[Show abstract][Hide abstract] ABSTRACT: Sick leave due to neck pain (NP-SL) is costly and negatively impacts the productivity of the nursing and midwifery workforce. Identification of modifiable risk indicators is necessary to inform preventive efforts. This study aimed to investigate the role of pain-related psychological features (pain catastrophizing, fear of movement, and pain coping) in NP-SL alongside other potential risk indicators.
A cross-sectional analysis of a large cohort study of Australian and New Zealand nurses and midwives, established between 1st April 2006 to 30th March 2008, was undertaken. Recruitment procedures adopted within each Nursing Council jurisdiction were governed by the individual regulatory authorities and their willingness to engage with the study. Invitations directed potential participants to a purpose-built internet-based survey, where study information was provided and consent requested. Once consent was obtained, a range of standardized tools combined into one comprehensive electronic questionnaire was elicited. Exposure variables assessed included pain characteristics and a broad range of psychological, psychosocial, occupational, general health and demographic factors. Two-way interactions between age and gender and candidate exposures were also assessed. Binary logistic regression was performed using manual backward stepwise elimination of non-significant terms.
The cohort included 4,903 currently working nurses or midwives aged 18-65 years. Of these, 2,481 (50.6%) reported neck pain in the preceding 12 months. Our sample comprised of 1,854 working nurses and midwives with neck pain in the preceding year who supplied sick leave data. Of these, 343 (18.5%) reported taking sick leave in the preceding year due to their neck pain. The final most parsimonious multivariable model demonstrated neck pain severity (adjusted odds ratio, [aOR] = 1.59), passive pain coping (aOR = 1.08) and fear of movement (aOR = 1.06) increased the likelihood of NP-SL in the previous year. Interactions between demographic and general health factors exhibited both protective and risk relationships with NP-SL, and there was no association between pain catastrophizing and NP-SL.
Findings demonstrate that sick leave due to neck pain was associated with pain severity, fear of movement and passive pain coping. In addition, there were complex interactions found between demographic and general health factors. These features represent potentially modifiable targets for preventive programs.
[Show abstract][Hide abstract] ABSTRACT: Aboriginal Australians, including Aboriginal Health Workers (AHWs), smoke at rates double the non-Aboriginal population. This study utilized concept mapping methodology to identify and prioritize culturally relevant strategies to promote smoking cessation in AHWs. Stakeholder participants included AHWs, other health service employees and tobacco control personnel. Smoking cessation strategies (n = 74) were brainstormed using 34 interviews, 3 focus groups and a stakeholder workshop. Stakeholders sorted strategies into meaningful groups and rated them on perceived importance and feasibility. A concept map was developed using multi-dimensional scaling and hierarchical cluster analyses. Ten unique clusters of smoking cessation strategies were depicted that targeted individuals, family and peers, community, workplace and public policy. Smoking cessation resources and services were represented in addition to broader strategies addressing social and environmental stressors that perpetuate smoking and make quitting difficult. The perceived importance and feasibility of clusters were rated differently by participants working in health services that were government-coordinated compared with community-controlled. For health service workers within vulnerable populations, these findings clearly implicate a need for contextualized strategies that mitigate social and environmental stressors in addition to conventional strategies for tobacco control. The concept map is being applied in knowledge translation to guide development of smoking cessation programs for AHWs.
Health Education Research 12/2012; 28(1). DOI:10.1093/her/cys111 · 1.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Long-term measures to reduce tobacco consumption in Australia have had differential effects in the population. The prevalence of smoking in Aboriginal peoples is currently more than double that of the non-Aboriginal population. Aboriginal Health Workers are responsible for providing primary health care to Aboriginal clients including smoking cessation programs. However, Aboriginal Health Workers are frequently smokers themselves, and their smoking undermines the smoking cessation services they deliver to Aboriginal clients. An understanding of the barriers to quitting smoking experienced by Aboriginal Health Workers is needed to design culturally relevant smoking cessation programs. Once smoking is reduced in Aboriginal Health Workers, they may then be able to support Aboriginal clients to quit smoking.
