Work-relatedness of low back pain in nursing personnel: a systematic review

[Developing kinaesthetic competence and team dynamics : A quality improvement project in a stroke unit]

BACKGROUND

Movement training for stroke patients is a crucial component of their treatment. Lack of time and staff are often described as limiting factors for the development of kinaesthetic competence. In contrast, a positive team atmosphere and awareness of kinaesthetics are seen to be beneficial.

AIM

The goal of this quality improvement project was to promote the kinaesthetic competence of a stroke unit (SU) nursing team and to investigate its influence on team dynamics.

METHODS

As a team intervention for the project, a basic course in kinaesthetics in nursing, augmented by practical instructions, was conducted exclusively for the SU nursing team. The Kinaesthetics Competence Observation (KCO) instrument was used to determine competence development. The participants rated team dynamics on a scale of 0-10 points.

RESULTS

In all, 88% of the nursing team took part in the quality improvement project and successfully completed the basic course. The kinaesthetic competence improved by 4.2 KCO points and the team dynamics also increased by around 2 points.

DISCUSSION

A basic kinaesthetics course with practical instructions improves kinaesthetic competence. Continuous instruction, long-term process implementation and support from nursing managers are required to establish kinaesthetic competence in the long term.

CONCLUSION

The results show that a kinaesthetic training project carried out in this way has a positive influence not only on kinaesthetic competence but also on the dynamics of a care team.

The epidemiology of low back pain in chiropractors and chiropractic students: a systematic review of the literature

BACKGROUND

Chiropractors and chiropractic students commonly report low back pain (LBP). However, the burden of LBP in this occupational group has not been synthesized in the literature. This systematic review aims to describe the epidemiology of LBP in chiropractors and chiropractic students.

METHODS

We searched MEDLINE, Embase, CINAHL, and PsycINFO from inception to May 1, 2023. Eligible studies were cross-sectional, cohort, or case-control studies investigating the prevalence, incidence, associated factors, or risk factors of LBP in chiropractors or chiropractic students. Reviewers independently screened articles and assessed risk of bias using the appropriate JBI Checklists for the observational study design. We descriptively synthesized studies that were rated as low or moderate risk of bias.

RESULTS

Of 2012 citations screened, we included 2 cross-sectional studies in the evidence synthesis (1 study rated as moderate risk of bias on chiropractors, and 1 rated as low risk of bias on chiropractic students). For chiropractors, the 12-month prevalence of work-related overuse injuries to the low back was 35.6% (95% CI 29.1, 42.0) in women and 22.4% (95% CI 16.3, 29.6) in men. The 12-month prevalence of work-related acute physical injuries to the low back in chiropractors were 3.4% (95% CI 1.6, 6.8) for women and 0.7% (95% CI 0.1, 3.7) for men. Among chiropractic students, the 1-week prevalence of LBP was 69% (95% CI 64.8, 73.0). This was higher among female students (72.5%, 95% CI 67.1, 77.4) and lower among male students (64%, 95% CI 57.0, 70.6).

CONCLUSION

There is limited high-quality evidence on the epidemiology of LBP in chiropractors and chiropractic students. Our systematic review provides a synthesis of the body of literature, highlighting that chiropractors and chiropractic students commonly report LBP. Future high-quality research is needed to address the incidence, associated factors, and risk factors of LBP.

Co-occurring pain and addiction: prognostic implications for healthcare professionals in residential treatment for substance use disorder

Objectives: Chronic pain is both an important antecedent and consequence of substance use. Although evidence suggests healthcare professionals may be uniquely vulnerable to chronic pain, this vulnerability remains largely unexamined in the context of recovery from substance use disorders (SUDs). We characterized pain in a sample of treatment-seeking individuals, examined potential differences in pain trajectories between healthcare professionals and non-healthcare patients, and interrogated potential pain-related vulnerabilities in treatment outcomes between these groups. Methods: Patients with SUDs (n = 663; 251 women) completed questionnaires indexing pain intensity, craving, and abstinence self-efficacy (including self-efficacy in pain-related contexts). Assessments were conducted at treatment entry, 30 days, and discharge. Analyses included chi-square and longitudinal mixed models. Results: The proportion of healthcare and non-healthcare patients endorsing recent pain was equivalent (χ2=1.78, p=.18). Healthcare professionals reported lower pain intensity (p = 0.02) and higher abstinence self-efficacy (p < 0.001). Profession by pain interactions (ps <.040) revealed that among medical professionals, associations between pain and all three treatment outcomes of interest were more robust relative to the non-healthcare group. Conclusions: Results suggest that although healthcare professionals endorse similar rates of pain and lower average pain intensity, they may be uniquely vulnerable to pain-related disruptions in craving and abstinence self-efficacy.

More Than Just a Pain in the Back: Pain Among American Nurses and Its Relationship to Modifiable Work Factors and Work Performance

Nursing is a profession with high rates of workplace injuries, hazards, and turnover. Improving the health and safety of nurses at work is vital to retain and grow the workforce to meet future demands. The purpose of this study was to describe the breadth of pain among American nurses and explore the relationships between this pain and modifiable work factors and perceived work performance. We used a cross-sectional descriptive design of 2312 nurses from across the United States. Nurses completed a survey containing questions about demographics, the presence of pain in the past week, the number of pain sites, pain locations, severity, and the impact on work performance. The median number of pain locations reported was 2, back pain was the most reported pain site, and average pain severity ranged from 4 to 5. Significant modifiable work factors associated with pain were average patient load and shift length. Many participants indicated that their pain impacted work performance, while a smaller proportion acknowledged that their pain impacted patient care. Pain among nurses spans multiple locations, is moderately severe, and impacts work performance. Addressing related modifiable work factors may decrease pain and the impact on the health, safety, and work performance of the nursing workforce.

Don't Just Stand There. Rethinking the Ideal Body Posture for Otorhinolaryngologists

Surgeons have a high rate of work-related musculoskeletal injuries; an area that has received little attention. These injuries result in surgeons performing less efficiently, needing to take time off work, suffering higher rates of burnout, and may ultimately lead surgeons to retire earlier than planned. Otorhinolaryngologists are at particular risk for work-related musculoskeletal injuries. Beyond the clinician, sustaining such injuries can negatively impact patient safety. Ergonomic interventions have been used effectively to reduce work-related musculoskeletal injuries in other professions, yet not in surgery. With traditional teachings of ideal body postures to avoid injury and manual handling training being re-evaluated, it is important to explore evidence based interventions for reducing work-related musculoskeletal injuries in otorhinolaryngologists. New research encourages us to shift the focus away from the traditional one-size-fits-all approach to ergonomics and toward postural recommendations and education that promote a dynamic, individualized approach to avoiding sustained, static and awkward postures.

Effect of an educational intervention on nurses' competence in activities of daily living support in end-of-life care using a pretest-posttest repeated measures design

BACKGROUND

Most patients in specialized palliative care units need nursing support to perform activities of daily living (ADL), such as using a toilet or transferring out of a bed or chair. To deliver high-quality ADL support that facilitates patients' movement and protects nurses' musculoskeletal health, nurses need appropriate knowledge and skills. The objective of this study is to investigate the impact of education based on the "Advanced Kinaesthetics in Palliative care (AdKinPal) program" on the competence in Kinaesthetics, self-efficacy regarding ADL support in end-of-life care and musculoskeletal complaints of nurses from specialist palliative care units.

METHODS

A pretest-posttest repeated measures design was applied. The study took place in three specialised units for palliative care in Switzerland between June 2018 and April 2020. All the nurses who worked in participating wards (n = 62) and fulfilled the inclusion criteria were asked to participate. The intervention - the AdKinPal program - is an education-based training program conducted for six months. We took measurements using self-administered questionnaires at three points before and after the intervention. Using descriptive statistics, repeated measurement analysis of variance (ANOVA) and independent-samples t-tests, we analysed the participants' demographic characteristics as well as developments over time and relationships between the three outcome variables: Kinaesthetics competence, self-efficacy regarding ADL support in end-of-life care and musculoskeletal complaints.

RESULTS

Fifty-nine nurses and one physiotherapist participated, and 38 participants (63%) responded to all three questionnaires. The AdKinPal training improved the nurses' perceived Kinaesthetics competence and self-efficacy regarding ADL support in end-of-life care. Participants who reported lower back, neck or shoulder pain had a significantly lower Kinaesthetics competence.

CONCLUSIONS

The AdKinPal program can raise nurses' Kinaesthetics competence. Thereby, patients' autonomy and quality of life could be supported, and symptom management could be enhanced in a holistic manner. Furthermore, the AdKinPal program fosters nurses' self-efficacy in ADL support in end-of-life care. A strong sense of self-efficacy enhances professional well-being in many ways. Additionally, the nursing staff's musculoskeletal health can be promoted by enhancing their Kinaesthetics competence.

TRIAL REGISTRATION

DRKS00015908. Registration Date 23.11.2018.

