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Rydland HT, Bentsen HL, Ervik R, Grønning K, Islam K, Kjerstad E, Skogedal Lindén T. Promoting labour market inclusion of the chronically ill: a scoping review of Scandinavian countries' efforts. Scand J Public Health 2023; 51:1097-1107. [PMID: 35535443 PMCID: PMC10642227 DOI: 10.1177/14034948221096005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 03/03/2022] [Accepted: 04/01/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This article is a scoping review of efforts in labour market inclusion of the chronically ill in the Scandinavian countries, a research area that has received much political as well as research attention in recent years. The aim of the review was to identify promising strategies and the need for further research. METHODS Six electronic databases were searched for literature published between 2015 and 2020. We included peer-reviewed articles that studied the effect of measures, aimed at the workplace or at the individual, that are intended to increase participation. Our search resulted in 2718 articles; our screening procedures resulted in 47 included articles. RESULTS Among the included studies, musculoskeletal problems (17 articles) and mental health problems (29 articles) were the most frequent chronic conditions. Multimodal occupational rehabilitation programmes directed towards the individual employee were the most frequent interventions (30 articles). Return to work (24 articles) and sickness absence (12 articles) were the most common outcomes. About half (25 articles) of the included studies reported a positive impact of the intervention on work inclusion of the chronically ill. CONCLUSIONS Our review found little evidence of how government programmes directed towards the supply side of the labour market succeed in including the chronically ill. Our review further indicated that multidisciplinary workplace interventions have a substantial effect. We also identified a significant lack of research on the effect of various governmental policies and programmes, including local health, work and welfare services, and limited coordination and cooperation between health and work services professions.
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Affiliation(s)
| | | | - Rune Ervik
- NORCE Norwegian Research Centre AS, Bergen, Norway
| | - Kjersti Grønning
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kamrul Islam
- NORCE Norwegian Research Centre AS, Bergen, Norway
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Grøn S, Bülow K, Jonsson TD, Degn J, Kongsted A. What do people believe to be the cause of low back pain? A scoping review. Braz J Phys Ther 2023; 27:100562. [PMID: 37972538 PMCID: PMC10679815 DOI: 10.1016/j.bjpt.2023.100562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 10/13/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE To explore how causal beliefs regarding non-specific low back pain (LBP) have been quantitatively investigated. METHODS A scoping review based on the guidelines by the JBI (former Joanna Briggs Institute) was conducted. We searched Medline, Embase, Psychinfo, and CINAHL for relevant studies and included peer-reviewed original articles that measured causal beliefs about non-specific LBP among adults and reported results separate from other belief domains. RESULTS A total of 81 studies were included, of which 62 (77%) had cross sectional designs, 11 (14%) were cohort studies, 3 (4%) randomized controlled trials, 4 (5%) non-randomized controlled trials, and 1 (1%) case control. Only 15 studies explicitly mentioned cause, triggers, or etiology in the study aim. We identified the use of 6 questionnaires from which a measure of causal beliefs could be obtained. The most frequently used questionnaire was the Illness Perception Questionnaire which was used in 8 of the included studies. The studies covered 308 unique causal belief items which we categorized into 15 categories, the most frequently investigated being causal beliefs related to "structural injury or impairment", which was investigated in 45 (56%) of the studies. The second and third most prevalent categories were related to "lifting and bending" (26 studies [32%]) and "mental or psychological" (24 studies [30%]). CONCLUSION There is a large variation in how causal beliefs are measured and a lack of studies designed to investigate causal beliefs, and of studies determining a longitudinal association between such beliefs and patient outcomes. This scoping review identified an evidence gap and can inspire future research in this field.
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Affiliation(s)
- Søren Grøn
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Chiropractic Knowledge Hub, Campusvej 55, 5230 Odense M, Denmark.
| | - Kasper Bülow
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Centre for Health and Rehabilitation, University College Absalon, Slagelse, Denmark
| | | | - Jakob Degn
- Independent researcher (chiropractic practice)
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Chiropractic Knowledge Hub, Campusvej 55, 5230 Odense M, Denmark
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Muacevic A, Adler JR. Sick Leave Patterns in Common Rheumatological Diseases. Cureus 2023; 15:e34034. [PMID: 36814744 PMCID: PMC9940451 DOI: 10.7759/cureus.34034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2023] [Indexed: 01/22/2023] Open
Abstract
Objectives The study aims to analyze the patterns and determinants of sick leaves (SL) associated with the most common rheumatological diseases and estimate the associated productivity loss cost (PLC). Method A retrospective study reviewed all SLs that were issued from a rheumatology outpatient clinic between 2016 and 2019 for the following diagnoses: low back pain (LBP), knee osteoarthritis (OA), rheumatoid arthritis (RA), and disc disorders. The duration of each sick leave was captured and analyzed by patients' age category, gender, and diagnosis. The human capital method was used to estimate the PLC. Result One thousand and two SLs have been issued during the study period, for a cumulative 4,649 days. The majority of the patients were female (86.3%), and the mean (SD) age was 42.01 (10.71) years. SL durations ranged from 2 to 14 days. The most frequent diagnosis was RA (34.3%), followed by LBP (30.1%). Disc disorder, knee OA, and RA were independently associated with 2.01 (p=0.014), 9.07 (p<0.001), and 7.75 (p<0.001) odd ratios for long SL (≥7 days), by reference to LBP. The average PLC was estimated at $235.29 per day of sick leave, for a total cumulative cost of $235,755.30. Conclusion Rheumatological diseases are responsible for approximately 4.5 days of SL prescribing per day in our clinic, with an average yearly cost of $58,938.83. Monitoring the pattern of sick leave and identifying the interplay between their cofactors are essential to developing a comprehensive approach to enable evidence-based clinical practices along with advancements in work-based protective measures and policies.