We undertook a fundamental qualitative description study underpinned by social ecological theory. The research was participatory, and academic researchers worked in partnership with personnel from the local Aboriginal health council. The barriers Aboriginal Health Workers experience in relation to quitting smoking were explored in 34 semi-structured interviews (with 23 Aboriginal Health Workers and 11 other health staff) and 3 focus groups (n = 17 participants) with key informants. Content analysis was performed on transcribed text and interview notes.
Aboriginal Health Workers spoke of burdensome stress and grief which made them unable to prioritise quitting smoking. They lacked knowledge about quitting and access to culturally relevant quitting resources. Interpersonal obstacles included a social pressure to smoke, social exclusion when quitting, and few role models. In many workplaces, smoking was part of organisational culture and there were challenges to implementation of Smokefree policy. Respondents identified inadequate funding of tobacco programs and a lack of Smokefree public spaces as policy level barriers. The normalisation of smoking in Aboriginal society was an overarching challenge to quitting.
Aboriginal Health Workers experience multilevel barriers to quitting smoking that include personal, social, cultural and environmental factors. Multidimensional smoking cessation programs are needed that reduce the stress and burden for Aboriginal Health Workers; provide access to culturally relevant quitting resources; and address the prevailing normalisation of smoking in the family, workplace and community.
International Journal for Equity in Health 05/2012; 11(1):27. DOI:10.1186/1475-9276-11-27 · 1.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aboriginal Health Workers (AHWs) have a mandate to deliver smoking cessation support to Aboriginal people. However, a high proportion of AHWs are smokers and this undermines their delivery of smoking cessation programs. Smoking tobacco is the leading contributor to the burden of disease in Aboriginal Australians and must be prevented. Little is known about how to enable AHWs to quit smoking. An understanding of the factors that perpetuate smoking in AHWs is needed to inform the development of culturally relevant programs that enable AHWs to quit smoking. A reduction of smoking in AHWs is important to promote their health and also optimise the delivery of smoking cessation support to Aboriginal clients.
We conducted a fundamental qualitative description study that was nested within a larger mixed method participatory research project. The individual and contextual factors that directly or indirectly promote (i.e. perpetuate) smoking behaviours in AHWs were explored in 34 interviews and 3 focus groups. AHWs, other health service staff and tobacco control personnel shared their perspectives. Data analysis was performed using a qualitative content analysis approach with collective member checking by AHW representatives.
AHWs were highly stressed, burdened by their responsibilities, felt powerless and undervalued, and used smoking to cope with and support a sense of social connectedness in their lives. Factors directly and indirectly associated with smoking were reported at six levels of behavioural influence: personal factors (e.g. stress, nicotine addiction), family (e.g. breakdown of family dynamics, grief and loss), interpersonal processes (e.g. socialisation and connection, domestic disputes), the health service (e.g. job insecurity and financial insecurity, demanding work), the community (e.g. racism, social disadvantage) and policy (e.g. short term and insecure funding).
An extensive array of factors perpetuated smoking in AHWs. The multitude of personal, social and environmental stressors faced by AHWs and the accepted use of communal smoking to facilitate socialisation and connection were primary drivers of smoking in AHWs in addition to nicotine dependence. Culturally sensitive multidimensional smoking cessation programs that address these factors and can be tailored to local needs are indicated.
BMC Health Services Research 04/2012; 12(1):102. DOI:10.1186/1472-6963-12-102 · 1.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Sick leave due to low back pain (LBP-SL) is costly and compromises workforce productivity. The fear-avoidance model asserts that maladaptive pain-related cognitions lead to avoidance and disuse, which can perpetuate ongoing pain. Staying home from work is an avoidant behavior, and hence pain-related psychological features may help explain LBP-SL. We examined the relative contribution of pain catastrophizing, fear of movement, and pain coping (active and passive) in LBP-SL in addition to pain characteristics and other psychosocial, occupational, general health, and demographic factors. Two-way interactions between age and gender and candidate exposures were also considered. Our sample comprised 2164 working nurses and midwives with low back pain in the preceding year. Binary logistic regression was performed on cross-sectional data by manual backward stepwise elimination of nonsignificant terms to generate a parsimonious multivariable model. From an extensive array of exposures assessed, fear of movement (women, odds ratio [OR]=1.05, 95% confidence interval [CI] 1.02-1.08; men, OR=1.17, 95% CI 1.05-1.29), passive coping (OR=1.07, 95% CI 1.04-1.11), pain severity (OR=1.61, 95% CI 1.50-1.72), pain radiation (women, OR=1.45, 95% CI 1.10-1.92; men, OR=4.13, 95% CI 2.15-7.95), and manual handling frequency (OR=1.03, 95% CI 1.01-1.05) increased the likelihood of LBP-SL in the preceding 12 months. Administrators and managers were less likely to report LBP-SL (OR=0.44, 95% CI 0.27-0.71), and age had a protective effect in individuals in a married or de facto relationship (OR=0.97, 95% CI 0.95-0.98). In summary, fear of movement, passive coping, frequent manual handling, and severe or radiating pain increase the likelihood of LBP-SL. Gender-specific responses to pain radiation and fear of movement are evident.
