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The Prevalence of Low Back Pain and Evaluation of Prevention Strategies among the Electrophysiology and Catheterization Laboratory Community (Physicians, Nurses, Technicians) in Rural Hospitals

By Khalid Sawalha, Nicholas Beresic, Shoaib Khan and Gilbert-Roy Kamoga

Submitted: December 4th 2020Reviewed: December 23rd 2020Published: January 18th 2021

DOI: 10.5772/intechopen.95740

Downloaded: 13

Abstract

Musculoskeletal disorders, such as low back pain, are a common and costly problem in today’s workforce. Employees who work in a rural hospital’s electrophysiology (EP) or catheterization lab (Cath lab) appear to be especially susceptible to injury. This increase in risk has been attributed to a shortage of physicians, less community-based resources available to hospital staff, and the forward-flexed postures EP/Cath lab professionals maintain for extended periods of time while working in the operating room. Traditionally, exercise and physical activity routines, health education, and continued management support have been promoted as low cost/low risk interventions to address low back pain. However, the extent to which hospital policy and culture enable these prevention strategies to be implemented is unknown. Thus, the objective of this study was to determine the prevalence of low back pain in rural EP/Cath laboratories and the significance of exercise and physical activity routines, health education, and continued management support as low back pain prevention strategies in the rural EP/Cath lab community.

Keywords

  • low back pain
  • rural hospitals
  • healthcare workers safety

1. Introduction

Hospital workers are highly susceptible to musculoskeletal disorders due to the regular lifting, positioning, and transporting of patients, combined with a fast pace work environment and a general collective temperament of putting their patients’ health before their own. [1] Upon closer review, the EP/Cath lab subset of the rural hospital workforce appears to be especially susceptible to the specific musculoskeletal disorder of low back pain. This has been attributed to the sustained forward-flexed postures they commonly maintain while working in the operating room [2], combined with a shortage of rural physicians and less community-based resources available to rural hospital staff as compared to their urban counterparts. [3] As a strategy to address this dilemma, exercise and physical activity routines, health education, and continued management support have been broadly promoted as cost-effective programs which are powerful enough to improve the health of the workforce, yet also produce a positive return on investment. [4] In theory the implementation of these low cost/low risk programs is a sound strategy based on evidence-based guidelines. The American College of Physicians strongly recommends nonpharmacologic treatments for chronic low back pain, including exercise and mindfulness-based stress reduction, because the benefits clearly outweigh the risk. [5] In practice, though, limited time and the inability to incorporate the program into everyday work routines have been found to be the two main reasons why these worksite-based fitness programs have failed to produce significant findings. [6] To overcome these barriers, hospital management must concurrently have the social, financial, and strategic investments in place which complement and support these specific wellness interventions to realize significant and lasting reductions in musculoskeletal disorders. [7] Unfortunately, the extent to which these investments have been made by hospital management, and thus perceived effective by the EP/Cath lab workforce, is unknown. Thus, the objective of this study was to determine the prevalence of low back pain in rural EP/Cath laboratories and the significance of exercise and physical activity routines, health education, and continued management support as low back pain prevention strategies in the rural EP/Cath lab community.

2. Methods and data collection

Those individuals who worked in the EP/Cath laboratories of two rural hospitals in the state Arkansas were eligible to participate in the study. A convenience sample design was used, and all research data were collected through the electronic transmission of a Qualtrics survey. The survey included three general sections: Nordic Musculoskeletal Questionnaire (NMQ), demographics/applicable work practice details, and low back pain prevention strategies. The first section featuring the NMQ was used to calculate the prevalence of musculoskeletal symptoms within the study population. The NMQ was developed for the analysis of musculoskeletal symptoms, [8] and has been validated and applied to a wide range of occupational groups, including nursing. [9] Additionally, the validity and reliability of the NMQ was assessed to be moderate to high and its use appropriate for epidemiological research related to musculoskeletal disorders. [10] The second section on demographics/applicable work practice assessed height, weight, gender, age, number of years worked in an EP/Cath lab setting, number of hours per week in a lead apron, and percentage of average shift spent standing in the lab. The third section on low back pain prevention strategies assessed exercise and physical activity routines, health education, and continued management support. These questions were developed through the examination of peer-reviewed journal articles, scientific posters, and government websites which promote specific behaviors or actions that had the potential to prevent or reduce low back pain. [11]

