Multifaceted intervention for the prevention and management of musculoskeletal pain in nursing staff: Results of a cluster randomized controlled trial

Nurses' Attitudes Toward Holistic and Complementary Medicine in Pain Management

BACKGROUND

The effects of nurses' attitudes toward complementary and alternative medicine (CAM) in pain management in terms of safety and quality of life are important. Nurses turn to a CAM approach to deal with pain problems.

AIM

This study aimed to investigate nurses' attitudes toward CAM and to determine their sociodemographic and pain-related characteristics.

DESIGN

This study is a cross-sectional descriptive study.

METHODS

This study was carried out with 150 nurses between March 31 and April 30, 2023. Data were collected with the "Data Collection Form," "Pain Numerical Rating Scale," and "Attitudes toward Holistic and Complementary Medicine Scale" developed by the researchers.

RESULTS

The mean age of the nurses who participated in the study was 33.24 ± 8.69. It was determined that 55.3% of the nurses frequently used pharmacological and CAM treatments together in their pain management, and 71.3% of them used these treatments for less than 1 week. It was found that 65.3% of the nurses used massage, 60% used spa/hot-cold applications, 54.0% used acupuncture, 42.6% used art/color/music/dance therapy, and 12.6% used prayer or meditation in pain management.

CONCLUSIONS

It was determined that nurses used pharmacological and CAM methods together in pain management. Nurses can be offered CAM therapy options in addition to pharmacological treatments to manage their pain, and information can be given.

Factors Contributing to Muscle Fatigue of Low Back Region in ICU Nurses: A Qualitative Study

AIMS

To explore ICU nurses' experiences of back and waist fatigue and establish a basis for developing effective intervention strategies to reduce low back muscle fatigue in the future.

DESIGN

Qualitative study using focus group.

METHODS

Eighteen ICU nurses participated in focus group interviews. Data were analysed using Nvivo11.0 software with content analysis.

RESULTS

ICU nurses frequently suffer from lower back pain due to the severity of patient conditions and the use of numerous tubes and catheters, which often lead tounsafe postures. The absence of proper lifting systems exacerbates high-risk postures, contributing to acute lower back muscle injuries. Additionally, inadequate promotion of correct posture and prevention strategies, along with insufficent training on occupational hazards, futher exacerbates the issue.

CONCLUSIONS

Human fator, machinery, environments, as well as their interactions significantly affect ICU nurses' experience of low back and waist muscle fatigue.

REPORTING METHOD

Reported according to the SRQR (Standards for Reporting Qualitative Research) guideline.

IMPACT

Offersnew insights into applying the human-machine-environment theory toto clinical nursing practice research. Highlightsthat the unconscious or passive adoption of poor postures by ICU nurses as a major factor contributing to muscles fatigue. Emphasizes the need for comprehensive intervention programsto prevent work-related low back muscle fatigue among ICU nurses.

PATIENT OR PUBLIC CONTRIBUTION

Based on our findings, we have discussed the result with hospital management highlighting the urgent need for mesures to protect ICU nurses back and waist muscles. We believe this proactive approach is essentialfor ensuring the long-term well-being of healthcare professionals and maintaining the high standards of patient care.

Systematic review of digital health interventions to support self-management of low back pain in the workplace

Background

Low back pain (LBP) is a prevalent condition in working populations, imposing significant individual, organisational, and societal burdens, including reduced quality of life, impaired work performance, and high healthcare costs. Digital health interventions (DHIs) offer scalable solutions for self-managing LBP in workplace settings, yet their tailoring, integration, and effectiveness remain unclear.

Objective

This systematic review evaluates the effectiveness of DHIs in supporting LBP self-management in workplace environments. It examines intervention components, tailoring methods, integration with occupational health (OH) pathways, and their impact on clinical and work-related outcomes.

Methods

A systematic search was conducted across PubMed, MEDLINE, EMBASE, CINAHL, the Cochrane Library, and Web of Science, following PRISMA guidelines. Randomised controlled trials evaluating DHIs for workplace LBP were included. Data extraction focused on intervention characteristics, tailoring approaches, and primary outcomes, including pain intensity, disability, and physical performance. The quality of evidence was assessed using the Cochrane risk-of-bias and GRADE frameworks.

Results

Five studies were included, featuring DHIs delivered via web-based platforms or mobile applications. Interventions incorporated exercise, ergonomics education, and work activity modification. Only one study used a tailored approach based on theoretical frameworks and individualised work classifications. Moderate-quality evidence supported improvements in pain, disability, and physical performance, but effects on quality of life, psychosocial factors, and work outcomes were inconsistent. Integration with occupational health pathways was absent in all studies.

