The effect of body mechanics instruction on work performance among young workers

Do Turkish patients with lumbar disc herniation know body mechanics?

BACKGROUND AND OBJECTIVE

Most common and important cause of the low back pain is lumbar disc herniation. Patients with lumbar disc herniation face with difficulties during daily activities due to the reduction of physical functions. In order to maintain daily activities without pain and discomfort, the patients should be informed about proper positions and body mechanics. The aim of the study was to determine the knowledge and the applications of the patients with lumbar disc herniation about body mechanics.

METHODS

This descriptive study was conducted with 75 patients with lumbar disc herniation in Edirne, Turkey. The population consisted of 75 patients who accepted to participate in the study. In the collection of data the questionnaire, which was developed according to literature by the researcher, was used. Descriptive statistics, student t-test, variance and correlation analysis were used for assessment of the data. The significance level was accepted at 0.05.

RESULTS

It was found that 53.3% of the patients experienced awful/very severe pain. and there were some points that the patients have enough information about; mobilisation, standing, carrying the goods, leaning back while sitting, leaning somewhere while standing, getting support from the chair when standing up, avoiding sudden position changes, changing feet frequently while standing. It was detected that a statistical relation between educational level and knowledge about body mechanics exists.

CONCLUSION

This study shows that individuals with lumbar disc herniation have not enough information about body mechanics and they experienced long-term severe pain. Nurses and other health care workers have important role in explaining the importance of body mechanics to the patients and should encourage them to use that in daily life.

Back Injury Prevention Interventions in the Workplace

The purpose of this integrative review is to describe the state of knowledge about the effect of worksite back injury prevention programs on selected study outcomes. Fifteen experimental and quasi-experimental studies published between 1987 and 1994 were identified through a comprehensive literature search. The research studies were reviewed and analyzed using a data collection abstracting tool. Four types of back injury prevention intervention programs were identified: back belts, back schools, exercise/flexibility training, and educational classes. Positive program outcomes were reported for all four program types; however, the back school and the exercise/flexibility training programs were studied more frequently and demonstrated a greater proportion of positive results than the other two program types. Conclusions should be viewed cautiously due to the small number of studies reviewed and their methodological limitations. Implications for occupational health nursing practice and future research related to worksite back injury prevention are offered.

Efficacy of Office Ergonomics Education

The incidence of musculoskeletal injuries associated with computer use is increasing. Education has been advocated as a prevention method for reducing the incidence and severity of musculoskeletal injuries. Although the inclusion of education in musculoskeletal injury prevention programs has become a popular practice, the efficacy of educational programming is poorly defined in the literature. The present study was designed to investigate the efficacy of worker education programs in preventing musculoskeletal injuries in a population of reservation center employees who spend the majority of their work day using the computer. Participants were randomly assigned to one of three study groups (control, traditional education, or interactive education). Data collection utilized self-report surveys and observational checklists to collect data prior to intervention and at approximately 3, 6, and 12 months post intervention. Preliminary analysis of the data seems to indicate that, overall, education does have some impact on worker comfort, work area configuration, and worker postures.

Evaluation of the implementation fidelity of an ergonomic training program designed to prevent back pain

The aim of this study was to evaluate the implementation fidelity of a multidimensional ergonomic program designed to prevent back pain injuries among healthcare personnel. The program, provided by peer trainers included training intended to modify patient handling and transfer behaviour, trainee follow-up, prevention activities aimed at work environment improvements and follow-up monitors training. Two hundred twenty-one peer trainers at 139 Quebec healthcare institutions participated in our study. Only 61.5% were involved in training; most of them taught safe patient handling, positioning, transfer, and preparation techniques, which are the cornerstones of the program; 72.7% were involved in prevention activities, 46.1% in follow-up activities, and 10.7% in follow-up monitors training. The study results should help organizations anticipate and prevent potential discrepancies between prescribed and implemented programs.

