Occupational low back pain prevention capacity of nurses in China: A multicenter cross-sectional study.

Introduction: Nurses have a high prevalence of occupational low back pain, especially since the outbreak of the COVID-19 pandemic, which has increased the nurses' workloads. It has brought a huge burden on nurses and their professional development. Nurses' occupational low back pain prevention capacity is the logical starting point and core of interventions to prevent its occurrence. To date, there is no study investigating it with a scientific scale. Therefore, a multicenter cross-sectional study was conducted to explore the current status of nurses' capacity in occupational low back pain prevention and its influencing factors in China. Methods: Using a two-stage, purposive and convenience mixed sampling method, 1331 nurses from 8 hospitals across 5 provinces (Hubei, Zhejiang, Shandong, Henan, and Sichuan) in the southern, western, northern, and central areas of mainland China were involved in this study. The demographic questionnaire and occupational low back pain prevention behavior questionnaire were used for data collection. The descriptive analysis, univariate analysis, and multiple stepwise linear regression were used for data analysis. Results: The results showed that the occupational low back pain prevention behavior questionnaire score was 89.00 (80.00, 103.00) [M (Q1, Q3)], which indicated that nurses' ability was at a moderate level. Participation in prevention training before, perceived stress at work, and working hours per week were predictors for nurses' occupational low back pain prevention capacity. Discussion: To improve nurses' prevention ability, nursing managers should organize various training programs, strengthen regulations to reduce nurses' workload and stress, provide a healthy workplace, and offer incentives to motivate nurses.

Changes in task-specific fear of movement and impaired trunk motor control by pain neuroscience education and exercise: A preliminary single-case study of a worker with low back pain.

We report a case (a worker with low back pain) who was provided patient education and therapeutic exercise, and we performed a detailed kinematic analysis of his work-related activity over time. The subjects were one 28-year-old male worker with low back pain. In addition, to clearly identify impaired trunk movement during work-related activity in the low back pain subject, 20 age-matched healthy males (control group) were also included as a comparison subject. He received pain neurophysiology education and exercise instruction. We analyzed the subject's trunk movement pattern during a lifting task examined by a three-dimensional-motion capture system. In addition, task-specific fear that occurred during the task was assessed by the numerical rating scale. The assessment was performed at the baseline phase (4 data points), the intervention phase (8 data points), and the follow-up phase (8 data points), and finally at 3 and 8 months after the follow-up phase. No intervention was performed in the control group; they underwent only one kinematic evaluation at baseline. As a result, compared to the control group, the low back pain subject had slower trunk movement velocity (peak trunk flexion velocity = 50.21 deg/s, extension velocity = -47.61 deg/s), and his upper-lower trunk segments indicated an in-phase motion pattern (mean absolute relative phase = 15.59 deg) at baseline. The interventions reduced his pain intensity, fear of movement, and low back pain-related disability; in addition, his trunk velocity was increased (peak trunk flexion velocity = 82.89 deg/s, extension velocity = -77.17 deg/s). However, the in-phase motion pattern of his trunk motor control remained unchanged (mean absolute relative phase = 16.00 deg). At 8 months after the end of the follow-up, the subject's in-phase motion pattern remained (mean absolute relative phase = 13.34 deg) and his pain intensity had increased. This report suggests that if impaired trunk motor control remains unchanged after intervention, as in the course of the low back pain subject, it may eventually be related to a recurrence of low back pain symptoms.

Psychometric Evaluation of the Chinese Version of Occupational LowBack Pain Prevention Behaviors Questionnaire Among Clinical Nurses: A Validation Study.

