Low back pain in physical therapists: a cultural approach to analysis and intervention

Low back pain is one of the most prevalent work related injuries in the physical therapy profession. New graduates and therapists working in rehabilitation and acute care hospitals are at the highest risk for developing low back pain [9]. Although physical therapists are trained in maintaining proper body mechanics and preventing work related injuries, between 30% and 63% of therapists will experience low back pain at some point in their careers [2,4,9]. The culture of physical therapy is one of the primary factors contributing to this problem, with many therapists reporting that their decision to use back pain preventive strategies depends on their colleagues' use of these strategies. The authors will use Green and Kreuter's PRECEDE-PROCEED model to identify behavioral, environmental, educational and ecological factors contributing to the problem; then will propose a health promotion intervention using the social action theory at the community level to decrease work-related low back pain in physical therapists while simultaneously addressing the culture of physical therapy.     

A multimedia case based approach to the study of office ergonomics

Multimedia technology has the capacity to provide students with an interactive approach to problem based learning and to bridge the gap between theoretical knowledge and clinical practice. The present paper describes the design and development of the program ErgoROM, a CD which presents a case study to assist occupational therapy students in their studies of office ergonomics. A pilot study showed that overall, 91% of respondents rated the ErgoROM as either "Excellent" or "Very Good". Additionally they reported that ErgoROM had a positive impact on active learning and critical thinking.     

Immune responses to low back pain risk factors

$\underline{Objective}$: Investigate effects of interactions between biomechanical, psychosocial and individual risk factors on the body's immune inflammatory responses. $\underline{Background}$: Current theories for low back pain causation do not fully account for the body's response to tissue loading and tissue trauma. $\underline{Methods}$: Two groups possessing a preference for the sensor or intuitor personality trait performed repetitive lifting combined with high or low mental workload on separate occasions. Spinal loading was assessed using an EMG-assisted subject-specific biomechanical model and immune markers were collected before and after exposure. $\underline{Results}$: Mental workload was associated with a small decrease in AP shear. Both conditions were characterized by a regulated time-dependent immune response making use of markers of inflammation, tissue trauma and muscle damage. Intuitors' creatine kinase levels were increased following low mental workload compared to that observed in Sensors with the opposite trend occurring for high mental workload. $\underline{Conclusions}$: A temporally regulated immune response to lifting combined with mental workload exists. This response is influenced by personality and mental workload.     

Return to work with chronic low back pain: using an evidence-based approach along with the occupational therapy framework

This paper will attempt to apply the occupational therapy framework [1] along with an evidence-based approach and an occupation-based intervention with a population of workers with chronic low back pain (CLBP) to help them return to work and maintain their work status. This paper will focus primarily on those clients with CLBP who still have a link to their employment but who do not perceive themselves as being capable to go back to their job despite conflicting opinions from other stakeholders (primary health care professionals, employer or insurer). They are being evaluated in occupational therapy shortly before return to work and followed until their optimal functional capacities are reached. This means that either all functional goals related to the actual physical demands of their job have been reached or that further treatment does not result in functional improvement.     

Work-related factors contributing to chronic disability in low back pain

Low back pain is a costly and incapacitating musculoskeletal disorder. Prospective studies documenting the capacity of work-related factors to predict chronicity are few in number, the methodology used is very diversified, and the results obtained diverge. The aim of the present study is to investigate the capacity of work-related objective (non-psychosocial) and psychosocial factors to predict chronic disability related to low back pain. A longitudinal prospective study with two measurement times was carried out. The sample (N = 258) consisted of workers with subacute low back pain who were on sick leave and receiving compensation from the CSST (Quebec Workers' Compensation Board). Of all the work-related variables measured, perceived stress and fears and beliefs about work were associated with return to work status at the six-month follow-up. The results obtained show the importance of considering fears and beliefs about work when identifying people in the subacute phase of low back pain who are at risk of developing chronic disability.     

Establishing self and meaning in low back pain narratives

Pain narratives encounter the problem of verbalising private and internalised experiences. Words appear to fall short of giving meaning to the feelings and impact of pain. In this paper we report on how people describe their low back pain and the way in which they claim to present this to clinicians. In the research interviews they need to establish themselves as believable narrators and provide accounts of how they legitimise their pain in clinical encounters. As a result, the interviews provide complex and layered narratives of pain and its representation.     

