Mickey Kerr

Disability resulting from occupational low back pain. Part II : What do we know about secondary prevention? A review of the scientific evidence on prevention after disability begins

This is the second of two papers that systematically review available scientific evidence on the causes of disability from occupational low back pain, and the effectiveness of interventions to prevent it after its onset (secondary prevention). This paper reviews the national history of how back pain and the risk factors for its extension into chronic disability, followed by a critical summary of intervention studies attempting to reduce the duration of this disability, and to evaluate the results.

Study of the effectiveness of a participatory ergonomics intervention in reducing worker pain severity through physical exposure pathways.

A participatory ergonomics programme was implemented in an automotive parts manufacturing factory. An ergonomics change team was formed composed of members from management and the organized labour union. It was hypothesized that the physical change projects implemented as part of this process would result in decreased worker exposures to peak and cumulative physical demands and reduced worker perceptions of physical effort and pain severity. A quasi-experimental design was employed, utilizing a sister plant in the corporation as a referent group. A longitudinal questionnaire approach was used to document pre-post changes in worker perceptions. In general, the physical change projects were rated as improvements by workers and were successful at reducing peak and/or cumulative mechanical exposures. However, there were few systematic changes in perceived effort or pain severity levels. Explanations include the confounding effects of differential production rate and staffing changes at the intervention and referent plants and/or insufficient overall intervention intensity due to a relatively short intervention period, plant and team ambivalence towards the process and the low overall impact on exposure of the particular changes implemented.

Effectiveness of a participatory ergonomics intervention in improving communication and psychosocial exposures

A participatory ergonomics programme was implemented in an automotive parts manufacturing factory in which an ergonomics change team was formed, composed of members from management, the organized labour union and the research team. It was hypothesized that the participatory nature of this change process would result in enhanced worker perceptions of workplace communication dynamics, decision latitude and influence, which in conjunction with anticipated mechanical exposure reductions would lead to reduced worker pain severity. Utilizing a sister plant in the corporation as a referent group, a quasi-experimental design was employed with a longitudinal, repeat questionnaire approach to document pre-post intervention changes. Nine participatory activities (psychosocial interventions) were implemented as part of the process. Communication dynamics regarding ergonomics were significantly enhanced at the intervention plant compared to the referent plant. However, there were no significantly different changes in worker perceptions of decision latitude or influence between the two plants, nor did pain severity change. Possible explanations for these results include limited intervention intensity, context and co-intervention differences between the two plants, high plant turnover reducing the statistical power of the study and lack of sensitivity and specificity in the psychosocial measures used. Further research should include the development of psychosocial tools more specific to participatory ergonomic interventions and the assessment of the extent of change in psychosocial factors that might be associated with improvements in pain.

Achieving a climate for patient safety by focusing on relationships

OBJECTIVE Despite many initiatives, advances in patient safety remain uneven in part because poor relationships among health professionals have not been addressed. The purpose of this study was to determine whether relationships between health professionals contributed to a patient safety climate, after implementation of an intervention to improve inter-professional collaboration. DESIGN/SETTING This was a secondary analysis of data collected to evaluate the Interprofessional Model of Patient Care (IPMPC) at The Ottawa Hospital in Ontario, Canada, which consists of five sites. A series of generalized estimating equation models were generated, accounting for the clustering of responses by site. PARTICIPANTS Thirteen health professionals including physicians, nurses, physiotherapists and others (n = 1896) completed anonymous surveys about 1 year after the IPMPC was introduced. INTERVENTION The IPMPC was implemented to improve interdisciplinary collaboration. MAIN OUTCOME MEASURES Reliable instruments were used to measure collaboration, respect, inter-professional conflict and patient safety climate. RESULTS Collaboration (β = 0.13; P = 0.002) and respect (β = 1.07; P = 0.03) were significant independent predictors of patient safety climate. Conflict was an independent and significant inverse predictor of patient safety climate (β = -0.29; P = 0.03), but did not moderate linkages between collaboration and patient safety climate or between respect and patient safety climate. CONCLUSIONS Through the IPMPC, all health professionals learned how to collaborate and build a patient safety climate, even in the presence of inter-professional conflict. Efforts by others to foster better work relationships may yield similar improvements in patient safety climate.

Nurses Negotiating Professional–Familial Care Boundaries Striving for Balance Within Double Duty Caregiving

The purpose of this sequential, two-phase mixed-methods study was to examine the health of male and female nurses who provided care to older relatives (i.e., double duty caregivers). We explored the experiences of 32 double duty caregivers, which led to the development of an emergent grounded theory, Negotiating Professional–Familial Care Boundaries with two broad dialectical processes: professionalizing familial care and striving for balance. This article examines striving for balance, which is the process that responds to familial care expectations in the midst of available resources and reflects the health experiences of double duty caregivers. Two subprocesses of striving for balance, reaping the benefits and taking a toll, are presented in three composite vignettes, each representing specific double duty caregiving (DDC) prototypes (making it work, working to manage, living on the edge). This emergent theory extends current thinking of family caregiving that will inform the development and refinement of practices and policies relevant to DDC.

Identifying Factors that Predict Women's Inability to Maintain Separation from an Abusive Partner

In this study, the extent to which nine indicators of intrusion (i.e., unwanted interference in everyday life) predicted the odds of women maintaining separation from an abusive partner was examined using data from a community sample of 286 Canadian women. Higher levels of depression and PTSD symptoms significantly and independently increased womens risk of being unable to maintain separation from a former or new abusive partner over a 12-month period (Odds Ratios 4.6 and 2.7, respectively). These finding underscore the importance of supporting women to identify and manage mental health problems as a means of enhancing their safety.