Validation of a questionnaire for assessing physical work load

Factors Affecting Perioperative Nurse Adherence to Ergonomic Safety Measures

AORN has identified safety risks unique to the perioperative setting and has developed ergonomic safety measures to help prevent musculoskeletal injuries and disorders. Little is known about adherence to these safety measures or the perceived barriers and facilitators to adherence. This study used a cross-sectional survey to determine the prevalence of pain and occurrence of musculoskeletal injuries and disorders. We asked perioperative staff members about their perceived barriers and facilitators to adherence with safety measures. A total of 155 perioperative nurses in one health system completed the online survey (55% response rate). Most (93%) had experienced at least one musculoskeletal injury or disorder or related pain. Years worked as a perioperative nurse and having neck pain were associated with safety measure adherence. The most reported barrier to safety measure adherence was inadequate staffing. Study findings highlight the need for increased attention to the physical workload demands in the perioperative setting.

Beneficial and harmful effects of physical activity on care-seeking for low back pain: the AUTBACK study

PURPOSE

People who seek more care for low back pain (LBP) tend to experience poorer recovery (e.g. higher pain and disability levels). Understanding the factors associated with care-seeking for LBP might improve patient outcomes and potentially alleviate the burden of LBP on global health systems. This study aimed to investigate the relationship between different intensities, volumes, and domains of physical activity and care-seeking behaviours, in people with a history of LBP.

METHODS

Longitudinal data from adult twins were drawn from the AUstralian Twin BACK study. The primary outcome was the total self-reported frequency (counts) of overall utilisation of care for LBP, over 1 year. Secondary outcomes were the utilisation of health services, and the utilisation of self-management strategies, for LBP (assessed as total frequency over 1 year). Explanatory variables were device-based measures of sedentary behaviour and moderate-to-vigorous intensity physical activity, and self-reported physical workload, and work, transport, household, and leisure domain physical activity, at baseline.

RESULTS

Data from 340 individuals were included. Median age was 56.4 years (IQR 44.9-62.3 years) and 73% of participants were female. Medium-to-high baseline volumes of sedentary behaviour were significantly associated with greater counts of overall care utilisation (IRR 1.60, 95%CI 1.04-2.44) and utilisation of self-management strategies (IRR 1.60, 95%CI 1.02-2.50) for LBP, over 1 year. Medium-to-high baseline volumes of household domain physical activity were significantly associated with greater counts of utilising self-management strategies for LBP over 1 year (IRR 1.62, 95%CI 1.04-2.53). No explanatory variables were associated with the utilisation of health services for LBP.

CONCLUSION

People who engage in higher baseline volumes of sedentary behaviour or physical activity in the household setting (e.g. housework, gardening, yard work, general household maintenance) utilise 1.6 times more care for LBP over 1 year. Findings suggest that higher volumes of these behaviours may be harmful for LBP. No intensities, volumes, or domains of physical activity demonstrated clear benefits for LBP. Where feasible, patients and clinicians should collaborate to screen and develop strategies to reduce engagement in sedentary behaviour or physical activity in the household setting. Contextual factors (e.g. patient symptom severity, sociocultural roles, occupational demands) should be considered when devising appropriate behaviour change strategies.

Occupational exposure to whole-body vibration and neck pain in the Swedish general population

The primary aim of this study was to determine if occupational exposure to whole-body vibration (WBV) was associated with reporting neck pain. A cross-sectional study was conducted on a sample of the general population living in northern Sweden, aged 24-76 years. Data was retrieved through a digital survey that collected subjectively reported information on exposure to WBV and biomechanical exposures as well as neck pain. The study included 5,017 participants (response rate 44%). Neck pain was reported by 269 men (11.8%) and 536 women (20.2%). There was a statistically significant association between reporting occupational exposure to WBV half the time or more (adjusted OR 1.91; 95% CI 1.22-3.00) and reporting neck pain. In gender-stratified analyses, the same pattern was observed in men, while there were too few women to determine any association. We conclude that occupational exposure to whole-body vibration was associated with neck pain in men.Practitioner summary: This cross-sectional, survey-based study investigated associations between self-reported occupational whole-body vibration and neck pain. It showed significant associations between frequent exposure to whole-body vibration and neck pain among men but not women. In occupational health care settings, whole-body vibration could be considered as a possible risk factor for neck pain.

Underreporting of work-related low back pain among registered nurses: A mixed method study

BACKGROUND

Identifying and addressing work-related health problems early is crucial, but workers often perceive barriers in reporting these to management. This study aimed to investigate the factors associated with nurses' reporting of work-related low back pain to their managers and explored the reasons why nurses with patient handling injuries did not report them.

METHODS

This study is a concurrent mixed-method analysis of data from two statewide cross-sectional surveys of California registered nurses conducted in 2013 and 2016. The reporting of work-related low back pain to management (n = 288) was examined for associations with individual, occupational, and organizational factors. For qualitative analysis, the reasons for not reporting patient handling injuries were explored using open-ended responses (n = 42).

RESULTS

Reporting was associated with BIPOC (Black, Indigenous, and People of Color) men (adjusted odds ratio [AOR]: 1.31, 95% confidence interval [CI]: 1.07-1.59) compared to non-Hispanic White women; being a non-US educated nurse (AOR: 0.90, 95% CI: 0.80-1.01); experiencing greater low back pain (AOR: 1.07, 95% CI: 1.02-1.12); missing work (AOR: 1.38, 95% CI: 1.21-2.62); perceiving high physical workload (AOR: 0.89, 95% CI: 0.81-0.98); perceiving high people-oriented culture (AOR: 1.14, 95% CI: 1.04-1.25); and perceiving high ergonomic practices (AOR: 0.89, 95% CI: 0.81-0.98). Identified themes on the reasons for not reporting injuries included organizational-culture attitudes toward work-related injuries and injury characteristics of musculoskeletal disorders.

CONCLUSIONS

The findings indicate a need for management to remove structural barriers and improve organizational practices, and for a culture that promotes trust and open communication between workers and management.

A New Instrument for Assessing Work-Related Body Mechanics and Strain in the General Population

Clinical pain is often linked to poor body mechanics, with individuals sometimes presenting multiple painful disorders. Such disorders may be influenced by behaviors that affect the general resiliency and health of the musculoskeletal system. We aimed to develop a self-reported scale using the Malmö Diet and Cancer Study questions on work-related body mechanical exposures. An expert panel identified 41 variables having content validity for musculoskeletal problems. Exploratory factor analysis was conducted on a random selection of 50% of the cohort (n = 6,789 adults); the remaining was reserved for confirmatory factor analyses (CFA), item response theory (IRT) item calibration, and differential item functioning investigations. Supported by standard measure development methods and fit criteria, the final unidimensional item bank contains 13 items. Overall CFA statistics (root mean square error of approximation = .09; comparative fit index = .96; Tucker-Lewis index = .96; standardized root mean residuals = .05) indicated excellent single-factor model fit and appropriateness of IRT modeling and calibration. Expert review and item information values (score-precision) guided selection of an 8-item short form with acceptable score-level reliabilities (≥.70) for T-scores = 39-80+. This measure provides reliable assessment of body mechanics strain in adults and can be useful when evaluating different contributions to musculoskeletal problems affecting pain-treatment success in future clinical research. PERSPECTIVE: This article presents the development and psychometric properties of a new measure, "Work-related Body Mechanics and Strain Scale (WR-BMSS)." The scale has 13-items or alternatively an 8-item short form. This measure could potentially help clinicians who seek to assess how musculoskeletal problems may contribute to patient pain and disability.

