The role of physical and psychological factors in occupational low back pain: a prospective cohort study
- Anne-Marie Feyera,
- Peter Herbisona,
- Ann M Williamsonb,
- Indira de Silvac,
- John Mandrykd,
- Leigh Hendried,
- Max C G Helye
- aDepartment of Preventive and Social Medicine, University of Otago, PO Box 913, Dunedin, New Zealand, bSchool of Psychology, University of New South Wales, Sydney, NSW 2050, Australia, cData Analysis and Research Unit, WorkCover, GPO Box 5364, Sydney, NSW 2001, Australia, dNational Occupational Health and Safety Commission, GPO Box 58, Sydney, NSW 2001, Australia, eDepartment of Human Factors and Ergonomics, National Safety Council of Australia, PO Box 708, Newtown, NSW 2042, Australia
- Associate Professor Anne-Marie Feyer, Department of Preventive and Social Medicine, University of Otago, PO Box 913, Dunedin, New Zealand email afeyer{at}gandalf.otago.ac.nz
- Accepted 16 September 1999
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. Pre-existing GHQ score, either at the end of training or at baseline, had no effect 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.
