Back Pain in the NHS:

Gill Gilworth, Senior Research Fellow Sophie Eyres, Research Fellow Academic Unit of Musculoskeletal and Rehabilitation Medicine, University of Leeds

This presentation:

Literature review - back pain/musculoskeletal disorders in the NHS and risk factors Overview of the Extending Working Life programme at Leeds Work in progress: Understanding musculoskeletally related sickness absence and job loss in Nurses and Nursing Assistants

Musculoskeletal Disorders:

Average sickness rate for UK industry is 3.7%. The NHS averages 5.6% The link between Nursing and MSD is well documented (HSE 2002, Hignett 1996) MSDs are the most common reason for early retirement due to ill-health in the NHS (Pattani et al 2001)

Back pain in Nurses

Studies have been reporting high levels of back pain in Nurses for many years. Hignett (1996) in a review paper re-affirmed nursing as one of the occupations with the greatest prevalence of back pain.

MS pain in nurses, risk factors:

Physical factors:
Lifting/moving patients (Jensen 1990, Mitchelmore 1996) Cumulative load: (Kumar 1990, Mitchelmore 1996) Workload/staffing: (Ootim 2002, Shaiman et al 2001)

MS pain in nurses, risk factors:

Individual factors:

Age (Seacombe & Ball 1992, Myers et al 2002) Experience (Heap 1987) Speciality (Stubbs et al 1986)

MS pain in nurses, risk factors Psychosocial factors:

Job satisfaction (Aitken et al 2001) Stress/Emotional job demands (Aitken et al 2001) Autonomy/respect (Shaiman et al 2001)

Prevalence of MSD in Physiotherapy (Cromie et al 2000)

Musclo-skeletal symptoms 12 month prevalence: LBP 62.5% Neck 47.6 % Upper back 41% Thumbs 33.6% Shoulders 22.9% Wrists 21.8% Elbows 13.2% Knees 11.2%

Risk factors in Physiotherapy

(Cromie et al 2000)

A number of risk factors have been reported as increasing prevalence of MS pain: Work factors such as working in awkward positions/postures Workload particularly of mobilisation and manipulations Frequency and repetitiveness of treatment

Younger physiotherapists are more at risk 50% have first episode as a student most vulnerable during first 4-5 years of practice

Lifetime prevalence of MSD within physiotherapy may be as high as 91% (Cromie et al 2000)

PTs report making changes to working habits and improved body mechanics to help manage symptoms
(Holder et al 1999)

Risk factors physiotherapists: work speciality

Bork et al (1996) identified neurological rehabilitation had the highest prevalence of reported MSD in lower and upper back Paediatrics highest prevalence of MSD upper back

Low back pain/MSDs in Doctors

There are less studies on low back pain in doctors A telephone survey of 55 junior doctors was reported in the BMJ in 1997

Doctors telephone survey n=55

26 reported having received instruction in lifting/moving patients 38 had tried to lift patients alone, 52 had tried to lift patients with the aid of a medical colleague of these 10 had sustained injuries (all back injuries)

Everybody seems to appreciate the gravity of the problem, yet nobody has the courage to be the first to take the lead in openly debating the matter and proposing possible solutions. This could be because of the inability to obtain an accurate picture of the causes of the problem itself (Ootim,2002)

Leeds University Extending Working Life programme:

Rheumatoid Arthritis Work Instability Scale Understanding musculoskeletally related sickness absence and job loss in Nurses and development of a Nurse-Work Instability Scale Development of a WIS for TBI Epilepsy-Work Instability Scale MS-Work Instability Scale ? Back pain Work Instability Scale

Improving Job Retention in Nurses:

Understanding

musculoskeletally related sickness absence and job loss in Nurses and Nursing Assistants
Funded by the Department of Health

The current research project:

Survey of Leeds nursing staff The Qualitative study and development of the Nurse Work Instability Scale The tracking of care pathways

Work Instability, a definition:

Work Instability is a state in which the consequences of a mis-match between an individuals functional (and possibly cognitive) abilities and the demands of their job could threaten continuing employment if not resolved.

Survey of Leeds nursing staff:

Survey form includes record of significant musculoskeletal symptoms in last 3 months Pain assessment map Sickness absence 3 generic Work Instability questions e.g. I get on with the work but afterwards I have a lot of pain

Nurses survey:demographics

N = 1496 returned 92% Female Age range 20 65 years (mean 39.91) 59.96% Musculoskeletal symptoms in past 3 months

Nurses survey: Musculoskeletal symptoms (N=881)

Back Pain 71.8% (631) Shoulder or neck pain 50.1% (440) Any other pain 10.24% (90) Sickness absence in last 3 months 51.9% (448) Musculoskeletal sickness absence 33.3% (149)

Nurses survey WIS scores:

0 20.8% (131) 25.2% (111) 37.8% (34) 71% (424) WIS Score 1 2 26.6% 16.2% (168) (102) 27% (119) 24.4% (22) 16.2% (97) 12.3% (54) 6.7% (6) 2.7% (16) 3 15.7% (99) 14.5% (64) 8% (8.9) 1.0% (6) Missing 20.8% (131) 20.9% (92) 20% (3) 9% (54)

Backs (N =631) Neck/Shoulder (N=440) Other (N=90) No Symptoms (N =597)

Ongoing work - Qualitative study and development of the Nurse WIS:

Qualitative interviews to generate items and form draft measure Face to face content validity Large postal survey Rasch Analysis Gold standard assessment Test re-test postal survey

Ongoing work The tracking of care pathways:

Nurses who go off work with musculoskeletal symptoms will be identified These staff will be interviewed regularly over the phone All participants in this stage of the study will be examined by Professor of MS medicine All findings will be used to evaluate current practise and identify gaps in the service

Acknowledgements:

The Department of Health have funded this project. The research team at Leeds: Gill Gilworth Prof. Alan Tennant Prof. M. Anne Chamberlain Sophie Eyres Amy Carey