Objective: This study aimed to translate and validate of the Chinese version of the Occupational Low Back Pain Prevention Behaviors Questionnaire among clinical nurses. Methods: A total of 1,186 clinical nurses were recruited from three provinces in northeast China. The reliability of the translated questionnaire was measured by internal consistency, split-half reliability, and test-retest reliability. The validity of the translated questionnaire was evaluated by content validity index, exploratory factor analysis and confirmatory factor analysis. Results: The Cronbach's α value of the questionnaire was 0.891, and the coefficient values for the six domains ranged between 0.804 and 0.917. The split-half reliability and test-retest reliability were 0.663 and 0.734, respectively. Furthermore, the content validity index of the questionnaire was 0.938. The 6-factor structure, supported by the eigenvalues, total variance explained, and scree plot accounted for 63.038% of the total variance. In the confirmatory factor analysis, as the results of model fitting, χ2/df = 3.753, RMSEA = 0.048, GFI = 0.929, AGFI = 0.913, TLI = 0.934, IFI = 0.943, CFI = 0.943, PGFI = 0.759, PNFI = 0.807. Conclusion: The Chinese version of the Occupational Low Back Pain Prevention Behaviors Questionnaire had suitable reliability and validity among clinical nurses. Under the high prevalence of occupational low back pain, the questionnaire can provide a reference for developing educational intervention plans among clinical nurses.

A bibliometric analysis of occupational low back pain studies from 2000 to 2020.

This study aimed to explore the evolution tracks of occupational low back pain (OLBP) studies during 2000 ∼ 2020 through strict and systematic bibliometric analysis. The analysis began with data retrieval in Web of Science using defined search terms associated with OLBP. Bibliometric tools, including BibExcel and CiteSpace, were employed to conduct performance analysis and co-citation network analysis. Totally, 4,127 documents were identified from 2000 to 2020. The United States contributed the most publications. The leading journals mainly focused on medicine and ergonomics. The co-citation analysis illuminated the development of OLBP studies and the top three published keywords were musculoskeletal disorder, risk factors, and fear avoidance. This paper can help researchers have a broader and deeper understanding of OLBP studies, provide a general insight into aggregate performance in the OLBP field, and find further research directions.

Abordagem da lombalgia ocupacional na Atenção Primária / Occupational low back pain approach in Primary Care

A grande incidência de lombalgia na população leva a uma grande demanda de tratamento no nível básico, além de gerar gastos com crises agudas nos níveis secundário e terciário. Essa revisão sistemática busca entender quais abordagens seriam pertinentes à condição para que o médico da atenção primária consiga ter a conduta mais adequada e resolutiva. A pesquisa foi realizada na plataforma PubMed utilizando-se descritores "occupational", "low back pain", "primary care" e "approach", onde obteve-se 24 resultados posteriores a 2014 dos quais descartou-se 16 por não compreenderem o objetivo inicial. A partir da leitura buscou-se trazer abordagens eficientes no âmbito da atenção primária de modo a otimizar a resolutividade com base na literatura mais recente disponível. Os resultados apontaram a adoção de uma conduta multidisciplinar, bem como a associação de fármacos adjuvantes a analgésicos no tratamento farmacológico, como preconizado pelo Ministério da Saúde.

The high incidence of low back pain leads to high demand for treatment at the primary level and creates expenses with acute crises at the secondary and tertiary levels. This systematic review seeks to understand which approaches would be pertinent to the condition so that the primary care physician can take the most appropriate and resolving conduct. The research was carried out on the PubMed platform using descriptors "occupational", "low back pain", "primary care", and "approach", where 24 results after 2014 were obtained and 16 were discarded because they did not match the initial objective. After the reading, efficient approaches were shown in order to optimize the resolution based on the most recent literature available in the scope of primary care. The results indicated the adoption of a multidisciplinary approach and the association of adjuvant drugs with analgesics in pharmacological treatment, as recommended by the Ministry of Health.

A Diagnostic Assistant Tool for Work-Related Low Back Pain in Hospital Workers.

AIMS: The study objective was to develop a clinical risk score to assist occupational medicine physicians in diagnosing hospital workers' occupational lower back pain (LBP). SETTINGS AND DESIGN: A cross-sectional data collection design was conducted at Saraburi Hospital, Thailand. METHODS AND MATERIALS: The sample consisted of 220 hospital workers who cared for patients and had LBP. They were assessed for the frequency of targeted activities (CPR, lifting, transferring patients) and other activities from work as well as ergonomic assessments, and diagnosed with LBP by three occupational medicine physicians. STATISTICAL ANALYSIS USED: Predicted factors of multivariable logistic regression were analysed to find clinical risk scores to help the diagnosis. RESULTS: The physicians agreed on the diagnosis, based on ergonomic risk factors and their experiences that 86 persons have occupational LBP. A diagnostic assistant tool consists of six predictors: the duration of LBP, having LBP within the last 7 days, bending, twisting, lateral bending, and reaching. The scores predicted occupational LBP correctly with an AuROC of 90.0% (95% CI; 84.8-93.5%). The positive likelihood ratio for occupational LBP was 0 in the low risk category (<6 points) and 16.8 (95% CI; 8.0-35.6) in the high risk (>8 points). CONCLUSIONS: A diagnostic assistant tool is used to assist occupational medicine physicians in diagnosing hospital workers' occupational LBP.