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Davis J, Newton C, Singh G, Nolan D, O’Sullivan K. ‘Keep moving, but carefully’: back pain beliefs among NHS staff. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2022. [DOI: 10.1080/21679169.2022.2047781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jack Davis
- Physiotherapy Department, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
| | - Christopher Newton
- Physiotherapy Department, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
| | - Gurpreet Singh
- Physiotherapy Department, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
| | - David Nolan
- Graves Move More Centre, PhysioWorks, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Kieran O’Sullivan
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, University of Limerick, Limerick, Ireland
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Höper AC, Terjesen CL, Fleten N. Comparing the new interdisciplinary Health in work intervention to conventional monodisciplinary welfare interventions at Norwegian workplaces: Protocol for a pragmatic cluster-randomized trial (Preprint). JMIR Res Protoc 2022; 11:e36166. [PMID: 35388792 PMCID: PMC9030981 DOI: 10.2196/36166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/21/2022] [Accepted: 02/21/2022] [Indexed: 11/28/2022] Open
Abstract
Background Musculoskeletal and mental health complaints are the dominant diagnostic categories in long-term sick leave and disability pensions in Norway. Continuing to work despite health complaints is often beneficial, and a good work environment can improve work inclusion for people affected. In 2001, the Norwegian Labour and Welfare Administration began to offer inclusive work measures to improve the psychosocial work environment and work inclusion of people with health complaints. In 2018, the Norwegian Labour and Welfare Administration and specialist health services started offering the new collaborative Health in work program. Its workplace intervention presents health and welfare information that may improve employees’ coping ability regarding common health complaints. It encourages understanding of coworkers’ health complaints and appropriate work adjustments to increase work participation. Objective This protocol presents an ongoing, 2-arm, pragmatic cluster-randomized trial. Its aim is to compare the effect of monodisciplinary inclusive work measures (treatment as usual) and interdisciplinary Health in work in terms of changes in overall sickness absence, health care use, health-related quality of life, and costs. The secondary objectives are to compare changes in individual sickness absence, psychosocial work environment, job and life satisfaction, health, and health anxiety at both the individual and group levels. Methods Data will be collected from national registers, trial-specific registrations, and questionnaires. Effects will be explored using difference-in-difference analysis and regression modeling. Multilevel analysis will visualize any cluster effects using intraclass correlation coefficients. Results Inclusion was completed in July 2021 with 97 workplaces and 1383 individual consents. Data collection will be completed with the last questionnaires to be sent out in July 2023. Conclusions This trial will contribute to filling knowledge gaps regarding the effectiveness and costs of workplace interventions, thereby benefiting health and welfare services, political decision makers, and the public and business sectors. The findings will be disseminated in reports, peer-reviewed journals, and conferences. Trial Registration ClinicalTrials.gov NCT04000035; https://clinicaltrials.gov/ct2/show/NCT04000035 International Registered Report Identifier (IRRID) DERR1-10.2196/36166
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Affiliation(s)
- Anje Christina Höper
- Occupational Health in the North, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Occupational and Environmental Medicine, University Hospital North Norway, Tromsø, Norway
| | - Christoffer Lilja Terjesen
- Occupational Health in the North, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Rehabilitation, University Hospital North Norway, Tromsø, Norway
| | - Nils Fleten
- Occupational Health in the North, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Norwegian Labour and Welfare Administration Troms and Finnmark, Tromsø, Norway
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The Effects of Workplace Interventions on Low Back Pain in Workers: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312614. [PMID: 34886343 PMCID: PMC8657220 DOI: 10.3390/ijerph182312614] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 01/08/2023]
Abstract
This systematic review and meta-analysis aimed to analyze the effects of workplace interventions (WI) on clinical outcomes related to low back pain (LBP) in a worker population, and to assess socio-economic parameters as participants on sick leave, days of sick leave, and return to work following WI. A systematic literature search was performed to select randomized clinical trials that investigated the effectiveness of WI on return to work, sick leave, and working capacity of workers affected by nonspecific LBP. Fourteen articles were included in the review and meta-analysis. The meta-analysis showed improvements in pain (p = 0.004), disability (p = 0.0008), fear-avoidance for psychical activity (p = 0.004), and quality of life (p = 0.001 for physical scale and p = 0.03 for mental scale) for patients who underwent WI compared to controls. Moreover, the pain reduction following WI was statistically significant in the healthcare workers’ group (p = 0.005), but not in the other workers’ group. The participants on sick leave and the number of days of sick leave decreased in the WI group without statistical significance (p = 0.85 and p = 0.10, respectively). Finally, LBP recurrence was significantly reduced in the WI group (p = 0.006). WI led to a significant improvement of clinical outcomes in a workers’ population affected by LBP.
