Article

Effectiveness of a Stretching Exercise Program on Low Back Pain and Exercise Self-Efficacy Among Nurses in Taiwan: A Randomized Clinical Trial

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Abstract

The purpose of this study was to examine the effectiveness of a stretching exercise program (SEP) on low back pain (LBP) and exercise self-efficacy among nurses in Taiwan. A total of 127 nurses, who had been experiencing LBP for longer than 6 months and had LBP with pain scores greater than 4 on the Visual Analogue Scale for Pain (VASP), were randomly assigned to an experimental group and a control group. The experimental group (n = 64) followed an SEP, whereas the control group (n = 63) was directed to perform usual activities for 50 minutes per time, three times a week. Data were collected at four time points: at baseline, and 2, 4, and 6 months after the intervention. During the 6-month follow-up, the experimental group had significantly lower VASP scores than did the control group at the second, fourth, and sixth months. In addition, the experimental group showed significantly higher exercise self-efficacy than did the control group at the fourth and sixth months. A total of 81% of the participants in the experimental group reported a moderate to high level of LBP relief. The findings can be used to enhance self-care capabilities with SEP for nurses that experience LBP or are vulnerable to such work-related pain. SEP is an effective and safe nonpharmacological intervention for the management of LBP.

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... The current study utilised aerobic warm-up exercises, static stretches and resistance exercises from previous research studies (Table 1). [14][15][16][17][18][19] The resistance exercises changed in Week Three and Week Four to allow for progression. Each ...
... At pretest the CG Oswestry score was 15.4±10.5% (two outliers were present; however, they were included in the statistical analysis) and HG Oswestry score was 16.2±13.2% and the HG Oswestry score was 8.0±7.7%. The four-week follow-up VASP score for the CG was 4.0±2.3 ...
... In accordance with previous studies, the intervention programme was designed to strengthen the abdominals, paraspinal muscles, gluteal muscles, hamstrings and multifidi as well as to stretch the erector spinae, hamstrings, hip flexors and quadratus lumborum muscles. [14][15][16][17][18][19] The current study used a four-week intervention period which compared favourably with that of other studies between four and eight weeks long. [18,19] This study requested that the patients perform the exercises three times per week. ...
Article
Full-text available
BACKGROUND: Low back pain (LBP) is a prevalent condition affecting a large portion of the population worldwide and it is one of the leading causes of morbidity and work absenteeism. OBJECTIVES: To investigate the effectiveness of a four-week, home-based exercise programme in treating subacute LBP in adults. METHODS: A quantitative experimental research design was used. Twenty male and female adults (between 18 and 65 years) with subacute LBP were recruited by means of advertisements and word of mouth and allocated into either a control group (CG) or a home-based exercise group (HG). Both groups underwent a pre-test that consisted of answering two questionnaires, the Visual Analogue Scale for Pain (VASP) and the Oswestry Low Back Pain and Disability Questionnaire. The CG received no intervention over the four-week intervention period, while the intervention group (HG) was given an exercise programme and instructed to perform the exercises at home, three times a week for four weeks. After four weeks (post-test), the two questionnaires were repeated. After eight weeks (the follow-up test) both groups again completed the two questionnaires. Descriptive statistics, non-parametric inferential statistics and Cohen's effect size (d) were used to analyse the data and statistical significance was set at a confidence level of 95% (p
... The effects of stretching on pain reduction do not appear to be limited to the time immediately after stretching but instead appear to be chronically affected by periods of stretching training. The majority of studies support the contention that chronic stretching reduces pain in the neck (27)(28)(29)(30)(31)(32), shoulder (33), chest (81), lower back (34,41,42), knee (35), ankle (36)(37)(38)(39), and overall musculoskeletal system (40). While the vast majority of chronic stretching studies demonstrate pain relief, several studies have not reported a beneficial effect on pain (82-86). ...
... Patients suffering from low-back pain showed improvement in their pain perception while performing twice-weekly SS of erector spinae, hamstrings, and triceps surae muscles for 6 weeks in 30-minute sessions (34). Comparably, stretching for 12 months (3 per week for 50 minutes each with multiple SS exercises) reduced low-back pain during the menstrual cycle when compared to a control group (41), while a similar frequency and duration SS for 6 months in nurses prompted a reduction in low-back pain compared to a control group (42). On the contrary, no positive effect of SS on low-back pain was reported with stretching of the quadriceps (82); typically, the hamstrings are a prime target for the low-back pain population (34,41,42). ...
... Comparably, stretching for 12 months (3 per week for 50 minutes each with multiple SS exercises) reduced low-back pain during the menstrual cycle when compared to a control group (41), while a similar frequency and duration SS for 6 months in nurses prompted a reduction in low-back pain compared to a control group (42). On the contrary, no positive effect of SS on low-back pain was reported with stretching of the quadriceps (82); typically, the hamstrings are a prime target for the low-back pain population (34,41,42). Another study with no positive pain outcomes had a lower training volume (1 minute per week for hamstrings) and targeted different muscles (multiple muscles rather than hamstrings alone) (83). ...
... About 5% to 15% becomes low back pain if no treatment has been applied (Wong & Khoo, 2009). Research has shown that approximately 75% to 90% of women have experienced discomfort during menstruation (Chen, Wang, Chen, & Hu, 2014;Wong & Khoo, 2009), of which 42% to 60% have experienced moderate-to-severe menstrual pain (Chen & Chen, 2005;Chen et al., 2014). Menstrual low back pain (MLBP) is the third most common form of menstrual discomfort; it affects 46% to 56% of the population (Banikarim, Chacko, & Kelder, 2000;Chen & Chen, 2005), and the proportion increases with age (Fritz & Clifford, 2010). ...
... About 5% to 15% becomes low back pain if no treatment has been applied (Wong & Khoo, 2009). Research has shown that approximately 75% to 90% of women have experienced discomfort during menstruation (Chen, Wang, Chen, & Hu, 2014;Wong & Khoo, 2009), of which 42% to 60% have experienced moderate-to-severe menstrual pain (Chen & Chen, 2005;Chen et al., 2014). Menstrual low back pain (MLBP) is the third most common form of menstrual discomfort; it affects 46% to 56% of the population (Banikarim, Chacko, & Kelder, 2000;Chen & Chen, 2005), and the proportion increases with age (Fritz & Clifford, 2010). ...
... Menstrual low back pain (MLBP) is the third most common form of menstrual discomfort; it affects 46% to 56% of the population (Banikarim, Chacko, & Kelder, 2000;Chen & Chen, 2005), and the proportion increases with age (Fritz & Clifford, 2010). Among young women who experience MLBP, 58% to 90% manage the condition through conservative approaches, such as resting (Banikarim et al., 2000;Chen et al., 2014;Wong & Khoo, 2009). Back pain is commonly associated with muscular strength and flexibility and hormones (Godfrey & Dugan, 2009;Iwamoto, Abe, Tsukimura, & Wakano, 2004). ...
Article
This study aimed to examine the effectiveness of a modified stretching exercise program on young women with menstrual low back pain. Overall, 127 young women were randomly assigned to the experimental (n = 63) and control (n = 64) groups. The experimental group followed the modified stretching exercise program, whereas the control group performed their usual activities. At 1, 4, 8, and 12 months, the experimental group had significantly lower scores on the visual analog scale for pain (95% confidence interval [CI] = [0.73, 1.96]; p < .05) and the Oswestry Low Back Pain Disability Questionnaire than the control group (95% CI = [0.68, 2.03]; p < .001). At 12 months, the experimental group showed significantly higher exercise self-efficacy than the control group (95% CI = [–6.87, 0.62]; p = .003). These findings can be used to enhance self-care capabilities by using the modified stretching exercise program for young women with menstrual low back pain.
... The effects of stretching on pain reduction do not appear to be limited to the time immediately after stretching but instead appear to be chronically affected by periods of stretching training. The majority of studies support the contention that chronic stretching reduces pain in the neck (27)(28)(29)(30)(31)(32), shoulder (33), chest (81), lower back (34,41,42), knee (35), ankle (36-39), and overall musculoskeletal system (40). While the vast majority of chronic stretching studies demonstrate pain relief, several studies have not reported a beneficial effect on pain (82)(83)(84)(85)(86). ...
... Patients suffering from low-back pain showed improvement in their pain perception while performing twice-weekly SS of erector spinae, hamstrings, and triceps surae muscles for 6 weeks in 30-minute sessions (34). Comparably, stretching for 12 months (3 per week for 50 minutes each with multiple SS exercises) reduced low-back pain during the menstrual cycle when compared to a control group (41), while a similar frequency and duration SS for 6 months in nurses prompted a reduction in low-back pain compared to a control group (42). On the contrary, no positive effect of SS on low-back pain was reported with stretching of the quadriceps (82); typically, the hamstrings are a prime target for the low-back pain population (34,41,42). ...
... Comparably, stretching for 12 months (3 per week for 50 minutes each with multiple SS exercises) reduced low-back pain during the menstrual cycle when compared to a control group (41), while a similar frequency and duration SS for 6 months in nurses prompted a reduction in low-back pain compared to a control group (42). On the contrary, no positive effect of SS on low-back pain was reported with stretching of the quadriceps (82); typically, the hamstrings are a prime target for the low-back pain population (34,41,42). Another study with no positive pain outcomes had a lower training volume (1 minute per week for hamstrings) and targeted different muscles (multiple muscles rather than hamstrings alone) (83). ...
Article
While muscle stretching has been commonly used to alleviate pain, reports of its effectiveness are conflicting. The objective of this review is to investigate the acute and chronic effects of stretching on pain, including delayed onset muscle soreness. The few studies implementing acute stretching protocols have reported small to large magnitude decreases in quadriceps and anterior knee pain as well as reductions in headache pain. Chronic stretching programs have demonstrated more consistent reductions in pain from a wide variety of joints and muscles, which has been ascribed to an increased sensory (pain) tolerance. Other mechanisms underlying acute and chronic pain reduction have been proposed to be related to gate control theory, diffuse noxious inhibitory control, myofascial meridians, and reflex-induced increases in parasympathetic nervous activity. By contrast, the acute effects of stretching on delayed onset muscle soreness are conflicting. Reports of stretch-induced reductions in delayed onset muscle soreness may be attributed to increased pain tolerance or alterations in the muscle's parallel elastic component or extracellular matrix properties providing protection against tissue damage. Further research evaluating the effect of various stretching protocols on different pain modalities is needed to clarify conflicts within the literature.
... The effects of stretching on pain reduction do not appear to be limited to the time immediately after stretching but instead appear to be chronically affected by periods of stretching training. The majority of studies support the contention that chronic stretching reduces pain in the neck (27)(28)(29)(30)(31)(32), shoulder (33), chest (81), lower back (34,41,42), knee (35), ankle (36-39), and overall musculoskeletal system (40). While the vast majority of chronic stretching studies demonstrate pain relief, several studies have not reported a beneficial effect on pain (82)(83)(84)(85)(86). ...