The effectiveness of social media and in-person interventions for low back pain conditions in nursing personnel (SMILE).

AIM: To compare two educational approaches to reduce low back pain in nurses. DESIGN: A community randomized controlled clinical trial. METHODS: Data were collected with two interventions and a control arm between August 2018 and January 2019. Participants were recruited from three hospitals. Hospital 1 received an in-person educational programme, Hospital 2 received via the website and Hospital 3 received nothing. Statistical analysis was carried out with a follow-up of 3 and 6 months. RESULTS: A total of 180 female nurses with low back pain participated in the study. Dimensions of the quality of life improved over 3 and 6 months, pain and disability decreased over 3 months in both intervention groups and over 6 months in the social media group. CONCLUSION: Two educational approaches can be effective in decreasing pain, disability and improving quality of life. However, the findings suggest that the social media approach was more successful over the long-term and might be a better way to present the programme.

Influence of fear-avoidance belief on orthopedic nurses′ work engagement who had occupational low back pain / 中国实用护理杂志

Objective:To explore the status of occupational low back pain among orthopedic nurses, and to investigate the influence of fear-avoidance belief on their work engagement.Methods:A convenient sample of 325 orthopedic nurses were recruited from one tertiary grade orthopedic hospital in Tianjin City. The data collection tools included a demographic questionnaire, which assessed nurses′ demographic information and their general condition of low back pain, the Chinese version of Fear-avoidance Beliefs Questionnaire, and the Chinese version of Utrecht Work Engagement Scale.Results:91.7%(298/325) of orthopedic nurses reported that they had occupational low back pain, and the mean score of fear-avoidance belief was 59.18±14.55, and the mean score of Utrecht work engagement was 40.40±17.49. Nearly 89.3% (266/298) of nurses with low back pain had low or moderate level of work engagement. There was a statistically significant relationship between fear-avoidance belief and work engagement ( r=-0.306, P<0.001). Hierarchical Regression Analysis showed that variables, including higher education, salary per month, sick-leave, quitting job and fear-avoidance belief influenced orthopedic nurses′ work engagement. Specifically, fear-avoidance belief independently can explain 23.6% variation of work engagement. Conclusions:Orthopedic nurses′ occupational low back pain is very common, and the level of work engagement of this population is moderate, and fear-avoidance belief can predict work engagement. This revealed that nursing managers are supposed to pay attention to orthopedic nurses′ occupational low back pain, adopting appropriate nursing interventions to reduce these nurses′ pain, to decrease their fear-avoidance belief, which then in turn strengthen the nurses′ work engagement.

Development and validation of an instrument of occupational low back pain prevention behaviours of nurse.

AIM: To develop and test the psychometric properties of occupational low back pain prevention behaviours questionnaire in nursing personnel. DESIGN: A qualitative and quantitative research design to develop and validate an instrument. METHODS: A qualitative study was conducted from May - October 2017 with 20 participants to generate an item pool. Then, content and face validity was carried out. Next, the questionnaire was distributed among a sample of nurses. In all, 150 nurses participated (mean age 34.1; SD 7.66 years) in the study. Exploratory factor analysis used to determine the factor structure of the questionnaire. Item-scale correlation matrix was provided to examine the construct validity. Internal consistency (Cronbach's alpha) was estimated to assess reliability and intraclass correlation coefficient was calculated to examine stability. RESULTS: Six factors with 30 items emerged from the exploratory factor analysis that jointly accounted for 67.9% of the variance observed. Item-scale correlation matrix showed satisfactory results lending support to construct validity of the questionnaire. The Cronbach's alpha coefficient for the whole scale showed excellent internal consistency (0.92), although this was not true for the knowledge subscale. The intraclass correlation coefficient with a 2-week interval also indicated that the questionnaire had satisfactory stability (0.97). CONCLUSION: This study provides initial support for reliability and validity of the Occupational Low Back Pain Prevention Behaviour Questionnaire. IMPACT: This study offers an instrument to assess low back pain preventive behaviours among nurses. The instrument is useful for nursing personnel and could be used in hospitals and healthcare settings to implement appropriate interventions.