[Show abstract][Hide abstract] ABSTRACT: Cross-sectional design.
To investigate lumbar multifidus (LM) thickness differences, using ultrasound imaging in people during remission from recurrent low back pain (LBP) and healthy participants, during the following lower extremity movements: (1) active straight leg raise (ASLR), (2) crook-lying active leg raise (CLR), and (3) prone straight leg raise (PSLR).
ASLR, CLR, and PSLR are used clinically to challenge the ability of the trunk muscles to control spinal motion in people with LBP, and it is believed that decreased LM activity is related to altered spinal control in this population. However, it is unclear whether LM behavior differs between healthy individuals and people with recurrent LBP during symptom remission in such tasks.
The present study used ultrasound imaging to measure LM percentage thickness change parasagitally at the L4-5 and L5-S1 levels in people with recurrent LBP during symptom remission and in healthy participants, during the ASLR, CLR, and PSLR tasks.
LM percentage thickness change was greater in the recurrent LBP group than in healthy participants during the PSLR task (P<.01) and greater in both groups during the PSLR than the ASLR and CLR tasks (P<.01). LM percentage thickness change was greatest at L4-5 in both groups (P<.01) and during all tasks (P≤.02). No difference was found in LM percentage thickness change between groups in either the ASLR (P = .70) or CLR (P = .69) task.
These data suggest that, during symptom remission, individuals with recurrent LBP, compared to healthy individuals, may have greater activity in at least some parts of the LM. Further investigation is required to determine whether the LM percentage thickness change observed in this study may be explained by differential changes in deep and/or superficial fibers of LM activity. This observation may have implications for clinical practice, but requires further investigation.
Journal of Orthopaedic and Sports Physical Therapy 03/2011; 41(3):155-64. DOI:10.2519/jospt.2011.3410 · 3.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Disability due to back pain in nurses results in reduced productivity, work absenteeism and attrition from the nursing workforce internationally. Consistent use of outcome measures is needed in intervention studies to enable meta-analyses that determine efficacy of back pain preventive programs.
This study investigated the psychometric and measurement properties of the Oswestry Disability Index (ODI) in nursing students to determine its suitability for assessing back pain related disability in intervention studies.
Bachelor of Nursing students were recruited. Test-retest reliability and the ability of the ODI to discriminate between individuals with serious and non-serious back pain were investigated. The measurement error of the ODI was examined with the minimal detectable change at the 90% confidence level (MDC(90)).
Student nurses (n=214) had a low mean ODI score of 8.8+/-7.4%. Participants with serious back pain recorded higher scores than the rest of the cohort (p<0.05). Test-retest reliability examined in 33 individuals was ICC=0.88 (95%CI 0.77-0.94). The MDC(90)=6%, and 36% of nursing students scored below the MDC(90) indicating the tool had limited ability to detect longitudinal change in disability in this population.
Data from this and previous studies demonstrate that the measurement properties of the ODI are inappropriate for studying back pain related disability in nurses. The ODI is not recommended for back pain intervention studies in the nursing population and an alternative tool that is sensitive to lower levels of disability must be determined.
