Managing low back pain: knowledge and attitudes of hospital managers

Now this is a really useful, although unsurprising, study of hospital line manager’s knowledge of the management of low back pain. Sad to say, Caitriona Cunningham, Catherine Doody, and Catherine Blake of UCD School of Physiotherapy and Performance Science, Dublin, Ireland, found that 54% (N=32) of the managers who responded to their survey believed that “a staff member needs to be pain free prior to return to work (RTW)”. The managers were employed in Irish University Hospital, and reflect the views of 64% of the managers approached.

Unsurprising? Yes, because this news is old news – to people researching acute low back pain. But somehow the message just hasn’t got through – especially sad in a hospital setting. In addition, managers reported “difficulties in dealing with colleagues of workers with LBP and in knowing the work capacity of the worker with LBP. Managers demonstrated poor awareness of the importance of the manager–worker relationship in influencing RTW.”

Hospitals should be one of first places to actively and appropriately managing acute low back pain. Why? Well, the nature of the work itself, which is high stress, high demand, with low control and high responsibility suggests that people working in hospitals may find it difficult to return to work (ACC, 2002), and the long duration of work disability among nurses (Tate, Yassi & Cooper, 1999).

Despite this, the literature is replete with studies of biomechanical demands in nursing (e.g.Morlock et al., 2000; Skotte, 2001; Videman, Ojajarvi, Riihimaki, & Troup, 2005) – and patient handling guidelines barely mention psychosocial factors or strategies for reducing work disability amongst nursing staff.

This study by Cunningham, Doody & Blake also found that “managers believed more information, easier access to health services, more ergonomic training and better staff resources were necessary supports in facilitating the management of workers with LBP”. Surely, if these things were effective, placed like the UK, Australia and New Zealand, who have thrown vast amounts of money at providing patient handling equipment, training and so on, would have by now demonstrated some reduction in time lost from low back pain.

At least in two hospitals that I have worked in, patient handling strategies seem to have increased the reporting of low back pain, while approaches to reduce disability have remained firmly focused on returning individuals to ‘suitably selected work’. Now this isn’t a bad thing, suitable work and early, managed return to work is a great component of effective rehabilitation from acute low back pain.

BUT, and it’s a big but, it also requires support from line managers. And at least from this study, it seems they haven’t got that particular message – and are not yet even aware of the need to ask for support to learn how. Instead, they seem to have problems managing individuals who are experiencing ongoing disability, and are unaware of the influence of at-work interpersonal and psychosocial factors.

The methodology and generalisability of this study is relatively weak – but for a moment, if you’re working in a hospital, think of the line managers in your workplace. What exposure do they have to recent research in low back pain and return to work? And how good is the research into workplace rehabilitation? So, although this study is telling us perhaps what we already know, it is incredibly relevant – we just need to take it to the next step and answer questions like ‘how can managers learn more?’, ‘what do they need to do?’, ‘what happens when rehabilitation takes longer than expected?’, ‘how can hospitals provide suitable support while under budget squeeze?’.

It’s nice to see a simple study like this carried out in the ‘real world’ – because this is where you and I live.

Do managers feel our pain?

doi:10.1093/occmed/kqn015

Managing low back pain: knowledge and attitudes of hospital managers
     Caitriona Cunningham, Catherine Doody, and Catherine Blake
     Occup Med (Lond) published 15 March 2008

Morlock, M. M., Bonin, V., Deuretzbacher, G., Muller, G., Honl, M., & Schneider, E. (2000). Determination of the in vivo loading of the lumbar spine with a new approach directly at the workplace–first results for nurses. Clinical Biomechanics, 15(8), 549-558.

Skotte, J. H. (2001). Estimation of low back loading on nurses during patient handling tasks: the importance of bedside reaction force measurement. Journal of Biomechanics, 34(2), 273-276.

Tate, R B., Yassi, A; Cooper, J. (1999), Predictors of Time Loss After Back Injury in Nurses, Spine, Volume 24(18), p 1930

Videman, T., Ojajarvi, A., Riihimaki, H., & Troup, J. D. G. (2005). Low back pain among nurses: a follow-up beginning at entry to the nursing school. Spine, 30(20), 2334-2341.

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