title: A multifaceted workplace intervention for low back pain in nurses' aides: a pragmatic stepped wedge cluster randomised controlled trial.
abstract: This study established the effectiveness of a workplace multifaceted intervention consisting of participatory ergonomics, physical training, and cognitive-behavioural training (CBT) for low back pain (LBP). Between November 2012 and May 2014, we conducted a pragmatic stepped wedge cluster randomised controlled trial with 594 workers from eldercare workplaces (nursing homes and home care) randomised to 4 successive time periods, 3 months apart. The intervention lasted 12 weeks and consisted of 19 sessions in total (physical training [12 sessions], CBT [2 sessions], and participatory ergonomics [5 sessions]). Low back pain was the outcome and was measured as days, intensity (worst pain on a 0-10 numeric rank scale), and bothersomeness (days) by monthly text messages. Linear mixed models were used to estimate the intervention effect. Analyses were performed according to intention to treat, including all eligible randomised participants, and were adjusted for baseline values of the outcome. The linear mixed models yielded significant effects on LBP days of -0.8 (95% confidence interval [CI], -1.19 to -0.38), LBP intensity of -0.4 (95% CI, -0.60 to -0.26), and bothersomeness days of -0.5 (95% CI, -0.85 to -0.13) after the intervention compared with the control group. This study shows that a multifaceted intervention consisting of participatory ergonomics, physical training, and CBT can reduce LBP among workers in eldercare. Thus, multifaceted interventions may be relevant for improving LBP in a working population.
authors.affiliation: National Research Centre for the Working Environment, Copenhagen Ø, Denmark Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.
authors.forename: Charlotte Diana Nørregaard
authors.initials: CDN
authors.lastname: Rasmussen
authors.forename: Andreas
authors.initials: A
authors.lastname: Holtermann
authors.forename: Hans
authors.initials: H
authors.lastname: Bay
authors.forename: Karen
authors.initials: K
authors.lastname: Søgaard
authors.forename: Marie
authors.initials: M
authors.lastname: Birk Jørgensen
mesh_terms: D000328:Adult; D016000:Cluster Analysis; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000451:nursing / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D009728:Nursing Assistants; D009788:Occupational Therapy / Q000379:methods*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D017132:Workplace