Conclusions

The lack of tailoring and integration within occupational health systems limits the scalability and impact of DHIs for workplace LBP. Future research should focus on personalised, theory-driven interventions and systemic alignment with occupational health policies to enhance their feasibility, implementation, and long-term outcomes.

Integrating Chiropractic Care and Tai Chi Training for the Treatment of Chronic Nonspecific Neck Pain in Nurses: A Single-Arm Mixed-Methods Pilot Trial

Objectives: Chronic nonspecific neck pain (CNNP) is prevalent among health care workers, with particularly high rates among nurses. Nurses experiencing CNNP often report decreased job satisfaction, increased absenteeism, and reduced productivity. In recent years, nonpharmacologic approaches have gained attention as effective treatments for the management of CNNP, with exercise and manual therapies representing two of the most common. Early evidence shows that multimodal treatments may be more effective than unimodal strategies. The purpose of this current study was to assess the feasibility and observe the clinical outcomes of combined multimodal chiropractic care (MCC) and Tai Chi (TC) for CNNP in nurses. Methods: A single-arm mixed-methods pilot trial was conducted including 16 weeks of MCC and TC in nurses with self-reported CNNP. Feasibility outcomes were recruitment, retention, and adherence to the interventions. Clinical outcomes of interest included neck pain and related disabilities. Secondary outcomes of interest were functional, affective, and work-related performance. Qualitative interviews were also conducted. Results: Of the 59 screened, 36 met the eligibility criteria, and 21 were enrolled. The retention rate was 71.4%, and adherence rates were 85.3% for MCC and 62.5% for TC classes. Multiple pain and disability-related outcomes exhibited modest improvement from baseline to 16-week follow-up. Qualitative analysis identified six emergent themes: (1) neck pain being an inherent part of nursing, (2) nurses push through their pain, (3) MCC relieves pain and is instructive for preventing pain, (4) TC provides overall relaxation, (5) both interventions increased body awareness and improved posture, and (6) scheduling difficulties were a key obstacle for participating. Conclusions: Observed reductions in neck pain and disability suggest the potential utility of combined MCC and TC interventions for managing CNNP. Along with qualitative feedback regarding facilitators and barriers to participation, the findings support and inform a future randomized trial evaluating the combined benefits of MCC and TC for CNNP in nurses. Clinical Trial Registration #NCT06523036.

Investigating the Effectiveness of a Workplace Musculoskeletal Disorders Management Program

Musculoskeletal disorders (MSDs) present a major occupational health challenge, especially among office workers. Objective: To evaluate the effectiveness of a workplace intervention program for managing MSDs and measure its impact on presenteeism/absenteeism and health status. Methods: This semi-experimental study was conducted between May 2019 and October 2022 in Greece and involved 247 office workers randomly assigned to early and late intervention groups. The intervention included a seminar on ergonomics and proper workstation practices with a demonstration of exercises. Data were collected by the SF-36, the Standardised Nordic, and the Work Productivity and Activity Impairment Questionnaires. Results: In the early intervention group (n = 143), presenteeism significantly decreased (p = 0.045), from a mean value of 0.11 to 0.07, but not absenteeism. Significant improvements were observed in physical (p = 0.007) and mental health (p = 0.012). Reductions in pain were recorded for the neck (p = 0.032), shoulders (p = 0.015), wrists (p = 0.014), upper back, lower back, hips, and knees (p = 0.044 for each). In the late intervention group (n=104), there were no significant changes in absenteeism or presenteeism. Mental health improved significantly (p = 0.008), and reductions in pain were noted for the neck (p = 0.001), wrist (p = 0.0005), and upper back (p = 0.001). Conclusions: This workplace intervention program proved effective both in reducing pain in various body areas and reducing presenteeism, and improved physical and mental health were observed in the intervention groups while absenteeism remained unchanged.

Cost-Effectiveness of a Multi-faceted Workplace Intervention to Reduce Musculoskeletal Pain in Nursing Staff: A Cluster-Randomized Controlled Trial (INTEVAL_Spain)

PURPOSE

To evaluate the cost-effectiveness of a multifaceted workplace intervention to reduce musculoskeletal pain (MSP) in nursing staff.

METHODS

The study was a 1-year cluster-randomized controlled trial. The intervention combined participatory ergonomics, health promotion, and case management. The control group received usual care. Societal and health system perspectives were used. Costs included direct health and indirect costs. The effects were MSP and quality-adjusted life years (QALYs). MSP was measured using the Standardized Nordic Questionnaire at baseline and 6- and 12-month follow-up. QALYs were measured using the EuroQol-5D-3L at 6- and 12-month follow-up. Incremental costs and QALYs were modelled using generalized linear models. MSP was analysed through generalized logistic models. Incremental cost-effectiveness ratios (ICERs) were calculated, and cost-effectiveness planes and acceptability curves were constructed.

