Effects of a home-exercise therapy programme on cervical and lumbar range of motion among nurses with neck and lower back pain: a quasi-experimental study

Comparison of Outcomes of Physical Therapy Exercises Combined with Either a Video-Based Smartphone Application System or a Written Exercise Program Handout in 34 Patients with Non-Specific Neck Pain

BACKGROUND An exercise program was developed using risk factors for non-specific neck pain. This study aimed to compare the effects video-based versus image- and text-based remote home training performed using this exercise program in patients with non-specific neck pain. MATERIAL AND METHODS Among the 37 patients with non-specific neck pain recruited, 34 patients who satisfied the inclusion criteria were enrolled in this study. The participants were randomized into the experimental (n=17) and control (n=17) groups. The patients in the experimental group performed exercises using a video-based application system, whereas those in the control group performed exercises using an image- and text-based printout. In-home training was implemented for 6 weeks in both groups. The neck pain intensity, disability index, active range of motion (aROM), forward head posture (FHP), and compensatory neck flexion were measured before and after the intervention. The within-group and between-group differences were analyzed at the end of the interventions. RESULTS Improvements in pain intensity, cervical ROM, disability index, FHP, and compensatory neck flexion were observed after in-home training in the experimental group (P.05). Between-group comparison revealed that the experimental group exhibited greater improvement in pain intensity, cervical ROM, and FHP than the control group (P<.05). CONCLUSIONS The findings of this study suggest that the video-based home exercise program improved pain intensity, aROM, neck disability index, FHP, and compensatory neck flexion in patients with non-specific neck pain.

Early career demanding psychosocial work environment and severe back pain and neck/shoulder pain in experienced nurses: A cohort study

AIMS

Back pain and neck/shoulder pain are common among nurses. The aim of this study was to investigate the association between nurses' exposure to a demanding psychosocial work environment during the first three years after graduation and the occurrence of severe back pain and neck/shoulder pain in the longer term, 11-15 years later.

METHODS

The Longitudinal Analysis of Nursing Education (LANE) study (nursing graduates from 26 Swedish universities in the years 2002, 2004 and 2006) was used to create two risk cohorts of nurses not reporting severe back pain (n=1764) or neck/shoulder pain (n=1707). Nurses exposed to a demanding psychosocial work environment for one, two or three of the first three years in their career were compared to nurses not having a demanding psychosocial work environment for any of these three years regarding the incidence of severe back pain or neck/shoulder pain at follow-up, 11-15 years later. Relative risks (RR) with 95% confidence intervals (CI) were calculated using binomial regression.

RESULTS

The RR (95% CI) of having severe back pain for nurses who had a demanding psychosocial work environment for one of the three years was 1.36 (0.82-2.28) and 2.08 (1.21-3.57) for two of the three years and 2.82 (1.43-5.55) for all three years. Corresponding RRs (95% CIs) for severe neck/shoulder pain were 1.35 (0.87-2.10), 1.49 (0.88-2.51) and 1.41 (0.62-3.20), respectively.

CONCLUSIONS

Nurses who were repeatedly exposed to a demanding psychosocial work environment early in their career reported severe back pain to a higher extent in the longer term.

Nurses’ beliefs about back pain, their coping strategies and participant activation for self-management

Background

Back pain affects nurses’ physical, social and emotional well-being, as they encounter difficulties in executing their social and occupational duties.

Objectives

Our study investigated the impact of a cross-cultural back pain campaign on nurses’ beliefs about back pain; activating the participants to self-manage; coping strategies; sick leave claimed; and frequency of doctor visits.

Method

A single sample pre- and post-test design was used. The intervention was a 12-week educational campaign based on evidence-based back pain messages. Primary outcomes were measured by their beliefs about back pain and their activation to self-manage. Analyses were conducted using SPSS version 27.0 software, and significant differences from before and after the campaign were analysed using the Chi-square test at a 0.05 significance level.

Results

There were no significant differences in the age, gender and work hours of the nurses who participated before and after the campaign, except for their professional work settings (< 0.05). All secondary outcomes improved significantly after the campaign, and outcomes on beliefs about back pain showed significantly positive changes in six of the 14 items, while all questions pertaining to patient activation improved significantly.

Conclusion

The 12-week back pain campaign, based on contextualised, evidence-based back pain messages for Zambian nurses, motivated the participants to self-manage their back pain. However, not all beliefs about back pain changed positively after the campaign.

Clinical implications

The findings of this back pain education campaign show promise as a strategy to improve knowledge, behaviours and beliefs about back pain in African settings.