International journal of nursing studies 12/2009; 47(5):604-7. DOI:10.1016/j.ijnurstu.2009.10.013 · 2.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Nordic Musculoskeletal Questionnaire (NMQ) quantifies musculoskeletal pain and activity prevention in 9 body regions. The purpose of this study was to develop an extended NMQ (NMQ-E) to collect greater information regarding musculoskeletal pain, examine test-retest reliability and the reproducibility of alternate administration methods. Reliability was examined using observed proportion of agreement for all (P(o)), positive (P(pos)) and negative (P(neg)) responses, kappa (kappa), proportion of maximum kappa achieved (kappa/kappa(max)), intra-class correlation coefficient (ICC) and standard error of measurement (SEM). The NMQ-E was self-administered by 59 Bachelor of Nursing students at a 24-h interval with mean P(o) = 0.88-0.98 and kappa/kappa(max) = 0.71-0.96 for 10 dichotomous questions and mean ICC((2,1)) = 0.97 and SEM = 1.05 years for the age at symptom onset question. The NMQ-E was completed via self and interview administration by 31 student nurses at a 0.97 +/- 1.14 day interval with mean P(o) = 0.92-0.98 and kappa/kappa(max) = 0.76-1.00 for binary questions and mean ICC((2,1)) = 0.90 and SEM = 1.51 years for age at symptom onset data. In both sub-studies, mean P(pos) was lower than mean P(neg) and low prevalence reduced kappa in many instances. The NMQ-E collects reliable information regarding the onset, prevalence, and consequences of musculoskeletal pain and can be administered by self-completion and personal interview. PERSPECTIVE: This study presents an NMQ-E that collects reliable information regarding the onset, prevalence, and consequences of musculoskeletal pain in 9 body regions. The NMQ-E can be utilized in descriptive studies or longitudinal studies of disease outcome and can be administered via self-completion and personal interview.
The journal of pain: official journal of the American Pain Society 05/2009; 10(5):517-26. DOI:10.1016/j.jpain.2008.11.008 · 4.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Exercise is one of the few effective treatments for LBP. Although exercise is often based on the premise of reduced spinal stiffness, trunk muscle adaptation may increase stiffness. This study developed and validated a method to assess trunk stiffness and damping, and tested these parameters in 14 people with recurring LBP and 17 pain-free individuals. Effective trunk stiffness, mass and damping were estimated with the trunk modeled as a linear second-order system following trunk perturbation. Equal weights (12-15% body weight) were attached to the front and back of the trunk via pulleys such that the trunk could move freely and no muscle activity was required to hold the weights. The trunk was perturbed by the unexpected release of one of the weights. Trunk kinematics and cable force were used to estimate system properties. Reliability was assessed in 10 subjects. Trunk stiffness was greater in recurrent LBP patients (forward perturbation only), but damping was lower (both directions) than healthy controls. Estimates were reliable and validated by accurately estimated mass. Contrary to clinical belief, trunk stiffness was increased, not reduced, in recurrent LBP, most likely due to augmented trunk muscle activity and changes in reflex control of trunk muscles. Although increased stiffness may aid in the protection of spinal structures, this may have long-term consequences for spinal health and LBP recurrence due to compromised trunk dynamics (decreased damping).
Journal of Biomechanics 01/2009; 42(1):61-6. DOI:10.1016/j.jbiomech.2008.10.001 · 2.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A systematic literature review was undertaken to assess the effectiveness of interventions that aim to prevent back pain and back injury in nurses. Ten relevant databases were searched; these were examined and reference lists checked. Two reviewers applied selection criteria, assessed methodological quality and extracted data from trials. A qualitative synthesis of evidence was undertaken and sensitivity analyses performed. Eight randomised controlled trials and eight non-randomised controlled trials met eligibility criteria. Overall, study quality was poor, with only one trial classified as high quality. There was no strong evidence regarding the efficacy of any interventions aiming to prevent back pain and injury in nurses. The review identified moderate level evidence from multiple trials that manual handling training in isolation is not effective and multidimensional interventions are effective in preventing back pain and injury in nurses. Single trials provided moderate evidence that stress management programs do not prevent back pain and limited evidence that lumbar supports are effective in preventing back injury in nurses. There is conflicting evidence regarding the efficacy of exercise interventions and the provision of manual handling equipment and training. This review highlights the need for high quality randomised controlled studies to examine the effectiveness of interventions to prevent back pain and injury in nursing populations. Implications for future research are discussed.
