Accepted: 9 July 2017

DOI: 10.1111/jocn.13981

ORIGINAL ARTICLE

Back School programme for nurses has reduced low back pain
levels: A randomised controlled trial

Melinda J
aromi PhD, Senior Lecturer, Deputy Head of Institute1 | Aniko Kukla DNP, RN,
CPNP | Brigitta Szil

2 1

agyi MS, Assistant Lecturer | Agnes Simon-Ugron PhD, Senior

ria Kov

Lecturer3 | Vikto
Bob

acsne aly MS, PhD Student4 | Alexandra Makai MS, PhD
Student4 | Pawel Linek PhD, Physiotherapist5 | Pongr

PhD, Habil, Associate
ac Acs

ra Leidecker MS, Assistant Lecturer1
Professor, Head of Institute1 | Eleono

1
Faculty of Health Sciences, Institute of
Physiotherapy and Sport Science, University
Aims and Objectives: (i) To examine patient lifting techniques used by nurses, and

cs, Pecs, Hungary
of Pe (ii) to evaluate an effectiveness of the Spine Care for Nurses programme in chronic
2
Veterans Administration Louis Stokes nonspecific low back pain syndrome reduction and the execution of proper patient
Medical Center, Cleveland, OH, USA
3 lifting techniques.
Faculty of Physical Education and Sport,
Institute of Physiotherapy and Theoretical Background: Millions of nurses around the world suffer from occupational-related
Subjects, Babes-Bolyai University, Cluj-
chronic nonspecific low back pain (chronic nonspecific low back pain syndrome).
Napoca, Romania
4
Faculty of Health Sciences, Doctoral Generally, low back pain in nurses is a result of increased pressure on the spine and
School of Health Sciences, University of can be associated with improperly conducted patient lifting techniques.
Pe
cs, Pecs, Hungary
5
Methods: A randomised controlled trial was conducted among 137 nurses with
Department of Kinesitherapy and Special
Methods in Physiotherapy, The Jerzy chronic nonspecific low back pain syndrome. Participants were randomised into an
Kukuczka Academy of Physical Education in
experimental and control group (experimental group n = 67, control group n = 70).
Katowice, Katowice, Poland
Nurses in the experimental group attended the Spine Care for Nurses programme for
Correspondence
3 months. The programme consisted of didactic education, spine-strengthening exer-
Melinda J
aromi, Faculty of Health Sciences,
Institute of Physiotherapy and Sport cises and education on safe patient handling techniques. The control group only

cs, Pe
Sciences, University of Pe
cs, Hungary.
received a brief written lifestyle guidance. The Zebris WinSpine Triple Lumbar exami-
Email: jaromi@etk.pte.hu
nation was used to analyse nurses’ patient lifting techniques (horizontal and vertical
lifting). The lumbar pain intensity was measured with a 0–100 visual analogue scale.
Results: The pre-intervention average chronic nonspecific low back pain syndrome
intensity score on visual analogue scale decreased from 49.3 to the postintervention
score of 7.5. The correct execution of vertical lifting techniques in the experimental
group increased from 8.91%–97.01% (control group: 8.57% pre-intervention test
and postintervention test 11.42%). The horizontal patient lifting technique pre-inter-
vention increased from 10.44%–100% correct execution in the experimental group
(control group: pre-intervention test 10.00% and postintervention test 11.42%).
Conclusion: The Spine Care for Nurses programme significantly reduced chronic
nonspecific low back pain syndrome and increased the number of properly executed
horizontal and vertical patient lifting techniques in nurses.

Findings are reported in accordance with the CONSORT reporting guidelines.

J Clin Nurs. 2018;27:e895–e902. wileyonlinelibrary.com/journal/jocn © 2017 John Wiley & Sons Ltd | e895


e896 | JAROMI ET AL.

Relevance to clinical practice: We recommend that healthcare organisations should

consider the implementation of regular Spine Care for Nurses programmes as suc-
cessful low back injury prevention programmes.