Quantifying the lumbar spine movements of surgeons during surgical lists in a teaching hospital.

BACKGROUND: Low back pain (LBP) is a common occupational musculoskeletal complaint among health professionals. No research has quantified lumbar movement patterns in the surgical workplace, identifying 'at risk' behaviours with objective measures. This project aimed to identify lumbar movement patterns and change in LBP of surgeons and surgical trainees during a surgical list. METHODS: Surgeons or surgical trainees were recruited in a tertiary metropolitan hospital. Low back movements were quantified in real time via a monitoring system. This measured three-dimensional movement, velocity, acceleration and orientation to gravity during a typical theatre session. Pre- and post-surgery LBP, or low back injury measures of functional disability were quantified using the Oswestry disability index. Mean (standard deviation) and median (interquartile range) low back movement patterns were described. A Wilcoxon signed-rank test determined differences in LBP recorded from beginning to end of recording periods. RESULTS: Participants (n = 28) recorded data for a mean (standard deviation) of 6.1 (2.2) h. On average, 27.7 lumbar flexion events were recorded per monitoring session, with flexion movements held for >30 s an average of 5.6 times. Many of the flexion events were considered low range (between 20° and 40°) with an average of 19.1 events per session. Orthopaedic trainees recorded the highest average of lumbar and sustained lumbar flexions per hour (4.13 times). LBP significantly increased over the work day (z = -2.53, P = 0.012). CONCLUSION: This study provides a base for the understanding of low back movement patterns during surgery. This data may be useful in helping surgeons to identify their 'high risk' movements and prevent low back symptoms.

Atuação interdisciplinar em grupos de qualidade de vida para pacientes com Lesões por esforços repetitivos/Distúrbios osteomusculares relacionados ao trabalho - LER/DORT / Interdisciplinary approach in quality of life groups for patients with Repetitive strain injuries/Work-related musculoskeletal disorders - RSI/WMSD

Resumo Introdução: o atendimento isolado de pacientes com lesões por esforços repetitivos/distúrbios osteomusculares relacionados ao trabalho (LER/DORT) por profissionais de diferentes áreas é insuficiente para contemplar todos os aspectos sociais e de saúde afetados por esses agravos. Objetivo: relatar o trabalho conjunto interdisciplinar entre Fisioterapia e Psicologia, desenvolvido por meio de grupos de qualidade de vida (GQV) para pacientes com LER/DORT atendidos no Centro de Referência de Saúde do Trabalhador de Guarulhos-SP. Métodos: foram analisados os relatórios dos GQV desenvolvidos de 2009 a 2014 e as gravações das reuniões dos dois grupos mais recentes. Discussão: as identidades pessoais e profissionais dos pacientes afetados pelas LER/DORT estavam abaladas com o adoecimento, a invisibilidade da doença, os longos períodos de tratamento e de afastamento do trabalho e com a exclusão social decorrente desse quadro. O GQV propiciou um espaço de reflexão e socialização para os trabalhadores adoecidos, auxiliando-os no resgate da sua identidade e cidadania. A atuação conjunta interdisciplinar da Fisioterapia e da Psicologia nos grupos se mostrou fundamental para enfrentar a complexidade e a multifatorialidade desses agravos, ampliando a visão e a experiência dos profissionais e instrumentalizando-os para um olhar mais integrado e humanizado voltado ao trabalhador adoecido.

