Back pain in the nursing profession I. Epidemiology and pilot methodology

Abstract

A survey of 3912 nurses suggests that 750,000 working days are lost annually from back pain and that 1 in 6.(159 per-1000 at risk) attributes the onset of pain to a patient-handling incident. Attempts to identify risk areas within nursing using point prevalence data have failed to confirm previous results using historical data (Stubbs et al 1980). Evidence is presented that suggests the conditions being assessed in each case are different. The need for further epidemiological data is emphasized together with ergonomic assessment of the tasks performed throughout the nursing profession. Such an assessment will form the foundation for safer systems of work within the National Health Service and, it is hoped, a reduction in the magnitude of the back pain problem.     

The influence of a seated break on prolonged standing induced low back pain development

With the recent attention to ‘sitting disease’, health practitioners and scientists are promoting standing in the workplace to decrease sedentary time, despite a high prevalence of low back pain (LBP) development during prolonged standing. The purpose of this study was to assess how a seated break inserted between bouts of prolonged standing would influence LBP development, posture and movement. A total of 20 participants stood for 45 minutes, sat for 15 minutes and repeated this sequence while lumbar and thoracic angles were measured, and LBP visual analogue scale reports were taken. Of the sample, 55% participants reported LBP in standing. A stand to sit ratio of 3:1 did not provide lasting recovery of LBP from standing and pain developers utilised a limited range of their lumbar spine angle and increased thoracic extension, resulting in static postures that caused tissue aggravation that was not resolved after 15 minutes of sitting. Prolonged standing in the workplace has the potential to result in LBP for some workers and alternate ways to reduce sedentary time should be investigated.     

Comparison of fatal occupational injuries in construction industry in the United States,South Korea,and China

In order to understand country specific similarities and differences in fatality risks of construction industry, this study compared the profile of fatal occupational injuries (FOI) in construction industry in three countries. Occupational fatal injury data of U.S., South Korea, and China from 2011 to 2015 were obtained from various public resources and analyzed with statistical analyses. Results showed that the construction industry in all three countries had consistently high FOI and the top common accident types were “fall from a higher level” and “struck by”. China recorded the highest average number of FOI in construction of 2328, followed by the U.S. of 881 and South Korea of 533. However, South Korea had the highest average mortality rate of 17.9, followed by the U.S. of 9.4 and China of 5.3. In addition, Poisson regression indicated that the number of FOI of the U.S. increased at an annual rate of 5.8%, whereas China's decreased at 7.1% and South Korea's decreased at 4.9%. The similarities and differences between U.S. and South Korea in workforce profile of FOI were also reported. However, the findings should be interpreted with caution due to probable underreporting of FOI and differences in surveillance systems.     

Nanomaterials in the field of design ergonomics: present status

Application of nanotechnology and nanomaterials is not new in the field of design, but a recent trend of extensive use of nanomaterials in product and/or workplace design is drawing attention of design researchers all over the world. In the present paper, an attempt has been made to describe the diverse use of nanomaterials in product and workplace design with special emphasis on ergonomics (occupational health and safety; thermo-regulation and work efficiency, cognitive interface design; maintenance of workplace, etc.) to popularise the new discipline ‘nanoergonomics’ among designers, design users and design researchers. Nanoergonomics for sustainable product and workplace design by minimising occupational health risks has been felt by the authors to be an emerging research area in coming years.

Practitioner Summary: Use of nanomaterials in the field of design ergonomics is less explored till date. In the present review, an attempt has been made to extend general awareness among ergonomists/designers about applications of nanomaterials/nanotechnology in the field of design ergonomics and about health implications of nanomaterials during their use.     

One lumbar extension training session per week is sufficient for strength gains and reductions in pain in patients with chronic low back pain ergonomics

Chronic low back pain (CLBP) is the leading cause of absenteeism from the workplace and research into exercise interventions to address this problem is required. This study investigated training frequency for participants with CLBP. Participants either trained once a week (1 × week, n = 31), or twice a week (2 × week, n = 20) or did not (control group, n = 21). Participants were isometric strength tested in weeks 1 and 12 and trained dynamically either 1×week (80% of maximum) or 2×week (80% and 50%). The results (pre vs. post) showed significant increases in maximal strength, range of motion and reductions in pain for both training groups. Pain scores for the 1 × week and 2 × week both reached minimal clinical improvement change unlike the control group. Thus, one lumbar extension training session per week is sufficient for strength gains and reductions in pain in low back pain in CLBP patients. PRACTITIONER SUMMARY: CLBP is the leading cause of absenteeism from the workplace. The present study using a modified randomised control trial design investigated exercise training frequency for participants with CLBP. One lumbar extension training session per week is sufficient for strength gains and reductions in low back pain in CLBP patients.     

