This is the second of two papers that systematically review available scientific evidence on the causes of disability from occupational low back pain, and the effectiveness of interventions to prevent it after its onset (secondary prevention). This paper reviews the national history of how back pain and the risk factors for its extension into chronic disability, followed by a critical summary of intervention studies attempting to reduce the duration of this disability, and to evaluate the results.

Disability resulting from occupational low back pain. Part II: What do we know about secondary prevention? A review of the scientific evidence on prevention after disability begins.

OBJECTIVE--To investigate the risk factors for low back pain in hospital nurses, with particular emphasis on the role of specific nursing activities. METHODS--A cross sectional survey of 2405 nurses employed by a group of teaching hospitals was carried out. Self administered questionnaires were used to collect information about occupational activities, non-occupational risk factors for back symptoms, and history of low back pain. RESULTS--The overall response rate was 69%. Among 1616 women, the lifetime prevalence of back pain was 60% and the one year period prevalence 45%. 10% had been absent from work because of back pain for a cumulative period exceeding four weeks. Rates in men were generally similar to those in women. In women back pain during the previous 12 months was weakly associated with height, and was significantly more common in those who reported frequent non-musculoskeletal symptoms such as headache and low mood. After adjustment for height and non-musculoskeletal symptoms, significant associations were found with frequency of manually moving patients around on the bed, manually transferring patients between bed and chair, and manually lifting patients from the floor. In contrast, no clear increase in risk was found in relation to transfer of patients with canvas and poles, manually lifting patients in and out of the bath, or lifting patients with mechanical aids. Confirmation of these findings is now being sought in a prospective study of the same population. CONCLUSIONS--This study confirms that low back pain is highly prevalent among nurses and is associated with a high level of sickness absence. People who often report non-musculoskeletal symptoms were significantly more likely to report low back pain. Specific manual handling tasks were associated with an increased risk of back pain; however, no such association was found with mechanised patient transfers.

https://oem.bmj.com/content/oemed/52/3/160.full.pdf

Manual handling activities and risk of low back pain in nurses.

Although patient handlers suffer from low-back injuries at an alarming rate worldwide, there has been limited research quantifying the risk for the specific tasks performed by the patient handlers. The current study used both a comprehensive evaluation system (low-back disorder risk model) and theoretical model (biomechanical spinal loading model) to evaluate risk of LBD of 17 participants (12 experienced and five inexperienced) performing several patient handling tasks. Eight of the participants were female and nine were male. Several patient transfers were evaluated as well as repositioning of the patient in bed; these were performed with one and two people. The patient transfers were between bed and wheelchair (fixed and removable arms) and between commode chair and hospital chair. A 'standard' patient (a 50 kg co-operative female; non-weight bearing but had use of upper body) was used in all patient handling tasks. Overall, patient handling was found to be an extremely hazardous job that had substantial risk of causing a low-back injury whether with one or two patient handlers. The greatest risk was associated with the one-person transferring techniques with the actual task being performed having a limited effect. The repositioning techniques were found to have significant risk of LBD associated with them with the single hook method having the highest LBD risk and spinal loads that exceeded the tolerance limits (worst patient handling job). The two-person draw sheet repositioning technique had the lowest LBD risk and spinal loads but still had relatively high spinal loads and LBD risk. Thus, even the safest of tasks (of the tasks evaluated in this study) had significant risk. Additionally, the current study represented a 'best' case scenario since the patient was relatively light and co-operative. Thus, patient handling in real situations such as in a nursing home, would be expected to be worse. Therefore, to have an impact on LBD, it is necessary to provide mechanical lift assist devices.

A comprehensive analysis of low-back disorder risk and spinal loading during the transferring and repositioning of patients using different techniques

https://digitalcommons.unl.edu/cgi/viewcontent.cgi?article=1058&context=veterans

Development and evaluation of a multifaceted ergonomics program to prevent injuries associated with patient handling tasks

