Multidimensional intervention and sickness absence in assistant nursing students

Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
Occupational Medicine (Impact Factor: 1.03). 10/2009; 59(8):563-9. DOI: 10.1093/occmed/kqp124
Source: PubMed


When handling patients, nursing assistant (NA) students and nurse students are frequently exposed to risk factors for low back pain (LBP) including sudden loads and twisting and bending of the spine. Furthermore, LBP is a major cause of sickness absence.
To ascertain if a multidimensional prevention programme combining physical training, patient transfer technique and stress management prevents sickness absence and LBP in NA students.
The study was a 14-month cluster randomized controlled study. The participants were NA students from 37 randomly selected classes located at two schools of health and social care in Copenhagen, Denmark. The participants completed a comprehensive questionnaire regarding sickness absence, LBP and psychosocial factors on commencement and after completion of the study.
Of 766 female NA students, 668 (87%) completed the baseline questionnaire. Sickness absence during the study period increased in both groups but the increase was significantly lower in the intervention group than the control group, mean (standard deviation) number of days 12 (20) versus 18 (34), P < 0.05. The intervention group reported no change in the mean level of general health perception, energy/fatigue or psychological well-being at follow-up, while the control group reported a decline on those scales. There were no significant differences in the prevalence of LBP at follow-up between the intervention and control group.
Compared to the control group, the intervention group had significantly less sickness absence. The intervention had no preventive effect on LBP prevalence.

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    ABSTRACT: We have previously shown that a multidimensional programme combining physical training, patient transfer techniques and stress management significantly reduced sickness absence rates in student nurse assistants (NAs) after 14 months of follow-up. At follow-up, the control group had reduced SF-36 scores for general health perception [general health (GH)], psychological well-being [mental health (MH)] and energy/fatigue [vitality (VT)] compared with the intervention group, which remained at the baseline level for all three measures. To ascertain whether this effect remained after a further 36 months of follow-up and to analyse the association of GH, MH and VT scores with sickness absence. This was a cluster randomized prospective study. The original study involved assessment at baseline and follow-up at 14 months (the duration of the student NA course). Of 568 subjects from the original intervention study, 306 (54%) completed a postal questionnaire at 36 months. Sickness absence increased in both groups between the first and second follow-up. At the second follow-up, the intervention group had a mean of 18 days of sickness absence compared with 25 in the control group but this was not significant. GH at 14 months follow-up was found to predict sickness absence levels after 3 years. MH and VT scores showed an inverse association with sickness absence but the results were not significant. The results suggest that the initial intervention did not have a sustained effect on sickness absence 36 months after initial follow-up of the study group.
    Preview · Article · Jan 2011 · Occupational Medicine
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    ABSTRACT: Training and the provision of assistive devices are considered major interventions to prevent back pain and its related disability among workers exposed to manual material handling (MMH). To determine the effectiveness of MMH advice and training and the provision of assistive devices in preventing and treating back pain. We searched CENTRAL (The Cochrane Library 2011, issue 1), MEDLINE, EMBASE, CINAHL, Nioshtic, CISdoc, Science Citation Index, and PsychLIT to February 2011. We included randomised controlled trials (RCT) and cohort studies with a concurrent control group that were aimed at changing human behaviour in MMH and measured back pain, back pain-related disability or sickness absence. Two authors independently extracted the data and assessed the risk of bias using the criteria recommended by the Cochrane Back Review Group for RCTs and MINORS for the cohort studies.We based the results and conclusions on the analysis of RCTs only. We compared these with the results from cohort studies. We included nine RCTs (20,101 employees) and nine cohort studies (1280 employees) on the prevention of back pain in this updated review. Studies compared training to no intervention (4), professional education (2), a video (3), use of a back belt (3) or exercise (2). Other studies compared training plus lifting aids to no intervention (3) and to training only (1). The intensity of training ranged from a single educational session to very extensive personal biofeedback.Six RCTs had a high risk of bias.None of the included studies showed evidence of a preventive effect of training on back pain.There was moderate quality evidence from seven RCTs (19,317 employees) that those who received training reported levels of back pain similar to those who received no intervention, with an odds ratio of 1.17 (95% confidence intervals (CI) 0.68 to 2.02) or minor advice (video), with a relative risk of 0.93 (95% CI 0.69 to 1.25). Confidence intervals around the effect estimates were still wide due to the adjustment for the design effect of clustered studies.The results of the cohort studies were similar to those of the randomised studies. There is moderate quality evidence that MMH advice and training with or without assistive devices does not prevent back pain or back pain-related disability when compared to no intervention or alternative interventions. There is no evidence available from RCTs for the effectiveness of MMH advice and training or MMH assistive devices for treating back pain. More high quality studies could further reduce the remaining uncertainty.
    No preview · Article · Jun 2011 · Cochrane database of systematic reviews (Online)
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    ABSTRACT: Background: Intervention studies in sickness absence research demonstrate a low effect and ambiguous results in reducing sickness absence and improving work status. The aim of this study was to determine if the effect of interventions is related to type of intervention, target population, inclusion criteria used, and impact of the scientific quality of the studies. Methods: Based on a structured review of 57 studies, short-term, medium-term, and long-term effects were analyzed with regard to the type of intervention, target population, inclusion criteria, and scientific quality of the studies. Results: The overall result was that the effect rate was low, ie, about 20% for short-term effect (up to 6 months) and medium-term effect (6–12 months), and 40% for long-term effect ($12 months). Interventions using stress reduction were most effective with regard to short-term and medium-term effects, whereas collaborative care was most effective for long-term effects. The effects were related to the inclusion criteria and, to a minor degree, to the scientific quality of the studies. Conclusion: In the field of sickness absence research, more attention should be paid to the interrelationship between the types of interventions, target populations, and inclusion criteria for the studies. Larger studies of high methodological quality are needed. Steps should be taken to standardize outcome measures.
    Preview · Article · May 2012 · Open Access Journal of Clinical Trials
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