A novel virtual reality application for autonomous assessment of cervical range of motion: development and reliability study

Background

Neck pain, one of the most common musculoskeletal diseases, affects 222 million people worldwide. The cervical range of motion (CROM) is a tool used to assess the neck's state across three movement axes: flexo-extension, rotation, and lateral flexion. People with neck pain often have a reduced CROM, and they feel pain at the end-range and/or accompany neck movements with compensatory trunk movements. Virtual reality (VR) setups can track the movement of the head and other body parts in order to create the sensation of immersion in the virtual environment. Using this tracking position information, a CROM assessment can be performed using a VR setup that may be carried out autonomously from the user's home. The objectives of this study were to develop a VR experience that could be used to perform a CROM assessment, and to evaluate the intra-rater and inter-rater reliability of the CROM measures guided by this VR experience. To the best of our knowledge, a study of this type has not been carried out before.

Materials & Methods

A total of 30 asymptomatic adults were assessed using a VR device (HTC Vive Pro Eye™). Two raters provided support with the VR setup, and the participants were guided by the VR experience as they performed the movements. Each rater tested each subject twice, in random order. In addition to a head-mounted display (HMD), a tracker located on the subject's back was used to measure trunk compensatory movements. The CROM was estimated using only the HMD position and this measurement was corrected using the tracker data. The mean and standard deviation were calculated to characterize the CROM. To evaluate the reliability, the interclass correlation coefficients (ICC) were calculated for intra-rater and inter-rater analysis. The standard error of measurement and minimum detectable change were also calculated. The usability of the VR system was measured using the Spanish version of the System Usability Scale.

Results

The mean CROM values in each axis of movement were compatible with those described in the literature. ICC values ranged between 0.86 and 0.96 in the intra-rater analysis and between 0.83 and 0.97 in the inter-rater analysis; these values were between good and excellent. When applying the correction of the trunk movements, both the intra-rater and inter-rater ICC values slightly worsened except in the case of the lateral flexion movement, where they slightly improved. The usability score of the CROM assessment/VR system was 86 points, which is an excellent usability score.

Conclusion

The reliability of the measurements and the usability of the system indicate that a VR setup can be used to assess CROM. The reliability of the VR setup can be affected by slippage of the HMD or tracker. Both slippage errors are additive, i.e., only when the sum of these two errors is less than the compensatory movement do the measurements improve when considering the tracker data.

Specific versus non-specific exercises for the neck extensor muscles in women with chronic idiopathic neck pain: A randomized controlled trial

BACKGROUND

Structural and functional impairments of the cervical extensor muscles have been demonstrated in people with neck pain. A global exercise approach targeting all neck extensor muscles has shown positive effects in this population. However, to date, the efficacy of exercises specifically targeting the deep neck extensors has neither been tested nor compared to global exercises for the neck extensors.

OBJECTIVES

To compare the effects on pain and disability of a specific lower deep neck extensors (SLDNE) versus a general neck extensor (GNE) exercise program in women with chronic idiopathic neck pain.

METHODS

Fourty-three women with chronic idiopathic neck pain were randomly allocated to either a six-week SLDNE or a GNE exercise program. As primary outcome, neck disability was measured with the Neck Disability Index (NDI). Secondarily, pain intensity (VAS), cervical ROM, pressure pain thresholds (PPTs), cervical and thoracic posture and self-perceived benefit of treatment (GROC) were also measured. Every outcome was measured at baseline and immediately after treatment, except NDI, which was also measured at 6-months follow-up. The GROC was only assessed post-intervention.

RESULTS

Both exercise programs lead to reduced neck disability immediately post-intervention (within-group mean difference [MD] = -6.09; 95% Confidence Interval [CI]: 7.75, -4.42 and -4.73; 95%CI: 6.57, -2.91 respectively) and at the 6-months follow-up (-4.47; 95%CI: 6.41, -2.53 and -4.74; 95%CI: 6.50, -2.97), but with no between group differences. Similar results were found for pain intensity post-intervention, with no between group interaction (within-group MD = -20.87 mm; 95% CI: 28.55, -13.19 and -18.00 mm; 95%CI: (-26.24, -9.76) for SLDNE and GNE groups, respectively). GROC improved after both interventions without any between-group difference.

CONCLUSIONS

A six-week exercise program specifically targeting the lower deep neck extensors lead to comparable outcomes as a general neck extensor exercise program in women with chronic idiopathic neck pain.

