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

Horneij, Eva LU (2004)
Abstract (Swedish)
Popular Abstract in Swedish

Sjukskrivning, huvudsakligen relaterad till muskuloskelettala besvär, har ökat i Sverige, framförallt bland kvinnor. Prevalensen besvär i nacke, skuldra och rygg är högre för sjukvårdsbiträden/undersköterskor i jämförelse med anställda inom andra yrken. Det övergripande syftet med föreliggande avhandling var att få ökade kunskaper om mätmetoder, riskfaktorer för framtida sjukskrivning samt om interventionsprogram med syfte att förebygga besvär i nacke, skuldra och rygg hos kvinnor som arbetar inom hemtjänsten. Avhandlingen baseras på fyra studier. I samtliga studier har studiepopulationen utgjorts av vårdbiträden/undersköterskor som arbetar inom hemtjänsten.



I Studie I... (More)
Popular Abstract in Swedish

Sjukskrivning, huvudsakligen relaterad till muskuloskelettala besvär, har ökat i Sverige, framförallt bland kvinnor. Prevalensen besvär i nacke, skuldra och rygg är högre för sjukvårdsbiträden/undersköterskor i jämförelse med anställda inom andra yrken. Det övergripande syftet med föreliggande avhandling var att få ökade kunskaper om mätmetoder, riskfaktorer för framtida sjukskrivning samt om interventionsprogram med syfte att förebygga besvär i nacke, skuldra och rygg hos kvinnor som arbetar inom hemtjänsten. Avhandlingen baseras på fyra studier. I samtliga studier har studiepopulationen utgjorts av vårdbiträden/undersköterskor som arbetar inom hemtjänsten.



I Studie I utvärderades 15 kliniska tester för mätning av funktionsnedsättning eller strukturavvikelse, med avseende på intra-och interbedömarreliabilitet på 18 respektive 44 personer (Steg 1). Intra-bedömarreliabilitet var acceptabel (kappa >0.40) för 14 av de 15 testerna. Åtta av testerna i Steg 1, med oacceptabel reliabilitet standardiserades ytterligare och utvärderades igen med avseende på interbedömarreliabilitet på 22 personer (Steg 2). Denna ytterligare standardisering medförde att interbedömarreliabiliteten för samtliga av dessa tester blev acceptabel.



I Studie II utvärderades muskelfunktionstester. Sex tester som mäter funktionsnedsättning eller strukturavvikelse och två tester som mäter aktivitetsnivå analyserades med avseende på interbedömarreliabilitet samt samstämmighet vid upprepade mätningar. Tjugotvå personer testades vid två tillfällen med, i snitt, ca fem dagars mellanrum. Sjutton av personerna testades vid ytterligare ett tillfälle efter, i snitt, ca 16 dagar. Interbedömarreliabiliteten var hög för samtliga tester. Endast en av testerna ansågs uppnå acceptabel samstämmighet mellan upprepade mätningar.



I Studie III studerades effekten av två olika program för tidig prevention avseende (i) rapporterade besvär i nacke, skuldra och rygg (ii) upplevd fysisk ansträngning i arbetet och upplevda psykosociala arbetsplatsfaktorer, medelst frågeformulär efter 12 och 18 månader. Deltagarna (n = 282) randomiserades till en av tre grupper: (i) Individuellt utformat träningsprogram (IT) (ii) Stresshanteringsprogram inom arbetsgruppen (SM) (iii) Kontrollgrupp. Resultaten visade inte några signifikanta skillnader mellan grupperna. Avseende ländryggsbesvär registrerades emellertid förbättringar inom båda interventionsgrupperna. Upplevd fysisk ansträngning i arbetet minskade inom SM-och IT grupperna, men framförallt inom IT-gruppen. Missnöje med arbetsrelaterade psykosociala faktorer ökade generellt inom SM gruppen.



