Physical capacity and risk for long-term sickness absence: a prospective cohort study among 8664 female health care workers.

OBJECTIVE: To assess the prospective associations between self-reported physical capacity and risk of long-term sickness absence among female health care workers. METHODS: Female health care workers answered a questionnaire about physical capacity and were followed in a national register of sickness absence lasting for two or more consecutive weeks during 1-year follow-up. Using Cox regression hazard ratio analyses adjusted for age, smoking, body mass index, physical workload, job seniority, psychosocial work conditions, and previous sickness absence, we modeled risk estimates for sickness absence from low and medium physical capacity. RESULTS: Low and medium aerobic fitness, low muscle strength, low flexibility, and low overall physical capacity significantly increased the risk for sickness absence with 20% to 34% compared with health care workers with high capacity. CONCLUSIONS: Low physical capacity increases the risk of long-term sickness absence among female health care workers.

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.

Do lifestyle factors and general health predict dropout among recently qualified eldercare workers? A two-year follow-up study.

BACKGROUND: The eldercare sector in Denmark as in many industrialised countries is characterised by difficulties in retaining labour. Research suggests a possible imbalance between lifestyle and health among eldercare trainees and the demanding work encountered as eldercare employees. The aim of the present study was to determine the predictive effect of lifestyle and self-rated health on dropout from the Danish eldercare sector two years after qualification. METHODS: We included 4,526 female eldercare trainees in the analyses of lifestyle parameters and 5,023 in the analyses of self-rated health. The participants in this prospective study were recruited from 27 of the 28 Danish colleges for eldercare. We linked survey data with national register data to obtain information about labour market attachment two years after qualification. RESULTS: The results of the present study showed that the poorer self-rated health, the higher the risk for dropout from the labour market (p < 0.0001). However, the results were less consistent regarding the predictive effect of a detrimental lifestyle. We found that overweight/obesity (p = 0.0021 and p = 0.0012) as well as smoking (p = 0.0017) decreased the risk of dropout from eldercare into education. We found no support for increased likelihood of dropout among physically inactive. CONCLUSIONS: The results of the present study show that a poorer self-rated health is a predictor for dropout, not only from the eldercare two years after qualification, but from the labour market as a whole. However, the results were less consistent regarding the predictive effect of a detrimental lifestyle on dropout.

Are low back pain and low physical capacity risk indicators for dropout among recently qualified eldercare workers? A follow-up study.

BACKGROUND: A high job turnover and dropout among eldercare workers has led to a significant shortage of qualified manpower in the Danish eldercare sector. OBJECTIVES: The predictive effect of some non-work-related causes for leaving the eldercare sector 2 years after qualification, physical capacity, duration, and severity of previous low back pain, was investigated. DESIGN AND SETTING: A 2-year prospective cohort study of all the Danish eldercare workers, who finished their education during 2004 (n = 6347). Questionnaire data from 2004 were followed up by register data on attachment to labour market, educational status, and association to trade from Statistics Denmark in 2006. METHODS: Data on physical capacity, duration, and severity of low back pain the last 12 months among the female participants were analysed by multinomial logistic regression to estimate odds-ratios for being either in the eldercare sector, in other health- and welfare sectors, in all other sectors, under education, or outside labour market, 2 years after qualification. RESULTS: Disability due to and duration of low back pain were significant predictors for dropout from the eldercare sector 2 years after qualification. Low physical capacity was not. Data on duration of low back pain suggest a trend towards a dose-response relationship: The longer the duration of low back pain, the higher odds for dropout. CONCLUSIONS: Low back pain and disability due to low back pain during the last year of education were independent predictors for dropout from the eldercare sector 2 years after qualification. However, low self-rated physical capacity did not predict job dropout or turnover.

Psychological well-being as a predictor of dropout among recently qualified Danish eldercare workers.