Occupational and environmental medicine 11/2007; 64(10):642-50. DOI:10.1136/oem.2006.030643 · 3.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Heart Failure Management Programs (HFMPs) have proven to be cost-effective in minimising recurrent hospitalisations, morbidity and mortality. However, variability between the programs exists which could translate into variable health outcomes.
To survey the characteristics of HFMPs throughout Australia and to identify potential heterogeneity in their organisation and structure.
Thirty-nine post-discharge HFMPs were identified from a systematic search of the Australian health-care system in 2002. A comprehensive 19-item questionnaire specifically examining characteristics of HFMPs was sent to co-ordinators of identified programs in early 2003.
All participants responded with six institutions (15%) indicating that their HFMP had ceased operations due to a lack of funding. The survey revealed an uneven distribution of the 33 active HFMPs operating throughout Australia. Overall, 4450 post-discharge HF patients (median: 74; IQR: 24-147) were managed via these programs, representing only 11% of the potential caseload for an Australia-wide network of HFMPs. Heterogeneity of these programs existed in respect to the model of care applied within the program (70% applied a home-based program and 18% a specialist HF clinic) and applied interventions (30% of programs had no discharge criteria and 45% of programs prevented nurses administering/titrating medications). Sustained funding was available to only 52% of the active HFMPs.
Inequity of access to HFMPs in Australia is evident in relation to locality and high service demand, further complicated by inadequate funding. Heterogeneity between these programs is substantial. The development of national benchmarks for evidence-based HFMPs is required to address program variability and funding issues to realise their potential to improve health outcomes.
European Journal of Cardiovascular Nursing 04/2006; 5(1):75-82. DOI:10.1016/j.ejcnurse.2005.08.001 · 1.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Systematic review.
To establish the effectiveness of school-based spinal health interventions in terms of: 1) improving knowledge about the spine/spinal care; 2) changing spinal care behaviors; and 3) decreasing the prevalence of spinal pain.
Spinal pain is a significant problem in children and adolescents that has been addressed through school-based spinal health interventions. No systematic review has been carried out on this topic to date.
A systematic literature review sought studies that evaluated school-based spinal health interventions. Using clearly defined study inclusion criteria, 11 databases were searched from their inception to March 2004. To identify further literature, three relevant journals were hand searched, reference lists were checked, and authors of included papers were contacted. Two reviewers independently appraised the quality of identified papers and extracted data regarding intervention and study characteristics, statistical analyses performed, and study results. Data were examined using a narrative synthesis of results, and the outcomes of interest were considered individually (knowledge, behaviors, pain prevalence).
Twelve papers were included in this review; all papers received a "weak" quality rating. Results of these studies indicate that school-based spinal health interventions may be effective in increasing spinal care knowledge and decreasing the prevalence of spinal pain. However, overall the evidence is inconclusive regarding spinal care behaviors.
The poor quality of the reviewed studies limits the conclusions that can be made regarding the effectiveness of school-based spinal health interventions.
[Show abstract][Hide abstract] ABSTRACT: Chronic heart failure (CHF) develops in frail elderly individuals who have suffered an acute or sustained insult to the structural efficiency of the heart due to the presence of underlying heart disease and/or hypertension. It is also more common in individuals with disproportionately high levels of cardiac disease or its risk factors, for example lower socioeconomic status. As such, this epidemic is particularly significant for older people, males and Aboriginal people; groups who comprise a greater proportion of the population in rural and remote Australia. The aim of this study is to determine if the rates of CHF differ between urban and rural Australia.
CHF prevalence rates derived from well validated international CHF prevalence data were applied to the Australian Bureau of Statistics Census data for 2001 and weighted to reflect the proportion of Aboriginal people in each geographical stratum.