... Patients suffering from low-back pain showed improvement in their pain perception while performing twice-weekly SS of erector spinae, hamstrings, and triceps surae muscles for 6 weeks in 30-minute sessions (34). Comparably, stretching for 12 months (3 per week for 50 minutes each with multiple SS exercises) reduced low-back pain during the menstrual cycle when compared to a control group (41), while a similar frequency and duration SS for 6 months in nurses prompted a reduction in low-back pain compared to a control group (42). On the contrary, no positive effect of SS on low-back pain was reported with stretching of the quadriceps (82); typically, the hamstrings are a prime target for the low-back pain population (34,41,42). ...
... Comparably, stretching for 12 months (3 per week for 50 minutes each with multiple SS exercises) reduced low-back pain during the menstrual cycle when compared to a control group (41), while a similar frequency and duration SS for 6 months in nurses prompted a reduction in low-back pain compared to a control group (42). On the contrary, no positive effect of SS on low-back pain was reported with stretching of the quadriceps (82); typically, the hamstrings are a prime target for the low-back pain population (34,41,42). Another study with no positive pain outcomes had a lower training volume (1 minute per week for hamstrings) and targeted different muscles (multiple muscles rather than hamstrings alone) (83). ...
... Thirty-five studies included some form of PA [60,69,75,76,78,83,88,96,98,. The PA interventions included walking [83,88,96,113,115,119,123,127,131,133,136], standing [119], aerobics [60,75], aerobics and resistance exercise [118], yoga [116,122,125,126,132,135], Tai-Chi [130], endurance training [117], muscle strength promotion [117,128], stretching [119,134,137], daily exercise [78,121], physiotherapy exercise [76], exercises with equipment (stair-stepper: [114], treadmill, Wii TM : [96,115], elastic bands and kettlebells [120,137,138], back muscle exercises [98,124,129], or unspecified [69]). ...
... [vi] Self-Efficacy: Self-efficacy was measured using three self-reported measures; the Self-Efficacy Scale [58], the Exercise Self-Efficacy Scale [124], and the Caring Efficacy Scale [150]. ...
... Twenty-four studies included a measure of body composition or body functioning. Outcomes related to at least one measure of body composition (e.g., weight, BMI, waist or other anthropometric indices) improved following intervention in 20 studies [58,76,78,[96][97][98]112,[114][115][116][117][118]124,[128][129][130][131]134,137,138]. These studies mostly assessed changes in weight/BMI/fat mass [96,97,112,[114][115][116]131], or body functioning (e.g., flexibility, muscle strength, aerobic capacity, correct body posture, pain reduction [58,76,78,98,114,117,118,124,[128][129][130][131]134,137,138]), with some assessing more than one outcome. ...
... Thirty-five studies included some form of PA [60,69,75,76,78,83,88,96,98,. The PA interventions included walking [83,88,96,113,115,119,123,127,131,133,136], standing [119], aerobics [60,75], aerobics and resistance exercise [118], yoga [116,122,125,126,132,135], Tai-Chi [130], endurance training [117], muscle strength promotion [117,128], stretching [119,134,137], daily exercise [78,121], physiotherapy exercise [76], exercises with equipment (stair-stepper: [114], treadmill, Wii TM : [96,115], elastic bands and kettlebells [120,137,138], back muscle exercises [98,124,129], or unspecified [69]). ...
... Twenty-four studies included a measure of body composition or body functioning. Outcomes related to at least one measure of body composition (e.g., weight, BMI, waist or other anthropometric indices) improved following intervention in 20 studies [58,76,78,[96][97][98]112,[114][115][116][117][118]124,[128][129][130][131]134,137,138]. These studies mostly assessed changes in weight/BMI/fat mass [96,97,112,[114][115][116]131], or body functioning (e.g., flexibility, muscle strength, aerobic capacity, correct body posture, pain reduction [58,76,78,98,114,117,118,124,[128][129][130][131]134,137,138]), with some assessing more than one outcome. ...
... Outcomes related to at least one measure of body composition (e.g., weight, BMI, waist or other anthropometric indices) improved following intervention in 20 studies [58,76,78,[96][97][98]112,[114][115][116][117][118]124,[128][129][130][131]134,137,138]. These studies mostly assessed changes in weight/BMI/fat mass [96,97,112,[114][115][116]131], or body functioning (e.g., flexibility, muscle strength, aerobic capacity, correct body posture, pain reduction [58,76,78,98,114,117,118,124,[128][129][130][131]134,137,138]), with some assessing more than one outcome. Of the 20 studies reporting improvements in body composition, 10 were RCTs [58,76,115,118,124,[128][129][130][131]138], six were non-randomised controlled studies [96,114,116,117,134,137] and four were uncontrolled studies [78,97,98,112]. ...
Article
Full-text available
Background: Prior research has investigated various strategies to improve health, wellbeing and the job-related outcomes of nurses. However, the scope of this evidence is not clear and the types of intervention most likely to have positive outcomes are unknown. Objective: To provide an overview and synthesis of the effectiveness of interventions conducted with the goal of improving health, wellbeing and the job-related outcomes of nurses. Methods: A systematic database search was conducted from January 2000 to December 2018, with pre-defined criteria (Cochrane Central Register of Controlled Trials; MEDLINE and PubMed; EMBASE; CINAHL; PsycINFO; and BioMed Central). In total, 136 intervention studies with a total sample of 16,129 participants (range 9-3381) were included and evaluated. Data extraction, quality assessment and risk of bias analyses were performed. Results: Studies included randomised controlled trials (RCTs; n = 52, 38%), randomised crossover design studies (n = 2, 1.5%) and non-randomised pre-post studies with a control group (n = 31, 23%) and without a control group (n = 51, 37.5%). The majority of interventions focused on education, physical activity, mindfulness, or relaxation. Thirty-seven (27%) studies had a multimodal intervention approach. On average, studies had relatively small samples (median = 61; mode = 30) and were conducted predominantly in North America (USA/Canada, n = 53). The findings were mixed overall, with some studies reporting benefits and others finding no effects. Dietary habits was the most successfully improved outcome (8/9), followed by indices of body composition (20/24), physical activity (PA) (11/14), and stress (49/66), with >70% of relevant studies in each of these categories reporting improvements. The lowest success rate was for work-related outcomes (16/32). Separate analysis of RCTs indicated that interventions that focus solely on education might be less likely to result in positive outcomes than interventions targeting behavioural change. Conclusions: Interventions targeting diet, body composition, PA, or stress are most likely to have positive outcomes for nurses' health and/or wellbeing. The methodologically strongest evidence (RCTs) is available for body composition and stress. Interventions relying solely on educational approaches are least likely to be effective. Organisational outcomes appear to be more challenging to change with lifestyle intervention, likely requiring more complex solutions including changes to the work environment. There is a need for more high-quality evidence since many studies had moderate or high risk of bias and low reporting quality.
... Reasons for exclusion included lack of appropriate randomisation, including non-nursing subjects in the study population, an inadequate follow-up period, Iranian language, and failing to measure appropriate outcome measures. Ten studies matched these inclusion criteria (Ajimsha et al., 2014;Chen et al., 2014;Ewert et al., 2009;Jaromi et al., 2012;Jensen et al., 2006;Kamioka et al., 2011;Roussel et al., 2015;Svensson et al., 2011;Svensson et al., 2009;Warming et al., 2008). A total of 14 studies were therefore included in the review (four from phase one and ten from phase two). ...
... Intervention characteristics Table 2 represents the characteristics and content of the interventions of the four low risk of bias studies. One study evaluated stretching exercises (Chen et al., 2014); one study a combination of ergonomics with back school (Jaromi et al., 2012); one study manual handling training versus a stress management program (Jensen et al., 2006); and one study a multidimensional intervention (Ewert et al., 2009). One study had a mixed design, meaning that it studied the prevention and treatment effect, involving both non-low back pain and low back pain subjects (Jensen et al., 2006) and three studies had a treatment design, involving only people with low back pain (Chen et al., 2014;Ewert et al., 2009;Jaromi et al., 2012). ...
... One study evaluated stretching exercises (Chen et al., 2014); one study a combination of ergonomics with back school (Jaromi et al., 2012); one study manual handling training versus a stress management program (Jensen et al., 2006); and one study a multidimensional intervention (Ewert et al., 2009). One study had a mixed design, meaning that it studied the prevention and treatment effect, involving both non-low back pain and low back pain subjects (Jensen et al., 2006) and three studies had a treatment design, involving only people with low back pain (Chen et al., 2014;Ewert et al., 2009;Jaromi et al., 2012). ...
Article
Objectives: To investigate the efficacy of interventions for the prevention and treatment of low back pain in nurses. Design: Systematic review. Data sources: The review was registered on the PROSPERO database (CRD42015026941) and followed the PRISMA statement guidelines. A two phase approach was used. In phase one, all randomised controlled trials included in the systematic review of Dawson et al. (2007) which reviewed interventions for low back pain in nurses until 2004 were selected. In phase two, relevant randomised controlled trials and cluster randomised controlled trials published from 2004 until December 2015 were identified by an electronic search of nine databases (Embase, CINAHL, SPORTDiscus, PsycARTICLES, Cochrane Library, Web of Science, PEDro, Scopus and MEDLINE). To be eligible, trials had to examine the efficacy of interventions either for the prevention or treatment of low back pain in nurses. Primary outcomes of interest were any measure of pain and/or disability. Review methods: Three reviewers independently assessed eligibility and two reviewers independently conducted a risk of bias assessment (Cochrane Back and Neck Group). Results: Four studies were retrieved from phase one. In phase two, 15,628 titles and abstracts were scanned. From these, 150 full-text studies were retrieved and ten were eligible. Fourteen studies (four from phase one, ten from phase two) were eligible for risk of bias assessment. The included trials were highly heterogeneous, differing in pain and disability outcome measures, types of intervention, types of control group and follow-up durations. Only four of the included studies (n=644 subjects) had a low risk of bias (≥6/12). Manual handling training and stress management in isolation were not effective in nurses with and without low back pain (risk of bias, 7/12, n=210); the addition of a stretching exercise intervention was better than only performing usual activities (risk of bias, 6/12, n=127); combining manual handling training and back school was better than passive physiotherapy (risk of bias, 7/12, n=124); and a multidimensional intervention (risk of bias, 7/12, n=183) was not superior to a general exercise program in reducing low back pain in nurses. Conclusions: Only four relevant low risk of bias randomised controlled trials were found. At present there is no strong evidence of efficacy for any intervention in preventing or treating low back pain in nurses. Additional high quality randomised controlled trials are required. It may be worth exploring the efficacy of more individualised multidimensional interventions for low back pain in the nursing population.
... The current study utilised aerobic warm-up exercises, static stretches and resistance exercises from previous research studies (Table 1). [14][15][16][17][18][19] The resistance exercises changed in Week Three and Week Four to allow for progression. Each ...
... At pretest the CG Oswestry score was 15.4±10.5% (two outliers were present; however, they were included in the statistical analysis) and HG Oswestry score was 16.2±13.2% and the HG Oswestry score was 8.0±7.7%. The four-week follow-up VASP score for the CG was 4.0±2.3 ...
... In accordance with previous studies, the intervention programme was designed to strengthen the abdominals, paraspinal muscles, gluteal muscles, hamstrings and multifidi as well as to stretch the erector spinae, hamstrings, hip flexors and quadratus lumborum muscles. [14][15][16][17][18][19] The current study used a four-week intervention period which compared favourably with that of other studies between four and eight weeks long. [18,19] This study requested that the patients perform the exercises three times per week. ...