Long-term effectiveness of a back education programme in elementary schoolchildren: an 8-year follow-up study

The purpose of this study was to investigate the long-term effectiveness of a spine care education programme conducted in 9- to 11-year-old schoolchildren. The study sample included 96 intervention subjects and 98 controls (9- to 11-year-olds at baseline). Intervention consisted of a 6-week school-based back education programme (predominantly biomechanically oriented) and was implemented by a physical therapist. Self-reported outcomes on back care knowledge, spinal care behaviour, self-efficacy towards favourable back care behaviour, prevalence of back and neck pain during the week and fear-avoidance beliefs were evaluated by the use of questionnaires. Post-tests were performed within 1 week after programme completion, after 1 year and after 8 years. Whereas the educational back care programme resulted in increased back care knowledge up to adulthood (P < 0.001), intervention did not change spinal care behaviour or self-efficacy. Pain prevalence figures increased less in the experimental group compared to the controls over the 8-year time span, yet statistical significance was not reached. Dropout analysis revealed spinal pain prevalence rates to be different in both groups throughout the study, including at baseline. Back education at young age did not reinforce fear-avoidance beliefs up to adulthood. Predominantly biomechanical oriented back education in elementary schoolchildren is effective in improving the cognitive aspect of back care up to adulthood, yet not in changing actual behaviour or self-efficacy. The current study does not provide evidence that educational back care programmes have any impact on spinal pain in adulthood. The true long-term impact of school-based spinal health interventions on clinically relevant outcome measures merits further attention.

A measure of university employees' exposure to risk factors for work-related musculoskeletal disorders

This study examined the computer workstations of 50 faculty and staff at a regional comprehensive university in the southeastern United States. Data were collected using a subjective questionnaire and the observational Computer Workstation Analysis tool. The researchers found no significant differences between participants' perceptions of their risk for work-related musculoskeletal disorders (WRMDs) and observations of workstations at the worksite. The researchers recommend developing an ergonomics program delivered by occupational health team members with knowledge and skill in WRMD prevention, identification, and treatment.

Can a new behaviorally oriented training process to improve lifting technique prevent occupationally related back injuries due to lifting?

STUDY DESIGN

A prospective randomized control trial.

OBJECTIVE

To determine the degree to which a new behavior-based lift training program (LiftTrainer; Ascension Technology, Burlington, VT) could reduce the incidence of low back disorder in distribution center jobs that require repetitive lifting.

SUMMARY OF BACKGROUND DATA

Most studies show programs aimed at training lifting techniques to be ineffective in preventing low back disorders, which may be due to their conceptual rather than behavioral learning approach.

METHODS

A total of 2144 employees in 19 distribution centers were randomized into either the LiftTrainer program or a video control group. In the LiftTrainer program, participants were individually trained in up to 5, 30-minute sessions while instrumented with motion capture sensors to quantify the L5/S1 moments. Twelve months following the initial training, injury data were obtained from company records.

RESULTS

Survival analyses (Kaplan-Meier) indicated that there was no difference in injury rates between the 2 training groups. Likewise, there was no difference in the turnover rates. However, those with a low (<30 Nm) average twisting moment at the end of the first session experienced a significantly (P < 0.005) lower rate of low back disorder than controls.

CONCLUSIONS

While overall the LiftTrainer program was not effective, those with twisting moments below 30 Nm reported fewer injuries, suggesting a shift in focus for "safe" lifting programs.

Relative effectiveness of worker safety and health training methods

OBJECTIVES

We sought to determine the relative effectiveness of different methods of worker safety and health training aimed at improving safety knowledge and performance and reducing negative outcomes (accidents, illnesses, and injuries).

METHODS

Ninety-five quasi-experimental studies (n=20991) were included in the analysis. Three types of intervention methods were distinguished on the basis of learners' participation in the training process: least engaging (lecture, pamphlets, videos), moderately engaging (programmed instruction, feedback interventions), and most engaging (training in behavioral modeling, hands-on training).

RESULTS

As training methods became more engaging (i.e., requiring trainees' active participation), workers demonstrated greater knowledge acquisition, and reductions were seen in accidents, illnesses, and injuries. All methods of training produced meaningful behavioral performance improvements.