Influence of Job Insecurity on Musculoskeletal Disorders: A Mediation Model with Nursing Aides

Work-related musculoskeletal disorders are some of the most prevalent diseases in the world. They have a multifactorial aetiology encompassing ergonomic and psychosocial risk factors. The aim of this study is to analyse the way job insecurity and physical workload are linked to musculoskeletal disorders, as well as the mediating role other psychosocial work risks can have on this potential relationship. A parallel mediation path regression analysis was designed using a sample of 457 nursing aides. The influence job insecurity and physical workload has on the onset of musculoskeletal symptoms together with the variables which mediate this relationship were examined. The results prove that both independent variables explain the onset of musculoskeletal symptoms in these professionals. The influence exerted by job insecurity is mediated by the social support received at work and the demands of the job. However, when analysing the physical workload, the social support received at work is not relevant as a mediator in this relationship. Job insecurity and physical workload are significant variables on the occurrence of musculoskeletal symptoms. The data obtained supports the need to focus on physical and psychosocial factors in order to prevent these disorders.

The impact of different intensities and domains of physical activity on analgesic use and activity limitation in people with low back pain: a prospective cohort study with a one-year follow-up

BACKGROUND

Analgesics are the most common form of managing low back pain (LBP). No previous study has examined which domains and intensities of physical activity are most beneficial in reducing the frequency of analgesic use for LBP, and its related activity limitation.

METHODS

This cohort study forms part of the AUstralian Twin low BACK pain study, investigating the impact of physical activity on LBP. Information on demographics, LBP and health-related factors, including physical activity were collected at baseline. Data on the total counts of analgesic use and activity limitation for LBP were collected weekly for one-year. Negative binomial regression models were conducted separately for each type of physical activity. Results were presented as Incidence Rate Ratios (IRR) and 95% Confidence Intervals (CI).

RESULTS

From an initial sample of 366 participants, 86 participants reported counts of analgesic use and 140 recorded counts of activity limitation across the follow up period. The negative binomial regression models for analgesic use counts indicated moderate-vigorous physical activity (IRR 0·97, 95% C.I 0·96-0·99) and physical workload (IRR 1·02, 95% C.I 1·01-1·05) to be significant. For activity limitation counts, significant associations were shown for sedentary time (IRR 1·04, 95% C.I 1·01-1·09) and leisure activity (IRR 0·94, 95% C.I 0·81-0·99).

CONCLUSIONS

Our findings highlight the potential importance of supporting engagement in moderate-vigorous and leisure physical activity, as well as minimising sedentary time and physical workload to reduce the risk of activity limitation and the need for analgesic use in people with LBP.

The Role of Job Resources in the Relationship between Job Demands and Work-Related Musculoskeletal Disorders among Hospital Nurses in Thua Thien Hue Province, Vietnam

(1) Background: This cross-sectional study aimed to determine the moderating effect of job resources (JR) in the relationship between job demands (JD) and work-related musculoskeletal disorders (WRMSDs) among hospital nurses in the Thua Thien Hue province, Vietnam. (2) Methods: Data were collected via a self-reporting questionnaire administrated to 225 nurses from two hospitals in the Thua Thien Hue province of Vietnam from August to September 2020. The questionnaire included information on musculoskeletal symptoms, JD and JR, and the demographics and job characteristics of participants. The simple moderation analysis was used for data analysis. (3) Results: The findings indicated that 87.6% of nurses had experienced WRMSDs in at least one body region during the previous 12 months, with lower back (65.3%), neck (61.8%), and shoulders (61.8%) being the three most common sites. Physical workloads (PW) and psychological demands (PDs) were significantly correlated with WRMSDs severity (p < 0.05). This study further underlined the moderating role of coworker support (CS) on the relationship between PW and WRMSD severity. WRMSDs severity significantly increased when PW was high alongside a low level of CS. (4) Conclusions: The current study indicated that nurses should be provided with appropriate CS to minimize WRMSDs severity. Furthermore, an intervention program for managing WRMSDs in nurses may involve minimizing physical risk factors and PDs.

Inguinal hernia repair among men: development and validation of a preoperative risk score for persistent postoperative pain

PURPOSE

Persistent postoperative pain (PPP) is a prevalent complication after inguinal hernia repair. The aim of this study was to develop and validate a preoperative risk score for PPP.

METHODS

We developed the risk score based on a cohort of 2,508 Danish men, who answered a questionnaire six months after inguinal hernia repair performed 2015-2016. PPP was defined as a numerical rating scale score ≥ 2 during activity six months postoperatively. Logistic regression analyses were undertaken to determine statistically significant predictors of PPP. Univariable analysis selected potential predictors with a p value ≤ 0.20, and a subsequent multivariable model was built using backward elimination with a criterion of p value < 0.10. We created a risk score based on the β coefficients of the multivariable model. The risk score was validated internally using Hosmer-Lemeshow goodness of fit test, calibration belt test, and receiver operating characteristic curve analyses with 95% confidence intervals based on the bootstrap analysis. External validation was performed in a cohort of 293 men recruited preoperatively.

RESULTS

Predictors of PPP were age 18-49 and 50-59 (versus ≥ 60) years (p < 0.001), total load lifted > 1,000 kg/day (p = 0.001), working in a bent-over position > 1 h/day (p < 0.001), leisure-time physical activity < 2 h/week (p = 0.009), increasing body mass index (per unit) (p < 0.003), and repair of recurrent hernia (p = 0.001).The preoperative risk score predicted risks of 6-61% in the development population. The model showed good internal and external validity.

CONCLUSION

The results suggest that the risk of PPP after inguinal hernia repair can be predicted using a preoperative risk score.

Safe patient handling legislation and changes in programs, practices, perceptions, and experience of musculoskeletal disorders by hospital characteristics: A repeated cross-sectional survey study

BACKGROUND

Safe patient handling legislation has been enacted in 11 states in the United States to protect healthcare workers from patient handing injuries. Implementations and outcomes may vary across hospitals by the characteristics of the institution.

OBJECTIVES

This study was to investigate the changes in safe patient handling programs in hospitals, and nurses' perceptions, work practices, and musculoskeletal symptoms by hospital characteristics after the passage of California's safe patient handling legislation.

DESIGN

Repeated cross-sectional surveys.

SETTINGS

Two statewide surveys of registered nurses were conducted in California, where a safe patient handling law became effective in 2012. Random samples were selected from the lists of the California Board of Registered Nurses (2000 nurses in 2013 and 3000 nurses in 2016).

PARTICIPANTS

Among survey respondents (26% in 2013 and 20% in 2016), the study sample included 254 nurses in 2013 and 281 nurses in 2016, who met the eligibility for this study: nurses employed in a hospital and had direct patient care or patient handling duties.

METHODS

Data were collected by postal and on-line surveys. Data were compared by hospital size, geographic area, hospital teaching status, and ownership (for-profit, non-profit, government).

