Quad-bike incidents are a major cause of occupational injury and fatality on farms warranting health and safety attention. As part of a larger study, we carried out a face-to-face survey with 216 farmers in New Zealand. We quantitatively identified farmers' propensity for risk-taking, unrealistic optimism, and fatalism as risk factors in quad-bike loss-of-control events (LCEs). The purpose of the analysis presented in this article was to use these same farmers' recollections of LCEs to explore the a priori constructs in more detail using qualitative methods. Participants reporting one or more LCEs described their first LCE and any experienced in the previous 12 months. Participants provided open-text responses about what occurred at each LCE, their reflections, and general thoughts on LCE risk factors. Directed qualitative content analysis (QCA) was used to "unpack" risk-taking, unrealistic optimism, and fatalism whilst also delineating any additional concepts that farmers associate with LCEs. Risk-taking elements were more evident than unrealistic optimism or fatalism and more suggestive of farmers finding themselves in risky situations rather than engaging in risk-seeking behavior per se. Additional inductively derived categories of fatigue/stress, multitasking, inexperience, and quad-bike faults highlight the complex nature of LCEs and the importance of risk assessment covering these concepts as well as risky situations.

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Purpose: This study explored the experiences of adult farmers living with chronic low back disorders (LBDs) in Saskatchewan. Method: A qualitative phenomenological approach with inductive thematic analysis was used to analyze semi-structured interviews that had been audio recorded and transcribed verbatim. Interview items focused on the perceived cause of LBDs, their impact on social and work life, coping strategies, and health care access and use. Results: A total of 12 face-to-face interviews were conducted with 11 men and 1 woman aged 40–84 years. Two overarching themes emerged: seasonality and isolation. Related sub-themes included pushing through, doing less, barriers to health care, and self-management. Conclusions: Farmers are faced with seasonal demands and geographical constraints, which lead them to push through the pain or do less when experiencing an episode of low back pain. In addition, farmers identified many barriers to accessing health care services that caused them to develop self-management techniques to cope or to go without care. This study provides the groundwork for future research addressing the unique occupational demands of farmers. Knowledge of farmers’ experiences with chronic LBDs and their challenges regarding health care access can help inform health care providers and decision makers and contribute to tailored services and management approaches for similar rural and remote regions in other parts of the world.

Background Walking is an easily prescribed physical activity for people with low back pain (LBP). However, the evidence for its effectiveness to improve pain and disability levels for people with chronic low back pain (CLBP) within a community setting has not been evaluated. This study evaluates the effectiveness of a clinician guided, pedometer-driven, walking intervention for increasing physical activity and improving clinical outcomes compared to education and advice. Methods Randomized controlled trial recruiting N = 174 adults with CLBP. Participants were randomly allocated into either a standardized care group (SG) or pedometer based walking group (WG) using minimization allocation with a 2:1 ratio to the WG. Prior to randomization all participants were given a standard package of education and advice regarding self-management and the benefits of staying active. Following randomization the WG undertook a physiotherapist guided pedometer-driven walking program for 12 weeks. This was individually tailored by weekly negotiation of daily step targets. Main outcome was the Oswestry Disability Index (ODI) recorded at baseline, 12 weeks, 6 and 12 months. Other outcomes included, numeric pain rating, International Physical Activity Questionnaire (IPAQ), Fear-Avoidance Beliefs Questionnaire (FABQ), Back Beliefs questionnaire (BBQ), Physical Activity Self-efficacy Scale, and EQ-5D-5L quality of life estimate. Results N = 138 (79%) participants completed all outcome measures at 12 weeks reducing to N = 96 (55%) at 12 months. Both observed and intention to treat analysis did not show any statistically significant difference in ODI change score between the WG and the SG at all post-intervention time points. There were also no significant between group differences for change scores in all secondary outcome measures. Post hoc sensitivity analyses revealed moderately disabled participants (baseline ODI ≥ 21.0) demonstrated a greater reduction in mean ODI scores at 12 months in the WG compared to SG, while WG participants with a daily baseline step count < 7500 steps demonstrated a greater reduction in mean ODI scores at 12 weeks. Conclusions Overall, we found no significant difference in change of levels of (ODI) disability between the SG and WG following the walking intervention. However, ODI responses to a walking program for those with moderate levels of baseline disability and those with low baseline step count offer a potential future focus for continued research into the benefit of walking as a management strategy for chronic LBP. Trial registration United States National Institutes of Health Clinical Trails registry (http://ClinicalTrials.gov/) No. NCT02284958 (27/10/2014).

Introduction.There is a gap in our knowledge of the place and contribution of rural hospitals in the New Zealand health system. There is no current description of rural hospital services, no national policies and little published research regarding their value. Aim. To explore rural hospital leader perspectives of the role of rural hospitals. Methods. An on-line survey of rural hospital leaders conducted to capture perspectives on areas including facility nomenclature; access and equity; funding and the health reforms. Results. Fifty-five rural hospital leaders representing 19/24 rural hospitals responded. 'Rural Hospital' was the most common term used to describe facilities with 80% of respondents indicating this as their preferred term. Other descriptive terms varied widely from primary through to secondary care. Respondents indicated that the loss of rural hospital in-patient beds would be unacceptable to communities (median 0, IQR 0, 1). Scores on questions about 'range of services' (median 7, IQR 6, 8), 'accessibility' (median 7, IQR 6, 8) and how rural hospitals were addressing health equity (median 6, IQR 5, 7) were variable. The process for allocating funds to rural hospitals was perceived as lacking transparency (median 3, IQR 2, 5). National strategy and 'local governance and control' were both rated as important (median 9, IQR 7, 10 and median 9, IQR, 8, 10) for a rural hospital's future. Discussion. By capturing a collective national rural hospital leadership voice, this study facilitates the understanding of the rural hospital concept. The findings inform subsequent research needed to gain a clearer picture of New Zealand rural hospital provision.