Early Prevention of Non-specific Neck, Shoulder and Back Disorders in Home-care Personnel. Assessments, Predictors of Sick Leave and Intervention

Abstract: The overall aim of this thesis was to gain further knowledge of the assessments, predictors of future sick leave and intervention with regard to early prevention of neck, shoulder and back disorders in nursing aides/assistant nurses working in the home-care service. In Paper I, 15 clinical tests on impairment level related to the low back, were examined for intra- and inter-rater reliability on 18 and 44 subjects, respectively (Step 1). Intra-rater reliability was acceptable for 14 of the 15 tests (kappa>0.40). Eight of the tests in Step 1, indicating a non-acceptable reliability, were further standardised and retested for inter-rater reliability on 22 subjects (Step 2). This further standardisation procedure resulted in an acceptable inter-rater reliability for all these tests. In order to improve reliability, it is suggested that when tests are performed by different raters, test procedures and magnitude of force and the applied area of the palpation fingers in pain palpation tests, should be checked regularly and compared with co-raters. In Paper II, six physical performance tests on the impairment level and two tests on the activity level were examined for inter-rater reliability and between-days repeatability. Twenty-two subjects were tested twice with, on average, a five day interval. Seventeen of these were tested again, after, on average, 16 days. The inter-rater reliability was high for all tests. Only one of the tests on activity level was considered to reach acceptable between-days repeatability. In Paper III, the effects of two different, early prevention programmes on: (i) reported neck, shoulder and back pain, (ii) perceived physical exertion at work and perceived psychosocial work-related factors, were evaluated by questionnaires after 12 and 18 months. Subjects (n = 282) were randomly assigned to one of three groups (i) for individually designed physical training programmes (IT), (ii) for work-place stress management (SM) and (iii) for the control group. Results revealed no significant differences between the three groups. However, improvements in low back pain were registered within both intervention groups. Perceived physical exertion at work was reduced within the SM-and the IT groups, but more so within the IT group. Dissatisfaction with work-related, psychosocial factors generally increased within the SM group. As risk factors related with neck, shoulder and back disorders are multifactorial, a combination of the content of the intervention programmes may be advantageous. In Paper IV, predictors of future sick leave were analysed. The study included two groups. In Study group 1, comprising 443 subjects, only factors related to health were associated with future sick leave due to any cause. In Study group II, comprising 274 subjects, factors related to health, work as well as leisure time were associated with future sick leave due to neck, shoulder and back disorders, underscoring the multifactorial background of these disorders which should be noted when customising programmes for the early prevention of sick leave due to neck, shoulder and back disorders among nursing aides/assistant nurses.