the effect on work status and adverse events.

SEARCH METHODS

We searched CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, PubMed and two clinical trials registers up to 4 August 2015. We also checked the reference lists of articles and contacted experts in the field of research on LBP.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) or quasi-RCTs that reported on back school for acute or subacute non-specific LBP. The primary outcomes were pain and disability. The secondary outcomes were work status and adverse events. Back school had to be compared with another treatment, a placebo (or sham or attention control) or no treatment.

DATA COLLECTION AND ANALYSIS

We used the 2009 updated method guidelines for this Cochrane review. Two review authors independently screened the references, assessed the quality of the trials and extracted the data. We set the threshold for low risk of bias, a priori, as six or more of 13 internal validity criteria and no serious flaws (e.g. large drop-out rate). We classified the quality of the evidence into one of four levels (high, moderate, low or very low) using the adapted Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We contacted study authors for additional information. We collected adverse effects information from the trials.

MAIN RESULTS

The search update identified 273 new references, of which none fulfilled our inclusion criteria. We included four studies (643 participants) in this updated review, which were all included in the previous (2004) update. The quality of the evidence was very low for all outcomes. As data were too clinically heterogeneous to be pooled, we described individual trial results. The results indicate that there is very low quality evidence that back schools are no more effective than a placebo (or sham or attention control) or another treatment (physical therapies, myofascial therapy, joint manipulations, advice) on pain, disability, work status and adverse events at short-term, intermediate-term and long-term follow-up. There is very low quality evidence that shows a statistically significant difference between back schools and a placebo (or sham or attention control) for return to work at short-term follow-up in favour of back school. Very low quality evidence suggests that back school added to a back care programme is more effective than a back care programme alone for disability at short-term follow-up. Very low quality evidence also indicates that there is no difference in terms of adverse events between back school and myofascial therapy, joint manipulation and combined myofascial therapy and joint manipulation.

AUTHORS' CONCLUSIONS

It is uncertain if back schools are effective for acute and subacute non-specific LBP as there is only very low quality evidence available. While large well-conducted studies will likely provide more conclusive findings, back schools are not widely used interventions for acute and subacute LBP and further research into this area may not be a priority.

Is that really my movement? - Students' experiences of a video-supported interactive learning model for movement awareness

Healthcare staff and students have a great risk of developing musculoskeletal symptoms. One cause of this is heavy load related work activities such as manual handling, in which the quality of individual work technique may play a major role. Preventive interventions and well-defined educational strategies to support movement awareness and long-lasting movement changes need to be developed. The aim of the present study was to explore nursing students’ experiences of a newly developed interactive learning model for movement awareness. The learning model, which is based on a life-world perspective with focus on interpersonal interaction, has been used with 11 undergraduate students from the second and final year. Each student participated in three individual video sessions with a facilitator. Two individual interviews were carried out with each student during the learning process and one interview 12–18 months after the last session. The interviews were audio-recorded and transcribed verbatim, and a phenomenological hermeneutic method inspired by Paul Ricoeur and described by Lindseth and Norberg was used to interpret the interviews and diary notes. The interpretation resulted in three key themes and nine subthemes. The key themes were; “Obtaining better preconditions for bodily awareness,” “Experiencing changes in one's own movement,” and “Experiencing challenges in the learning process.” The interactive learning model entails a powerful and challenging experience that develops movement awareness. The experience of meaningfulness and usefulness emerges increasingly and alternates with a feeling of discomfort. The learning model may contribute to the body of knowledge of well-defined educational strategies in movement awareness and learning in, for example, preventive interventions and ergonomic education. It may also be valuable in other practical learning situations where movement awareness is required.

We cannot ignore nurses' health anymore: a synthesis of the literature on evidence-based strategies to improve nurse health

Nurses are known to suffer from health problems because of the physical and stressful nature of nurses' work. With the advent of health care reform and the increasing importance of nurses to quality and cost-effective health care, the health of nurses can no longer be ignored. The purpose of this synthesis of the literature is to determine what interventions and evidence-based practices have been found that support and improve the health of nurses. Whittemore and Knafl's integrative review methodology was chosen to guide the synthesis. Eighteen studies, all conducted in clinical settings, were identified. Interventions included on-site wellness, ergonomic and exercise programs; holistic practices, including Tai Chi and massage; the use of clinical supervision; mental health programs; and the use of minimal, no lift and lift-team programs. There is a critical need for more research specifically designed to improve the health and safety of the nursing workforce.

Endorsement of the CONSORT guidelines, trial registration, and the quality of reporting randomised controlled trials in leading nursing journals: A cross-sectional analysis

OBJECTIVE

To establish the reporting quality of trials published in leading nursing journals and investigate associations between CONSORT Statement or trial registration endorsment and reporting of design elements.

