Survey on chronic disabling low back pain among care workers at nursing care facilities: a multicenter collaborative cross-sectional study

Occupational low back pain among Japanese caregivers: A large-scale cross-sectional study

BACKGROUND

Caregivers in Japan experience a high prevalence of low back pain (LBP), with age, sex, individual pain experiences, and central sensitization symptoms potentially influencing its chronic progression.

OBJECTIVE

To determine the prevalence of LBP among caregivers, as well as its relation to age and sex, and explore work status, psychological factors, and central sensitization symptoms as contributing factors to chronic LBP (CLBP).

METHODS

A large-scale cross-sectional survey was conducted among 1214 caregivers in 35 geriatric healthcare facilities. The survey assessed LBP and CLBP prevalence, work status, psychological factors, and central sensitization-related symptoms. Multivariate logistic regression analysis was used to identify factors influencing CLBP.

RESULTS

Among 936 valid respondents, the LBP prevalence was 69.2%. No significant sex differences were found in the prevalence of LBP and CLBP. Old age, higher pain severity, and severe symptoms related to central sensitization increased the risk of CLBP. However, work status and psychological factors did not significantly contribute to CLBP.

CONCLUSION

There is a high prevalence of LBP among caregivers, age and individual pain experience significantly impact CLBP. These findings emphasize the need for therapeutic strategies to manage pain intensity, especially in the acute phase, to prevent the progression to chronicity.

Subgroup characteristics in care workers with low back pain: cluster analysis-based severity of central sensitivity syndromes and low back pain

PURPOSE

This multicentre, collaborative, cross-sectional study aimed to explore the characteristics of subgroups based on central sensitivity syndromes (CSSs) and low back pain (LBP) severity. Furthermore, we investigated the relationship between the classified subgroups and work status among the care workers.

PATIENTS AND METHODS

In 660 care workers, we assessed LBP intensity, pain duration, pain sites, CSS (using the central sensitization inventory-9), psychological factors (using the pain catastrophizing scale and pain self-efficacy questionnaire), and work status (interference, amount of assistance, frequency of assistance, and work environment). We used hierarchical clustering analysis to divide the participants into subgroups based on CSS and LBP severity. We further performed multiple comparison analyzes and adjusted the residuals (chi-square test) to reveal differences between clusters.

RESULTS

Care workers with LBP were divided into four subgroups (Cluster 1: no CSS and mild LBP, Cluster 2: mild CSS and severe LBP, Cluster 3: mild CSS and mild LBP, Cluster 4: severe CSS and moderate LBP). Cluster 4 tended to have a higher number of pain sites, severe pain catastrophizing, and poor pain self-efficacy. In addition, Cluster 4 showed a higher frequency of assistance and an inadequate working environment and equipment. By contrast, Cluster 2 tended to have low pain self-efficacy. In addition, Cluster 2 experienced the highest work-related interference compared with any of the subgroups.

CONCLUSION

Our findings suggested that the severe LBP and severe CSS subgroups had common and different characteristics concerning psychological factors and work status, including interference with work. Our results may help to improve the management of care workers with LBP.

Fear-Avoidance Beliefs Associated with Non-Specific Chronic Low Back Pain in College Athletes

Purpose

This study aimed to determine the psychosocial factors associated with non-specific chronic low back pain (NS-CLBP) among college athletes.

Material and Methods

A cross-sectional study was performed at one university. A non-anonymous, self-administered online questionnaire was collected from each athlete. Participants with a history of orthopaedic spine disease or surgery were excluded. Online responses from 368 college athletes belonging to 18 clubs were collected, among which 263 were included in the analysis. In the 263 responses, 41 individuals were identified as having NS-CLBP. Multivariate logistic regression analyses were performed to determine factors associated with presence of NS-CLBP. Independent variables included the Fear-Avoidance Beliefs Questionnaire physical activity subscale (FABQ-PA) score, Tampa Scale for Kinesiophobia-11 (TSK-11) score, Roland-Morris Disability Questionnaire (RDQ) score, and body mass index (BMI). Additionally, the Mann-Whitney U-test was utilized to compare FABQ-PA, TSK-11, RDQ scores, and BMI between the NS-CLBP and non-NS-CLBP groups.