RESULTS

Total mean costs per person were €614 and €216 for the intervention and control group, respectively, with a societal perspective. The intervention mean cost was €38/person. From the societal perspective, the ICER showed that overall additional €68 (€9 from a health system perspective) were required to achieve 1-extra-percentage-point reduction of MSP. ICERs were €34 from the societal and €4 from the health system perspectives for neck, shoulders and upper back pain; €53 and €7 for low back; €179 and €23 for hands; €39 and €5 for legs; €115 and €14 for the knees; €36 and €5 for feet For MSP in the elbows. For participants with pain in the elbow, and for QALYs, the ICER showed that the intervention group was dominated by the control group.

CONCLUSION

This intervention was not cost-effective in terms of QALYs. However, in terms of MSP, with a willingness to pay of €100, the probability of the intervention being cost-effective was around 90%. Further studies incorporating our recommendations are needed to confirm these findings.

STUDY REGISTRATION

ISRCTN15780649, retrospectively registered.

A systematic review of programs and interventions for reduction of sickness absence in nursing staff with work-related musculoskeletal disorders

Negative consequences of musculoskeletal pain and injuries on the nurses' health and well-being can increase job dissatisfaction and impose high costs on healthcare centers due to lost workdays and compensation claims. This study aimed to identify policies, programs, and interventions that might be effective in the prevention and reduction of sickness absence and improvement of work outcomes in nursing staff with these problems. The systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Electronic databases were searched up to November 9-23, 2022. The keywords "musculoskeletal disorders", "nurse", "return to work", "sickness absence", and "sick leave" and their equivalents were combined using Boolean operators OR/AND. Reference lists of eligible literatures were also screened to identify related studies. In this study, a total of 3365 records were retrieved. After two rounds of screening, 15 studies were selected for qualitative synthesis. These studies included seven randomized controlled trial, five pre-post studies, two cohort, and one cross-sectional. Six types of interventions identified including back college, early workplace-based intervention, physical activity/training, psychosocial education, multifaceted intervention, and ergonomics program. There is insufficient evidence to identify effective interventions in preventing and reducing sickness absence, and improvement of work outcomes in nursing personnel with work-related musculoskeletal disorders. Numerous factors affected the occurrence of such disorders, and their consequences, therefore comprehensive strategy tailored to the injured person's needs should be considered.

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.

Clinical Issues - May 2024

Wearing shoe covers in the perioperative setting Key words: shoe covers, shoes, contamination, transmission, bacteria. Wearing eyelash extensions in the perioperative setting Key words: eyelash extensions, sterile field, bonding agent, eye infection, cosmetic products. Promoting health in the workplace Key words: health-promotion program, injury-prevention program, musculoskeletal, mindfulness, stretching. Releasing amputated limbs Key words: amputated limb release, specimen management, burial, cultural, religious.

Musculoskeletal disorders, associated factors, and literature review for intervention according to gender

Introduction

The relationship of risk factors with musculoskeletal disorders and their intervention is a topic of interest, given their prevalence among workers. Thus, analyzing risk factors from approaches such as the gender perspective may be an alternative.

Objectives

To analyze risk factors in a health entity with a high prevalence of musculoskeletal disorders in upper limbs and to describe possible intervention measures according to scientific evidence, from a gender perspective.

Methods

This is an analytical study. A questionnaire was applied to 93 workers on demographic aspects, presence of factors related to the environment, the task, and the organization, extra-work activities related to musculoskeletal disorders in the upper limbs. Chi-square was used to identify significant relationships between the sex variable and individual, occupational, and non-occupational factors, corroborated by Fisher's test and prevalence ratio. According to the associations identified, a literature review was carried out to establish possible strategies.

Results

Significant relationships were found between the sex variable and task-related factors such as the presence of repetitive or sudden movements (p < 0.05), supporting postulates of labor segregation. According to the literature consulted, the effectiveness of activities such as physical preparation and adaptation of the workplace under professional guidance, training activities, and breaks is discussed. It is important to review organizational factors.

Conclusions

By identifying significant relationships between the sex variable and task-related factors, the present study contributes to the postulate of labor segregation, in terms of concentration of female labor in activities with particular working conditions. Regarding literature and actions, it is important to generate more studies from this perspective.

