Skip to main content
SpringerLink
Log in

Association of Low Back Pain, Impairment, Disability & Work Limitations in Nurses

  • Original Paper
  • Published:
Journal of Occupational Rehabilitation Aims and scope Submit manuscript

Abstract

Introduction: Health care professionals use measures of pain and impairment to identify potential disability and subsequently to predict workers’ ability to do their work. However, there is little evidence that measures used are associated with ability to do one’s job. Methods: A cross-sectional study was conducted. Nurses (n = 100) were classified into either off/modified work (due to LBP) or regular work groups. Trunk ROM, trunk muscular endurance, pain and disability were measured relative to the outcomes work status and Work Limitations Questionnaire (WLQ) score. Results: Regression analyses which included Roland Morris Questionnaire (RMQ, disability) and Sørenson (back extensor endurance) in the final models correctly classified the work status of 87% of the participants and accounted for 60% of variance in the WLQ score. Conclusions: Use of the RMQ and Sørenson test as diagnostic and prognostic tools should be considered in assisting return to work and treatment decision-making in female nurses with LBP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Anderson GBJ. Epidemiological features of chronic low-back pain. Lancet 1999;354(Aug. 14):581–585.

    Article  Google Scholar 

  2. Frank JW, Kerr MS, Brooker A, DeMaio SE, Maetzel A, Shannon HS, et al. Disability resulting from occupational low back pain part I: What do we know about primary prevention? A review of the scientific evidence before disability begins. Spine 1996;21(24):2908–17.

    Article  PubMed  CAS  Google Scholar 

  3. Cassidy DJ, Carroll LJ, Cote P. The Saskatchewan health and back pain survey: The prevalence of low back pain and related disability in Saskatchewan adults. Spine 1998;23(17):1860–6.

    Article  PubMed  CAS  Google Scholar 

  4. Jensen RC. Disabling back injuries among nursing personnel: Research needs. Res Nurs Health 1987;10:29–38.

    Article  PubMed  CAS  Google Scholar 

  5. Pheasant S, Stubbs D. Back pain in nurses: epidemiology and risk assessment. Appl Ergon 1992;23(4):226–32.

    Article  PubMed  CAS  Google Scholar 

  6. Hignett S. Work-related back pain in nurses. J Adv Nurs 1996;23(6):1238–46.

    Article  PubMed  CAS  Google Scholar 

  7. Smedley J, Egger P, Cooper C, Coggon D. Prospective cohort study of predictors of low back pain in nurses. Br Med J 1997;314(26):1225–8.

    CAS  Google Scholar 

  8. Yassi A, Khokhar J, Tate R, Cooper J, Snow C, Vallentyne S. The epidemiology of back injuries in nurses at a large Canadian tertiary care hospital: implications for prevention. Occup Med 1995;45(4):215–20.

    Article  CAS  Google Scholar 

  9. Magora A. Investigation of the relationship between low back pain and occupation. Scand J Rehabil Med 1974;6:81–8.

    PubMed  CAS  Google Scholar 

  10. Baty D, Stubbs DA. Postural stress in geriatric nursing. Int J Nurs Stud 1987;24(4):339–44.

    Article  PubMed  CAS  Google Scholar 

  11. Nordin M, Örtengren R, Anderson GBJ. Measurement of trunk movements during work. Spine 1984;9(5):465–9.

    Article  PubMed  CAS  Google Scholar 

  12. Gundewall B, Liljeqvist M, Hansson TH. Primary prevention of back symptoms and absence from work. Spine 1993;18(5):587–94.

    Article  PubMed  CAS  Google Scholar 

  13. Punnett L, Fine LJ, Keyserling WM, Herrin GD, Chaffin DB. Back disorders and nonneutral trunk postures of automobile assembly workers. Scand J Work Environ Health 1991;17:337–46.

    PubMed  CAS  Google Scholar 

  14. Hazard RG, Haugh LD, Green PA, Jones PL. Chronic low back pain. The relationship between patient satisfaction and pain, impairment, and disability. Spine 1994;19(8):881–7.

    Article  PubMed  CAS  Google Scholar 

  15. Jette AM. Outcomes research: Shifting the dominant research paradigm in physical therapy. Phys Ther 1995;75(11):965–70.

    PubMed  CAS  Google Scholar 

  16. Rainville J, Ahern D, Phalen L, Childs L, Sutherland R. The association of pain with physical activities in chronic low back pain. Spine 1992;17(9):1060–4.

    Article  PubMed  CAS  Google Scholar 

  17. Rigby AS, Rudolpher SM, Badley EM, Brayshaw NC. The relationship between impairment and disability in arthritis: an application of the theory of generalized linear models to the ICIDH. Int Disability Stud 1989;11(2):84–8.