Results

The FABQ-PA (odd ratio = 1.096, P = 0.003) was significantly associated with NS-CLBP. No significant association was observed between NS-CLBP and TSK-11 (P = 0.776), RDQ (P = 0.074), and BMI (P = 0.296). The scores for FABQ-PA, TSK-11, RDQ, and BMI in the group with NS-CLBP were found to be significantly higher compared to the group without NS-CLBP (P < 0.001, P = 0.034, P < 0.001, and P = 0.022, respectively).

Conclusion

The present study revealed a significant relationship between higher FABQ-PA scores and NS-CLBP among college athletes. Conversely, TSK-11 and BMI values showed no significant association with NS-CLBP presence. The findings suggest that addressing fear-avoidance beliefs may be crucial in managing NS-CLBP among college athletes.

Work-Related, Non-Specific Low Back Pain among Physiotherapists in France: Prevalence and Biomechanical and Psychosocial Risk Factors, as a Function of Practice Pattern

BACKGROUND

Physiotherapists worldwide experience lower back pain (LBP). Up to 80% of physiotherapists report having experienced an episode of LBP at some point in their career, and LBP is the most common musculoskeletal disorder in this profession. In France, the prevalence of LBP among physiotherapists and associated work-related risk factors have not previously been studied.

OBJECTIVE

To determine whether the risk of work-related non-specific LBP among French physiotherapists depends on practice pattern.

METHOD

A link to an online self-questionnaire was sent to French physiotherapists. The various practice patterns were compared with regard to the prevalence of LBP, the total number of days with LBP during the previous 12 months, and the degree of exposure to biomechanical, psychosocial and organisational risk factors.

RESULTS

Among the 604 physiotherapists included in the study, the prevalence of work-related, non-specific LBP in the previous 12 months was 40.4%. The prevalence was significantly greater among physiotherapists working in geriatrics (p = 0.033) and significantly lower in sports medicine (p = 0.010). Differences in exposure to risk factors were also found.

CONCLUSIONS

The risk of non-specific LBP among French physiotherapists appears to depend on the mode of practice. All the various dimensions of risk must be taken into account. The present study could serve as a basis for more targeted research on the most exposed practices.

Associations of Central Sensitization-Related Symptoms with Low Back Pain-Related Factors and Work Status in Caregivers

Low back pain (LBP) is associated with psychological factors and central sensitization-related symptoms (CSSs). The relationship between CSSs, LBP-related factors, and work status in caregivers remain unclear. This multicentre, collaborative, cross-sectional study aimed to determine the association between CSS severity, LBP-related factors, and work status in caregivers with LBP. We measured LBP intensity, pain duration, pain sites, CSSs (using the Central Sensitization Inventory-9: CSI-9), psychological factors (using the Pain Catastrophizing and Pain Self-Efficacy scales), and work status (interference, amount of assistance, frequency of assistance, and work environment) in 660 caregivers. CSS severity was categorised as no (CSI-9:0−9), mild (CSI-9:10−19), or moderate/severe (CSI-9:20−36). We further performed multiple comparison analyses and adjusted the residual chi-square to reveal differences between CSS severity groups. Caregivers with more severe CSSs tended to exhibit worse LBP intensity (p < 0.01), widespread pain (p < 0.01), catastrophic thinking (p < 0.01), and pain self-efficacy (p < 0.01), and they also tended to experience work interference (p < 0.01). Caregivers without CSSs tended to receive a smaller amount of assistance with a lower frequency (p < 0.05). The number of participants with an adequate environment and equipment was significantly less in the moderate/severe CSS group (p < 0.01). Thus, our findings may suggest that CSS severity is associated with LBP intensity, widespread pain, psychological factors, and work status in caregivers.

Work engagement, well-being, and intent to continue working based on educational support among foreign care workers in Japan

Background

Global aging continues to progress. The shortage of human resources involved in long-term care (LTC) is a serious problem worldwide. It is necessary to promote the stable employment of foreign care workers. The purpose of this study was to identify which factors, including well-being, work engagement, and original items, contribute to foreign care workers’ intent to continue working.