CONCLUSIONS

Training involving behavioral modeling, a substantial amount of practice, and dialogue is generally more effective than other methods of safety and health training. The present findings challenge the current emphasis on more passive computer-based and distance training methods within the public health workforce.

Child labor and musculoskeletal disorders: the Pelotas (Brazil) epidemiological survey

OBJECTIVES

[corrected] This article describes the prevalence of musculoskeletal pain in several anatomic sites in children and teens, and investigates, while adjusting for potential confounders, the association between musculoskeletal pain and back pain and the following: age, gender, sports practice, use of computer/video games/television, school attendance, intensity of involvement in household domestic activities, care of other children, care of sick/elderly family members, work activities, and workloads.

METHODS

We conducted a cross-sectional study interviewing 3,269 children aged 10-17 years in the low-income areas of Pelotas, Brazil.

RESULTS

The prevalence of pain in the neck, knee, wrist or hands, and upper back exceeded 15%. Workers in manufacturing had a significantly increased risk for musculoskeletal pain (prevalence ratio [PR]=1.31) and for back pain (PR=1.69), while workers in domestic service had 17% more musculoskeletal pain and 23% more back pain than nonworkers. Awkward posture (PR=1.15) and heavy physical work (PR=1.07) were associated with musculoskeletal pain, while monotonous work (PR=1.34), awkward posture (PR=1.31), and noise (PR=1.25) were associated with back pain.

CONCLUSIONS

Musculoskeletal pain is common among working children and teens. Knowledge of occupational risk factors can support actions to restructure work conditions to reduce or eliminate childhood exposure to hazardous conditions. Our results suggest that strategies to prevent musculoskeletal disorders in child workers should be developed.

Back education efficacy in elementary schoolchildren: a 1-year follow-up study

STUDY DESIGN

A control group-designed 1-year follow-up study involving 9 to 11-year-old schoolchildren who followed back education.

OBJECTIVES

To evaluate the efficacy of a back education program, consisting of six sessions of 1 hour each, in elementary school.

SUMMARY OF BACKGROUND DATA

In surveys among children and teenagers during the past few years, as many as half of all children in a community report a history of low back pain. Although several authors advocate the implementation of back education in elementary school, no guidelines exist and little is known about the efficacy of such a program.

METHODS

A total of 198 children (subjected to back education) and 165 controls performed a practical test, evaluating the use of back care principles while sitting, taking off shoes, picking up a pen, and handling a load and a book bag. Post-tests were performed within 1 week after the intervention, after 3 months, and after 1 year. The week prevalence of back and neck pain was evaluated at these test moments in extended samples of intervention children (n = 347) and controls (n = 349). To evaluate habit changes, a limited group of intervention pupils (n = 38) and controls (n = 31) was additionally evaluated in a candid camera observation at the last post-test.

RESULTS

At all post-tests intervention pupils scored significantly higher (P < 0.001) than controls for all practical test items. Candid camera evaluation scores were higher in the intervention group sample compared with the control group sample for four of the eight evaluated items. Following back education significantly decreased the week prevalence of back and neck pain.

CONCLUSIONS

Back education in elementary schoolchildren is efficacious up to 1 year. The role of early back education in preventing back pain at the adult age merits further attention.

A systematic review of workplace interventions to prevent low back pain

A systematic review of randomised controlled trials was undertaken to evaluate the effectiveness of workplace interventions to prevent low back pain. Potential trials were located by a computerised search supplemented with citation tracking. The methodological quality of the trials was assessed on 11 criteria and the level of evidence for each intervention was determined, based upon the amount, consistency and quality of evidence from the trials. The review located 13 trials that were generally of moderate quality. The trials suggest that work place exercise is effective, braces and education are ineffective, and workplace modification plus education is of unknown value in preventing low back pain.