    CAS  Google Scholar 

  18. Sullivan SM, Donegan Shoaf L, Riddle DL. The relationship of lumbar flexion to disability in patients with low back pain. Phys Ther 2000;80(3):240–50.

    PubMed  CAS  Google Scholar 

  19. Waddell G. A new clinincal model for the treatment of low back pain. Spine 1987;12(7):632–44.

    Article  PubMed  CAS  Google Scholar 

  20. Seçkin Ü, Bölükbasi N, Gürsel G, Eröz S, Sepici V, Ekim N. Relationship between pulmonary function and exercise tolerance in patients with ankylosing spondylitis. Clin Exp Rheumatol 2000;28:503–6.

    Google Scholar 

  21. Dionne CE, Von Korff M, Koepsell TD, Deyo RA, Barlow WE, Checkoway H. A comparison of pain, functional limitations, and work status indices as outcome measures in back pain research. Spine 1999;24(22):2339–45.

    Article  PubMed  CAS  Google Scholar 

  22. Stratford PW, Binkley JM. A comparison study of the back functional scale and Roland Morris questionnaire. J Rheumatol 2000;27:1928–36.

    PubMed  CAS  Google Scholar 

  23. Stratford P, Spadoni G. The reliability, consistency, and clinical application of a numeric pain rating scale. Physiother Can 2001;53(2):88–91.

    Google Scholar 

  24. Roland M, Morris R. A study of the natural history of back pain. Part 1: Development of a reliable and sensitive measure of disability in low-back pain. Spine 1983;78(11):141–4.

    Article  Google Scholar 

  25. MacRae IF, Wright V. Measurement of back movement. Ann Rheum Dis 1969;28:584–9.

    PubMed  CAS  Google Scholar 

  26. Moll JMH, Wright V. Normal range of spinal mobility. Ann Rheum Dis 1971;30:381–6.

    Article  PubMed  CAS  Google Scholar 

  27. Beattie P, Rothstein JM, Lamb RL. Reliability of the attraction method for measuring lumbar spine backward bending. Phys Ther 1987;67(3):364–9.

    PubMed  CAS  Google Scholar 

  28. Lerner D, Amick III BC, Rogers WH, Malspeis S, Bungay K, Cynn D. The Work Limitations Questionnaire. Med Care 2001;39(1):72–85.

    Article  PubMed  CAS  Google Scholar 

  29. Lerner D, Reed JI, Massarotti E, Wester LM, Burke TA. The Work Limitations Questionnaire’s validity and reliability among patients with osteoarthritis. J Clin Epidemiol 2002;55:197–208.

    Article  PubMed  Google Scholar 

  30. Fletcher RH, Fletcher SW, Wagner EH. Chapter 3/diagnosis. In: Satterfield TS, editor. Clinical epidemiology: the essentials. 3rd ed. Baltimore: Williams & Wilkins; 1996. p. 43–74.

    Google Scholar 

  31. Norman GR, Streiner DL. Chapter 15: Logistic regression. In: Biostatistics, the bare essentials. 2nd ed. Hamilton: B.C. Descker Inc.; 2000. p. 139–44.

  32. Kerr MS, Frank JW, Shannon HS, Norman RWK, Wells RP, Neumann PW, et al. Biomechanical and psychosocial risk factors for low back pain at work. Am J Public Health 2001;91(7):1069–75.

    Article  PubMed  CAS  Google Scholar 

  33. Rantanen P. Physical measurements and questionnaires as diagnostic tools in chronic low back pain. J Rehabil Med 2001;33:31–5.

    Article  PubMed  CAS  Google Scholar 

  34. Luoto S, Heliövaara M, Hurri H, Alaranta H. Static back endurance and the risk of low-back pain. Clin Biomech 1995;10(6):323–4.

    Article  Google Scholar 

  35. Hultman G, Nordin M, Saraste H, Ohlsèn H. Body composition, enduranace, strength, cross-sectional area, and density of MM erector spinae in men with and without low back pain. J Spinal Disord 1993;6(2):114–23.

    Article  PubMed  CAS  Google Scholar 

  36. Latimer J, Maher CG, Refshauge K, Colaco I. The reliability and validity of the Biering-Sorenson test in asymptomatic subjects and subjects reporting current or previous nonspecific low back pain. Spine 1999;24(20):2085–90.

    Article  PubMed  CAS  Google Scholar 

  37. Holmström E, Moritz U, Andersson M. Trunk muscle strength and back muscle endurance in construction workers with and without low back disorders. Scand J Rehabil Med 1992;24:3–10.

    PubMed  Google Scholar 

  38. Nicolaisen T, Jørgensen K. Trunk strength, back muscle endurance and low-back trouble. Scand J Rehabil Med 1985;17:121–7.