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Tran T, Harris C, Ciccarelli M. The impact of a hand therapy workplace-based educational approach on the management of lateral elbow tendinopathy: A randomized controlled study. J Hand Ther 2021; 36:45-59. [PMID: 34756796 DOI: 10.1016/j.jht.2021.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 09/14/2021] [Accepted: 09/21/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Lateral elbow tendinopathy (LET) is one of the most prevalent work-related musculoskeletal conditions. Management strategies for LET rarely consider patients' work environments and have limited focus on education regarding occupational risk factors. Workplace-based rehabilitation has shown benefits in the return to work processes for injured workers with other health conditions, but no studies have investigated the impact of a workplace-based educational approach in the management of LET. PURPOSES First, to identify the impact of an additional workplace-based educational intervention to standard hand therapy care on the outcomes of pain, grip strength, and function. Second, to identify the effectiveness of standard hand therapy on the same clinical outcomes. STUDY DESIGN A randomized controlled trial. METHODS Forty-nine participants were randomized to the control group (n = 25) or intervention group (n == 24). The control group received standard hand therapy for 12 weeks. The intervention group received standard hand therapy for the first 12 weeks plus an additional workplace-based educational intervention, "Working Hands-ED," delivered by a hand therapist. Pain levels for provocative tests, grip strength, and function were measured using a Numeric Rating Scale, Jamar Dynamometer, and the Patient-Rated Tennis Elbow Evaluation questionnaire at baseline, weeks 6 and 12. The Patient-Specific Functional Scale was also used for the intervention group. RESULTS There were no statistical differences between both groups for all clinical outcomes by 12 weeks (P> .05). Pain levels for all provocative tests and Patient-Rated Tennis Elbow Evaluation scores statistically improved within both groups (P < .05), however with small effect sizes observed. The Patient-Specific Functional Scale scores statistically improved for the intervention group by 12 weeks (P < .05). CONCLUSION The addition of a hand therapy workplace-based intervention did not result in superior clinical outcomes for pain, grip strength, and function. The study identified that a multimodal self-management approach used by hand therapists improved their patients' pain and function regardless of whether the education was given in the clinic or the workplace.
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Affiliation(s)
- Thuy Tran
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia.
| | - Courtenay Harris
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Marina Ciccarelli
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
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Simula AS, Jenkins HJ, Hancock MJ, Malmivaara A, Booth N, Karppinen J. Patient education booklet to support evidence-based low back pain care in primary care - a cluster randomized controlled trial. BMC FAMILY PRACTICE 2021; 22:178. [PMID: 34493219 PMCID: PMC8422671 DOI: 10.1186/s12875-021-01529-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/19/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Inappropriate imaging and low-value care for low back pain (LBP) are common. A new patient-education booklet was created to overcome identified barriers to the delivery of recommended care, including the use of inappropriate imaging. Our aim was to assess the effectiveness of this booklet as part of primary care for LBP patients in comparison to usual care. METHODS A cluster-randomized trial was performed. The intervention involved providing practitioners with the new patient-education booklet and a 30-min training session on its use. The booklet was provided during the clinical consult to all consenting LBP patients in the intervention group. Primary outcomes were the proportion of patients presenting with LBP who underwent imaging examinations during the first three months of follow-up and PROMIS PF-20 (Patient-Reported Outcomes Measurement Information System, 20-item physical functioning short form) change between baseline and three-month follow-up. Secondary outcomes, including sick leave and imaging examinations at 12 months, were investigated. Logistic regression using GEE-estimation was used for dichotomous outcomes, Poisson regression using GEE-estimation for count outcomes, and linear mixed models for continuous outcomes. RESULTS Using the patient education booklet appeared to substantially reduce the proportion of LBP patients who underwent an imaging examination at three months, but the result was not statistically significant (OR 0.57, 95% confidence interval (Cl) 0.27 to 1.22). At 12 months, the effect was slightly larger and statistically significant (OR 0.50, 95%Cl 0.30 to 0.83, p = 0.008). No difference was observed in the PROMIS PF-20 T-score change between baseline and 3 months or 12 months (p = 0.365 and p = 0.923, respectively). The number of sick leave days in the intervention group was less than that in the control group at 3 months (RR 0.47, 95%Cl 0.26 to 0.83, p = 0.010) and at 12 months (RR 0.36, 95%Cl 0.18 to 0.72, p = 0.004). CONCLUSIONS The booklet appeared to be effective in reducing the proportion of LBP patients who underwent imaging examinations over 12 months. The intervention had no discernible effect on the PROMIS PF20 T-score change. The number of sick leave days was substantially lower in the intervention group. TRIAL REGISTRATION ISRCTN, ISRCTN14389368 , Registered 4 April 2019-Retrospectively registered.