METHODS

The top 15 nursing journals were searched using Medline for randomised controlled trials published in 2012. Journals were categorised as CONSORT and trial registration promoting based on requirements of submitting authors or the journal's webpage as at January 2014. Data on sequence generation, allocation concealment, follow up, blinding, baseline equivalence and sample size calculation were extracted by one author and independently verified by the second author against source data.

RESULTS

Seven journals were CONSORT promoting and three of these journals were also trial registration promoting. 114 citations were identified and 83 were randomised controlled trials. Eighteen trials (21.7%) were registered and those published in trial registration promoting journals were more likely to be registered (RR 2.64 95%CI 1.14-6.09). We assessed 68.7% of trials to be low risk of bias for sequence generation, 20.5% for allocation concealment, 38.6% for blinding, 55.4% for completeness of follow up and 79.5% for baseline equivalence. Trials published in CONSORT promoting journals were more likely to be at low risk of bias for blinding (RR 2.33, 95%CI 1.01-5.34) and completeness of follow up (RR 1.77, 95%CI 1.02-3.10), but journal endorsement of the CONSORT Statement or trial registration otherwise had no significant effect. Trials published in CONSORT and trial registration promoting journals were more likely to have high quality sample size calculations (RR 2.91, 95%CI 1.18-7.19 and RR 1.69, 95%CI 1.08-2.64, respectively).

CONCLUSION

Simple endorsement of the CONSORT Statement and trials registration is insufficient action to encourage improvement of the quality of trial reporting across the most important of trial design elements.

A systematic review of observational instruments used to assess nurses' skills in patient mobilisation

AIMS AND OBJECTIVES

The aim of this study was to identify and describe the existing observation instruments that are used to assess nurses' skills in patient mobilisation and to evaluate the psychometric properties of the included instruments.

BACKGROUND

Structured knowledge about instruments for assessing nurses' skills in patient mobilisation is limited.

DESIGN

Systematic review.

METHODS

Studies were identified via electronic database searches and reference lists and were included based on the eligibility criteria. Data regarding the type of instrument, the number of items/domains and the psychometric properties of the instruments were extracted, and the quality of the instruments were appraised according to Zwakhalen et al.'s (BMC Geriatrics, 2006) proposed criteria.

RESULTS

A total of 26 studies, reporting on 16 instruments, were included in this review. The instruments differed in terms of: (1) type of patient-mobilisation task, (2) focus of the instrument, (3) level of structure and (4) use by the observer. Most of the instruments were developed and used in evaluation studies that measured nurses' mobilisation techniques as an outcome of an educational intervention. The total quality score of the included instruments varied between 6-11 points out of a maximum quality score of 19.

CONCLUSION

Although patient mobilisation is part of nurses' everyday work, we suggest from the results of this review that no common consensus exists about the best way to perform patient-mobilisation tasks. The results from this study further show that no instrument measured all of the important aspects of effective patient mobilisation.

RELEVANCE FOR CLINICAL PRACTICE

Most of the instruments that were reviewed were able to detect differences in patient-mobilisation techniques. However, convincing evidence is lacking with regard to the content, psychometric properties and practicability of these instruments for use in clinical practice. We suggest the development and validation of a new comprehensive instrument.

Occupational low back pain in nursing workers: massage versus pain

Objective: To assess the efficacy of massage for decreasing occupational low back pain in workers of a Nursing team in an Emergency Room. Method: A randomized controlled trial, using a socio-demographic/morbidity questionnaire and a Pain Numeric Scale. Forty-five subjects were randomly allocated for intervention (G1 – Massage by acupressure), placebo group (G2 – application of Garlium Arseneid Laser 904nm turned off) and control (G3 – no intervention). Results: The main triggering factor, as well as the worsening of pain, was the patient manipulation, both with a prevalence of 34.9%. The main treatment for low back pain before this research was the use of medication, with a prevalence of 44.2%. In accordance with a variance analysis, only G1 presented a significant statistical difference, with a better result after 12 sessions. Massage presented an enormous effect (d = 4.59), corresponding to 86% of reduction in the pain level. Conclusion: Massage was effective to decrease occupational low back pain of those Nursing workers.


Occupational back pain among rehabilitation nurses in Saudi Arabia: the influence of knowledge and awareness

Occupational low back pain among nurses has been the subject of research studies worldwide. However, evidence of the influence of nurses' awareness of safe handling practices and compliance with standard guidelines on low back pain remains scarce. This study examined the association between occupational low back pain and level of awareness of back care, and described the self-reported nature of low back pain in relation to organizational policies among nurses in Saudi Arabia. A total of 155 nurses working in a rehabilitation hospital participated in the study. The lack of a patient handling policy at the workplace was identified as a significant risk factor for the development of low back pain, whereas exercising regularly was a protective factor. Not only mechanical exposure but also organizational factors and level of awareness were related to the development of low back pain. This study highlights the need to develop institutional plans for injury reporting, and provides evidence of the importance of incorporating awareness as part of prevention strategies.