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Prospective cohort study of predictors of incident low back pain in nurses

Abstract Objective: To assess the impact of handling patients and indicators of individual susceptibility on risk of low back pain in nurses. Design: Prospective cohort study with follow up by repeated self administered questionnaires every three months over two years. Setting: NHS university hospitals trust. Subjects: 961 female nurses who had been free from low back pain for at least one month at the time of completing a baseline questionnaire. Main outcome measures: Incidence of new low back pain during follow up and of pain leading to absence from work. Results: Of 838 women who provided data suitable for analysis, 322 (38%) developed low back pain during follow up (mean 18.6 months), including 93 (11%) whose pain led to absence from work. The strongest predictor of new low back pain was earlier history of the symptom, and risk was particularly high if previous pain had lasted for over a month in total and had occurred within the 12 months before entry to the study (incidence during follow up 66%). Frequent low mood at baseline was strongly associated with subsequent absence from work for back pain (odds ratio 3.4; 95% confidence interval 1.4 to 8.2). After adjustment for earlier history of back pain and other potential confounders, risk was higher in nurses who reported frequent manual transfer of patients between bed and chair, manual repositioning of patients on the bed, and lifting patients in or out of the bath with a hoist. Conclusions: Of the indicators of individual susceptibility that were examined, only history of back trouble was sufficiently predictive to justify selective exclusion of some applicants for nursing posts. The main route to prevention of back disorders among nurses is likely to lie in improved ergonomics. Key messages A history of back trouble, particularly if recent and prolonged, is highly predictive of new episodes of back pain There are grounds for excluding nurses with recent and prolonged back pain from the most physically demanding jobs Age, height, and weight are not sufficiently discriminatory for risk of back pain to influence selection and appointment of nurses Back pain is more common in nurses who lift and move patients frequently without the use of mechanical aids Controlled trials are needed to assess the benefits of ergonomic intervention aimed at prevention of back pain in nurses