Effects of sign characteristics and training methods on safety sign training effectiveness

This study investigated whether or not training methods affected the effectiveness of symbol training and if there were any relationships between sign symbol characteristics and training effectiveness. Altogether, 26 Mainland China industrial safety signs were used and 60 participants were randomly assigned into four equal-sized groups of control, paired-associate learning, recall training and recognition training. The result was that participants from all the training groups showed significantly greater improvement in comprehension performance than those in the control group, indicating that the training methods improved comprehension of the meaning of safety signs. Participants from the recall training group performed better in the post-training test than those from other training groups. It seems that the recall task elicited a deeper level of learning than the recognition task and that questioning and feedback had a positive effect on training effectiveness. The results also showed that sign characteristics had no significant influence on training effectiveness. It was concluded that recall training is more effective in enhancing comprehension of industrial safety signs than paired-associate learning or recognition training. The findings of this study provide a basis for useful guidelines for designing symbol-training programmes and for designing more user-friendly safety signs.

Statement of Relevance: The present study shows that recall training was more effective in improving comprehension of industrial safety signs than paired-associate learning or recognition training and cognitive sign features did not influence training effectiveness. They provide a basis for useful guidelines for designing symbol-training programmes and for designing more user-friendly safety signs.     

Flexible workspace design and ergonomics training: impacts on the psychosocial work environment, musculoskeletal health, and work effectiveness among knowledge workers

A macroergonomics intervention consisting of flexible workspace design and ergonomics training was conducted to examine the effects on psychosocial work environment, musculoskeletal health, and work effectiveness in a computer-based office setting. Knowledge workers were assigned to one of four conditions: flexible workspace (n=121), ergonomics training (n=92), flexible workspace+ergonomics training (n=31), and a no-intervention control (n=45). Outcome measures were collected 2 months prior to the intervention and 3 and 6 months post-intervention. Overall, the study results indicated positive, significant effects on the outcome variables for the two intervention groups compared to the control group, including work-related musculoskeletal discomfort, job control, environmental satisfaction, sense of community, ergonomic climate, communication and collaboration, and business process efficiency (time and costs). However, attrition of workers in the ergonomics training condition precluded an evaluation of the effects of this intervention. This study suggests that a macroergonomics intervention is effective among knowledge workers in office settings.     

Occupational and environmental risk factors for falls among workers in the healthcare sector

Falls are a leading cause of occupational injury for workers in healthcare, yet the risk factors of falls in this sector are understudied. Falls resulting in workers' compensation for time-loss from work from 2004–2007 for healthcare workers in British Columbia (BC) were extracted from a standardised incident-reporting database. Productive hours were derived from payroll data for the denominator to produce injury rates; relative risks were derived through Poisson regression modelling. A total of 411 falls were accepted for time-loss compensation. Compared to registered nurses, facility support workers (risk ratio (95% CI) = 6.29 (4.56–8.69)) and community health workers (6.58 (3.76–11.50)) were at high risk for falls. Falls predominantly occurred outdoors, in patients' rooms and kitchens depending on occupation and sub-sector. Slippery surfaces due to icy conditions or liquid contaminants were a leading contributing factor. Falls were more frequent in the colder months (January–March). The risk of falls varies by nature of work, location and worker demographics. The findings of this research will be useful for developing evidence-based interventions.

Statement of Relevance: Falls are a major cause of occupational injury for healthcare workers. This study examined risk factors including occupation type, workplace design, work setting, work organisation and environmental conditions in a large healthcare worker population in BC, Canada. The findings of this research should contribute towards developing evidence-based interventions.     