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

Purpose

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

Materials and methods

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

Results

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

Conclusions

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

Participatory ergonomics: What works for whom and why? A realist review

Participatory workplace interventions to improve workforce musculoskeletal health are infrequently analysed regarding why they work, for whom or under what circumstances. This review sought to identify intervention strategies which achieved genuine worker participation. In total, 3388 articles on participatory ergonomic (PE) interventions were screened; 23 were suitable to analyse within a realist framework identifying contexts, mechanisms of change, and outcomes. The interventions which succeeded in achieving worker participation were characterised by one or more of these contexts: workers' needs as a core starting point; a positive implementation climate; clear distribution of roles and responsibilities; allocation of sufficient resources; and managerial commitment to and involvement in occupational safety and health. Interventions that were organised and delivered in this way generated relevance, meaning, confidence, ownership and trust for the workers in an interrelated and multi-directional manner. With such information, PE interventions may be carried out more effectively and sustainably in the future.Practitioner summary: This review focuses on the question: which mechanisms support genuine worker participation, in what context and with which necessary resources, to reduce musculoskeletal disorders. Results emphasise the importance of starting with workers' needs, making the implementation climate egalitarian, clarifying the roles and responsibilities of all involved, and providing sufficient resources.Abbreviations: PE: participatory ergonomic(s); WMSD: Work-related musculoskeletal disorders; EU: European Union; MSD: Muskuloskeletal disorders; OSH: Occupational health and safety; C: context; M: mechanism; O: outcome; CMOCs: CMO configurations; NPT: Normalization process theory; OECD: The Organisation for Economic Co-operation and Development: EU-OSHA: European Occupational Safety and Health Agency.

Efficacy of Interventions in Reducing the Risks of Work-Related Musculoskeletal Disorders Among Healthcare Workers: A Systematic Review and Meta-Analysis

BACKGROUND

Work-related musculoskeletal disorders (WMSDs) are prevalent among healthcare professionals, including nurses, therapists, doctors, and paramedics, due to the potential injuries incurred during patient transfer and handling. This review aimed to assess the effectiveness of existing interventions in reducing the risks of WMSDs in this population.

METHODS

Four databases including PubMed/MEDLINE, Web of Science, Scopus, and ScienceDirect were searched to identify randomized and nonrandomized controlled trials, as well as studies with pre-post design. Two reviewers independently extracted data and assessed the quality of the included studies using the Effective Public Health Practice Project criteria. A meta-analysis was performed to obtain quantitative results.

RESULTS

A total of 40 studies were included in the review. Among the interventions, motorized assistive devices showed the most significant relative reduction in WMSD risks (p < .0000; standardized mean difference [SMD] = -3.32, 95% confidence interval [CI] = [-4.53, -2.12]), followed by combined interventions of cognitive and exercise (p < .0001; SMD = -0.62, 95% CI = [-0.91, -0.33]), combined intervention of cognitive and assistive device intervention (p = .02; SMD = -0.77, 95% CI = [-1.42, -0.12]), nonmotorized assistive device (p = .02; SMD = -0.63, 95% CI = [-1.15, -0.12]), cognitive intervention (p < .0001; SMD = -0.62, 95% CI = [-0.91, -0.33]), and physical exercise (p = .06; SMD = -0.16, 95% CI = [-0.32, 0.00]) intervention.

CONCLUSION

The overall evidence indicates that interventions have a significant effect in reducing the risk of WMSDs among healthcare workers, with motorized assistive devices showing the most promising results. The findings from this review can provide valuable guidance for hospital administrators, policymakers, and other experts in implementing effective strategies to prevent WMSDs among healthcare professionals.

The Onset of Musculoskeletal Pain in the COVID-19 Era: A Survey of Physiotherapy Students in Sicily

