Back Care Program

Long-term study shows that training can help prevent injuries

The majority of back injuries in construction
relate to manual materials handling.

 

by Nadine Marks, B.Sc. (P.T.), Project Coordinator, CSAO

Research conducted by CSAO indicates that a multifaceted training program can reduce the incidence of back injuries.

Background

Problems with back injuries in construction are well-documented and ongoing. Statistics from the Workplace Safety and Insurance Board (WSIB) show that back injuries continue to represent about 25% of all lost-time injuries (LTIs) in Ontario construction. This has been the case over the past decade, despite the fact that all-injury frequency has steadily decreased.

The majority of back injuries in construction (63%) are reported in connection with manual materials handling. Another 23% are due to slips and falls. The average cost of each of these injuries is $8,000. With a rate of about 2,200 back injuries in a typical year, that adds up to $18 million annually. A solution to the problem is urgently needed.

CSAO Program

Since 1990, CSAO has had a back care training program covering factors such as anatomy, posture, lifting techniques, ergonomics, exercises, treatment practices, and back care on and off the job.

The multifaceted program is based on adult learning principles designed to result in true attitudinal and behavioral changes. After each session, participants are evaluated to determine whether effective learning has occurred.

Program Evaluation

Because evidence on the effectiveness of education in preventing back injuries is limited, CSAO decided to evaluate its own back care program.

The specific objectives were to determine whether workers who had been trained in the program showed improvement in:

The sessions were conducted by a trained physical therapist. A back strength and flexibility exercise program was delivered concurrently. The study was conducted over a four-year period.

Subjects

Of the initial 44 subjects included in the study, 39 completed the 8-week training program. Their ages varied from 21 to 62 with a mean age of 44. All subjects had some history of low back disability, ranging from mild to moderately severe

.

 

The group consisted of 8 drywallers, 12 carpenters, 2 welders, 5 plumbers, 1 steamfitter, and 11 electricians. All were union members actively employed in their respective trades.

A control group was chosen to match the subjects in age, occupation, and range of LTIs for 1986-89, which was a period of relatively full employment and complete data.

Measures

The long-term effectiveness of the CSAO program in reducing back injuries was analyzed using LTI claim information from the WSIB.

In addition, when possible, worksite follow-up visits at 6-month intervals were conducted to track each subject's back condition and employment status. This biannual monitoring was continued for a total of 48 months.

At the start of the study, subjects were given a health questionnaire to complete. This provided subjective data on health generally and back pain in particular. The process was repeated at the end of the program and the results were compared.

In addition, a back fitness test measuring strength and flexibility was given before and after the program.

Short-term measures of outcome were based on results from these two evaluation methods: questionnaire and fitness test.

Results

Health Questionnaire - After taking the program, all subjects reported that their back pain was either at the same level or had decreased compared to what it was before the program. 90% of the subjects reported that everyday work activities were easier to perform after taking the program. 79% felt more optimistic about controlling their low back pain. All of the subjects said that the program was beneficial and that they were using at least some of the principles of proper back care on and off the job.

Back Fitness Test - Results showed no overall improvement in the group.

LTIs - From 1990 to 1995 there were no back LTIs in the group that had taken the CSAO program; in the control group there was a total of 14 lost-time back injuries.

Follow-up Visits - Interviews during the 4-year study revealed that subjects were using, on and off the job, some of the principles acquired in the program. This was confirmed by on-site observation. Only seven of the subjects had continued with a back exercise program.

 

There were no back LTIs in the group
that had taken the CSAO program.

 

Conclusions

  1. A back care program that covers points such as anatomy, posture, lifting, ergonomics, and warm-up exercises can help to control the problem of low back disability in construction.
  2. For participants in the program, the number of LTIs due to back injuries was significantly reduced.
  3. After taking the program, workers continued to practise the principles of proper back care to some degree on and off the job.
  4. The participants' perception of the severity of their own back pain and degree of disability improved. This psychological dimension is important because it can significantly affect a worker's likelihood of recurrent injury and success of recovery.
  5. There is a direct cost-effectiveness to a multifaceted back care program. The fact that low back injuries did not recur in the program group, compared to 14 LTIs in the control group, strongly suggests a positive effect, though a precise cost-benefit analysis was beyond the scope of this study.

For more information, refer to "An Evaluation of a Multifaceted Back Care Program for the Construction Industry" in Applied Occupational and Environmental Hygiene, Volume 12, Number 10, October 1997, pp. 642-7.


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