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Feasibility of an evidence-based stretching program on healthcare worker pain scores and professional quality of life

Lija Gireesh, DNP, APRN, FNP-BC, COHN-SChristiana Care Health System

Nursing Research Conference 11/2/2018

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Problem Identification & Significance

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Literature review

• Pain is the most common symptom associated with work related musculoskeletal disorders

• Consistent evidence in literature that workplace based physical activity interventions significantly reduce general musculoskeletal pain

• 10 articles identified and evidence appraised for the project

– 7 RCT and 3 Systematic Reviews of RCT

– 7 studies conducted in Europe and 3 in Asia

– Heterogeneity in interventions and subjects

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Gaps & Clinical implications

Gaps Paucity of an evidence‐based nurse driven program in United States to reduce musculoskeletal disorders among healthcare workers

Paucity of studies addressing relationship among confounding variables causing musculoskeletal disorders

Paucity of studies analyzing effects of a single intervention to reduce musculoskeletal disorders

Implications Negligible start‐up cost with significant long‐term benefits.

Nurse‐led evidence‐based project

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PICOT Question

What is the effect of an evidence-based stretching program at workplace compared to usual practice (no stretching program) on generalized pain scores and professional quality of life among healthcare workers during a four-week program?

(P): Healthcare workers (nurses, patient care technicians, clerks)

(I) : Stretching program at work for 10 minutes

(C) : Usual practice

(O) : Reduction in pain scores and improved professional QOL

(T) : 4 weeks

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Theoretical framework: Nola Pender’s Health promotion model

Retrieved from https://www.google.com/search?q=nola+pender%27s+health+promotion+model&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjupbL04_nVAhXFOCYKHVuRA7QQ_AUICigB&biw=1280&bih=904#imgrc=SFHD3gZPPiuy6M:&spf=1503918213871

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Project Design

• One group pre-test post-test comparative design• Convenience sample of healthcare workers• Inclusion: age 18-65 years, able to consent, participates at

least 2 times/week• Exclusion: Age > 65 years, serious medical conditions,

chronic pain• Power analysis using G*power based on Wilcoxon signed

rank test found 35 subjects required• Setting: Inpatient medical-surgical units of a tertiary care

hospital• Intervention:

10 minute evidence based stretching program during work hours for 4 weeks

Investigator developed brochure regarding stretching program

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Measures

• Variables– Generalized pain– Professional quality of life

• Tools– Visual Analogue Scale of Pain (VASP)– ProQOL– Investigator developed pre-screening tool– Investigator developed program evaluation tool

• Data collection– IRB approved– Secured through REDCap– Data collection at 2 timeframes

• After consenting prior to intervention • After program completion .

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Evaluation

• Data Analysis

– SPSS version 24 software

– Data cleaned, coded and checked for shape of distribution and outliers

– Pairwise deletion for missing data

– Descriptive statistics

– Non-parametric Wilcoxon signed rank test and paired T-test to test hypothesis

– Distribution of scores for each instrument evaluated

– Cronbach’s alpha for internal consistency

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Data Analysis: Participant Enrollment

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Results: Demographics

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Results: Pain Scores

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Results: ProQOL

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Strength & Limitations

• Strengths– Accessibility of the program to staff at their work site during work-

time.– Nurse-led proactive intervention– Fostered nursing culture of evidence-based practice and safety– Opportunity for the nurse prepared at DNP level to act as

transformational leader– Project planned using nursing theories

• Limitations– Feasibility project, hence results could not be generalized.– Healthcare workers with chronic pain excluded from the study, hence

effect of intervention on this population could not be studied. – No randomization – Lack of diversity in sample– Confounding variables were not evaluated

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Project summary

• Evidence-based stretching program at work place

• Cost effective intervention

• Nurse-led program

• Provided pilot data for the feasibility and sustainability of such a program at workplace.

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References

• Andersen, L. L., Christensen, K. B., Holtermann, A., Poulsen, O. M., Sjogaard, G., Pedersen, M. T., & Hansen, E. A. (2010). Effect of physical exercise interventions on musculoskeletal pain in all body regions among office workers: A one year randomized controlled trial. Manual Therapy, 15(1), 100 -104. doi: 10.1016/j.math.2009.08.004

• Bureau of Labor Statistics, U.S. Department of Labor (2016). Hospital workers suffered 294,000 nonfatal workplace injuries and illnesses in 2014. The Economics Daily.

• Masters, K. (2012). Nursing Theories: A framework for professional Practice. Sudbury, MA. Jones & Barlett Learning.

• Occupational Safety and Health Administration (OSHA) (2013). Facts about hospital worker safety. Retrieved from https://www.osha.gov/dsg/hospitals/documents/1.2_Factbook_508.pdf

• Pederson, M, T., Andersen, C. H., Zebis, M. K., Sjogaard, G., & Andersen, L. L. (2013). Implementation of specific strength training among industrial laboratory technicians: long term effects on back, neck and upper extremity pain. BioMed Central Musculoskeletal Disorders, 14, 287. doi: 10.1186/1471-2474

• ProQOL.org (2017). Professional quality of life elements: theory and measurements. Retrieved from http://www.proqol.org/Home_Page.php

• Tullar, J.M., Brewer, S., Amick, B. C., Irvin, E., Mahood, Q., Pompeti, L. A., Wang, A., Van Eerd, D., Gimeno, D. & Evanoff, B. (2010). Occupational safety and health interventions to reduce musculoskeletal symptoms in healthcare sector. Journal of Occupational Rehabilitation, 20 (2), 199- 219. doi:10.1007/s10926-010-9231-y

• Van, E. D., Munhall, C., Irvin, E., Rempel, D., Brewer, S., Van der Beek, A. J., … Amick, B. (2016). Effectiveness of workplace interventions in the prevention of upper extremity musculoskeletal disorders and symptoms: an update of the evidence. Occupational and environmental Medicine, 73(1), 62 -70. doi: 10.1136/oemed-2015-102992

• Zebis, M. K., Andersen, L. L., Pedersen, M. T., Mortensen, P., Andersen, C. H., Pedersen, M. M.,…..Sjogaard, G. (2011). Implementation of neck/shoulder exercises for pain relief among industrial workers: A randomized controlled trial. BioMed Central Musculoskeletal Disorders, 12, 205. doi: 10.1186/1471-2474-12-205

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