Take Home Messages:

1. Neck pain typically follows a persistent or recurrent course. Between 60% to 80% of workers who advise a sore neck at some point report they have a sore neck a year later.
2. Age has little impact on the outlook for neck problems.
3. Most evidence indicates that specific workplace or physical job demands did not impact recovery from neck problems.
4. White collar workers had shorter sick leave time that blue collar workers.
5. There is reasonable evidence to indicate that workers who are engaged in general exercise and sporting activities are more likely to experience improvement in neck pain.
6. Prior neck problems and prior sick leave increase the likelihood of a poorer recovery.

Why the study matters:

Neck problems are common in the community, and common in employees.

What the study involved:

The Bone and Joint Decade is an initiative of the United Nations and the World Health Organisation. The Task Force on Neck Pain and Its Associated Disorders was set up as part of the Bone and Joint Decade. The taskforce comprised a 13-member Scientific Secretariat, a 17-member Advisory Committee, in association with 18 research associates and graduate students. The major work of the taskforce was to review and summarise available neck research.

This research paper summarised information about the outlook for workers with neck pain. 226 studies were reviewed for this paper and of those 70 were accepted as of sufficient scientific quality to be included in the review.

Summary of study findings:

The authors point out that having an understanding of the course of neck pain guides expectations for recovery. Identifying factors that will make a difference also assists workplaces to develop appropriate policies, promote lifestyle changes that reduce neck problems, and help formulate ways of improving the workplace to assist.

The findings were as follows:

1. The course of neck pain Employees who report neck pain have a 50% chance of reporting neck pain if asked a year later. Many of the studies asked people about whether they had neck pain at specific points in time, but in general the study found that neck pain was often a long term bother. Those with severe neck pain when first asked had reduced likelihood of neck pain recovery.
2. The findings that neck pain is often a long term problem is consistent with studies of the general population (including workers and non workers).
3. Women are a little more likely to report persistent or recurrent neck pain when compared to men. Older age does not seem to be an important predictor of recovery in workers with neck pain.
4. Job demand characteristics and ergonomic factors that have been studied have little or no predictive value in determining whether the neck problem will improve or not. The researchers point out that factors such as working on an assembly line, working on a sewing machine, employment duration, hours of work, strenuousness of work operations, physical load, heavy lifting or overhead work had little or no relationship to long term outlooks.
5. Factors that did show an increased likelihood of a poor outcome were previous musculoskeletal conditions, previous sick leave, and people who worked in blue collar versus white collar jobs. For some occupations, such as sewing machine operators, changing jobs was associated with a better outlook.
6. Feeling that one has little influence over the work situation had a modest impact on outlook, with people feeling that they did not have influence over the situation having poorer outcomes.
7. Exercise was associated with a better neck outlook, although the authors pointed out this was different from general population studies were exercise did not improve recovery.

Original research:

Elastic lumbar supports can be purchased at a number of outlets, and they are typically in the order of $100.

It’s generally been considered that lumbar back supports don’t help prevent back problems.  However one study completed a few years ago showed that it could help reduce injuries in homecare workers. Homecare workers go into people’s houses to clean or help with personal care. 

This study, undertaken by the wonderfully practical EMGO Institute in the Netherlands, looked at whether providing lumbar support for homecare workers who had back problems made a difference, and if so, whether it was cost effective.

For the people who had ongoing back problems, researchers measured the number of days they reported back complaints; the number of days they were off work; and their reported quality of life. Researchers also measured direct and indirect costs.

Homecare workers who were given a lumbar support had an average of 54 fewer days with back pain and an average of five days less time off work. 

Direct costs were €235 lower in those who were given the lumbar support, while indirect costs were €255 lower in those who received back supports.

Some of these results were not statistically significant. This probably means that researchers did not have enough people in this study to ensure that the results were not by chance only. 

Nevertheless, they conclude these are important findings and recommend other larger studies are done. They also recommend that more studies be done looking at the impact of lumbar support for people who are not homecare workers.

Back complaints in homecare workers are a significant problem. There are often not a lot of modified duties available, and if there are simple strategies to help the worker get back to their usual job then it is worth implementing them.

This study is worthwhile, as lumber supports are a fairly simple - and cost effective - way of assisting people with back problems. 

Authors

Roelofs PD. Bierma-Zeinstra SM. van Poppel MN. van Mechelen W. Koes BW. van Tulder MW.

Institution

Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. p.roelofs@erasmusmc.nl

Title

Cost-effectiveness of lumbar supports for home care workers with recurrent low back pain: an economic evaluation alongside a randomized-controlled trial.

Source

Spine. 35(26):E1619-26, 2010 Dec 15.

Abstract

STUDY DESIGN: Economic evaluation from a societal perspective alongside a 12-months randomized-controlled trial.

OBJECTIVE: To determine the cost-effectiveness of wearing a lumbar support for home care workers with recurrent low back pain (LBP) (secondary prevention).

SUMMARY OF BACKGROUND DATA: LBP is a large medical and economical burden. Evidence on the secondary preventive use of lumbar supports is sparse.

METHODS: A total of 360 home care workers with a self-reported history of LBP were randomly assigned to usual care or usual care plus wearing a lumbar support on working days with LBP, during a 1-year period. Primary clinical outcome measures were the average number of self-reported days with LBP, number of calendar days sick leave in general, and quality of life. Direct and indirect costs were measured by means of cost diaries. Differences in mean costs between groups, cost-effectiveness, and cost-utility ratios were evaluated, and cost-effectiveness planes and acceptability curves presented by applying nonparametric bootstrapping techniques.

RESULTS: During the intervention period, the home care workers using a lumbar support in addition to usual care reported on average 54 fewer days with LBP (95% confidence interval [CI], -85 to -29). The estimated mean difference in sick leave was not statistically significant (-5.0 days per year in favor of the lumbar support group; 95% CI, -21.1 to 6.8). There was no statistically significant difference in quality of life. Direct costs were 235 euros (US$ 266) lower in the lumbar support group (95% CI, -386 to -79). Indirect costs were 255 euros (US$ 288) lower, but this was not statistically significant (95% CI, -879 to 299).

CONCLUSION: Lumbar support seems to be a cost-effective addition to usual care for home care workers with recurrent LBP. For estimating the LBP-related indirect costs, it would be more precise when an objective measure for LBP-related sick leave would have been available. There is a need for more evidence to confirm these findings, also in other working populations.

Pubmed link:  http://www.ncbi.nlm.nih.gov/pubmed/20823783

Course and prognostic factors for neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.
L. J. Carroll, S. Hogg-Johnson, P. Cote, G. van der Velde, L. W. Holm, E. J. Carragee, E. L. Hurwitz, P. M. Peloso, J. D. Cassidy, J. Guzman, M. Nordin, S. Haldeman, Bone, P. Joint Decade -2010 Task Force on Neck and Disorders and Its Associated.
Spine 2008;33:S93-100.
 

Link to PubMed abstract