DR.

MELINDA JÁROMI (Orcid ID : 0000-0002-8931-3470)

Accepted Article
Article type : Original Article

Back School programme for nurses has reduced low back pain levels: a randomized

controlled trial

Járomi M3 , Kukla A4, Szilágyi B1, Ugron Á5, Kovácsné Bobály V2, Makai A2 , Linek P6,

Ács P7, Leidecker E1

1
University of Pécs, Faculty of Health Sciences, Institute of Physiotherapy and Sport

Sciences
2
University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences
3
Deputy Head of Institute, University of Pécs, Faculty of Health Sciences, Institute of

Physiotherapy and Sport Science

4
Veterans Administration Louis Stokes Medical Center, Cleveland
5
Babes-BolyaiUniversity Cluj-Napoca, Faculty of Physical Education and Sport, Institute

of Physiotherapy and TheoreticalSubjects

Babes-Bolyai University
6
Department of Kinesitherapy and Special Methods in Physiotherapy, The Jerzy Kukuczka

Academy of Physical Education in Katowice

7
Head of Institute, University of Pécs, Faculty of Health Sciences, Institute of Physiotherapy

and Sport Science

This article has been accepted for publication and undergone full peer review but has not
been through the copyediting, typesetting, pagination and proofreading process, which may
lead to differences between this version and the Version of Record. Please cite this article as
doi: 10.1111/jocn.13981
This article is protected by copyright. All rights reserved.
 Corresponding author:
Accepted Article
Melinda Járomi

Senior Lecturer, Deputy Head of Institute

University of Pécs, Faculty of Health Sciences, Institute of Physiotherapy and Sport Sciences

Rétst4.,Pécs H-7621, Hungary

Tel.: +36 72 535-980

Fax number: +36 72 535-984

E-mail: jaromi@etk.pte.hu

Authors:

Pongrác Ács

Associate Professor, Head of Institute

University of Pécs, Faculty of Health Sciences, Institute of Physiotherapy and Sport Sciences

Rétst4.,Pécs H-7621, Hungary

Tel.: +36 72 535-980

Fax number: +36 72 535-984

E-mail: pongrac.acs@etk.pte.hu

Eleonóra Leidecker

Assistant Lecturer

University of Pécs, Faculty of Health Sciences, Institute of Physiotherapy and Sport Sciences

Rétst4.,Pécs H-7621, Hungary

Tel.: +36 72 535-980

This article is protected by copyright. All rights reserved.

 Fax number: +36 72 535-984
Accepted Article E-mail: noran@etk.pte.hu

Aniko Kukla DNP, RN, CPNP

Veterans Administration Louis Stokes Medical Center.

10701 East Blvd

Cleveland, OH, 44106

216-242-7078

E - mail:anikokukla@gmail.com

Brigitta Szilágyi

Assistant Lecturer

University of Pécs, Faculty of Health Sciences, Institute of Physiotherapy and Sport Sciences

Rétst4., H-7623 Pécs, Hungary;

Tel.: +36 72 535-980

Fax number: +36 72 535-984

E-mail: brigitta.szilagyi@etk.pte.hu

Ágnes Simon-Ugron

Senior Lecturer

Babes-BolyaiUniversity Cluj-Napoca, Faculty of Physical Education and Sport, Institute

of Physiotherapy and TheoreticalSubjects

Babes-Bolyai University

No.1 Mihail Kogalniceanu Street,RO-400084Cluj-Napoca

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 Fax.0040-264-420709.
Accepted Article E-mail:ugron.agnes@ubbcluj.ro

Viktória Kovácsné Bobály

PhD Student

University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences

7621 Pécs, Vörösmarty st. 4.

Phone +36 (72) 513-678

E-mail: viktoria.bobaly@gmail.com

Alexandra Makai

PhD Student

University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences

7621 Pécs, Vörösmarty st. 4.

Phone +36 (72) 513-678

E-mail: makaiszasza@gmail.com

Pawel Linek

Physiotherapist

Department of Kinesitherapy and Special Methods in Physiotherapy, The Jerzy Kukuczka

Academy of Physical Education in Katowice

Mikolowska str. 72B

Katowice, 40-065

Poland

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 E-mail: linek.fizjoterapia@vp.pl
Accepted Article
Acknowledgments:

The present scientific contribution is dedicated to the 650th anniversary of the foundation of

the University of Pécs, Hungary.