RESULTS

Between 2013 and 2016, nurses' reports showed improvements in safe patient handling policies and programs across the different characteristics of hospitals. In 2016, nurses in large, teaching, non-profit, and rural hospitals reported slightly better scores for safe patient handling program variables than their counterparts; however, changes in the use of mechanical lifting devices and experiences of musculoskeletal symptoms and injury were not significantly different by hospital characteristics. Overall, teaching hospitals consistently showed greater improvements than non-teaching hospitals for both hospital-level (safe patient handling programs and organizational practices) and individual-level (perceptions and symptoms) variables.

CONCLUSIONS

Our findings indicate overall improvements of safe patient handling programs in California hospitals after the passage of safe patient handling legislation. Positive changes appear to be greater among teaching, non-profit, and rural hospitals. However, greater positive changes in safe patient handling programs shown in certain hospital characteristics were not necessarily linked to more improvements in nurses' safe work practices and experiences of musculoskeletal symptoms or injuries.

Physical workload during caregiving activities and related factors among the caregivers of children with cerebral palsy

BACKGROUND

Caregiving demands contribute to both psychological and physical health of caregivers. Physical workload (PW) can be an important cause of musculoskeletal disorders in caregivers of children with cerebral palsy (CP).

AIMS

To investigate PW during caregiving activities and related factors among caregivers of children with CP.

METHODS

Children with CP (n = 291) and their caregivers (n = 291) were recruited for this cross-sectional study. Caregivers were categorized as their child has presence of intellectual disability (ID) and independent walking ability. Gross motor function was assessed using the Gross Motor Function Classification System (GMFCS) in children. PW; presence and distribution of musculoskeletal pain sites; levels of disability of neck, low back, arm, and leg; levels of depressive symptoms; and health-related quality of life (HRQOL) were assessed in caregivers.

RESULTS

Significant differences were observed in PW, low back pain-related disability, depressive symptoms, and HRQOL between caregivers of children with and without an ID (p < 0.05). All study variables were significantly different between caregivers of children who can and cannot independently walk (p < 0.05). PW was correlated with caregiver's age, body mass index, lower extremity dysfunction, depressive symptoms, and child's GMFCS level (p < 0.05).

CONCLUSIONS

Caregivers of a child having an ID and walking disability had higher PW. These caregivers had more problems related to musculoskeletal disorders, higher depressive symptoms, and lower HRQOL. Higher PW was associated with lower level of gross motor function of child and older age, higher body mass index, higher level of lower extremity disfunction and low back pain disability, and lower HRQOL of caregivers.

Cohort profile: the AUstralian Twin BACK pain and physical activity study (AUTBACK study)

PURPOSE

Despite the growing evidence that physical activity and familial factors play a role in low back pain (LBP), there is a lack of robust longitudinal studies that (1) investigate the types and dosages of physical activity that are protective or harmful for LBP, (2) employ objective measures of physical activity and (3) conduct appropriate adjustment for confounders. The AUstralian Twin BACK (AUTBACK) study was established to elucidate the longitudinal LBP-physical activity relationship with the benefits of controlling for familial (both genetic/nongenetic) factors that may influence physical activity engagement and LBP.

PARTICIPANTS

Participants are twins registered at Twins Research Australia (TRA), older than 18 years, with access to internet. We collected data on LBP status (weekly) and physical activity levels (monthly) for 12 months as well as a wide range of health, lifestyle and physical activity (objective, self-reported, including different types and dosages) data.

FINDINGS TO DATE

We included 401 twins, 157 being complete twin pairs (n=314). Lifetime prevalence of LBP was 85%. Participants spent 61% of their week in sedentary time and only 4% in moderate/vigorous intensity physical activity (accelerometer). So far, 168 participants (40% of the sample) have completed the 12-month follow-up. A total of 7150 weekly (LBP status) and 1763 monthly questionnaires (physical activity status) have been answered (92% response rate).

FUTURE PLANS

The 12-month follow-up will be completed by June 2020. This cohort represents a novel and comprehensive resource for researchers in the field, and includes high-quality, and frequent data on LBP and physical activity. It allows the investigation of genetic and shared environmental factors on the LBP-physical activity relationship. The AUTBACK group has planned a number of projects, with the main one being the investigation of the influence of physical activity on recurrence of LBP. Data linkage opportunities are available, including with other studies conducted by TRA.

Impact of California's safe patient handling legislation on musculoskeletal injury prevention among nurses

BACKGROUND

This study evaluated the impact of California's safe patient handling (SPH) legislation on musculoskeletal injury prevention among hospital nurses.

METHODS

Two serial cross-sectional surveys were conducted using postal and online questionnaires in statewide random samples of California registered nurses in 2013 and 2016. Analysis included hospital nurses who performed patient handling (n = 254 and n = 281, respectively).

RESULTS

In 2016, there were significant improvements in nurses' knowledge of a SPH policy in their hospital (87%), receipt of annual SPH training (73%), and availability of lift equipment (80%); 33% perceived their hospital's SPH programs as excellent or very good. Significant prevalence reduction was observed for work-related musculoskeletal symptoms (61% vs 52%; Adjusted Prevalence Ratio = 0.78, 95% CI 0.66-0.91).

CONCLUSIONS

Our findings indicate the significant role of SPH legislation with positive impacts on SPH policies and programs at the hospital level and on musculoskeletal health outcomes at the worker level.

Is occupational or leisure physical activity associated with low back pain? Insights from a cross-sectional study of 1059 participants

BACKGROUND

Low back pain is a highly prevalent and disabling musculoskeletal disorder. Physical activity is widely used as a prevention strategy for numerous musculoskeletal disorders; however, there is still conflicting evidence as to whether physical activity is a protective or risk factor for low back pain or whether activity levels differ between people with and without low back pain.

OBJECTIVE

To investigate the association between low back pain and different types (occupational and leisure) and intensities (moderate and vigorous) of physical activity.

METHODS

This is cross-sectional observational study. We included in this study a total of 1059 individuals recruited from a Spanish twin registry with data available on low back pain.

OUTCOME

Self-reported leisure and occupational physical activity were the explanatory variables. The low back pain outcome used in this study was recurrent low back pain.

RESULTS

Our results indicate that leisure physical activity is associated with a lower prevalence of recurrent low back pain. In contrast, occupational physical activity, such as carrying, lifting heavy weight while inclined, awkward postures (e.g. bending, twisting, squatting, and kneeling) are associated with a higher prevalence of recurrent low back pain. There was no statistically significant association between other occupational physical activities, such as sitting or standing, and low back pain.

CONCLUSION

Leisure and occupational physical activity are likely to have an opposed impact on low back pain. While leisure physical activity appears to be protective, occupational physical activity appears to be harmful to low back pain. Future longitudinal studies should assist in formulating guidelines addressing specific types and intensity of physical activity aimed at effectively preventing low back pain.

Validity and reliability of the Turkish version of the Physical Workload Questionnaire

BACKGROUND

Although it is necessary to regularly record and assess physical workloads in a workplace to prevent work-related musculoskeletal disorders, there is no easy to use, valid and reliable questionnaire such as the Physical Workload Questionnaire (PWQ) in Turkish.