KEYWORDS
Back School, chronic nonspecific low back pain in nurses, horizontal and vertical patient lifting
techniques, proper patient lifting and handling techniques, Spine Care for Nurses programme

1 | INTRODUCTION What does this paper contribute to the wider

global clinical community?
Chronic nonspecific low back pain syndrome (cnsLBP) is a significant • Presents outcomes of a spine health and exercise pro-
occupational health problem among health professionals around the gramme specifically designed for nurses
globe. Among health workers, nurses are the most vulnerable popu- • Draws attention to the interventions aimed at preventing
lation for these types of injuries, as patient handling tasks, such as and decreasing the occurrence and intensity of lower
horizontal and vertical lifting, are an unavoidable part of daily patient back pain among nurses.
care. If not executed properly, patient handling tasks lead to low • Presents elements of improper movements that increase
back injuries and cause pain and suffering (Bolanle, Chidozie, Ade- the load on the lower spine, and describes proper and
wale, & Ayodele, 2010; Edlich, Winters, Hudson, Britt, & Long, improper patient handling techniques.
€ z, 2016; Molics et al., 2013; Yassi et al.,
2004; Gencß, Kahraman, & Go
2001). The European Occupational Safety and Health Administration
(OSHA, 2016) identifies the following risk factors contributing to from incorrect repetitive motion. Moreover, spine-friendly patient
cnsLBP: low physical strength in healthcare personnel, inadequate handling techniques, such as a traumatic patient handling using the
knowledge and practice of patient lifting techniques, improper or Bobath and the Dotte methods, are great options for instruction.
unavailable lifting equipment or lack of assistance when transferring These techniques help healthcare workers to execute effective
patients. CnsLBP injuries are the result of repetitive motion, micro- patient handling/lifting and reduce the occurrence of new back pain
trauma, improper posture and unplanned movements during patient caused by patient lifting (Gill, Bennett, Savelsbergh, & van Dieen,
lifting/transferring (Karahan, Kav, Abbasoglu, & Dogan, 2009; Ol
ah, 2007; Kingma, Faber, Bakker, & van Deen, 2006). There exist low
2006). back pain prevention programmes that have different intensity, num-
ber of sessions, content of education and results (Hartvigsen, Lau-
ritzen, Lins, & Lauritzen, 2005; Jaromi et al., 2012).
2 | BACKGROUND The purposes of the study were to examine patient lifting tech-
niques used by nurses during patient handling and lifting tasks and
Programmes called “Back School,” designed specifically for health- to evaluate whether an intervention programme called Spine Care
care professionals, provide education about spine health and ergo- for Nurses would result in a reduction of cnsLBP and an improve-
nomic training. A prior study has shown that the Back School ment in the execution of proper patient lifting techniques. Hypothe-
programme reduces the occurrence and intensity of cnsLBP in ses: (1) we assumed that nurses do not use appropriate patient
healthcare workers (Ghadyani, Tavafian, Kazemnejad, & Wagner, handling/lifting techniques; (2) we hypothesised that nurses, while
2016; Jaromi, Nemeth, Kranicz, Laczko, & Betlehem, 2012; Shieh, lifting patients, use techniques of major trunk flexion and improper
Sung, Su, Tsai, & Hsieh, 2016). The theoretical part of the pro- rotational movements, which as a result increases the load on the
gramme is aimed at increasing knowledge related to spinal anatomy, spine, especially in the lower back; (3) we assumed that after the
biomechanics and body mechanics. Furthermore, safe patient han- Spine School Programme, handling and lifting techniques improve,
dling/lifting skills and rules are presented to the nurses along with flexion and rotational movements decrease during lifting patients
tips for spinal protection during leisure and at work activities. The and the intensity of low back pain decreases among nurses.
exercise programmes include muscle strengthening, correct posture,
mobilising and stretching activities and the practice of proper patient
3 | METHODS
handling/lifting techniques (Mannion, Taimelas, & Muntener, 2001;
Meng et al., 2011; Monroe et al., 2011).
3.1 | Participants
Possible outcomes of a spine health and ergonomic training pro-
gramme are as follows: increased spine health knowledge, increase The nurses were recruited from the local academic medical centres
in physical strength, improved posture and averted microtrauma with the help of the head nurses. The study was carried out at the


