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160
handling that the job entails. Nurses are fre-quently required to undertake
stresses.45
Strategies
activities that carry the highest risk, but first the levels of risk associated with
different tasks must be assessed. Biomechanical evaluation contributes to the
assessment, but epidemiological evi-dence is also required. We report a
survey in which the risk of back symptoms in nurses was examined in relation
to a range of lifting tasks.
Methods
The study population comprised the 2405 hospital based
nurses employed by
Low back pain was defined as pain lasting for longer than a day
in an area (indicated in a diagram) between the twelfth ribs and the
gluteal folds. Subjects were asked to exclude pain that only occurred
in association with pregnancy, menstruation, or febrile illness.
MRC Environmental
Epidemiology Unit,
University of
Southampton,
Southampton General
Hospital,
Southampton
J Smedley
P Egger
C Cooper
D Coggon
Correspondence to:
Dr J Smedley; MRC
Environmental
Epidemiology Unit,
University of Southampton,
Southampton General
Hospital, Southampton
S016 6YD.
161
about lifetime back pain and associated fea-tures has been assessed
in an earlier study in the general population. Subjects were asked to
associated disability.
complete the questions a second time, one year after their first response.
The level of agreement was 91% for reported lifetime low back pain,
82% (minimum) for reported sciat-ica, and 87% for reported sickness
absence.6
patients was mea- sured indirectly by comparing the responses of
nurses of the same grade working on the same ward. Good agreement
problems.
was found for task fre-quency, only 16% of reports differed from the
low back pain in the past 12 months with height and with report
ofvarious non-musculoskeletal symptoms. Risk of back pain increased
with stature, but the trend was weak and failed to reach significance.
More striking was the rela-tion to other symptoms. There was a strong
Results
Table 3 shows the relation of low back pain to certain other nonoccupational risk factors.
After adjustment for age, height, and report of nonmusculoskeletal symptoms, all of the associations
were weak and none was signifi-cant.
The occupational risk factors studied included hours worked
(full time or part time), shifts worked (days, nights, or both), and
grade (nursing assistant or higher).
Analysis, with logistic regression, showed no association between any
of these factors and the risk of back pain. Back symptoms in the past
Men
(n = 43*)
56
23
5
year were reported less frequently than the average by paediatric nurses,
but other-wise there were no clear patterns by depart- ment. Associations
Women
(n = 1616*)
60
25
10
29
39
40
45
and
Table 2 Association of low back pain in the past 12 months with height and report of nonmusculoskeletal symptoms in female nurses
Each risk factor
examined
Risk estimates
With
back pain*
Without
back pain*
separately
OR (95% CI)
160
187
119
161
104
223
231
124
180
113
1-1 (0-9-1-5)
1-3 (1-0-1-8)
1-3 (0-9-1-7)
1-3 (0-9-1-8)
1-2 (0-9-1-6)
1-4 (1-0-2-0)
1-3 (1-0-1-8)
1-3 (0-9-1-9)
566
156
760
100
2-1 (1-6-2-7)
1-7 (1-3-2-3)
Never or occasionally
521
181
686
149
1-5 (1-2-2-0)
1-4 (1-0-1-8)
Never or occasionally
Frequently
480
244
682
171
2-0 (1-6-2-5)
1-4 (1-1-1-9)
Never or occasionally
Frequently
629
94
818
38
3-2 (2-2-4-8)
2-0 (1-2-3-1)
740
115
1
2-1 (1-6-2-7)
1-3 (1-0-1-8)
Risk factor
Height (cm):
<157
158-163
164-166
167-170
) 171
Headache:
Never or occasionally
Frequently
Period pain:
Frequently
Fatigue:
Low mood:
Stress:
Never or occasionally
Frequently
545
176
*Answers to specific questions were missing for up to 70 women. All risk estimates were adjusted
for
age
in
quintiles.