Methods

We conducted an anonymous self-administered questionnaire survey of 259 foreign LTC workers at LTC facilities in Japan. The questionnaire survey items included the Japanese version of the Subjective Well-being Scale (J-SWBS), the Japanese version of the Utrecht Work Engagement Scale (J-UWES), and original items related to educational needs and issues. We used multiple regression analysis to predict variability from correlations among variables. And after that, we conducted a path analysis using structural equation modeling (SEM), and added that the explanatory variables (IV) were well-being, work engagement, and the original item component, and that the outcome variable (DV) was intention to continue working. We set a hypothetical model based on structural equations, corrected by path analysis, and examined its suitability.

Results

The number of returned questionnaires for 259 foreign care workers was 147 (response rate 56.7%), and the number of analyzable questionnaires was 129 (valid response rate 49.8%). For intention to continue working, the results of structural equation modeling showed direct effects for satisfaction with low back pain measure guidance (β = .255), satisfaction with the national examination guidance method (β = .217), well-being (β = .046), and work engagement (β = .026). In work-engagement, there was a direct effect of happiness (β = .715), willingness to learn good care (β = 4.849), and confidence in my ability (β = 2.902,), whilst in well-being, satisfaction with low back pain measure guidance (β = 1.582) and confidence in my ability (β = 1.999) were found to have direct effects.

Conclusions

To increase the intent of foreign care workers to continue working, appropriate guidance should be given related to the development of lumbago. In addition, to provide a place and scene where they can learn good care, having a relationship in practice where foreign care workers can feel that their abilities are being utilized, and developing and maintaining educational support that motivates them to learn good care may be effective.

Fraction and Number of Unemployed Associated with Self-Reported Low Back Pain: A Nation-Wide Cross-Sectional Study in Japan

This study examined a cross-sectional association between self-reported low back pain (LBP) and unemployment among working-age people, and estimated the impact of self-reported LBP on unemployment. We used anonymized data from a nationally representative survey (24,854 men and 26,549 women aged 20–64 years). The generalized estimating equations of the multivariable Poisson regression models stratified by gender were used to estimate the adjusted prevalence ratio (PR) and 95% confidence interval (CI) for unemployment. The population attributable fraction (PAF) was calculated using Levin’s method, with the substitution method for 95% CI estimation. The prevalence of self-reported LBP was 9.0% in men and 11.1% in women. The prevalence of unemployment was 9.3% in men and 31.7% in women. After adjusting for age, socio-economic status, lifestyle habits, and comorbidities, the PR (95% CI) for the unemployment of the LBP group was 1.32 (1.19–1.47) in men and 1.01 (0.96–1.07) in women, compared with the respective non-LBP group. The PAF (95% CI) of unemployment associated with self-reported LBP was 2.8% (1.6%, 4.2%) in men. Because the total population of Japanese men aged 20–64 in 2013 was 36,851 thousand, it was estimated that unemployment in 1037 thousand of the Japanese male working population was LBP-related.

Predictors of Effort-Reward Imbalance Among Employees Providing Three Types of Long-Term Care Services in Japan: Implications for Employee Well-Being

The purpose of this study was to identify predictive factors of effort-reward imbalance (ERI) among employees in multiple long-term care settings in Japan. This cross-sectional study by convenience sampling included 944 participants providing three types of long-term care: home-based (n = 201), community-based (n = 128), and institutional (n = 615). Multiple logistic regression analysis was used to identify factors associated with self-reported ERI. Low job satisfaction, being a care manager, holding a position of department head, working long hours, and having family-related stress were the common factors associated with ERI in employees across all three types of long-term care setting. Long-term care providers should consider the needs of care recipients and their family, as well as the needs of care employees, maximizing rewards so that turnover can be reduced and the diversity of individual work-family needs can be accommodated across multiple forms of long-term care settings.

Prevalence and influencing factors of low back pain among nurses in China: a systematic review and meta-analysis

Background

Low back pain (LBP) is one of the most common occupational injuries that nurses experience in their daily work, which ultimately causes disability or difficulty in performing heavy physical activity. There is scarce information that presents a direct figure about the prevalence of LBP in Chinese nurses.