JAROMI ET AL. | e897

cs, Faculty of Health Sciences, Institute of Physio-

University of Pe camera and the longitudinal axis of the triplet were at a 45-degree
therapy and Sports Sciences, and was approved by the Regional angle. The nurses were asked to perform two types of patient han-

cs, Hungary (No.:
Research Committee of the Clinical Centre, Pe dling tasks: vertical lifting, facilitating the patient from a seated to a
6145). standing position, and a horizontal lifting, transfer. The examination
The participants were collected from January–march 2015. All was carried out by a physiotherapist who was trained in the use of
subjects signed the consent form to participate based on the Decla- ZEBRIS Systems. VAS was used to measure pain level (0–100 ranked
ration of Helsinki. VAS scale; 0 = “no pain” 100 = “unbearable pain”). The participants
Inclusion criteria: nurses with diagnosed cnsLBP (persistent pain were asked to report the average cnsLBP pain experienced during
for at least 13 weeks prior the study), nurses currently employed in the previous week (before the study began and again after the
a healthcare setting and who had worked as bedside nurses for at experiment).
least 3 years prior the study.
Exclusion criteria: nurses with one or more diagnoses of the fol-
3.5 | Intervention
lowing: acute or subacute low back pain, spondylolisthesis, ankylos-
ing spondylitis, fracture, central or peripheral neurological disorders, In our research, the Back School programme called Spine Care for
cauda syndrome, herniated spinal disc, had received surgical recom- Nurses (Jaromi et al., 2012) was applied to the experimental
mendations to correct the reason for back pain, tumour, failed back group. The programme was performed twice a week for 12 weeks
syndrome, rheumatic or musculoskeletal disease that narrows joint in 60-min session each (total 24 sessions). The study participants
motion by 30%, depression and other psychiatric diseases (based on were advised to carry out on a daily basis the learned exercises
medical documentation), chronic pain syndrome, gynaecological and at home, with a frequency of at least five times a week, for
urological diseases resulting in lumbosacral pain, pregnancy, were 20 min per day. Additionally, we recommended that they applied
receiving current or were within 3 months of receiving physical ther- the learned exercises and patient lifting techniques in their daily
apy, or had undergone spine surgery within the last 6 months routines and work. Written materials were disseminated among
(Table 2). participants in the experimental group to support the acquirement
of their recommended exercises and patient lifting/transferring
skills (Table 1). The control group only received brief written life-
3.2 | Sample size calculation
style guidance.
The sample size was calculated to have a confidence interval (CI) of
95%, with a significance level of 5% (visual analogue scale [VAS] val-
3.6 | Statistical analysis
ues after 3-month physiotherapy, as reported in previous studies of
CLBP). We required 73 participants per group (Sahin, Albayrak, Dur- A randomised, controlled, prospective, quantitative, longitudinal clini-
mus, & Ugurlu, 2011). cal trial was performed. The SPSS 22.0 statistical software was used
for statistical analysis. Based on the normality test of the nonpara-
metric data (Kolmogorov–Smirnov test), the Wilcoxon test was used
3.3 | Randomisation
for comparison within groups for continuous scales, Mann–Whitney
Nurses who met the inclusion criteria were included in the study. U test was assessed to compare the intervention and control group
Subjects were randomly assigned to either the experimental or con- results or chi-square test was used to examine further differences
trol groups by drawing lots using the group numbers. Individuals between the intervention and control group. Time-dependent
who drew the number “1” were assigned to the experimental group changes in VAS score for both groups were evaluated by rank analy-
and those who drew number “2” were assigned to the control group. sis of covariance. Analyses were adjusted for baseline data of VAS
The trial was a single-blind study. The survey was conducted by score and age, BMI, year of work in health care. The results were
a physiotherapist who has experience in using the Zebris system, considered significant at the level of p < .05, and Bonferroni correc-
who did not take part in the Back School programme and who did tion was applied to reduce type I error in interpreting the data
not know which participant belongs to the study group and which to (a = 0.025).
the control group (Figure 1).

