Back or neck-pain-related disability of nursing staff in hospitals, nursing homes and home care in seven countries—results from the European NEXT-Study

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Abstract

Background

Musculoskeletal disorders are a widespread affliction in the nursing profession. Back or neck-pain-related disability of nursing staff is mainly attributed to physical and psychosocial risk factors.

Objectives

To investigate which—and to what extent—physical and psychosocial risk factors are associated with neck/back-pain-related disability in nursing, and to assess the role of the type of health care institution (hospitals, nursing homes and home care institutions) within different countries in this problem.

Design

Cross-sectional secondary analysis of multinational data of nurses and auxiliary staff in hospitals (n=16,770), nursing homes (n=2140) and home care institutions (n=2606) in seven countries from the European NEXT-Study.

Methods

Multinomial logistic regression analysis with raw models for each factor and mutually adjusted with all analysed variables.

Results

Analysis of the pooled data revealed effort-reward imbalance as the predominant risk factor for disability in all settings (odds ratios for high disability by effort-reward ratio: hospital 5.05 [4.30–5.93]; nursing home 6.52 [4.04–10.52] and home care 6.4 [3.83–10.70] [after mutual adjustment of psychosocial and physical risk factors]). In contrast, physical exposure to lifting and bending showed only limited associations with odds ratios below 1.6; the availability and use of lifting aids was—after mutual adjustment—not or only marginally associated with disability. These findings were basically confirmed in separate analyses for all seven countries and types of institutions.

Conclusions

The findings show a pronounced association between psychosocial factors and back or neck-pain-related disability. Further research should consider psychosocial factors and should take the setting where nurses work into account.

Section snippets

What is already known about the topic?

  • Back or neck pain (and the related disability) is a common problem in nursing.

  • Physical and psychosocial risk factors contribute to back or neck-pain-related disability.

  • The working environment determines the physical and psychosocial exposure for nurses.

What this paper adds

  • Effort reward imbalance (ERI) is a predominant risk factor in association with back or neck-pain-related disability.

  • Neither lifting and bending nor the availability or usage of technical lifting aids was consistently associated with back or neck-pain-related disability.

  • Both country and type of institution determine the risk factor pattern associated with disability.

Background

Back or neck pain is a health problem that affects all types of occupational groups. One third of all employees report work-related back pain (Paoli and Merllié, 2001). Despite this obviously widespread adversity, many occupational health researchers have focussed on the nursing profession, seen as a physically and psychosocially demanding profession with high prevalence rates of back-related complaints (Menzel, 2004). Besides the personal suffering, back pain is a major cause for

Objectives

The data that were analysed stem from the European NEXT-Study and allows:

  • (a)

    the investigation of which—and to what extent—physical and psychosocial risk factors are associated with neck/back-pain-related disability in nursing, and

  • (b)

    the assessment of the role of the type of health care institution (hospitals, nursing homes and home care institutions) overall and in the countries investigated.

Data

The ‘Nurses’ early exit study’ (NEXT) is a European research project investigating premature departure from the nursing profession (for general information: http://www.next-study.net). More than 56,000 health care workers from 11 countries have participated in cross-sectional and prospective questionnaire assessments. Separately for each country, quota samples were drawn that were intended to cover the main working areas (hospitals, nursing homes, and home care) and the national geographical

Methods

For all scales used in the analysis and described below satisfactory psychometric properties have been found (Kümmerling et al., 2003).

Descriptive analysis

Descriptive analysis (Table 2) indicates that the proportion of nursing staff without disability is highest in home care (62.3%) and somewhat lower in hospitals (53.8%) and nursing homes (52.0%, NH). As expected NH had the highest rate of respondents with high exposure to L&B (63.5%). Respondents in hospitals reported the lowest availability of lifting aids (in 62.9% not available) and the highest mean ERI ratio indicating a higher adverse imbalance between effort and rewards at work. In home

Discussion

This study showed a pronounced relationship between psychosocial factors and back or neck-pain-related disability, which was higher than the association with physical factors. Furthermore this analysis showed that this finding was consistent across all types of institutions and qualification levels in all countries, in both crude and adjusted models.

This result raises mainly three questions regarding the first study objective, the investigation of the association of physical and psychosocial

Conclusion

The strong relation of psychosocial factors (especially effort and reward) and disability adds these to a list of factors that should be addressed by preventive measures for back or neck-pain-related disability. This supports the call for multifactor interventions (Hignett, 2003) and highlights the need for research on interventions covering the contribution of both psychosocial and physical factors.

Acknowledgements

NEXT was funded by the European Commission within the 5th framework programme (EU-project no.: QLK6-CT-2001-00475). This secondary analysis was funded by the Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege, BGW (Germany).

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