Online teaching has resulted in university students adopting a sedentary lifestyle. Prolonged sitting and reduced physical activity due to pandemic restrictions have led to musculoskeletal pain in various body areas, significantly impacting students' quality of life. This study aims to investigate the effects of remote learning on Sicilian physiotherapy students during the COVID-19 pandemic, specifically focusing on the occurrence of musculoskeletal pain. An observational study was conducted using an online survey administered through Google Forms. The survey consisted of 26 multiple-choice questions and was distributed to students enrolled in physiotherapy programs at the universities of Catania, Messina, and Palermo. Participants were contacted via social channels or email, and data collection spanned 5 weeks. The collected data were analyzed using R software. A total of 128 questionnaires were collected. At the time of compilation, most respondents (n = 103/201, 51.2%) were enrolled in the third year of the course of study in physiotherapy at the universities of Catania, Messina, and Palermo. Their ages ranged between 22 and 25 years (43.3%), and most were female (n = 104/201, 51.7%). More than half of the students (51.6%) reported dedicating 15-22 h per week to distance learning for a duration of 6-12 months (50%). Regarding study location, most students preferred studying at a desk (82.8%), and slightly over half (57.8%) adopted a backrest while studying remotely. Analysis of the students' posture during study hours revealed common positions, including tilting the head forward by more than 20 degrees (47.8%), leaning the trunk forward by more than 20 degrees (71.9%), hunching both shoulders forward (57.0%), wrists positioned above the level of the elbows (46.1%), thighs pointing upwards (41.4%), and one or both feet in a downward or dorsiflexed position (69.5%). In conclusion the questionnaire responses indicate that the lifestyle of university students, influenced by online teaching, has deteriorated, leading to musculoskeletal pain, including myofascial pain. These results are primarily influenced by the adopted posture and the duration of time spent in these positions. Additionally, research is needed to identify the most effective therapeutic approaches for managing musculoskeletal pain.

Effectiveness of Workplace Interventions to Improve Health and Well-Being of Health and Social Service Workers: A Narrative Review of Randomised Controlled Trials

Health and social service workers face high levels of workload and job stressors, which can affect their health and well-being. Therefore, it is important to evaluate the effectiveness of workplace interventions that aim to improve their mental and physical health outcomes. This review summarizes the findings of randomized controlled trials (RCTs) that examined the impact of different types of workplace interventions on various health indicators among health and social service workers. The review searched the PubMed database from its inception to December 2022 and included RCTs that reported on the effectiveness of organizational-level interventions and qualitative studies that explored barriers and facilitators to participation in such interventions. A total of 108 RCTs were included in the review, covering job burnout (N = 56 RCTs), happiness or job satisfaction (N = 35), sickness absence (N = 18), psychosocial work stressors (N = 14), well-being (N = 13), work ability (N = 12), job performance or work engagement (N = 12), perceived general health (N = 9), and occupational injuries (N = 3). The review found that several workplace interventions were effective in improving work ability, well-being, perceived general health, work performance, and job satisfaction and in reducing psychosocial stressors, burnout, and sickness absence among healthcare workers. However, the effects were generally modest and short-lived. Some of the common barriers to participation in workplace interventions among healthcare workers were inadequate staff, high workload, time pressures, work constraints, lack of manager support, scheduling health programs outside work hours, and lack of motivation. This review suggests that workplace interventions have small short-term positive effects on health and well-being of healthcare workers. Workplace interventions should be implemented as routine programs with free work hours to encourage participation or integrate intervention activities into daily work routines.

Measuring, Analyzing, and Presenting Work Productivity Loss in Randomized Controlled Trials: A Scoping Review

OBJECTIVES

This study aimed to conduct a scoping review of randomized controlled trials (RCTs) and investigate which work productivity loss outcomes were measured in these RCTs, how each outcome was measured and analyzed, and how the results for each outcome were presented.

METHODS

A systematic search was conducted from January 2010 to April 2020 from 2 databases: PubMed and Cochrane Central Register of Controlled Trials. Data on country, study population, disease focus, sample size, work productivity loss outcomes measured (absenteeism, presenteeism, employment status changes), and methods used to measure, report, and analyze each work productivity loss outcome were extracted and analyzed.

RESULTS

We found 435 studies measuring absenteeism or presenteeism, of which 155 studies (35.6%) measured both absenteeism and presenteeism and were included in our final review. Only 9 studies also measured employment status changes. The most used questionnaire was the Work Productivity and Activity Impairment Questionnaire. The analysis of absenteeism and presenteeism data was mostly done using regression models (n = 98, n = 98, respectively) for which a normal distribution was assumed (n = 77, n = 89, respectively). Absenteeism results were most often presented in time whereas presenteeism was commonly presented using a percent scale or score.

CONCLUSIONS

There is a lack of consensus on how to measure, analyze, and present work productivity loss outcomes in RCTs published in the past 10 years. The diversity of measurement, analysis, and presentation methods used in RCTs may make comparability challenging. There is a need for guidelines providing recommendations to standardize the comprehensiveness and the appropriateness of methods used to measure, analyze, and report work productivity loss in RCTs.

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.

Interventions to prevent and reduce work-related musculoskeletal injuries and pain among healthcare professionals. A comprehensive systematic review of the literature

INTRODUCTION

Work-related musculoskeletal disorders (WMSDs) are among the main causes of injury and pain in healthcare professionals. Previous reviews provided a fragmented view of the interventions available for WMSDs. This review aims to provide a comprehensive description of interventions for preventing and reducing work-related musculoskeletal injuries and/or pain among healthcare professionals, and to assess the methodological quality of studies.