The effects of back schools--a meta-analysis

Back schools are educational programmes for the prevention and rehabilitation of back pain. A quantitative review (meta-analysis) was performed to synthesize the existing evidence on their effectiveness, for different outcome criteria and time categories. On the basis of a systematic literature research, 18 controlled back school studies with a total of 1682 participants could be included in the meta-analysis. Effect sizes that compared back school patients with patients in a control group were calculated for 14 outcome criteria and four time categories. Effectiveness of back schools was shown for the time period within 6 months of intervention. However, effects for the 14 examined criteria revealed large differences: in contrast to the strong effects on correct back posture and movements and on knowledge of back school contents, the intervention had only small effects on health economic variables (e.g. utilization of the health care system) and no effects on clinical variables (e.g. pain intensity). With regard to the time period following the 6 months after intervention, the analysed data does not strongly support the effectiveness of back schools. It is concluded that the effectiveness of back school intervention depends on the outcome criterion and time of measurement. The results suggest that the concept of back school programmes should be improved and systematically re-evaluated.

A controlled trial of an educational program to prevent low back injuries

BACKGROUND

Low back injuries are common and costly, accounting for 15 to 25 percent of injuries covered by workers' compensation and 30 to 40 percent of the payments made under that program. The high costs of injury, the lack of effective treatment. and the evidence that there are behavioral risk factors have led to widespread use of employee education programs that teach safe lifting and handling. The effectiveness of those programs, however, has received little rigorous evaluation.

METHODS

We evaluated an educational program designed to prevent low back injury in a randomized, controlled trial involving about 4000 postal workers. The program, similar to that in wide use in so-called back schools, was taught by experienced physical therapists. Work units of workers and supervisors were trained in a two-session back school (three hours of training), followed by three to four reinforcement sessions over the succeeding few years. Injured subjects (from both the intervention and the control groups) were randomized a second time to receive either training or no training after their return to work.

RESULTS

Physical therapists trained 2534 postal workers and 134 supervisors. Over 5.5 years of follow-up, 360 workers reported low back injuries, for a rate of 21.2 injuries per 1000 worker-years of risk. The median time off from work per injury was 14 days (range, 0 to 1717); the median cost was $204 (range, zero to $190,380). After their return to work, 75 workers were injured again. Our comparison of the intervention and control groups found that the education program did not reduce the rate of low back injury, the median cost per injury, the time off from work per injury, the rate of related musculoskeletal injuries, or the rate of repeated injury after return to work; only the subjects' knowledge of safe behavior was increased by the training.

CONCLUSIONS

A large-scale, randomized, controlled trial of an educational program to prevent work-associated low back injury found no long-term benefits associated with training.

Self-selected manual lifting technique: functional consequences of the interjoint coordination

The pattern of movement self-selected by 39 subjects to lift light loads from 9 cm above the ground is described in kinematic and electromyographic terms. Hamstring length changes were estimated from hip and knee angular kinematics. Subjects adopted a posture at the start of the lift intermediate between stoop and full-squat postures. A consistent coordination between knee, hip, and lumbar vertebral joints during lifting was described through calculation of the relative phase between adjacent joints and found to be exaggerated with increases in load mass. During the early phase of lifting, knee extension leads hip extension, which in turn leads extension of the lumbar vertebral joints. Early in the lifting movement, when load acceleration is greatest, the erectores spinae are thus relatively long and shortening slowly. Both of these factors produce greater back extensor strength. Rapid hamstring shortening is also delayed, which enhances their strength, and coactivation of the monoarticular knee extensors and biarticular hamstring observed early in the lifting movement suggested that the knee extensors contribute to hip extension through a tendinous action of the hamstrings.

Lifting instruction to children in an elementary school

Many people have advocated initiating back care education early in life because back pain and injuries are so common in the adult population. This study investigated the learning of a lifting technique and the risk factors involved in low back pain with 27 sixth-grade and 28 eighth-grade public school children. The students were instructed through verbal presentation, demonstration, and a practice session. Student performance was assessed with multiple choice tests and practical performance tests. Testing was administered prior to instruction, 2 days after instruction, and 6-7 weeks after instruction. There was a statistically significant improvement (p < 0.05) in all postinstruction scores compared with preinstruction scores in both the multiple choice and practical performance tests for both grade levels. The effectiveness of a brief instructional session on some back care education principles to children was demonstrated. Preventive intervention programs with children could be easily implemented in elementary school systems. The long-term outcome of such programs needs to be evaluated.