Objective

To systematically review and analyze the prevalence and influencing factors of LBP among nurses in China.

Methods

Related literature extracted from PubMed, Web of Science, Scopus, China National Knowledge Infrastructure databases were selected and reviewed based on the PRISMA guideline. Random effects models were used for data analysis, where heterogeneity was tested through I2. Egger's test was used to analyze the literature publication bias.

Results

The combined data indicated that the prevalence of LBP among nurses in China was 78% [95% confidence interval (CI) = 0.72–0.83]. The prevalence of LBP among nurses in China has declined in the past decade. Nurses presented a high risk of LBP in terms of female (OR = 2.38, 95% CI = 1.23–3.44, P < 0.0001), married (OR = 2.79, 95% CI = 1.57–3.86, P < 0.0001), 24 ≤ BMI < 28 (OR = 2.03, 95% CI = 1.18–3.08, P < 0.0001), and working for more than ten >10 years (OR = 2.54, 95% CI = 2.03–3.32, P < 0.0001).

Conclusions

There is a high prevalence of LBP among nurses in China. Interventions that include healthy dietary habits and physical activity mainly focusing on female married nurses who are working for at least 10 years should be implemented. Furthermore, nurses ought to apply ergonomic principles for personal protection at the workplace.

Relationship Between Attention Bias and Psychological Index in Individuals With Chronic Low Back Pain: A Preliminary Event-Related Potential Study

Introduction: Attention bias towards pain-related information exists in patients with chronic pain, and recently, attention bias modification (ABM) training has been administered to patients with chronic pain. In this study, we conducted an attention bias modification task in conjunction with event-related potential measurements for individuals with chronic low back pain (LBP) and investigated the relationship between attention bias and psychological assessment.

Methods: Eleven women and two men with chronic LBP participated in the study.

Results: The Japanese version of the STarT Back Screening Tool (J-SBST) total score was significantly correlated with the N1 amplitude of Cz. The J-SBST psychological score was significantly correlated with the N1 amplitude of Cz and with reaction time (RT). The Japanese version of the Pain Catastrophizing Scale (PCS) and Japanese version of the Beck Depression Inventory-Second Edition (BDI-II) scores were significantly correlated with the P2 amplitude at Fz (only PCS), Cz, and Pz.

Conclusions: Our findings suggest that J-SBST, which provides a comprehensive evaluation of psychological factors, PCN with measuring of catastrophizing in the context of actual or anticipated pain, and BDI-II, can likely help identify chronic LBP patients with attention bias. For chronic LBP patients who are classified according to J-SBST or PCN pain-related outcome improvement with ABM training can be expected.

Sleep disturbances and back pain : Systematic review and meta-analysis

BACKGROUND

In today's society, sleep disturbances and back pain are both common problems which threaten health. Although some studies have focused on the effects of sleep disturbances on back pain, no meta-analysis has been done. The purpose of this study is to systematically review and perform a meta-analysis on the effects of sleep disturbances on back pain.

METHODS

A literature search in PubMed, Scopus and EMBASE with keywords until June 2019 was performed. The eligible articles were evaluated qualitatively and the results were pooled using random effects. The publication bias and the degree of heterogeneity were examined.

RESULTS

In all, 21 studies were included in the meta-analysis. Sleep disturbances were associated with back pain (odds ratio 1.52; confidence interval [CI] 1.37-1.68; P < 0.001). In men, the odds ratio was 1.49 (CI 1.34-1.65; P < 0.001). In women, the odds ratio was 1.56 (CI 1.33-1.81; P < 0.001). Begg's test (P = 0.856) and Egger test (P = 0.188) did not show any publication bias. A funnel plot and trim-and-fill method showed publication bias, and heterogeneity was also high.

CONCLUSIONS

Sleep disturbance is associated with risk of back pain. Improving sleep can be a deterrent against back pain. Therefore, interventions to reduce sleep disturbances can help to improve health. On the other hand, the relationship between sleep disturbances and back pain can be two-sided, and back pain can also lead to sleep disturbances. Not only in view of the lifetime prevalence and the multifactorial impairments of those affected, but also in consideration of social and economic burdens, this issue will remain of considerable importance.

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.