METHODS

A systematic literature review was performed, based on the Effective Public Health Practice Project process. A comprehensive search was conducted on six peer-reviewed databases and manually. The methodological quality of the studies included was rated as weak, moderate, or strong. The studies were organized based on the 2019 classification of the interventions by Oakman and colleagues.

RESULTS

Twenty-seven articles were included reporting individual (n = 4), task-specific (n = 4), work organization and job design (n = 2), work environment (n = 1), and multifactorial (n = 16) interventions. Overall quality rating was strong for 6 studies, moderate for 16, and weak for 5. Individual interventions such as neuromuscular and physical exercise were effective in reducing pain. Task-specific and work organization interventions could prevent certain injuries. Significant reduction of both injuries and pain resulted from multifactorial interventions, which were reported by the majority of strong (n = 5) and moderate (n = 10) quality articles.

CONCLUSIONS

This review provides healthcare professionals with evidence-based information to plan interventions targeted towards reducing WMSDs. In particular, more efforts are needed to implement and extend effective multifactorial interventions. Moreover, studies about each professional healthcare target group are needed.

PRACTICAL APPLICATION

Our results can guide policy-makers, healthcare managers and professionals to choose the best strategies to prevent and reduce WMSDs and to shape continuous education programs. This study prompts clinicians to develop inter-professional collaborations and to practice physical activities in order to reduce WMSDs.

Functional training improves the effectiveness of stretching programs for university cleaning staff

Purpose

The purpose of this study was to determine whether combining a structured stretching program with functional movement/body position training would yield additive effects on flexibility, ergonomic practices, and subjective pain levels for employees at high risk for work-related musculoskeletal disorders.

Design/methodology/approach

Nine control and 13 experimental university cleaning staff participated in a 10-week full-body stretching intervention led by undergraduate students. Experimental participants also engaged in functional movement/body position training once per week. Joint range of motion, task ergonomic form, pain level, and stretching motivation results were compared pre- and post-intervention.

Findings

Overall flexibility (+25.75 ± 3.33%) and task ergonomic form (+26.3 ± 10.5%) significantly improved and were negatively correlated with pain levels (r = −0.541 and r = −0.317, respectively). Experimental participants experienced greater improvements in shoulder (control: +16.8 ± 9.0%; experimental: +64.2 ± 11.5%) and hip (control: +31.4 ± 9.9%; experimental: +91.2 ± 19.9%) flexibility as well as in task-specific ergonomic form for vertical (control: +0.0 ± 5.3%; experimental: +35.2 ± 10.1%) and horizontal wiping (control: −4.7 ± 4.7%; experimental: +29.0 ± 7.8%). Intrinsic motivation was increased for both groups (+26.2 ± 15.4%).

Originality/value

Supplementing a workplace stretching program with functional movement/body position training has the potential to improve flexibility and decrease pain while simultaneously increasing the likelihood that cleaning staff will participate in self-directed stretching in the future. The intervention serves as a model for workplace health management and wellness-focused community building on university campuses who insource cleaning staff.

Does Postural Feedback Reduce Musculoskeletal Risk?: A Randomized Controlled Trial

Background: There is a high prevalence of musculoskeletal disorders among personnel working in the healthcare sector, mainly among nursing assistants and orderlies. Objective: The objective is to analyze the effectiveness of a multi-component intervention that included postural feedback in reducing musculoskeletal risk. Method: A total of 24 nursing assistants and orderlies in a hospital setting were randomly assigned to an intervention group or a control group. After collecting sociodemographic information, a selection of tasks was made and assessed using the REBA (rapid entire body assessment) method. A multi-component intervention was designed combining theoretical and practical training, including feedback on the postures performed by the professionals involved, especially those involving high musculoskeletal risk. This program was applied only to participants in the intervention group. Subsequently, eight months after the first assessment and intervention, the second assessment was carried out using the same method and process as in the first evaluation. Results: The results indicate that the musculoskeletal risk in the second assessment in the intervention group was significantly reduced. However, no significant changes were observed in the control group. Conclusion: The multi-component intervention applied can significantly reduce the musculoskeletal risk of nursing assistants and orderlies. In addition, it is a low-cost intervention with great applicability.

Lateral epicondylosis: A literature review to link pathology and tendon function to tissue-level treatment and ergonomic interventions

BACKGROUND

Common treatments for lateral epicondylosis (LE) focus on tissue healing. Ergonomic advice is suggested broadly, but recommendations based on biomechanical motion parameters associated with functional activities are rarely made. This review analyzes the role of body functions and activities in LE and integrates the findings to suggest motion parameters applicable to education and interventions relevant to activities and life roles for patients.