OBJECTIVE

To linguistically and culturally adapt the PWQ into Turkish, and to examine the validity and reliability of this adapted version.

METHODS

One hundred twenty-six participants were recruited. All participants filled in the Oswestry Disability Index (ODI) and the Nordic Musculoskeletal Questionnaire. To determine test-retest reliability, all participants filled in the PWQ after a time interval of one week.

RESULTS

There was a significant difference in the PWQ indices between the participants with an occupation requires less vs. higher workload (p < 0.05). The PWQ index was significantly correlated with the proximal musculoskeletal symptoms (ρ= 0.301, p < 0.05), but not significantly correlated with distal musculoskeletal symptoms (ρ= 0.121, p > 0.05). The PWQ index was significantly correlated with the ODI (ρ= 0.193, p < 0.05). The internal consistency of the PWQ was excellent (α= 0.865) and item-total correlations were acceptable. Test-retest reliability was high (ICC = 0.865).

CONCLUSIONS

The PWQ is the unique valid and reliable questionnaire available in Turkish for assessing physical workload due to body posture and strenuous effort during work.

Protective and Harmful Effects of Physical Activity for Low Back Pain: A Protocol for the AUstralian Twin BACK Pain (AUTBACK) Feasibility Study

Low back pain (LBP) is a major health problem globally, but approaches to prevention are not yet clearly identified because modifiable risk factors are not well established. Although physical activity is one promising modifiable risk factor, it is still not known what types and doses of physical activity are protective or harmful for LBP. The aim of this study is to establish the feasibility of a definitive cohort study that will investigate the effects of different types and doses of physical activity on the risk of developing recurrent LBP while accounting for genetic factors. This will be a pilot longitudinal twin study and twins will be recruited from the Australian Twin Registry, and will be followed over 1 year. Thirty adult complete twin pairs with a history of LBP, but symptom free at recruitment, will be included. Data on physical activity (predictor) will be collected using four questionnaires and an objective measure (accelerometer) at baseline and at 6-month follow-up. Twins will also complete an additional physical activity questionnaire monthly. Data on LBP (outcome) will be collected at baseline and weekly. Data will be collected using short message service (SMS) and email. We will keep records of the recruitment rate, follow-up rate, and completeness of data. Barriers to completing the study will be investigated. The results of this study will inform the design and implementation of a future definitive study, which will help to clarify the effects of different types and doses of physical activity on the risk of developing recurrent LBP.

The Brazilian Twin Registry

The Brazilian Twin Registry (BTR) was established in 2013 and has impelled twin research in South America. The main aim of the initiative was to create a resource that would be accessible to the Brazilian scientific community as well as international researchers interested in the investigation of the contribution of genetic and environmental factors in the development of common diseases, phenotypes, and human behavior traits. The BTR is a joint effort between academic and governmental institutions from Brazil and Australia. The collaboration includes the Federal University of Minas Gerais (UFMG) in Brazil, the University of Sydney and University of Melbourne in Australia, the Australian Twin Registry, as well as the research foundations CNPq and CAPES in Brazil. The BTR is a member of the International Network of Twin Registries. Recruitment strategies used to register twins have been through participation in a longitudinal study investigating genetic and environmental factors for low back pain occurrence, and from a variety of sources including media campaigns and social networking. Currently, 291 twins are registered in the BTR, with data on demographics, zygosity, anthropometrics, and health history having been collected from 151 twins using a standardized self-reported questionnaire. Future BTR plans include the registration of thousands of Brazilian twins identified from different sources and collaborate nationally and internationally with other research groups interested on twin studies.

The prevalence differences of musculoskeletal problems and related physical workload among hospital staff

BACKGROUND

The musculoskeletal problems (MSP) vary among different occupations since they had different characteristics and physical workloads. Therefore, it is important to know the difference between the occupational groups to design preventing physiotherapy interventions.

OBJECTIVE

To investigate the prevalence differences of MSPs and related physical workload among hospital staff.

METHODS

In this cross-sectional study, 416 hospital staff completed the Nordic Musculoskeletal Questionnaire for MSP and Physical Workload Questionnaire for assessing the physical workload.

RESULTS

One-year prevalence of low back, neck, upper back, and shoulders were 73.8%, 59.9%, 59.4%, and 52.2%, respectively. The most preventing MSPs from work found in the low back (39.2%), upper back (26.7%), and the neck (24.5%). MSP of low back impacted nurses the most with a 1-year prevalence of 81.3% and 57.1% of nurses were prevented from working. Nurses, service and cleaning staff had significantly more physical workload than secretaries and physicians.

CONCLUSIONS

MSP of low back had the highest prevalence among hospital staff and it was the leading cause which prevented from working. Nurses were the most in danger in terms of MSPs among hospital staff. Physical workload was significantly higher in nurses, service and cleaning staff than secretaries and physicians.

Risk Factors for Low Back Disorders in Saskatchewan Farmers: Field-based Exposure Assessment to Build a Foundation for Epidemiological Studies

BACKGROUND

Studies of many geographical settings and agricultural commodities show that low back disorders are an important public health issue among farmers, who represent a special rural population. However, few studies have examined the impact of low back disorders on farmers' work or the strategies that they adopt to avoid associated pain and disability.

OBJECTIVE

This study protocol will investigate 3 issues related to low back disorders in Saskatchewan farmers: (1) the vibration, heavy lifting, and awkward postures farmers encounter during their work that might contribute to low back disorders; (2) the impact low back disorders have on farmers in terms of their ability to work; and (3) the types of preventative measures and solutions that farmers implement to reduce the occurrence of low back pain.

METHODS

To answer these questions, researchers will travel to 30 farms to make measurements of vibration, lifting, and posture during the farmers' regular work tasks. Farmers will be interviewed about any pain and/or disability using standardized interview questions. Farmers will also be asked about safety measures they have implemented at their farm, such as modified tools or equipment, to reduce the occurrence of low back disorders or pain.

RESULTS

Data collection is currently underway for this study, with the intention to complete all data collection and analysis by the end of 2018.

CONCLUSIONS

Occupational determinants of health such as vibration, heavy lifting, and awkward postures are important in the development and progression of low back disorders, and the results of this study will allow for cost-effective epidemiological studies of these determinants in the future. In identifying prevention strategies, this study will also facilitate future research evaluating the effectiveness of safety measures.

Occupational factors associated with obesity and leisure-time physical activity among nurses: A cross sectional study

BACKGROUND AND OBJECTIVE

Adverse working conditions contribute to obesity and physical inactivity. The purpose of this study was to examine the associations of occupational factors with obesity and leisure-time physical activity among nurses.

METHODS

This study used cross-sectional data of 394 nurses (mean age 48 years, 91% females, 61% white) randomly selected from the California Board of Registered Nursing list. Data on demographic and employment characteristics, musculoskeletal symptom comorbidity, physical and psychosocial occupational factors, body mass index (BMI), and physical activity were collected using postal and on-line surveys from January to July in 2013.