Environmental Risk Assessment of Low Back Pain in ICU Nurses: An Instrument Development Study

Aim

To develop a valid, reliable assessment tool to measure risk factors associated to low back pain (LBP) in intensive care unit (ICU) nurses.

Background

LBP is defined as the pain extending from the 12th rib to the iliac crest and often coexists with buttock pain. Nursing has been identified among the top professions at risk of LBP. A mean of 70% prevalence per year in ICU nurses was reported, exceeding those employed in heavy industry. Environmental factors in workplace were also most important risks related to LBP in this population except factors including individual, physical, psychosocial, and lifestyle. However, there is lack of tools to assess environmental risk related to LBP for nurse managers currently.

Methods

Focus group interviews, field research, and panel discussion were used to develop item pool. Two-round expert reviews and preinvestigation were carried out to form initial scale named Environmental Risk Assessing Instrument-Occupational Low Back Pain in Nurses (ERAI-N). A cross-sectional survey with 188 ICU participants in Hunan Province in China was implemented to collect data. Cronbach's alpha, split-half reliability, and test-retest reliability were used to test ERAI-N's reliability. Expert review was performed to test ERAI-N's content validity, and confirmatory factor analysis (CFA) was performed to assess its construct validity, being carried out in IBM SPSS Amos 26 Graphics.

Results

Final version of ERAI-N scale had five dimensions with 18 items that were space, equipment, belief, guideline, and safe culture. ERAI-N scale's score of Cronbach's alpha, Guttman split-half, and intraclass correlation coefficient (ICC) was 0.958, 0.927, and 0.994, respectively. Item-level content validity scores ranged from 0.89 to 1.0, and scale-level content validity was 0.983. Standardized factor loadings ranged from 0.567 to 0.974. Model adjusted fit statistics were as follows: the chi-square statistic and degrees of freedom (χ 2/df) = 3.943, root mean square error of approximation (RMSEA) = 0.071, incremental fit index (IFI) = 0.905, comparative fit index (CFI) = 0.904, parsimony normed fit index (PNFI) = 0.641, and parsimonious comparative fit index (PCFI) = 0.661.

Conclusions

ERAI-N scale had moderate reliability, content validity, and construct validity. Implications for Nursing Management. Designers may use ERAI-N scale to plan the interior layout when design a new ICU. Nurse managers might utilize this instrument as a managing tool to assess whether there is environmental risk factors related to LBP in ICU.

Evaluation of the Efficacy of a Lift-Assist Device Regarding Caregiver Posture and Muscle Load for Transferring Tasks

The aim of this study was to confirm the effect of a lift-assist device when performing a patient-lifting task. Ten working caregivers participated in this experiment, and lifting patients from bed to wheelchair (B2C) and wheelchair to bed (C2B) was performed for manual care (MC) and lift-assist device (robot) care (RC). EMG sensors and IMU motion sensors were attached as indicators of the assistive device's effectiveness. EMG was attached to the right side of eight muscles (UT, MD, TB, BB, ES, RF, VA, and TA), and flexion/extension angles of the neck, shoulder, back, and knee were collected using motion sensors. As a result of the analysis, both B2C and C2B showed higher muscle activities in MC than RC. When using a lift-assist device to lift patients, the RC method showed reductions in muscle activities compared to MC. As a result of the work-posture analysis, both the task type and the task phase exhibited pronounced reductions in shoulder, back, and knee ROM (range of motion) compared to those of MC. Therefore, based on the findings of this study, a lift-assist device is recommended for reducing the physical workloads of caregivers while performing patient-lifting tasks.

Musculoskeletal disorder (MSD) prevention practices by nurses working in health care settings: Facilitators and barriers to implementation

The incidence of musculoskeletal disorders (MSD) in the healthcare professional population is concerning. In particular, the high incidence of back injuries is an issue for nurses. Although many MSD prevention initiatives are being implemented, these practices are not succeeding in reducing MSDs. Why are these efforts struggling to close the gap between knowledge and practice? This article aims to report on individual and organizational factors that may influence nurses' implementation of MSD prevention practices. A survey was sent to nurses in the Quebec health and social services network. A total of 399 questionnaires were completed and analyzed. The results revealed that nurses have the required knowledge on MSD prevention practices, but have difficulty applying them in their professional context. It would appear that successful implementation of MSD prevention practices relies mainly on organizational factors, including management support, organizational culture, feedback mechanisms, and training that is adapted to the work environment.

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.

Development and evaluation of a new assistive device for low back load reduction in caregivers: an experimental study

Low back pain among healthcare professionals is associated with the manual handling of patients. Some bed features for turning and repositioning have been developed; however, the load during patient care remains heavy. We developed a device to reduce low back load in caregivers during patient bedside care and evaluated it objectively and subjectively from a caregiver's perspective using a randomised crossover study. Overall, 28 clinical nurses and care workers were randomly assigned to two interventional groups: administering care with (Device method) and without (Manual method) the device in an experimental room. We measured the caregiver's trunk flexion angle using inertial measurement units and video recording during care and then defined a trunk flexion angle of > 45° as the threshold; the variables were analysed using linear mixed models. Subsequently, participants responded to a survey regarding the usability of the device. Trunk flexion time and percentage of time were 26.5 s (95% confidence interval: 14.1 s, 38.9 s) (p < 0.001) and 23.0% (95% confidence interval: 16.4%, 29.6%) (p < 0.001) lower, respectively, in the Device group than in the Manual group. Furthermore, caregivers evaluated the care they could administer with the device as being better than that associated with manual care.

Influence of Occupation on the Prevalence of Spinal Pain among Physiotherapists and Nurses

(1) Background: Neck pain (NP) and low back pain (LBP) are common musculoskeletal disorders, one of the major causes of disability globally. The aim of the study was to determine the influence of medical occupation (physiotherapist and nurse) on the prevalence of spinal pain, functional status and degree of disability. (2) Methods: a total of 544 people (462 females (84.9%) and 82 males (15.1%)), licensed to practice as a physiotherapist (n1 = 240 (44.1%)) or nurse (n2 = 304 (55.9%)) in Poland completed a special questionnaire designed by the authors of the study, and were assessed using the Neck Disability Index (NDI, Polish language version) and Revised Oswestry Disability Index (ODI, Polish language version). (3) Results: Compared to physiotherapists, nurses were older, shorter, had higher BMI, and longer work experience. In the whole study group, 30.2% of subjects reported NP, 17.7% reported thoracic pain (ThP) and 80.5% reported LBP. During working life, 90.9% of physiotherapists and 97.7% of nurses experienced spinal pain. Pain intensity measured with Visual Analogue Scale (VAS) was higher among nurses (mean 5.37) than among physiotherapists (mean 4.64). Nurses had a higher degree of disability caused by LBP and NP measured with ODI and NDI compared to physiotherapists. (4) Conclusions: Excessive strain of the spine associated with occupational activities has a strong impact on the intensity and frequency of spinal pain episodes. Physiotherapists and nurses mainly suffer from low back pain. Pain scores measured with VAS are higher in nurses than in physiotherapists.

Continuous assessment of trunk posture in healthcare workers assigned to wards with different MAPO index

Healthcare professionals generally experience an above-average incidence of low back disorders (LBDs) compared with workers of other professions, and its level of risk is commonly assessed using observational methods such as the MAPO method (Movement and Assistance of Hospital Patients). In this study, we continuously monitored the trunk posture of 30 healthcare workers using a single inertial sensor to: (1) understand whether the MAPO classification is effective in adequately discriminating the risk associated with the time spent in non-neutral trunk postures and (2) characterise the variability of biomechanical exposure among workers employed in wards with the same MAPO index. The results substantially confirm the validity of the MAPO approach in discriminating among wards characterised by different levels of biomechanical exposure associated with the risk of developing LBDs. However, they also highlight the need to assess workers' exposure on an individual basis due to the high intra-group variability.Practitioner summary: Employing a quantitative measurement setup to monitor trunk posture along with an observational method (ie MAPO) can identify the existence of criticalities or the poor application of ergonomic recommendations given during the training of healthcare workers even in hospital wards characterised by little or no risk of developing low back disorders.

Causal assessment in evidence synthesis: A methodological review of reviews

In fields (such as population health) where randomised trials are often lacking, systematic reviews (SRs) can harness diversity in study design, settings and populations to assess the evidence for a putative causal relationship. SRs may incorporate causal assessment approaches (CAAs), sometimes called 'causal reviews', but there is currently no consensus on how these should be conducted. We conducted a methodological review of self-identifying 'causal reviews' within the field of population health to establish: (1) which CAAs are used; (2) differences in how CAAs are implemented; (3) how methods were modified to incorporate causal assessment in SRs. Three databases were searched and two independent reviewers selected reviews for inclusion. Data were extracted using a standardised form and summarised using tabulation and narratively. Fifty-three reviews incorporated CAAs: 46/53 applied Bradford Hill (BH) viewpoints/criteria, with the remainder taking alternative approaches: Medical Research Council guidance on natural experiments (2/53, 3.8%); realist reviews (2/53, 3.8%); horizontal SRs (1/53, 1.9%); 'sign test' of causal mechanisms (1/53, 1.9%); and a causal cascade model (1/53, 1.9%). Though most SRs incorporated BH, there was variation in application and transparency. There was considerable overlap across the CAAs, with a trade-off between breadth (BH viewpoints considered a greater range of causal characteristics) and depth (many alternative CAAs focused on one viewpoint). Improved transparency in the implementation of CAA in SRs in needed to ensure their validity and allow robust assessments of causality within evidence synthesis.

