A multifaceted workplace intervention for low back pain in nurses' aides: a pragmatic stepped wedge cluster randomised controlled trial

Abstract

This study established the effectiveness of a workplace multifaceted intervention consisting of participatory ergonomics, physical training, and cognitive-behavioural training (CBT) for low back pain (LBP). Between November 2012 and May 2014, we conducted a pragmatic stepped wedge cluster randomised controlled trial with 594 workers from eldercare workplaces (nursing homes and home care) randomised to 4 successive time periods, 3 months apart. The intervention lasted 12 weeks and consisted of 19 sessions in total (physical training [12 sessions], CBT [2 sessions], and participatory ergonomics [5 sessions]). Low back pain was the outcome and was measured as days, intensity (worst pain on a 0-10 numeric rank scale), and bothersomeness (days) by monthly text messages. Linear mixed models were used to estimate the intervention effect. Analyses were performed according to intention to treat, including all eligible randomised participants, and were adjusted for baseline values of the outcome. The linear mixed models yielded significant effects on LBP days of -0.8 (95% confidence interval [CI], -1.19 to -0.38), LBP intensity of -0.4 (95% CI, -0.60 to -0.26), and bothersomeness days of -0.5 (95% CI, -0.85 to -0.13) after the intervention compared with the control group. This study shows that a multifaceted intervention consisting of participatory ergonomics, physical training, and CBT can reduce LBP among workers in eldercare. Thus, multifaceted interventions may be relevant for improving LBP in a working population.

Figure 1

Overview of the 12 weeks of intervention. The intervention lasted 12 weeks and consisted of 19 sessions (participatory ergonomics [5 sessions], CBT [2 sessions], and physical training [12 sessions]) corresponding to 27 hours (participatory ergonomics [9 hours], CBT [6 hours], and physical training [12 hours]). For support of the intervention implementation, the supervisors of the participating teams were invited to 3 knowledge sharing meetings of 1-hour duration while their team were in the intervention, and steering group meetings were held frequently throughout the study period (with 5 meetings during the intervention). Moreover, letters about the process and role expectations were sent to the ambassadors, supervisors, work environment consultants, and managers, and posters with information about the intervention were supplied throughout the intervention period. CBT, cognitive–behavioural training.

Figure 2

Trial profile. After assessing the payroll (n = 1699) for eligible participants, we excluded 625 who were not eligible (not belonging to the target job groups [ie, nurses' aides, kitchen and cleaning personnel, or janitors], no longer employed, long-term sick-listed, or not being permanently employed). Of the 1074 eligible employees, 594 were randomised in 4 groups in accordance with the stepped wedge design. Each of the 4 groups beginning the intervention at 4 time points 3 months apart consisted of 4 to 5 clusters and 12 to 15 working teams. The study comprised 4 steps, each lasting 3 months. Within each step, information about dropouts is given. The most frequent reason for dropping out of the study was no longer being employed (53 participants, 37%). Other reasons were due to time of the intervention activities interfering with their work tasks (31 participants, 22%), withdrawal of consent to participate (29 participants, 20%), sickness absence or leave (20 participants, 14%), and private reasons (10 participants, 7%). In the end, 586 participants were included in the analyses because 8 were never included in the text message system.