RESULTS

Of the participants, 31% were overweight and 18% were obese; 41% engaged in regular aerobic physical activity (≥ 150 min/week) and 57% performed regular muscle-strengthening activity (≥ 2 days/week). In multivariable logistic regression models, overweight/obesity (BMI ≥ 25 kg/m(2)) was significantly more common among nurse managers/supervisors (OR=2.54, 95% CI: 1.16-5.59) and nurses who worked full-time (OR=2.18, 95% CI: 1.29-3.70) or worked ≥ 40 h per week (OR=2.53, 95% CI: 1.58-4.05). Regular aerobic physical activity was significantly associated with high job demand (OR=1.63, 95% CI: 1.06-2.51). Nurses with passive jobs (low job demand combined with low job control) were significantly less likely to perform aerobic physical activity (OR=0.49, 95% CI: 0.26-0.93). Regular muscle-strengthening physical activity was significantly less common among nurses working on non-day shifts (OR=0.55, 95% CI: 0.34-0.89). Physical workload was not associated with obesity and physical activity.

CONCLUSIONS

Our study findings suggest that occupational factors significantly contribute to obesity and physical inactivity among nurses. Occupational characteristics in the work environment should be considered in designing effective workplace health promotion programs targeting physical activity and obesity among nurses.

Cross-national validation of prognostic models predicting sickness absence and the added value of work environment variables

PURPOSE

To validate Dutch prognostic models including age, self-rated health and prior sickness absence (SA) for ability to predict high SA in Danish eldercare. The added value of work environment variables to the models' risk discrimination was also investigated.

METHODS

2,562 municipal eldercare workers (95% women) participated in the Working in Eldercare Survey. Predictor variables were measured by questionnaire at baseline in 2005. Prognostic models were validated for predictions of high (≥30) SA days and high (≥3) SA episodes retrieved from employer records during 1-year follow-up. The accuracy of predictions was assessed by calibration graphs and the ability of the models to discriminate between high- and low-risk workers was investigated by ROC-analysis. The added value of work environment variables was measured with Integrated Discrimination Improvement (IDI).

RESULTS

1,930 workers had complete data for analysis. The models underestimated the risk of high SA in eldercare workers and the SA episodes model had to be re-calibrated to the Danish data. Discrimination was practically useful for the re-calibrated SA episodes model, but not the SA days model. Physical workload improved the SA days model (IDI = 0.40; 95% CI 0.19-0.60) and psychosocial work factors, particularly the quality of leadership (IDI = 0.70; 95% CI 053-0.86) improved the SA episodes model.

CONCLUSIONS

The prognostic model predicting high SA days showed poor performance even after physical workload was added. The prognostic model predicting high SA episodes could be used to identify high-risk workers, especially when psychosocial work factors are added as predictor variables.

An exploratory study of the effects of occupational exposure to physical demands on biomarkers of cartilage and muscle damage

Biomarkers of tissue damage, derived from tissues commonly injured as a result of occupational physical demands, may be of use for future prediction of work-related musculoskeletal disorders (WMSDs). This exploratory study assessed whether selected biomarkers are likely to be sensitive to the level of occupational physical demands. Twenty-four participants were recruited to form two groups, with relatively high and low levels of WMSD risk. Serum levels of Cartilage Oligomeric Matrix Protein (COMP), Interleukin-6 (IL6), and Creatine Kinase (CK)--which respectively indicate cartilage damage, muscle use, and muscle damage--were obtained,. Six blood samples were obtained before and after work on Monday, Wednesday, and Friday of one working week. Additionally, a self-report measure of risk factor exposure, the Hollmann Index, was used to, and did, confirm group differences in WMSD risk. COMP levels varied significantly over time, but not between groups. IL6 levels were greater in the high-risk group at all time points and varied significantly over time and between groups. CK levels did not vary significantly over time or between groups. IL6 successfully differentiated between the high and low risk groups, suggesting potential use in the occupational domain. Prospective studies are needed, though, to associate biomarker levels/changes with WMSD risk.

Influence of lifestyle factors on long-term sickness absence among female healthcare workers: a prospective cohort study

Background

While previous research has indicated that unhealthy lifestyle is associated with sickness absence, this association may be confounded by occupational class. To avoid this potential confounding, we examined the association between lifestyle factors (smoking, leisure-time physical activity and body mass index) and the occurrence of long-term sickness absence (LTSA; more than three consecutive weeks of registered sickness absence) within a cohort of female health care workers.

Methods

A total of 7401 employees filled out a questionnaire about their health behaviour and work environment. Subsequently, they were followed for 12 months in a national register on social transfer payments (DREAM register). Cox’s regression analyses, applied to grouped survival data, were used to estimate the prospective association between these lifestyle factors and LTSA.

Results

We found significant associations between all three lifestyle factors and risk of LTSA. The strongest lifestyle factor was current smoking, which increased the risk of LTSA by 35% (95% CI: 1.17-1.54) compared to non- smokers. For body mass index, the risk of LTSA increased with the distance away from 18.5 kg/m² in either direction (below 18.5 kg/m²: HR: 1.32 per kg/m²; 95% CI. 1.06-1.66; above 18.5 kg/m²: HR: 1.04 per kg/m²; 95% CI: 1.03-1.05). In other words, the more underweight or overweight the women were, the higher the risk of LTSA. A dose–response relationship was found between LTSA and leisure-time physical activity (trend test p-value = 0.01), so that increasing physical activity results in decreasing risk of LTSA.

Conclusion

In female healthcare workers, an unhealthy lifestyle (too high/ too low body mass index, smoking, and low physical activity) is associated with higher risk of LTSA.

A prospective cohort study of neck and shoulder pain in professional drivers

In a three-year follow-up study, the occurrence of neck and shoulder pain (NSP) in terms of frequency, duration and intensity was investigated in a population of 537 male professional drivers. Over the follow-up period, the cumulative incidences for neck and shoulder pain were 31.9% and 21.4%, respectively. After adjustment for potential confounders, a measure of cumulative whole-body vibration exposure was significantly associated with all NSP outcomes. Lifting loads and work with hands above shoulder level were significantly related to shoulder outcomes, while driving with trunk bent or twisted was associated with neck pain. Limited job decision, low social support and job dissatisfaction were significant predictors of neck outcomes. Psychological distress was associated with all NSP outcomes. The findings of this cohort study suggest that NSP outcomes are of multifactorial origin in driving occupations.

PRACTITIONER SUMMARY

This prospective cohort study highlighted the multifactorial nature of neck and shoulder pain (NSP) outcomes in a population of professional drivers. Cumulative whole-body vibration exposure, physical load factors and adverse psychosocial environment at the workplace, as well as individual-related psychological distress, were significant predictors of the occurrence of NSP in the professional drivers.

Reliability and validity of the Home Care STAT (Safety Task Assessment Tool)

Home care workers are a priority population for ergonomic assessment and intervention, but research on caregivers' exposures to hazards is limited. The current project evaluated the reliability and validity of an ergonomic self-assessment tool called Home Care STAT (Safety Task Assessment Tool). Participants (N = 23) completed a background survey followed by 10-14 days of self-monitoring with the STAT. Results showed that the most frequent task was house cleaning, and that participants regularly performed dangerous manual client moving and transferring tasks. Researcher in-home observations of 14 workers (duration ≤ 2 h) demonstrated that workers' self-assessments were moderately reliable. Correlational and multi-level analyses of daily self-assessment data revealed that several task exposures were significantly related to daily fatigue and/or pain. Other associations have implications for Total Worker Health™; for example, daily stress was positively associated with both pain and consumption of high calorie snacks. Findings support the STAT as a reliable and potentially valid tool for measuring home care workers' exposures to physically demanding tasks.