BACKGROUND: The eldercare sector is characterized by a shortage of labour and a high turnover rate, which constitutes a major challenge for the ageing societies of western Europe. The aim of the present study was to investigate if a low level of psychological well-being at the time of graduation predicts dropout among eldercare workers two years later. METHODS: We included 4,968 female eldercare trainees in this prospective study, recruited from 27 of the 28 Danish colleges for eldercare. Psychological well-being in 2004 was measured with the five-item Mental Health Inventory (MHI-5) of the 36-item Short-Form Health Survey (SF-36). We linked the survey data with national register data to obtain information about labour market attachment two years after qualification. RESULTS: In 2006, 37% of all participants had left the eldercare sector. Compared to participants with high psychological well-being at baseline, participants with medium and low psychological well-being were more likely to dropout to sectors unrelated to health and welfare (odds ratio (OR) 1.40 (95% confidence interval (95% CI) = 1.06-1.85) and 1.66 (95% CI = 1.27-2.19), respectively). They were also more likely to drop out of the labour market (OR 1.48 (95% CI = 1.08-2.04) and 1.60 (95% CI = 1.12-2.20), respectively). Psychological well-being was not related to dropout to other health- and welfare sectors or dropout to further education. CONCLUSIONS: The fact that more than one third of all participants had left the eldercare sector two years after qualification demonstrates the importance of retention initiatives early in working life. In addition a focus on psychological well-being among eldercare workers should be considered.

Changes in physical performance among construction workers during extended workweeks with 12-hour workdays.

PURPOSE: To investigate changes of physical performance during long working hours and extended workweeks among construction workers with temporary accommodation in camps. METHODS: Nineteen construction workers with 12-h workdays and extended workweeks participated. Physical performance in the morning and evening of the second and eleventh workdays was tested by endurance, ability to react to a sudden load, flexibility of the back, handgrip strength and sub-maximal HR during a bicycle test. HR was registered throughout two separate workdays. RESULTS: HR during each of the two separate workdays corresponded to a relative workload of 25%. Sub-maximal HR was lower, reaction time faster and handgrip strength higher in the end of each test day. In the end of the work period, sub-maximal HR was lower, reaction time faster and sitting balance was better. CONCLUSION: No trends of decreased physical performance were found after a workday or a work period.

The impact of ergonomic work environment exposures on the risk of disability pension: Prospective results from DWECS/DREAM.

The objectives were to identify the impact of ergonomic work environment exposures on the risk of disability pension. A representative sample of 8475 employees of the total working population in Denmark were interviewed regarding work environment exposures and followed in a national register with data on granted disability pension. For women, approximately 34% of the disability pension cases were attributable to ergonomic work environment exposures. For men, 21% of the disability pension cases were attributable to ergonomic work environment. Ergonomic work environment, especially physically demanding work, working with hands lifted and repetitive work, are areas of intervention at the workplace that can facilitate and prolong labour market participation. The study provides estimates for the association between ergonomic exposures at work and administrative, cost-related measures of work disability in a large population-based longitudinal cohort study over 14 years. Approximately 21% for men and 34% for women of the disability pension cases were attributable to ergonomic work environment exposures.

Multidimensional intervention and sickness absence in assistant nursing students.

BACKGROUND: When handling patients, nursing assistant (NA) students and nurse students are frequently exposed to risk factors for low back pain (LBP) including sudden loads and twisting and bending of the spine. Furthermore, LBP is a major cause of sickness absence. AIMS: To ascertain if a multidimensional prevention programme combining physical training, patient transfer technique and stress management prevents sickness absence and LBP in NA students. METHODS: The study was a 14-month cluster randomized controlled study. The participants were NA students from 37 randomly selected classes located at two schools of health and social care in Copenhagen, Denmark. The participants completed a comprehensive questionnaire regarding sickness absence, LBP and psychosocial factors on commencement and after completion of the study. RESULTS: Of 766 female NA students, 668 (87%) completed the baseline questionnaire. Sickness absence during the study period increased in both groups but the increase was significantly lower in the intervention group than the control group, mean (standard deviation) number of days 12 (20) versus 18 (34), P < 0.05. The intervention group reported no change in the mean level of general health perception, energy/fatigue or psychological well-being at follow-up, while the control group reported a decline on those scales. There were no significant differences in the prevalence of LBP at follow-up between the intervention and control group. CONCLUSIONS: Compared to the control group, the intervention group had significantly less sickness absence. The intervention had no preventive effect on LBP prevalence.

Factors predicting dropout in student nursing assistants.