4 | RESULTS
3.4 | Outcome measurements
Lifting techniques were assessed by Zebris WinSpine Triple Lumbar The final study population consisted of 137 nurses (nine male, 128
biomechanical motion analysis (Zebris Medical GmbH). During the female) with chronic LBP syndrome. The nurses’ average age was
triple lumbar biomechanical study, two triplets, microphones with 41.4 years (range: 29–52 years.). They had been employed in a
three fixed positions, were placed at the height of the lumbar one healthcare setting for an average of 18.1 years (range: 5.5–28 years).
and the lumbar five vertebrae’s processus spinosus. The participant The average time from cnsLBP diagnosis was 25.8 weeks (range:
was standing in front of the camera at a distance of 80 cm. The 14–49 weeks).


e898 | JAROMI ET AL.

T A B L E 1 The structure of the applied educational programme and movement therapy

Back School theoretical training Back School practical training
Week 1 • Anatomy, biomechanical and body mechanical knowledge • Elongation exercises
about spine • Isometric trunk muscle strengthening exercises in lying posi-
• Compression, bending, torsion and shear forces influencing tion
the spine and intervertebral discs • Exercises for correct body posture
• Biomechanical parameters of correct body posture
Week 2 • Spine-friendly working situations • Development of correct body posture in sitting position
• Ergonomics of manual handling • Isometric muscle strengthening exercises in sitting position
• Ergonomics of work in front of screen • Elongation exercises
Week 3 • Emergence of spine diseases, causes of pain • Adequate and inadequate lifting techniques
• Prevention of spine diseases • Isometric muscle strengthening exercises in sitting and stand-
ing positions
Week 4 • Motion elements loading the spine, correct spine usage • Practising correct spine usage
• Vertical lifting techniques • Relaxation and breathing exercises
• Exercises for trunk strengthening
• Stretching exercises
Week 5 • Motion elements loading the spine • Practising correct spine usage
• Horizontal lifting • Static stabilisation exercises
• Atraumatic patient handling • Patient handling exercises in case of inactive patients
• Patient handling according to the method of Dotte
• Patient handling according to the method of Bobath
Week 6 • Possibilities of treatment in spine diseases, mechanism of • Static stabilisation exercises
action, efficiency, indication, contraindication • Patient handling exercises in case of partially active patients
Week 7 • The elements of spine-friendly lifestyle • Static stabilisation exercises with tools
• Patient handling according to the method of Dotte
• Patient handling according to the method of Bobath
Week 8 • Spine-friendly lifestyle during everyday activities • Dynamic stabilisation exercises
• Patient handling according to the method of Bobath
Week 9 • Spine-friendly lifestyle during free-time activities • Trunk muscle strengthening exercises in a 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
• Trunk muscle strengthening exercises in yoga and Pilates
Week 12 • Spine protection in fitness • Profession-specific motions
• Trunk muscle strengthening exercises in fitness, low-impact
aerobic

Kempf (2000), Zatsiorsky (2000), Jordan (2002).

The experimental group included 67 nurses (five male, 62 female, the experimental group carried out vertical lifting correctly. In the
average age: 41.7 years, range: 31–51 years; employed in health control group, only 11.42% of the nurse participants performed ver-
care for 17.3 years, range: 6–26 years), and there were three fewer tical lifting correctly (Table 3).
nurses in this group than in the control group (they resigned from The range of motion (ROM) value of the trunk flexion during ver-
participation during the study because of health problems). The aver- tical lifting significantly decreased in the experimental group
age time from cnsLBP diagnosis was 25.9 weeks (range: 15–48 (p ˂ .001) after the Spine Care for Nurses programme, which was
weeks). The control group included 70 nurses (four male, 66 female). contrary to the control group results where significant change in the
The average age was 41.1 years (range: 29–50 years); employed ROM value of the trunk flexion (p = .95) did not occur (Table 4).
in health care: 19.8 years (range: 5.5–28 years). Time elapsed since At baseline, horizontal lifting was performed correctly by 10.44%
the diagnosis of the cnsLBP was 27.2 (17–59) weeks. in the experimental group, and by 10.00% in the control group. After
the Back School programme, 100.00% in the experimental group and
11.42% in the control group performed patient handling correctly.
4.1 | Examination of lifting techniques
During horizontal lifting, the rotation measured at the lumbar
Before the experiment, vertical lifting was correctly performed by spine had significantly decreased in the experimental group
8.95% and 8.57% in the experimental and control group, respec- (p ˂ .001) after the study, whereas there was no significant dif-
tively. After the Back School programme, 97.01% of the members of ference in the control group (p = .36). There was a significant