    PubMed  CAS  Google Scholar 

  39. Payne N, Gledhill N, Katzmarzyk PT, Jamnik V. Health-related fitness, physical activity, and history of back pain. Can J Appl Physiol 2000;25(4):236–49.

    PubMed  CAS  Google Scholar 

  40. Kankaanpää M, Laaksonen D, Taimela S, Kokko S-M, Airaksinen O, Hänninen O. Age, sex, and body mass index as determinants of back and hip extensor fatigue in the isometric sørensen back endurance test. Arch Phys Med Rehabil 1998;79:1069–75.

    Google Scholar 

  41. Mannion AF, Dolan P. Electromyographic median frequency changes during isometric contraction of the back extensors to fatigue. Spine 1994;19(11):1223–9.

    Article  PubMed  CAS  Google Scholar 

  42. Mannion AF, Connolly B, Wood K, Dolan P. The use of surface EMG power spectral analysis in the evaluation of back muscle function. J Rehabil Res Dev 1997;34(4):427–39.

    PubMed  CAS  Google Scholar 

  43. Simmonds MJ, Olson SL, Jones S, Hussein T, Lee CE, Novy DM, et al. Psychometric characteristics and clinical usefulness of physical performance tests in patients with low back pain. Spine 1998;23(22):2412–2421.

    Article  PubMed  CAS  Google Scholar 

  44. Moffroid M, Reid S, Henry SN, Haugh LD, Ricamato A. Some endurance measures in persons with chronic low back pain. J Orthop Sports Phys Ther 1994;20(2):81–7.

    PubMed  CAS  Google Scholar 

  45. Alaranta H, Hurri H, Heliövaara M, Soukka A, Harju R. Non-dynamometric trunk performance tests: Reliability and normative data. Scand J Rehabil Med 1994(26):211–5.

    PubMed  CAS  Google Scholar 

  46. Moreland J, Finch E, Stratford P, Balsor B, Gill C. Interrater reliability of six tests of trunk muscle function and endurance. J Orthop Sports Phys Ther 1997;26(4):200–8.

    PubMed  CAS  Google Scholar 

  47. Biering-Sørensen F. A prospective study of low back pain in a general population. Scand J Rehabil Med 1983;15:71–9.

    PubMed  Google Scholar 

  48. Nordin M, Kahanovitz N, Verderame R, Parnianpour M, Yabut S, Viola K, et al. Normal trunk muscle strength and endurance in women and the effect of exercises and electrical stimulation part 1: Normal endurance and trunk muscle strength in 101 women. Spine 1987;12(2):105–11.

    Article  PubMed  CAS  Google Scholar 

  49. Mannion AF, Junge A, Taimela S, Müntener M, Lorenzo K, Dvorak J. Active therapy for chronic low back pain. Part 3. Factors influencing self-rated disability and its change following therapy. Spine 2001;26(8):920–9.

    Article  PubMed  CAS  Google Scholar 

  50. Yip Yb. A study of work stress, patient handling activities and the risk of low back pain among nurses in Hong Kong. J Adv Nurs 2001;36(6):794–804.

    Article  PubMed  CAS  Google Scholar 

  51. Zimmerman T. The effectiveness of different intervention strategies in preventing back pain in members of the nursing population and the general population. Work 1998;11:221–31.

    Article  Google Scholar 

  52. Buckle P. Epidemiological aspects of back pain within the nursing profession. Int J Nurs Stud 1987;24(4):319–24.

    Article  PubMed  CAS  Google Scholar 

  53. O’Brien-Pallas L, Thomson D, Alksnis C, Luba M, Pagneiello A, Ray K, et al. Stepping to success and sustainability: An analysis of Ontario’s nursing workforce. Toronto: Nursing Effectiveness, Utilization, Outcomes and Research Unit, University of Toronto; 2003 November.

  54. Kramer D. The changing world of health care. Toronto: Institute for Work and Health; 2001 June. Report No.: 22a.

    Google Scholar 

  55. Parks KA, Crichton KS, Goldford RJ, McGill SM. A Comparison of Lumbar range of motion and functional ability scores in patients with low back pain. Spine 2003;28(4):380–4.

    Article  PubMed  CAS  Google Scholar 

  56. Jackson AW, Morrow Jr JR, Brill PA, Kohl HW, Gordon NF, Blair SN. Relations of sit-up and sit-and-reach tests to low back pain in adults. J Orthop Sports Phys Ther 1998;27(1):22–6.

    PubMed  CAS  Google Scholar 

  57. Lubrano E, Helliwell P. Deterioration in anthropometric measures over six years in patients with ankylosing spondylitis. Physiotherapy 1999;85(3):138–43.

    Article  Google Scholar 

  58. Grönblad M, Hurri H, Kouri J-P. Relationships between spinal mobility, physical performance tests, pain intensity and disability assessments in chronic low back pain patients. Scand J Rehabil Med 1997;29:17–24.