A total of 45 participants were invited to participate in the study. Upon receiving IRB approval, the survey was sent to the work email address of all study participants. Data were deidentified and summarized using Microsoft Excel. Analysis showed fifteen individuals either selected they did not want to participant in the study or did not complete the survey in its entirety and thus, were omitted from the final data set. Ultimately, a total of 30 completed surveys were included in the final data set for analysis.

3. Results

The first section of the survey featuring the NMQ assessed the prevalence of musculoskeletal symptoms in nine different regions of the body. The largest group, 18 (60%), stated they experienced pain in the lower back (L4 to S1) spinal level, while 12 (40%) reported no low back pain. Among the 60% of respondents who have experienced low back pain, eight (26.67%) had trouble in the last week and six (20%) were prevented from doing their normal work (at home or away from home) (Table 1).

Region of BodyRecorded “Yes” (n = 30)
Neck46.67%
 Trouble in the last 12 months14
 Prevented from normal work1
 Trouble in the last 7 days4
Shoulders40.00%
 Trouble in the last 12 months12
 Prevented from normal work2
 Trouble in the last 7 days4
Elbows13.33%
 Trouble in the last 12 months4
 Prevented from normal work1
 Trouble in the last 7 days1
Wrists/Hands13.33%
 Trouble in the last 12 months4
 Prevented from normal work1
 Trouble in the last 7 days1
Upper Back36.67%
 Trouble in the last 12 months11
 Prevented from normal work1
 Trouble in the last 7 days3
Lower Back60.00%
 Trouble in the last 12 months18
 Prevented from normal work6
 Trouble in the last 7 days8
Hips/Thighs26.67%
 Trouble in the last 12 months8
 Prevented from normal work3
 Trouble in the last 7 days2
Knees23.33%
 Trouble in the last 12 months7
 Prevented from normal work2
 Trouble in the last 7 days4
Feet/Ankles30.00%
 Trouble in the last 12 months9
 Prevented from normal work1
 Trouble in the last 7 days5
Per Person Mean and SD4.57 ± 4.03

Table 1.

Nordic musculoskeletal questionnaire number of recorded “Yes’s”.

4. Discussion

When we compare our study to a sample of Radiologic Technologists study who similarly wear lead aprons1, the current study showed a higher overall pervasiveness of low back pain (60% to 47.62%) but less low back pain symptoms on the short-term basis (33.33% to 26.67%). Despite these discrepancies, low back pain was found to be the most prevalent musculoskeletal symptom recorded in both studies. Another significant finding in this study is the data showed an increase in the prevalence of low back pain once five years of service in an EP/Cath lab setting has been completed (58–61%) (Table 2). To provide a sense of comparison, Goldstein, et al. in (2004) likewise reported an upward trajectory in the prevalence of low back pain among Interventional Cardiologists as the number of years of service increased. [12]

TotalLBPNo LBP
Number301812
Height (inches)67.30 ± 5.4767.28 ± 5.5467.33 ± 5.61
Weight (pounds)196.17 ± 31.79194.44 ± 36.58198.75 ± 24.16
Gender (% male)46.6744.4450.00
Age40.93 ± 11.9238.67 ± 9.9344.33 ± 14.20
Years working in EP/Cath lab setting9.53 ± 9.798.22 ± 6.6011.50 ± 13.36
 under 51275
 5–10862
 11–16422
 17–20431
 21 or more202
Hours per week in lead apron18.13 ± 10.4516.17 ± 10.5321.08 ± 10.02
% of shift spent standing in lab60.50 ± 24.9659.44 ± 26.5162.08 ± 23.50

Table 2.

