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Preventing back pain will require rethinking how we work

We need to a fundamental rethink of how we deal with work-related back problems. Valerie Everett

Nearly 10% of Australians (1.8 million people) have back problems, according to a report released today by the Australian Institute of Health and Welfare (AIHW) (based on data from the 2007-08 National Health Survey).

Prevalence doubles from the 15- to 19-year-old age group to the 30- to 34-year-old group. It’s fairly stable from 35 to 64, and then declines slightly. The peak coincides strongly with the working population, so it’s no surprise that the impact on productivity is substantial.

Back pain keeps people out of work. A 2009 Australian survey found a staggering 80% of people with back problems and disability had an employment restriction. About a third of the people suffering back problems work full-time compared to 47.5% of those without back problems. Those who have problems with their back are almost one-and-a-half times more likely to not be in the workforce at all.

And it costs: a 2001 Queensland study found that direct health-care costs for back pain was one billion a year, but indirect costs added a further eight billion.

The AIHW report found there was a slight change in the prevalence of back problems from the previous three years, but it was not statistically significant. Meanwhile, workers compensation data from Victoria shows that from 2003 to 2009 the frequency of claims for back disorders and other musculoskeletal disorders has declined at a slower rate than that of all claims as shown in the graph below. Claims in general decreased from 64,591 to 47,240 (36%), while claims for back problems decreased from 9,816 to 7,327 (25%).

Unpublished data, ISCRR, 2012

Indeed, chronic musculoskeletal disorders are the costliest of all conditions for workers compensation schemes and have been the focus of preventive campaigns for some time. But the fact that the rates are declining at a slower rate than for other complaints suggests that there’s scope for improvement.

Currently, occupational health and safety interventions focus on physical risk factors using a risk management framework in which hazards are identified, assessed and controlled. This approach is reflected in the national standards set by SafeWork Australia.

But, as the AIHW report and compensation data show, there’s little change in the number of people suffering from back problems despite current efforts. This suggests we need to think differently about prevention.

Interestingly, the report also finds people with back problems are more likely (2.5 times) to report affective disorders than people without such pain. It says the “chronic and pervasive nature of back problems often lead to poorer quality of life, psychological distress, mental disorders and disability.”

But occupational health research suggests there’s a more complex relationship between psychological distress and back pain. Evidence has been mounting that psychosocial factors associated with the way work is organised and the way people are managed are major determinants of this significant health problem, alongside a lack of decision-making latitude and poor relationships with supervisors.

A study of Boeing employees in Seattle in the late 1980s famously found that psychosocial risk factors predicted the occurrence of back pain much better than physical factors. Although the methodology of this study was subsequently criticised, the authors may have had a valid point.

Poor relationships with supervisors are predictors of back pain. Dominique/Flickr

An award-winning 1998 study showed that work-related backaches are not “all in your head” as one blog writer wrote in his headline. The study authors stated, “We can show that both physical and psychosocial conditions in the workplace play a role in causing back injury.”

Now, although there’s plenty of evidence that back problems have persisted despite a significant investment in prevention, there’s still a great resistance to including psychosocial factors in workplace risk management interventions. This is a classic case of the failure of translating research into practice.

Embracing findings like this requires a fundamental change in thinking about pain, about occupational health and safety, and about management responsibilities. It needs planned system-level and organisational change, probably starting with research to better understand the beliefs and interests that protect the physical model of back pain from challenge.

Meanwhile, research evidence mounts. Last week, I read a new study from the National Institute of Occupational Health in Norway. Over 2,000 employees in 28 organisations were followed up over two years to assess the exposure of fourteen psychological or social workplace risk factors and two mechanical risk factors for back pain, and back pain severity.

After adjusting for age, sex, skill level and back pain severity (and other potential confounders) at the outset of the study, the most consistent predictors of back pain prevention were found to be decision control, empowering leadership and fair leadership.

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