Management of Occupational LBP in Health Care Professionals

Epidemiology

Hospital workers experience more occupational health problems than other professional groups, the most common being low back pain (LBP) (Karahan et al., 2009). LBP is responsible for high treatment costs, frequent sick leave, prolonged back pain and potentially sometimes job loss which may lead to psychological problems like depression (Punnett et al., 2005). For the purpose of this Wiki page we will be discussing the literature regarding Nursing & Physiotherapist professionals. The majority of the literature reports the prevalence of LBP to be high in both Nurses and Physiotherapists as compared to other health care professions. However, the prevalence of LBP within these professions varies significantly between different countries.

The lifetime perveance of LBP in Nurses has been reported as 63% in Iran (Azizpour et al., 2017), 59.1% in Bangladesh (Islam et al., 2020), 61.7% in Saudi Arabia (Gaowgzeh, 2019), 59% in South Africa (Dlungwane et al., 2018), 55.3% in Nigeria (Awosan et al., 2017) and 77.1% in Turkey (Karahan et al., 2009). In contrast he lifetime prevalence of LBP in Physiotherapists has been reported as 35% in Australia (West & Gardner, 2001), 73.7% in Slovenia (Rugeli, 2003), 60.8% in Bangladesh (Mondal et al., 2016), 49.2% in Canada (Mierzejewski & Kumar, 1997), 33.3% in Nigeria (Awosan et al., 2017) and 72.7% in Turkey (Karahan et al, 2009). However only two of these studies directly compared the prevalence of LBP in Nurses to Physiotherapists. These studies reported a prevalence of 77.1% & 55.3% in Nurses compared to 72.7% & 33.3% in physiotherapists across Hospitals in Turkey (Karahan et al, 2009) and Nigeria (Awosan et al., 2017).

Aetiology

The majority of cases (78.3%) of LBP among Nurses and Physiotherapists are reported to have occurred after starting work (Karahan et al., 2009). The likely cause of LBP is therefore attributed to the common actions and movements involved with these professions. These include:

1. Lifting of heavy objects/patients including patient manual handling (Awosan et al., 2017, Dlungwane et al., 2018, Gaowgzeh, 2019, Islam et al., 2020, Karahan et al., 2009, Mierzejewski & Kumar, 1997, Rugeli, 2003, West & Gardner, 2001).

2. Frequent bending/trunk flexion (Mierzejewski & Kumar, 1997, West & Gardner, 2001).

3. Pulling patients up the bed (Dlungwane et al., 2018, Mierzejewski & Kumar, 1997, West & Gardner, 2001).

4. Prolonged positioning/bad posture (Awosan et al., 2017, Dlungwane et al., 2018, Islam et al., 2020, West & Gardner, 2001).

5. Standing for long hours (Awosan et al., 2017).

6. High workload/Treating excessive number of patients in 1 day (West & Gardner, 2001).

7. Performing manual therapy (West & Gardner, 2001).

8. 6-month rotational roles (76%) have an increased prevalence compared to 12-month rotational roles (16%) (Dlungwane et al., 2018).

Risk Factors

Personal

  • Insomnia
  • Previous episode of LBP
  • Kinesiophobia
  • BMI >25
  • Hx of Arthritis
  • Absence of exerice
  • Number of Pregnancies
  • Female

Occupational

  • Number of trunk torsions per day
  • Number of Patient transfers per day
  • Poor team collaboration and support
  • Working for longer than 4hrs
  • Standing for longer than 4hrs
  • Sitting at a desk for longer than 4hrs
  • Lack of assisted transfer devices

Yoshimoto et al, (2019) found in a comparative cross-sectional study, looking into low back pain risk factors. That previous episodes of low back pain, kinesiophobia, and insomnia were all significantly associated with severe disabling low back pain. 718 nurses completed survey questionnaires, where 15% of them had low back pain. They found the above factors had the greatest correlation, despite physical flexibility and workload differences. Interestingly no association was found between low back pain and physical parameters such as trunk flexibility and work-related lifting frequency. Unfortunately, the population sample is confined to one medical center in Japan, limiting the generalizability of the study as well. And due to the cross-sectional design, causality cannot be defined.

Boughattas et al, (2017) approximately 58% of the 208 nurses in this study had low back pain. Unfortunately, the authors of this study use outdated literature to discuss important explanations of why these risk factors may impact on the nurse populations.

Andersen et al (2019) looked into the incidence of back-related injury, during patient transfer, something healthcare workers do multiple times a day. This was a prospective cohort study using a survey questionnaire (n=2080) 17 different hospitals in Denmark, were sent a questionnaire every 14 days for one year. There were associated incidence of back injury of which was associated significantly with the number of patient transfers. 1-4 = Odds ratio 3.58, 5-8 OR = 7.60 and >9 OR = 12.27 - Lack of assistive devices were a common phenomenon amongst these injuries including slide sheet (30%) intelligent beds (19%) and walking aids (18%).

