Prevalence of Pain among Intensive Care Unit Personnel

Low Back Pain (LBP) is a ubiquitous health problem affecting most of healthcare staff. Most studies are focused on prevalence of pain among nurses in intensive care units in countries all over the world. 

Twenty-seven studies reporting data from 2004 to 2020 on the prevalence of LBP in a defined ICU nurses were included (participants:6258; range: 3-1345). Twenty-one (77.8%) studies were of “high” quality. Among the included studies, the lowest and the highest prevalence were found to be 34.5% and 100.0%, respectively. Conclusion was that LBP is prevalent among ICU nurses. Greater attention is urgently needed to address this burdensome health problem among ICU nurses, particularly with an emphasis to develop preventive strategies [1]. 

The objecitve of a study in 2014 was to identify the occupational factors associated with low back pain using a surveillance tool and to characterize the low back pain by the resistance of the extensor muscles of the vertebral column among nursing professionals at an Intensive Care Unit Conclusions of study are that the main occupational factors associated with the low back pain were the posture and the characteristics of the physical and organizational conditions [2]. Another study showed that individual-level interventions are not likely to succeed in eliminating manual patient lifting by nurses. Our results suggested that interventions without administrative measures might have limited success [2]. Another study was undertaken to evaluate an education program to prevent low back pain among nurses. This interventional study used a one-group, pretest/posttest design and was conducted in four hospitals in Bolu, Turkey. Nurses’ knowledge was assessed before and after training; 60 nurses were evaluated while performing five procedures that can lead to low back pain using an observation form. These forms were given to the nurses 3 months after the training to assess their knowledge and observations of the five specified behaviors were repeated. The mean knowledge and procedures scores of the nurses were higher just after and 3 months after the training compared to before training [2]. 

Yet a smaller number of studies reveal the high prevalence of pain among ICU personnel including physicians, physiotherapists and technicians. Psychosocial factors, such as psychological fatigue, and ergonomic factors, such as bending or twisting the neck, play important roles in the development of pain. This study indicates that ICU personnel have a high prevalence of pain, with 72.7%, 64.4%, and 52.9% of ICU nurses, ICU doctors, and ICU workers reporting pain, respectively [3].

Hypotheses 

• H1 The prevalence of examined medical professionals with low back pain will be above 50%.
• H2 Nurses/technicians will have a higher occurrence of low back pain than physicians and physiotherapists.
• H3 Health workers are not educated about protective, facilitating positions for the purpose of preservation spine in the workplace.

The research was conducted in Croatia at the Clinical Hospital Center Zagreb, at the Clinic for Anesthesia, Reanimation and Intensive Medicine and Pain Therapy.  The total of 277 respondents (physicians, nurses/technicians, physiotherapists) working at the intensive care units of the Clinic for Anesthesia, Reanimation and Intensive Medicine and Pain Therapy participated in the research. Through a questionnaire of 16 questions, respondents had to choose the appropriate [4-5] answer based on which statistics and corresponding results were obtained.The demographic data of the respondents were presented with descriptive statistics, and the normality of the distribution of continuous numerical variables was tested with the D'Agostino-Pearson test. The existence of differences between categorical variables was tested with the χ2-test.All statistical analyses were performed using MedCalc 20.110 (MedCalc Software Ltd, Ostend, Belgium). P values less than 0.05 were considered statistically significant.

As shown in (Table 1) A total of 277 healthcare workers, 178 (64 %) female and 99 (36%) male, at the Clinic for Anesthesia and Intensive Care, University Hospital Centre Zagreb, Croatia, participated in the research. Three groups were examined: nurses (N 173), physiotherapists (N 24), and physicians (N 80). 

 Table 1: Demographic and occupational characteristics. 

The obtained results show that back pain is most common among nurses (152 = 88 %), but also present in physicians (62 = 78 %), and physiotherapists (13 = 54 %). If necessary, all medical workers take analgetics (N 219). Out of 215 respondents only a small number of health workers use orthopedic insoles regularly (39=14 %). 

Although the majority of healthcare workers have had no previous injuries or illnesses (N 189), some previous diseases are present in female respondents, mostly in nurses (N 57). When asked whether they use any form of physical therapy to reduce back pain (massage, swimming, exercise), 154 (56%) health workers give an affirmative answer - 99 (57 %) nurses, 19 (79 %) physiotherapists, 36 (45 %) physicians, while 123 (44 %) health workers do not use any form of physical therapy. When asked in their daily work whether they apply techniques to reduce the load on the spine (hospital bed at hip height, lifting loads from squatting, moving and turning an immobile patient with the help of colleagues), 187 give an affirmative answer, while 90 sometimes or almost never they use protective forms. Considering the years of experience at the workplace, those with 5 to 10 years of work experience state that they use orthopedic insoles (N15). Some form of analgesia, if necessary, is mostly used by those with less than 5 years of work experience. Respondents with 5-10 years of work experience (N 27) already have some impairment or illness. The most represented healthcare workers who use some form of physical therapy are those with less than 5 years of work experience (N 40) and with 5-10 years of work experience (N 49).  As many as 31 workers out of 46 having 21-30 years of work experience use some form of physical therapy. 

39 respondents wear orthotic insoles, the pain is genuine in 9 of them, and they continue to use some form of analgesia, while 17 already have some damage or illness. 24 people who wear orthopedic insoles use some form of physical therapy, and 29 of them adhere to techniques to reduce the load on the spine. 

Considering the working hours, pain is present in 149 respondents in the 12-hour shift. Insoles are used by 12 of them in a 8-hour shift, by 21 in a 12 hour-shift, and 6 of them in a 24-hour shift. 

