Association between recovery outcomes for work-related low back disorders and personal, family, and work factors.

STUDY DESIGN: Incident cases of work-related low back disorders were identified in an automotive metal stamping plant. Individuals were asked to recall health and work habits at the time of diagnosis of the work-related disorder and to report their current low back pain and physical functioning. OBJECTIVES: To evaluate five measures of health outcomes for work-related low back disorders in an industrial population and to determine potentially modifiable correlates of recovery. SUMMARY OF BACKGROUND DATA: The factors that influence recovery in actively working adults and how to best measure recovery outcome in this population are not well known. METHODS: Eighty-eight hourly employees of a metal stamping plant who experienced a work-related low back disorder were interviewed. Health status, health habits, and family and work relations were assessed with a structured interview to determine their association with various recovery outcomes (low back pain, low back pain disability, physical functioning, general physical health, and lost workdays). Interview information was supplemented with data from the plant's Occupational Safety and Health Administration Form 200 log. RESULTS: The clinical measures of recovery from the work-related low back disorders examined had similar overall predictive ability. However, in multivariate analyses, different potentially modifiable prognostic variables emerged as significant among them. Poorer self-rated health status and high personal stress were correlated with low back pain disability. Higher levels of cigarette smoking were correlated with higher levels of low back pain disability, lower physical functioning, and more severe low back pain at follow-up. CONCLUSION: The choice of measure of recovery from work-related low back disorders should be made in the context of the rehabilitation intervention goal. Interventions designed to modify and promote healthful personal behavior should be given more emphasis in rehabilitation efforts for work-related low back disorders.

Initiating an ergonomic analysis. A process for jobs with highly variable tasks.

Occupational health nurses play a vital role in addressing ergonomic problems in the workplace. Describing and documenting exposure to ergonomic risk factors is a relatively straightforward process in jobs in which the work is repetitive. In other types of work, the analysis becomes much more challenging because tasks may be repeated infrequently, or at irregular time intervals, or under different environmental and temporal conditions, thereby making it difficult to observe a "representative" sample of the work performed. This article describes a process used to identify highly variable job tasks for ergonomic analyses. The identification of tasks for ergonomic analysis was a two step process involving interviews and a survey of firefighters and paramedics from a consortium of 14 suburban fire departments. The interviews were used to generate a list of frequently performed, physically strenuous job tasks and to capture clear descriptions of those tasks and associated roles. The goals of the survey were to confirm the interview findings across the entire target population and to quantify the frequency and degree of strenuousness of each task. In turn, the quantitative results from the survey were used to prioritize job tasks for simulation. Although this process was used to study firefighters and paramedics, the approach is likely to be suitable for many other types of occupations in which the tasks are highly variable in content and irregular in frequency.

Epidural administration of methylprednisolone and morphine for pain after a spinal operation. A randomized, prospective, comparative study.

The results of postoperative epidural administration of saline solution (a placebo), morphine, methylprednisolone, and a combination of morphine and methylprednisolone for the reduction of pain after an operation for spinal stenosis or a herniated intervertebral disc were compared in a prospective, randomized blinded study. Epidural administration of morphine and methylprednisolone--either alone or in combination--significantly reduced the need for analgesia after an operation for spinal stenosis (p < 0.05) but not after an operation for a herniated intervertebral disc. Morphine and methylprednisolone did not have an addictive effect on the reduction of pain. Itching was significantly more common in the patients who had received morphine than in those who had received the placebo (p = 0.04). Although urinary retention was more frequent after the use of morphine than after the use of the placebo, the difference was not significant with the size of the sample that was analyzed (p = 0.25).

The effects of method of use, tool design, and roof height on trunk muscle activities during underground scaling bar use.

Epidemiologic studies have shown that the scaling bar, a hand tool used in underground mining, is frequently associated with the risk of back injury. An experiment was performed to investigate the effects of method of tool use, mine roof height, and tool design upon the activity of six trunk muscles and the ability to exert force with the bar. Roof height and scaling bar design had the largest effects on levels of muscle activation. Striking force did not differ significantly between tool designs. A biomechanical model was used to evaluate the collective effects of the trunk musculature activities upon spine loading. It was found that a significant reduction in predicted spine compression and shear forces can be achieved through the use of a counterbalanced scaling bar. The implications of these results are discussed.