Prevalence and Associated Factors of Low Back Pain Among Healthcare Professionals at University of Gondar Comprehensive and Specialized Hospital, Northwest Ethiopia: Cross-Sectional Study

Introduction

Low back pain is defined as mechanical pain of the lower part of the back. Globally large number of people suffer from low back pain and this number is increasing. This study aims to assess the prevalence and associated factors of low back pain among healthcare professionals at University of Gondar Compressive Specialized Hospital, northwest Ethiopia.

Methods

An institutional cross-sectional study was conducted among 423 healthcare professionals from March 20/2021-April 20/2021. A sample was selected from each profession through systematic random sampling technique after proportional allocation to each profession. Data were collected using a pre-tested structured self-administered English-version questionnaire, which was adapted from a standardized Nordic musculoskeletal questionnaire. The prevalence of low back pain was calculated and described by using frequency tables. Multivariate logistic regression model was fitted to identify factors associated with the prevalence of low back pain. Significance was considered at p<0.05 with 95% confidence interval.

Results

In this study, 423 healthcare professionals were included with the response rate of 95%. Among them 59.95% were males, 48.26% were less than 30 years old, 86% were degree holders and 57.21% were married. The prevalence of low back pain was 57.46% with 95% confidence interval (95%; CI = 52.6, 62.2). The median age of the respondents was 31± (28–32 IQR) years. Being female [AOR 1.81, 95% (CI = 1.079, 3.018)], frequent bending and twisting [AOR = 1.89, 95% CI (1.121, 3.200)], prolonged standing [AOR = 2.61, 95% (CI = 1.487, 4.597)], being a nurse [AOR = 5.80, 95% (CI = 2.070, 16.226)], and being a physician [AOR = 3.82, 95% (CI = 1.264, 11.531)] were predicted variables for low back pain.

Conclusion

More than 50 percent of the participants were suffering from low back pain. In this study being female, frequent bending, prolonged standing, and type of professionals were statistically significant factors of low back pain. It is better to equip the hospital with appropriate assistive devices to decrease frequent bending and twisting of healthcare workers.

Formulation of Japanese Orthopaedic Association (JOA) clinical practice guideline for the management of low back pain- the revised 2019 edition

BACKGROUND

The latest clinical guidelines are mandatory for physicians to follow when practicing evidence-based medicine in the treatment of low back pain. Those guidelines should target not only Japanese board-certified orthopaedic surgeons, but also primary physicians, and they should be prepared based entirely on evidence-based medicine. The Japanese Orthopaedic Association Low Back Pain guideline committee decided to update the guideline and launched the formulation committee. The purpose of this study was to describe the formulation we implemented for the revision of the guideline with the latest data of evidence-based medicine.

METHODS

The Japanese Orthopaedic Association Low Back Pain guideline formulation committee revised the previous guideline based on a method for preparing clinical guidelines in Japan proposed by Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014. Two key phrases, "body of evidence" and "benefit and harm balance" were focused on in the revised version. Background and clinical questions were determined, followed by literature search related to each question. Appropriate articles were selected from all the searched literature. Structured abstracts were prepared, and then meta-analyses were performed. The strength of both the body of evidence and the recommendation was decided by the committee members.

RESULTS

Nine background and nine clinical qvuestions were determined. For each clinical question, outcomes from the literature were collected and meta-analysis was performed. Answers and explanations were described for each clinical question, and the strength of the recommendation was decided. For background questions, the recommendations were described based on previous literature.

CONCLUSIONS

The 2019 clinical practice guideline for the management of low back pain was completed according to the latest evidence-based medicine. We strongly hope that this guideline serves as a benchmark for all physicians, as well as patients, in the management of low back pain.

THE PREVALENCE OF LOW BACK PAIN IN NURSES AT A UNIVERSITY HOSPITAL IN THE EASTERN AREA OF SÃO PAULO

ABSTRACT Objective: To evaluate the prevalence of low back pain in nurses at a university hospital in São Paulo and establish a relationship with social aspects. Methods: A cross-sectional study was carried out, through the application of a questionnaire containing social questions(weight, age, height, work sector, working hours, physical activity, presence and frequency of low back pain) in addition to the Oswestry questionnaire. Results: One hundred fifty-three nurses participated in the study. Of these, 92.30% of the women and 73.91% of the men presented low back pain, with a third classifying the pain as sporadic. In relation to BMI, pain is lower in those who are underweight (60%) and higher among those who are overweight (96.77%). Most of the sample was sedentary (66%), and of these, 96% had low back pain. There was no difference in the comparison by working hours, in relation to work sector, pain was more present in the following sectors: coordination (100%); children’s ward (92%); adult emergency room (90%) and adult ICU (31%). Thirty nurses worked double shifts, and of these, 90% reported low back pain, while among those who worked only at the university hospital, 89.4% reported pain. In relation to working hours, the longer the working day, the greater the pain. In the function assessment (Oswestry), 99 participants obtained a value of up to 30% disability. Conclusion: Based on the results of this work, it is concluded that there is a high prevalence of low back pain in nurses at the Hospital Universitário; however, it was not possible to determine a direct risk factor associated with this high prevalence. Level of Evidence IV; Cross-sectional study.

Non-specific Low Back Pain Among Nurses in Qassim, Saudi Arabia

Introduction

Non-specific low back pain (LBP) is a complex and multifactorial health problem. Evidence has shown that LBP is an important occupational hazard and nurses are particularly at high risk. While several studies have addressed the prevalence of LBP worldwide, the prevalence of LBP in Saudi Arabia remains unclear. In this study, we aimed to estimate the prevalence and associated factors of LBP among nurses in the Qassim region, Saudi Arabia.

Methods

This was a multicenter cross-sectional study carried out in four major public hospitals in the Qassim region. A total of 323 nurses were recruited through a two-stage sampling method. A previously validated questionnaire was used to gather data. The main outcome measures were; LBP prevalence during working life, demographic factors, lifestyle factors, work-related factors, and psychological factors. Multivariable logistic regression analysis was used to determine factors independently associated with LBP. 

Results

The study showed that LBP prevalence was 65.6% (n=212). Over one-third of the study, participants sought treatment for LBP (n=82, 38.7%). Age and the type of ward were found significantly associated with LBP [adjusted odds ratios (aOR): 0.39; 95% confidence interval (CI): 0.19, 0.77; p value=0.007] & (aOR: 0.36; 95% CI: 0.15, 0.86; p-value =0.02), respectively. However, gender, working hours, number of patients, stress, and smoking were not identified as LBP risk factors in this study.

Conclusion

The findings of this study suggest that LBP is a highly prevalent occupational health problem among nurses in Qassim. Young nurses 20-30 years are more likely to suffer from LBP, while nurses working in the general surgery wards have a lower risk for LBP in this study. On-the-job training is essential particularly for new and young nurses on proper body mechanics when mobilizing patients or lifting heavy equipment. In addition, there is a need for evidence-based interventions to improve the workplace environment for nurses in hospitals in order to lower LBP prevalence.

Healthcare workers' knowledge for safe handling and moving of the patient

Objectives. Healthcare workers are at risk of injury during patient handling activities. There is a lack of research in safe patient handling. The objective of this study was to examine the knowledge level of safe patient handling among Brazilian healthcare workers and to analyze its associated factors. Methods. This cross-sectional study was performed in two hospitals and 47 outpatient facilities with 644 participants in Brazil. Healthcare workers completed a self-administered questionnaire about their working characteristics, history of lower back pain and knowledge of safe patient handling. Results. The mean score of safe patient handling knowledge was 11.89 out of 22 maximum points. More than half (59%) of the participants did not see the risk of their activity. Educational level, type of healthcare facility and outpatient clinics were associated with safe patient handling knowledge in the logistic regression model. Conclusion. There was a substantial deficit in safe patient handling knowledge. There is a need for courses and textbooks to move beyond ineffective preventive strategies and minimize the risk of manual patient handling. Healthcare workers are at risk of injury during patient handling activities. Nursing schools in developing countries must focus on researching this topic to ensure safe patient handling.

The effectiveness of social media and in-person interventions for low back pain conditions in nursing personnel (SMILE)

AIM

To compare two educational approaches to reduce low back pain in nurses.

DESIGN

A community randomized controlled clinical trial.

METHODS

Data were collected with two interventions and a control arm between August 2018 and January 2019. Participants were recruited from three hospitals. Hospital 1 received an in-person educational programme, Hospital 2 received via the website and Hospital 3 received nothing. Statistical analysis was carried out with a follow-up of 3 and 6 months.