Abstract Introduction: the isolated care of patients with repetitive strain injury/work-related musculoskeletal disorders (RSI/WMSD) by different professionals is insufficient to cover all health and social aspects affected by these injuries. Objective: to report the interdisciplinary joint work between Physiotherapy and Psychology, developed through quality of life (QOL) groups for RSI/WMSD patients, at the Centro de Referência de Saúde do Trabalhador (Worker's Health Reference Center) in Guarulhos, São Paulo, Brazil. Methods: we analyzed the QOLs groups reports from 2009 to 2014, and the recordings of the two most recent groups meetings. Discussion: the RSI/WMSD patients' personal and professional identities were affected by their falling ill, the disease invisibility, the long periods of treatment and consequent absences from work, as well as by the social exclusion resulting from all these situations. The QOL group provided the sick workers with a space for reflection and socialization, and helped them recover their identity and citizenship. Physiotherapy and Psychology interdisciplinary joint work carried out in the groups was essential to face the RSI/WMSD complexity and its multiple factors. It also contributed to broaden the physioterapists' and psychologists' visions and experiences, supplying them with the needed tools to pursue a more integrated and humanized approach towards sick workers.

Regional socioeconomic disparities in outcomes for workers with low back pain in the United States.

BACKGROUND: Although regional socioeconomic (SE) factors have been associated with worse health outcomes, prior studies have not addressed important confounders or work disability. METHODS: A national sample of 59 360 workers' compensation (WC) cases to evaluate impact of regional SE factors on medical costs and length of disability (LOD) in occupational low back pain (LBP). RESULTS: Lower neighborhood median household incomes (MHI) and higher state unemployment rates were associated with longer LOD. Medical costs were lower in states with more workers receiving Social Security Disability, and in areas with lower MHI, but this varied in magnitude and direction among neighborhoods. Medical costs were higher in more urban, more racially diverse, and lower education neighborhoods. CONCLUSIONS: Regional SE disparities in medical costs and LOD occur even when health insurance, health care availability, and indemnity benefits are similar. Results suggest opportunities to improve care and disability outcomes through targeted health care and disability interventions.

Predicción clínica del dolor lumbar inespecífico ocupacional / Clinical prediction of occupational and non-specific low back pain / Predição clínica da dor lombar inespecífico ocupacional

El dolor lumbar inespecífico ocupacional (DLIO) es una condición de salud que genera un alto ausentismo laboral y discapacidad. Por su origen multifactorial es difícil determinar diagnósticos y pronósticos certeros. La predicción clínica del DLIO se identifica como una serie de modelos que integran un análisis multivariado para determinar tempranamente el diagnóstico, el curso y el impacto ocupacional de esta condición de salud. Objetivo: determinar los factores predictores del DLIO, así como el tipo de instrumentos referidos en la evidencia científica y establecer los alcances de la predicción. Materiales y métodos: la búsqueda de títulos se realizó en las bases de datos de PubMed, Science Direct, Springer y Ebsco publicados entre 1985 y 2012. Los artículos seleccionados fueron clasificados mediante un análisis bibliométrico, lo que permitió definir los más relevantes. Resultados: 101 títulos cumplieron con los criterios establecidos, pero solo 43 con el objetivo de la revisión. En cuanto a la predicción del DLIO, los estudios presentaron heterogeneidad en relación con los factores a predecir, por ejemplo: diagnóstico, tránsito del dolor lumbar de agudo a crónico, discapacidad, ausentismo laboral y retorno al trabajo. En relación con los instrumentos aplicados en la clínica se encontró en un 71,4% de los cuestionarios. Conclusión: la predicción clínica se considera una estrategia para determinar el curso o el pronóstico del DLIO y permite determinar las características que aumentarían el riesgo de cronicidad en trabajadores con esta condición de salud. De igual manera, las reglas de predicción clínica son herramientas que tienen como objetivo facilitar la toma de decisión en torno a la evaluación, al diagnóstico, al pronóstico y a la intervención del dolor lumbar, las cuales deben integrar factores de riesgo de orden físico, psicológico y social.

Non-specific Occupational Low Back Pain (NOLBP) is a health condition that generates a high absenteeism and disability. Due to multifactorial causes is difficult to determine accurate diagnosis and prognosis. The clinical prediction of NOLBP is identified as a series of models that integrate a multivariate analysis to determine early diagnosis, course, and occupational impact of this health condition. Objective: to identify predictor factors of NOLBP, and the type of material referred to in the scientific evidence and establish the scopes of the prediction. Materials and method: the title search was conducted in the databases PubMed, Science Direct, and Ebsco Springer, between 1985 and 2012. The selected articles were classified through a bibliometric analysis allowing to define the most relevant ones. Results: 101 titles met the established criteria, but only 43 met the purpose of the review. As for NOLBP prediction, the studies varied in relation to the factors for example: diagnosis, transition of lumbar pain from acute to chronic, absenteeism from work, disability and return to work. Conclusion: clinical prediction is considered as a strategic to determine course and prognostic of NOLBP, and to determine the characteristics that increase the risk of chronicity in workers with this health condition. Likewise, clinical prediction rules are tools that aim to facilitate decision making about the evaluation, diagnosis, prognosis and intervention for low back pain, which should incorporate risk factors of physical, psychological and social.

