Musculoskeletal complaints among nurses related to patient handling tasks and psychosocial factors – Based on logbook registrations
Introduction
Nurses have both a high prevalence of low back pain and neck/shoulder pain (Ando et al., 2000, Eriksen, 2003, Lagerstrom et al., 1998, Maul et al., 2003, Smedley et al., 1995, Smedley et al., 2003, Trinkoff et al., 2003, Yip, 2001) and a considerable high prevalence of knee pain (Daraiseh et al., 2003, Lagerstrom et al., 1995, Smith et al., 2003, Smith and Leggat, 2004).
The etiology of low back pain (LBP) and neck/shoulder pain (NSP) is multifactorial (Brulin et al., 1998, Burdorf and Sorock, 1997, Linton, 2001, Malchaire et al., 2001). Psychosocial factors like low job satisfaction and lack of social support have been found related to LBP and NSP among nurses (Lagerstrom et al., 1998, Smedley et al., 2003, Yip, 2001) and physical load like patient handling tasks have been associated with LBP, NSP (Engels et al., 1994b, Hignett, 1996b, Hui et al., 2001, Lagerstrom et al., 1998, Smedley et al., 1998, Yip, 2001), as well as knee pain (KP) (Menzel et al., 2004). However, in addition to the physical load, a few studies (Alexopoulos et al., 2003, Lagerstrom et al., 1995) indicate that psychosocial factors, such as high perceived exertion and high job demand, may be more related to neck pain than LBP whereas age may be related to knee pain.
In the medical health care sector the mechanical exposure has been assessed directly by objective measurements, e.g. heart rate, movements or muscle activity by use of electromyography measurements (EMG), lumbar motion monitor and calculated lumbar compression forces/shear forces (Marras et al., 1999, Marras et al.,, Nuikka et al., 2001, Schibye et al., 2003), observations (e.g. OWAS, REBA, PEO) (Engels et al., 1994a, Hignett, 1996a, Hignett and McAtamney, 2000) or by retrospective self-reported questionnaires (Ando et al., 2000, Brulin et al., 1998, Hui et al., 2001, Smedley et al., 1995, Trinkoff et al., 2003, Yip, 2001). Estimations of load, posture or activities are often based upon questions about the average working day or a defined working period (Eriksen et al., 2004, Maul et al., 2003, Smedley et al., 2003). When evaluated over time the common period is a full working day at the most (Ando et al., 2000, Trinkoff et al., 2003). Very few studies have used logbooks to evaluate musculoskeletal complaints (MSC) in addition to psychosocial factors and patient handling tasks during a working period (Gonge et al., 2001).
The aims of this study were:
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to evaluate the inter-method reliability of a patient handling task registration sheet as a part of a self-reported logbook.
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to study the day-to-day variation of musculoskeletal complaints among hospital nurses, during four days (three working days followed by a day off).
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to examine whether patient handling tasks and psychosocial factors were associated with musculoskeletal complaints.
We hypothesized that a self-reported logbook would be a reliable tool for the registration of patient handling tasks. We expected that the numbers reporting both MSC and the pain level would increase during the observation period and decline after a day off work. Further we expected that both patient handling tasks and psychosocial factors are associated with MSC.
Section snippets
Material and method
For this cross-sectional study we invited 148 nurses, from a university hospital in Copenhagen, to fill in logbooks during three consecutive working days followed by a fourth day off work. The nurses were randomly selected between internal medicine (n = 93) and surgery wards (n = 55). The data were colleted over a 12-month period.
Most of the participating nurses were females (92%) with a mean age of 33.0 years (range 21–60). For the male nurses the mean age was 37.2 years (range 25–60). All the
Inter-method reliability
We evaluated the reliability of the task registration sheet by use of percentage agreement and intra-class correlation coefficient (ICC) for each task separately. To evaluate the percentage agreement we calculated both the actually observed agreement and the modified agreement (accepting a difference of +/−1 of the number of tasks registered between the observer and the nurse). The agreement was defined as the percentage of the total number of observations for which both the observer and the
The inter-method-reliability of the task registration sheet
The average percentage of the actual agreement between the observers and the nurses was 82% for all the transfer tasks and 80% for all the care tasks. Whereas the average modified percentage agreement was 95% for both tasks. The mean intra-class correlation coefficient was 0.933 (95% CI 0.847–0.971) for all the transfer tasks and 0.907 (95% CI 0.792–0.960) for all the care tasks. For the different transfer tasks the ICC ranged from 0.558 to 1.000, Table 3. Three transfer tasks, “from lying to
Discussion
We showed that the logbook in general was a reliable and useful for the registration of the number and the specific patient handling tasks. The number of nurses reporting MSC pain and the intensity of pain increased over a three-day working period and decreased again on the following day off. Further, we showed that the associations between physical workload and psychosocial factors and MSC seem to depend upon the type of MSC. Stress adjusted OR 4.0, 95% CI (1.0–15.4) and transfer tasks
Conclusion
We showed that the logbook in general is a reliable and a useful instrument for the registration of specific patient handling tasks. In detail five out of eight transfer tasks and eight out of twelve care tasks were reliable. The number of nurses that reported MSC and the pain level increased over three working days and dropped at the day off, to the same level as on the first day of registration. This indicates that the number of nurses reporting MSC and the level of pain may be reversible to
Acknowledgements
The authors wish to thank physiotherapist Lone H. Larsen for her devoted work in collecting the logbooks and giving constructive comments on the design.
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