    PubMed  Google Scholar 

  59. Gilmor J. Body mass index and health. Statistics Canada. http://www.statcan.ca/english/ads/82-003-XPB/toc.htm.

  60. McGill S, Childs A, Liebenson C. Endurance times for low back stabilization exercises: Clinical targets for testing and training from a normal database. Arch Phys Med Rehabil 1999;80(August):941–944.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

This project was funded by Sunnybrook & Women’s Practice Based Research Award as well as the Orthopaedic & Arthritic Institute Musculoskeletal Research Program. Special thanks to all the Sunnybrook & Women’s College Health Sciences Centre nurses that participated and promoted this study in difficult times.

Author information

Authors and Affiliations

  1. Departments of Occupational Health & Safety and Rehabilitation, Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Center, 43 Wellesly St. East, Toronto, Ontario, M4Y 1H1, Canada

    Suzanne Denis

  2. Department of Clinical Epidemiology and Biostatistics, and Program in Occupational Health and Environmental Medicine, McMaster University; Adjunct Scientist, Institute for Work & Health, Toronto, Canada

    Harry S. Shannon

  3. School of Rehabilitation Science, McMaster University, Hamilton, Canada

    Jean Wessel & Paul Stratford

  4. Musculoskeletal Research Program, Sunnybrook Health Sciences Center, Toronto, Canada

    Iris Weller

Authors
  1. Suzanne Denis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Harry S. Shannon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jean Wessel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paul Stratford
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Iris Weller
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Suzanne Denis.

Appendix: Physical performance measures

Appendix: Physical performance measures

Trunk range of motion measures:

The Modified Schöber and the Beattie extension measures for lumbar flexion and extension were performed as described by Moll and Wright [26] and Beattie et al. [27] respectively.

Trunk static endurance measures:

Subjects were informed that all trunk endurance tests were timed tests until fatigue. Before each endurance test, criteria for terminating the test were explained to the subject. Criteria included; subject unable to continue due to fatigue, subject terminating the test due to pain or other symptoms, and the rater terminating the test if the subject could not maintain the test position. The test position was described and demonstrated, and the subject instructed to maintain the test position as long as possible.

Sørenson test

  • The Sørenson test for extensor static endurance was performed with the subject positioned prone on treatment bed and the iliac crests level with the upper edge of the bed. The lower half of the body was secured to the treatment bed by means of 3 straps at the level of the greater trochanter, at the knee crease and at the malleolar level of the ankles. A pillow was placed on the bed under the ankles and legs and the 3 straps tightened as firmly as possible, considering the subject’s comfort level. The subject placed her hands on the floor, 40 cm below the top of the treatment bed.

  • The subject was instructed to place her hands across her chest and maintain her upper body in a position level with the lower body, i.e. parallel to the floor.

  • A small-suspended sac, with a 2.5-cm ribbon hanging off the end, was placed between the scapulae, controlling the horizontal position during the test. The subject was notified if the position was not maintained, i.e. the trunk was no longer in contact with the ribbon. The rater asked the subject to resume a level position with her trunk once, if this could not be successfully maintained the test was terminated.

Static flexion endurance test

  • The subject was positioned in crook lying with knees flexed to 90°, feet flat on bed and arms by their side.

  • The rater placed her middle finger at the edge of the subject’s inferior scapular angle. The subjects were asked to roll up so their fingertips glided up their thighs towards the knees. When the inferior angle of the scapula came off the treatment bed the subject was asked to stop and the level on the thigh reached was marked with the assessor’s finger. The subject was asked to lie back down and the distal edge of a piece of 1/2 inch adhesive tape was placed on the thigh at the fingertip mark.

  • The subjects were asked to curl up until their fingertips touched the tape and maintain that position. When the fingertips lost contact with the tape the test was ended.

Static side bridge endurance test

  • The side bridge test performed was a modification of the original test described by McGill et al. [60]. The subject was positioned in side lying, resting on a pronated forearm with the elbow placed under shoulder level. The legs were together, knees bent to 90°, and hips flexed no more than 20°.

  • The subjects were instructed that their body weight was to be supported on the forearm and outside of the leg. As they raised their hip off the bed a straight line was formed between the knees, hips and the shoulders. The non-supporting arm was held across the chest with the hand placed on the opposite shoulder. The rater’s hand was placed on the bed directly under the greater trochanter.

  • The subject was notified if the hip touched the rater’s hand. The rater asked the subject to resume a level position with their trunk once, if this could not be successfully maintained the test was terminated.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Denis, S., Shannon, H.S., Wessel, J. et al. Association of Low Back Pain, Impairment, Disability & Work Limitations in Nurses. J Occup Rehabil 17, 213–226 (2007). https://doi.org/10.1007/s10926-007-9065-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10926-007-9065-4

Keywords

Search

Navigation