RESULTS

A total of 180 female nurses with low back pain participated in the study. Dimensions of the quality of life improved over 3 and 6 months, pain and disability decreased over 3 months in both intervention groups and over 6 months in the social media group.

CONCLUSION

Two educational approaches can be effective in decreasing pain, disability and improving quality of life. However, the findings suggest that the social media approach was more successful over the long-term and might be a better way to present the programme.

Prevalence of musculoskeletal disorders among perioperative nurses: a systematic review and META-analysis

BACKGROUND

To evaluate the prevalence of work-related musculoskeletal disorders (WRMSDs) in perioperative nurses and to explore their association with personal characteristics.

METHODS

Medline, Cumulative Index to Nursing and Allied Health Literature, Scopus, Web of Science, Cochrane Library and Joanna Briggs Institute Database were systematically searched. A meta-analysis calculating event rates, and relative 95% Confidence Intervals (CI) was performed for each musculoskeletal body region. The contribution of perioperative nurses' sex, age, and BMI was assessed through a meta-regression.

RESULTS

Twenty-two studies, considering 3590 perioperative nurses, were included in the systematic review. The highest prevalence of WRMSDs was found for the lower-back (62%; 95% CI 0.54-0.70), followed by knee (47%; 95% CI 0.36-0.59), shoulder (44%; 95% CI 0.37-0.51), waist (42%; 95% CI 0.31-0.53), neck (39%; 95% CI 0.29-0.51), ankle-feet (35%; 95% CI 0.22-0.51), upper-back (34%; 95% CI 0.25-0.44), hand-wrist (29%; 95% CI 0.20-0.40), and elbow (18%; 95% CI 0.12-0.26). Meta-regression showed that sex, age, and BMI were not significant predictors of low-back disorders (p = 0.69; R² = 0).

CONCLUSIONS

WRMSDs represent a high prevalence issue among perioperative nurses. Perioperative nurses, in general, are steadily exposed to both physical and temporal risk factors. Further studies should be addressed to identify specific interventions aimed at reducing the burden of WRMSDs including ergonomic education and physical rehabilitation. Our data could be used in future studies as a reference to assess the risk of WRMSDs in other health-care professionals' population.

Evaluation of Absenteeism, Pain, and Disability in Nurses With Persistent Low Back Pain Following Cognitive Functional Therapy: A Case Series Pilot Study With 3-Year Follow-Up

OBJECTIVE

Persistent low back pain (PLBP) is a common and costly health problem worldwide. Better strategies to manage it are required. The purpose of this study was to longitudinally evaluate absenteeism, pain, and disability in nurses with PLBP following a cognitive functional therapy (CFT) intervention.

METHODS

In this case series pilot study, 33 eligible nurses with PLBP were recruited. During the baseline phase (phase A; no intervention), outcome measures were collected on 2 occasions 6 months apart (A1 and A2). During phase B, participants received an individualized CFT intervention for 14 weeks. During phase C (no intervention), outcomes were measured immediately after the intervention, as well as 3, 6, 9, 12, and 36 months after the intervention (secondary outcomes only until 12 months). LBP-related work absenteeism, pain intensity (numerical pain rating scale) and disability (Oswestry Disability Index) were the primary outcomes. Health care seeking, a range of psychological and lifestyle variables, and global perceived effect were secondary outcomes.

RESULTS

Days of absenteeism due to LBP were significantly reduced in the first and second calendar years after the CFT intervention but not the third and fourth. Disability was significantly reduced immediately after (-4.4; 95% CI = -6.5 to -2.2) and at 3 months (-4.3; 95% CI = -6.6 to -2.0), 9 months (-6.0; 95% CI = -8.1 to -3.9), and 12 months (-4.9; 95% CI = -7.0 to -2.8) after the intervention. Pain was significantly reduced immediately after (-1.2; 95% CI = -1.7 to -0.8) and at 3 months (-1.5; 95% CI = -2.0 to -0.9), 9 months (-1.1; 95% CI = -1.9 to -0.3), and 12 months (-0.9; 95% CI = -1.5 to -0.2) after the intervention. Total health care seeking (consults and proportion of participants) was significantly reduced after the intervention. All psychosocial variables, except for 1, demonstrated significant improvements at all follow-up assessments.

CONCLUSIONS

This case series pilot study demonstrated significant reductions in LBP-related absenteeism, pain intensity, disability, health care seeking, and several psychological and lifestyle behaviors until the 1-year follow-up among nurses with PLBP following an individualized CFT intervention. Further evaluation of the efficacy of CFT in high-quality randomized clinical trials among nurses is recommended.

Determining the Efficiency of Ergonomic Belt During Patient Handling and its Effect on Reducing Musculoskeletal Disorders in Nurses

INTRODUCTION

Nursing personnel are always at risk for work-related musculoskeletal disorders, and patient transportation is one of the major risk factor for these disorders.

OBJECTIVE

The aim of this study was to evaluate the ergonomic belt to improve patient transferring conditions.

METHODS

The subjects included 60 health care workers (HCW) of a hospital with patient transfer experience. The ergonomic belt was examined to help move the patient from one bed to another. The prevalence of musculoskeletal disorders was assessed through the Nordic questionnaire, the degree of perceived exertion through the Borg criterion, and the patient's movement through the MAPO index before and after the intervention.

RESULTS

The results showed a significant decrease in Borg scale scores and MAPO index in two factors of education and auxiliary tools and overall scores of this index. We also saw a significant reduction in musculoskeletal disorders in the neck, shoulders and arms, waist, hands and wrists, thighs, knees and legs. There were no significant differences in the elbow and forearm before and after using the ergonomic belt.

CONCLUSION

In general, it can be concluded that the use of ergonomic belt had helped to reduce the risk of musculoskeletal disorders, as well as reducing the perceived exertion of nurses and other relevant personnel.

Effects of educational program based on Precede-Proceed model in promoting low back pain behaviors (EPPLBP) in health care workers Shahid Beheshti University of medical sciences: randomized trial

The PRECEDE-PROCEED model is an adaptable planning model that could be served in public health issues. The purpose of this study is to investigate the effects of an educational program based on Precede-Proceed model on promoting Low Back Pain (LBP) behaviors among health care workers (HCWs). This Double-blinded randomized trial study was conducted on 112 from 120 HCWs aged from 30 to 55 years The eligible HCWs were randomly divided to intervention group 1 (N = 38), respectively intervention group 2 and control group (N = 37) for which the Precede-Proceed - based educational program was implemented and control group (N = 37). The random multi-stage cluster sampling method was used to recruit HCWs. HCWs completed a self-reported questionnaire on their Low Back Pain Behaviors assessment questionnaire based on the Precede-Proceed Model and a visual analogue scale (VAS) was also used. The data were gathered at initial of the study, 6 and 12 months follow-ups from three groups and were analyzed through SPSS version 19. There was a significant interaction between the factors “group” and “test time” (p < 0.05, p < 0.001) of knowledge, perceived self-efficacy, and attitude, reinforcing factors, enabling factors, public health, quality of life and LBP preventive behaviors of the intervention group., although, no significant alternate became located in the mean score of above structures of the control group. The findings of the present study confirmed the effectiveness of the PRECEDE-PROCEED model-based educational program on preventing LBP by enhancing scores of model constructs. However, these results should be repeated in further studies to be able to apply this program in health system.

MAPO Method to Assess the Risk of Patient Manual Handling in Hospital Wards: A Validation Study

OBJECTIVE

To validate the effectiveness of MAPO method (Movement and Assistance of Hospital Patient) after the introduction of some changes to improve assessment objectivity.

BACKGROUND

The number of operators exposed to patient manual handling is increasing considerably. MAPO, proposed in 1999 as a useful tool to estimate the risk of patient manual handling, is a method characterized by analytical quickness. It has recently been improved to better match the 2012 ISO (International Organization for Standardization) technical report.

METHODS

A multicenter study was conducted between 2014 and 2016 involving 26 Italian hospitals in the Apulia Region. MAPO method was used to assess the risk of patient manual handling in 116 wards. A total of 1,998 exposed subjects were evaluated for the presence or absence of acute low back pain in the previous 12 months.

RESULTS

Only 12% of the investigated wards fell in the green exposure level (MAPO index = 0.1-1.5), 37% resulted in the average exposure level (MAPO index = 1.51-5) and the remaining 51% in the higher exposure level (MAPO index >5). The results confirmed a positive association between increasing levels of MAPO index and the number of episodes of acute low back pain (adjusted p trend = .001).

CONCLUSION

The improvements made over the past years led to a more objective assessment procedure. Despite the changes, the study confirmed the effectiveness of MAPO method to predict low back pain.

APPLICATION

MAPO method is an accurate risk assessment tool that identifies and evaluates workplace risks. The proper application of the method significantly improves working conditions.

Effects of a workplace exercise program on physical capacity and lower back symptoms in hospital nursing assistants: a randomized controlled trial

PURPOSE

Considering the relevance of muscle strength for sustaining good musculoskeletal health among workers who perform physically demanding work, the aim of this study was to evaluate the effectiveness of a therapeutic exercise program on muscle strength and low back symptoms among hospital nursing assistants.

