Even the best back programs help little
Postal workers’ Cadillac’ program studied
The recent study of educational programs to prevent low back pain involved about 4,000 postal workers performing a variety of tasks in an industrial setting. The researchers put together an education program they felt represented the best found in any American workplace.
"We felt we had a real Cadillac back program," says Lawren H. Daltroy, DrPh, lead author of the study and associate director of the Robert Breck Brigham Multipurpose Arthritis and Musculoskeletal Diseases Center at Brigham and Women’s Hospital in Boston. "We didn’t want to assess a weak program. This was the best you could study, so we know you can trust the results."
And the results were surprising to the researchers, who have personally participated in many back schools to educate workers. James Ryan, MD, MPH, FACOEM, an OH physician and co-author of the study, says he was surprised to find such a definitively negative outcome.
"Honestly, we were expecting a different outcome," he says. "We were expecting it to have a significant impact. There were previous studies that were uncontrolled or poorly controlled, and they did show an impact. This was a big enough study that we should have seen the impact if it was there."
The program was taught by experienced physical therapists. They trained 2,534 postal workers and 134 supervisors, with everyone receiving three hours of training in a two-session back school.1 Afterward, they received three or four reinforcement sessions over the course of a few years. Injured workers were randomized a second time to either receive training or no training after their return to work.
Over 5.5 years of follow-up, 360 workers reported low back injuries, for a rate of 21.2 injuries per 1,000 worker-years of risk. The median time off for each injury was 14 days, and the median cost was $204. After returning to work, 75 workers were injured again.
"Our comparison of the intervention and control groups found that the education program did not reduce the rate of low back injury, the median cost per injury, the time off from work per injury, the rate of related musculoskeletal injuries, or the rate of repeated injury after return to work," the authors write. "Only the subjects’ knowledge of safe behavior was increased by the training."
In an accompanying editorial, Nortin M. Hadler, MD, a researcher at the University of North Carolina School of Medicine in Chapel Hill, praises the study and says "we must put an end to 50 years of disappointment in the quest for the correct way to lift.’"2 He goes on to say back pain should be seen more as a common illness than a workplace injury. "Back pain in the workplace is just one window on the human predicament," he writes. "Rather than focusing on ergonomic remedies, we should guarantee workplaces that are comfortable when we are well and accommodating when we are ill."
References
1. Daltroy LH, Iversen MD, Larson MG, et al. A controlled trial of an educational program to prevent low back injuries. N Engl J Med 1997; 337:322-328.
2. Hadler NM. Workers with disabling back pain. N Engl J Med 1997; 337:341-343.
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