Mechanisms for reducing low back pain: a mediation analysis of a multifaceted intervention in workers in elderly care

Matthew L. Stevens*, Eleanor Boyle, Jan Hartvigsen, Gemma Mansell, Karen Søgaard, Marie B. Jørgensen, Andreas Holtermann, Charlotte D.N. Rasmussen

*Corresponding author for this work

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Abstract

Purpose: A multifaceted workplace intervention consisting of participatory ergonomics, physical training, and cognitive–behavioural training (CBT) has shown effectiveness for reducing low back pain (LBP). However, the mechanisms of action underlying these intervention components are not well understood. Methods: This was a mediation analysis of a cluster-randomised controlled trial of a multifaceted intervention in 420 workers in elderly care. Mediation analysis was carried out via structural equation modelling. Potential mediators investigated were: fear-avoidance beliefs, perceived muscle strength, use of assistive devices at work and perceived physical exertion at work. LBP outcomes assessed were: days with LBP, LBP intensity and days with bothersome LBP. Results: There were no significant indirect effects of the intervention on LBP outcomes. There were significant effects of the intervention on both fear-avoidance measures [β = − 0.63, 95% CI (1.23, 0.03); β = − 1.03, 95% CI (− 1.70, − 0.34)] and the use of assistive devices [β = − 0.55, 95% CI (− 1.04, − 0.05)], but not on perceived muscle strength [β = − 0.18, 95% CI (− 0.50, 0.13)] or physical exertion [β = − 0.05, 95% CI (− 0.40, 0.31)]. The only potential mediator with a significant effect on LBP outcomes was physical exertion, which had a significant effect on LBP intensity [β = 0.14, 95% CI (0.04, 0.23)]. Conclusions: A multifaceted intervention consisting of participatory ergonomics, physical training, and CBT was able to decrease fear-avoidance beliefs and increase use of assistive devices in the workplace. However, these changes did not explain the effect of any of the intervention components on days with LBP, LBP intensity and days with bothersome LBP.

Original languageEnglish
JournalInternational Archives of Occupational and Environmental Health
Volume92
Issue number1
Pages (from-to)49-58
ISSN0340-0131
DOIs
Publication statusPublished - Jan 2019

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Low Back Pain
Physical Exertion
Self-Help Devices
Human Engineering
Workplace
Cluster Analysis
Randomized Controlled Trials

Keywords

  • Cognitive behavioural training
  • Musculoskeletal disorders
  • Nurses’ aides
  • Participatory ergonomics
  • Physical training
  • Workplace interventions

Cite this

@article{c9a338278be14f7ea46f302a720d2e01,
title = "Mechanisms for reducing low back pain: a mediation analysis of a multifaceted intervention in workers in elderly care",
abstract = "Purpose: A multifaceted workplace intervention consisting of participatory ergonomics, physical training, and cognitive–behavioural training (CBT) has shown effectiveness for reducing low back pain (LBP). However, the mechanisms of action underlying these intervention components are not well understood. Methods: This was a mediation analysis of a cluster-randomised controlled trial of a multifaceted intervention in 420 workers in elderly care. Mediation analysis was carried out via structural equation modelling. Potential mediators investigated were: fear-avoidance beliefs, perceived muscle strength, use of assistive devices at work and perceived physical exertion at work. LBP outcomes assessed were: days with LBP, LBP intensity and days with bothersome LBP. Results: There were no significant indirect effects of the intervention on LBP outcomes. There were significant effects of the intervention on both fear-avoidance measures [β = − 0.63, 95{\%} CI (1.23, 0.03); β = − 1.03, 95{\%} CI (− 1.70, − 0.34)] and the use of assistive devices [β = − 0.55, 95{\%} CI (− 1.04, − 0.05)], but not on perceived muscle strength [β = − 0.18, 95{\%} CI (− 0.50, 0.13)] or physical exertion [β = − 0.05, 95{\%} CI (− 0.40, 0.31)]. The only potential mediator with a significant effect on LBP outcomes was physical exertion, which had a significant effect on LBP intensity [β = 0.14, 95{\%} CI (0.04, 0.23)]. Conclusions: A multifaceted intervention consisting of participatory ergonomics, physical training, and CBT was able to decrease fear-avoidance beliefs and increase use of assistive devices in the workplace. However, these changes did not explain the effect of any of the intervention components on days with LBP, LBP intensity and days with bothersome LBP.",
keywords = "Cognitive behavioural training, Musculoskeletal disorders, Nurses’ aides, Participatory ergonomics, Physical training, Workplace interventions",
author = "Stevens, {Matthew L.} and Eleanor Boyle and Jan Hartvigsen and Gemma Mansell and Karen S{\o}gaard and J{\o}rgensen, {Marie B.} and Andreas Holtermann and Rasmussen, {Charlotte D.N.}",
year = "2019",
month = "1",
doi = "10.1007/s00420-018-1350-3",
language = "English",
volume = "92",
pages = "49--58",
journal = "International Archives of Occupational and Environmental Health",
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Mechanisms for reducing low back pain : a mediation analysis of a multifaceted intervention in workers in elderly care. / Stevens, Matthew L.; Boyle, Eleanor; Hartvigsen, Jan; Mansell, Gemma; Søgaard, Karen; Jørgensen, Marie B.; Holtermann, Andreas; Rasmussen, Charlotte D.N.