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Affiliation(s)
- Anna S Simula
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 8000, 90014, Oulu, Finland. .,Department of General Medicine, the South Savo Social and Health Care Authority, Porrassalmenkatu 35-37, 50100, Mikkeli, Finland.
| | - Hazel J Jenkins
- Department of Health Professions, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Balaclava Road, North Ryde, NSW, 2109, Australia.,Department of Chiropractic, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Balaclava Road, North Ryde, NSW, 2109, Australia
| | - Mark J Hancock
- Department of Health Professions, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Balaclava Road, North Ryde, NSW, 2109, Australia
| | - Antti Malmivaara
- Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Neill Booth
- Faculty of Social Sciences (Health Sciences), Tampere University, Arvo Ylpön katu 34, 33014, Tampere, Finland
| | - Jaro Karppinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 8000, 90014, Oulu, Finland.,Finnish Institute of Occupational Health, Aapistie 1, 90220, Oulu, Finland.,Rehabilitation Services of South Karelia Social and Health Care District, Lappeenranta, Finland
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Tran T, Falkmer T, Ciccarelli M. Do hand therapists have a role in workplace-based education to manage tennis elbow? Beliefs about effective treatments among Australian hand therapists and medical practitioners. Work 2021; 66:539-549. [PMID: 32623416 DOI: 10.3233/wor-203196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Lateral elbow tendinopathy (LET), commonly known as tennis elbow, is a prevalent work-related upper extremity musculoskeletal disorder. Medical practitioners and hand therapists manage LET with commonly available clinic-based treatments, despite no sound evidence to suggest long-term relief and functional restoration for workers with LET. Workplace-based rehabilitation is effective for injured workers with other health conditions, but no studies have investigated this rehabilitation approach in the management of LET. OBJECTIVES (i) Identify, compare, and contrast Australian hand therapists' and medical practitioners' perceptions about the effectiveness of common treatments for LET, and (ii) obtain their views towards a hand therapist delivered workplace-based education approach. METHODS In this cross-sectional study, 38 medical practitioners from Western Australia and 104 hand therapists around Australia completed online surveys. Independent t-tests were used to identify between-group differences in responses. RESULTS Despite some between-group differences regarding the perceived effectiveness of common LET treatments, both groups believed education about LET pathology, activity modification, postures, and workplace recommendations were most effective. Most medical practitioners (81%) and hand therapists (71%) believed workplace-based education delivered by a hand therapist would be beneficial for patients with acute and chronic LET. CONCLUSION Australian hand therapists and medical practitioners believed educational approaches were the most important component in the management of LET, and supported workplace-based educational interventions provided by hand therapists in the management of LET.
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Affiliation(s)
- Thuy Tran
- School of Occupational Therapy, Social Work, and Speech Pathology, Curtin University, Perth, WA, Australia.,Hand Works Occupational Therapy, Bullcreek, Western Australia, Australia
| | - Torbjörn Falkmer
- School of Occupational Therapy, Social Work, and Speech Pathology, Curtin University, Perth, WA, Australia.,Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden
| | - Marina Ciccarelli
- School of Occupational Therapy, Social Work, and Speech Pathology, Curtin University, Perth, WA, Australia
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Ryynänen K, Oura P, Simula AS, Holopainen R, Paukkunen M, Lausmaa M, Remes J, Booth N, Malmivaara A, Karppinen J. Effectiveness of training in guideline-oriented biopsychosocial management of low-back pain in occupational health services - a cluster randomized controlled trial. Scand J Work Environ Health 2021; 47:367-376. [PMID: 33847366 PMCID: PMC8259706 DOI: 10.5271/sjweh.3959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective: This study aimed to investigate the effectiveness of brief training in the guideline-oriented biopsychosocial management of low-back pain (LBP) in occupational health services using a cluster-randomized design. A small sample of physiotherapists and physicians from the intervention units (N=12) were given three- to seven-day training focusing on the biopsychosocial management of LBP, while professionals in the control units (N=15) received no such training. Methods: Eligible patients with LBP, with or without radicular pain, aged 18–65, were invited to participate. A web-based questionnaire was sent to all recruited patients at baseline, three months and one year. The primary outcome measure was disability (Oswestry Disability Index, ODI) over one year. Between-group differences were analyzed using linear and generalized linear mixed models adjusted for baseline-response delay as well as variables showing between-group imbalance at baseline. Results: The final study sample comprised 234 and 81 patients in the intervention and control groups, respectively at baseline, and 137 and 47 patients, respectively, at one year. At baseline, the mean duration of pain was longer in the intervention group (P=0.017), and pain-related fear concerning physical activity was lower (P=0.012). We observed no significant difference between the groups’ primary outcome measure (adjusted one-year mean difference in the ODI: 2.3; 95% confidence interval -1.0–5.7; P=0.175) or most secondary outcomes. Conclusions: Brief training in guideline-oriented biopsychosocial management of LBP for occupational health professionals did not appear to be effective in reducing patients’ symptom over one-year follow-up compared to treatment as usual.