I Studie IV analyserades prediktorer för framtida sjukskrivning, oberoende av orsak (Studiegrupp 1) samt på grund av besvär i nacke, skuldra och/eller rygg (Studiegrupp 2). I Studiegrupp 1 ingick 443 personer som inte var sjukskrivna när de fyllde i det första frågeformuläret. I Studiegrupp 2 ingick 274 personer, som inte var sjukskrivna när de fyllde i det första frågeformuläret och som inte varit sjukskrivna på grund av besvär i nacke, skuldra och/eller rygg under de senaste 12 månaderna dessförinnan. Resultaten av studien visade att enbart faktorer relaterade till hälsa predicerade framtida sjukskrivning oberoende av orsak medan faktorer relaterade till hälsa, arbete såväl som fritid predicerade sjukskrivning på grund av besvär i nacke, skuldra och/eller rygg.



Sammanfattningsvis pekar resultaten i denna avhandling mot att



• kliniska tester som utförs på en population som är i arbete bör företrädesvis utföras av samma bedömare. Om testerna utförs av olika bedömare föreslås att såväl testprocedur såsom storlek på den applicerade kraften samt ytan på palpations finger (fingrar) vid smärtpalpationstester, kontrolleras regelbundet och jämförs med medbedömare i syfte att förbättra interbedömarreliabilitet.



• Interbedömarreliabiliteten för samtliga muskelfunktionstester var hög. Samstämmigheten mellan upprepade mätningar ansågs acceptabel för endast en av testerna, nämligen det cervikala lyfttestet (PILE).



• Ingen entydig effekt av vare sig IT-eller SM programmet på besvär i nacke, skuldra eller rygg kunde påvisas. Eftersom dessa besvär är multifaktoriella, kan en kombination av innehållet i de två programmen ha varit att föredra.



• Enbart faktorer relaterade till hälsa predicerade sjukskrivning oberoende av orsak. Framtida sjukskrivning på grund av besvär i nacke, skuldra och/eller rygg predicerades av faktorer relaterad till hälsa, arbete samt till fritid vilket belyser det multifaktoriella sambandet mellan besvär i nacke, skuldra och rygg och sjukskrivning. Detta bör beaktas vid genomförande av interventionsprogram med syfte att förebygga sjukskrivning på grund av nacke, skuldra och rygg hos vårdbiträden och undersköterskor som arbetar inom äldreomsorgen. (Less)
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... (More)
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. (Less)
Please use this url to cite or link to this publication:
author
opponent
  • Professor Öberg, Birgitta, Linköping university, Linköping
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Physical medicine, risk, prospective, working population, stress management, physical training, physical performance, clinical tests, nursing, repeatability, reliability, kinesitherapy, revalidation, rehabilitation, Rehabilitering (medicinsk och social)
pages
128 pages
publisher
Eva Horneij, Department of Physical Therapy, Lasarettsgatan 7, 221 85 Lund, Sweden,
defense location
Auditoriet, Kulturen, Lund
defense date
2004-11-18 10:15
ISBN
91-628-6268-5
language
English
LU publication?
yes
id
da05f6b0-4e68-45b6-b670-5adfb860427e (old id 467419)
date added to LUP
2007-09-07 13:53:01
date last changed
2016-09-19 08:45:04
@phdthesis{da05f6b0-4e68-45b6-b670-5adfb860427e,
  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.<br/><br>
<br/><br>
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&gt;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.<br/><br>
<br/><br>
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.<br/><br>
<br/><br>
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.<br/><br>
<br/><br>
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.},
  author       = {Horneij, Eva},
  isbn         = {91-628-6268-5},
  keyword      = {Physical medicine,risk,prospective,working population,stress management,physical training,physical performance,clinical tests,nursing,repeatability,reliability,kinesitherapy,revalidation,rehabilitation,Rehabilitering (medicinsk och social)},
  language     = {eng},
  pages        = {128},
  publisher    = {Eva Horneij, Department of Physical Therapy, Lasarettsgatan 7, 221 85 Lund, Sweden,},
  school       = {Lund University},
  title        = {Early Prevention of Non-specific Neck, Shoulder and Back Disorders in Home-care Personnel. Assessments, Predictors of Sick Leave and Intervention.},
  year         = {2004},
}