mutually
adjusted
OR (95% CI)
162
Discussion
The prevalence of back symptoms recorded in
this survey cannot be compared directly with those found in most other
studies because of
identical question to
an
Table 3 Association oflow back pain in the past 12 months with non-occupational
Risk factor
With
back pain
n
Without
back pain
n
Risk estimated
(a)
OR (95% CI)
211
511
276
572
1
1.1 (0-9-1-4)
0
1-2
297
294
374
293
1
0-8 (0 6-1 0)
07 (05-10)
409
203
109
509
219
131
654
68
786
3+
Cigarette smoking:
Never
Ex
Current
No
Yes
128
183
0-9 (0 6-1 1)
0-8 (06-11)
1-2 (1-0-1 5)
1 0 (0-8-1-4)
1-2 (0-9-1 5)
1 0 (0-8-1-4)
back pain that we examined, non-musculoskeletal symptoms showed the strongest asso-ciations with back
73
1 1 (0-8-1-6)
1
1-1 (0-8-1-6)
than
an
the
of other studies that have shown that people who are depressed or
dissatisfied with their
work are more likely to complain of back symptoms.9-12 In particular,
longitudinal study has shown that depression predicts the
subsequent back pain, and that the
one
Table 4 Association oflow back pain in the past 12 months with occupational
activities in female nurses
Risk estimate-
0
1-4
5+
0
1-4
5+
Manually move a patient
around on the bed:
0
1-4
5-9
With
back pain *
450
197
43
168
227
128
152
531
the floor:
547
228
41
274
257
1-3 (0-8-2-1)
1-0(0-8-1-3)
1-3 (0-8-2-1)
669
1
1-3(1 0-1-8)
137
246
270
1-0(0-8-1-3)
OR (95% CI)
123
157
84
169
(b)
109
21
(a)
OR (95% CI)
1
1-5 (1-1-1-9)
1-7 (1-2-2-3)
1-5 (1-1-2-1)
120
167
10+
Without
back pain*
26
175
260
1-4(1 0-1-8)
1-4(1-1-1-9)
1-8 (1-3-2-5)
1-5 (1-1-2-1)
1-0 (0-5-1-8)
0-9 (0-5-1-8)
1
1-1 (0-8-1-6)
1-5 (1 1-22)
1-6 (1 1-23)
1 7 (1-2-2-3)
(classified as in table 2) (b) adjusted for age (in quintiles) and for height and report of non-mus-culoskeletal
symptoms (classified as in table 2).
trouble
frequency in an
average working shift
Transfer a patient on
higher response
high proportion of
was the
*Information was missing for up to 122 women; t(a) adjusted for age (in quintiles) and height
Activity:
higher (despite
1-2 (09-1 5)
to hospital admission:
were
study
rate), which supports the view that nurses are at an increased risk of
nurses who had taken
No
Yes
Number of children:
(b)
OR (95% CI)
Current participation in
regular sport or exercise:
onset
of
trouble."I
Surveys in Sweden,'4
Denmark,'5 and Britain'6 have failed
to
of back symptoms in a
British longitudinal study did suggest an
asso-ciation,
in the tallest
entry
to
1-2 (0-8-1-7)
relation ofback
1-7 (1-2-2-4)
severe trauma.2'
around on the bed, transferring patients between bed and chair, and
lifting patients up from the floor were associated with increased risk of
back
Of the
pain
to
reproductive hiStory,3
10 18
smoking,"' 1920 or
438
567
231
1 3 (1-0-1-6)
1-3 (1-01-6)
58
611
738
63
1 0 (0-7-1-5)
0
1+
569
102
679
120
1
1 0(07-1-3)
0
1-4
5+
426
222
554
212
32
0
1+
with a hoist:
0
1+
of the bath:
230
24
1-1 (0-8-1-6)
1-3 (1 0-1 6)
0-9 (0-5-1-6)
1-0(07-1-3)
1-2 (1 0-1 6)
0-8 (0-5-1-5)
*Information was missing for up to 213 women; t(a) adjusted for age (in quintiles) and height
in table
(classified as
2) (b) adjusted for age (in quintiles) and for height and report of non-musculoskeletal
symptoms (classified as in table 2).
of non-musculoskeletal symptoms. In
contrast, no association was found with
lifting or transfer-ring patients with a
hoist or with canvas and poles. In
general, this pattern of risk is consistent with biomechanical evaluation,4
but
163
particular,
been more handicapped by back disorders and therefore more inclined to par-
occupational activity.
patients.
This study was supported
those who were pain free, and nurses with heavier jobs may have been
more conscious of their symptoms and had a lower threshold for
to obscure associations
part by a grant
with the
help
from Wessex
computing.
are
obtained in a cross
sectional study is likely
to
1983;26:755-65.
Roman A. Occupational
methodological difficul-
in
5 Gagnon M, Sicard C, Sirois JP. Evaluation of forces on the lumbo-sacral joint and assessment of
work and energy transfers in nursing aides lifting patients. Ergonomics
1986;29:407-21.
low
back
pain.
1992.
Southampton
(MD
D.
Occupational
[abstract].
1992;46:227-30.
Fisher
LG. A social
epidemiology
of
769-79.
Orthop Scand
1977;170(suppl): 1-117.
A.
105.
prospective study.
ongoing
activi-
1984;9: 106-19.
16 Walsh K, Cruddas M,
pain
this
currently following up
population of nurses, with the aim of
low back
1985;27:518-24.
thesis.)
Southampton: University
lifting.
around on
in
our
being
or
Meanwhile
is
in the
chronic
17:420-4.
hospital beds and for bed to
use
of hoists as a
means
of
Yusuf E.
in
21 Walsh
pain
in
people admitted
to
hospital
for traffic