BACKGROUND: The dropout rate among student nursing assistants (NAs) in Danish health and social care education is high at >20%. AIMS: To explore if recent low back pain (LBP) history is a predictor of dropout among NA students, taking into account conventional risk factors for LBP, general health and physical fitness. METHODS: Prospective study with 14-month follow-up (the duration of the education) in two schools of health and social care in the Region of Copenhagen, Denmark. Participants completed a comprehensive questionnaire, and their physical fitness (balance, back extension endurance, back flexion endurance and sagittal flexibility) was assessed at baseline. Dropout was defined as failure to complete NA education. RESULTS: A total of 790 subjects, 87% of those invited, completed the questionnaire; 612 subjects also completed the physical tests and were included in the present study and 500 (83%) were women. Recent LBP was not an independent predictor of school dropout. However, only among women who had LBP were other factors (a history of previous exposure to heavy physical workload, a low mental health score and failure to pass the back extension endurance test) associated with risk of dropout, OR (95% CI)=2.5 (1.2-5.3). Among men, only low height was significantly associated with dropout risk. CONCLUSIONS: A recent LBP history was not an independent single predictor of dropout from NA education but was a risk factor in combination with other factors.

The role of physical fitness as risk indicator of increased low back pain intensity among people working with physically and mentally disabled persons: a 30-month prospective study.

STUDY DESIGN: A prospective cohort study. OBJECTIVE: To study if low level of physical fitness was associated with increased low back pain (LBP) intensity at 30-month follow-up. SUMMARY OF BACKGROUND DATA: The evidence of low physical fitness as a risk factor for LBP is inconclusive due to contradictory results. METHODS: Study participants were 327 employees (women = 271, men = 56) at institutions for physically and mentally disabled persons. Physical fitness was measured by tests of: back extension and flexion endurance, flexibility and balance; and by self-assessed aerobic fitness, muscle strength, endurance, flexibility and balance, using visual analogue scales. Low back pain, lifestyle parameters, and physical and psychosocial work factors were assessed by questionnaires at baseline and at follow-up. Outcome was defined as an increase above 2 steps in average LBP intensity during the previous year (0-10). RESULTS: Persons with low level back endurance showed an insignificantly higher risk of increased LBP intensity (OR = 2.4, P = 0.076), whereas persons with medium level back endurance were at significantly higher risk (OR = 2.7, P = 0.034) compared with those with high level back endurance. The general association between isometric back extension endurance and increased LBP intensity was insignificant (P = 0.067). Persons with medium level self-assessed aerobic fitness were at lower risk of increased LBP intensity compared with those with high level (OR = 0.37, P = 0.02), although the general association of aerobic fitness was insignificant (0.066). Performance-based back flexion endurance, flexibility, and balance; and self-assessed muscle strength, endurance, flexibility, and balance were not associated with increased LBP intensity. CONCLUSION: The significant association between medium level back extension endurance and increased LBP intensity supports the finding of other studies that particularly back extension endurance is an important physical fitness component in preventing LBP and that the subcomponents of physical fitness are related in different ways to LBP.

Validity and reliability of self-assessed physical fitness using visual analogue scales.

To test the validity and reliability of self-assessed physical fitness samples included healthcare assistants working at a hospital (women=170, men=17), persons working with physically and mentally handicapped patients (women=530, men= 123), and two separate groups of healthcare students (a) women=91 and men=5 and (b) women=159 and men=10. Five components of physical fitness were self-assessed by Visual Analogue Scales with illustrations and verbal anchors for the extremes: aerobic fitness, muscle strength, endurance, flexibility, and balance. Convergent and divergent validity were evaluated by age-adjusted correlations stratified by sex with performance-based measures of physical fitness. Self-assessed aerobic fitness (r = .36 - .64) (women/men), muscle strength (r = .30 - .51), and flexibility (r = .36 - .31) showed moderate convergent validity. The divergent validity was satisfactory except for flexibility among men. The reliability was moderate to good (ICC = .62 - .80). Self-assessed aerobic fitness, muscle strength, and flexibility showed moderate construct validity and moderate to good reliability using visual analogues.

The role of back muscle endurance, maximum force, balance and trunk rotation control regarding lifting capacity.