METHODS

One hundred and twenty-nine nursing assistants filled out a questionnaire on personal, occupational information and health status, which allowed the identification of workers able to exercise. Ninety participants were randomly allocated to an intervention and a reference group. The therapeutic exercise program (TEP) lasted 12 weeks and included warm-up, strengthening and stretching exercises. Muscle strength of trunk flexors and trunk extensors, hamstring flexibility, and low back symptoms were evaluated before and after the intervention period by two blinded assessors. The comparison between groups was carried out using Mann-Whitney and χ² tests at a significance level of 0.05.

RESULTS

The average participation in the exercise program was 17.5 sessions. Results showed increased trunk flexors muscle strength (p = 0.002; effect size: 0.77), improved pressure pain threshold for dorsal longissimus (p = 0.001; effect size > 0.8), and reduced low back symptoms (p = 0.002; OR = 6.25). No differences between groups were identified for back extensor muscle strength or flexibility.

CONCLUSION

The exercise program applied is a feasible intervention which resulted clinically relevant results for nursing assistants' musculoskeletal health expressed through trunk flexors muscle strength improvement and low back symptoms control among nursing assistants. This RCT brings contribution to the Occupational Health field as the exercise program applied resulted in clinically relevant results for nursing assistants' musculoskeletal health. This study brings contribution especially for low-income and middle-income countries where low back pain and disability can be considered more severe as adequate resources to address the problem are scarce. Thus, we must highlight the importance of low-cost preventive strategies, like exercise programs carried out in hospital settings to avoid the progress of disability among active nursing personnel.

Light-emitting diode photobiomodulation therapy for non-specific low back pain in working nurses: A single-center, double-blind, prospective, randomized controlled trial

BACKGROUND

Low back pain (LBP) affects approximately 51% to 57% of hospital nurses and nurses' aides in Europe. New high-risk groups include home- and long-term-care nurses and physiotherapists. A number of European countries are experiencing a shortage of healthcare workers. Light therapy has been shown to be an effective treatment for various musculoskeletal disorders, including lateral epicondylitis, temporomandibular joint pain, carpal tunnel syndrome, and delayed-onset muscle soreness. A systematic review and meta-analysis demonstrated that low-level laser therapy is an effective method for relieving non-specific chronic low back pain (NSCLBP). However, the efficacy of light-emitting diode (LED) therapy for NSCLBP is disputed. This study aims to evaluate the effect of LED therapy on NSCLBP.

METHODS AND ANALYSIS

We conducted a prospective, double-blind, randomized placebo-controlled trial of 148 patients with NSCLBP. The patients were randomly assigned to 2 groups: intervention group, where patients received LED photobiomodulation therapy 3 times a week for 2 weeks, and the sham group, where patients had sham therapy 3 times a week for 2 weeks. Primary outcome measures included the visual analog scale for pain, lumbar active range of motion assessments, and chair-rising times. Secondary outcome measures included a multidimensional fatigue inventory, fear-avoidance beliefs questionnaire, and the Oswestry disability index. The outcome measures were assessed before therapy and 2weeks, 4 weeks, 8 weeks, 12 weeks, and 6 months after the first interventions were completed.

DISCUSSION

This study is a prospective, single-center, double-blind, randomized, controlled study. This study aims to research the efficacy of a 2-week LED program for NSCLBP working nurse. Our results will be useful for patients, working nurses, nurses' aides, and other healthcare workers with chronic low back pain.

TRIAL REGISTRATION NUMBER

NCT04424823.

Development and validation of an instrument of occupational low back pain prevention behaviours of nurse

AIM

To develop and test the psychometric properties of occupational low back pain prevention behaviours questionnaire in nursing personnel.

DESIGN

A qualitative and quantitative research design to develop and validate an instrument.

METHODS

A qualitative study was conducted from May - October 2017 with 20 participants to generate an item pool. Then, content and face validity was carried out. Next, the questionnaire was distributed among a sample of nurses. In all, 150 nurses participated (mean age 34.1; SD 7.66 years) in the study. Exploratory factor analysis used to determine the factor structure of the questionnaire. Item-scale correlation matrix was provided to examine the construct validity. Internal consistency (Cronbach's alpha) was estimated to assess reliability and intraclass correlation coefficient was calculated to examine stability.

RESULTS

Six factors with 30 items emerged from the exploratory factor analysis that jointly accounted for 67.9% of the variance observed. Item-scale correlation matrix showed satisfactory results lending support to construct validity of the questionnaire. The Cronbach's alpha coefficient for the whole scale showed excellent internal consistency (0.92), although this was not true for the knowledge subscale. The intraclass correlation coefficient with a 2-week interval also indicated that the questionnaire had satisfactory stability (0.97).

CONCLUSION

This study provides initial support for reliability and validity of the Occupational Low Back Pain Prevention Behaviour Questionnaire.

IMPACT

This study offers an instrument to assess low back pain preventive behaviours among nurses. The instrument is useful for nursing personnel and could be used in hospitals and healthcare settings to implement appropriate interventions.

Intervertebral Disc Disease of the Lumbar Spine in Health Personnel with Occupational Exposure to Patient Handling-A Systematic Literature Review and Meta-Analysis

Lifting or carrying loads or working while the trunk is in a bent position are well established risk factors for the development of disc disease of the lumbar spine (LDD). Patient handling is associated with certain hazardous activities, which can result in exposure to heavy loads and high pressure for the discs of the lumbar spine of the nurses performing these tasks. The purpose of this review was to examine the occurrence of work-related LDD among health personnel (HP) with occupational exposure to patient handling activities in comparison to un-exposed workers. A systematic literature search was conducted using the following databases: PubMed, CINAHL, Scopus, and Web of Science. A meta-analysis of odds ratios (OR) was conducted by stratifying for various factors. Five studies reported a higher prevalence for LDD among nurses and geriatric nurses (11.3-96.3%) compared to all controls (3.78-76.47%). Results of the meta-analysis showed a significantly increased OR for LDD among HP compared to all controls (OR 2.45; 95% confidence interval (CI) 1.41, 4.26). In particular, the results of this review suggest that nurses have a higher probability of developing disc herniation than office workers.

Association between Health Problems and Turnover Intention in Shift Work Nurses: Health Problem Clustering

Shift work nurses experience multiple health problems due to irregular shifts and heavy job demands. However, the comorbidity patterns of nurses’ health problems and the association between health problems and turnover intention have rarely been studied. This study aimed to identify and cluster shift work nurses’ health problems and to reveal the associations between health problems and turnover intention. In this cross-sectional study, we analyzed data from 500 nurses who worked at two tertiary hospitals in Seoul, South Korea. Data, including turnover intention and nine types of health issues, were collected between March 2018 and April 2019. Hierarchical clustering and multiple ordinal logistic regressions were used for the data analysis. Among the participants, 22.2% expressed turnover intention and the mean number of health problems was 4.5 (range 0–9). Using multiple ordinal logistic regressions analysis, it was shown that sleep disturbance, depression, fatigue, a gastrointestinal disorder, and leg or foot discomfort as a single health problem significantly increased turnover intention. After clustering the health problems, four clusters were identified and only the neuropsychological cluster—sleep disturbance, fatigue, and depression—significantly increased turnover intention. We propose that health problems within the neuropsychological cluster must receive close attention and be addressed simultaneously to decrease nurse’s turnover intentions.

Exercise Intensity Matters in Chronic Nonspecific Low Back Pain Rehabilitation

INTRODUCTION

Exercise therapy (ET) is advocated as a treatment for chronic nonspecific low back pain (CNSLBP). However, therapy effect sizes remain low. In other chronic disorders, training at higher intensity has resulted in greater improvements on both general health related and disease specific outcomes compared to lower-intensity ET. Possibly, high-intensity training also improves effect sizes in CNSLBP.

OBJECTIVE

To compare the effects of a high-intensity ET program with a similar moderate-intensity ET program on disability, pain, function, exercise capacity, and abdominal/back muscle strength in persons with CNSLBP.

METHODS

In a randomized controlled trial, persons with CNSLBP performed a 12-wk ET program (24 sessions, 1.5 h per session, twice per week) at high-intensity training (HIT) or moderate-intensity training (MIT). Questionnaires to assess disability (Modified Oswestry Index [MODI]), pain intensity (Numeric Pain Rating Scale), and function (Patient Specific Functioning Scale), a cardiopulmonary exercise test to assess exercise capacity (V˙O2max, cycling time), and a maximum isometric muscle strength test to assess abdominal/back muscle strength (maximum muscle torque) were administered at baseline and after the training program.

