Journal of Advanced Nursing, 1997, 26, 380–388

The prevalence and cause of occupational back

pain in Hong Kong registered nurses
Peter French RGN PhD
Project Manager, The Institute of Advanced Nursing Studies, Hospital Authority,
Hong Kong

Lee Fung Wah Flora RN BN(Hons)

Yan Chai Hospital

Liu Sum Ping RN BN(Hons)

Yan Chai Hospital

Luk Kar Bo RN BN(Hons)

Pamela Youde Nethersole Eastern Hospital

and Wong Heung Yee Rita RN BN(Hons)

Yan Chai Hospital, Hong Kong

Accepted for publication 5 July 1996

FRENCH P., LEE F.W.F., LIU S.P., LUK K.B. & WONG H.Y.R. (1997) Journal of Advanced
Nursing 26, 380–388
The prevalence and cause of occupational back pain in Hong Kong registered
nurses
It is well known that many patient-oriented tasks contribute to occupational back
pain in nurses and this is borne out by previous studies. In order to know whether
the incidence of back pain and the contributing factors are the same in Hong Kong, a
descriptive study was adopted to investigate the situation locally. This study
explored the prevalence and perceived contributing factors of back pain, utilizing a
non-experimental survey approach. Baseline data for this study were gathered by
means of a questionnaire. The questionnaire elicited characteristics of the subjects’
history and contributing factors to back pain. Of 47 nursing sta
at an acute care
hospital, the reported occurrence of some form of back pain during their career was
found to be 80·9%. Approximately one-third of nurses with back pain experienced
pain at least once a month. The top two dynamic factors contributing to back pain
were lifting patients and transferring patients. Meanwhile, stooping was identified
as the most common static factor contributing to back pain. In addition of those who
had experienced some form of back pain, 92·1% stated that they have never
reported their back pain to their employers. Contributing factors such as transferring
patients from bed to chair and lifting patients within bed without assistance
indicate poor practice which should be eliminated by the existence of continuing
in-service education.

Keywords: occupational health, back pain, nursing

Correspondence: Dr H.P. French, Project Manager, The Institute of

Advanced Nursing Studies, Queen Elizabeth Hospital, 30 Gascoigne Road,
Kowloon, Hong Kong.

380 © 1997 Blackwell Science Ltd


I NTRODUCTI ON
The authors’ experience of nursing in Hong Kong indicated
that there was a serious problem with occupationally
induced lower back pain. The issue did not seem to be
acknowledged as a serious problem.
Because of the potential health risks to nurses, the
danger to patients and the costs to the service which may
be involved, it was thought necessary to look at the size
and nature of the problem in Hong Kong.
LITERATURE REVIEW
The prevalence of back pain and its occupational signifi-
cance has been documented thoroughly. Nurses are in an
occupational group which experiences more serious back
injuries and occupational back pain than most other pro-
fessions. A number of studies have compared the back pain
rates of nurses with those of other occupations. Studies in
the United Kingdom have demonstrated that the incidence
of back pain among nurses is as great as that among indus-
trial manual workers (Reed 1980). It has been found to be
more frequently due to occupational factors in nurses than
in, for instance, a control group of teachers (Cust et al.
1972). Others have confirmed the work relatedness of
occupational back pain (Harber et al. 1985).
The e
ects on nurses and the service have also been
indicated in this study which found that 29% of nurses
take medication for low back pain, and 9% regularly miss
work due to low back pain. Back pain among nurses is a
major cause of days lost due to sickness, and this exacts
a huge drain on health service resources. Back pain
accounted for 16·2% of all sick leave in a sample studied
by Stubbs et al. (1983). A number of studies indicate that
around 43% of subjects report recent back pain and up to
79% report episodes of work-related back pain during their
career (Stubbs et al. 1983, Videman et al. 1984, Skovron
et al. 1987, Cato et al. 1989).
Regular su
ering
According to one survey, one in four nurses su
ered back
pain regularly either at work or at the end of the working
day (Bulaitis 1992). Videman et al. (1984) found that low
back pain which led to unfitness for daily tasks in the
previous 5 years was reported by 18% of qualified nurses
and 29% of nursing aides.
A number of studies have found that the majority of
nurses continued to work despite their discomfort. A
survey conducted by Mandel & Lohman (1987) indicated
that nurses who missed work comprised only 13% of those
reporting painful episodes lasting at least 2 days. Owen
(1989) estimated that over one-third of nurses had episodes
of back pain related to work, yet only 13% of these nurses
had reported the episode. Cato et al. (1989) also found that
© 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 26, 380–388
Occupational back pain
78% of nurses did not report back pain to management.
Both episodic and chronic back pain are infrequently
reported to the nurses’ employer (Bulaitis 1992, Harber
et al. 1985).
It has been estimated that around 3% of nurses change
their jobs due to back pain (Harber et al. 1985, Stubbs et al.
1986, Owen 1989). These studies raised the issue of the
cost to the service of losing experienced sta
. Such costs
included recruitment, retraining, compensation, and poss-
ible e
ect of low morale in wards experiencing high sta