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Affiliation(s)
- Katja Ryynänen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
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Fortún-Rabadán R, Jiménez-Sánchez C, Flores-Yaben O, Bellosta-López P. Workplace physiotherapy for musculoskeletal pain-relief in office workers: A pilot study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:75. [PMID: 34084822 PMCID: PMC8057194 DOI: 10.4103/jehp.jehp_888_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 08/02/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Musculoskeletal pain is highly prevalent among office workers and causes high costs to the public health system. Strategies including education and exercise are recommended, with major benefits when conducted by physical therapists in the occupational environment. However, the required investment is uncommon among companies. This study aimed to evaluate the efficacy of a multimodal physiotherapy intervention to relieve musculoskeletal pain in office workers. MATERIALS AND METHODS The study employed a single group study with a pre-post study design and was conducted at Universidad San Jorge in 2018. Outcome variables were: workplace ergonomics (INSHT Guide), existence and severity of musculoskeletal disorders (Nordic Musculoskeletal Questionnaire), musculoskeletal pain intensity (Numeric Rating Scale), and Clinical Global Impression Scale. Office workers in a university setting (n = 24, 19 females) were assessed at baseline, after 4 weeks of in-person sessions and following 3 weeks of autonomous performance. The physiotherapy program included education, ergonomic supervision, self-treatment, strengthening, and stretching exercises. A repeated-measures ANOVA or Friedman test (with post hoc comparisons) and Chi-squared test were used to compare the study variables. RESULTS At baseline, cervical spine (54%), shoulder (42%), and lumbar regions (37.5%) were the most symptomatic regions according to the Nordic Musculoskeletal Questionnaire. Even if the proportion of symptomatic areas did not decrease significantly after the intervention, a great reduction of musculoskeletal pain intensity was observed after the program in the cervical (P < 0.001), lower back (P = 0.005), shoulder (P = 0.006) regions, and in the overall pain level (P < 0.001). CONCLUSIONS These results support that a multimodal physiotherapy program can relieve work-related musculoskeletal pain in office workers and serve as a basis for future controlled trials.
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Affiliation(s)
- Rocío Fortún-Rabadán
- iPhysio Research Group, Department of Physical Therapy, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain
| | - Carolina Jiménez-Sánchez
- iPhysio Research Group, Department of Physical Therapy, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain
- Hospital Mutua de Accidentes de Zaragoza, Zaragoza, Spain
| | - Olatz Flores-Yaben
- iPhysio Research Group, Department of Physical Therapy, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain
| | - Pablo Bellosta-López
- iPhysio Research Group, Department of Physical Therapy, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain
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McParland JL, Andrews P, Kidd L, Williams L, Flowers P. A scoping review to ascertain the parameters for an evidence synthesis of psychological interventions to improve work and wellbeing outcomes among employees with chronic pain. Health Psychol Behav Med 2021; 9:25-47. [PMID: 34104548 PMCID: PMC8158208 DOI: 10.1080/21642850.2020.1863809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Psychological interventions have mixed effects on improving employee outcomes, partly due to significant variability across studies and a lack of focus on mechanisms of action. This scoping review reports on the parameters of these interventions and examines intervention content to bring clarity to this heterogeneous topic area and direct future systematic review work. Method: Six databases were searched (Cinahl, Cochrane, Embase, Medline, PsychINFO and Web of Science) from April 2010 to August 2020, and a grey literature search was undertaken. Screening was undertaken independently by two authors. The results summarised country, participant and employment characteristics, psychological interventions and work, health and wellbeing outcomes. 10% of the papers were analysed to determine the feasibility of coding intervention descriptions for theory and behaviour change technique (BCT) components. Results: Database searches yielded 9341 titles, of which 91 studies were included. Most studies were conducted in Europe (78%) and included males and females (95%) ranging in age from 31-56.6 years although other demographic, and employment information was lacking. Musculoskeletal pain was common (87%). Psychological interventions commonly included cognitive behavioural therapy (30%) and education (28%). Most studies employed a randomised control trial design (64%). Over half contained a control group (54%). Interventions were delivered in mostly healthcare settings (72%) by health professionals. Multiple outcomes were often reported, many of which involved measuring sickness absence and return-to-work (62%) and pain and general health (53%). Within the feasibility analysis, most papers met the minimum criteria of containing one paragraph of intervention description, but none explicitly mentioned theory or BCTs. Conclusion: Psychological interventions for employees with chronic pain vary in their nature and implementation. We have shown scoping reviews can be used to assess the feasibility of applying tools from health psychology to identify the content of these interventions in future systematic review work to improve intervention development.
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Affiliation(s)
- Joanna L McParland
- Department of Psychology, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Pamela Andrews
- Department of Psychology, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Lisa Kidd
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland, UK
| | - Lynn Williams
- Department of Psychological Sciences and Health, Faculty of Humanities and Social Sciences, University of Strathclyde, Glasgow, Scotland, UK
| | - Paul Flowers
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
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Crawford JO, Berkovic D, Erwin J, Copsey SM, Davis A, Giagloglou E, Yazdani A, Hartvigsen J, Graveling R, Woolf A. Musculoskeletal health in the workplace. Best Pract Res Clin Rheumatol 2020; 34:101558. [DOI: 10.1016/j.berh.2020.101558] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Abstract
Musculoskeletal symptoms, including pain, are often experienced by musicians at all levels. These symptoms may have a detrimental impact on musicians' personal and work lives, and may also impact upon the ensembles they work within. Providing musicians with appropriate, evidence-based advice regarding pain management is therefore paramount. In this review, we aim to improve the advice given to musicians regarding playing when in pain, by answering the question 'should musicians play in pain?'. This multidisciplinary narrative review draws upon contemporary pain science, including factors associated with poorer prognoses for those in pain, as well as the reported experiences of musicians with pain (including those who have taken time off from playing). Our current understanding of pain science provides further support for the potential for consequences related to avoiding activities due to pain. Pain is modulated by a number of neuro-immunological processes and is influenced by a range of psychosocial factors. Taking time off from playing might therefore not have any benefit. Importantly, one of the leading causes of a transition from acute to chronic pain is fear-avoidance behaviour (e.g. not playing when in pain); hence, encouraging such behaviour cannot be supported. Musicians who have taken time off from playing due to pain have experienced a range of consequences, including emotional and financial consequences. These experiences indicate that there are potential negative consequences related to taking time off from playing which need to be weighed against any benefits. We conclude that musicians should not necessarily be advised to take time off from playing to manage their pain, in keeping with current best practice for pain management. Instead, we recommend that musicians be educated on contemporary pain science and when to seek treatment from a health professional for individualised advice to reduce the burden of musicians' pain.