Conflict of interest: The final version of the article has been read and approved by all

authors. The authors have no interests.

ABSTRACT

Background: Millions of nurses around the world suffer from occupational-related chronic

non-specific low back pain (cnsLBP). Generally, LBP in nurses is a result of increased

pressure on the spine, and can be associated with improperly conducted patient lifting

techniques.

Aims and Objectives: The purposes of the study were:1) to examine patient lifting

techniques used by nurses; and 2) to evaluate an effectiveness of the Spine Care for Nurses

programme in cnsLBP reduction and the execution of proper patient lifting techniques.

Methods: A randomized controlled trial was conducted among 137 nurses with cnsLBP.

Participants were randomized into an experimental and control group (experimental group

n=67, control group n=70). Nurses in the experimental group attended the Spine Care for

Nurses programme for three months. The programme consisted of didactic education, spine-

strengthening exercises, and education on safe patient handling techniques. The control group

only received a brief written lifestyle guidance. The Zebris WinSpine Triple Lumbar

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 examination was utilised to analyse nurses’ patient lifting techniques (horizontal and vertical
Accepted Article lifting). The lumbar pain intensity was measured with a 0–100 Visual Analogue Scale (VAS).

Results: The pre-intervention average cnsLBP intensity score on VAS decreased from 49.3,

to the post-intervention score of 7.5. The correct execution of vertical lifting techniques in the

experimental group increased from 8.91% to 97.01% (control group: 8.57% pre and post

11.42%). The horizontal patient lifting technique pre-intervention increased from 10.44% to

100% correct execution in the experimental group (control group: pre 10.00% and post

11.42%).

Conclusion: The Spine Care for Nurses programme significantly reduced cnsLBP and

increased the number of properly executed horizontal and vertical patient lifting techniques in

nurses.

Keywords: chronic non-specific low back pain (cnsLBP) in nurses; Spine Care for Nurses

Programme; Back School; proper patient lifting and handling techniques; horizontal and

vertical patient lifting techniques.

Findings are reported in accordance with the CONSORT reporting guidelines.

Summary Box

What does this paper contribute to the wider global clinical community?

- Presents outcomes of a spine health and exercise programme specifically designed for

nurses

- Draws attention to the interventions aimed at preventing and decreasing the occurrence and

intensity of lower back pain among nurses.

- Presents elements of improper movements that increase the load on the lower spine, and

describes proper and improper patient handling techniques.

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 INTRODUCTION
Accepted Article
Chronic non-specific low back pain syndrome (cnsLBP) is a significant occupational

health problem among health professionals around the globe. Among health workers, nurses

are the most vulnerable population for these types of injuries, as patient handling tasks, such

as horizontal and vertical lifting, are an unavoidable part of daily patient care. If not executed

properly, patient handling tasks lead to low back injuries and cause pain and suffering (Yassi

et al. 2001, Edlich et al. 2004, Bolanle et al. 2010, Genc et al. 2016, Molics et al 2013). The

European Occupational Safety and Health Administration (OSHA, 2016) identifies the

following risk factors contributing to cnsLBP: low physical strength in health-care personnel,

inadequate knowledge and practice of patient lifting techniques, improper or unavailable

lifting equipment or lack of assistance when transferring patients. CnsLBP injuries are the

result of repetitive motion, microtrauma, improper posture, and unplanned movements during

patient lifting/transferring (Oláh 2006, Karahan et al. 2009).

Background

Programmes called ‘Back School’, designed specifically for health-care professionals,

provide education about spine health and ergonomic training. A prior study has shown that

the Back School programme reduces the occurrence and intensity of cnsLBP in health-care

workers (Járomi et al. 2012, Ghadyani et al. 2016, Shieh et al. 2016,). The theoretical part of

the programme is aimed at increasing knowledge related to spinal anatomy, biomechanics

and body mechanics. Furthermore, safe patient handling/lifting skills and rules are presented

to the nurses along with tips for spinal protection during leisure and at work activities. The

exercise programmes include muscle strengthening, correct posture, mobilizing and

stretching activities and the practice of proper patient handling/lifting techniques (Mannion et

al. 2001, Monroe et al. 2011, Meng et al. 2011).