Article
Full-text available
Background: Low back pain (LBP) is a prevalent condition affecting a large portion of the population world-wide and it is one of the leading causes of morbidity and work absenteeism. Objective: To investigate the effectiveness of a four-week, home-based exercise program in treating subacute LBP in adults. Methods: A quantitative, experimental research design was employed. Twenty male and female adults aged between 18 and 65 years with subacute LBP were recruited by means of advertisements and word of mouth and allocated into either a control group (CG) or a home-based exercise group (HG). Both groups underwent a pre-test that consisted of answering two questionnaires, the Visual Analogue Scale for Pain (VASP) and the Oswestry LBP and Disability Questionnaire. The (CG) received no intervention over the four-week intervention period, while the intervention group (HG) was given an exercise program and instructed to perform the exercises at home, three times a week for four weeks. After four weeks (post-test), the two questionnaires were repeated. After eight weeks (follow-up test) both groups again completed the two questionnaires. Descriptive statistics, non-parametric inferential statistics and Cohen’s effect size (d) were used to analyse the data and statistical significance was set at a confidence level of 95% (p?0.05). Results: Following the home-based exercise intervention there were significant improvements observed in lower back pain and function for the HG. The HG’s Oswestry scores improved significantly (p=0.005) and their VASP also showed a significant improvement (p=0.011). Significant improvements also occurred between the pre-test and four-week follow-up for the HG’s Oswestry score (p=0.021) and for the HG’s VASP (p=0.005). No significant improvement was found for the CG between pre-test and post-test or between pre-test and the four-week follow-up. Large effect sizes (d>0.8) were also observed for the HG between the pre- and the post-test (d=1.59) as well as between the HG and the CG at post-test (d=1.52) and at the four-week follow-up (d=1.6). Conclusion: The exercise intervention resulted in statistically significant and clinically significant improvements in both function and pain in adults with subacute LBP.
... Patients with low self-efficacy may present with a lack of confidence, shy away from activities they see as threats, lessen efforts towards a task if difficulties arise, dwell on shortcomings and failures, or lack commitment to goals or personal desires (Bandura, 1994). By contrast, those with high selfefficacy will portray confidence, set personal goals and continually Self-efficacy has been examined as a barrier to exercise adherence in patients with heart failure (Rajati et al., 2014) and low back pain (Chen, Wang, Chen, & Hu, 2014;Coppack, Kristensen, & Karageorghis, 2012). The systematic review conducted by Rajati et al. (2014) discovered that learning by doing, role modelling, positive feedback, recognition of symptoms, and problem solving improved self-efficacy in heart failure patients. ...
... Breaking down an exercise to a more manageable task can allow for smaller, but sooner success that can be progressively made more challenging. Chen et al. (2014) found that by just engaging in regular exercise, self-efficacy for exercise increased over time and back pain decreased. Barkley and Fahrenwald (2013) developed a self-efficacy coaching intervention for cardiac rehabilitation patients that incorporated all four sources of self-efficacy. ...
Article
Full-text available
Patient adherence to rehabilitation programmes is frequently low – particularly adherence to home exercise programmes. Home exercise programmes have been identified as complementary to clinic-based physical therapy in an orthopaedic setting. Barriers to patient adherence have previously been identified within the literature. Low self-efficacy is a barrier to adherence that clinicians have the ability to have an impact on and improve. The theory of self-efficacy is defined as a person's confidence in their ability to perform a task. This theory examines the ability of a person to change through exerting control over inner processes of goal setting, self-monitoring, feedback, problem solving and self-evaluation. If clinicians are able to identify patients with low self-efficacy prior to the prescription of a home exercise programme, adjustments to individualized care can be implemented. Individualized care based on improving self-efficacy for home exercise programmes may improve patient adherence to these programmes. The purpose of this article was to use the theory of self-efficacy to direct clinicians in providing individualized programmes to patients with varying levels of self-efficacy.
... Most trials described adequate sequence generation (22/27). 2,12,46,48,50,52,65,67,74,76,13,8,14,6,16,18,22,25,33,39,44 No trials had low risk of bias for blinding, despite trial-specific measures specifically described by Costa et al 25 The lack of blinding was agreed by the team due to the nature of participating in an exercise intervention in comparison to a nonexercise control. 37% (n = 10) of trials 2,12,25,44,48,50,52,74,76,75 had a low risk of attrition bias. ...
... We identified 31 different treatment targets in these 18 trials, with a range of 0 to 7 targets per trial (median of 3), but 19 of these were only mentioned in 1 trial each. The most frequently reported treatment targets were 'reducing back pain', 18,39,43,48,52,66,72,74,6 'increasing muscle strength', 14,48,50,51,8,1,75,6 'targeting spinal stabilization or altered spinal control or trunk stability', 12,25,33,39,46,72,1 'stretching or improved flexibility' 14,43,48,50,8,1,75 and 'improved posture'. 25,61,75,6 Outcome Domains "refresher" class 12 weeks after randomisation. ...
Article
Exercise is a core treatment for persistent non-specific low back pain (NSLBP), but results from randomised controlled trials (RCTs) of exercise typically show only small to moderate standardised mean differences (SMDs) compared to non-exercise controls. The choice of primary outcome, and relationship to the specific targets of exercise may influence this. This systematic review aimed to explore whether primary outcomes match the exercise treatment targets used in NSLBP RCTs and the potential impact of matching on SMDs. Included RCTs were conducted with patients with persistent NSLBP, compared exercise to no exercise, with sample sizes >60 per arm. Screening, data extraction and risk of bias assessment were independently undertaken by paired reviewers. Of 19272 initial titles, 27 RCTs were included with 31 treatment targets and 6 primary outcome domains identified. Only 25% of included RCTs had primary outcomes that matched the treatment targets. SMDs of exercise versus comparison arms were observed to be larger in the matched (SMD 0.54 (95% CI 0.23 to 0.85), p=0.0006) compared to the unmatched category (SMD 0.22 (95% CI 0.01, 0.44) p=0.04) but this difference was not statistically significant (p=0.10). These exploratory findings may have implications for future teams developing RCTs of exercise for NSLBP and warrant further investigation in larger datasets.
... et al., 2013;Rutledge et al., 2018;Smedley et al., 2003). For instance, Pakbaz et al. (2019) investigated the effectiveness of a face-to-face intervention (back school programme) on low back pain and functional disability in Iranian nurses and found that the programme reduced LBP and functional disability over a 2-month period (Pakbaz et al., 2019). Chen et al. (2014 reported that stretching exercises delivered in-person, resulted in significantly lower pain scores (VAS) at two, four and sixmonth follow-up compared with the control group in nurses with low back pain (Chen et al., 2014). Toelle et al. (2019) investigated the clinical effects of a multidisciplinary mHealth back pain App (Kaia App) in ...
... For instance, Pakbaz et al. (2019) investigated the effectiveness of a face-to-face intervention (back school programme) on low back pain and functional disability in Iranian nurses and found that the programme reduced LBP and functional disability over a 2-month period (Pakbaz et al., 2019). Chen et al. (2014 reported that stretching exercises delivered in-person, resulted in significantly lower pain scores (VAS) at two, four and sixmonth follow-up compared with the control group in nurses with low back pain (Chen et al., 2014). Toelle et al. (2019) investigated the clinical effects of a multidisciplinary mHealth back pain App (Kaia App) in a randomized controlled trial. ...
Article
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Aim To compare two educational approaches to reduce low back pain in nurses. Design A community randomized controlled clinical trial. Methods Data were collected with two interventions and a control arm between August 2018 and January 2019. Participants were recruited from three hospitals. Hospital 1 received an in‐person educational programme, Hospital 2 received via the website and Hospital 3 received nothing. Statistical analysis was carried out with a follow‐up of 3 and 6 months. Results A total of 180 female nurses with low back pain participated in the study. Dimensions of the quality of life improved over 3 and 6 months, pain and disability decreased over 3 months in both intervention groups and over 6 months in the social media group. Conclusion Two educational approaches can be effective in decreasing pain, disability and improving quality of life. However, the findings suggest that the social media approach was more successful over the long‐term and might be a better way to present the programme.
... 20 This is called self-efficacy, the theory of which was used as the conceptual framework in developing programs to improve knowledge, skills and self-efficacy in the job performance and care provided by NPs. [21][22][23][24][25][26][27][28] Strategies included four principal sources of information composed of enactive mastery experiences, vicarious experiences, verbal persuasion, and physiological and affective states. 20 A review of studies, in Thailand and developed countries, revealed that most interventions for developing programs used four principal sources of information (direct experience, reflection, observation, role play, and online instruction). ...
... Furthermore, the results revealed significant differences in knowledge, skills and self-efficacy achieved after receiving a variety of interventions. [21][22][23][24][25][26][27][28] The SCPD program was developed based on NPs' competency in DM care management, a literature review and self-efficacy theory. The process of program development involved five steps based on the following curriculum development of Uys & Gwele 29 : 1) establish the context and foundations; 2) formulate the outcomes or objectives; 3) select a curriculum model and develop a macro-curriculum; 4) develop the micro-curriculum; and 5) plan for the evaluation of implementation and outcomes. ...
Article
This randomized control trial examined the effects of a strengthening diabetes care program among Thai nurse practitioners working in a diabetic clinic at primary care units in a province in northern Thailand. The program was developed in three stages: 1) Self-administered questionnaires for analysis of the nurse practitioners’ competency in diabetes care management 2) Development of program contents to strengthen their competencies with five modules for classroom training nd three modules for e-learning program, and 3) A 4-week intervention, which coprised four consecutive days for classroom training and hree weeks for an e-learning prgram. The program was evaluated three times: pre-intervent on and weeks 4 and 8 post-inter ention. Sixty NPs were randomly assigned into experimental group (n=30) and control group (n=30). Data were collected with five self-administered questionnaires on demographic data form, perceived self-efficacy, outcome expectancy, knowledge, and care skills in diabetes care, and analyzed by using descriptive statistics, Repeated Measures ANOVA and Independent t-test.The findings revealed significant increases in mean scores of the experimental group on perceived self-efficacy, outcome expectancy, knowledge and skills in diabetes care higher than the control group at weeks 4 and 8 post-intervention. Based on the findings, the diabetes program can be used to strengthen nurse practitioners’competencies to build their confidence in diabetes care at primary care units with short course training and a subsequent e-learning program suitable for self-directed learning. Supervision should be monitored to help nurse practitioners in effective job performance. © 2019, Thailand Nursing and Midwifery Council. All rights reserved.
... 43,65 It is reported that spinal flexibility exercises 66 similar to the present study may be beneficial for lumbar radiculopathy, which is also the case for people with LBP with or without leg pain. 67 Lumbar flexion is thought to increase the volume of the intervertebral foramen, allowing nerve root swelling and edema to resolve, and may therefore assist in spinal nerve root decompression. 68 ...