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Affiliation(s)
- Jessica Stanhope
- School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - Philip Weinstein
- School of Biological Sciences, The University of Adelaide, Adelaide, SA, Australia
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Palsson TS, Boudreau S, Høgh M, Herrero P, Bellosta-Lopez P, Domenech-Garcia V, Langella F, Gagni N, Christensen SW, Villumsen M. Education as a strategy for managing occupational-related musculoskeletal pain: a scoping review. BMJ Open 2020; 10:e032668. [PMID: 32051307 PMCID: PMC7045149 DOI: 10.1136/bmjopen-2019-032668] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Musculoskeletal (MSK) pain is the primary contributor to disability worldwide. There is a growing consensus that MSK pain is a recurrent multifactorial condition underpinned by health and lifestyle factors. Studies suggest that education on work-related pain and individualised advice could be essential and effective for managing persistent MSK pain. OBJECTIVE The objective of this scoping review was to map the existing educational resources for work-related MSK (WRMSK) pain, and the effects of implementing educational strategies in the workplace on managing WRMSK pain. METHODS This scoping review assessed original studies that implemented and assessed education as a strategy to manage WMSK pain. Literature search strategies were developed using thesaurus headings (ie, MeSH and CINAHL headings) and free-text search including words related to MSK in an occupational setting. The search was carried out in PubMed, CINAHL, Cochrane Library and Web of Science in the period 12-14 February 2019. RESULTS A total of 19 peer-reviewed articles were included and the study design, aim and outcomes were summarised. Of the 19 peer-reviewed articles, 10 randomised controlled trial (RCT) studies assessed the influence of education on work-related MSK pain. Many studies provided a limited description of the education material and assessed/used different methods of delivery. A majority of studies concluded education positively influences work-related MSK pain. Further, some studies reported additive effects of physical activity or ergonomic adjustments. CONCLUSIONS There is a gap in knowledge regarding the best content and delivery of education of material in the workplace. Although beneficial outcomes were reported, more RCT studies are required to determine the effects of education material as compared with other interventions, such as exercise or behavioural therapy.
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Affiliation(s)
| | | | - Morten Høgh
- Department of Health Science and Technology, Aalborg Universitet, Aalborg, Denmark
| | - Pablo Herrero
- Physiotherapy, San Jorge University, Zaragoza, Spain
| | - Pablo Bellosta-Lopez
- Department of Physiotherapy, Faculty of Health Sciences, University of San Jorge, Villanueva de Gallego, Aragón, Spain
| | - Victor Domenech-Garcia
- Department of Physiotherapy, Faculty of Health Sciences, University of San Jorge, Villanueva de Gallego, Aragón, Spain
| | - Francesco Langella
- Orthopedic and Traumatology, IRCCS Istituto Ortopedico Galeazzi, Milano, Lombardia, Italy
| | - Nicolo Gagni
- Orthopedic and Traumatology, IRCCS Istituto Ortopedico Galeazzi, Milano, Lombardia, Italy
| | - Steffan Wittrup Christensen
- Department of Health Science and Technology, Aalborg Universitet, Aalborg, Denmark
- Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark
| | - Morten Villumsen
- Department of Health Science and Technology, Aalborg Universitet, Aalborg, Denmark
- Aalborg Municipality, Aalborg, Denmark
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16
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Johnsen TL, Eriksen HR, Baste V, Indahl A, Odeen M, Tveito TH. Effect of Reassuring Information About Musculoskeletal and Mental Health Complaints at the Workplace: A Cluster Randomized Trial of the atWork Intervention. JOURNAL OF OCCUPATIONAL REHABILITATION 2019; 29:274-285. [PMID: 29785466 PMCID: PMC6531384 DOI: 10.1007/s10926-018-9786-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Purpose The purpose of this study was to investigate the possible difference between the Modified atWork intervention (MAW) and the Original atWork intervention (OAW) on sick leave and other health related outcomes. atWork is a group intervention using the workplace as an arena for distribution of evidence-based knowledge about musculoskeletal and mental health complaints. Methods A cluster randomized controlled trial with 93 kindergartens, comprising a total of 1011 employees, was conducted. Kindergartens were stratified by county and size and randomly allocated to MAW (45 clusters, 324 respondents) or OAW (48 clusters, 313 respondents). The randomization and intervention allocation processes were concealed. There was no blinding to group allocation. Primary outcome was register data on sick leave at cluster level. Secondary outcomes were health complaints, job satisfaction, social support, coping, and beliefs about musculoskeletal and mental health complaints, measured at the individual level. Results The MAW group reduced sick leave by 5.7% during the intervention year, while the OAW group had a 7.5% increase. Overall, the changes were not statistically significant, and no difference was detected between groups, based on 45 and 47 kindergartens. Compared to the OAW group, the MAW group had a smaller reduction for two of the statements concerning faulty beliefs about back pain, but believed less in the hereditary nature of depression. Conclusions The MAW did not have a different effect on sick leave at cluster level compared to the OAW. Trial registration https://Clinicaltrials.gov/ : NCT02396797. Registered March 23th, 2015.