Demographics/applicable work practice details stratified by the presence or absence of low Back pain (LBP).

Finally, the top two prevention strategies reported by those with low back pain were “regularly complete at least 150 minutes per week of moderate-intensity aerobic physical activity” and “if a worksite-based fitness program will be offered to you at your department, will you be interested on joining it for at least a year” (Table 3). As motivation to exercise appears to be high, interestingly no responses were recorded when asked if their worksite-based fitness program occurred on company time or if low back pain and other musculoskeletal symptoms were periodically evaluated. In addition, only one response was recorded when asked if ergonomic-related topics were discussed during team meetings. These findings suggest it is the cultural norm of the EP/Cath lab community to believe it is the personal responsibility of the employee rather than shared responsibility of the employee and hospital (EP/Cath lab) management to address the widespread low back pain present in the workforce, personified by only 36.67% of respondents reporting “hospital management believes improvements in physical conditioning will help to prolong career.”

Prevention StrategyLBP (n = 18)No LBP (n = 12)
Currently participate in early morning fitness program65
 Yes: Includes strength training exercises64
 Yes: Includes stretching exercises55
 Yes: Overall do you do your fitness program regularly54
Worksite-based fitness program currently offered to dept45
 Yes: Occurred on company-time00
 Yes: Each class included exercises targeting the various muscle groups of the body45
 Yes: Customized around dept’s specific needs, preferred communication methods, and resources available to the employees to help create a sense of ownership21
If a worksite-based fitness program will be offered to you at your department, will you be interested on joining it for at least a year101
 Yes: How often to hold class (days/week)3 Responses: Daily 6 Responses: 3x 1 Response: 1x1 Response: Daily
 Yes: How long to hold class (minutes)2 Responses: 10–15 6 Responses: 15–20 2 Responses: Other1 Response: 10–15
 Yes: Led by a faciliator or instructor71
Ergonomic-related topics discussed during team meetings01
 Yes: Includes discussion on poor posture(s)01
 Yes: Includes discussion on stress management01
 Yes: Includes discussion on active coping strategies01
 Yes: Strategies developed to overcome limited time to stretch01
 Yes: Strategies developed to overcome lack of regular breaks01
 Yes: Strategies developed to overcome requirement to keep the body in a sustained forward-flexed posture during surgery01
Regularly complete at least 150 minutes per week of moderate-intensity aerobic physical activity103
Regularly complete stretching exercises66
Regularly complete strength training exercises two or more days/week84
 Yes: Systematically change number of sets, reps, or weight used in strength training program74
 Yes: Know how to engage the deep core muscles74
Hospital management believes improvements in physical conditioning will help to prolong career65
Low back pain and other musculoskeletal symptoms periodically evaluated00
Functional Movement Screen or another validated screening tool periodically used to identify faulty movement patterns or muscular imbalances12

Table 3.

Prevention strategies completed by EP/Cath lab physicians, managers, and technicians stratified by the presence or absence of low Back pain (LBP).

5. Conclusion

The primary goal of this study was to illustrate the prevalence and generalized characteristics of back pain among EP and Cath laboratories in rural hospital settings. Conclusions that may be drawn from this study are the prevalence of low back pain demonstrated within this study were consistent when compared to available studies, low back pain is a common condition among EP and Cath lab employees, and several low cost/low risk preventative strategies for reducing musculoskeletal symptoms in the workforce are not currently being completed by those who participated in the study.

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Khalid Sawalha, Nicholas Beresic, Shoaib Khan and Gilbert-Roy Kamoga (January 18th 2021). The Prevalence of Low Back Pain and Evaluation of Prevention Strategies among the Electrophysiology and Catheterization Laboratory Community (Physicians, Nurses, Technicians) in Rural Hospitals [Online First], IntechOpen, DOI: 10.5772/intechopen.95740. Available from:

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