Article
Objectives: To evaluate the effect of spinal mobilization with leg movement (SMWLM) on low back and leg pain intensity, disability, pain centralization, and patient satisfaction in participants with lumbar radiculopathy. Design: A double-blind randomized controlled trial. Setting: General hospital. Participants: Adults (N=60; mean age 44y) with subacute lumbar radiculopathy. Interventions: Participants were randomly allocated to receive SMWLM, exercise and electrotherapy (n=30), or exercise and electrotherapy alone (n=30). All participants received 6 sessions over 2 weeks. Main outcome measures: The primary outcomes were leg pain intensity and Oswestry Disability Index score. Secondary variables were low back pain intensity, global rating of change (GROC), straight leg raise (SLR), and lumbar range of motion (ROM). Variables were evaluated blind at baseline, post-intervention, and at 3 and 6 months of follow-up. Results: Significant and clinically meaningful improvement occurred in all outcome variables. At 2 weeks the SMWLM group had significantly greater improvement than the control group in leg pain (MD 2.0; 95% confidence interval [95% CI], 1.4-2.6) and disability (MD 3.9; 95% CI, 5.5-2.2). Similarly, at 6 months, the SMWLM group had significantly greater improvement than the control group in leg pain (MD 2.6; 95% CI, 1.9-3.2) and disability (MD 4.7; 95% CI, 6.3-3.1). The SMWLM group also reported greater improvement in the GROC and in SLR ROM. Conclusion: In patients with lumbar radiculopathy, the addition of SMWLM provided significantly improved benefits in leg and back pain, disability, SLR ROM, and patient satisfaction in the short and long term.
... Research conducted by Chen, Wang, Chen, and Hu (2012) also discovered a similar finding, whereby the stretching program promotes moderate to high level of LBP relief and improvement on exercise self-efficacy (Chen et al., 2012). It is believed that patients' reduced functional disability is because of their reduced pain level (Areeudomwong et al., 2012). ...
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To evaluate the effectiveness of core stability training and dynamic stretching on thoracolumbar range of motion (ROM), pain level and functional disability among chronic low back pain patients. Forty-three participants aged from 19-67 years old with the primary complaint of low back pain of more than 12 weeks' duration were assigned to three groups: core stability (CS) (n=17), dynamic stretching (DS) (n=16) and control (n=12). All participants received regular thermotherapy and electrotherapy from the hospital rehabilitation unit. The CS group and DS groups were assigned with additional training, namely core stability training and dynamic stretching training programs for the respective groups. No additional training was given to the control group. The participants' thoracolumbar range of motion (ROM), pain level and functional disability were tested over four different testing periods (pre, acute, ongoing, post). The current study shows both the CS group and DS group show significant improvement (p<0.05) in thoracolumbar ROM (CS group; ηp 2 = 0.50, CS group; ηp 2 = 0.66), pain level (CS group; ηp 2 = 0.85, CS group; ηp 2 = 0.81), and functional disability (CS group; ηp 2 = 0.65, CS group; ηp 2 = 0.82). In summary, both core stability exercise and dynamic stretching are effective in improving thoracolumbar ROM, pain-level, functional disability among chronic low back pain patients.
... However, a major difficulty in assessing the effectiveness of physical training in the treatment of low back pain is the wide range of measures summarized under the term "exercise". They range from Tai Chi [18,19,20], Pilates [21,22,23], vibration training [24,25], nordic walking [26,27], aquatic exercises [28,29,30], stretching [31,32], and strength training [33,34,35] to mixed types [36,37]. Such heterogeneous and in part unspecific treatments will hardly lead to comparable effects. ...
... Chronic pain can be understood as pain where it is more than 12 weeks, which will be experienced after the recoverying from previous injury (Hussein et al. 2016). In fact, about 35-90% of all professionals experienced this common occupational injury once in their lives (Chen et al. 2014). Nevertheless, athletes and pregnant women also show a high prevalence of low back pain (Norsyam et al. 2016;Puentedura and Louw 2012). ...
... They emphasized the importance of association of physical fitness and self-efficacy. Previous studies have reported similar relation between musculoskeletal fitness and self-efficacy in different adult populations using EXSEM [19,20]. Results confirm findings from these studies in adults linking higher musculoskeletal fitness levels to higher levels of selfefficacy. ...
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Background: Self-efficacy that is associated with various pain-related disabilities such as chronic low back pain (LBP), should be questioned besides physical assessments. Objectives: To investigate the physical factors associated with self-efficacy in patients with chronic mechanic LBP. Methods: One hundred nine patients diagnosed as chronic mechanic LBP (65 females, 44 males) between 20-50 years old were included to this study. The intensity of LBP was assessed by using a 10-cm Visual Analogue Scale. For musculoskeletal fitness measurement; muscle strength, muscle endurance, and flexibility tests were applied. Functional Reach Test for balance evaluation, Self-Efficacy Scale for self-efficacy measurement, Roland-Morris Disability Questionnaire for disability level evaluation were used. Results: We found a moderate negative correlation between self-efficacy and pain intensity (r=-0.506); a negative and strong correlation between self-efficacy and disability level (r=-0.654) (p< 0.05). While self-efficacy had a significant association with right (r= 0.265) and left (r= 0.290) lateral side bending flexibility (p< 0.05). According to multiple regression analysis results, it was found that while disability level had a significant effect on self-efficacy (β=-2.014; p< 0.01). Conclusions: Poor musculoskeletal fitness and pain intensity may cause decreasing self-efficacy but the major determinant of decreased self-efficacy was low-back related disability scores.
... Within-group comparison across the three time-points (weeks 0-4, 4-8 and 0-8) of the study revealed that the stretching exercise had significant effects on pain and functional disability. These findings are consistent with previous reports that demonstrated evidence for the use of stretching exercises in the management of low back pain ( Hayden et al, 2005;Buchner et al, 2006;Richard et al, 2012;Chen et al, 2014). Reduction in pain and consequent improvement in function following stretching exercise have been attributed to elongation of the muscle tendon unit, reduction in peak force, decrease in rate of force production and tensile stress on the muscle tendon unit, and alteration of the visco-elastic property of the muscle-tendon unit, thus resulting in less tight tissue (Magnusson et al, 1996). ...
Article
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This study compared the effectiveness of stretching exercises, repeated over eight weeks combined with back care education, lumbar stabilisation combined with back care education, and back care education only, on pain and functional disability in quarry workers with work-related low back pain. The study involved 96 Nigerian quarry workers with work-related low back pain that were randomly assigned into; stretching exercise with back care education group, lumbar stabilisation exercise with back care education group, and back care education group. Participants' pain was evaluated using Quadruple Visual Analogue Scale while functional disability was assessed using Oswestry Low Back Pain Disability Questionnaire. Eighty-six participants completed the study (stretching exercise = 29, lumbar stabilisation =27 and back care education =30). There were no significant differences in demographic and clinical characteristics between the three groups at baseline. At week four of the study, stretching exercise demonstrated more significant reductions (p < 0.05) in pain and functional disability than back care education. Also, participants in the stretching exercise demonstrated more significant reductions (p < 0.05) in pain and functional disability than those in both lumbar stabilisation exercise and back care education at the end of week eight of the study. Stretching exercises are therefore better than lumbar stabilisation exercises and back care education in reducing pain and functional disability in individuals with work-related low back pain and are hence recommended for reducing pain and functional disability in individuals with work-related low back pain.
... The beneficial effect of exercise on the sensation of pain observed in the NPs, in this study, confirms the findings of literature. An Asian survey by Chen et al. [34] verified the effectiveness of an MSE program on lower back pain in 127 NPs, separated into EG and CG, followed for 24 weeks; in the study, the EG showed significantly lower pain scores than the CG after the intervention. This type of intervention has also been investigated in other individual profiles and the results have also been positive, similar to the study by Puppin et al. [33], in which the effect of 8 weeks of MSE in 55 patients with back pain was evaluated, and the outcomes showed a significant reduction in pain in the EG compared to the CG. ...
Article
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Introduction: Nursing professionals (NPs) experience musculoskeletal pain that leads them to leave work. Objective: To analyze the effects of muscle stretching exercises (MSE) on pain among NPs. Method: This is a randomized controlled parallel experiment, in which 28 NPs (7 men and 21 women) were allocated into experimental (EG, n = 15; 47.4 years ± 9.5) and control (CG, n = 13; 39.15 years ± 9.6) groups. MSEs were performed for two months, three days a week, 40 min per session. A visual numeric scale was used, for which the intensity ranged from 0 (no pain) to 10 (maximum pain). The research was registered at the Brazilian Clinical Trials Registry website (TRIAL: RBR- 8chg6q). For statistics, the Shapiro-Wilk, T-independent and two-way ANOVA tests were applied for repeated measures with Tukey’s post-hoc test (P ≤ 0.05). Results: Most NPs work on weekends (68%) and/or have other professional activities (60.7%); 42.9% had to miss work at least once in the year prior to the survey and 66.7% of those were due to medical reasons; 42.9% work more than 10 hours/day. Of the NPs, 89.3% of the volunteers in both groups lived daily with pain in some region of the body. Pain decreased after the MSE program was initiated in the EG (p = 0.001) and differed from the CG (p = 0.002). Conclusion: MSEs were beneficial for pain reduction in NPs.
... The overall finding was yoga sessions and conventional stretching were equally efficient than self-care book in improving function and pain level. In the third muscular stretching study reviewed [13] examined the effectiveness of stretching exercise program on low back pain (LBP) and exercise selfefficacy among nurses in Taiwan. The researchers reported that after 6 months of undergoing stretching program, 81% of participants reported a moderate to high level of LBP relief. ...
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Chronic low-back pain (CLBP) affects most adults at some point in their lives. The purpose of the review was to search and analyze contemporary studies on muscular stretching and core stability (CS) exercise in rehabilitation of CLBP. Science Direct, Springer, and Google Scholar database were searched for related articles published from 2008–2013. A total of 57 articles were identified; however, only 10 papers fulfilled the criteria for this review. The results showed that both CS exercise and muscular stretching improve pain level and functional disability among CLBP patients. However, there is modest evidence from the relevant reviews that CS exercise is superior to muscular stretching in CLBP rehabilitation since CS exercise improves the deep core muscles, whereas muscular stretching has no effect on the deep core muscles. The effects of specific types of stretching techniques (e.g., effect of dynamic stretching and PNF stretching) are unclear because most studies reviewed utilize only basic stretching techniques. Hence, there is a need for further studies to examine the effects of specific stretching techniques on CLBP.
... In a recent systematic review [70] investigating intervention studies among nursing personnel with LBP, only three RCTs including exercise in the interventions and having a low risk of bias were found. Stretching [71] or combined strength training and stretching [72] decreased pain among nurses with chronic pain, but a programme including counselling, segmental stabilisation, and general exercise was not superior to general exercise alone in reducing pain among nurses with sub-acute LBP [73]. At present there is no strong evidence for the efficacy of any intervention in the prevention or treatment of LBP in nursing personnel [70]. ...