Prevalence of Pain and Its Risk Factors Among ICU Personnel in Tertiary Hospital in China: A Cross-Sectional Study

Background

Although pain is commonly observed among medical staff, studies on pain among intensive care unit personnel are uncommon, especially intensive care unit (ICU) doctors and workers. Moreover, few studies have focused on the prevalence of pain and the associated factors.

Purpose

The aim of this study was to estimate the prevalence of pain among ICU personnel (including doctors, nurses and workers) and explore the risk factors for their pain.

Methods

We conducted an online survey that included sociodemographic and work-related items and questions about pain, ergonomics, and psychological factors. We used the short version of the validated Depression-Anxiety-Stress Scale (DASS-21) to assess the relationship between pain and mental disorders. All ICU personnel at West China Hospital of Sichuan University participated in this study.

Results

A total of 356 ICU personnel were included in the final analysis. The prevalence of pain was 72.2% among ICU nurses, 64.4% among ICU doctors and 52.9% among ICU workers. The most frequent location of pain was the lower back among nurses (65.9%) and workers (47.1%) and the neck among doctors (49.1%). The factors contributing to pain among ICU personnel were bending or twisting the neck, high levels of psychological fatigue, low self-perceived health status, female sex and high body mass index (BMI). Moreover, participants with pain indicated significantly higher depression (p ≤ 0.001), anxiety (p ≤ 0.001), and stress levels (p = 0.002) than those without pain.

Conclusion

This study indicates that ICU personnel exhibit a high prevalence of pain. Many factors, especially psychosocial and ergonomic factors, contribute to pain levels among ICU personnel and the poorer mental health levels observed in those experiencing pain. Therefore, disease prevention and health promotion measures are needed to protect the health of ICU personnel.

Ergonomic Risk-prone Activities toward Nurses in the Intensive Care and Emergency Room

BACKGROUND: Nurses have the risk of ergonomic hazards in providing nursing care, especially with increasingly dynamic health services such as during Coronavirus disease-19 pandemic like today. AIM: The aim of the study was to evaluate activities prone to produce ergonomic risks during the implementation of nursing care in intensive care and emergency room (ER) of a hospital in Riau, Indonesia. METHODOLOGY: This study was conducted by observing the routine activities conducted by the nurses and using similar task group techniques equipped with Rapid Entire Body Assessment instrument. Those observed activities were obtained from 17 intensive care room nurses and ten ER nurses. There were six activities observed in the intensive care room: Bathing, transferring the patient, wounds dressing, taking blood samples for the AGDA examinations, as well as inserting the intravenous needle and electrocardiograms. Meanwhile, there were two activities observed in the ER: Transferring the patient and inserting the intravenous needle. RESULTS: The highest ergonomic risks activity in the intensive care room was bathing the patient with a total score of 13. At the ER, the highest risk score was transferring the patient with a total score of 12. Both activities were at level 4, indicating a high-risk condition. Thus, examinations and changes should be immediately initiated. CONCLUSION: The results are significant to be paid attention by the related parties at the hospital to facilitate some improvements immediately. In addition, the ergonomic approaches that can be suggested to the nurses are regular stretching, physical exercises, and applying ergonomic principles while working.

Test - re-test reliability and concurrent validity of cervical active range of motion in young asymptomatic adults using a new inertial measurement unit device

OBJECTIVES

Cervical range of motion (CROM) is one of the first things evaluated in cervical disorders. DyCare-Lynx is an inertial measurement unit device that was recently designed to measure CROM. Therefore, the objectives of the present study were to test the reliability and validity of the DyCare-Lynx device for active CROM.

MATERIALS AND METHODS

This study included 36 healthy individuals for the reliability study and 31 individuals for the validity study. Test-retest reliability was examined in three different days, by the same examiner with a 4 ± 1-day interval between them in all cervical movements in random order. For validity, the CROM was tested with the Zebris Motion Analysis system and DyCare-Lynx simultaneously.

RESULTS

The interclass correlation coefficient (ICC) of the DyCare-Lynx ranged from 0.54 to 0.90. The standard error of measurement (SEM) ranged from 2.12°-7.65°. The smallest detectable change (SDD) ranged from 11.25% to 29.75%. The Pearson's r correlation of DyCare-Lynx with Zebris ranged from 0.655 to 0.957.

CONCLUSION

DyCare-Lynx showed moderate to excellent reliability and moderate-to-high validity. Moreover, SEM was low with acceptable SDD values for all movements. Overall, it can be suggested that DyCare-Lynx is a reliable and valid tool to evaluate active CROM.