Ergonomic evaluation of slide boards used by home care aides to assist client transfers

Home care aides risk musculoskeletal injury because they lift and move clients; the body weight of most adults exceeds the NIOSH recommended limit for lifting. Methods to reduce manual patient lifting in institutional settings are often technically or economically infeasible in home care. Our goal was to identify suitable, safe, low-technology transfer devices for home care use. Sixteen experienced home care aides performed client transfers from wheelchair to bed (upward) and bed to wheelchair (downward) in a simulated home care environment (laboratory), using four different slide boards and by hand without a device. Aides’ hand forces were measured during client transfers; aides also evaluated usability of each board. Hand forces exerted while using slide boards were mostly lower than in manual transfer, and forces were lower in downward versus upward transfers. Aides judged a board with a sliding mechanism easier to use than boards without a sliding mechanism.

Practitioner Summary: This paper provides quantitative biomechanical measurements showing that slide boards reduced the hand forces needed by home care aides to transfer clients from bed to wheel chair and vice versa, compared to manual lifting. Using a semi-quantitative usability survey, aides identified boards with a sliding mechanism easiest to use.     

The effects of occupational interventions on reduction of musculoskeletal symptoms in the nursing profession

The objective of the review was to gain more insight into the effects of occupational interventions for primary prevention of musculoskeletal symptoms in healthcare workers. The Cochrane Collaboration methodological guidelines for systematic reviews functioned as a starting point. Thirteen studies meeting the inclusion criteria were analysed for methodological quality and effects. Eight outcome effect areas were established and defined as areas in which an effect had been determined in at least two studies. A method based on levels of scientific evidence was then used to synthesize the information available. Strong scientific evidence for the beneficial effect of occupational interventions was found for the outcome effect areas physical discomfort, technical performance of transfers and frequency of manual lifting. Insufficient evidence was found for the effect areas absenteeism due to musculoskeletal problems, musculoskeletal symptoms, fatigue, perceived physical load and knowledge of risk factors at work and ergonomic principles. Training and education combined with an ergonomic intervention were found to be effective.     

The effects of occupational interventions on reduction of musculoskeletal symptoms in the nursing profession

The objective of the review was to gain more insight into the effects of occupational interventions for primary prevention of musculoskeletal symptoms in healthcare workers. The Cochrane Collaboration methodological guidelines for systematic reviews functioned as a starting point. Thirteen studies meeting the inclusion criteria were analysed for methodological quality and effects. Eight outcome effect areas were established and defined as areas in which an effect had been determined in at least two studies. A method based on levels of scientific evidence was then used to synthesize the information available. Strong scientific evidence for the beneficial effect of occupational interventions was found for the outcome effect areas physical discomfort, technical performance of transfers and frequency of manual lifting. Insufficient evidence was found for the effect areas absenteeism due to musculoskeletal problems, musculoskeletal symptoms, fatigue, perceived physical load and knowledge of risk factors at work and ergonomic principles. Training and education combined with an ergonomic intervention were found to be effective.     

The effects of an office ergonomics training and chair intervention on worker knowledge, behavior and musculoskeletal risk

A large-scale field intervention study was undertaken to examine the effects of office ergonomics training coupled with a highly adjustable chair on office workers’ knowledge and musculoskeletal risks. Office workers were assigned to one of three study groups: a group receiving the training and adjustable chair (n=96), a training-only group (n=63), and a control group (n=57). The office ergonomics training program was created using an instructional systems design model. A pre/post-training knowledge test was administered to all those who attended the training. Body postures and workstation set-ups were observed before and after the intervention. Perceived control over the physical work environment was higher for both intervention groups as compared to workers in the control group. A significant increase in overall ergonomic knowledge was observed for the intervention groups. Both intervention groups exhibited higher level behavioral translation and had lower musculoskeletal risk than the control group.     

Prevalence of occupation-related pain among baristas and an examination of low back and shoulder demand during the preparation of espresso-based beverages

Many baristas complain of low back pain (LBP) and upper extremity discomfort while at work. This study documented the prevalence of LBP and shoulder pain, via questionnaire, among a population of baristas to determine whether cumulative low back loads and shoulder moments are associated with pain reporting. Fifty-nine baristas completed the questionnaire; ten were also video-recorded for biomechanical analysis while making espresso beverages and cumulative and peak low back loads and shoulder moments were calculated. Seventy-three percent of those who completed the questionnaire reported having experienced LBP, and half attributed this pain to their job as a barista. Furthermore, 68% reported having experienced shoulder pain and half also attributed this pain to their job. Those who suffered from LBP had higher peak low back compression and those with shoulder pain had, in general, higher moments about their dominant shoulder.     