A dor lombar inespecífico ocupacional (DLIO) é uma condição de saúde que gera um alto absentismo laboral e discapacidade. Por sua origem multifatorial é difícil determinar diagnósticos e prognósticos certeiros. A predição clínica da DLIO se identifica como uma série de modelos que integram uma análise multivariada para determinar prematuramente o diagnóstico, o curso e o impacto ocupacional desta condição de saúde. Objetivo: determinar os fatores preditores da DLIO, assim como o tipo de instrumentos referidos na evidencia científica e estabelecer os alcances da predição. Materiais e métodos: a busca de títulos realizou-se nas bases de dados PubMed, Science Direct, Springer e Ebs-co publicados entre 1985 e 2012. Os artigos selecionados foram classificados mediante uma análise bibliométrica, o que permitiu definir os mais relevantes. Resultados: 101 títulos cumpriram com os critérios estabelecidos, mais só 43 com o objetivo da revisão. Em quanto à predição da DLIO, os estudos apresentaram heterogeneidade em relação com os fatores a predizer, por exemplo: diagnóstico, trânsito da dor lombar de agudo a crônico, discapacidade, absentismo laboral e retorno ao trabalho. Em relação com os instrumentos aplicados na clínica se encontrou em um 71,4% dos questionários. Conclusão: a predição clínica se considera uma estratégia para determinar o curso ou o prognostico da DLIO e permite determinar as características que aumentariam o risco de cronicidade em trabalhadores com esta condição de saúde. Igualmente, as regras de predição clínica são ferramentas que tem como objetivo facilitar a toma de decisão em torno à avaliação, ao diagnostico, ao prognóstico e à intervenção da dor lombar, as quais devem integrar fatores de risco de ordem física, psicológica e social.

Can we identify people at risk of non-recovery after acute occupational low back pain? Results of a review and higher-order analysis.

PURPOSE: To identify prognostic factors in the literature that may predict a poor recovery from acute occupational low back pain (LBP). METHODS: Four international databases (Medline, CINAHL, EMBASE, and PsycINFO) were reviewed, searching all articles indexed up to November 2007 with the term low back pain combined with the terms prognostic, prospective, or cohort. Following application of inclusion criteria, 10 articles were found to be appropriate for data extraction. Each article was critically appraised by two independent reviewers. Statistical pooling was performed on any factor evaluated in at least three independent cohorts. RESULTS: Seven cohorts were identified, with a total sample size of 2,484 subjects. Only three factors were followed in at least three cohorts and were therefore suitable for statistical pooling: female gender (OR=1.28, 95% CI: 1.03-1.58); pain radiation (OR=1.37, 95% CI: 0.79-2.39); and previous history of back pain (OR=0.91, 95% CI: 0.52-1.60). There was significant heterogeneity within the female gender factor; compensation of subjects for study participation appeared to moderate its effect. CONCLUSION: After statistical pooling, only female gender achieved statistical significance as a prognostic factor for prolonged recovery. Further research is necessary to determine prognostic factors for non-recovery in acute LBP.

The Significance of Anti-type I Collagen Antibody Titer in Occupational Low Back Pain

OBJECTIVE: To assess the significance of anti-type I collagen antibody titer in estimating cumulative trauma and predicting the presence of occupational low back pain. METHOD: Under the hypothesis that cumulative trauma on the spine will expose collagen and stimulate the formation of auto-antibody, we measured the serum anti-type I collagen antibody titers (IgM and IgG) in 408 male workers of a metal welding and manufacturing company. The antibody titers were measured in duplicates by ELISA. Statistical analysis was done to compare the titers according to occupational profiles (type of occupation and duration of employment) and clinical profiles (occurrence of low back pain, duration of low back pain and clinical impression). RESULTS: The anti-type I collagen IgG antibody titers were significantly increased in labor workers (n=357) in comparison with office workers (n=51)(p or =3 months)(n=8). CONCLUSION: These data suggest that anti-type I collagen IgM and IgG antibody may be useful in predicting the presence of occupational low back pain and estimating cumulative trauma, respectively.