RESULTS

Thirty-eight participants (HIT: n = 19, MIT: n = 19) were included (mean age, 44.1 yr, SD = 9.8, 12 males). Groups did not differ at baseline. Between group differences (P < 0.01) in favor of HIT were found for MODI, V˙O2max, and cycling time. Within group improvements (P < 0.01) were found in both groups on MODI (HIT:-64%, MIT:-33%), Numeric Pain Rating Scale (HIT, -56%; MIT, -39%), Patient-Specific Functioning Scale (HIT:+37%, MIT:+39%), V˙O2max (HIT:+14, MIT:+4%), cycling time (HIT:+18%, MIT:+13%), and back muscle strength (HIT:+10%, MIT:+14%).

CONCLUSIONS

High-intensity training proved to be a feasible, well tolerated, and effective therapy modality in CNSLBP. Moreover, it shows greater improvements on disability and exercise capacity than a similar ET performed at moderate intensity.

Fear-avoidance beliefs are associated with exercise adherence: secondary analysis of a randomised controlled trial (RCT) among female healthcare workers with recurrent low back pain

Background

Exercise is recommended for the treatment and management of low back pain (LBP) and the prevention of chronicity. Exercise adherence has been only modest in intervention studies among people with musculoskeletal pain. Fear-avoidance beliefs (FABs) are known to affect exercise adherence.

The purpose was twofold: to examine which bio-psycho-social factors contributed to exercise adherence during a 6-month neuromuscular exercise intervention among female healthcare workers with recurrent LBP, and to investigate how exercising affects FABs at 6 and 12 months’ follow-up.

Methods

Some 219 healthcare workers aged 30–55 years with mild-to-moderate re-current non-specific LBP were originally allocated into: 1) exercise, 2) counselling, 3) combined exercise and counselling, and 4) control groups. In the present secondary analysis, groups 1 and 3 (exercise only and exercise+counselling) were merged to be exercisers and groups 2 and 4 were merged to be non-exercisers. Baseline variables of the exercise compliers (≥24 times over 24 weeks; n = 58) were compared to those of the non-compliers (< 1 time/week, 0–23 times; n = 52). The effects of the exercise programme on FABs were analysed by a generalised linear mixed model according to the intention-to-treat principle (exercisers; n = 110 vs non-exercisers; n = 109) at three measurement points (baseline, 6, and 12 months). A per-protocol analysis compared the more exercised to the less exercised and non-exercisers.

Results

A low education level (p = 0.026), shift work (p = 0.023), low aerobic (p = 0.048) and musculoskeletal (p = 0.043) fitness, and high baseline physical activity-related FABs (p = 0.019) were related to low exercise adherence. The exercise programme reduced levels of both physical activity- and work-related FABs, and there was a dose response: FABs reduced more in persons who exercised ≥24 times compared to those who exercised 0–23 times.

Conclusion

Healthcare workers who had lower education and fitness levels, worked shifts, and had high physical activity-related FABs had a lower adherence to the 6-month neuromuscular exercise programme. Exercising with good adherence reduced levels of FABs, which have been shown to be linked with prolonged LBP. Motivational strategies should be targeted at persons with low education and fitness levels and high FABs in order to achieve better exercise adherence.

Effective interventions for preventing work related physical health complaints in nursing students and novice nurses: A systematic review

From the start of their career, nursing students and novice nurses are at risk of developing physical health problems due to high physical workload, which may lead to early exit from nursing. To provide an overview of interventions preventing physical health problems in early career, a systematic review was performed. A comprehensive search of the literature was conducted up to December 2017. Primary outcome of interest was education/work dropout. Secondary outcomes were musculoskeletal symptoms. Independent authors selected studies, appraised quality and extracted data. After screening 7111 titles and abstracts, eleven studies were included. Seven studies evaluated interventions for moving/handling training. Four evaluated other interventions. None focused on our primary outcome education/work dropout. All studies reported on physical complaints among student nurses only. Overall, risk of bias was high and clinical heterogeneity prohibited pooling of data. Intervention effects were small and inconsistent. In conclusion, evidence for the effectiveness of interventions in the nursing curricula for the prevention/treatment of physical complaints is scarce and where available conflicting. We recommend high quality research on dropout due to physical health problems, as well as on the prevention/treatment of physical complaints.

The Comorbidity of Musculoskeletal Disorders and Depression: Associations with Working Conditions Among Hospital Nurses

Background: Musculoskeletal disorders (MSDs) are the leading cause of pain and disability among nurses and are frequently accompanied by depression. However, the association between the comorbidity of MSDs and depression and working conditions has not been studied, which was the aim of this study. Methods: In 2015, all nurses (n = 1,102) employed at a community hospital in the Northeast United States were invited to participate in this cross-sectional study. A survey was distributed in which participants were asked to report on MSDs, depressive symptoms, as well as subjective working conditions assessed including physical demands, psychological demands, decision authority, social support, and work-family conflict. Findings: 397 nurses responded (36%), and the prevalence of the comorbidity of MSDs and depression was 14.5%. Poisson regression (PR) models suggested that work-family conflict was associated with increased risk of the comorbidity (PR = 2.18; 95% confidence interval [CI] = 1.33-3.58), as was 8-hour night shift (PR = 2.77; 95% CI = [1.22, 6.31]) or 12-hour day shift (PR = 2.20; 95% CI = [1.07, 4.50]). Other working conditions were not directly associated with the comorbidity. Conclusions/Application to Practice: The comorbidity of MSDs and depression is prevalent among hospital nurses, and work-family conflict and working night shift or longer shifts were significantly associated with this. Effective workplace programs are needed to address nurses' working conditions to reduce their work-family conflict, thereby improving their musculoskeletal and mental health.

Association between high fear-avoidance beliefs about physical activity and chronic disabling low back pain in nurses in Japan

Background

High prevalence of low back pain (LBP) in nurses has been reported globally. Ergonomic factors and work-related psychosocial factors have been focused on as risk factors. However, evidence on the role of fear-avoidance beliefs (FABs) concerning LBP in nurses is lacking. This study examined LBP prevalence and the association between FABs and chronic disabling LBP that interfered with work and lasted ≥ 3 months.

Methods

Female nurses (N = 3066; mean age = 35.8 ± 10.6 years) from 12 hospitals in Japan participated. A self-reported questionnaire was used to collect information on sociodemographics, LBP, work-related factors, and psychological distress. FABs about physical activity were assessed using a subscale from the FAB Questionnaire (score range = 0–24). The participants were asked to choose one of four statements regarding their LBP in the past 4 weeks: 1) I did not have LBP, 2) I had LBP without work difficulty, 3) I had LBP with work difficulty but without requiring absence from work, and 4) I had LBP requiring absence from work. If the participant had LBP in the past 4 weeks, it was also inquired if the LBP had lasted for ≥ 3 months. Chronic disabling LBP was defined as experiencing LBP with work difficulty in the past 4 weeks which had lasted for ≥ 3 months. In the nurses who had experienced any LBP in the past 4 weeks, we examined the association between FABs and experiencing chronic disabling LBP using multiple logistic regression models adjusting for pain intensity, age, body mass index, smoking status, psychological distress, hospital department, weekly work hours, night shift work, and the12 hospitals where the participants worked.

Results

Four-week and one-year LBP prevalence were 58.7 and 75.9%, respectively. High FABs (≥ 15) were associated with chronic disabling LBP (adjusted odds ratio = 1.76, 95% confidence interval [1.21–2.57], p = 0.003).

Conclusions

LBP is common among nurses in Japan. FABs about physical activity might be a potential target for LBP management in nurses.

Trial registration

UMIN-CTR UMIN000018087. Registered: June 25, 2015.

Factors associated with disabling low back pain among nursing personnel at a medical centre in Japan: a comparative cross-sectional survey

OBJECTIVES

Low back pain (LBP) is a common cause of disability among nursing personnel. Although many studies regarding the risk factors for LBP among nursing staff have focused on the physical load at work, multidimensional assessments of risk factors are essential to identify appropriate preventive strategies. We aimed to investigate the association of multidimensional factors (individual, physical, psychological and occupational) with disabling LBP among nursing personnel in Japan.

DESIGN

Observational study with comparative cross-sectional design.

SETTING

Data were collected using the self-administered questionnaire at a tertiary medical centre.

PARTICIPANTS

After excluding participants with missing variables, 718 nursing personnel were included in the analysis.

OUTCOME MEASURES

A self-administered questionnaire assessed individual characteristics, rotating night shift data, severity of LBP, previous episode of LBP, sleep problem, kinesiophobia (Tampa Scale for Kinesiophobia), depressive condition (K6), physical flexibility and frequency of lifting at work. A logistic regression model was used to evaluate the factors associated with disabling LBP (LBP interfering with work) among nursing personnel.

RESULTS

Of all participants, 110 (15.3%) reported having disabling LBP. The multivariable logistic regression analysis after adjustment for several confounding factors showed that kinesiophobia (highest tertile, adjusted OR (aOR): 6.13, 95% CI : 3.34 to 11.27), previous episode of LBP (aOR: 4.31, 95% CI: 1.50 to 12.41) and insomnia (aOR: 1.66, 95% CI: 1.05 to 2.62) were significantly associated with disabling LBP.