Article
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Background: Low back pain (LBP) is common among healthcare workers, whose work is physically strenuous and thus demands certain levels of physical fitness and spinal control. Exercise is the most frequently recommended treatment for LBP. However, exercise interventions targeted at sub-acute or recurrent patients are scarce compared to those targeted at chronic LBP patients. Our objective was to examine the effects of 6 months of neuromuscular exercise on pain, lumbar movement control, fitness, and work-related factors at 6- and 12-months' follow-up among female healthcare personnel with sub-acute or recurrent low back pain (LBP) and physically demanding work. Methods: A total of 219 healthcare workers aged 30-55 years with non-specific LBP were originally allocated to four groups (exercise, counselling, combined exercise and counselling, control). The present study is a secondary analysis comparing exercisers (n = 110) vs non-exercisers (n = 109). Exercise was performed twice a week (60 min) in three progressive stages focusing on controlling the neutral spine posture. The primary outcome was intensity of LBP. Secondary outcomes included pain interfering with work, lumbar movement control, fitness components, and work-related measurements. Between-group differences were analysed with a generalised linear mixed model according to the intention-to-treat principle. Per-protocol analysis compared the more exercised to the less exercised and non-exercisers. Results: The mean exercise attendance was 26.3 (SD 12.2) of targeted 48 sessions over 24 weeks, 53% exercising 1-2 times a week, with 80% (n = 176) and 72% (n = 157) participating in 6- and in 12-month follow-up measurements, respectively. The exercise intervention reduced pain (p = 0.047), and pain interfering with work (p = 0.046); improved lumbar movement control (p = 0.042), abdominal strength (p = 0.033) and physical functioning in heavy nursing duties (p = 0.007); but had no effect on other fitness and work-related measurements when compared to not exercising. High exercise compliance resulted in less pain and better lumbar movement control and walking test results. Conclusion: Neuromuscular exercise was effective in reducing pain and improving lumbar movement control, abdominal strength, and physical functioning in nursing duties compared to not exercising.
... This quasi-experimental study was approved by the Institutional Review Board, Faculty of Medicine Siriraj Hospital (Si 377/2016). The sample size was calculated using the mean pain score from a previous study 17 and adding 25% to allow for missing data. The required sample size of subjects was sixty. ...
... Thus, self-efficacy improvement is very important in the process of changing behavior. [29] In the present study, self-efficacy increased in the control group after one month. Increasing self-efficacy without increasing knowledge may be worrisome. ...
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Background and aims: Pain is the fifth vital sign, and pediatric nurses plays a key role in the process of pediatric pain management. The present study aimed to determine the effect of pain management training on the knowledge, attitude and self-efficacy of pediatric nurses. Methods: This is a quasi-experimental study including two groups of test and control. The experimental group received a workshop method with a content including (ethical aspect, physiology, assessment tools, and pharmaceutical and non-pharmacological pain management) and was not given in the control group. The PNKAS self-efficacy questionnaires was completed by the participants before and one month after the beginning of the study. The data were analyzed using descriptive statistics and independent T-test, Fisher exact, and Chi-square tests using SPSS version 20 software. Results: The mean pre-test scores of knowledge and attitude in the control and experimental groups was 50.79-47.14, and after one month was 47.46-53.09, respectively, showed that, training was significantly effective in the knowledge and attitude of the experimental group (P value = 0.01). The mean pre-test score of self-efficacy in the control and experimental groups was (17.01-18.06), and one month later was 20.36-21.03 respectively. Although the self-efficacy score increased in both groups, training significantly increased the self-efficacy of pediatric nurses in the experimental group (P value <0.001). Conclusion: Pain management training is required due to the poor knowledge of pediatric nurses and the importance of pain management in improving the quality of nursing care and the satisfaction of patients with the In addition, feeling high self-efficacy without sufficient knowledge of pain management can disrupt pediatric pain management.
... One study also indicated that stretching was associated with a reduction in "bothersome soreness" (Jamtvedt et al. 2010). However, most research has demonstrated that stretching prior to exercise is ineffective in reducing soreness or other symptoms of muscle damage (Black and Stevens 2001;Gulick et al. 1996;High et al. 1989;Johansson et al. 1999;Khamwong et al. 2011;Lund et al. 1998;McHugh and Nesse 2008), with 1 recent exception showing some benefit of stretching (Chen et al. 2014). ...
Article
Recently, there has been a shift from static stretching (SS) or proprioceptive neuromuscular facilitation (PNF) stretching within a warm-up to a greater emphasis on dynamic stretching (DS). The objective of this review was to compare the effects of SS, DS, and PNF on performance, range of motion (ROM), and injury prevention. The data indicated that SS- (-3.7%), DS- (+1.3%), and PNF- (-4.4%) induced performance changes were small to moderate with testing performed immediately after stretching, possibly because of reduced muscle activation after SS and PNF. A dose-response relationship illustrated greater performance deficits with ≥60 s (-4.6%) than with <60 s (-1.1%) SS per muscle group. Conversely, SS demonstrated a moderate (2.2%) performance benefit at longer muscle lengths. Testing was performed on average 3-5 min after stretching, and most studies did not include poststretching dynamic activities; when these activities were included, no clear performance effect was observed. DS produced small-to-moderate performance improvements when completed within minutes of physical activity. SS and PNF stretching had no clear effect on all-cause or overuse injuries; no data are available for DS. All forms of training induced ROM improvements, typically lasting <30 min. Changes may result from acute reductions in muscle and tendon stiffness or from neural adaptations causing an improved stretch tolerance. Considering the small-to-moderate changes immediately after stretching and the study limitations, stretching within a warm-up that includes additional poststretching dynamic activity is recommended for reducing muscle injuries and increasing joint ROM with inconsequential effects on subsequent athletic performance.
... Seleção de artigos com estratégias de prevenção, a intervenção utilizada, número de participantes, principais resultados e Nível de Evidência (NE), Florianópolis, SC, Brasil, 2019As intervenções mostraram-se heterogêneas com metodologias diversas, diferentes grupos de controle, medidas de resultados e acompanhamentos. Os estudos envolveram mais pesquisas internacionais, mas todas de delineamento experimental 6,15-22 e quase experimental3,[13][14]23 de ensaios clínicos, com exceção de uma revisão sistemática; 4 desenvolvidas, principalmente, nos locais de trabalho, geralmente hospitais,3,[13][14][15]18,[20][21][22][23] uma clínica16 e três instituições universitárias.6,19,22 Constatado que, entre os recursos existentes, principalmente fisioterapêuticos, poucos têm sido utilizados em profissionais de enfermagem. ...
Article
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Objetivo: identificar estratégias de prevenção e reabilitação da dor lombar em trabalhadores de enfermagem. Método: revisão integrativa de literatura. As buscas aconteceram nas bases de dados LILACS, MEDLINE/PUBMED e na biblioteca eletrônica SCIELO com artigos em inglês, espanhol ou português de 2009 a 2019. Resultados: resultaram 14 publicações e a construção de três categorias: “estratégias de prevenção”, “estratégias reabilitativas complementares” e “estratégias combinadas”. A prevenção envolveu a educação online e a baseada em Modelo de Crenças em Saúde, as estratégias complementares foram representadas pela massagem, liberação miofascial e yoga. As estratégias combinadas como a Escola de Coluna parecem fornecer um modelo mais adequado para o manejo da dor lombar não específica. Conclusão: o número escasso de publicações acerca do tema sugere novos estudos para se obterem melhores evidências da eficácia dessas estratégias e também a utilização de novas abordagens, principalmente, multimodais nessa população específica no ambiente laboral.
... In 300 addition, low back exercises can effectively train the 301 muscles and decrease fatigue, increase abdominal mus-302 cle endurance, and expand the range of waist activi-303 ties, thereby reducing the degree of NSCLBP [22]. Low 304 back exercise is different and more targeted than physi-305 cal exercise that is mostly stretching exercises, running, 306 walking, and other body movements [38]. Health ed-307 ucation stresses the advantages of low back exercises 308 and nursing manipulation techniques used at work, thus 309 increasing nurse compliance, which has synergistic ef-310 fect with low back exercises and yields a greater pain 311 improvement effect. ...
Article
Background: Many non-drug interventions for decreasing non-specific chronic low back pain (NSCLBP) in nurses have been extensively studied, but the most effective approach is still unclear. Objective: This systematic review and network meta-analysis evaluated the efficacies of 12 non-drug interventions in reducing NSCLBP in nurses. Methods: PubMed, ScienceDirect, Web of Science, Cochrane, EMBASE, CINAHL, Medline, WANFANG, VIP, China Knowledge Integrated, and SinoMed were searched from their establishment to July 2019. Randomized controlled trials (RCTs) comparing non-drug interventions for NSCLBP in nurses were included and analyzed using Stata v15 statistical software. Results: A total of 31 RCTs (n= 7116) and 12 non-drug interventions were included. The first three results with the highest surface areas under the curve ranking area (SUCRAs) were low back exercise plus healthy education, single low back exercise, and yoga (SUCRAs: 79.4%, 76.2%, and 75.1%, respectively). In addition, single yoga was inferior to protective equipment (standardized mean difference [SMD] = 3.88, 95% confidence interval [CI]: 0.92 to 6.84) and multidisciplinary intervention (SMD =-4.06, 95% CI: -7.33 to -0.78). Conclusions: Low back exercise plus health education may be the best approach to reduce NSCLBP in nurses. Considering the heterogeneity, our findings need to be confirmed in future multicenter large sample RCTs in different countries.
... 17,30,31 The positive effect of exercise on the sense of pain shown in nurses in this study supports the results of the literature. The Asian study conducted by Chen et al. 32 ascertained the efficacy of the MSE program for pain in 127 nurses, split up into experimental and control groups, joined for 24 weeks; the experimental group study reported lower pain intensity than the control group following the intervention. ...
Article
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The study aimed to assess the effect of muscle stretching exercise on neck pain and disability among nurses in Palestine. A quasi-experimental, pre-post design with a convenience sample of 90 nurses with moderate-to-severe neck pain from two hospitals in Palestine participated in the study. The hospitals were randomly selected to be an experimental and the other one as a control group. The experimental group received the instruction to perform structured neck and around shoulder stretching exercises two sessions/day for 5 days/week for 1 month. The control group was told to maintain their current level of physical activity. Results showed that the magnitude of improvement in neck pain and disability was greater in the experimental group than in the control group (t(88) = 8.5, P = 0.001).
... A widely held area of interest is the identification of the various risk factors leading to the onset of symptoms (physical, psychological and organizational) [10][11][12]. Nurses are prone to lower back injury and pain because of bending and lifting during clinical practice [13]. In addition, rising levels of patient obesity are also thought to put nurses' backs at higher risk [14]. ...
Article
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Nursing is a profession with high incidence and prevalence of low back pain (LBP), with its medical and professional consequences. These prevalence rates vary among countries, and with various measurements have been used to determine LBP. Individual and work-related factors are regarded as causal factors for many back injuries. The aims of study this were: (1) to estimate the prevalence of LBP using different measures, (2) to determine medical and professional consequences of LBP, and (3) to determine the associated factors and significant predictors of LBP. A cross-sectional study was conducted among 254 nurses from different departments/wards at Hamad General Hospital (HGH), Doha, Qatar over two months (February and March, 2015). A self-administered modified Nordic questionnaire was used to collect data regarding five different measures of LBP, its medical and occupational consequences and individual/lifestyle and work-related risk factors of LBP. Descriptive and analytic statistical analyses were done using chi-square and multivariate logistic regression techniques. Significance was considered at p ≤ 0.05. The findings of this study broadly confirm the high levels of back pain in nursing, with a one-year prevalence of LBP of 54.3 % for LBP of at least one day, 26.8 % for chronic LBP, 18.1 % for sick leave seeking LBP, and 34.3 % for medical treatment seeking LBP. Difficult or impossible activities of daily living were reported due to LBP in climbing stairs (50.7 %), walking (42.8 %), standing up (39.9 %), sleeping (33.3 %), getting out of bed (30.4 %) and wearing clothes (20.3 %). Work stop due to LBP was reported by 76.8 % of nurses, with 2.03 ± 3.09 days within the last year. Treatment was sought in 58.7 % by medical care, and 15.9 % by physiotherapy, while seeking rest days and/or sick leave was sought in 50.8 % of nurses with LBP. Sports practice (p = 0.003), office work (p < 0.001) and exposure to physical stress (p = 0.002) were the only significant predictors of LBP among nurses, when logistic regression analysis was conducted. The prevalence of LBP among nurses at HGH is high and should be actively addressed, however, it was not a major cause of sick leave. Preventive measures should be taken to reduce the risk of lower back pain, such as arranging proper rest periods, educational programs to teach the proper use of body mechanics and sports activity programs.