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 Possible outcomes of a spine health and ergonomic training programme are: increased
Accepted Article spine health knowledge, increase in physical strength, improved posture and averted

microtrauma from incorrect repetitive motion. Moreover, spine-friendly patient handling

techniques, such as a traumatic patient handling using the Bobath and the Dotte methods are

great options for instruction. These techniques help health-care workers to execute effective

patient handling/lifting and reduce the occurrence of new back pain caused by patient lifting

(Kingmal et al. 2006, Gill et al. 2007). There exist low back pain prevention programmes that

have different intensity, number of sessions, content of education and results (Hartvigsen et

al. 2005, Jaromi et al. 2012).

The purposes of the study were to examine patient lifting techniques utilized by

nurses during patient handling and lifting tasks, and to evaluate whether an intervention

programme called Spine Care for Nurses would result in a reduction of cnsLBP, and an

improvement in the execution of proper patient lifting techniques. Hypotheses: (1) we

assumed that nurses do not use appropriate patient handling/lifting techniques; (2) we

hypothesized that nurses, while lifting patients, use techniques of major trunk flexion and

improper rotational movements, which as a result increases the load on the spine, especially

in the lower back; (3) we assumed that after the Spine School Programme, handling and

lifting techniques improve, flexion and rotational movements decrease during lifting patients

and the intensity of low back pain decreases among nurses.

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 METHODS
Accepted Article Participants

The nurses were recruited from the local academic medical centres with the help of

the head nurses. The study was carried out at the University of Pécs, Faculty of Health

Sciences, Institute of Physiotherapy and Sports Sciences and was approved by the Regional

Research Committee of the Clinical Centre, Pécs, Hungary (No.: 6145).

The participants were collected from january to march 2015. All

subjects signed the consent form to participate based on the Declaration of

Helsinki.

Inclusion criteria: nurses with diagnosed cnsLBP (persistent pain for at least 13 weeks

prior the study), nurses currently employed in a health-care setting and who had worked as

bedside nurses for at least three years prior the study.

Exclusion criteria: nurses with one or more diagnoses of the following: acute or

subacute LBP, spondylolisthesis, ankylosing spondylitis, fracture, central or peripheral

neurological disorders, cauda syndrome, herniated spinal disc, had received surgical

recommendations to correct the reason for back pain, tumor, failed back syndrome, rheumatic

or musculoskeletal disease that narrows joint motion by 30%, depression and other

psychiatric diseases (based on medical documentation), chronic pain syndrome,

gynaecological and urological diseases resulting in lumbosacral pain, pregnancy, were

receiving current or were within three months of receiving physical therapy, or had

undergone spine surgery within the last six months.

Sample size calculation

The sample size was calculated in order to have a confidence interval (CI) of 95%,

with a significance level of 5% (VAS values after tree month physiotherapy, as reported in

previous studies of CLBP). We required 73 participants per group (Sahin et al 2011)

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Accepted Article Randomization

Nurses who met the inclusion criteria were included in the study. Subjects were

randomly assigned to either the experimental or control groups by drawing lots using the

group numbers. Individuals who drew the number ‘1’ were assigned to the experimental

group and those who drew number ‘2’ were assigned to the control group.

The trial was a single-blind study. The survey was conducted by a physiotherapist who has

experience in using the Zebris system, who did not take part in the back school program, and

who did not know which participant belongs to the study group and which to the control

group.