A physical workload index to evaluate a safe resident handling program for nursing home personnel

OBJECTIVE

The aim of this study was to obtain a comprehensive analysis of the physical workload of clinical staff in long-term care facilities, before and after a safe resident handling program (SRHP).

BACKGROUND

Ergonomic exposures of health care workers include manual handling of patients and many non-neutral postures. A comprehensive assessment requires the integration of loads from these varied exposures into a single metric.

METHOD

The Postures, Activities, Tools, and Handling observational protocol, customized for health care, was used for direct observations of ergonomic exposures in clinical jobs at 12 nursing homes before the SRHP and 3, 12, 24, and 36 months afterward. Average compressive forces on the spine were estimated for observed combinations of body postures and manual handling and then weighted by frequencies of observed time for the combination. These values were summed to obtain a biomechanical index for nursing assistants and nurses across observation periods.

RESULTS

The physical workload index (PWI) was much higher for nursing assistants than for nurses and decreased more after 3 years (-24% versus -2.5%). Specifically during resident handling, the PWI for nursing assistants decreased by 41% of baseline value.

CONCLUSION

Spinal loading was higher for nursing assistants than for nurses in long-term care centers. Both job groups experienced reductions in physical loading from the SRHP, especially the nursing assistants and especially while resident handling.

APPLICATION

The PWI facilitates a comprehensive investigation of physical loading from both manual handling and non-neutral postures. It can be used in any work setting to identify high-risk tasks and determine whether reductions in one exposure are offset by increases in another.

Job stress and work-related musculoskeletal symptoms among intensive care unit nurses: a comparison between job demand-control and effort-reward imbalance models

BACKGROUND

The aims of this study were to compare job demand-control (JDC) and effort-reward imbalance (ERI) models in examining the association of job stress with work-related musculoskeletal symptoms and to evaluate the utility of a combined model.

METHODS

This study analyzed cross-sectional survey data obtained from a nationwide random sample of 304 intensive-care unit (ICU) nurses. Demographic and job factors were controlled in the analyses using logistic regression.

RESULTS

Both JDC and ERI variables had strong and statistically significant associations with work-related musculoskeletal symptoms. Effort-reward imbalance had stronger associations than job strain or iso-strain with musculoskeletal symptoms. Effort-reward imbalance alone showed similar or stronger associations with musculoskeletal symptoms compared to combined variables of the JDC and ERI models.

CONCLUSIONS

The ERI model appears to capture the magnitude of the musculoskeletal health risk among nurses associated with job stress at least as well and possibly better than the JDC model. Our findings suggest that combining the two models provides little gain compared to using effort-reward imbalance only.

Prevention of low back pain and its consequences among nurses' aides in elderly care: a stepped-wedge multi-faceted cluster-randomized controlled trial

BACKGROUND

A high prevalence of low back pain has persisted over the years despite extensive primary prevention initiatives among nurses' aides. Many single-faceted interventions addressing just one aspect of low back pain have been carried out at workplaces, but with low success rate. This may be due to the multi-factorial origin of low back pain. Participatory ergonomics, cognitive behavioral training and physical training have previously shown promising effects on prevention and rehabilitation of low back pain. Therefore, the main aim of this study is to examine whether a multi-faceted workplace intervention consisting of participatory ergonomics, physical training and cognitive behavioral training can prevent low back pain and its consequences among nurses' aides. External resources for the participating workplace and a strong commitment from the management and the organization support the intervention.

METHODS/DESIGN

To overcome implementation barriers within usual randomized controlled trial designed workplace interventions, this study uses a stepped-wedge cluster-randomized controlled trial design with 4 groups. The intervention is delivered to the groups at random along four successive time periods three months apart. The intervention lasts three months and integrates participatory ergonomics, physical training and cognitive behavioral training tailored to the target group. Local physiotherapists and occupational therapists conduct the intervention after having received standardized training. Primary outcomes are low back pain and its consequences measured monthly by text messages up to three months after initiation of the intervention.

DISCUSSION

Intervention effectiveness trials for preventing low back pain and its consequences in workplaces with physically demanding work are few, primarily single-faceted, with strict adherence to a traditional randomized controlled trial design that may hamper implementation and compliance, and have mostly been unsuccessful. By using a stepped wedge design, and obtain high management commitment and support we intend to improve implementation and aim to establish the effectiveness of a multi-faceted intervention to prevent low back pain. This study will potentially provide knowledge of prevention of low back pain and its consequences among nurses' aides. Results are expected to be published in 2015-2016.

TRIAL REGISTRATION

The study is registered as ISRCTN78113519.

Should physical activity recommendation depend on state of low back pain?

BACKGROUND

Leisure time physical activity is recommended for preventing long-term sickness absence (LTSA). Although low back pain (LBP) is a risk factor for sickness absence and physical activity is recommended for people with LBP, it is unknown if leisure time physical activity prevents LTSA among persons with different levels of LBP.

METHODS

Prospective cohort study among 8655 Danish female healthcare workers responding to a questionnaire in 2004-2005 on leisure time physical activity and LBP, and subsequently followed for 1 year on periods with LTSA ∼2 consecutive weeks or more of sickness absence in a national register of social transfer payments (DREAM). Multi-adjusted Cox regression analysis was used to model risk estimates for LTSA associated with low, moderate, high and very high leisure time physical activity at baseline among healthcare workers with no LBP (0 days past 12 months, n = 2761), non-chronic LBP (1-30 days the past 12 months, n = 3942) and persistent LBP (>30 days the past 12 months, n = 1952).

RESULTS

A strongly reduced risk for LTSA from high leisure time physical activity was found among healthcare workers with no LBP [hazard ratio (HR): 95% confidence interval (CI) 0.47:0.23-0.97 for low vs. very high activity] and non-chronic LBP (HR: 95%CI 0.43:0.23-0.84 of low vs. very high activity), but not among healthcare workers with persistent LBP (HR: 95%CI 1.15:0.55-2.44 of low vs. very high activity).

CONCLUSIONS

Leisure time physical activity is a strong predictive factor on LTSA among female healthcare workers with no and non-chronic LBP, but not among those with more persistent LBP.

Independent effect of physical workload and childhood socioeconomic status on low back pain among health care workers in Denmark

STUDY DESIGN

Prospective cohort study.

OBJECTIVE

To investigate the independent effect of physical workload and childhood socioeconomic status (CSES) on low back pain (LBP) and LBP-related sickness absence among female health care workers.

SUMMARY OF BACKGROUND DATA

The role of physical workload on LBP independently from CSES is still subject to controversy.

METHODS

We used questionnaire data from 1661 female social and health care workers responding to a questionnaire in 2004, 2005, and 2006. We collected information on CSES (parental occupation), physical workload, and LBP-prevalence (no LBP, subchronic LBP, and frequent LBP), and LBP-related sickness absence. The participants were categorized into 5 groups according to CSES (I = highest, V = lowest). Data were analyzed using logistic regression analysis.