PURPOSE

This study examines LE pathology, tendon and muscle biomechanics, and population exposure outlining potentially hazardous activities and integrates those to provide motion parameters for ergonomic interventions to treat or prevent LE. A disease model is discussed to align treatment approaches to the stage of LE tendinopathy.

STUDY DESIGN

Integrative review METHODS: We conducted in-depth searches using PubMed, Medline, and government websites. All levels of evidence were included, and the framework for behavioral research from the National Institutes of Health was used to synthesize ergonomic research.

RESULTS

The review broadened the diagnosis of LE from a tendon ailment to one affecting the enthesis of the capitellum. It reinforced the continuum of severity to encompass degeneration as well as regeneration. Systematic reviews confirmed the availability of evidence for tissue-based treatments, but evidence of well-defined harm reducing occupational interventions was scattered amongst evidence levels. Integration of biomechanical studies and population information gave insight into types of potentially hazardous activities and provided a theoretical basis for limiting hazardous exposures to wrist extensor tendons by reducing force, compression, and shearing during functional activities.

CONCLUSIONS

These findings may broaden the first treatment approach from a passive, watchful waiting into an active exploration and reduction of at-risk activities and motions. Including the findings into education modules may provide patients with the knowledge to lastingly reduce potentially hazardous motions during their daily activities, and researchers to define parameters of ergonomic interventions.

Process evaluation of a complex workplace intervention to prevent musculoskeletal pain in nursing staff: results from INTEVAL_Spain

Background

INTEVAL_Spain was a complex workplace intervention to prevent and manage musculoskeletal pain among nursing staff. Process evaluations can be especially useful for complex and multifaceted interventions through identifying the success or failure factors of an intervention to improve the intervention implementation.

Objectives

This study performed a process evaluation of INTEVAL_Spain and aimed to examine whether the intervention was conducted according to the protocol, to investigate the fulfilment of expectations and the satisfaction of workers.

Methods

The intervention was a two-armed cluster randomized controlled trial and lasted 1 year. The process evaluation included quantitative and qualitative methods. Quantitative methods were used to address the indicators of Steckler and Linnan’s framework. Data on recruitment was collected through a baseline questionnaire for the intervention and the control group. Reach and dose received were collected through participation sheets, dose delivered and fidelity through internal registries, and fulfilment of expectations and satisfaction were collected with two questions at 12-months follow-up. Qualitative methods were used for a content analysis of discussion groups at the end of the intervention led by an external moderator to explore satisfaction and recommendations. The general communication and activities were discussed, and final recommendations were agreed on. Data were synthesized and results were reported thematically.

Results

The study was performed in two Spanish hospitals during 2016-2017 and 257 workers participated. Recruitment was 62 and 51% for the intervention and the control group, respectively. The reach of the activities ranged from 96% for participatory ergonomics to 5% for healthy diet. The number of sessions offered ranged from 60 sessions for Nordic walking to one session for healthy diet. Fidelity of workers ranged from 100% for healthy diet and 79% for participatory ergonomics, to 42 and 39% for Nordic walking and case management, respectively. Lowest fidelity of providers was 75% for case management and 82% for Nordic walking. Fulfilment of expectations and satisfaction ranged from 6.6/10 and 7.6/10, respectively, for case management to 10/10 together for the healthy diet session. Discussion groups revealed several limitations for most of the activities, mainly focused on a lack of communication between the Champion (coordinator) and the workers.

Conclusions

This process evaluation showed that the implementation of INTEVAL_Spain was predominantly carried out as intended. Process indicators differed depending on the activity. Several recommendations to improve the intervention implementation process are proposed.

Trial registration

ISRCTN15780649.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00716-x.

Health symptoms and impacts of work on nursing professionals in a public hospital

OBJECTIVE

To relate self-reported health symptoms and the impacts of work in terms of physical, social, and psychological illness in nursing professionals.

METHOD

Cross-sectional, correlational study carried out in a public hospital in the southern region of Brazil. A sample of nursing professionals who worked in direct care participated in the study. A social-occupational questionnaire of self-reported health symptoms and the Work-Related Damage Assessment Scale were used. The analysis was descriptive and analytical. Chi-square test and Spearman's correlation coefficient were used, with a significance level of 5%.

RESULTS

A total of 308 professionals participated, with a prevalence of physical illness and higher means for pain in the body, legs and back. Significant relations were identified among the social-occupational variables, health symptoms, and physical, social or psychological illness. High and moderate correlations among the factors investigated were evidenced.

