Low back symptoms among hospital nurses, associations to individual factors and pain in multiple body regions

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Abstract

Nursing personnel (n = 263) employed in three hospitals in the United States completed questionnaires investigating musculoskeletal symptoms (MSS) in multiple body regions. The aims of this study were to: i) determine prevalence rates and significant associations between multiple MSS in the lower back and other body regions and ii) investigate significant associations between MSS in multiple body regions and individual/lifestyle factors. Results showed high prevalence rates of symptoms in the lower back, shoulders, and lower extremities. Significant associations were found between multiple MSS in the lower back and; i) upper back, neck, and shoulders and ii) lower extremities. Smoking, body mass index and work experience were found to be significantly associated with MSS in multiple body regions. In conclusion, symptoms in the lower back may lead to problems in other body areas possibly due to awkward postures, unintentional disregard for safe practices or transfer of pain due to biological factors. Interventionists should conduct periodic assessments to detect early symptoms and increase awareness to avoid proliferation of symptoms, comorbidity and chronicity.

Relevance to industry

The possibility that symptoms in one body region may be related to symptoms elsewhere emphasizes the importance of conducting periodic assessments on nursing personnel rather than wait for annual evaluations. Symptom reporting at the time of initial back pain can identify individuals at higher risk for developing chronic or comorbid musculoskeletal disorders.

Introduction

Work-related musculoskeletal symptoms (MSS) affect nearly a million workers in the United States (U.S.) each year (U.S. Bureau of Labor Statistics, 2004). Although MSS have shown to decline in recent years they continue to be the leading type of injury/illness in every major industry division (U.S. Bureau of Labor Statistics, 2004) and account for over 85% of all workers' compensation claims (Pransky et al., 2000).

Healthcare workers in particular have shown to experience higher rates of MSS than those in construction, mining, and manufacturing (Li et al., 2004, Crawford et al., 2008). Among healthcare workers, evidence shows that nurses in particular are at risk for MSS (Ando et al., 2000, Gerdle et al., 1994, Lagerstrom et al., 1995). Prior studies in nurses have primarily focused on the singular occurrence of MSS in various body regions (Lagerstrom et al., 1995, Engkvist et al., 1998, Hagen et al., 2006, Josephson et al., 1997, Josephson and Vingard, 1998, Leboeuf-Yde et al., 1997). However, it has been largely ignored that nurses can experience concurrent symptoms in the low back as well as other body regions. This scenario is likely, but too often overlooked.

In order to effectively assess, treat, and prevent MSS, it is important to identify and understand the underlying mechanisms leading to these problems (Genaidy et al., 2005). A widely held area of interest is the identification of the various risk factors leading to the onset of symptoms (physical, psychosocial, and organizational) (Devereux et al., 2002, Gonge et al., 2002, Smedley et al., 2003, Layer et al., 2009). When considering such factors it is important to include the possibility that symptoms in one area of the body may be an antecedent to the occurrence of symptoms in another area (Smith et al., 2004). Ektor-Anderson et al. (Ektor-Anderson et al., 1999) emphasize the need to analyze the number of painful areas as ‘mandatory as stratification for gender in causes for musculoskeletal pain’. Kamaleri et al., (Kamaleri et al., 2008c) concur stating “epidemiological research into musculoskeletal pain that concentrates on localized pain without assessing other pain sites will miss a crucial dimension”. Indeed, in a later publication Kamaleri et al., (Kamaleri et al., 2009) showed that individuals who initially reported pain in multiple body regions continue to report multi-site pain over a period of 14 years. Although a thorough understanding of the underlying biological mechanisms leading to and perpetuating MSS needs to be reached, it is implicit that the body functions as a whole and when subject to risk, it is likely it will respond as a whole. The injury or pain may occur in one body region, but the body is expected to utilize other regions to reduce the pain or compensate to counter that weakness.

When examining risks factors, studies limit their analysis by controlling or adjusting for individual or lifestyle factors. This does not allow for the examination of the independent contributions of these factors to MSS (Cole and Rivilis, 2004). Therefore, this investigation was conducted to consider the following two hypotheses: i) symptoms in the lower back will be significantly associated with symptoms in different body regions; ii) symptoms in multiple body regions will be significantly associated with individual and lifestyle factors.

The specific aims of this study were:

  • 1.

    Determine 1-month and 1-year prevalence rates of MSS for each of ten body regions: neck, shoulders, elbows/forearms, hands/wrists, fingers, upper back, lower back, hips/thighs, knees/lower legs, and ankles/feet.

  • 2.

    Examine significant associations between high intensity/high frequency (severe) MSS in the lower back and each of the nine remaining body regions.

  • 3.

    Examine significant associations between severe MSS for each of the ten body regions and individual/lifestyle factors

Multiple sites of MSS are common in the general population (Natvig et al., 2001). However, to the authors' knowledge, no study has described the full range of specific musculoskeletal pain sites (not only defined as ‘multi-site pain’ or ‘widespread pain’) (Genaidy et al., 2005, Natvig et al., 2001) and their relation to each other as well as to demographic and lifestyle/individual variables in a cohort of nurses.

Section snippets

Study preparation

Data were gathered by means of a questionnaire at three U.S. hospitals located in the states of Ohio and Kentucky in 2003. Preliminary meetings with hospital administrators and unit managers were conducted in order to detail study procedures. Flyers were posted in nurses' stations and on hospital units for recruitment. All participants were briefed on the research objectives by unit managers and were required to sign consent forms prior to participation. Necessary authorization from the

Prevalence of MSS in single body regions

Five body regions (neck, shoulders, lower back, knees/lower legs and ankles/feet) showed 1-month rates of approximately 50% or higher (Table 2). The 1-year prevalence of symptoms that were functionally limiting, range from 2.7% for fingers to 28.6% for the lower back. One-year prevalence rates were calculated using scores of ‘0’ = No and ‘1’ = Yes from question ‘3’.

One-year severe MSS were defined as nurses reporting a score of ≥4 in questions ‘1’ and/or ‘2’. Clearly, severe lower back symptoms

Discussion

While there have been numerous studies investigating work-related musculoskeletal risk factors, it is critical that a broader understanding of the underlying mechanisms is established. The concept that MSS in one body area may be associated (if not a precursor) to symptoms in another requires exploration: this investigation is an initial attempt at addressing this matter.

Conclusions

The possibility of preventing symptoms in some body areas by alleviating or treating symptoms in another may have considerable impact on the occurrences and potential chronicity of MSS. In a two-year prospective study conducted on nurses, Smedley et al. (Smedley et al., 1997) found that the strongest predictor of new lower back pain was earlier history of the symptom and later found that prior lower back symptoms were the strongest predictor for pain in the neck/shoulder (Smedley et al., 2003).

Acknowledgements

This research was supported (in part) by a pilot project research training grant from the University of Cincinnati. The University of Cincinnati, an Education and Research Center, is supported by Training Grant No. T42/CCT510420 from the Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health. The contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institute for Occupational Safety and

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