Evaluation of lifting capacity is widely used as a reliable instrument in order to evaluate maximal and safe lifting capacity. This is of importance in regard to planning rehabilitation programs and determining working ability. The aim of this study was to investigate the influence of basic functions on the lifting capacity measured by the progressive isoinertial lifting evaluation (PILE) and the functional capacity evaluation (FCE) tests in a lower (floor to waist) and an upper (waist to shoulder) setting and compare the two test constructs. Seventy-four female subjects without acute low back pain underwent an examination of their lifting capacities and the following basic functions: (1) strength and endurance of trunk muscles, (2) cardiovascular endurance, (3) trunk mobility and (4) coordination ability. A linear regression model was used to predict lifting capacity by means of the above-mentioned basic functions, where the F statistics of the variables had to be significant at the 0.05 level to remain in the model. Maximal force in flexion showed significant influence on the lifting capacity in both the PILE and the FCE in the lower, as well as in the upper, lifting task. Furthermore, there was a significant influence of cardiovascular endurance on the lower PILE and also of endurance in trunk flexion on the lower FCE. Additional inclusion of individual factors (age, height, weight, body mass index) into the regression model showed a highly significant association between body height and all lifting tasks. The r (2) of the original model used was 0.19/0.18 in the lower/upper FCE and 0.35/0.26 in the lower/upper PILE. The model r (2) increased after inclusion of these individual factors to between 0.3 and 0.4. The fact that only a limited part of the variance in the lifting capacities can be explained by the basic functions analyzed in this study confirms the assumption that factors not related to the basic functions studied, such as lifting technique and motor control, may have a strong influence on lifting capacity. These results give evidence to suggest the inclusion of an evaluation of lifting capacity in clinical practice. Furthermore, they raise questions about the predictive value of strength and endurance tests in regard to lifting capacity and work ability.

Computer users' risk factors for developing shoulder, elbow and back symptoms.

OBJECTIVES: This prospective study concentrated on determining factors of computer work that predict musculoskeletal symptoms in the shoulder, elbow, and low-back regions. METHODS: A questionnaire on ergonomics, work pauses, work techniques, and psychosocial and work factors was delivered to 5033 office workers at baseline in early 1999 (response rate 69%) and to 3361 respondents at the time of the follow-up in late 2000 (response rate 77%). An increased frequency or intensity of symptoms was the outcome variable, including only nonsymptomatic respondents from the baseline questionnaire (symptom frequency below 8 days within the last 12 months or intensity score below 4 within the last 3 months). RESULTS: In the follow-up, 10%, 18%, and 23% had symptoms more often in the elbow, shoulder, and low back, respectively, and 14%, 20%, and 22% had more intense symptoms. Women were more likely to be afflicted than men in all regions. In the full-fit multivariate logistic regression analysis, little influence on the timing of a rest pause and being disturbed by glare or reflection were significant predictors of shoulder symptoms, screen below eye height was a significant predictor for elbow symptoms, and previous symptoms was a significant predictor for symptoms in all regions. Computer worktime and psychosocial dimensions were not significant predictors. CONCLUSIONS: Influence on work pauses, reduction of glare or reflection, and screen height are important factors in the design of future computer workstations. Since previous symptoms was a significant predictor of recurrent symptoms in all three regions under study, it can be concluded that musculoskeletal symptoms are persistent.

Physiological profile and activity pattern of young soccer players during match play.

PURPOSE: The purpose of this study was to examine aerobic demands and activity patterns during match play in young soccer players with respect to competition level, age, and biological maturity. METHODS: Ten nonelite players (NbP) and nine elite players (EbP) in their early puberty (12 yr), and seven elite players (EeP) in their late puberty (14 yr) were studied. Heart rate (HR) and activity pattern were recorded during match play, whereas corresponding .VO(2) and HR values were obtained during submaximal and maximal treadmill tests in the laboratory. The maturity status was assessed from testicular volume. RESULTS: No difference in .VO(2max) was observed between the nonelite and the elite players in the beginning of puberty (58.7 +/- 5.3 vs 58.6 +/- 5.0 mL O(2).min-1.kg(-1)), whereas the elite players in the end of puberty were significantly more fit (63.7 +/- 8.5 mL O(2).min(-1).kg(-1)). During match play, a higher HR was recorded in the elite players in the beginning of puberty than their nonelite counterparts, whereas the two elite groups showed the same HR responses (HR 1st half/2nd half-NbP: 162/157; EbP: 177/174; EeP: 178/173). The elite players in the end of puberty thus performed a higher absolute and relative .VO(2) (.VO(2).min(-1) and mL O(2).min(-1).kg(-1)) compared with the nonelite players during both halves, corresponding to more time spent in standing/walking in the nonelite group. The elite players in the end of puberty showed higher absolute .V(O2) values during match play than the young elite players but identical relative aerobic loads. It seems that the midfield/attack group had the highest absolute .VO(2max) and was performing at the highest HR during the matches. CONCLUSION: The present study shows that young soccer players are highly specialized both according to playing level and position on the field.