Effectiveness of a multidimensional intervention program in improving occupational musculoskeletal disorders among intensive care unit nurses: a cluster-controlled trial with follow-up at 3 and 6 months

Background

Intensive care unit (ICU) nurses are at high risk for work-related musculoskeletal disorders (WRMDs). Data on occupational injuries indicate the significance of WRMDs among ICU nurses. Intervention programs have previously been developed to reduce WRMDs, but different intervention methods need to be adopted for different groups of people. This study aimed to evaluate the effectiveness of a multidimensional intervention program to prevent and reduce WRMDs in ICU nurses.

Methods

This study was designed as a two-armed cluster-controlled trial with an intervention group and a control group. The clusters were independent hospital ICUs, and the participants consisted of registered nurses in China. By cluster random sampling, 89 nurses from two ICUs were assigned to the intervention group, and 101 nurses from two other ICUs were assigned to the control group. A multidimensional intervention program based on previous studies was designed. This program combined improving risk perception, health behavior training, and promoting a safe working environment. The multidimensional intervention program was implemented in the intervention group, whereas routine specialist training was implemented in the control group. Baseline and follow-up (3 and 6 months) data were collected using self-reported online questionnaires. The primary outcome was the report rate of WRMDs in the past 7 days. Secondary outcomes were risk perception, application of health behavior, and perception of a safe working environment. The data were statistically analyzed using SPSS 19.0.

Results

A total of 190 nurses provided three recorded outcome measurements (intervention group, N = 89 (94.68%); control group, N = 101 (94.39%)). After 6 months, the intervention group experienced significant improvement relative to the control group in the report rate of WRMDs in the past 7 days (OR = 1.953, p = 0.037), risk perception (OR = 0.517, p < 0.001), application of health behavior (OR = 0.025, p < 0.001), and perception of a safe working environment (OR = 1.637, p = 0.024).

Conclusion

The multidimensional intervention program was superior to routine specialist training in preventing the occurrence of WRMDs in ICU nurses. WRMD training should include multifaceted approaches and pay increased attention to specific department functions.

Efficacy of a proprioceptive exercise program in patients with nonspecific neck pain: a randomized controlled trial

BACKGROUND

Nonspecific neck pain is associated with chronic pain, disability, reduced cervical mobility, postural control disorders and impaired proprioceptive control.

AIM

The aim of this study was to compare the effectiveness of two therapeutic exercise programs (i.e. cervical proprioception and cervical mobility) in reducing pain and disability in individuals with nonspecific neck pain. We further aimed to compare the effectiveness of the two treatments in improving pressure pain threshold, cervical range of motion and head repositioning accuracy.

DESIGN

This study was designed as a randomized controlled trial.

SETTING

This study took place in a private rehabilitation clinic.

POPULATION

Forty-two participants diagnosed with nonspecific neck pain, aged 18-65 years, were randomized to a cervical mobility group (N.=22) or a proprioception group (N.=20).

METHODS

The cervical mobility group combined a passive treatment and active mobility exercises, whereas the Proprioception group combined a passive treatment and proprioceptive exercises. Pain intensity, disability, pressure pain threshold, range of motion, and head repositioning accuracy were assessed at baseline and after 10 sessions.

RESULTS

Pain intensity and disability significantly improved for both interventions (p<0.01), but such improvement was greater for pain intensity in the proprioception group than in the cervical mobility group (P<0.01). Pressure pain threshold, range of motion and head repositioning accuracy improved only in the proprioception group (P<0.01).

CONCLUSIONS

A program based on cervical proprioception exercises demonstrated to improve pain, disability, pressure pain threshold, range of motion and head repositioning accuracy in patients with nonspecific neck pain. However, a program based on cervical mobility exercises only showed to improve pain intensity and disability, while such improvement was not clinically relevant.

CLINICAL REHABILITATION IMPACT

The proprioceptive exercise program may be considered as the treatment of choice in patients with nonspecific neck pain.

Effectiveness of Lifestyle Health Promotion Interventions for Nurses: A Systematic Review

BACKGROUND

Prior research has investigated various strategies to improve health, wellbeing and the job-related outcomes of nurses. However, the scope of this evidence is not clear and the types of intervention most likely to have positive outcomes are unknown.

OBJECTIVE

To provide an overview and synthesis of the effectiveness of interventions conducted with the goal of improving health, wellbeing and the job-related outcomes of nurses.