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Affiliation(s)
- Tone Langjordet Johnsen
- Division of Physical Medicine and Rehabilitation, Vestfold Hospital Trust, POB 2168, 3103, Tønsberg, Norway.
- Department of Health, Social and Welfare Studies, University College of Southeast Norway, Horten, Norway.
| | - Hege Randi Eriksen
- Uni Research Health, POB 7810, 5020, Bergen, Norway
- Department of Sport and Physical Activity, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Aage Indahl
- Division of Physical Medicine and Rehabilitation, Vestfold Hospital Trust, POB 2168, 3103, Tønsberg, Norway
| | - Magnus Odeen
- Uni Research Health, POB 7810, 5020, Bergen, Norway
| | - Torill Helene Tveito
- Uni Research Health, POB 7810, 5020, Bergen, Norway
- Department of Health, Social and Welfare Studies, University College of Southeast Norway, Horten, Norway
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Abstract
Individuals with back pain are often diagnosed with spine instability, even though it is unclear whether the spine is susceptible to unstable behavior. The spine is a complex system with many elements that cannot be directly observed, which makes the study of spine function and direct assessment of spine instability difficult. What is known is that trunk muscle activation is adjusted to meet stability demands, which highlights that the central nervous system closely monitors threats to spine stability. The spine appears to be protected by neural coupling and mechanical coupling that prevent erroneous motor control from producing segmental instability; however, this neural and mechanical coupling could be problematic in an injured spine. Finally, instability traditionally contemplated from a mechanical and control perspective could potentially be applied to study processes involved in pain sensitization, and possibly back pain that is iatrogenic in nature. This commentary argues for a more contemporary and broadened view of stability that integrates interdisciplinary knowledge in order to capture the complexity of back pain. J Orthop Sports Phys Ther 2019;49(6):415-424. Epub 25 Apr 2019. doi:10.2519/jospt.2019.8144.
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Ree E, Johnsen TL, Harris A, Malterud K. Workplace inclusion of employees with back pain and mental health problems: A focus group study about employees' experiences. Scand J Public Health 2018; 47:326-333. [PMID: 30301425 PMCID: PMC6492234 DOI: 10.1177/1403494818799611] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim: To explore how employees experience workplace inclusion of
their colleagues or themselves when having back pain or mental health problems.
Methods: Three focus group interviews with a sample of 16
kindergarten employees were conducted. Systematic Text Condensation was used for
analysis. Results: The participants emphasized that it was
easier to include colleagues whose health problems were specific, especially
when they were open about having problems and expressed their needs for
accommodation clearly. Discussions revealed difficulties of acceptance and
accommodating colleagues with longstanding health problems, when the burden on
the other staff members was heavy, and if it had negative consequences for the
kindergarten children. Some of the participants had experienced health problems
themselves, which was also described as challenging. Having health problems at
work often induced feelings of guilt, being a burden to their colleagues, and
experiencing a disparity between the ideals and the realities of inclusion
practices. Conclusions: Workplace inclusion of employees
is difficult when their health problems are unspecific, longstanding, and
lead to negative consequences for children or colleagues. System level
efforts are necessary to reduce negative stereotypes about employees with
health problems and facilitate inclusion practices.
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Affiliation(s)
- Eline Ree
- 1 Division of Physical Medicine and Rehabilitation, Vestfold Hospital Trust, Stavern, Norway.,2 Faculty of Health Sciences, Centre for Resilience in Healthcare (SHARE), University of Stavanger, Stavanger, Norway
| | - Tone Langjordet Johnsen
- 1 Division of Physical Medicine and Rehabilitation, Vestfold Hospital Trust, Stavern, Norway
| | - Anette Harris
- 3 Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Kirsti Malterud
- 4 Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway.,5 Department of Global Public Health and Primary Care, University of Bergen, Norway.,6 The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Iwakiri K, Sotoyama M, Takahashi M, Liu X, Koda S, Ichikawa K. Effectiveness of re-education based on appropriate care methods using welfare equipment on the prevention of low back pain among care workers: a 1.5 year follow-up study. INDUSTRIAL HEALTH 2018; 56:419-426. [PMID: 29910229 PMCID: PMC6172185 DOI: 10.2486/indhealth.2017-0175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Many care workers at elderly care facilities in Japan suffer occupational low back pain (LBP) despite the utilization of welfare equipment. When introducing welfare equipment such as hoists and sliding boards, education on appropriate care methods using welfare equipment is usually conducted, but the effect of education diminishes with time. This intervention study aimed to examine the effect of re-education on appropriate care methods using welfare equipment on the prevention of care workers' LBP at an elderly care facility. At the intervention facility, 49 care workers were enrolled in ergonomic education program for 1.5 yr in order to improve care methods using welfare equipment. At the non-intervention facility, 33 care workers were not enrolled in the program. Rates of severe LBP were not significantly different between the facilities. However, during the study period, the rate of severe LBP among care workers did not increase at the intervention facility, while it doubled among care workers at the non-intervention facility. The care workers at the intervention facility showed improvement in care methods using welfare equipment during the study period. Hence, we think that re-education regarding appropriate care methods using welfare equipment has the potential to prevent exacerbation of LBP.