JAROMI ET AL. | e899

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

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

F I G U R E 1 Flow diagram of how the
Excluded from analysis (n = 0) Excluded from analysis (n = 0)
number of participants has changed during
the study

T A B L E 2 Data of participants taking part in the study

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 15,158.00 3.80 0.701 .483
Gender 9/128 5/62 4/66 0.411 .681
BMI (kg/m2) 24.66 1.80 24.70 1.84 24.61 1.78 0.495 .621
Year of work in health care 18.59 4.47 17.34 3.95 19.79 4.64 3.295 .001
LBP (week) 26.60 10.00 25.94 9.36 27.22 10.60 0.699 .484

LBP, low back pain.

(p ˂ .001) change in the rotational movement range (ROM) Hypotheses (3) confirmed: after the Spine School Programme,
during horizontal lifting between the experimental and the the intensity of low back pain decreased among nurses.
control groups when compared pre- and postintervention
(Table 4).
Hypotheses (1) confirmed: nurses do not use appropriate patient 5 | DISCUSSION
handling/lifting techniques. Hypotheses (2) confirmed: nurses, while
lifting patients, use techniques of major trunk flexion and improper In several countries, nurses use regularly used preventive Directives,
rotational movements. Hypotheses (3) confirmed: after the Spine to handle LBP and manual patient lifting (Dawson et al., 2007; Edlich
School Programme, handling and lifting techniques improved, flexion et al., 2004; Trinkoff, Brady, & Nielsen, 2003; Yassi et al., 2001). In
and rotational movements decreased during lifting patients. other countries, nurses’ low back pain is still a researched issue.
In this countries, preventive programmes are not widely available,
the correct technique of patient handling is not automatic in nurses’
4.2 | Low back pain
work and their work is supported less by patient handling equip-
The average intensity of the low back pain in the experimental group ment; low back pain is common among nurses.
pre-intervention was 49 (based on the VAS 0–100), and postinter- Low back pain is multifactorial. Physical factors are (Bernal et al.,
vention, the intensity decreased to 7 (p ˂ .001). In the control group, 2015; Feng, Chen, & Mao, 2007; Freimann, Paasuke, & Merisalu,
the pain intensity did not change (p = .870). The between-group dif- 2016) ergonomically poor posture (Cmar-Medeni, Elbasan, & Duzgun,
ference for pain intensity score postintervention was significant 2016; Suni et al., 2016) and vertical and horizontal lifting of patients
(p ˂ .001) (Table 5). Then, we performed rank analysis of covariance that are the most common risk factors among nurses, that develops
where we adjusted the post-VAS scores for age, BMI and years of LBP (Al-Eisa & Al-Abbad, 2013).
work in health care. We found significant difference between the Trunk flexion and rotation is an adverse moving for the spine
intervention and control group’s VAS score (F = 281.620, p < .001). while lifting.


e900 | JAROMI ET AL.

T A B L E 3 Results of spine usage and lifting techniques pre- and postintervention

Control
Intervention group
group (n = 67) CI (n = 70) CI

Lifting techniques n % Lower (%) Upper (%) n % Lower (%) Upper (%) v2 p
PRE
VET VET2 6 8.956 2.12 15.79 6 8.57 2.01 10.58 0.01 .94
VET3 61 91.05 84.21 97.88 64 91.43 84.87 97.99
HET HET0 60 89.55 82.23 96.88 63 90.00 82.97 97.03 0.01 .93
HET1 7 10.45 3.12 17.77 7 10.00 2.97 17.03
POST
VET VET2 2 2.99 1.09 7.06 7 10.00 2.97 17.03 119.09 <.001
VET3 2 2.99 1.09 7.06 62 88.57 81.12 96.02
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 <.001
HET1 67 100.00 100.00 100.00 8 11.43 3.98 18.88

PRE, pre-intervention survey; POST, postintervention 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, impro-
per horizontal lifting techniques; HET1, correct horizontal lifting techniques.