Article
The purpose of this study was to evaluate the effectiveness of a releasing exercise program (REP) on anxiety and exercise self-efficacy among nurses. The REP consisted of warm-up and tension-releasing exercises and mood adjustment. Ninety-nine nurses (age = 33.38 ± 7.38 years) experiencing anxiety (average Visual Analog Scale for Anxiety [VASA] score of 5.63 ± 1.44 at baseline) were randomly assigned to an experimental group (n = 50) that received 50-min REP sessions 3 times a week or a control group (n = 49) that did not attend REP sessions. The outcome measures were VASA, the Chinese Version of the Beck Anxiety Inventory, and Exercise Self-Efficacy Scale scores. At Weeks 12 and 24, the experimental group had significantly lower anxiety levels and higher exercise self-efficacy scores than the control group. Therefore, the REP effectively reduces anxiety and enhances self-confidence in exercise capability.
Article
Objective: To determine which type of exercise is best for reducing pain and disability in adults with chronic low back pain (LBP). Design: Systematic review with network meta-analysis (NMA) of randomised controlled trials (RCTs). Literature search: Six electronic databases were systematically searched from inception to July 2021. Study selection criteria: RCTs testing the effects of exercise on reducing self-perceived pain or disability in adults (18-65 years) with chronic LBP. Data synthesis: We followed the PRISMA-NMA statement when reporting our NMA. A frequentist NMA was conducted. The probability of each intervention being the most effective was conducted according to SUCRA values. Results: We included 118 trials (9710 participants). There were 28 head-to-head comparisons, 7 indirect comparisons for pain, and 8 indirect comparisons for disability. Compared with control, all types of physical exercises were effective for improving pain and disability, except for stretching exercises (for reducing pain) and McKenzie method (for reducing disability). The most effective interventions for reducing pain were: Pilates, mind-body and core-based exercises. The most effective interventions for reducing disability were: Pilates, strength and core-based exercises. On SUCRA analysis, Pilates had the highest likelihood for reducing pain (93%) and disability (98%). Conclusion: Although most exercise interventions had benefits for managing pain and disability in chronic LBP, the most beneficial programmes were those that included: (i) at least 1-2 sessions/week of Pilates or strength exercises; (ii) sessions of <60 min of core-based, strength or mind-body exercises; and, (iii) training programs from 3 to 9 weeks of Pilates and core-based exercises.
Article
Objective: To identify the correlation between nursing supervision and low back pain (LBP) preventive behavior among nursing staff at the hospital. Method: Quantitative research using cross-sectional design. The respondents were 141 nursing staff members working at inpatient care facilities and outpatient care units of the non-psychiatric departments of Marzoeki Mahdi Hospital. Samples were taken using total sampling. The instruments used in this research were nursing supervision questionnaires and LBP preventive behavior instruments. Result: A Chi-square test with an (α≤0.050) level of significance indicates that there is a significant correlation between nursing supervision and LBP preventive behavior among nursing staff at the hospital (p=0.015); OR=2.440. Bivariate analysis shows that there is no significant correlation between respondents' characteristics (sex, age, body mass index (BMI), and self-efficacy) and LBP preventive behavior. Conclusion: The results of this research may serve as a recommendation for more intensive LBP preventive behavior among nursing staff through rigorous nursing supervision.
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Objectives To develop and internally validate prediction models to assess treatment success of both stand-alone and blended online vestibular rehabilitation (VR) in patients with chronic vestibular syndrome. Design Secondary analysis of a randomised controlled trial. Setting 59 general practices in The Netherlands. Participants 202 adults, aged 50 years and older with a chronic vestibular syndrome who received either stand-alone VR (98) or blended VR (104). Stand-alone VR consisted of a 6-week, internet-based intervention with weekly online sessions and daily exercises. In blended VR, the same intervention was supplemented with physiotherapy support. Main outcome measures Successful treatment was defined as: clinically relevant improvement of (1) vestibular symptoms (≥3 points improvement Vertigo Symptom Scale—Short Form); (2) vestibular-related disability (>11 points improvement Dizziness Handicap Inventory); and (3) both vestibular symptoms and vestibular-related disability. We assessed performance of the predictive models by applying calibration plots, Hosmer-Lemeshow statistics, area under the receiver operating characteristic curves (AUC) and applied internal validation. Results Improvement of vestibular symptoms, vestibular-related disability or both was seen in 121, 81 and 64 participants, respectively. We generated predictive models for each outcome, resulting in different predictors in the final models. Calibration for all models was adequate with non-significant Hosmer-Lemeshow statistics, but the discriminative ability of the final predictive models was poor (AUC 0.54 to 0.61). None of the identified models are therefore suitable for use in daily general practice to predict treatment success of online VR. Conclusion It is difficult to predict treatment success of internet-based VR and it remains unclear who should be treated with stand-alone VR or blended VR. Because we were unable to develop a useful prediction model, the decision to offer stand-alone or blended VR should for now be based on availability, cost effectiveness and patient preference. Trial registration number The Netherlands Trial Register NTR5712.
Article
Background: Low back pain has been the leading cause of disability globally for at least the past three decades and results in enormous direct healthcare and lost productivity costs. Objectives: The primary objective of this systematic review is to assess the impact of exercise treatment on pain and functional limitations in adults with chronic non-specific low back pain compared to no treatment, usual care, placebo and other conservative treatments. Search methods: We searched CENTRAL (which includes the Cochrane Back and Neck trials register), MEDLINE, Embase, CINAHL, PsycINFO, PEDro, SPORTDiscus, and trials registries (ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform), and conducted citation searching of relevant systematic reviews to identify additional studies. The review includes data for trials identified in searches up to 27 April 2018. All eligible trials have been identified through searches to 7 December 2020, but have not yet been extracted; these trials will be integrated in the next update. Selection criteria: We included randomised controlled trials that assessed exercise treatment compared to no treatment, usual care, placebo or other conservative treatment on the outcomes of pain or functional limitations for a population of adult participants with chronic non-specific low back pain of more than 12 weeks' duration. Data collection and analysis: Two authors screened and assessed studies independently, with consensus. We extracted outcome data using electronic databases; pain and functional limitations outcomes were re-scaled to 0 to 100 points for meta-analyses where 0 is no pain or functional limitations. We assessed risk of bias using the Cochrane risk of bias (RoB) tool and used GRADE to evaluate the overall certainty of the evidence. When required, we contacted study authors to obtain missing data. To interpret meta-analysis results, we considered a 15-point difference in pain and a 10-point difference in functional limitations outcomes to be clinically important for the primary comparison of exercise versus no treatment, usual care or placebo. Main results: We included 249 trials of exercise treatment, including studies conducted in Europe (122 studies), Asia (38 studies), North America (33 studies), and the Middle East (24 studies). Sixty-one per cent of studies (151 trials) examined the effectiveness of two or more different types of exercise treatment, and 57% (142 trials) compared exercise treatment to a non-exercise comparison treatment. Study participants had a mean age of 43.7 years and, on average, 59% of study populations were female. Most of the trials were judged to be at risk of bias, including 79% at risk of performance bias due to difficulty blinding exercise treatments. We found moderate-certainty evidence that exercise treatment is more effective for treatment of chronic low back pain compared to no treatment, usual care or placebo comparisons for pain outcomes at earliest follow-up (MD -15.2, 95% CI -18.3 to -12.2), a clinically important difference. Certainty of evidence was downgraded mainly due to heterogeneity. For the same comparison, there was moderate-certainty evidence for functional limitations outcomes (MD -6.8 (95% CI -8.3 to -5.3); this finding did not meet our prespecified threshold for minimal clinically important difference. Certainty of evidence was downgraded mainly due to some evidence of publication bias. Compared to all other investigated conservative treatments, exercise treatment was found to have improved pain (MD -9.1, 95% CI -12.6 to -5.6) and functional limitations outcomes (MD -4.1, 95% CI -6.0 to -2.2). These effects did not meet our prespecified threshold for clinically important difference. Subgroup analysis of pain outcomes suggested that exercise treatment is probably more effective than education alone (MD -12.2, 95% CI -19.4 to -5.0) or non-exercise physical therapy (MD -10.4, 95% CI -15.2 to -5.6), but with no differences observed for manual therapy (MD 1.0, 95% CI -3.1 to 5.1). In studies that reported adverse effects (86 studies), one or more adverse effects were reported in 37 of 112 exercise groups (33%) and 12 of 42 comparison groups (29%). Twelve included studies reported measuring adverse effects in a systematic way, with a median of 0.14 (IQR 0.01 to 0.57) per participant in the exercise groups (mostly minor harms, e.g. muscle soreness), and 0.12 (IQR 0.02 to 0.32) in comparison groups. Authors' conclusions: We found moderate-certainty evidence that exercise is probably effective for treatment of chronic low back pain compared to no treatment, usual care or placebo for pain. The observed treatment effect for the exercise compared to no treatment, usual care or placebo comparisons is small for functional limitations, not meeting our threshold for minimal clinically important difference. We also found exercise to have improved pain (low-certainty evidence) and functional limitations outcomes (moderate-certainty evidence) compared to other conservative treatments; however, these effects were small and not clinically important when considering all comparisons together. Subgroup analysis suggested that exercise treatment is probably more effective than advice or education alone, or electrotherapy, but with no differences observed for manual therapy treatments.
Article
Background: Therapeutic exercise (TE) is recommended in multimodal treatment for patients with non-specific chronic back pain (cLBP). Objective: The aim of this study is to identify an exercise or a spectrum of exercises, well described and reproducible by the clinician, for cLBP patients. Methods: Systematic review by researching in the databases MEDLINE, EMBASE, PEDro, CINAHL, and Scopus. Evidence from Randomized Controlled Trials (RCTs) supported the TE in patients with non-specific cLBP, provided that it was well described and could be repeated by another therapist. Methodological evaluation was performed using the PEDro scale and only studies with a score of ⩾ 6 were included. The assessment of the intervention description was carried out with the TIDieR checklist. The risk of bias was examined. Results: Twenty-one articles were included in this systematic review. The defective description and the poorly reporting of the intervention makes it more difficult for the clinician to include the TE into clinical practice. Conclusions: The findings of this study showed that the reporting of the intervention in high quality RCT on chronic low back pain is low, threatening the external validity of the results.