Lack of team-work and support in task completion OR 3.16. Conclusion - Improving team collaboration in tasks, reducing patient transfer,s and providing necessary assistive devices are needed to reduce LBP incidence.

Simsek et al, (2017), 1682 Health care workers, including nurses, medical secretaries, physicians, allied health professionals and caregivers. Found that being female, aged >65yrs, ^BMI, Married, lack of exercise, working more than 4hrs standing, sitting at a desk more than 4hrs, more years of service, low job satisfaction were associated with increased risk of low back pain. These were all significant (P=<0.01 however, the ORs were marital status, standing time at work and computer use were all <0.02 OR meaning a misrepresentation of the practical implication of these significant values. Also,the relation to pain and age, suggests younger ages 21-35yrs female workers are in more pain 6.22 and 4.76 for female and male, and at 46-55yrs male workers have higher VAS scores 5.55 and 7.19 for female and male.

Treatment

References

Awosan, K.J., Yikawe, S.S., Oche, O.M. and Oboirien, M., 2017. Prevalence, perception and correlates of low back pain among healthcare workers in tertiary health institutions in Sokoto, Nigeria. Ghana medical journal, 51(4), pp.164-174.

Azizpour, Y., Delpisheh, A., Montazeri, Z. and Sayehmiri, K., 2017. Prevalence of low back pain in Iranian nurses: a systematic review and meta-analysis. BMC nursing, 16(1), p.50.

Dlungwane, T., Voce, A. and Knight, S., 2018. Prevalence and factors associated with low back pain among nurses at a regional hospital in KwaZulu-Natal, South Africa. Health SA Gesondheid, 23(1).

Gaowgzeh, R.A.M., 2019. Low back pain among nursing professionals in Jeddah, Saudi Arabia: Prevalence and risk factors. Journal of back and musculoskeletal rehabilitation, 32(4), pp.555-560.

Islam, M.J., Haseen, F., Saha, S.K., Khasru, M.R., Morshed, M. and Salek, A.K.M., 2020. Prevalence and Risk Factors of Low Back Pain among Medical Professionals Working In Selected Tertiary Hospitals in Dhaka City. Bangladesh Journal of Neurosurgery, 9(2), pp.135-141.

Karahan, A., Kav, S., Abbasoglu, A. and Dogan, N., 2009. Low back pain: prevalence and associated risk factors among hospital staff. Journal of advanced nursing, 65(3), pp.516-524.

Mierzejewski, M. and Kumar, S., 1997. Prevalence of low back pain among physical therapists in Edmonton, Canada. Disability and Rehabilitation, 19(8), pp.309-317.

Mondal, R., Sarker, R.C., Akter, S., Banik, P.C. and Baroi, S.K., 2018. Prevalence of low back pain and its associated factors among physiotherapists in Dhaka city of Bangladesh in 2016. Journal of Occupational Health and Epidemiology, 7(2), pp.70-74.

Punnett, L., Prüss‐Ütün, A., Nelson, D.I., Fingerhut, M.A., Leigh, J., Tak, S. and Phillips, S., 2005. Estimating the global burden of low back pain attributable to combined occupational exposures. American journal of industrial medicine, 48(6), pp.459-469.

Rugelj, D., 2003. Low back pain and other work-related musculoskeletal problems among physiotherapists. Applied ergonomics, 34(6), pp.635-639.

West, D.J. and Gardner, D., 2001. Occupational injuries of physiotherapists in North and Central Queensland. Australian Journal of Physiotherapy, 47(3), pp.179-190.

Yoshimoto, T., Oka, H., Ishikawa, S., Kokaze, A., Muranaga, S. and Matsudaira, K., 2019. Factors associated with disabling low back pain among nursing personnel at a medical centre in Japan: a comparative cross-sectional survey. BMJ open, 9(9), p.e032297

Boughattas, W., El Maalel, O., Maoua, M., Bougmiza, I., Kalboussi, H., Brahem, A., Chatti, S., Mahjoub, F. and Mrizak, N., 2017. Low back pain among nurses: prevalence, and occupational risk factors. Occupational Diseases and Environmental Medicine, 5(1), pp.26-37

Simsek, S., Yagci, N. and Senol, H., 2017. Prevalence of and risk factors for low back pain among healthcare.

Andersen, L.L., Vinstrup, J., Villadsen, E., Jay, K. and Jakobsen, M.D., 2019. Physical and Psychosocial Work Environmental Risk Factors for Back Injury among Healthcare Workers: Prospective Cohort Study. International journal of environmental research and public health, 16(22), p.4528.

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