METHODS

A systematic database search was conducted from January 2000 to December 2018, with pre-defined criteria (Cochrane Central Register of Controlled Trials; MEDLINE and PubMed; EMBASE; CINAHL; PsycINFO; and BioMed Central). In total, 136 intervention studies with a total sample of 16,129 participants (range 9-3381) were included and evaluated. Data extraction, quality assessment and risk of bias analyses were performed.

RESULTS

Studies included randomised controlled trials (RCTs; n = 52, 38%), randomised crossover design studies (n = 2, 1.5%) and non-randomised pre-post studies with a control group (n = 31, 23%) and without a control group (n = 51, 37.5%). The majority of interventions focused on education, physical activity, mindfulness, or relaxation. Thirty-seven (27%) studies had a multimodal intervention approach. On average, studies had relatively small samples (median = 61; mode = 30) and were conducted predominantly in North America (USA/Canada, n = 53). The findings were mixed overall, with some studies reporting benefits and others finding no effects. Dietary habits was the most successfully improved outcome (8/9), followed by indices of body composition (20/24), physical activity (PA) (11/14), and stress (49/66), with >70% of relevant studies in each of these categories reporting improvements. The lowest success rate was for work-related outcomes (16/32). Separate analysis of RCTs indicated that interventions that focus solely on education might be less likely to result in positive outcomes than interventions targeting behavioural change.

CONCLUSIONS

Interventions targeting diet, body composition, PA, or stress are most likely to have positive outcomes for nurses' health and/or wellbeing. The methodologically strongest evidence (RCTs) is available for body composition and stress. Interventions relying solely on educational approaches are least likely to be effective. Organisational outcomes appear to be more challenging to change with lifestyle intervention, likely requiring more complex solutions including changes to the work environment. There is a need for more high-quality evidence since many studies had moderate or high risk of bias and low reporting quality.

The impact of modified exercise and relaxation therapy on chronic lower back pain in office workers: a randomized clinical trial

This study aimed to evaluate the effectiveness of a modified package of exercise therapy combined with relaxation on pain intensity, range of motion (ROM), anxiety, and quality of life (QoL) in office workers with chronic lower back pain. In this clinical trial, 72 office workers aged 20 to 50 years with chronic low back pain were randomized to one of four groups including; group 1, exercise therapy; group 2, psychotherapy (relaxation therapy); group 3, modified protocol (exercise therapy followed by relaxation therapy); group 4, control group (no intervention). Participants exercised 3 times weekly for 6 weeks for 40-45 min of exercise/relaxation. Pain intensity, ROM, anxiety, and QoL were evaluated at baseline, 6 weeks, and 12 weeks after the end of the intervention. Results showed significant decreases in pain intensity and anxiety in the three experimental groups compared to the control group. The three intervention groups indicated a significant decrease in pain intensity and anxiety after 6 and 12 weeks. ROM significantly improved in the exercise therapy and the modified protocol over time (after 6 and 12 weeks). A significant difference in QoL was found between the groups, with the greatest improvement found in the psychotherapy and modified protocol groups. This therapeutic package (including exercise movements and psychological interventions) was found to have a superior effect on pain intensity, ROM, anxiety, and QoL after 6 and 12 weeks compared to other interventions (only exercise and psychotherapy).

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.

Short-term effects of manipulative treatment versus a therapeutic home exercise protocol for chronic cervical pain: A randomized clinical trial

BACKGROUND

While both manipulative treatment and physical exercises are used to treat cervical pain, it remains unclear which is most effective.

OBJECTIVE

To compare the short-term effects of high-velocity, low-amplitude manipulation techniques (MT) with those of home-exercise (HE) with stretching and low-intensity (10% of max) isometric contractions on pain and function.

METHODS

Single-blind randomized clinical trial was performed. A total of 27 asymptomatic subjects were randomly assigned to 2 groups: manipulation techniques (MT, n= 13) and home exercise (HE, n= 14). The visual analogue scale (VAS); neck disability index (NDI); pressure pain thresholds; cervical spine range of motion and electromyography during the cranio-cervical flexion test was measured before and one week after the intervention.

RESULTS

After the intervention, both groups showed improved (P< 0.05) NDI and VAS scores and flexion in both rotation ranges compared with the pre-intervention values. For the NDI, pain intensity, and neck flexion, the effects sizes were large; for the majority of the other measurements, the effect sizes were small to moderate. The MT group showed significantly better results than the HE group for 2 out of 17 tests.

CONCLUSIONS

Both interventions improved function and pain after one week, with only marginal between-group differences in favor of MT.