RESULTS

Irrespective of CSES, high physical workload increased the odds ratio (OR) of future subchronic LBP (OR = 2.03; 95% confidence interval [CI], 1.61-2.57) and frequent LBP (OR = 2.20; 95% CI, 1.65-3.00), but not LBP-related sickness absence. The odds of subchronic LBP were lower in CSES groups II (OR = 0.62; 95% CI, 0.42-0.93) and III (OR = 0.58; 95% CI, 0.39-0.86) referencing CSES group I, irrespective of physical workload. The odds of short-term LBP-related sickness absence were higher in CSES groups III (OR = 2.78; 95% CI, 1.41-5.47) and IV (OR = 2.18; 95% CI, 1.11-4.27) referencing CSES group I, irrespective of physical workload. We found no interaction between physical workload and CSES.

CONCLUSION

Physical workload and CSES are independently associated with future LBP within a group with similar occupational status.

LEVEL OF EVIDENCE

N/A.

Does self-assessed physical capacity predict development of low back pain among health care workers? A 2-year follow-up study

STUDY DESIGN

Prospective cohort study.

OBJECTIVE

To determine the prognostic value of self-assessed physical capacity for the development of low back pain (LBP) among female health care workers without LBP.

SUMMARY OF BACKGROUND DATA

High physical capacities in terms of strength, endurance, flexibility, and balance are assumed to prevent LBP among persons with high physical work demands. However, the few existing studies investigating this relationship show contrasting findings.

METHODS

Female health care workers answered a questionnaire about physical capacity in 2004, and days with LBP in 2005 and 2006. The odds ratios (ORs) for developing nonchronic (1-30 d of the past 12 mo) and persistent (>30 d of the past 12 mo) LBP in 2006 from self-assessed physical capacity were investigated with multiadjusted logistic regressions among female health care workers without LBP in 2005 (n = 1612).

RESULTS

Health care workers with low and medium physical capacity had increased risk of developing nonchronic LBP (OR = 1.52 [CI = 1.05-2.20] and OR = 1.37 [CI = 1.01-1.84], respectively), and health care workers with low physical capacity had an increased risk of developing persistent LBP (OR = 2.13 [CI = 1.15-3.96]), referencing those with high physical capacity.

CONCLUSION

Self-assessed low physical capacity is a strong predictor for developing nonchronic and persistent LBP among pain-free female health care workers. Future intervention studies should investigate whether increased physical capacity, for example, through exercise training prevents development of LBP among female health care workers.

Psychosocial work environment factors and weight change: a prospective study among Danish health care workers

Background

Lifestyle variables may serve as important intermediate factors between psychosocial work environment and health outcomes. Previous studies, focussing on work stress models have shown mixed and weak results in relation to weight change. This study aims to investigate psychosocial factors outside the classical work stress models as potential predictors of change in body mass index (BMI) in a population of health care workers.

Methods

A cohort study, with three years follow-up, was conducted among Danish health care workers (3982 women and 152 men). Logistic regression analyses examined change in BMI (more than +/− 2 kg/m²) as predicted by baseline psychosocial work factors (work pace, workload, quality of leadership, influence at work, meaning of work, predictability, commitment, role clarity, and role conflicts) and five covariates (age, cohabitation, physical work demands, type of work position and seniority).

Results

Among women, high role conflicts predicted weight gain, while high role clarity predicted both weight gain and weight loss. Living alone also predicted weight gain among women, while older age decreased the odds of weight gain. High leadership quality predicted weight loss among men. Associations were generally weak, with the exception of quality of leadership, age, and cohabitation.

Conclusion

This study of a single occupational group suggested a few new risk factors for weight change outside the traditional work stress models.

Threshold of musculoskeletal pain intensity for increased risk of long-term sickness absence among female healthcare workers in eldercare

PURPOSE

Musculoskeletal disorders increase the risk for absenteeism and work disability. However, the threshold when musculoskeletal pain intensity significantly increases the risk of sickness absence among different occupations is unknown. This study estimates the risk for long-term sickness absence (LTSA) from different pain intensities in the low back, neck/shoulder and knees among female healthcare workers in eldercare.

METHODS

Prospective cohort study among 8,732 Danish female healthcare workers responding to a questionnaire in 2004-2005, and subsequently followed for one year in a national register of social transfer payments (DREAM). Using Cox regression hazard ratio (HR) analysis we modeled risk estimates of pain intensities on a scale from 0-9 (reference 0, where 0 is no pain and 9 is worst imaginable pain) in the low back, neck/shoulders and knees during the last three months for onset of LTSA (receiving sickness absence compensation for at least eight consecutive weeks) during one-year follow-up.

RESULTS

During follow-up, the 12-month prevalence of LTSA was 6.3%. With adjustment for age, BMI, smoking and leisure physical activity, the thresholds of pain intensities significantly increasing risk of LTSA for the low back (HR 1.44 [95%CI 1.07-1.93]), neck/shoulders (HR 1.47 [95%CI 1.10-1.96]) and knees (HR 1.43 [95%CI 1.06-1.93]) were 5, 4 and 3 (scale 0-9), respectively, referencing pain intensity of 0.

CONCLUSION

The threshold of pain intensity significantly increasing the risk for LTSA among female healthcare workers varies across body regions, with knee pain having the lowest threshold. This knowledge may be used in the prevention of LTSA among health care workers.

The greatest risk for low-back pain among newly educated female health care workers; body weight or physical work load?

Background

Low back pain (LBP) represents a major socioeconomic burden for the Western societies. Both life-style and work-related factors may cause low back pain. Prospective cohort studies assessing risk factors among individuals without prior history of low back pain are lacking. This aim of this study was to determine risk factors for developing low back pain (LBP) among health care workers.

Methods

Prospective cohort study with 2,235 newly educated female health care workers without prior history of LBP. Risk factors and incidence of LBP were assessed at one and two years after graduation.

Results

Multinomial logistic regression analyses adjusted for age, smoking, and psychosocial factors showed that workers with high physical work load had higher risk for developing LBP than workers with low physical work load (OR 1.8; 95% CI 1.1–2.8). In contrast, workers with high BMI were not at a higher risk for developing LBP than workers with a normal BMI.

Conclusion

Preventive initiatives for LBP among health care workers ought to focus on reducing high physical work loads rather than lowering excessive body weight.

Does occupational lifting and carrying among female health care workers contribute to an escalation of pain-day frequency?

BACKGROUND

The aim of the study was to investigate if different frequencies, loads and trunk postures of occupational lifting and carrying increases the risk of sub-chronic (1-30 days last 12 months) low back pain (LBP) to become persistent (>30 days last 12 months) among female health care workers.

METHODS

Female health care workers answered a questionnaire about occupational lifting or carrying frequency (rarely, occasionally and frequently), load (low: 1-7 kg, moderate: 8-30 kg and heavy: >30 kg) and trunk posture (upright or forward bent back), and days with LBP in 2005 and 2006.