turnover. With wastage such as this occurring, patients
and taxpayers clearly pay a price, too. Nurse wastage
figures combined with the sickness absence rates indicated
the possible magnitude of the problem.
Preventive strategies
An understanding of the activities associated with back
pain is necessary for the development of appropriate pre-
ventive strategies. The unique nature of the job is probably
the major cause of the high prevalence of back pain among
nurses. Many of the factors identified are postural in
nature. Direct patient contact activities, particularly
patient lifting and transferring, are most frequently men-
tioned as causes of occupational back pain (Stubbs et al.
1983, Harber et al. 1985, 1988, Cato et al. 1989, Owen
1989). These two tasks accounted for 79% of low back
pain among nurses.
However, Harber et al. (1988) argue that nurses are socia-
lized in nursing training with some set of beliefs which
they retained throughout their professional career, such
as: patient contact tasks cause back pain. To some extent,
these beliefs might bias the understanding of actual injury
experiences when recalling such activities related to
back pain.
One observational study on 63 nurses found that non-
patient contact actions occurred more frequently than
patient contact activities per shift, and that static actions
were common. Such static action, especially in a nonup-
right position, further increased biomechanical stress on
the lower back (Harber et al. 1987b). Other studies have
reported that back pain in nurses might be related to factors
other than direct patient care. These included carrying and
pushing, previous back injury, headache, and frequent
exercise (Harber et al. 1987a, Mandel & Lohman 1987).
Hong Kong nurses
Occupational back pain in Hong Kong nurses is poorly
understood in terms of its frequency, cost and cause.
According to employees’ compensation legislation, the
prescribed occupational diseases that were entitled to
receive compensation for health care workers were only
tuberculosis and viral hepatitis (Hong Kong Labour
Department 1994). Hence, the Department of Health in
381
P. French et al.
Hong Kong does not seem to collect statistics on occu-
pational back pain in nurses. The prevalence, morbidity,
lost work time, and poor work performance due to back
pain is largely unreported in Hong Kong nurses.
THE STUDY
After reviewing the literature, it can be concluded that
occupational back pain is regarded as a common conse-
quence of nursing work in other parts of the world. In
order to discover whether similar phenomena occur in
Hong Kong and which factors are most significant, a
descriptive study was designed and conducted. The con-
tributing factors to back pain were explored.
The specific objectives of this study were to determine
the prevalence of occupational back pain in Hong Kong
registered nurses, and to ascertain which patient-oriented
tasks were the most significant in the genesis of occu-
pational back pain.
Concept clarification
A common diculty in the study of back pain is its highly
variable and subjective nature (Stubbs et al. 1983).
Individuals might have di
erent conceptions of the term
‘back pain’. Accordingly, key terms in this study were
defined so as to make explicit the nature of the concept to
be studied. Occupational back pain was defined as all con-
ditions of pain, ache, sti
ness or fatigue localized to the back
related to nursing practice (Svensson & Andersson 1983).
Patient-oriented tasks were those nursing activities that
involved direct patient contact (Harber et al. 1988). They
were mainly divided into two types of actions, dynamic
and static. Dynamic patient-oriented tasks were those
patient contact activities involving motion, while static
patient-oriented tasks were those patient contact activities
in which the nurse maintained a static antigravity posture
for at least 30 seconds, and in which there was no transfer
of the patient (Harber et al. 1987b).
Design
This study aimed to describe phenomena and identify fac-
tors that contributed to prevalence of occupational back
pain in registered nurses in Hong Kong. The design was
based on the approach of descriptive study.
As proposed by Wilson-Barnett & Batehup (1988), a
descriptive survey was necessary to identify relevant fac-
tors in a given area, to report the frequency of events, and
to provide maps or a matrix from which to do more work.
Questionnaire
A 13-item questionnaire was developed after a review of
the literature (Stubbs et al. 1983, Harber et al. 1987b). This
382 © 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 26, 380–388
self-developed tool addressed the incidence of work-
related back pain and the perceived contributing factors
to back pain (see Appendix). The questionnaire was div-
ided into three sections. The first sought demographic data
including age, working experience and present working
area of the subjects. The second gathered information on
the first episode, usual sites of back pain, current practices
and consequences associated with back pain. Questions
about dynamic and static patient-oriented tasks which
contributed to back pain were included in the final section.
A pilot study was conducted in order to test and evaluate
the self-developed questionnaire. Ten volunteers with
similar characteristics of the study sample were recruited
to answer the questionnaire and were interviewed after
completion. Therefore, face validity of the self-developed
questionnaire was plausible.
Sample
The subjects were registered general nurses drawn from
one acute general hospital in Hong Kong. As the aim of
the study focused on patient-oriented tasks in relation to
occupational back pain, nurses in clinical areas who
engaged in direct patient contact were selected for the
study. Nursing ocers (sister/head nurse), ward managers
and departmental operation managers were excluded from
this study.
Simple random sampling was used to select the subjects.
A nursing sta
duty list for the period 26.12.1994 to
22.1.1995 was obtained from the hospital as a basis for the
sampling frame. Subjects were selected by drawing names
from a box. Sixty out of 590 nurses, approximately 10%
of the target population, were selected for the study.
Data collection
The selected subjects were contacted by the researchers
individually in their wards. Each subject received a self-
administered questionnaire with instructions on how to
complete and return the questionnaire. Meanwhile, writ-
ten information was also provided which included the
purpose, importance, anonymity and confidentiality of the
study. All subjects were invited to participate and the sub-
ject’s consent was indicated by the return of the completed
questionnaire.
Forty-nine out of 60 questionnaires were returned which
gave an overall response rate of 81·7%. Two questionnaires
were excluded in the analysis as they were incomplete.
Thus, the results are based on 47 responses.
Data analysis
The data analysis used a quantitative method. All collected
data were organized and summarized by descriptive
statistics.