In: International Archives of Occupational and Environmental Health, Vol. 92, No. 1, 01.2019, p. 49-58.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Mechanisms for reducing low back pain

T2 - a mediation analysis of a multifaceted intervention in workers in elderly care

AU - Stevens, Matthew L.

AU - Boyle, Eleanor

AU - Hartvigsen, Jan

AU - Mansell, Gemma

AU - Søgaard, Karen

AU - Jørgensen, Marie B.

AU - Holtermann, Andreas

AU - Rasmussen, Charlotte D.N.

PY - 2019/1

Y1 - 2019/1

N2 - Purpose: A multifaceted workplace intervention consisting of participatory ergonomics, physical training, and cognitive–behavioural training (CBT) has shown effectiveness for reducing low back pain (LBP). However, the mechanisms of action underlying these intervention components are not well understood. Methods: This was a mediation analysis of a cluster-randomised controlled trial of a multifaceted intervention in 420 workers in elderly care. Mediation analysis was carried out via structural equation modelling. Potential mediators investigated were: fear-avoidance beliefs, perceived muscle strength, use of assistive devices at work and perceived physical exertion at work. LBP outcomes assessed were: days with LBP, LBP intensity and days with bothersome LBP. Results: There were no significant indirect effects of the intervention on LBP outcomes. There were significant effects of the intervention on both fear-avoidance measures [β = − 0.63, 95% CI (1.23, 0.03); β = − 1.03, 95% CI (− 1.70, − 0.34)] and the use of assistive devices [β = − 0.55, 95% CI (− 1.04, − 0.05)], but not on perceived muscle strength [β = − 0.18, 95% CI (− 0.50, 0.13)] or physical exertion [β = − 0.05, 95% CI (− 0.40, 0.31)]. The only potential mediator with a significant effect on LBP outcomes was physical exertion, which had a significant effect on LBP intensity [β = 0.14, 95% CI (0.04, 0.23)]. Conclusions: A multifaceted intervention consisting of participatory ergonomics, physical training, and CBT was able to decrease fear-avoidance beliefs and increase use of assistive devices in the workplace. However, these changes did not explain the effect of any of the intervention components on days with LBP, LBP intensity and days with bothersome LBP.

AB - Purpose: A multifaceted workplace intervention consisting of participatory ergonomics, physical training, and cognitive–behavioural training (CBT) has shown effectiveness for reducing low back pain (LBP). However, the mechanisms of action underlying these intervention components are not well understood. Methods: This was a mediation analysis of a cluster-randomised controlled trial of a multifaceted intervention in 420 workers in elderly care. Mediation analysis was carried out via structural equation modelling. Potential mediators investigated were: fear-avoidance beliefs, perceived muscle strength, use of assistive devices at work and perceived physical exertion at work. LBP outcomes assessed were: days with LBP, LBP intensity and days with bothersome LBP. Results: There were no significant indirect effects of the intervention on LBP outcomes. There were significant effects of the intervention on both fear-avoidance measures [β = − 0.63, 95% CI (1.23, 0.03); β = − 1.03, 95% CI (− 1.70, − 0.34)] and the use of assistive devices [β = − 0.55, 95% CI (− 1.04, − 0.05)], but not on perceived muscle strength [β = − 0.18, 95% CI (− 0.50, 0.13)] or physical exertion [β = − 0.05, 95% CI (− 0.40, 0.31)]. The only potential mediator with a significant effect on LBP outcomes was physical exertion, which had a significant effect on LBP intensity [β = 0.14, 95% CI (0.04, 0.23)]. Conclusions: A multifaceted intervention consisting of participatory ergonomics, physical training, and CBT was able to decrease fear-avoidance beliefs and increase use of assistive devices in the workplace. However, these changes did not explain the effect of any of the intervention components on days with LBP, LBP intensity and days with bothersome LBP.

KW - Cognitive behavioural training

KW - Musculoskeletal disorders

KW - Nurses’ aides

KW - Participatory ergonomics

KW - Physical training

KW - Workplace interventions

U2 - 10.1007/s00420-018-1350-3

DO - 10.1007/s00420-018-1350-3

M3 - Journal article

C2 - 30173369

AN - SCOPUS:85052804268

VL - 92

SP - 49

EP - 58

JO - International Archives of Occupational and Environmental Health

JF - International Archives of Occupational and Environmental Health

SN - 0340-0131

IS - 1

ER -