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Objective: To test the clinical effect of a web-based lower back pain intervention on quality of life and selected lower back pain outcomes. Design: A prospective single-blinded randomized intervention. Setting: Occupational preventive service. Subjects: One hundred office workers with non-specific subacute lower back pain. Intervention: The 50 intervention group subjects were educated daily about sitting correctly and asked to perform exercises shown by video demonstrations on the university website. The exercise routines included strengthening, mobility and stretching exercises focused on the postural stability muscles. The 50 control group subjects only received standard occupational care. Measures: Outcomes were measured by the EuroQol questionnaire five dimensions three levels, the Oswestry Disability Index, and the StarT Back Screening Tool questionnaires. At nine months, the intervention group outcomes were compared to the baseline data and the control group outcomes. Results: For 97% (n = 45) of the experimental group quality of life (clinical utility) improved significantly; 3.58 times greater than the control group. Oswestry Disability Index showed an odds ratio (OR) of 5.42 with a 37% (n = 17) change for the intervention group with respect to the control group. With regard to the StarT Back Screening Tool, 76% (n = 35) of the intervention group improved their clinical state (odds ratio = 3.04 with respect to the control group improvement). Logistic regression analysis revealed positive changes in EuroQol questionnaire, increasing the likelihood of observing positive changes in StarT Back Screening Tool (OR = 15.5) and Oswestry Disability Index (OR = 4.5). Conclusions: The intervention showed clinical improvements in quality of life and selected lower back pain outcomes in the experimental group compared to the control group.
Article
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To introduce a newly designed massage instrument, the Hand Grip T-bar (HT-bar) and use it to relieve chronic non-specific low back pain (nLBP) through deep cross-friction massage (roptrotherapy). 22 subjects (9 males and 13 females, aged 51.6±6.7) with chronic nLBP were allocated randomly to a Roptrotherapy group (n=12) and a Transcutaneous Electrical Nerve Stimulation (TENS) group (n=10). The Roptrotherapy group received deep cross-friction massage with the HT-bar, which was made of metal and had a cylinder for increasing weight and grooves for an easy grip. It was applied across the middle and lower back for 20 minutes a day, 3 days a week for 2 weeks. The TENS group received TENS for 20 minutes a day, 5 days a week for 2 weeks. The outcome was measured on the pain numeric rating scale (PNRS), by the Oswestry disability index (ODI), and by the Roland & Morris Disability Questionnaire (RMDQ) at pre-treatment, at immediate post-treatment and 2 weeks later. The application of the HT-bar was assessed by a questionnaire to 19 therapists. At post-treatment, immediately and 2 weeks later, both groups showed significant improvement in PNRS, ODI and RMDQ. During the two weeks after post-treatment, however, the Roptrotherapy group improved in PNRS, ODI and RMDQ, but the TENS group did not. Over 80% of the therapists responded that the HT-bar was useful and comfortable. This study suggests that deep cross-friction massage can be a beneficial therapeutic technique and that the HT-bar can be a useful instrument in deep cross-friction massage for chronic nLBP patients.
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Exercise therapy is widely used as an intervention in low back pain. To evaluate the effectiveness of exercise therapy in adult nonspecific acute, subacute, and chronic low back pain versus no treatment and other conservative treatments. MEDLINE, EMBASE, PsychInfo, CINAHL, and Cochrane Library databases to October 2004; citation searches and bibliographic reviews of previous systematic reviews. Randomized, controlled trials evaluating exercise therapy for adult nonspecific low back pain and measuring pain, function, return to work or absenteeism, and global improvement outcomes. Two reviewers independently selected studies and extracted data on study characteristics, quality, and outcomes at short-, intermediate-, and long-term follow-up. 61 randomized, controlled trials (6390 participants) met inclusion criteria: acute (11 trials), subacute (6 trials), and chronic (43 trials) low back pain (1 trial was unclear). Evidence suggests that exercise therapy is effective in chronic back pain relative to comparisons at all follow-up periods. Pooled mean improvement (of 100 points) was 7.3 points (95% CI, 3.7 to 10.9 points) for pain and 2.5 points (CI, 1.0 to 3.9 points) for function at earliest follow-up. In studies investigating patients (people seeking care for back pain), mean improvement was 13.3 points (CI, 5.5 to 21.1 points) for pain and 6.9 points (CI, 2.2 to 11.7 points) for function, compared with studies where some participants had been recruited from a general population (for example, with advertisements). Some evidence suggests effectiveness of a graded-activity exercise program in subacute low back pain in occupational settings, although the evidence for other types of exercise therapy in other populations is inconsistent. In acute low back pain, exercise therapy and other programs were equally effective (pain, 0.03 point [CI, -1.3 to 1.4 points]). Limitations of the literature, including low-quality studies with heterogeneous outcome measures inconsistent and poor reporting, and possibility of publication bias. Exercise therapy seems to be slightly effective at decreasing pain and improving function in adults with chronic low back pain, particularly in health care populations. In subacute low back pain populations, some evidence suggests that a graded-activity program improves absenteeism outcomes, although evidence for other types of exercise is unclear. In acute low back pain populations, exercise therapy is as effective as either no treatment or other conservative treatments.
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This prospective longitudinal clinical study analyses the therapy outcome of 365 patients with either chronic neck (n = 134) or low back (n = 231) pain treated with a multidisciplinary biopsychosocial therapy approach. Patients with chronic neck pain (NP) or low back pain (LBP) for 3 months or longer, corresponding sick leave for longer than 6 weeks, and clearly defined inclusion and exclusion criteria underwent a 3-week standardized inpatient multidisciplinary biopsychosocial therapy. Baseline sociodemographic, occupational, functional, and psychological data at entry into the study (T0) were comparable in both groups. At the 6-month follow-up (T1), five different therapy outcomes were analysed in both groups: back-to-work status, generic health status (the 36-item Short Form Health Survey, SF-36), pain intensity (visual analogue scale), functional capacity (Hannover back capacity score), and satisfaction with the therapy. Both treatment groups improved significantly in all outcome criteria between T0 and T1. In the total group, the back-to-work rate was 67.4%. At the final follow-up there were no significant differences between the group with chronic NP and the group with chronic LBP in the outcome criteria back-to-work status, improvement of health status and functional capacity, satisfaction with therapy, and reduction of pain. Evaluation of the main results of this study suggests that patients with chronic NP also derive significant benefit from a multidisciplinary treatment strategy, demonstrated in the literature so far mainly for patients with chronic LBP.
Article
A systems approach to understanding and minimizing the causes of low back pain in the workplace. Low back pain affects 80% of the population at some point during their lifetime; it is responsiblefor over 40% of the compensation costs for work-related injuries. This book provides an understanding of the mechanisms influencing low back pain in the workplace and indicates how low back pain might be prevented, saving employers extraordinary amounts in medical costs and protecting workers from the most common on-the-job injury. With a unique, multidisciplinary perspective that shows how various influences or risk factors can be considered collectively, The Working Back: A Systems View: Explains basic concepts in anatomy and physiology that are essential to understanding and preventing low back pain. Provides a systems perspective on the occupational causes of back pain, not only addressing factors such as spine loading, but also considering the potential impact of psychosocial and organizational interactions, genetics, and physiology. Discusses implementing preventive engineering and administrative controls and integrating risk interventions into the workplace. Offers an expert analysis of current medical research on low back pain in one comprehensive, accessible reference. This book gives readers the knowledge to assess a work environment and prescribe effective interventions. It is a hands-on reference for ergonomists, manufacturing engineers, process engineers, industrial engineers and managers, safety engineers, nurses, therapists, chiropractors, physicians, and workers with back pain. It is also an excellent resource for graduate or undergraduate students of kinesiology, physiology, ergonomics, physical therapy, nursing, industrial design, engineering, and general medicine.
Article
Objectives: Nursing personnel working in nursing homes have quite a high musculoskeletal disorders (MSDs) rate in many countries. The aims of this follow-up study were to access the incidences and to explore the work-related psychosocial factors for neck, shoulder and low back disorder among female nursing personnel at a nursing home located in Chunghua. Methods: In this one year follow-up study, the baseline data comprised 80 female nursing personnel to complete a questionnaire by face-to-face interview. Of these, 75 (93.8%) completed a second questionnaire 1-year later. The variables of this questionnaire including self-reported MSDs in different body regions, personal characteristics, perceived physical exertion and psychosocial factors such as job control, emotional demand of clients, time pressure, job satisfaction and social support. Results: Of the 75 subjects, the 1-year incidence rate of neck, shoulder and low back disorder were 38.2%, 54.8% and 55.9%, respectively. Univariate analysis showed that time pressure and perceived physical exertion were related to neck disorders; time pressure and emotional demand of clients were related to shoulder disorders; and current work-years were related to low back disorders. Multiple logistic regression analysis revealed that the higher the perceived physical exertion and the higher the time pressure, the greater the risk of neck disorders; the higher time pressure, the greater the risk of shoulder disorders; while the less the current work-years, the more the risk of low back disorders. Conclusions: This study indicated that factors related with incident MSDs were multiple. In particular, time pressure was the most important psychosocial factor. For lowering time pressure and physical loading and also decreasing MSDs occurrence among nursing personnel, this study suggests that the employer should hire more staff under cost controls.
Article
The fear avoidance model of chronic pain is well established for specific chronic pain groups and of considerable clinical utility, but it suffers from poor generalizability. Therefore, in this study we examined the role of self-efficacy (SE) in the relationship between pain-related fear (PRF) and three pain-related outcomes-pain severity, disability, and depression-in a more heterogeneous chronic pain sample. Sixty-eight participants between the ages of 18 and 75 years experiencing chronic pain were recruited from the general public. Participants completed a questionnaire that measured catastrophizing, SE, fear of movement, avoidance behavior, PRF, pain severity, disability, and depression. In support of our first hypotheses, higher SE was associated with: 1) less catastrophizing, fear of movement, avoidance of pain, and PRF; and 2) less pain severity, disability, and depression. And higher catastrophizing, fear of movement, avoidance of pain, and PRF were associated with higher pain severity, disability, and depression. Although complete mediation was not found, post hoc examination of partial correlations revealed that the relationship between PRF and disability was partially mediated by SE; however, SE had no mediatory effect on the relationship between PRF and either pain severity or depression. Within the constraints of a relatively small sample size, we concluded that within a heterogeneous pain population, PRF remains the most integral component of the fear avoidance model.
Article
The purpose of this study was to examine the effects of relaxation techniques and back massage on postoperative pain, anxiety, and vital signs on postoperative days 1-3 in patients who had undergone total hip or knee arthroplasty (THA, TKA). Sixty patients having a THA or TKA were randomly assigned to either a experimental group or a control group. The McGill Pain Questionnaire Short Form (MPQ-SF) and State Anxiety Inventory (SAI) were used to measure pain and anxiety, respectively. Vital signs, including blood pressure (systolic and diastolic), pulse, and respiratory rate, were also obtained. Statistically significant differences in pain intensity (F = 14.50; p = .000), anxiety level (F = 19.13; p = .000), and vital signs (F = 169.61, 9.14, 14.23, 65.64; p = .000) measured over time were found between the experimental and the control group. Results of this research provide evidence to support the use of relaxation techniques and back massage at bed rest times of patients to decrease pain and anxiety. The interventions helped them to forget about their pain for a while and improved their anxiety state. After an evaluation of the conclusions, use of these interventions should be implemented by nurses into routine plans of care for patients.