During the 12-hour shift, 129 respondents use some form of analgesia, 60 already have had some earlier damage or illness, while 104 do not have any damage. 

During the 8-hour shift, 52 of them use some form of physical therapy, while 31 do not. In a 12-hour shift, 92 of them use some form of physical therapy, while 72 do not, in a 24-hour shift, 10 use some form of physical therapy, and 20 do not. In a 12-hour shift, 115 healthcare workers apply protective measures at the workplace (bed, squat...). 

As many as 199 health workers feel pain if they are on their feet for more than 5 hours, 32 of them wear insoles, and 24 use some form of analgesia, 81 have some disease or damage, 134 use some form of physical therapy, while 162 use protective measures at work.

Nurses/technicians have the most pain in their backs (152 N) among ICU staff, the lumbar part of the spine being most affected. 28 nurses also report pain in a larger area of the spine (combination of thoracic, cervical, lumbar).The next group by suffering back pain are physicians, pain is present in 62, mostly in the area of the lumbar part (N 33). In the cervical part of the spine it is present in 15 physicians, in the thoracic part in 8, and in the combination of the larger extent of the affected parts of the spine (cervical, thoracic, lumbar) in 24 of them.Although the least number of physical therapists participated in this research, pain is present in 13, while 11 of them do not have pain. The most frequently painful part of the back is lumbar (N17).If necessary, health workers take some form of analgesia, and the most represented are nurses (N 178).Considering the years of service less than five, the trend of back pain in the lumbar spine area is higher (N57), while healthcare professionals with 5-10 years of experience follow the trend of back pain in the lumbar spine area (N 47).Orthopedic insoles are mostly used by people who have back pain in the lumbar part of the spine (N 17).149 healthcare workers have back pain during a 12-hour working day, mostly in the lumbar region (N 103), while some form of analgesia use 129 healthcare workers. Working for more than 5 hours results in back pain in the lumbar part of the spine (N 140), and if necessary, they use some form of analgesia (N 18).Orthopedic insoles are mostly worn by nurses/technicians (N 20), followed by physicians (N 13) and physiotherapists (N 6).Some form of illness or damage from before is most prevalent in nurses (N 57).19 physiotherapists use some form of physical activity, while nurses are the most numerous, 99 of them follow the trend of using some form of physical therapy.122 (71 %) nurses/technicians use certain techniques for easier performance at work, 22 (92 %) physiotherapists, and 43 (54 %) doctors. Considering the years of work experience from the table, we can conclude that some form of illness or impairment is least common among people with less than 31 years of experience (N7).Considering the years of service, 5-10 mostly use some form of protective forms to perform work (58).157 healthcare workers do not wear orthopedic insoles at all. Taking into account the working hours of healthcare professionals, 92 respondents use some form of physical therapy during the 12-hour random time, while 72 respondents do not. Working less than five hours, 97 respondents do not use any form of physical therapy.

Hypothesis 1 is statistically significant (P < 0.001), confirming that more than 50% of medical workers have pain in some part of the back. 82% of the 277 surveyed healthcare professionals gave an affirmative answer, which exceeds the percentage of more than 50%. There are statistically significant differences if we compare education (P < 0.001), where the pain is most genuine in 152 (88%) nurses, 62 (78%) doctors, and least 13 (54%) physiotherapists. If we compare with working hours, there is a statistically significant difference (P < 0.001) in healthcare workers who have 12-hour shift (91%). There is a statistically significant difference compared to standing during the working day (P < 0.001), where 199 (86%) of the healthcare workers state that they feel the presence of pain in some parts of the back after standing for more than 5 hours. Hypothesis 2 is statistically significant (P < 0.001), it confirms that the pain is most genuine in 152 (88%) nurses/technicians, and that they have a higher occurrence of low back pain than doctors and physiotherapists. Hypothesis 3 is partially statistically significant because it takes into account questions 8, 9 and 10. 158 (57%) whether healthcare workers are familiar with special techniques used in daily work with patients that reduce the burden on the spine. There is a statistically significant difference if we compare by education where is P<0.001 (χ2-test) i. e. where 96% of physiotherapists are familiar with the mentioned techniques, followed by nurses (57%), while the least familiar are doctors (45%). 193 health workers (70%) state that they would like to have education about protective positions for the purpose of preserving the spine. The statistically significant difference is with regard to working hours P < 0.006, (χ2-test), where the most affirmative answers are 106 of them (65%) given by people who work 12 hours, followed by people who work 8 hours in a higher percentage (83%), but a smaller number 69.If we take into account the question related to whether healthcare professionals apply techniques to reduce the load on the spine during their daily work (hospital bed at the height of your hips, lifting loads from a squat, moving and turning an immobile patient with the help of colleagues), 187 healthcare professionals gave an affirmative answer which is 68%, a statistically significant difference if we compare it with education P<0.004, and working hours P < 0.006.This study indicates that ICU personnel exhibit a high prevalence of pain. Ergonomic factors, contribute to pain levels among ICU personnel. As many as 227 (82%) respondents attibute back pain to working conditions, just 88 (32%) go on sick-leave, but 263 (95%) consider that back pain should be qualified as occupational disease.  193 (70 %) respondents consider education about special techniques used in daily work with patients that reduce the burden on the spine is important.  Therefore, disease prevention and health promotion measures are needed to protect the health of ICU personnel at the Clinical Hospital Center Zagreb, at the Clinic for Anesthesia, Reanimation and Intensive Medicine and Pain Therapy.

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