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Lawren H. Daltroy, Dr. P.H., Maura
D. Iversen, B.S.{P.T., S.D., Martin G. Larson, S.D., Robert Lew,
Ph.D., Elizabeth Wright, Ph.D., James Ryan, M.D., M.P.H., Craig
Zwerling, M.D., Ph.D., Anne H. Fossel, and Matthew H. Liang,
M.D., M.P.H.
Introduction : Widespread use of employee education programs
to offset behaviorial risk factors leading to low back injuries
have received little rigorous evaluation. Control of LBP is of
paramount importance, as it affects 70 to 80 percent of adults
at some time in the United States and Canada. Low back injury
accounts for 15 to 25 percent of injuries covered by worker's
compensation and 30 to 40 percent of the payments made under
that program. "Back school" type education programs
teach safe lifting and handling. The authors of this study evaluated
one such educational program in a randomized controlled trial
involving about 4,000 postal workers over a 5 year period.
Method: Mail
handlers, maintenance workers and clerks employed by the U.S.
Postal Service were taught principles of back safety, correct
lifting and handling, posture, exercise and pain management by
physical therapists. Work stations were examined and modified,
ie: shelf heights adjusted, lumbar supports and rollers added
to chairs. Mechanized operations were paced by the therapist.
Protective equipment such as back supports was not a part of
the program. The unit of analysis was an administrative grouping
of employees sharing a work environment and a common supervisor.
A total of 34 work units were split between training and control
in a random manner. Therapist provided additional reinforcement
training 6 months after the first sessions and yearly thereafter.
Results: Over a period of five years (September 1985
- September 1990) 12 staff physical therapists and 2 senior therapists
trained 2,534 workers and 134 supervisors in primary back injury
prevention. A cross section of the worker population in 1990
showed the training on control groups to be similar in age, sex,
craft category and duration of employment as it was at the onset
of the study. A midpoint survey found significant increases in
knowledge of safe behavior among workers in the intervention
group when compared with the control group.
No significant improvement in actual behavior or reductions in
the proportion of workers with tired backs were reported by subjects.
Over 5 1/2 years, intervention group units (trained) had a higher
rate of injury than control groups, but this difference was considered
insignificant. Lifting and handling injuries in the intervention
and control groups were also not significantly different, nor
was there a significance between groups in other musculoskeletal
injuries reported. There was little difference in the proportions
of total injuries that resulted in lost work days: (61 percent
for the intervention group versus 56 percent for the control
group). The median total cost per back injury, as accrued through
the end of the study was $103 in the control group versus $309
in the intervention group.
Discussion: The results of this study randomized trial indicate
that back schools, by themselves, are not an effective intervention
for the primary prevention of industrial low back injury.
Quote:
"The education program successfully imparted knowledge and
skills related to safe lifting and handling, but despite this
training and for most intervention group workers, its regular
reinforcement, the increased practice of desirable behavior did
not take place."
Published: New England Journal of Medicine, July 31, 1997.
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