RESULTS

The odds ratio (OR) for developing persistent LBP in 2006 from these characteristics of occupational lifting and carrying was investigated with multi-adjusted logistic regressions among female health care workers with sub-chronic LBP (n = 2381) in 2005. Among health care workers with sub-chronic LBP, increased risk of persistent LBP was found from frequently lifting or carrying with forward bent back of moderate loads (OR: 1.63; 95% CI: 1.15-2.33) and heavy loads (OR: 1.56; 95% CI: 1.04-2.34). No increased risk for LBP to develop into a persistent condition was found for frequent lifting with upright back, frequent lifting or carrying of light loads, or occasionally lifting or carrying of any loads.

CONCLUSIONS

Preventive initiatives for sub-chronic LBP to develop into a persistent condition ought to focus on reducing frequent lifting and carrying of moderate and heavy loads with forward bent back.

Spreading of chronic pain between body regions: prospective cohort study among health care workers

OBJECTIVE

To estimate the prognostic value of pain in one body region on the risk for developing chronic pain in other body regions.

METHODS

Prospective cohort study among 5052 Danish female health care workers responding to a baseline and follow-up questionnaire in 2005 and 2006, respectively. Using adjusted logistic regression analysis, the risk for developing chronic pain (>30 days last year) at follow-up in the low back (among those without low back pain during the last year at baseline) when experiencing sub-chronic (1-30 days last year) or chronic pain in other body regions (i.e., the neck/shoulders and/or the knees at baseline) was modelled. Similar risks were modelled for developing chronic pain in the neck/shoulders and knees.

RESULTS

Chronic pain in the neck/shoulders (OR 3.14; 95% CI 1.74-5.70) or knees (OR 2.57; 95% CI 1.28-5.16) at baseline increased the risk for developing chronic pain in the low back at follow-up. Likewise, chronic pain in the neck/shoulders (OR 2.39; 95% CI 1.36-4.17) or low back (OR 1.82 95%; CI 1.07-3.09) at baseline increased the risk for developing chronic pain in the knees at follow-up. The risk for developing chronic neck/shoulder pain was not significantly increased when having pain in the low back or knees at baseline.

CONCLUSION

Among health care workers, chronic musculoskeletal pain in one body region increases the risk for developing chronic pain in other pain-free body regions. Prevention of musculoskeletal disorders among health care workers should focus holistically on the musculoskeletal system.

Factors associated with safe patient handling behaviors among critical care nurses

BACKGROUND

Patient handling is a major risk factor for musculoskeletal (MS) injury among nurses. The aims of the study were to describe nurses' work behaviors related to safe patient handling and identify factors influencing their safe work behaviors, including the use of lifting equipment.

METHODS

A cross-sectional study using a mailed questionnaire with a nationwide random sample of 361 critical care nurses. Nurses reported on the physical, psychosocial, and organizational characteristics of their jobs and on their MS symptoms, risk perception, work behaviors, and demographics. Hierarchical multiple linear regression analyses were used to identify significant factors.

RESULTS

More than half of participants had no lifting equipment on their unit, and 74% reported that they performed all patient lift or transfer tasks manually. Significant factors for safer work behavior included better safety climate, higher effort-reward imbalance, less overcommitment, greater social support, and day shift work. Physical workload, personal risk perception, or MS symptom experiences were not associated with safe work behavior.

CONCLUSIONS

Safe work behaviors are best understood as socio-cultural phenomena influenced by organizational, psychosocial, and job factors but, counter to extant theories of health behaviors, do not appear to be related to personal risk perception. Management efforts to improve working conditions and enhance safety culture in hospitals could prove to be crucial in promoting nurses' safe work behavior and reducing risk of MS injury.

The predictive effect of fear-avoidance beliefs on low back pain among newly qualified health care workers with and without previous low back pain: a prospective cohort study

BACKGROUND

Health care workers have a high prevalence of low back pain (LBP). Although physical exposures in the working environment are linked to an increased risk of LBP, it has been suggested that individual coping strategies, for example fear-avoidance beliefs, could also be important in the development and maintenance of LBP. Accordingly, the main objective of this study was to examine (1) the association between physical work load and LBP, (2) the predictive effect of fear-avoidance beliefs on the development of LBP, and (3) the moderating effect of fear-avoidance beliefs on the association between physical work load and LBP among cases with and without previous LBP.

METHODS

A questionnaire survey among 5696 newly qualified health care workers who completed a baseline questionnaire shortly before completing their education and a follow-up questionnaire 12 months later. Participants were selected on the following criteria: (a) being female, (b) working in the health care sector (n = 2677). Multinomial logistic regression analysis was used to evaluate the effect of physical work load and fear-avoidance beliefs on the severity of LBP.

RESULTS

For those with previous LBP, physical work load has an importance, but not among those without previous LBP. In relation to fear-avoidance beliefs, there is a positive relation between it and LBP of than 30 days in both groups, i.e. those without and with previous LBP. No moderating effect of fear-avoidance beliefs on the association between physical work load and LBP was found among cases with and without LBP.

CONCLUSION

Both physical work load and fear-avoidance beliefs matters in those with previous LBP. Only fear-avoidance beliefs matters in those without previous LBP. The study did not find a moderating effect of fear-avoidance beliefs on the association between physical work load and LBP.

Musculoskeletal complaints among nurses related to patient handling tasks and psychosocial factors--based on logbook registrations

The aims were to evaluate the inter-method reliability of a registration sheet for patient handling tasks, to study the day-to-day variation of musculoskeletal complaints (MSC) and to examine whether patient handling tasks and psychosocial factors were associated with MSC. Nurses (n=148) fulfilled logbooks for three consecutive working days followed by a day off. Low back pain (LBP), neck/shoulder pain (NSP), knee pain (KP), psychosocial factors (time pressure, stress, conscience of the quality of work) and patient transfers and care tasks were reported. The logbook was reliable for both transfer and care tasks. The numbers of nurses reporting MSC and the level of pain increased significantly during the three working days (15%-30% and 17%-37%, respectively) and decreased on the day off. Stress and transfer task were associated with LPB and transfer tasks were associated with KP. Our results confirm a relationship between work factors and MSC and indicate that logs could be one way to obtain a better understanding of the complex interaction of various nursing working conditions in relation to MSC.

Predictors of severe trunk postures among short-haul truck drivers during non-driving tasks: an exploratory investigation involving video-assessment and driver behavioural self-monitoring

Short-haul truck (lorry) drivers are particularly vulnerable to back pain and injury due to exposure to whole body vibration, prolonged sitting and demanding material handling tasks. The current project reports the results of video-based assessments (711 stops) and driver behavioural self-monitoring (BSM) (385 stops) of injury hazards during non-driving work. Participants (n = 3) worked in a trailer fitted with a camera system during baseline and BSM phases. Descriptive analyses showed that challenging customer environments and non-standard ingress/egress were prevalent. Statistical modelling of video-assessment results showed that each instance of manual material handling increased the predicted mean for severe trunk postures by 7%, while customer use of a forklift, moving standard pallets and moving non-standard pallets decreased predicted means by 12%, 20% and 22% respectively. Video and BSM comparisons showed that drivers were accurate at self-monitoring frequent environmental conditions, but less accurate at monitoring trunk postures and rare work events. The current study identified four predictors of severe trunk postures that can be modified to reduce risk of injury among truck drivers and showed that workers can produce reliable self-assessment data with BSM methods for frequent and easily discriminated events environmental.