The role of physical and psychological factors in occupational low back pain: a prospective cohort study

Abstract

Objective-To examine risk factors for onset of low back pain (LBP) in healthcare workers. Methods-Nursing students, during their 3 year training period, and 1 year after training were studied in a prospective cohort study, with repeated self reported measurements of determinants of LBP at 6 monthly intervals for 3 years during training, and after a 12 month interval there was an additional final follow up. Results-During training, increased risk of new episodes of LBP was associated with having had LBP at baseline, with part time work, and with a high score on the general health questionnaire (GHQ). A high GHQ score preceded the onset of LBP, in such a way that a high score at the immediately previous follow up increased risk of LBP at the next follow up. 12 Months after training, a history of recurring LBP during training increased the risk of a new episode as did having obtained work as a nurse. A high GHQ score at this follow up was also associated with a concurrently increased risk. Preexisting GHQ score, either at the end of training or at baseline, had no eVect on risk of LBP 12 months after training. Conclusions-Other than a history of LBP, pre-existing psychological distress was the only factor found to have a pre-existing influence on new episodes of LBP. Increased levels of psychological distress (as measured by the GHQ) preceded the occurrence of new episodes of pain by only short intervening periods, implying a role for acute distress in the onset of the disorder. This finding suggests that management of the onset of occupational LBP may be improved by management of psychological distress. (Occup Environ Med 2000;57:116-120) Keywords: low back pain; nurses; psychological factors At some time in their lives, most people will experience low back pain (LBP).1 2 It is the most common and the most expensive source of compensated work related injury in modern industrialised countries.3 4 Moreover, both the rate and the degree of disability accruing from LBP are increasing worldwide. Physical load on the back has commonly been implicated as a risk factor for LBP, and in particular, for work related LBP. Certain occupations and certain work tasks seem to have a higher risk of LBP.7-10 However, the evidence for the relation between physical load and musculoskeletal disease has often been weak or contradictory, and it is generally agreed that work related physical load can only partially explain the high prevalence of the problem. 11By contrast, association of non-physical factors with LBP has been one of the more robust findings in the scientific literature. Psychological factors have been consistently found to be associated with LBP, with disability arising from LBP, and with treatment outcome. 12-16Poor psychosocial work environment and work dissatisfaction have also been found to be associated with LBP and the development of chronicity 12 17 18 although contradictory findings have been reported. 19 20 Despite the many publications examining LBP, several key issues concerning occurrence and pr...

Effectiveness of intervention for low back pain in female caregivers in nursing homes: a pilot trial based on multicenter randomization

“…A meta-analysis based on 229 studies on gender differences in caregiver psychological and physical health and caregiving stressors suggested that women had higher levels of burden and depression, and lower levels of subjective well-being and physical health [13]. An interesting prospective cohort study reported that the management of occupational low back pain might be improved by the management of psychological distress [33]. In the present study, the CES-D and the MHS used were based on SF-8 for the other outcome measurements; however, as with the results for low back pain, a meaningful effect was not observed.…”

Psychosocial Factors Related to Low Back Pain among School Personnel in Nagoya, Japan.

“…Interest has been increasing with respect to psychosocial factors relating to LBP during the past several years in occupational health research. Considerable evidence exists which indicates that social and psychosocial factors play a major role in the symptom complex of LBP 1,[3][4][5][6][7][8][9] . In Japan, although the incidence of illness from employment is declining, frequency of LBP maintains high rates 10) .…”

Chronic Low Back Pain Frequency and its Risk Factors in Clinical and Office Staff of Hospitals

“…Feyer et al demonstrated that a high score for the general health questionnaire (GHQ) was related to low back pain (5). In this study the population had a good mental health status.…”

“…Feyer et al in Australia demonstrated that general health questionnaire (GHQ) with high score was a risk factor for low back pain (5). Roupa et al in Greece showed that 40% of nurses with some history of low back pain that had effects on their mood and sleep quality (6).…”