Incidence and Risk Factors for Occupational Low Back Pain Among Shipyard Workers / 대한산업의학회지

OBJECTIVES: This study was conducted to estimate the incidence rate, and to identify the risk factors for the occupational low back pain among shipyard workers. METHODS: The study subjects consisted of 9,784 workers who were employed in a ship-building industry(excluded workers who had a history of low pack pain before 1995 or did not take periodic health examination in 1995). The cases were 220 people who experienced back pain from January 1, 1996 to December 31, 1998. To assess risk factors for occupational low back pain, Cox propotional hazard model was used. RESULTS: During the recent three years from 1996 to 1998, the incidence rate per 1,000 persons was 7. 8 in 1996, 8. 8 in 1997, and 3. 1 in 1998. The main causes of work-related low back pain were sprain, strain and disc herniation. Lifting was the most common cause of back pain(35. 3%), and carrying(10.2%) and pulling(8.0%) were followed. In Cox proportional harzard model, independent risk factors for back pain were body mass index(R.R.; 1.54, 959o C.I.: 1.06-2.25), shift work(R.R.; 1.65, 95% C.I.: 1.19-2.28), and lifting heavy material(R.R. ; 3.95, 95% C.I: 2.29-6.82). CONCLUSIONS: This study suggests that the risk factors of back pain in shipyard workers were body mass index, shift work and lifting.

Incidence Density and Risk Factors of Low Back Pain among the Workers in a Welding Material Manufacturing Factory / 한국역학회지

This study was performed to understand the incidence density and detect the risk factors of occupational low back pain. A cross-sectional study was conducted with a questionnaire in a welding material manufacturing factory in October, 1993. Therefore, we selected 140 workers who had never complained of low back pain as cohorts. Also, we added 236 newly entered persons who had never complained of low back pain. The total number of cohorts were 376 workers. And then we continued with a questionnaire survey in October, 1996 and with a questionnaire survey and medical examinations by a specialist in October, 1997. Follow-ups were done for 337 workers. The number of newly developed low back pain among workers were 127. The characteristics of low back pain were as follows. The durations of pain were less than or equal to 2 days (42.6%), from 3 days to less than 1 week (8.7%), from 1 week to less than 1 month (11.0%), 1 month or more (6.2%). The frequency was everyday (7.9%), once per week (21.3%), once per month (14.2%), once per 2-3 months (9.4%), once per 5 months (11.0%). The severity of pain was slight (9.4%), mild (33.1%), moderate (13.4%), severe (10.2%) and very severe (1.6%). The onset of most low back pain was insidious (41.7%). The diagnosis of low back pain was muscle strain (37.8%), lumbar sprain (23.6%) and myofacial pain syndrome (3.9%). The number of newly developed low back pain among workers were 127, their incidence density was 15.7 per 100 person-years. In univariate analysis, age, marital status, educational level, smoking habit, category of job, tenures and frequency of stretching exercises showed a statistical significance. The multivariate logistic regression analysis confirmed that category of job and tenures (p<0.05) were independent risk factors for low back pain among workers. The number of newly developed occupational low back pain among production workers were 71, their incidence density was 11.3 per 100 person-years. In univariate analysis, age, marital status, educational level, regular exercise, tenures, posture of waist and lifting of heavy materials showed a statistical significance. The multivariate logistic regression analysis confirmed that posture of waist (p<0.05) and lifting of heavy materials (p<0.1) were independent risk factors for occupational low back pain among production workers.