Article
A systematic review was undertaken to update the understanding of the available evidence for antenatal physical therapy interventions for low back or pelvic pain in pregnant women to improve functional outcomes when compared with other treatments or no treatment. Seven electronic databases were systematically searched and supplemented by hand searching through reference lists. Two reviewers independently selected trials for inclusion and independently assessed the internal validity of the included trials using the Clinical Appraisal Skills Program tool. Four trials with 566 participants were identified that met the inclusion criteria. The validity of the trials was moderate. Exercise, pelvic support garments and acupuncture were found to improve functional outcomes in pregnant women with low back or pelvic pain. No meta-analysis was performed because of the heterogeneity of functional outcome measures. While there is some evidence that physical therapy using exercise, acupuncture and pelvic supports may be useful, further research needs to consider other treatment modalities used by physical therapists and establish an appropriate, reliable and valid functional outcome measure to assess low back and pelvic pain in pregnancy.
Pain is a syndrome characterized by several neurophysiological changes including that of the autonomic nervous system. Chronic low back pain (LBP) is a major health problem and is a frequent reason for using unconventional therapies especially acupuncture. This study was conducted to evaluate the autonomic status and pain profile in chronic LBP patients and to observe the effect of electro acupuncture therapy. Chronic LBP patients (n=60) were recruited from the Department of Orthopaedics, GTB Hospital, Delhi. Age and sex matched healthy volunteers were selected as controls (n=30). Following a written consent, LBP patients were randomly allocated into two study groups - Group A received 10 sittings of electro acupuncture, on alternate days, at GB and UB points selected for back pain, while the Group B received a conventional drug therapy in the form of oral Valdecoxib together with supervised physiotherapy. Controls were assessed once while the patients were assessed twice, before and after completion of the treatment program (3 weeks). The autonomic status was studied with non-invasive cardiovascular autonomic function tests which included E: I ratio, 30:15 ratio, postural challenge test and sustained handgrip test. Pain intensity was measured with the visual analogue scale (VAS) and the global perceived effect (GPE). Statistical analysis was performed using repeated measure's ANOVA with Tukey's test. Pain patients showed a significantly reduced vagal tone and increased sympathetic activity as compared to the controls (P<0.05 to P<0.001 in different variables). Following treatment, both the study groups showed a reduction in vagal tone together with a decrease in the sympathetic activity. There was also a considerable relief of pain in both groups, however, the acupuncture group showed a better response (P<0.01). We conclude that there is autonomic dysfunction in chronic LBP patients. Acupuncture effectively relieves the pain and improves the autonomic status and hence can be used as an alternative/additive treatment modality in these cases.
Low back pain is a common health problem among hospital nurses. However, the prevalence, characteristics, and work-related risk factors of low back pain have not been widely investigated in Taiwan. This study used a cross-sectional survey of 217 hospital nurses to gather self-reported information on the prevalence of back pain, demographic and pain characteristics, and work-related risk factors from 178 respondents who indicated a past history of back pain. The association between the characteristics of back pain and work-related risk factors was also examined. The lifetime prevalence of back pain was 82.03%, and the point prevalence of back pain was 43.78%. The mean pain score is 41.67. The number of years at work was significantly associated with the pain score for an individual's most recent episode of back pain, the extent of bothersomeness of back pain and leg pain, and the extent to which back pain interfered with normal work. Back pain is common among hospital nurses in Taiwan. Years at work are significantly associated with pain severity and disability caused by back pain.
Article
This paper is a report of a study conducted to describe the prevalence and risk factors for lower back pain amongst a variety of Turkish hospital workers including nurses, physicians, physical therapists, technicians, secretaries and hospital aides. Hospital workers experience more low back pain than many other groups, the incidence varies among countries. Work activities involving bending, twisting, frequent heavy lifting, awkward static posture and psychological stress are regarded as causal factors for many back injuries. A 44-item questionnaire was completed by 1600 employees in six hospitals associated with one Turkish university using a cross-sectional survey design. Data were collected over nine months from December 2005 to August 2006 and analysed using Chi square and multivariate logistic regression techniques. Most respondents (65.8%) had experienced low back pain, with 61.3% reporting an occurrence within the last 12 months. The highest prevalence was reported by nurses (77.1%) and the lowest amongst secretaries (54.1%) and hospital aides (53.5%). In the majority of cases (78.3%), low back pain began after respondents started working in the hospital, 33.3% of respondents seeking medical care for 'moderate' low back pain while 53.8% (n = 143) had been diagnosed with a herniated lumbar disc. Age, female gender, smoking, occupation, perceived work stress and heavy lifting were statistically significant risk-factors when multivariate logistic regression techniques were conducted (P < 0.05). Preventive measures should be taken to reduce the risk of lower back pain, such as arranging proper rest periods, educational programmes to teach the proper use of body mechanics and smoking cessation programmes.
Article
Background: Postoperative pain is an expected phenomenon. However, its passage beyond acceptable limits is a common and costly experience. This is particularly the case in day surgery, partly because of the increasing demand to reduce waiting lists for elective surgery, and partly because of lack of knowledge about patients' experiences of postoperative pain and relevant published research. The latter is mainly concerned with different interpretations of the phenomenon of pain that appear to have led to a variety of often inappropriate pain measurement tools. Aim: This paper critically reviews some of the available objective and subjective measures of pain and establishes the suitability of a Visual Analogue Scale (VAS) for measuring the intensity of pain after day surgery. Method: Nursing and health care papers published since 1983 were sought using the keywords: postoperative pain, day surgery, ambulatory surgery, rating scales, VAS, severity, assessment, tool, nursing, validity, sensitivity, reliability and their various combinations. The databases used were Medline, CINAHL, Nursing Collection, Embase, Healthstar, BMJ and several on-line Internet journals, specifically Ambulatory Surgery. The search included only papers published in the English language. Findings: A range of interpretations of pain have led to the development of various measurement tools that address different components of pain. This inconsistency has led to ineffective pain management. Based on established criteria, the VAS was found to be methodologically sound, conceptually simple, easy to administer and unobtrusive to the respondent. On these grounds, the VAS seems to be most suitable for measuring intensity of pain after day surgery. Conclusions: Common guidelines on the definition and measurement of pain are needed. In day surgery, the availability of a unified and reliable measure of pain that can address its sensory component, such as the VAS, will provide more reliable information about the pain experience and, hence, improve its overall management.
Article
This study compared perceived exercise self-efficacy, exercise benefits, exercise barriers, and commitment to a plan for exercise between Korean women with a diagnosis of either osteoporosis or osteoarthritis. The influence of exercise self-efficacy, exercise benefits and barriers on commitment to a plan for exercise was also assessed in each group. Participants in the study were 154 Korean women over 40 years of age who were recruited from hospitals, health centers or a nursing home. The two groups differed on commitment to a plan for exercise with commitment greater among women with osteoporosis. Exercise self-efficacy was the most influential variable on commitment to a plan for exercise accounting for 27% of the variance in commitment among osteoporosis patients and 53% of the variance among osteoarthritis patients. This study generated information relevant to tailoring exercise interventions to the differing needs and perceptions of Korean women with osteoporosis and osteoarthritis.
Article
To gain more insight into the prevalence rates of musculoskeletal complaints of neck-shoulder and low back and to determine the relation between physical and psychosocial work-related risk factors and the complaints mentioned in non-specialized nurses, operation room nurses, Intensive Care (IC) nurses and X-ray technologists. The study population consists of 3,169 employees affiliated to eight university hospitals in the Netherlands. The study was conducted using a cross-sectional survey design. The parameters under study were having or having had (severe) low back or neck-shoulder complaints during the past year. In logistic regression analyses odds ratio's and CI 95% were estimated for all relevant risk factors for each of the four professional groups. In all groups prevalence rates of musculoskeletal complaints were high: low back 76%, neck-shoulder 60%. Operation room nurses perceived more neck-shoulder complaints (12 months prevalence) than non-specialized nurses and IC nurses perceived less severe low back complaints than non-specialized nurses. Four physical risk factors and one psychosocial factor were associated with low back complaints in all groups. The results of the present study indicate that both low back complaints and neck-shoulder complaints are major health problems in the four professional groups under study. The prevalence rate of neck-shoulder complaints in operation room nurses is higher than in non-specialized nurses and IC nurses, the latter groups having high prevalence rates already. The exposure to risk factors is perceived differently by each of the professional groups. The professional groups under study all are target for preventive interventions; these interventions need to be specified for each of the professional groups.
Article
To determine the effectiveness of changes in factors associated with self-efficacy theory for predicting weight change in obese women of two ethnic groups. Obese (body mass index [BMI] > or = 30 kg/m2) White (n = 34) and African American (n = 30) women (mean age 44 years) were assessed on measures of body satisfaction, self-efficacy, and weight change over 20 weeks. Community wellness centers. A supported exercise and nutrition information treatment. Changes in Body Areas Satisfaction Scale (BAS), Physical Self-Concept Scale (PSCS), and Exercise Self-Efficacy Scale (ESES) scores and changes in body weight over 20 weeks. Significant improvements were found on measures of exercise self-efficacy, body satisfaction, and weight, with a trend (P = .073) toward significantly greater mean weight loss by the White group (-15.5 kg vs -9.1 kg). Linear multiple regression analyses, with simultaneous entry of changes in BAS, PSCS, and ESES scores, significantly predicted changes in weight for both the White (R2 = .25) and African American (R2 = .50) group. The primary predictor of weight change for the White group was change in BAS scores (beta = -.42) and for the African American group was change in ESES scores (beta = -.68). Self-efficacy theory was supported as an explanatory model for both groups, with notable differences. Implications for weight loss intervention design and application are discussed.
Article
To evaluate the basic 8-week People with Arthritis Can Exercise (PACE) program for improvements in primary (symptoms, functioning, level of physical activity) and secondary (psychosocial) outcomes. A total of 346 individuals with self-reported arthritis from 18 sites participated in a randomized controlled trial of PACE. Outcomes were measured at baseline and 8 weeks. The intervention group completed self-reported assessments at 3 and 6 months. Two-level multiple linear regression models were estimated to calculate adjusted outcome means in the intervention and control groups. A mixed-effects repeated-measures model was used to calculate adjusted means in the intervention group at 3 and 6 months. Both intent-to-treat (ITT) and as-treated (AT) analyses were conducted. At 8 weeks, the intervention group had improvements in the following outcomes: 2 symptom outcomes (pain, fatigue) and 1 psychosocial outcome (self-efficacy for managing arthritis) in the ITT analyses; 1 symptom outcome (pain), 1 function outcome (chair stands), and 1 psychosocial outcome (self-efficacy for arthritis management) in the AT analyses. In addition, completers who attended>or=9 classes had improvements in 3 symptom outcomes (pain, fatigue, stiffness), 2 function outcomes (10-pound lifts, chair stands), and 1 psychosocial outcome (self-efficacy for arthritis management) at 8 weeks. Relative to baseline, PACE participants maintained significant improvements in symptoms at 6 months, but declined in function and self-efficacy for exercise. If adults with arthritis attend a majority of PACE classes, they may expect improvements in symptoms, self-efficacy for arthritis management, and upper and lower extremity function. Achieving sustained improvement in outcomes may require continued participation in PACE.
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