Musculoskeletal disorders represent a significant occupational problem among nurses; however, data on musculoskeletal health of nurses in Sub-Sahara Africa are sparse. This study sought to determine the lifetime, 12-months period and point prevalence of work-related musculoskeletal disorders (WMSDs); the associated job risk factors and the coping strategies toward reducing the risk among nurses from selected hospitals in Ibadan, South-west Nigeria A previously validated self administered questionnaire which sought information on demographics, prevalence and pattern of WMSDs, associated job risk factors and coping strategies was employed as the survey instrument. A total of 160 questionnaires were distributed to nurses in the different hospitals but 128 questionnaires were returned yielding an 80% response rate. 10 of the returned questionnaires were excluded because of incomplete data. Eighty-four point four percent of the nurses have had WMSDs once or more in their occupational lives. The 12-months period and point prevalence rate of WMSDs at any body region was 78% and 66.1% respectively. WMSDs occurred mostly in low back (44.1%), neck (28.0%), and knees (22.4%). 30.3% treated themselves or had visited other health practitioners for care. Nurses with > 20 years of clinical experience are about 4 times more likely to develop WMSDs (OR 3.81; CI 1.08-13.4) than those with 11-20 years experience. Working in the same positions for long periods (55.1%), lifting or transferring dependent patients (50.8%) and treating an excessive number of patients in one day (44.9%) were the most perceived job risk factors for WMSDs. Getting help in handling heavy patients (50.4%), modification of nursing procedures in order to avoid re-injury (45.4%), and modifying patient's/nurse position (40.3%) were the top three coping strategies. A high proportion of Nigerian nurses reported WMSDs at some body site in their occupational lives with the low back being injured most often. Education programmes on prevention and coping strategies for musculoskeletal disorders are recommended for nurses in order to reduce the rate of occupational hazards and also promote efficiency in patient care.

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Work-Related Musculoskeletal Disorders among Nurses in Ibadan, South-west Nigeria: a cross-sectional survey

A survey of hospital staff nurses of a large tertiary care hospital was performed to investigate occupational low-back pain. Attack rates of 41% (37% "occupational") and 52% (occupational) were found using recall periods of two weeks and six months, respectively. Comparison with a control group suggests the validity of the work-relatedness of low-back pain in nurses. Factors associated with the disorder were also investigated, with results showing no differences due to nursing division assignment but significant association with specific tasks.

Occupational low-back pain in hospital nurses.

Back pain among nurses is a common problem. Prior studies of this problem have been based on cross-sectional or retrospective data. This 18-month prospective study involving nurses newly graduated from nursing school investigated personal, worksite, and training factors associated with future risk of back pain. Each nurse underwent a preliminary interview and periodic follow-ups to identify those with back injuries. Contingency tables and logistic regression analyses demonstrated that prior significant back pain episodes (evidenced by previous job changes because of back pain, frequent medication use, etc.) were associated with increased future risk. Training at nursing school or on the job did not have a protective effect. This pilot study therefore suggests factors useful in placement and counseling of new nurses and indicates the need for further implementation of mechanical lift assist device use. © 1994 Wiley-Liss, Inc.

Personal history, training, and worksite as predictors of back pain of nurses

Work and personal factors associated with occupational back pain were investigated based upon responses to questionnaires administered to hospital nurses. Factor analysis of outcome measures developed two indices of occupational back pain: "pain factor" and "impact factor." Factor analysis also separated reported work activities into five groups. By logistic regression, frequency of "carrying and pushing" and "patient care activity" were associated with occupational back pain. These findings suggest that research and training should not focus on patient transfers only, but must emphasize nonpatient contact activities performed by nurses.

Importance of non-patient transfer activities in nursing-related back pain. I: Questionnaire survey

Nurses' beliefs and attitudes about causes and prevention of occupational back pain of nurses (OBPN) were studied by interviewing 68 nurses using a semi-structured format. Direct patient contact activities, particularly patient transfers, were most frequently mentioned as causes of OBPN. Attitudes and beliefs about preventive methods focused upon personal work practices and personal behavior such as choice of clothing and personal exercise. The findings of this study suggest that the causes of and preventive methods for OBPN identified by nurses differ from the actual work tasks performed and possibly associated with OBPN as determined by other studies. The authors postulate that nurse training and attitudes lead to a narrow focus; avoiding preconceived concepts is necessary for preventing OBPN.

Nurses' beliefs about cause and prevention of occupational back pain.

To determine the low back stressor exposures of hospital nursing staff members, the daily activities of 63 staff members were observed and coded In addition to direct patient contact activities, non-patient contact activities were common Many patient contact actions were static (isometric), requiring maintenance of an antigravity position which stresses the low back These findings suggest the need to expand the focus of work practice training, equipment redesign, and future research activities

Elizabeth Billet

Papers

Occupational low-back pain in hospital nurses.

Personal history, training, and worksite as predictors of back pain of nurses

Importance of non-patient transfer activities in nursing-related back pain. I: Questionnaire survey

Nurses' beliefs about cause and prevention of occupational back pain.

Importance of non-patient transfer activities in nursing-related back pain: II. observational study and implications