Multifaceted intervention for the prevention and management of musculoskeletal pain in nursing staff: Results of a cluster randomized controlled trial

Abstract

BackgroundNurses and nursing aides are at high risk of developing musculoskeletal pain (MSP). This study aimed to evaluate a multifaceted intervention to prevent and manage MSP in two hospitals.Material and methodsWe performed a two-armed cluster randomized controlled trial, with a late intervention control group. Clusters were independent hospital units with nursing staff as participants. The intervention comprised three evidence-based components: participatory ergonomics, health promotion activities and case management. Both the intervention and the control group received usual occupational health care. The intervention lasted one year. MSP and work functioning data was collected at baseline, six and 12-month follow-up. Odds ratios (OR) and their 95% confidence intervals (95%CI) were calculated for MSP risk in the intervention group compared to the control group using logistic regression through GEE. Differences in work functioning between the intervention and control group were analyzed using linear regression through GEE. The incidence of sickness absence was calculated through logistic regression and Cox proportional hazard modeling was used to analyze the effect of the intervention on sickness absence duration.ResultsEight clusters were randomized including 473 nurses and nursing aides. At 12 months, the intervention group showed a statistically significant decrease of the risk in neck, shoulders and upper back pain, compared to the control group (OR = 0.37; 95%CI = 0.14–0.96). A reduction of low back pain was also observed, though non statistically significant. We found no differences regarding work functioning and the incidence and duration of sickness absence.ConclusionsThe intervention was effective to reduce neck, shoulder and upper back pain. Our results, though modest, suggests that interventions to prevent and manage MSP need a multifactorial approach including the three levels of prevention, and framed within the biopsychosocial model.

Low back pain among health workers

“…The application of preventive programs and exercises among healthcare workers can reduce the incidence of musculoskeletal diseases, including LBP. Exercise once a week for 6 months combined with five sessions of back care counseling after working hours in real-life settings effectively reduced the intensity of LBP, work interference due to LBP, and fear of pain [19,32].…”

“…The prevalence of LBP among healthcare workers varies and in studies it ranges from 53% [12] to 92% in those involved in rotating shift work [16]. Long-term work, associated with forced body movements and postures, especially in nurses and technicians, lifting weights, with shift work, can enhance the occurrence of LBP, and thus negatively affect the work process, but also the quality of life of health workers [16][17][18][19][20][21].…”

Process Evaluation of a Complex Workplace Intervention to Prevent Musculoskeletal Pain in Nursing Staff: Results From INTEVAL_Spain.

“…The process evaluation was part of INTEVAL_Spain, a two-armed cluster randomized controlled trial with an intention-to-treat intervention. Detailed information on the content, methodology and evaluation of INTEVAL_Spain has been described previously [21][22][23]. Participation was voluntary and signed informed consent was obtained from all workers who agreed to participate in the study.…”

“…Components of the intervention were participatory ergonomics (primary prevention); healthy lifestyle promotion programme with Nordic walking, mindfulness, and healthy diet session (primary prevention); and tailored case management (secondary and tertiary prevention). The intervention effectiveness was evaluated in an intention-totreat cluster randomized controlled trial with the primary outcomes of reduction of MSP and sickness absence and lasted one year [21,22]. At one year follow-up, the effect evaluation showed that the intervention group had a signi cantly lower prevalence of MSP at the neck, shoulders and upper back compared to the control group [22].…”

“…The intervention effectiveness was evaluated in an intention-totreat cluster randomized controlled trial with the primary outcomes of reduction of MSP and sickness absence and lasted one year [21,22]. At one year follow-up, the effect evaluation showed that the intervention group had a signi cantly lower prevalence of MSP at the neck, shoulders and upper back compared to the control group [22]. No effects were found regarding the reduction of sickness absence.…”