Prevalence and Risk Factors of Occupational Low Back Pain among the Production Workers in a Steel and a Welding Material Manufacturing Factories / 대한산업의학회지

A cross-sectional study was conducted for detecting the risk factors and to propose an effective control program for occupational low back pain. The subjects were 1,665 male production workers employed at a steel factory and a welding material manufacturing factory. The data were collected by a self-reported questionnaire and a medical examination with a rehabilitation specialist for ten days in September, 1997. The contents of the questionnaire were as follows: general characteristics, physical characteristics, employment status, type of work, working environment and the experience of low back pain. The number of cases with symptoms of occupational low back pain were 321, so the point prevalence was 19.3 persons/100 persons. The number of cases with a history of occupational low back pain for one year were 554, so the one year period prevalence was 33.3 persons/100 persons. The point and one year period prevalences of occupational low back pain showed no significant differences in age, marital status, educational level and body mass index. The point and one year period prevalences of occupational low back pain showed no significant differences in alcohol drinking, smoking, stretching exercise and regular exercise. The point and one year period prevalences of occupational low back pain were significantly higher in the unsatisfied group than the satisfied group(p < 0.01), However, no significant differences were found among tenures and shift work. The point and one year period prevalences of occupational low back pain were significantly higher in the lifting of heavy materials group than the nonlifting group(p < 0.01). However, no significant differences were found among posture of the waist and the working posture. Through the multivariate logistic regression, significantly associated factors with occupational low back pain were found to be dissatisfaction with job(point prevalence: OR=1.78, 95% CI: 1.21-2.61; one year prevalence: OR=1.76, 95% CI: 1.26-2.47), lifting of heavy materials(point prevalence: OR=1.94. 95% CI: 1.44-2.61: one year prevalence: OR=2.17, 95% CI: 1.70-2.77) and tenure(point prevalence: OR=1.03. 95% CI: 1.01-1.06: one year prevalence: OR=1.02, 95% CI: 1.00-1.05).

Cost-Benefit Analysis of Back School Program for Occupational Low Back pain Patients / 예방의학회지

Although occupational low back pain accounts for 20~40% of all occupational illness and injury, there are limited numbers of studies regarding the effectiveness of back school program. The objective of this study was to evaluate the economic benefit of back school program for early return to work of occupational low back pain patients in the current occupational injury compensation and management system. The cost-benefit analysis in this study was conducted to evaluate the relative magnitude of benefit to cost. The total cost was estimated by calculating the value of components in back school program according to governmental budget protocol. The back school program was consisted of three major approaches, pain center, work-hardening program and functional restoration program and each of components had various facilities and experts. The total amount of cost was estimated as 250,866,220 won per year. The most promising type of back school program were quite intensive (a 3 to 5-week stay in a specialized center), therefore, if we adopted the 5-week stay course, 10 courses could be held in a year. Following to the medical act, 20 patients per doctor could participate in a each course, ie, total 200 patients in a year. As a result, we could estimate the cost of 1,254,331 won a patient. we estimated the benefit by using data of a few local labor offices about average medical treatment beneficiary and off-duty beneficiary of 46 occupational low back pain patients in 1994. Ullman and Larsson(1977) mentioned that the group of chronic low back pain patients who participated in back school program needed less time to recover by 48.4% of beneficiary duration. And in the trying to estimate the benefit, we asked 10 rehabilitation board certificate doctors about reduction proportion of treatment cost by introducing back school program. The answered reduction proportions were in the range of 30~45%, average 39%. As a final result, we could see that the introduction of back school program in treatment of chronic occupational low back pain patients could produce the benefit to cost ratio as 3.90 and 6.28. And we could conclude that the introduction of back school program was beneficial to current occupational injury compensation and management system.

Psychometric Charateristics of Occupational Low Back Pain Patients / 예방의학회지

This study was done for identifying the factors which affect psychologic symptoms of low back(LBP) patients. The study subjects were 43 work-related low back pain patients, 28 work-related non-low back pain patients and 47 general low back injury patients. The study material is SCL 90-R for checking psychologic symptoms and questionnaire for obtaining general information about the subjects. The data were analyzed by model of analysis of covariance adjusted by several variables such as gender, age, education and marital status and then compared the least square means of symptom score between groups. To identify the factors that affect psychologic symptom, duration of suspension, return to work and interaction factor of these two variables were analyzed by multivariate model and we calculated partial correlation coefficient of these variables. As a result, work-related LBP patients showed higher score of symptoms in somatization, depression and psychosis than work-related non-LBP and non-work-related LBP. Duration of suspension and return to work were significant explanatory variables for psychologic symptom score of work-related LBP. Then, we may conclude that the treatment and rehabilitation programe for work-related LBP should cover the strategy of early return to work.