CONCLUSIONS

The present study indicated that kinesiophobia, a previous episode of LBP, and sleep problems were associated with disabling LBP among nursing personnel. In the future, workplace interventions considering assessments of these factors may reduce the incidence of disabling LBP in nursing staff, although further prospective studies are needed.

End-Users and Caregivers' Involvement in Health Interventional Research Carried Out in Geriatric Facilities: A Systematic Review

Public involvement (PI) is of great interest. However, little is known about this topic in the design, development, and/or implementation of health interventions in geriatric facilities. This study aimed to provide a critical overview of the involvement of caregivers and end-users in interventions in these facilities, based on Rifkin’s analytical framework. This systematic review, supplemented by a questionnaire to the corresponding authors, covered non-drug intervention reports targeting nurses, doctors, residents, and their relatives. Articles were published in Pubmed, Medline, Scopus, and Cinahl, from January 2016 to April 2018. Ninety-seven articles were included. The review shows a low level or partial PI in geriatric facilities where it exists. These results are further supported by the authors’ responses to the questionnaire. PI remains uncommon in geriatric institutions and consists of a consumerist model, suggesting the need for improved practices. More efforts are needed to experiment with recommendations to meet the challenges of PI and enhance the public ownership of interventions. The protocol was registered on Prospero under the number CRD42018098504.

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.

Efficacy of six months neuromuscular exercise on lumbar movement variability - A randomized controlled trial

INTRODUCTION

Lumbar movement variability during heavy, repetitive work may be a protective mechanism to diminish the progression of lumbar disorders and maintain neuromuscular functional integrity. The effect of neuromuscular exercise (NME) on the variability of lumbar movement is still to be determined.

METHODS

A randomised controlled trial was conducted on a population of nursing personnel with subacute LBP. Following randomization, the NME group participants completed an NME program of six months duration. The participants in the control group only attended the assessment sessions. The outcomes were assessed at: baseline; after six months intervention; 12 months. The primary outcome was lumbar movement variability based on angular displacement and velocity.

RESULTS

A positive treatment effect on lumbar movement variability was seen after six months of NME intervention. Angular displacement improved, and angular velocity remained constant. At the 12-month follow up, however, the effect faded in the NME group. Lumbar movement variability worsened in the control group over all time periods.

CONCLUSION

NME may improve lumbar movement variability in the short term and may indicate improved neuromuscular functional integrity. The design of an optimal NME program to achieve long-term improvement in lumbar movement variability is a subject worthy of further research.

Muscle Synergies During Repetitive Stoop Lifting With a Bioelectrically-Controlled Lumbar Support Exoskeleton

Lower back problems are common in the world, which leads to the development of various lumbar support exoskeletons to alleviate this problem. In general, previous studies evaluating lumbar support devices quantified assistance by reporting the reduction in back muscle activity and perceived fatigue. However, despite the beneficial effects of such devices, the effects of using such exoskeletons on muscle coordination are not well-studied. In this study, we examined the short-term change in muscle coordination of subjects using a bioelectrically-controlled lumbar support exoskeleton in a fatiguing stoop lifting task with muscle synergy analysis. Results indicate that muscle coordination changes were dominated by changes in timing coefficients, with minimal change in muscle synergy vectors. Analysis on muscle coordination changes would be useful to design future generations of exoskeletons.

Effects of two types of smartphone-based stress management programmes on depressive and anxiety symptoms among hospital nurses in Vietnam: a protocol for three-arm randomised controlled trial

INTRODUCTION

Due to an increasing demand for healthcare in low-income and middle-income countries in Asia, it is important to develop a strategy to manage work-related stress in healthcare settings, particularly among nurses in these countries. The purpose of this three-arm randomised controlled trial (RCT) is to examine the effects of a newly developed smartphone-based multimodule stress management programme on reducing severity of depressive and anxiety symptoms as primary outcomes at 3-month and 7-month follow-ups among hospital nurses in Vietnam.

METHODS AND ANALYSIS

The target study population will be registered nurses working in a large general hospital (which employs approximately about 2000 nurses) in Vietnam. They will be invited to participate in this study. Participants who fulfil the eligibility criteria will be randomly allocated to the free-choice, multimodule stress management (intervention group A, n=360), the internet cognitive behavioural therapy (iCBT), that is, fixed-order stress management (intervention group B, n=360), or a treatment as usual control group (n=360). Two types (free-choice and fixed sequential order) of smartphone-based six-module stress management programmes will be developed. Participants in the intervention groups will be required to complete one of the programmes within 10 weeks after the baseline survey. The primary outcomes are depressive and anxiety symptoms, measured by using the Depression Anxiety and Stress Scales (DASS) at 3-month and 7 month follow-ups.

ETHICS AND DISSEMINATION

The study procedures have been approved by the Research Ethics Review Board of Graduate School of Medicine/Faculty of Medicine, the University of Tokyo (no 11991) and the Ethical Review Board for Biomedical Research of Hanoi University of Public Health (no 346/2018/YTCC-HD3). If a significant effect of the intervention programmes will be found in the RCT, the programmes will be made available to all nurses in the hospital including the control group. If the positive effects are found in this RCT, the e-stress management programmes will be disseminated to all nurses in Vietnam.

TRIAL REGISTRATION NUMBER

UMIN000033139; Pre-results.

How was a national moving and handling people guideline intended to work? The underlying programme theory

In healthcare, moving and handling people (MHP) often cause musculoskeletal disorders. To prevent musculoskeletal disorders due to MHP, many national evidence-based guidelines have been developed. However, little is known about how these guidelines were intended to work, i.e. their 'programme theory', how implementation by intended users is influenced by contextual factors and mechanisms to produce outcomes. This paper identifies the programme theory of a national MHP guideline (MHPG) using thematic analysis of the MHPG document, three organisational planning documents, and interviews with MHPG developers. The analysis identified the intended users of the MHPG as health and safety managers and MHP coordinators. The programme theory comprised contextual factors, potentially hindering (e.g. budget constraints) or facilitating (e.g. changing demographics) implementation, being influenced by mechanisms mainly based on ethical (quality of care, evidence-based practices), and economic reasoning (reducing cost of MHP, return on investment) to reduce injuries caused by MHP - the intended outcome.

Work-Related Upper Limb Symptoms in Hand-Intensive Health Care Occupations: A Cross-Sectional Study With a Health and Safety Perspective

BACKGROUND

Research with physical therapists reveals high rates of work-related musculoskeletal injuries, especially low back pain, with early career onset. Less focus has been given to upper limb disorders (ULDs) in these professionals, who frequently perform repetitive arm/hand and precision finger motions during work.

OBJECTIVE

The objective was to estimate prevalence of body-site-specific upper limb (UL) symptoms and diagnosed ULDs in Irish chartered physical therapists, physiotherapists, and athletic therapists, with adjustment for leisure time injury, and document first onset of specific UL symptoms.

DESIGN

The design was a cross-sectional survey (N = 347) using random sampling (physiotherapists in private practice), proportionate cluster sampling (hospital-based physiotherapists), and all-population sampling (physical therapists and athletic therapists).

METHODS

The methods used were a postal questionnaire with annual, current, and incapacitating UL symptoms (neck, shoulders, elbows, wrists, fingers, thumbs) (Nordic Questionnaire); symptom onset; diagnosed UL disorders; and sociodemographics; prevalence with 95% CIs, and adjusted prevalence (general linear modeling).

RESULTS

Adjusted annual prevalence of UL symptoms in at least 1 body site was 78.1% (95% CI = 71.4-82.2), and of incapacitating symptoms was 21.0% (95% CI = 16.4-27.0). Shoulder (53.2%, 95% CI = 47.9-58.7), neck (49.4%, 95% CI = 44.2-55.0), and thumbs (46.1%, 95% CI = 40.7-51.5) were mostly affected. Hospital-based therapists had a significantly higher prevalence of incapacitating symptoms compared with others (35.7% vs 23.3%). Respondents totaling 28.2% had at least 1 lifetime diagnosis of ULD, most commonly shoulder tendonitis (12.5%, 95% CI = 8.4-15.3) and overuse syndrome (11.8%, 95% CI = 8.4-15.3). First onset was mostly after 5 years working as a therapist; however, this differed by anatomical site.

LIMITATIONS

A cross-sectional study design limited interpretation of symptoms as work-related causes.

CONCLUSIONS

The high prevalence of ULD and symptoms warrants attention from occupational health and safety personnel. Training in injury prevention and risk assessment should be provided during education and as part of continuing education.