Outcome measurements

Lifting techniques were assessed by Zebris WinSpine Triple Lumbar biomechanical

motion analysis (Zebris Medical GmbH). During the triple lumbar biomechanical study, two

triplets, microphones with three fixed positions, were placed at the height of the lumbar 1 and

the lumbar 5 vertebrae’s processus spinosus. The participant was standing in front of the

camera at a distance of 80 cm. The camera and the longitudinal axis of the triplet was at a 45

degree angle. The nurses were asked to perform two types of patient handling tasks: vertical

lifting, facilitating the patient from a seated to a standing position; and a horizontal lifting,

transfer. The examination was carried out by a physiotherapist who was trained in the use of

ZEBRIS Systems. The Visual Analogue Scale (VAS) was used to measure pain level (0–100

ranked VAS scale; 0 = ‘no pain’ 100 = ‘unbearable pain’). The participants were asked to

report the average cnsLBP pain experienced during the previous week (before the study

began and again after the experiment).

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 Intervention
Accepted Article In our research, the Back School programme called Spine Care for Nurses (Járomi et

al. 2012) was applied to the experimental group. The programme was performed twice a

week for 12 weeks in 60-minute session each (total 24 sessions). The study participants were

advised to carry out on a daily basis the learned exercises at home, with a frequency of at

least five times a week, for 20 minutes per day. Additionally, we recommended that they

applied the learned exercises and patient lifting techniques in their daily routines and work.

Written materials were disseminated among participants in the experimental group to support

the acquirement of their recommended exercises and patient lifting/transferring skills (Table

3). The control group only received brief written lifestyle guidance.

Statistical analysis

A randomized, controlled, prospective, quantitative, longitudinal clinical trial was

performed. The SPSS 22.0 statistical software was used for statistical analysis. Based on the

normality test of the non-parametric data (Kolmogorov–Smirnov test), the Wilcoxon test was

used for comparison within groups for continuous scales, Mann–Whitney U test was assessed

to compare the intervention and control group results, or χ2-test were utilized to examine

further differences between the intervention and control group. Time dependent changes in

VAS score for both groups were evaluated by rank analysis of covariance. Analyses were

adjusted for baseline data of VAS score and age, BMI, year of work in health care. The

results were considered significant at the level of p<0.05 and Bonferroni correction was

applied to reduce type I error in interpreting the data (α = 0.025).

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 RESULTS
Accepted Article The final study population consisted of 137 nurses (9 male, 128 female) with chronic

LBP syndrome. The nurses’ average age was 41.4 years (range: 29–52 yrs.). They had been

employed in a health-care setting for an average of 18.1 years (range: 5.5–28 yrs). The

average time from cnsLBP diagnosis was 25.8 weeks (range: 14–49 weeks).

The experimental group included 67 nurses (5 male, 62 female, average age: 41.7

years, range: 31–51 yrs; employed in healthcare for 17.3 years, range: 6–26 yrs), and there

were three fewer nurses in this group than in the control group (they resigned from

participation during the study because of health problems). The average time from cnsLBP

diagnosis was 25.9 weeks (range: 15–48 wks). The control group included 70 nurses (4 male,

66 female). The average age was 41.1 years (range: 29–50yrs); employed in healthcare: 19.8

years (range: 5.5–28 yrs). Time elapsed since the diagnosis of the cnsLBP was 27.2 (17–59)

weeks (Table 1, Table 2).

Examination of lifting techniques

Before the experiment vertical lifting was correctly performed by 8.95% and 8.57% in

the experimental and control group, respectively. After the Back School programme 97.01%

of the members of the experimental group carried out vertical lifting correctly. In the control

group only 11.42% of the nurse participants performed vertical lifting correctly (Table 4).

The range of motion(ROM) value of the trunk flexion during vertical lifting

significantly decreased in the experimental group (p˂0.001) after the Spine Care for Nurses

programme, which was contrary to the control group results where significant change in the

ROM value of the trunk flexion (p = 0.95) did not occur (Table 5).

At baseline, horizontal lifting was performed correctly by 10.44% in the experimental

group, and by 10.00% in the control group. After the Back School programme, 100.00% in

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 the experimental group and 11.42% in the control group performed patient handling correctly
Accepted Article (Table 3).

During horizontal lifting, the rotation measured at the lumbar spine had significantly

decreased in the experimental group (p˂0.001) after the study, whereas there was no

significant difference in the control group (p = 0.36). There was a significant (p˂0.001)

change in the rotational movement range (ROM) during horizontal lifting between the

experimental and the control groups when compared pre and post- intervention (Table 5).