The effectiveness of back pain and injury prevention programs in the workplace

Musculoskeletal disorders in the workplace cause thousands of injuries and cost industry billions of dollars yearly. Work injury prevention programs have been developed and implemented as a means for cost containment. A variety of preventive strategies have been investigated in primary research. The purpose of this review article is to examine the effectiveness of back injury and pain prevention programs in the workplace. Nine studies published between 1995 and 2000 were reviewed and analyzed. Studies used primarily one of three types of preventive strategies: 1) back belts, 2) education and task modification, and 3) education and task modification with workstation redesign. The effectiveness of back belts to prevent back pain and injury remains inconclusive. Positive outcomes were associated with studies reporting high compliance that used job-specific and individualized/small group education and training approaches. Themes that arose following a critical review of primary research studies are discussed.     

An office chair to influence the sitting behavior of office workers

Since the introduction of ergonomic guidelines in the design of office chairs, a lot of effort has been put in designing these office chairs accordingly. Because these features all have to be adjusted in different ways (mostly a knob underneath the seat surface), and because every office chair offers different solutions, often users do not use all of the adjustments, and thus do not use the office chair an the optimal ergonomic way. The aim of this paper is to study the influence of feedback on sitting habits of office workers in a field test during 4 weeks. 40 office workers were selected for this test (13 male, 27 female). They were divided in three groups. A control group, a group that received a sitting instruction and a group that received sitting instruction and feedback on their posture every hour that they sit. The results show that there is an effect in average increase in basic posture on both the group that received instruction and the group that received feedback. This effect decreases over time. There was no effect in the control group.     

Factors contributing to work related low back pain among personal care workers in old age

This study aims to preliminary explore the work related and individual factors that contributed to the occurrence of low back pain (LBP) that affected work activities of Personal Care Workers (PCWs). A cross-sectional study was conducted to 36 PCWs in an old age home of Hong Kong. The study is divided into three parts: 1) a questionnaire to document the workload exposure factors and the musculoskeletal symptoms survey of the PCWs, 2) work posture evaluation; and 3) an evaluation of the physical fitness and lifting capacity of the PCWs. Univariate analyses were used to explore the risk factors associated with LBP that affected work activities. The results indicated that individual physical profile and lifting capacities did not contribute to occurrence of low back pain at work. For the work demand factors, the perceived physical demands in lifting and lowering heavy objects, awkward sustain neck and back postures, loading on the back, and perceived effort of cleaning task contributed to the occurrence of LBP. For the physical environment factors, thermal stress and improper ventilation were associated with the occurrence of LBP cases. For the individual factor, LBP cases were associated with workers' self perceived muscular effort, and perceived risk of mental illness in response to work requirements.     

Effect of frequent WBC treatments on the back pain therapy in elderly men

Abstract

Cryotherapy is the application of a stimulus of a cryotherapeutic temperature below ?100?°C in a period of 1–3?min in order to stimulate and use physiological reactions of human body to cold. It can be applied to specific body parts or to a whole body. Whole-body cryotherapy is a treatment method applied in treatment of motor organ issues, nervous system diseases, psychiatry, dermatology and laryngology. The research group consisted of 80 male in the age range of 65–77 suffering from chronic, lasting more than 3 months, lower back pain. The subjects qualified to the research were divided into two groups. Group A consisted of 40 patients who participated in whole-body cryotherapy (WBC) twice a week. Group B also contained 40 patients who participated in WBC whole week. Examinations were conducted twice. The first one was conducted before the commencement of the treatment while the second one after the therapy was over. The results of the research did not show any statistically significant improvement in patients from Group A. However, the results obtained by Group B have proven significant condition improvement and enable the researchers to conclude that WBC is effective in treating patients with lower back pain.     

Proper manual handling techniques to prevent low back pain, a Cochrane systematic review

Training and provision of assistive devices are considered major interventions to prevent and treat low back pain (LBP) among workers exposed to manual material handling (MMH). To establish the effectiveness of training and provision of assistive devices in preventing and treating LBP an update of a Cochrane literature review was performed to November 2010. Randomised controlled trials (RCTs) and cohort studies with a concurrent control group (CCTs) were included. Nine RCTs (20.101 employees) and nine CCTs (1280 employees) were included for prevention: six more than in the previous version. No study on treatment was found. None of the included RCTs and CCTs provided evidence that training and provision of assistive devices prevented LBP when compared to no intervention or another intervention.     