A Cross-Sectional Survey of Low Back Pain in Nurses Working in Orthopedic Departments

The study aimed to gain knowledge about low back pain (LBP) in nurses working in the orthopedic departments of tertiary hospitals in Sichuan province, China. We used a cross-sectional survey to examine the prevalence of LBP among 797 inpatient nurses who had worked for 1 year in an orthopedic department in one of 29 hospitals (Grade 3A) in Sichuan province. The survey included a questionnaire to determine the prevalence of LBP and factors related to LBP, a screening graph of LBP symptoms, the Roland Morris Disability Questionnaire (RMDQ), and the Fear Avoidance Beliefs Questionnaire (FABQ) for LBP. The 1-year period prevalence of LBP in the nursing population was 66.8% and the point prevalence was 51.3%. Among the 523 nurses who had experienced LBP, the mean total number of days that LBP had been experienced during the past year was 20.2 ± 16.3 days (range = 1-90 days). The annual number of episodes of LBP was 5.7 ± 4.5 times/year (range = 1-20 times/year). More than half the orthopedic nurses (51.1%) planned to quit, and 5.8% thought of leaving their job due to LBP. These study findings indicate that nurses in this region experience a burden of LBP similar to those in other regions in the world.

Effectiveness and cost-effectiveness of neuromuscular exercise and back care counseling in female healthcare workers with recurrent non-specific low back pain: a blinded four-arm randomized controlled trial

Background

Registered healthcare workers worldwide have a high prevalence of work-related musculoskeletal disorders, particularly of the back. Multidisciplinary interventions among these workers have improved fear avoidance beliefs, but not low back pain (LBP) and related sickness absences, cost-effectiveness studies are scarce. Our purpose was to investigate the effectiveness and cost-effectiveness of three intervention-arms (combined neuromuscular exercise and back care counselling or either alone) compared with non-treatment.

Methods

We randomly assigned female healthcare workers with recurrent non-specific LBP to one of four study-arms: Combined neuromuscular exercise and back care counseling; Exercise; Counseling; and no intervention Control. We assessed the effectiveness of the interventions on intensity of LBP, pain interfering with work and fear avoidance beliefs against the Control, and calculated the incremental cost-effectiveness ratios for sickness absence and QALY.

Results

We conducted three sub-studies in consecutive years of 2011, 2012, and 2013 to reach an adequate sample size. All together 219 women were randomized within each sub-study, of whom 74 and 68% had adequate questionnaire data at 6 and 12 months, respectively. No adverse events occurred. Compliance rates varied between intervention-arms. After 12 months, the Combined-arm showed reduced intensity of LBP (p = 0.006; effect size 0.70, confidence interval 0.23 to 1.17) and pain interfering with work (p = 0.011) compared with the Control-arm. Work-related fear of pain was reduced in both the Combined- (p = 0.003) and Exercise-arm (p = 0.002). Physical activity-related fear was reduced only in the Exercise-arm (p = 0.008). During the study period (0–12 months) mean total costs were lowest in the Combined-arm (€476 vs. €1062–€1992, p < 0.001) as were the mean number of sickness absence days (0.15 vs. 2.29–4.17, p = 0.025). None of the intervention-arms was cost-effective for sickness absence. There was 85% probability of exercise-arm being cost-effective if willing to pay €3550 for QALY gained.

Conclusions

Exercise once a week for 6 months combined with five sessions of back care counseling after working hours in real-life settings effectively reduced the intensity of LBP, work interference due to LBP, and fear of pain, but was not cost-effective.

Trial registration

ClinicalTrials.gov, NCT01465698 November 7, 2011 (prospective).

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6293-9) contains supplementary material, which is available to authorized users.

Prevalence of low back pain and associated factors among nurses in Jordan

BACKGROUND

Low back pain (LBP) is a significant work-related problem, especially among nurses. This is due to its high prevalence and impact on the healthcare system, either directly through treating affected nurses, or indirectly through the decrease in nurses' productivity.

AIM

The aim of this study is to measure the prevalence rates of LBP among nurses in Jordan, and to uncover the associated factors and consequences.

METHODS

A cross-sectional design study. Data were collected through a data collection sheet, developed based on literature, from seven public hospitals and one university hospital over a period of 2 months.

RESULTS

A total of 384 nurses completed the data sheet with a response rate of 76.8%. Current prevalence of LBP was 69% (n = 265), 1-year prevalence was 78.9% (n = 303), while accumulative prevalence was 83.6% (n = 321). Factors associated with LBP were older age, female gender, being overweight, and having longer experience in nursing; 40% of nurses agreed that the LBP increased their number of sick leaves, 58.7% agreed it lowered their productivity, and 9% reported that it forced them to change unit.

CONCLUSION

LBP is a significant work-related problem among Jordanian nurses, with high-prevalence rates, and debilitating medical and professional consequences. Interdisciplinary efforts are needed to reduce these consequences.

The self-reported and observed competence of nursing staff in mobility care based on Kinaesthetics in nursing homes - A cross-sectional study

BACKGROUND

The majority of care-dependent persons living in nursing homes have mobility impairment affecting the physical, psychological, and social aspects of the persons' lives. Therefore, nursing staff needs competence to provide good mobility enhancing care.

AIM

This study assesses the self-reported and observed competence of nursing home staff in mobility care based on Kinaesthetics in order to increase attention about nursing staff's impact on nursing home residents' mobility.

METHODS

A cross-sectional study design involving a survey and an observational study was employed. Survey data were collected using the Kinaesthetics Competence Self-Evaluation (KCSE) scale. For the observational study, data were collected with a video camera and rated using the Kinaesthetics Competence Observation (KCO) instrument. Data were analysed using descriptive statistics, correlation methods and a generalised linear model.

RESULTS

The majority of survey participants (n = 180) indicated their competence in mobility care based on Kinaesthetics as very good (mean score 13, SD 1.44, on a scale from 4 to 16). The observed competence of nursing staff (n = 40) was good (mean score 10.8, SD 2.44, out of a possible score from 4 to 16). Positive correlations were found between self-reported or observed competence in mobility care based on Kinaesthetics and employment rate, work experience in nursing home care and Kinaesthetics training.

CONCLUSION

A combined assessment of self-evaluation and observation is recommended in order to get a comprehensive picture of knowledge, skills, attitude and dynamic state of nursing staffs' competence in mobility care based on Kinaesthetics.

Hospital Staff's Risk of Developing Musculoskeletal Disorders, Especially Low Back Pain

Introduction

Health-related absenteeism impacts individuals, companies, and society. Its consequences are reflected in the cost of benefits, substitutes, and reduced productivity. Research shows that musculoskeletal disorders (MSDs) are the most common work-related health problem reported by hospital staff. This study determines the groups at the Ljubljana University Medical Centre that are most susceptible to MSDs, especially low back pain.

Methods

Using data from the Health Data Centre of the Slovenian National Public Health Institute and the medical centre, this cross-sectional study analysed absenteeism among medical centre employees. The correlation between MSD / low-back pain risk factors and incidence was determined using logistic regression. An odds ratio was calculated to determine the probability of MSDs, most especially low back pain via sex, age, occupation, and education.

Results

Sick leave at the medical centre is higher than 5%, exceeding the Slovenian healthcare sector average. MSDs, as the main reason for absence, is significantly more frequent in women, non-medical staff, and employees with a maximum secondary school education. Among the MSDs, low back pain predominates as a reason for absence and is most frequent among nurses, midwives, and employees of 20 to 44.9 years old.

Conclusion

This study offers insight into the health status of medical centre employees. The high percentage of sick leave is mainly due to musculoskeletal disorders, including low back pain. This is an important basis for further monitoring and analysis of sick leave indicators and for planning systematic and continuous workplace health-promoting measures to manage ergonomic risk factors and reduce health-related absenteeism.

A scoping review of biopsychosocial risk factors and co-morbidities for common spinal disorders

OBJECTIVE

The purpose of this review was to identify risk factors, prognostic factors, and comorbidities associated with common spinal disorders.

METHODS

A scoping review of the literature of common spinal disorders was performed through September 2016. To identify search terms, we developed 3 terminology groups for case definitions: 1) spinal pain of unknown origin, 2) spinal syndromes, and 3) spinal pathology. We used a comprehensive strategy to search PubMed for meta-analyses and systematic reviews of case-control studies, cohort studies, and randomized controlled trials for risk and prognostic factors and cross-sectional studies describing associations and comorbidities.

RESULTS

Of 3,453 candidate papers, 145 met study criteria and were included in this review. Risk factors were reported for group 1: non-specific low back pain (smoking, overweight/obesity, negative recovery expectations), non-specific neck pain (high job demands, monotonous work); group 2: degenerative spinal disease (workers' compensation claim, degenerative scoliosis), and group 3: spinal tuberculosis (age, imprisonment, previous history of tuberculosis), spinal cord injury (age, accidental injury), vertebral fracture from osteoporosis (type 1 diabetes, certain medications, smoking), and neural tube defects (folic acid deficit, anti-convulsant medications, chlorine, influenza, maternal obesity). A range of comorbidities was identified for spinal disorders.

CONCLUSION

Many associated factors for common spinal disorders identified in this study are modifiable. The most common spinal disorders are co-morbid with general health conditions, but there is a lack of clarity in the literature differentiating which conditions are merely comorbid versus ones that are risk factors. Modifiable risk factors present opportunities for policy, research, and public health prevention efforts on both the individual patient and community levels. Further research into prevention interventions for spinal disorders is needed to address this gap in the literature.