Work-related back pain in nurses

This summary draws together the findings form over 80 studies published over three decades. The studies reviewed are categorized into three groups: (a) epidemiological; (b) 'testing out'; and (c) exploratory. There has been agreement on a number of points, in particular that nursing is among the high risk occupations with respect to low back problems, with a point prevalence of approximately 17%, an annual (period) prevalence of 40-50% and a lifetime prevalence of 35-80%. When considering the contributory factors there is some divergence, but one of the popular notions is generally proven, that more frequent patient handling appears to correlate with increased incidence of low back pain. However, the traditional approach of training in lifting and handling techniques alone has been shown to be of little, or no, long-term benefit and the value of ergonomics remains to be seen. Much work has also been done by taking aspects of nursing work into the laboratory, using experimental studies which have mostly focused on specific sub-tasks (of the generic task of patient handling), looking at specific transfers and procedures (e.g. bed to chair) or transfer techniques ('stoop versus squat'). Although a level of quantification can be made about the different techniques, it is questionable whether this is of any practical use, especially when considering the wide variation of loads encountered during manual handling of patients. The limitations of using quantitative methodologies is revealed in the very small number of exploratory studies. All of the studies cited in this review used methodologies based in the positivist paradigm. There does not appear to be any published work using participative or interview methods to obtain qualitative data which might identify contributory factors in the onset of occupational low back pain in nursing staff.