Abstract

Low back pain (LBP) is a ubiquitous problem affecting nearly half of all workers in the health care (HC) setting. Hospital nurses report a 35 percent point prevalence and a 55 percent annual prevalence of LBP. Nursing is among the occupations ranked highest in work-related LBP, so substantial research efforts have been dedicated to understanding the interactions between workplace demands and worker characteristics that increase risk of LBP. Patient lifting and transfer is clearly the most prominent causal factor, and usual interventions include lift/transfer devices, no-lift policies, and ergonomic assessments. Efforts to reduce physical ergonomic exposures in hospitals and nursing homes have met with some success, but engineering and policy solutions are only effective if coupled with sufficient worker training and participation. Besides the high physical exposures in the HC setting, research has also highlighted the importance of organisational and psychosocial factors in LBP incidence rates. These include high psychosocial demands (when paired with low job control), effort-reward imbalance, and low social support. Thus, LBP prevention efforts in the HC setting need to address psychosocial as well as physical job characteristics. Given the high prevalence of LBP among HC workers, one question is whether more efforts should be directed toward secondary prevention – focusing on job accommodation, return-to-work facilitation, and other aspects of organisational support to prevent long-term work absence and job loss after the initial report of LBP. Such disability prevention efforts, when instituted at the organisational level, have shown sizable cost benefits to employers and insurers, but their effects on long-term employee health and well-being lack sufficient evidence. These studies do, however, suggest that how HC organisations respond to individual workers with LBP may be equally important as their systemic efforts to reduce LBP incidence rates.