The economic evaluation of a Participatory Ergonomics programme to prevent low back and neck pain

This study was an economic evaluation conducted alongside a cluster randomised controlled trial with a follow-up of 12 months. The aim was to evaluate the cost-effectiveness and cost-benefit of the Stay@Work Participatory Ergonomics programme (PE) compared to a control group (no PE). In total, 37 departments (n=3047 workers) were randomised into either the intervention (PE) or control group (no PE). During a meeting, working groups followed the steps of PE, and composed and prioritized ergonomic measures aimed to prevent low back pain (LBP) and neck pain (NP). Working groups had to implement the ergonomic measures within three months in their department. Cost data included those directly related to LBP and NP. Cost-effectiveness analyses (CEA) and cost-benefit analyses (CBA) were performed. After 12 months, health care costs and costs of productivity losses were higher in the intervention group than in the control group (the mean total cost difference was $/euro$127; 95% CI $/euro$-164 - $/euro$418). From a societal perspective, the CEA showed that PE was not cost-effective compared to control for LBP and NP prevalence, work performance, and sick leave. The CBA from a company perspective showed a monetary loss of $/euro$78 per worker. The PE programme was neither cost-effective nor cost-beneficial on any of the effect measures.     

From the employment office to the social welfare office: Social assistance recipiency among first-time unemployed in Sweden

Social assistance receipt among first-time unemployed in Sweden is investigated by analysing data files obtained by merging register data from the city of Goteborg. First-time unemployed males were observed during 1993 and 1994 and were followed in the register of social assistance recipients for 18 months after the debut. Many of the newly unemployed had no access to unemployment compensation. Slightly more than one out of five newly unemployed became social assistance recipients. Lengthy periods of unemployment combined with no access to unemployment compensation signify a high risk of becoming a social assistance recipient. This risk varies a great deal with age, citizenship, human capital and job search activity of the unemployed.     

Bring publics back into networked public relations research: A dual-projection approach for network ecology

This essay critiques the absence of publics in networked public relations research, and proposes the dual-projection approach as a solution to simplify and analyze the multi-mode public relations network ecology (Yang & Taylor, 2015). Compared to most previous studies that employ organization-centric networks where ties stand for hyperlinks, collaborations, or coalitions, the new approach projects organization-public relationships and public-public relationships onto interorganizational ties. By doing so, it (1) brings publics back into networked public relations research; (2) presents organizations and publics—the two most important subjects of public relations research—equally in the same network, (3) drives literature further away from a dyadic view of relationship management, and (4) constitutes one of the first techniques that can analyze direct and timely consequences of organziation-public relationships in the network ecology. To demonstrate the new approach, the network of publics overlap is introduced and applied to US-based LGBTQ advocacy groups. The essay also discusses the theoretical inquiries needed to further dual-projection networks, and invites scholars to create novel ways to incorporate publics into their network studies using dual projection.     

A Kleinian approach to psychotherapy

This paper explores how certain key ideas of Melanie Klein regarding transference, separation, the significance of internal phantasy, the phenomenon of splitting internal objects, and experiences of greed, envy, and gratitude relate to the practice of psychotherapy. Problems of differentiating between persecutory and depressive anxieties as well as the defenses against specific anxieties, based on Klein's notion of the infantile roots of anxiety tied to loss, are discussed. The importance of attending to negative transference phenomena is elucidated. Implications of Kleinian theory for clinical social work practice and extended possibilities of work with asocial borderline and psychotic states are explored. How the therapist functions as a model of the biological mother is illustrated by case material of a borderline individual.     

The etiology of low back pain in military helicopter aviators: prevention and treatment

Low back pain (LPB) is a major health problem among military rotary-wing aircrews worldwide. In order to define the etiology and propose remedies to LBP in helicopter aviators a review and critique of the literature was conducted. In-flight sitting posture and vibration generated by the aircraft were identified as high risk factors for LBP. Consequently, researchers recommended ergonomic modifications to the crew stations. The efficacy of these technical interventions has not been proven. As well, these design changes are not financially practical. Following an in depth kinesiological analysis of the physical demands of this type of flying, and preliminary experimentation, an alternative aeromedical approach focusing on the aircrew rather than the craft is presented. The authors propose a set of flight-specific exercises that might effectively deal with this problem. A thorough testing of this approach is envisioned.