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Affiliation(s)
| | | | | | - Xinxin Liu
- National Institute of Occupational Safety and Health, Japan
| | - Shigeki Koda
- National Institute of Occupational Safety and Health, Japan
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Effectiveness of Multidisciplinary Group-Based Intervention versus Individual Physiotherapy for Improving Chronic Low Back Pain in Nursing Staff: A Clinical Trial with 3- and 6-Month Follow-Up Visits from Tehran, Iran. Asian Spine J 2017; 11:396-404. [PMID: 28670407 PMCID: PMC5481594 DOI: 10.4184/asj.2017.11.3.396] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/02/2016] [Accepted: 12/03/2016] [Indexed: 11/08/2022] Open
Abstract
Study Design Clinical trial. Purpose To evaluate the effectiveness of a multidisciplinary group-based intervention on improving pain and disability among Iranian nurses with chronic low back pain in Tehran, Iran. Overview of Literature Although low back pain (LBP) is one of the most important health problems, the challenge remains on how to find an effective intervention to reduce pain and related disabilities. Methods Overall, 136 eligible nurses with chronic mechanical LBP were classified into two groups. The intervention group (n=66 participants) participated in a physiotherapy educational program (for 120 minutes) plus a health educational program based on predictive constructs of the social cognitive theory (for 120 minutes). These interventions were delivered by a physiotherapist and a health education specialist. The control group (n=70 participants) participated in a physiotherapy educational program (for 120 minutes). Disability rate, pain severity, and back pain prevention behavior were measured initially and at 3- and 6-month follow-up visits using the visual analogue scale, Roland-Morris Disability, and Nursing Low Back Pain Preventive Behaviors Questionnaire. Data were analyzed by SPSS ver. 16. Results There were statistically significant differences between the two groups in the main outcome measures immediately after the educational program and at 3- and 6-month follow-up visits. Preventive behaviors of participants in the intervention group were improved at 3- and 6- month follow-up visits (p<0.001). The mean scores of predictive constructs regarding LBP preventive behaviors in the intervention group were improved after 3 and 6 months (p<0.001). Finally, in the intervention group, pain severity and disability were decreased significantly. Conclusions This study showed that a multidisciplinary educational program intervention can be an effective approach for reducing LBP and related disabilities among nurses.
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Frederiksen P, Indahl A, Andersen LL, Burton K, Hertzum-Larsen R, Bendix T. Can group-based reassuring information alter low back pain behavior? A cluster-randomized controlled trial. PLoS One 2017; 12:e0172003. [PMID: 28346472 PMCID: PMC5367686 DOI: 10.1371/journal.pone.0172003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 01/30/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Low back pain (LBP) is common in the population and multifactorial in nature, often involving negative consequences. Reassuring information to improve coping is recommended for reducing the negative consequences of LBP. Adding a simple non-threatening explanation for the pain (temporary muscular dysfunction) has been successful at altering beliefs and behavior when delivered with other intervention elements. This study investigates the isolated effect of this specific information on future occupational behavior outcomes when delivered to the workforce. DESIGN A cluster-randomized controlled trial. METHODS Publically employed workers (n = 505) from 11 Danish municipality centers were randomized at center-level (cluster) to either intervention (two 1-hour group-based talks at the workplace) or control. The talks provided reassuring information together with a simple non-threatening explanation for LBP-the 'functional-disturbance'-model. Data collections took place monthly over a 1-year period using text message tracking (SMS). Primary outcomes were self-reported days of cutting down usual activities and work participation. Secondary outcomes were self-reported back beliefs, work ability, number of healthcare visits, bothersomeness, restricted activity, use of pain medication, and sadness/depression. RESULTS There was no between-group difference in the development of LBP during follow-up. Cumulative logistic regression analyses showed no between-group difference on days of cutting down activities, but increased odds for more days of work participation in the intervention group (OR = 1.83 95% CI: 1.08-3.12). Furthermore, the intervention group was more likely to report: higher work ability, reduced visits to healthcare professionals, lower bothersomeness, lower levels of sadness/depression, and positive back beliefs. CONCLUSION Reassuring information involving a simple non-threatening explanation for LBP significantly increased the odds for days of work participation and higher work ability among workers who went on to experience LBP during the 12-month follow-up. Our results confirm the potential for public-health education for LBP, and add to the discussion of simple versus multidisciplinary interventions.
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Affiliation(s)
- Pernille Frederiksen
- Copenhagen Center for Back Research (COPE BACK), Centre for Rheumatology and Spine Diseases, Glostrup, Denmark
- Metropolitan University College, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Aage Indahl
- Uni Health, University of Bergen, Bergen, Norway
- Department of Research and Development, Clinic Physical Medicine and Rehabilitation, Vestfold Hospital Trust, Stavern, Norway
| | - Lars L. Andersen
- National Research Centre for the Working Environment, Copenhagen, Denmark
- Physical Activity and Human Performance group, Center for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Kim Burton
- Centre for Applied Psychological and Health Research, University of Huddersfield, Huddersfield, United Kingdom
| | | | - Tom Bendix
- Copenhagen Center for Back Research (COPE BACK), Centre for Rheumatology and Spine Diseases, Glostrup, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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