Hypotheses (1) confirmed: nurses do not use appropriate patient handling/lifting

techniques. Hypotheses (2) confirmed: nurses, while lifting patients, use techniques of major

trunk flexion and improper rotational movements. Hypotheses (3) confirmed: after the Spine

School Programme, handling and lifting techniques improved, flexion and rotational

movements decreased during lifting patients.

Low back pain

The average intensity of the low back pain in the experimental group pre-intervention

was 49 (based on the VAS 0–100), and post-intervention the intensity decreased to

7(p˂0.001). In the control group the pain intensity did not change (p = 0.870). The between

group difference for pain intensity score post-intervention was significant (p˂0.001) (Table

6). Than we performed rank analysis of covariance where we adjusted the post VAS scores

for age, BMI and years of work in health care. We found significant difference between the

intervention and control group’s VAS score (F=281.620, p<0.001).

Hypotheses (3) confirmed: after the Spine School Program the intensity of low back

pain decreased among nurses.

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 DISCUSSION
Accepted Article
In several countries, nurses use regularly used preventive Directives, in order to handle LBP
and manual patient lifting (Dawson et al 2007, Edlich et al 2004, Yassi et al 2001, Trinkoff et
al 2003). In other countries, nurses’ low back pain is still a researched issue.

In this countries, preventive programs are not widely available, the correct technic of patient
handling is not automatic in nurses’ work, and their work is supported less by patient
handling equipments; low back pain is common among nurses

LBP is multifactoral, with physical and psychosocial factor. (Freimann et al 2016, Bernal et
al 2015, Feng et al 2007) Ergonomically poor posture, (Cmar-Medeni et al 2016, Suni et al
2016) vertical and horizontal lifting of patients is a physical risk factor among nurses, that
develops LBP. (Al-Eisa, Al-Abbad et al 2013).

Trunk flexion and rotation is an adverse moving for the spine while lifting.

In University Bolu Saglik, Turkey, Karahan and Bayrakatar conducted a survey, and they
observed, that 57,1-82% of the nurses do not use body mechanics correctly. (Karahan et al
2004).

In our survey, we received similar results; nurses tested by us, did not use vertical lifting in
91% and horizontal lifting in 89% correctly.

Several intervention programs (back pain counselling, neuromuscular exercise, back school
program, ergonomics program) were published for nurses, with the aim of increasing their
ergonomic knowledge, their physical ability and with the aim of reducing work related low
back pain. Intervention programs have different contents, as well as their efficiency is tested
in different ways. (Karahan et al 2013, Vieira et al 2006, Rasmussen et al, 2013, Suni et al
2016).

In University of Manitoba, Canada, Yassi and his colleagues used preventive program,
„prevent patient lift and transfer injuries of health care workers” ( University of Manitoba,
Canada), causing the decrease of low back pain intensity, and the decrease of frequency of
manual patient handling tasks.

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 In Selcu University Turkey, Sahin used exercise program, physical therapy (TENS,
ultrasound, hot pack) and back school program in his survey, causing the decrease of pain
Accepted Article
and the improvement of the functional status of spine. (Sahin et al 2011).

In University Medical Center Rotterdam, Koppelaar and his colleagues examined the effect
of using ergonomic devices. His result was; using ergonomic devices decrease the frequency
of manully lifting patients and in patient transfer, the time spent in ackward back posture
decreases (Koppelaar et al 2011)

Szeto and his colleagues used multifaced ergonomic intervention program, that consisted of
ergonomic training, of regular exercise and of typing training. The program effected the
decrease of the discomfort score, of the physical risk factor, andthe decrease of the
psychosocial risk factor. (Szeto et al 2013).

In our survey, we received similar results. We surveyed cnsLBP intensity and patient
lifting techniques among nurses during patient handling/lifting. Correct lifting methods were
taught as an intervention in the Spine Care for Nurses programme. After the Spine Care for
Nurse programme, nurses utilized lifting methods that were biomechanically correct and
reduced the load on the spine, resulting in the reduction of intensity of the cnsLBP.

