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Commentary: Interventions to Reduce Back Pain in Rehabilitation Hospital Nursing Staff
Rehabilitation Nursing Editorial Board Member
Nurses, particularly rehabilitation nurses, are at considerable risk for on-the-job back injuries and resulting back pain. The article by Menzel, Lilley, and Robinson presents the results of a pilot study to test the effects of two different programs to reduce back pain of rehabilitation hospital nurses.
The researchers tested ergonomic intervention and cognitive-behavioral therapy (CBT). In choosing these, the researchers looked at past research of programs that teach body mechanics and use patient-handling equipment. They found that addressing body mechanics alone was not successful, but using patient-handling equipment reduced back injuries, compensation costs, and lost time away from the job. A program providing patient-handling equipment and training (ergonomics) was selected as the basic intervention (control group).
However, the researchers were not content to test a single “good enough” intervention. They further researched risk factors for back pain and successful prevention programs, finding that the most successful programs included elements addressing workplace stress and psychological factors. Using a value-added approach, a comprehensive intervention including CBT (a psychological treatment shown to have a strong preventive effect on low-back pain disability) was added to the ergonomics intervention to create a better intervention.
The study described in this article is a pilot study—a small-scale trial to test study procedures and instruments that is conducted before implementing a full-scale clinical trial. Pilot studies are especially important in complex intervention studies that use a repeated measures design, where several measures are obtained over the course of the study (McGuire & Yeager, 1999). Goals of a pilot study depend on what the researchers need to learn but may include testing procedures, tools, interventions, and protocols; measuring the potential effect of an intervention; and working out study personnel roles, data collection methods, and timelines. Pilot studies do not determine whether a given program actually works or is successful, but they do provide important information about whether the program should be studied further.
The purpose of this pilot study was to determine whether the CBT program was feasible and how much effect CBT and ergonomics, singly and combined, might have on back pain, disability, stress, pain-coping skills, and mood. As is typical in pilot studies, the interventions were tested in a small sample (31 people). Feasibility of the CBT intervention was supported by a high rate of attendance and completion of the sessions, as well as by positive comments from participants.
CBT was most effective for reducing disability in self-care and life-support activities and fairly effective for reducing disability in social activities. Both ergonomics and CBT improved measures of back pain intensity and unpleasantness. However, the combined intervention did not improve outcomes over either intervention alone. Such findings are typical for pilot studies because of the small sample sizes used. Readers should be cautioned against applying these findings to their own practice settings without careful thought.
This study adds to past research supporting patient-handling equipment and training as likely to improve back pain outcomes and applies them to a rehabilitation setting. It also suggests that more comprehensive programs might be more helpful. The authors offer their vision for future research in this area and are more fully prepared to carry it out because of the knowledge and experience gained by this study.
McGuire, D. B. & Yeager, K. A. (1999). Implementing the study. In M. A. Mateo & K.T. Kirchhoff (Eds.), Using and conducting nursing research in the clinical setting, second edition (pp. 300–315). Philadelphia: WB Saunders.