Predictors for effective prevention of low back pain in nurses

Background: In the frame of the multi-dimensional training program Back Protective Patient Transfer (BPPT) „instructors“ are trained to teach their colleagues on the wards, to give practical support and refresher courses. The aim is to generate sustainability. Patient transfers are planned using team structures with special regard to ergonomic devices and work place adjustment related to the specific transfer situations. By statistical analysis we found criteria for successful implementation strategies and effects on several outcomes (back health, work load). Methods: The cross-sectional questionnaire investigation took place in 2008 (21 German health care institutions), measuring prevalence rates of musculoskeletal disorders compared to a control group. Predictor variables of a) the program to ensure sustainability of effects and b) factors of individual implementation in the intervention group (n=249) were estimated by multivariate logistic and linear regression (forward elimination, p<0.05, most parsimonious model). Effect sizes were calculated using RRR (relative risk reduction) and RBI (relative benefit increase). Results: The most dominant predictors on back pain related outcomes are competencies in the use of BPPT-principles and of ergonomic equipment, aspects of sustainability (refresher courses) and work organization (RRR/RBI one half to at least two thirds). The personal support of instructors/nursing management increases effects on the application frequency of BPPT-principles by one third. Conclusions: The analysis demonstrates that the comparison of prevalence rates between intervention- and control group is not sufficient to estimate effects. Also the degree of the development of a „preventive culture“ in the intervention group should be controlled for final as well as for intermediate outcomes. Keywords: Health care workers, prognosis of MSD, early prevention