Prevention and management of musculoskeletal pain at work in nursing staff. Design, implementation and evaluation of a multifaceted intervention in the workplace

Abstract

Background: Nursing staff is an occupational group at high risk of developing musculoskeletal pain (MSP). Multifaceted approaches are needed to reduce MSP and improve return-to-work of workers with MSP. Methods: A scoping review was carried out up to 16 Feb 2021 to identify the elements, tasks and referral services of case management interventions for the return-to-work of workers with musculoskeletal disorders. A two-armed multifaceted cluster randomized controlled trial of one year duration was designed, implemented in two tertiary hospitals during 2016-2017, and evaluated in terms of effectiveness, process and cost-effectiveness. The intervention encompassed three levels of prevention and consisted of participatory ergonomics, health promotion (Nordic walking, mindfulness and healthy diet) and case management. Control groups received usual occupational health care. The effectiveness outcomes were MSP, sickness absence and work functioning. MSP and work functioning were collected at baseline, six and 12-months follow-up. Sickness absence was obtained from Human Resources Department. Process evaluation used quantitative indicators of Steckler and Linnan’s framework (recruitment, reach, dose delivered and received, fidelity and satisfaction), and qualitative data from a content analysis of discussion groups (satisfaction and recommendations). Economic evaluation costs were calculated from societal and Health System perspectives. The effects were MSP, sickness absence and Quality-adjusted life years. Incremental cost-effectiveness ratios (ICERs) were calculated. Depending on the outcomes, statistical analyses were performed by means, logistic and/or linear regression through generalized estimated equations and cox proportional hazard. Results: The review reported several elements and tasks of case managers. The intervention randomized eight clusters including 473 nursing staff, and 257 answered the baseline questionnaire. At 12 months, the intervention group showed a statistically significant decrease of the risk in neck, shoulders and upper-back pain, compared to the control. No statistically significant effect was found for MSP in other locations, sickness absence nor work functioning. Process evaluation showed that participatory ergonomics and mindfulness were implemented successfully, healthy diet was well implemented but had low reach, and Nordic walking and case management showed a low level of implementation. Recommendations included flexibility during recruitment, offering activities in several time slots and tailored to shifts as well involving and empowering the nursing staff in the decision process. Total mean costs were €173.43 and €117.53 for the intervention and control groups, respectively. The intervention costs were €27.96 per person. The ICER was €3.63 from a societal perspective (€1.69 health system perspective) per achieve 1-extra percentual point reduction of MSP in neck, shoulders and upper-back. Conclusions: There is a need to establish an agreed definition of case management for MSDs and our review proposed key points for its description. The intervention was effective and cost-effective to reduce neck, shoulder and upper back pain. The process evaluation showed that the implementation of INTEVAL_Spain was predominantly carried out as intended and recommendations to improve the intervention implementation process are proposed. Trial registration: ISRCTN15780649 Retrospectively registered, date assigned 13 July 2018.