What Do We Know About Interventions to Prevent Low Back Injury and Pain Among Nurses and Nursing Students? A Scoping Review

Study background Back injuries are common among nurses worldwide with lifetime prevalence of lower back pain ranging from 35% to 80%, making nursing a profession at great risk for back injuries. Purpose This systematic scoping review explored and mapped existing evidence regarding the prevention of low back injury and pain among nurses and nursing students. Methods Using a scoping review methodology, six databases were searched initially in September 2017 and updated June 2020. Studies investigating interventions designed to reduce back injuries and pain among regulated nurses and student nurses, published in peer-review journals and written in English, were eligible for inclusion in this review. Quantitative, qualitative, and mixed methods studies of regulated nurses, nursing students, and nursing aides were included. Two independent reviewers screened, critically analysed studies using a quality appraisal tool, extracted data, and performed quality appraisals. Results Two searches yielded 3,079 abstracts and after title, abstract and screening, our final synthesis was based on 48 research studies. Conclusions Forty years of research has demonstrated improvements in quality over time, the efficacy of interventions to prevent back injury and pain remains unclear, given the lack of high-quality studies. Further research, using multi-dimensional approaches and rigorous study designs, are needed.

Relationships between Height, Mass, Body Mass Index, and Trunk Muscle Activation during Seated Whole-Body Vibration Exposure

Operators of heavy equipment are often exposed to high levels of whole-body vibration (WBV), which has been associated with a variety of adverse health outcomes. Although anthropometric factors are known to impact vibration dose and risk of low back pain, studies have yet to investigate the influence of anthropometric factors on muscle activation during WBV exposure. This study quantified the relationships between muscle activation, vibration frequency, body mass, body mass index (BMI), and height both pre- and post-fatigue. Muscle activation of the external oblique (EO), internal oblique (IO), lumbar erector spinae (LE) and thoracic erector spinae (TE) were quantified using surface electromyography. Results indicate increased activation with increased mass, BMI, and frequency for the LE, TE, and IO, which may be a result of increased activation to stabilize the spine. Decreased muscle activation with increased height was seen in the TE, IO, and pre-fatigue EO, which could indicate higher risk for low back injury since height is associated with increased forces on the spine. This may contribute to the association between increased low back pain incidence and increased height. Results suggest that ISO 2631-1 health guidance should incorporate anthropometric factors, as these may influence muscle activation and back injury risk.

An analysis of pre-season risk factors for low back injury in high-school baseball pitchers: a prospective study

Pitching motion requires whole-body coordination; therefore, poor control of the lower extremities, pelvis and trunk may cause shoulder and elbow injuries. However, few studies have described the relationship between the shoulder joint function and low back injury in high-school baseball pitchers. A total of 128 healthy high school pitchers underwent pre-season medical checkups, where their shoulder range of motion and shoulder strength were measured. The participants completed a self-recorded daily questionnaire regarding the presence of low back pain. Pitchers were divided into injured and non-injured groups. Low back injury was observed in 13 participants (13.4%). In the injured group, horizontal adduction on the dominant shoulder was significantly less than in the non-injured group. A logistic regression analysis showed that horizontal adduction on the dominant side was a significant independent risk factor for low back injury during the season. It is important to recognize that restriction of the shoulder function not only causes shoulder and elbow injuries but can also risk low back injury.

A deep learning approach for lower back-pain risk prediction during manual lifting

Occupationally-induced back pain is a leading cause of reduced productivity in industry. Detecting when a worker is lifting incorrectly and at increased risk of back injury presents significant possible benefits. These include increased quality of life for the worker due to lower rates of back injury and fewer workers’ compensation claims and missed time for the employer. However, recognizing lifting risk provides a challenge due to typically small datasets and subtle underlying features in accelerometer and gyroscope data. A novel method to classify a lifting dataset using a 2D convolutional neural network (CNN) and no manual feature extraction is proposed in this paper; the dataset consisted of 10 subjects lifting at various relative distances from the body with 720 total trials. The proposed deep CNN displayed greater accuracy (90.6%) compared to an alternative CNN and multilayer perceptron (MLP). A deep CNN could be adapted to classify many other activities that traditionally pose greater challenges in industrial environments due to their size and complexity.

An Analysis of Pre-Season Risk Factors for Low Back Injury in High-School Baseball Pitchers: A Prospective Study

A pitching motion requires whole-body coordination; therefore, poor control of the lower extremities, pelvis and trunk may cause shoulder and elbow injuries. However, few studies have described the relationship between the shoulder joint function and low back injury in high-school baseball pitchers. In this study, 97 high-school baseball pitchers who underwent pre-season medical checkups were enrolled and their shoulder range of motion and strength were measured. The participants completed a self-recorded questionnaire regarding the presence of low back pain and were divided into injured and non-injured groups. The statistical analyses were performed to identify the independent risk factors for low back injury. Low back injury was observed in 13 participants (13.4%). In the injured group, horizontal adduction on the dominant shoulder was significantly less frequent than in the non-injured group. A logistic regression analysis showed that horizontal adduction on the dominant side was a significant independent risk factor for low back injury during the season. It is important to recognize that restriction of the shoulder function not only causes shoulder and elbow injuries but can also risk low back injury.

Comparing the risk of low-back injury using model-based optimization: Improved technique versus exoskeleton assistance

Although wearable robotic systems are designed to reduce the risk of low-back injury, it is unclear how effective assistance is, compared to improvements in lifting technique. We use a two-factor block study design to simulate how effective exoskeleton assistance and technical improvements are at reducing the risk of low-back injury when compared to a typical adult lifting a box. The effects of assistance are examined by simulating two different models: a model of just the human participant, and a model of the human participant wearing the SPEXOR exoskeleton. The effects of lifting technique are investigated by formulating two different types of optimal control problems: a least-squares problem which tracks the human participant’s lifting technique, and a minimization problem where the model is free to use a different movement. Different lifting techniques are considered using three different cost functions related to risk factors for low-back injury: cumulative low-back load (CLBL), peak low-back load (PLBL), and a combination of both CLBL and PLBL (HYB). The results of our simulations indicate that an exoskeleton alone can make modest reductions in both CLBL and PLBL. In contrast, technical improvements alone are effective at reducing CLBL, but not PLBL. The largest reductions in both CLBL and PLBL occur when both an exoskeleton and technical improvements are used. While all three of the lifting technique cost functions reduce both CLBL and PLBL, the HYB cost function offers the most balanced reduction in both CLBL and PLBL.

Quantifying Lumbar Movement Patterns of Allied Health Professionals in an Australian Health Care Facility

Health professionals responsible for return to work plans have little data about allied health movement to guide recommendations following lower back injury. This study aimed to quantify the lumbar movement patterns of allied health professionals within a health care facility throughout a normal workday. An observational case study was undertaken at a public health care facility with 122 allied health professionals. The lumbar movements were recorded with the ViMove together with pain scale measurement. The mean (SD) recording time for allied health was 7.7 (0.7) hours. A mean (SD) 3 (1.4) hours total were spent in standing, 3.8 (1.7) hours in sitting, and 0.8 (0.4) hours in locomotion. Forty-nine flexions were recorded on average per session, most identified as short term (<30 s) within low range (0°–20°). Lumbar movement patterns differed among professions. Thirty-seven (31%) participants reported a history of lower back injury, and 57 (47%) reported low back pain at the end of their workday. This study provides an insight into allied health professionals’ back movement in a hospital or community-based health care setting. These data may inform those who make return to work recommendations or provide rehabilitation services for allied health professionals working with a lower back injury.