Prevention of Chronic Low Back Pain in Female Nurses
Condition: Low Back Pain
MeSH terms: Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      NURSE-RCT is a randomized controlled trial which aims at prevention of evolution of chronic
      low back pain (LBP) and related disability in female nurses.

      The study investigates the effectiveness and financial feasibility of six months
      neuromuscular training and counselling, and their combination on LBP, movement dysfunction
      and fear-avoidance behaviour.

      The target for neuromuscular training is to reduce movement dysfunction and motor control
      impairments, caused by trauma and subfailure injuries of spinal ligaments. Training aims at
      enhancement of motor control of lumbar neutral zone in different positions and movements,
      balance, coordination, trunk muscle endurance and leg strength.

      The target for counselling is change in attitudes and behaviour, which help to reduce the
      fear of pain and encourage to physical activity and other physical tasks.

      The hypothesis is that together neuromuscular exercise and counselling have a stronger
      influence on LBP, movement dysfunction and fear-avoidance behaviour than either used alone.

      Assessments of effectiveness will be conducted after six, 12, and 24 months of the beginning
      of interventions.
    

Detailed description: 
      Musculoskeletal disorders are the main reason for work absenteeism and early retirement of
      nursing stuff, low back pain (LBP) being the leading cause. When compared to other communal
      staff in Finland, disability pensions are granted earlier to nursing stuff, the average age
      being 56 years. NURSE-RCT is a multidisciplinary study combining the most recent
      biomechanical and behavioral theories aimed to prevent evolution of chronic LBP.

      NURSE-study is a randomized controlled trial aiming at prevention of chronic LBP and related
      functional disability. Volunteers, female nurses (n~1200) from wards with bed patients of two
      geriatric hospitals and the university central hospital in Tampere, Finland will be invited
      to participate in the study. Each participant (n=160) will be randomized into one of the four
      study groups after the eligibility has been determined. A method of sequentially numbered
      sealed envelopes will be used to assign participants into study groups.

      The main target for exercise intervention is to restore impairments in movement control.
      First, the participants need to learn the proper technique of each exercise, second to
      achieve movement control of lumbar neutral zone in each exercise, and finally to increase the
      challenge of exercises for balance, coordination, muscular endurance and strength. Target
      dose for exercise is twice a week, 60 minutes per session for six months.

      The objective of counseling is to change participants' understanding of LBP towards less
      fearful and negative beliefs, and to provide encouragement for usual daily activities,
      including physical activity. Advice on nursing tasks that are strenuous for low back is aimed
      to improve awareness of injury risk and provide examples of proper postures and movements.
      Target dose for counseling is 10 sessions lasting for 45 minutes. Interventions will take
      place in facilities close to participants' work sites.

      The financial feasibility of the effects of the interventions is calculated by using the
      Potential Model,[www.miljodata.se],which was created to calculate the financial feasibility
      of work health related measures. It differs from typical health economic cost-benefit
      analyses in the sense that it is aimed at simulating the economic consequences of an
      investment from a business point of view. In addition to the immediate real losses and
      sickness absences, the indirect financial consequences like effects on over time work are
      taken into account.

      The rational of this study is to discover whether neuromuscular exercise and cognitive
      behavioral counseling are effective and economically feasible in reducing LBP and its'
      recurrence, and thus preventing chronic LBP, early retirement and disability pensions.
    

Intervention name(s): Exercise; Counseling; Exercise and counseling; Control group
Intervention type(s): Behavioral; Behavioral; Behavioral; Other
Intervention description(s): The main target for exercise intervention is to restore impairments in movement control. First, the participants need to learn the proper technique of each exercise, second to achieve movement control of lumbar neutral zone in each exercise, and finally to increase the challenge of exercises for balance, coordination, muscular endurance and strength. Target dose for exercise is twice a week, 60 minutes per session for six months.
The neuromuscular exercise program is progressive including three different performance levels. During the first eight weeks, the supervised exercise sessions will take place twice a week. The next 16 weeks the participants have one instructed weekly session, and they exercise once a week at home with help of a DVD or booklet produced for the study; Counseling is conducted according cognitive-behavioral principles. Fear-avoidance model is implemented using problem based learning. The objective is to change participants' understanding of LBP towards less fearful and negative beliefs, and to provide encouragement for usual daily activities, including physical activity. Advice on nursing tasks that are strenuous for low back is aimed to improve awareness of injury risk and provide examples of proper postures and movements. The target is that participants in counseling groups attend 10 sessions each lasting 45 minutes. During the first four weeks the groups meet every second week, and after that once a month up to six months. Participants will receive workbooks to enhance problem-based learning.; Participants take part in both exercise and counseling as described in the separate interventions.; Participants in the control group take part only in measurements of NURSE-RCT.
Other intervention name(s): Neuromuscular exercise; Control of lumbar neutral zone; Physical fitness; Behavioral counseling; Fear avoidance beliefs; Physical activity promotion; Neuromuscular exercise; Control of lumbar neutral zone; Physical fitness; Behavioral counseling; Fear avoidance beliefs; Physical activity promotion; No intervention
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: exercise; counseling; movement control; fear avoidance