Limitations and generalizability

The limitations of the study are a relative small sample size and the sample was

obtained with a convenience sampling method, therefore generalizability is limited.

Conclusion

CnsLBP among nurses is a result of improper patient lifting and transferring

techniques and it constitutes a significant problem in healthcare. The results of our study

show that a Back School programme effectively alters patient lifting methods in practice and

can reduce the intensity of pain in the lower lumbar region in nurses.

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 Relevance to clinical practice
Accepted Article The occurrence of cnsLBP is a common injury among nurses and is a result of poor

patient lifting techniques. Based on our research outcomes, we recommend that health-care

organizations should consider the implementation of regular Spine Care for Nurses

programmes (with a mixture of didactic and ergonomic exercise conducted at regular

intervals and minimum set hours) as successful low back injury prevention programmes.

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injuries in nurses. Journal of Nursing Administration 33(3), 153-8.

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workers. Spine (Phila Pa 1976) 26(16), 1739-1746.

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 Vieira R.E. (2005). Low back problems and possible improvements in nursing jobs. Nursing
Accepted Article and Healthcare Management and Policy doi:10.1111/j.1365-2648.2006.03877.x

Zatsiorsky, V.M. (2000). Kraft training, Meyer und Mayer, Wien.

Table 1 Flow diagram of how the number of participants has changed during the study

Assessed for eligibility (n=150)

Excluded (n=4)
Not meeting inclusion criteria (n=4)
Declined to participate (n=0)
Other reasons (n=0)

Randomized (n=146)

Allocated to intervention: Back School Programme
(n=73)
Received allocated intervention (n=67)
Did not receive allocated intervention (n=6)
4 private problems, 1 trauma, 1 pregnancy
Allocated to intervention: written lifestyle guidance
(n=73)
Received allocated intervention (n=70)
Did not receive allocated intervention (n=3)
3 private problems

Post-treatment Analysed (n=67) Post-treatment Analysed (n=70)

Excluded from analysis (n=0) Excluded from analysis (n=0)

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 Table 2 Datas of participants taking part in the study
Accepted Article
Total Intervention group Control group

n=137 n=67 n=70

Mean/Frequency Sd Mean/Frequency Sd Mean/Frequency Sd

Z p
Age 41.39 3.67 41.73 3.54 15158,00 3.80 -,701 ,483
Gender 9/128 5/62 4/66 -,411 ,681
BMI
24.66 1.80 24.70 1.84 24.61 -,495 ,621
(kg/m2) 1.78
Year of
work in
18.59 4.47 17.34 3.95 19.79 4.64 -3,295 ,001
health
care
LBP
26.60 10.00 25.94 9.36 27.22 10.60 -,699 ,484
(week)

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 Table 3
Accepted Article
The structure of the applied educational programme and movement therapy

Back School theoretical training Back School practical training

Week 1 -anatomy, biomechanical and -elongation exercises

body mechanical knowledge -isometric trunk muscle strengthening

about spine exercises in lying position

-compression, bending, torsion -exercises for correct body posture

and shear forces influencing the

spine and intervertebral discs

-biomechanical parameters of

correct body posture

Week 2 - spine-friendly working - development of correct body posture in

situations sitting position

- ergonomics of manual handling - isometric muscle strengthening exercises in

- ergonomics of work in front of sitting position

screen - elongation exercises

Week 3 - emergence of spine diseases, - adequate and inadequate lifting techniques

causes ofpain - isometric muscle strengthening exercises in

- prevention of spine diseases sitting and standing positions

Week 4 - motion elements loading the - practising correct spine usage

spine, correct spine usage - relaxation and breathing exercises

- vertical lifting techniques - exercises for trunk strengthening

- stretching exercises

Week 5 - motion elements loading the - practising correct spine usage

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 spine - static stabilization exercises
Accepted Article - horizontal lifting - patient handling exercises in case of inactive