Participation in workplace design with reference to low back pain: a case for the improvement of the police patrol car

Thirty Canadian police officers, divided into six groups, participated in the redesign of the interior of the patrol car. Three of the groups consisted of individuals having a history of low back disease. The effect of participating in a design process on the characteristics of the final design and on the perception of the low back pain was studied in a semi-experimental setting. The participants developed a strong commitment to the participatory design process, which was reflected in their productions. The differences between participants with and without a history of a low back disease was not marked. The former tended to stress posture-related elements in their analysis and design.     

A comparison of the burden and resultant risk associated with occupational falls from a height and on the same level in Australia

Occupational falls are one of the leading causes of occupational injury and death internationally. This study described the nature of occupational falls following an analysis of workers compensation data in Western Australia. Frequencies, proportions and incidence rates were calculated following mechanism, gender, age and industry stratification. The natures of injury and bodily locations affected were compared between mechanisms of fall. Industry incidence rates were ranked and their corresponding proportions reported. Cost and lost time were described and risk scores for each burden type (incapacity, cost and lost time) were calculated and compared between fall mechanisms. Of all occupational falls, the proportion, incidence rates and risk scores of falls on same level were consistently greater compared to falls from a height. Gender, age and industry groups that appear to be at highest risk vary with the measure used and mechanism of incident. This study translates epidemiological information into a risk score that can aid in prioritisation.

Practitioner Summary: This paper presents an in-depth analysis of Worker’s Compensation claims for falls in Western Australia. Calculated proportion, incidence rates and formulated risk scores for falls on the level were consistently greater compared to falls from a height. Limitations associated with the analysis of large-scale data-sets are described.     

Limited economic evaluation to assess the effectiveness of a university-wide office ergonomics program

The objective of this research was to evaluate the effectiveness and provide a limited economic evaluation of an office ergonomics program at a major university from 1995 to 2007. The relationship between office-related recordable injuries, reported lost time, severity of these injuries, and the Workers' Compensation (WC) paid was analyzed and the corresponding incident cost was calculated. Two major datasets analyzed were OSHA 200/300 logs (1991-2007) and WC claims paid (1999-2007). Since the beginning of the office ergonomics program in 1995 and through 2007 (13-year period), the number of office cumulative trauma disorder (CTD) cases decreased by 53%. Since the official start (in 1999) of a 50-50 cost share agreement for office equipment purchases between the university's Safety and Health Department (SHD) and the university departments evaluated, it was observed that the incident rate decreased by 63%, Total Days Away/restrict or Transfer (DART) rate decreased by 41%, Lost Time Case (LTC) rate decreased by 71% and office-related carpal tunnel syndrome decreased by almost 50%. The long-term goal of this research is to demonstrate the self-sustainability of an office ergonomics program by showing that equipment costs are eventually offset by a decrease in WC claims paid and lost time from office-related injuries and illnesses. While limited, this research helps in cost-justifying the implementation of future office ergonomics programs for large organizations.     

Accident patterns and prevention measures for fatal occupational falls in the construction industry

Contributing factors to 621 occupational fatal falls have been identified with respect to the victim's individual factors, the fall site, company size, and cause of fall. Individual factors included age, gender, experience, and the use of personal protective equipment (PPE). Accident scenarios were derived from accident reports. Significant linkages were found between causes for the falls and accident events. Falls from scaffold staging were associated with a lack of complying scaffolds and bodily action. Falls through existing floor openings were associated with unguarded openings, inappropriate protections, or the removal of protections. Falls from building girders or other structural steel were associated with bodily actions and improper use of PPE. Falls from roof edges were associated with bodily actions and being pulled down by a hoist, object or tool. Falls through roof surfaces were associated with lack of complying scaffolds. Falls from ladders were associated with overexertion and unusual control and the use of unsafe ladders and tools. Falls down stairs or steps were associated with unguarded openings. Falls while jumping to a lower floor and falls through existing roof openings were associated with poor work practices. Primary and secondary prevention measures can be used to prevent falls or to mitigate the consequences of falls and are suggested for each type of accident. Primary prevention measures would include fixed barriers, such as handrails, guardrails, surface opening protections (hole coverings), crawling boards/planks, and strong roofing materials. Secondary protection measures would include travel restraint systems (safety belt), fall arrest systems (safety harness), and fall containment systems (safety nets).