Use of an accident model to investigate and record causes of back injuries.
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BACKGROUND: Nursing assistants (NAs) working in nursing homes have among the highest back and shoulder injury rates in the US. Incidence, severity, and cost of non-traumatic soft tissue musculoskeletal disorders in the nursing home industry in Washington State are quite high. METHODS: To determine whether resident characteristics data reported on the Health Care Financing Administration Minimum Data Set (MDS) could be used as a surrogate measure of cumulative exposure to physical loads, we conducted an 18-month prospective study in one nursing home. RESULTS: The combined NA injury incidence rate (IR) was 45.8 self-reported back and shoulder injuries per 100 [FTE] workers per year. In general, MDS reported resident characteristics failed to predict risk with the exception of exposure to loss of voluntary leg mobility (OR = 1.11 per person-shifts of exposure, 95% CI [0.97-1.27]), with the highest risk on the day shift (OR = 1.15, 95% CI [0.95-1.40]). CONCLUSIONS: These findings suggest social integration and work organization issues may be more important predictors of back and shoulder injuries in nursing assistants than reported resident characteristics as measured by the MDS.
This study investigated the short-term effects of a workshop for 22 immediate supervisors designed to reduce musculoskeletal pain injuries. One group of supervisors received training on how to deal with musculoskeletal injuries, while the control group of 14 received no training. 36 male immediate supervisors and 171 male employees within the Swedish railroad system completed questionnaires before and after the intervention. The trained supervisors' ratings showed that they enjoyed the workshop and believed that it improved their skills. Moreover, trained supervisors significantly more often than the controls showed target behaviors and attitudes compatible with course content. Finally, employees of the trained supervisors reported significantly more often than the control group that their supervisor used target behaviors. It is concluded that an educational program for immediate supervisors is viable and may lead to changes in attitude and behavior. Teaching supervisors to work with employees is a rich field for future investigation; the long-term effects of such programs need to be studied.
The exponential increase in occupational low back pain disability is a problem that is not being addressed adequately in clinical practice. The notion of achieving primary control through ergonomic intervention, based on biomechanics principles, has so far been unhelpful. The traditional secondary prevention strategies of rest and return to restricted work duties are seemingly suboptimal. Biomechanics/ergonomic considerations may be related to the first onset of low back pain, but there is little evidence that secondary control based solely on these principles will influence the risk of recurrence or progression to chronic disability. More promising in this respect are programs that take account of the psychosocial influences surrounding disability. Work organizational issues are clearly important, but so also is the behavior of clinicians. The balance of the available evidence suggests that clinicians generally should adopt a proactive approach to rehabilitation by recommending, whenever possible, early return to normal rather than restricted duties as well as complementary psychosocial advice if the issue of chronic disability is to be successfully tackled.
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