T A B L E 4 Range of motion results of trunk flexion and rotation measured during patient lifting tasks
PRE POST

Mean SD 95% CI lower 95% CI upper Mean SD 95% CI lower 95% CI upper Z values p values
Intervention group (n = 67)
HET ROT 3.67 0.70 3.49 3.84 0.12 0.51 0.04 0.27 7.125 <.001
VET FLEX 50.25 1.63 49.82 50.64 36.78 3.57 35.89 37.65 7.116 <.001
Control group (n = 70)
HET ROT 3.68 .69 3.52 3.84 3.60 0.75 3.43 3.77 0.922 .356
VET FLEX 50.24 1.60 49.86 50.63 50.26 1.52 49.90 50.61 0.064 .949

HET ROT, rotating component of horizontal lifting technique; VET FLEX, flexion component of the vertical lifting technique; PRE, pre-intervention test;
POST, postintervention test; Min, minimum; Max, maximum; SD, standard deviation.

T A B L E 5 Pain results in the intervention and control groups at the start and after the treatment (VAS)
PRE POST

Mean SD 95% CI lower 95% CI upper Mean SD 95% CI lower 95% CI upper Z values p values
Intervention group (n = 67)
VAS 49.03 6.42 47.58 50.54 7.51 8.30 5.61 9.79 7.125 <.001
Control group (n = 70)
VAS 49.26 6.44 47.81 50.84 49.30 7.73 47.44 51.03 0.163 .870

PRE: pre-intervention test, POST: postintervention test, Min: minimum, Max: maximum, SD: standard deviation, VAS: visual analogue scale.

In University Bolu Saglik, Turkey, Karahan and Bayrakatar con- were published for nurses, with the aim of increasing their ergo-
ducted a survey, and they observed that 57,1%–82% of the nurses nomic knowledge, their physical ability and with the aim of reduc-
do not use body mechanics correctly (Karahan & Bayaraktar, 2004). ing work-related low back pain. Intervention programmes have
In our survey, we received similar results; nurses tested by us did different contents as well as their efficiency is tested in different
not use vertical lifting in 91% and horizontal lifting in 89% correctly. ways (Karahan & Bayaraktar, 2013; Rasmussen, Holtermann, Mor-
Several intervention programmes (back pain counselling, neuro- tensen, Sogaard, & Jorgensen, 2013; Suni et al., 2016; Vieira, Shra-
muscular exercise, Back School programme, ergonomics programme) wan, Helenice, & Jogesh, 2006).


JAROMI ET AL. | e901

In University of Manitoba, Canada, Yassi and his colleagues used ACKNOWLEDGEMENTS

preventive programme, “prevent patient lift and transfer injuries of
The present scientific contribution is dedicated to the 650th anniver-
health care workers” (University of Manitoba, Canada), causing the

cs, Hungary.
sary of the foundation of the University of Pe
decrease of low back pain intensity, and the decrease of frequency
of manual patient handling tasks.
In Selcuk University Turkey, Sahin used exercise programme, CONTRIBUTIONS
physical therapy (TENS, ultrasound, hot pack) and Back School pro-
Study design: MJ, AK, BS, Á-SU, VKB, EL; data collection and analy-
gramme in his survey, causing the decrease of pain and the improve-
sis: MJ, AM, PÁ, EL; and manuscript preparation: MJ, AK, BS, PL, EL.
ment of the functional status of spine (Sahin et al., 2011).
In University Medical Center Rotterdam, Koppelaar and his col-
leagues examined the effect of using ergonomic devices. His result CONFLICT OF INTEREST
was as follows using ergonomic devices decreases the frequency of
The final version of the article has been read and approved by all
manually lifting patients, and in patient transfer, the time spent in
authors. The authors have no interests.
awkward back posture decreases (Koppelaar, Knibbe, Miedema, &
Burdorf, 2011).
Szeto and his colleagues used multifaced ergonomic intervention ORCID
programme that consisted of ergonomic training, of regular exercise
Melinda J
aromi http://orcid.org/0000-0002-8931-3470
and of typing training. The programme effected the decrease of the
discomfort score, of the physical risk factor and the decrease of the
psychosocial risk factor (Szeto et al., 2013).
In our survey, we received similar results. We surveyed cnsLBP REFERENCES

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