CONCLUSION

The impact of work on nursing professionals' health is evidenced by the association between self-reported health symptoms and illness, especially the physical or social one, and reinforces the need for professional awareness over situations that are harmful to health.

How to analyze work productivity loss due to health problems in randomized controlled trials? A simulation study

Background

An increasing number of randomized controlled trials (RCTs) have measured the impact of interventions on work productivity loss. Productivity loss outcome is inflated at zero and max loss values. Our study was to compare the performance of five commonly used methods in analysis of productivity loss outcomes in RCTs.

Methods

We conducted a simulation study to compare Ordinary Least Squares (OLS), Negative Binominal (NB), two-part models (the non-zero part following truncated NB distribution or gamma distribution) and three-part model (the middle part between zero and max values following Beta distribution). The main number of observations each arm, N_obs, that we considered were 50, 100 and 200. Baseline productivity loss was included as a covariate.

Results

All models performed similarly well when baseline productivity loss was set at the mean value. When baseline productivity loss was set at other values and N_obs = 50 with ≤5 subjects having max loss, two-part models performed best if the proportion of zero loss> 50% in at least one arm and otherwise, OLS performed best. When N_obs = 100 or 200, the three-part model performed best if the two arms had equal scale parameters for their productivity loss outcome distributions between zero and max values.

Conclusions

Our findings suggest that when treatment effect at any given values of one single covariate is of interest, the model selection depends on the sample size, the proportions of zero loss and max loss, and the scale parameter for the productivity loss outcome distribution between zero and max loss in each arm of RCTs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12874-021-01330-w.

A scoping review to ascertain the parameters for an evidence synthesis of psychological interventions to improve work and wellbeing outcomes among employees with chronic pain

BACKGROUND

Psychological interventions have mixed effects on improving employee outcomes, partly due to significant variability across studies and a lack of focus on mechanisms of action. This scoping review reports on the parameters of these interventions and examines intervention content to bring clarity to this heterogeneous topic area and direct future systematic review work.

METHOD

Six databases were searched (Cinahl, Cochrane, Embase, Medline, PsychINFO and Web of Science) from April 2010 to August 2020, and a grey literature search was undertaken. Screening was undertaken independently by two authors. The results summarised country, participant and employment characteristics, psychological interventions and work, health and wellbeing outcomes. 10% of the papers were analysed to determine the feasibility of coding intervention descriptions for theory and behaviour change technique (BCT) components.

RESULTS

Database searches yielded 9341 titles, of which 91 studies were included. Most studies were conducted in Europe (78%) and included males and females (95%) ranging in age from 31-56.6 years although other demographic, and employment information was lacking. Musculoskeletal pain was common (87%). Psychological interventions commonly included cognitive behavioural therapy (30%) and education (28%). Most studies employed a randomised control trial design (64%). Over half contained a control group (54%). Interventions were delivered in mostly healthcare settings (72%) by health professionals. Multiple outcomes were often reported, many of which involved measuring sickness absence and return-to-work (62%) and pain and general health (53%). Within the feasibility analysis, most papers met the minimum criteria of containing one paragraph of intervention description, but none explicitly mentioned theory or BCTs.

CONCLUSION

Psychological interventions for employees with chronic pain vary in their nature and implementation. We have shown scoping reviews can be used to assess the feasibility of applying tools from health psychology to identify the content of these interventions in future systematic review work to improve intervention development.

Managing the Intervention Costs of Musculoskeletal Disorders in the Hospital Workplace

OCCUPATIONAL APPLICATIONSThis study demonstrates the applicability of multicriteria tools to solve occupational health and safety (OSH) problems related to cost management in the healthcare sector. To the best of our knowledge, this is the first work in which linear programming and established methods for risk assessment of work-related musculoskeletal disorders (i.e., the Key Item Method) have been combined with the knowledge and experience of the corresponding safety engineer (or OSH auditor or consultant). The ease of implementation of the whole process facilitates its future utilization in working practice without adding an undue burden on existing OSH practices.

The contemporary management of neck pain in adults

Neck pain is a common condition with a high prevalence worldwide. Neck pain is associated with significant levels of disability and is widely considered an important public health problem. Neck pain is defined as pain perceived between the superior nuchal line and the spinous process of the first thoracic vertebra. In some types of neck conditions, the pain can be referred to the head, trunk and upper limbs. This article aims to provide an overview of the available evidence on prevalence, costs, diagnosis, prognosis, risk factors, prevention and management of patients with neck pain.