- atraumatic patient handling patients

- patient handling according to

the method of Dotte

- patient handling according to

the method of Bobath

Week 6 - possibilities of treatment in - static stabilization exercises

spine diseases, mechanism of - patient handling exercises in case of partially

action, efficiency, indication, active patients

contraindication

Week 7 - the elements of spine-friendly - static stabilization exercises with tools

lifestyle - patient handling according to the method of

Dotte

- patient handling according to the method

ofBobath

Week 8 - spine-friendly lifestyle during - dynamic stabilization exercises

everyday activities - patient handling according to the method of

Bobath

Week 9 - spine-friendly lifestyle during - trunk muscle strengthening exercises in a

free time activities gym

Week 10 - spine-friendly sports - profession-specific motions

- progressive strength training on the basis of

biomechanics

Week 11 -spine protection and recreation - profession-specific motions

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 - trunk muscle strengthening exercises in yoga
Accepted Article and Pilates

Week 12 -spine protection in fitness - profession-specific motions

- trunk muscle strengthening exercises in

fitness, low-impact aerobic

(Kempf 2000, Zatsiorky 2000, Jordan 2002)

Table 4

Results of spine usage and lifting techniques pre- and post-intervention

Lifting Intervention Control

CI CI
techniques group (n=67) group (n=70)

n % lower upper n % lower upper χ2 p

VET2 6 8.956% 2,12% 15,79% 6 8.57% 2,01% 10,58%
HET VET

0,01 0,94
VET3 61 91.05% 84,21% 97,88% 64 91.43% 84,87% 97,99%
PRE

HET0 60 89.55% 82,23% 96,88% 63 90.00% 82,97% 97,03%

0,01 0,93
HET1 7 10.45% 3,12% 17,77% 7 10.00% 2,97% 17,03%
VET2 2 2.99% -1,09% 7,06% 7 10.00% 2,97% 17,03%
VET

VET3 2 2.99% -1,09% 7,06% 62 88.57% 81,12% 96,02% 119,09 <0.001

POST

VET4 63 94.03% 88,36% 99,70% 1 1.43% -1,35% 4,21%

HET

HET0 0 0.00% 0,00% 0,00% 62 88.57% 81,12% 96,02%

108,4 <0.001
HET1 67 100.00% 100,00% 100,00% 8 11.43% 3,98% 18,88%
Legend: PRE: Pre-intervention survey, POST: post-intervention survey, VET: vertical lifting technique, HET:

horizontal lifting technique, VET2: one-leg kneeling technique (correct lifting technique), VET3: Stoop

technique (improper lifting technique), VET4: squat technique (correct lifting technique), HET0: improper

horizontal lifting techniques, HET1: correct horizontal lifting techniques.

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 Table 5
Accepted Article Range of motion results of trunk flexion and rotation measured during patient lifting tasks

PRE POST
95% 95% 95% 95%
Z p
Mean SD CI CI Mean SD CI CI
values values
lower upper lower upper
Intervention
group
(n=67)
-
HET ROT 3.67 0.70 3,49 3,84 0.12 0.51 0,04 0,27<0.001
7.125
-
VET FLEX 50.25 1.63 49,82 50,64 36.78 3.57 35,89 37,65 <0.001
7.116
Control
group
(n=70)
-
HET ROT 3.68 .69 3,52 3,84 3.60 .75 3,43 3,77 0.356
0.922
-
VET FLEX 50.24 1.60 49,86 50,63 50.26 1.52 49,90 50,61 0.949
0.064
Legend: HET ROT: rotating component of horizontal lifting technique, VET FLEX: flexion component of the

vertical lifting technique, PRE: pre-intervention test, POST: post-intervention test, Min: minimum, Max: maximum,

SD: standard deviation.

Table 6

Pain results in the intervention and control groups at the start and after the treatment (VAS)

PRE POST
95% CI 95% CI 95% CI 95% CI Z p
Mean SD Mean SD
lower upper lower upper values values
Intervention
group (n=67)
VAS 49.03 6.42 47,58 50,54 7.51 8.30 5,61 9,79 -7.125 <0.001
Control group
(n=70)
VAS 49.26 6.44 47,81 50,84 49.30 7.73 47,44 51,03 -0.163 0.870
Legend: PRE: pre-intervention test, POST: post-intervention test, Min: minimum, Max: maximum, SD: standard

deviation, VAS: visual analogue scale.

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