Australia wide, the estimated prevalence of CHF was 17.87 per 1000, ranging from 13.98/1000 in the Australian Capital Territory to 29.50/1000 in rural Northern Territory. Overall, CHF was more prevalent in rural and remote regions (19.84/1000) and large urban centres (19.01/1000) than in capital cities (16.94/1000) (p<0.001). High prevalence rates were also noted in the idyllic rural locations favoured by retirees. In Victoria, Western Australia, South Australia and the Australian Capital Territory over 70% of the estimated individual cases were located in capital cities. In New South Wales, Queensland, Tasmania and the Northern Territory the highest proportion of cases occurred outside capital cities.
The main significance of these findings is that while a majority of heart failure may occur among people living in cities (because that is where most people live), a disproportionate number of cases occur among people living outside these cities (due to age and other socio-demographic risk factors) where services may be fewer and less accessible.
Rural and remote health 01/2005; 5(4):443. · 0.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Australia, like other countries, is experiencing an epidemic of heart failure (HF). However, given the lack of national and population-based datasets collating detailed cardiovascular-specific morbidity and mortality outcomes, quantifying the specific burden imposed by HF has been difficult.
Australian Bureau of Statistics (ABS data) for the year 2000 were used in combination with contemporary, well-validated population-based epidemiologic data to estimate the number of individuals with symptomatic and asymptomatic HF related to both preserved (diastolic dysfunction) and impaired left ventricular systolic (dys)function (LVSD) and rates of HF-related hospitalisation.
In 2000, we estimate that around 325,000 Australians (58% male) had symptomatic HF associated with both LVSD and diastolic dysfunction and an additional 214,000 with asymptomatic LVSD. 140,000 (26%) live in rural and remote regions, distal to specialist health care services. There was an estimated 22,000 incidents of admissions for congestive heart failure and approximately 100,000 admissions associated with this syndrome overall.
Australia is in the midst of a HF epidemic that continues to grow. Overall, it probably contributes to over 1.4 million days of hospitalization at a cost of more than 1 billion dollars. A national response to further quantify and address this enormous health problem is required.
[Show abstract][Hide abstract] ABSTRACT: Atrial fibrillation (AF), the most common chronic cardiac dysrhythmia, is an important cause of cardiovascular morbidity and mortality. However, there is a paucity of studies examining the potential benefits of optimizing the postdischarge management of patients with chronic AF.
To examine the effects of a nurse-led, multidisciplinary, home-based intervention (HBI) on the pattern of recurrent hospitalization and mortality in patients with chronic AF in the presence and absence of chronic heart failure (HF). PATIENT COHORT AND METHODS: Health outcomes in a total of 152 hospitalized patients (53% male) with a mean age of 73 +/- 9 years and a diagnosis of chronic AF who were randomly allocated to either HBI (n = 68) or usual postdischarge care (UC: n = 84) were examined. Specifically, the pattern of unplanned hospitalization and all-cause mortality during 5-year follow-up were compared on the basis of the presence (n = 87) and absence (n = 65) of HF at baseline.
Patients with concurrent HF exposed to HBI (n = 37) had fewer readmissions (2.9 vs 3.4/patient), days of associated hospital stay (22.7 vs 30.5: P = NS) and fatal events (51 % vs 66%) relative to UC (n = 50): P = NS for all comparisons. In the absence of HF, morbidity and mortality rates were significantly lower but still substantial during 5-year follow-up. In these patients, HBI was associated with a trend towards prolonged event-free survival (adjusted RR = 0.70; P = .12) and fewer fatal events (29% vs 53%, adjusted RR = 0.49; P = .08). HBI patients (n = 31) also had fewer readmissions (2.1 vs 2.6/patient) and days of associated hospital stay (16.3 vs 20.3/patient), although this did not reach statistical significance. On the basis of these data, it was calculated that a randomized study of an AF-specific HBI would require 250 patients followed for a median of 3 years to detect a 25% variation in recurrent hospital stay relative to UC.
These unique data provide sufficient preliminary evidence to support the hypothesis that the benefits of HBI in relation to the management of HF may extend to "high risk" patients with chronic AF in whom morbidity and mortality rates are also unacceptably high. Further, appropriately powered studies are required to confirm these benefits.
The Journal of cardiovascular nursing 03/2004; 19(2):118-27. DOI:10.1097/00005082-200403000-00006 · 2.05 Impact Factor