RESULTS
The ages of the subjects ranged from 22 to 45 years. All of
them were equally selected from di
erent clinical areas of
the hospital.
Frequency of back pain
Of the 47 respondents 38 (80·9%) respondents reported
that they had su
ered from back pain during their nursing
career. The frequency of their back pain was categorized
as ‘daily’, ‘once a week’, ‘once a month’, ‘a few times a
year’ and ‘less than once a year’, and ‘others’.
Figure 1 summarizes the frequency of back pain reported
by subjects. Two respondents (5%) reported that their back
pain occurred twice a week, within the category of others.
It can be seen that about 4 out of 10 subjects who had
experienced back pain in their career experienced it at
least once a month or more frequently. This represents
one-third of the original 47 respondents. In total seven out
of the respondents had experienced back pain at least a
few times a year.
Experience of back pain
All of the following results are based on responses from
the 38 subjects who had reported experience of back pain.
Relationship between years of working experience
and back pain
As shown in Table 1, the category of less than 2 years’
working experience had the highest prevalence; all sub-
jects in this category reported back pain. The second high-
est prevalence appeared in the category concerning work
experience of 2 to less than 5 years; 14 (87·5%) respon-
dents reported back pain and two (12·5%) did not. In the
category ‘5 to less than 8 years’, eight (66·7%) subjects
daily
once a week
once a month
a few times a year 5%
less than once a year
others
45%
Figure 1 Frequency of back pain.
© 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 26, 380–388
Occupational back pain
reported back pain, while 11 (78·6%) had back pain in the
category ‘more than 8 years’.
Incidents associated with the first episode of back
pain
Twenty-seven (71%) respondents who had su
ered back
pain reported that their first episode of back pain hap-
pened during the day. Most incidents of back pain had
occurred in an orthopaedic ward, closely followed in fre-
quency by elderly care and medical wards. Incidents
associated with the first episode of back pain are shown
in Table 2.
When asked how the first episode happened, 11 out of
27 subjects indicated that it occurred ‘after lifting a heavy
patient’. The second most frequently identified situation
was the ‘transfer of a patient from stretcher to bed’. Both
of them were dynamic patient-oriented tasks. In view of
all the described situations, only one ‘after prolonged
standing for surgery’ was a static patient-oriented task.
Factors contributing to back pain
Subjects were asked to identify patient contact activities
which they believed ‘could’ contribute to their back pain.
The number of responses was not restricted; an average of
four activities were selected by subjects. These activities
were categorized into dynamic and static. Results are pre-
sented separately in Tables 3 and 4. Of the dynamic factors,
‘transferring the patient’ was most frequently chosen,
followed by ‘lifting the patient within bed without assist-
ance’. The results demonstrate that the static factors are
also important in contributing to back pain. ‘Stooping’ was
most frequently chosen; 31 out of 38 subjects believed that
it was a contributing factor to back pain.
Usual sites of back pain
Subjects who had su
ered back pain were asked to
identify their usual sites of pain on a diagram in the
16%
13%
8%
13%
383
P. French et al.

Table 3 Number of subjects who reported the following dynamic
factors contributing to their back pain (n=38)
Dynamic factor
Lifting patient within bed with assistance
Lifting patient within bed without assistance
Lifting patient from floor with assistance
Lifting patient from floor without assistance
Transferring patient (bed to chair; bed to bed)
Ambulating patient
Restraining struggling patient
Giving assistance when patient starts to fall
low back pain, and the other four (10·5%) had low back,
buttock and leg pain. Therefore, it was indicated that ‘low
back’ was the most usual site of back pain in nurses.
Number of
responses
E
ects of back pain
22
In responding to question 11 ‘Have you ever reported the
27
incidence of back pain?’ in the questionnaire (see
21
20 Appendix), 35 (92·1%) subjects stated they had not
31 reported their back pain to the ward in-charge, nursing
8 ocer or ward manager. Twenty-six (68·7%) respondents
19 stated the back pain had restricted their activities, and
12 three (7·9%) had been transferred to another nursing post
because of their back pain.

Table 4 Number of subjects who reported the following static

factors contributing to their back pain (n=38) DISCUSSION
The findings of this study demonstrated a high prevalence
Static factor Number of responses
of back pain (80·9%) in this sample of registered nurses
and compare with other worst reports in similar studies
Leaning over patient 17
Stooping 31 reported in other countries. These studies demonstrated
Squatting 12 that the prevalence of back pain ranged from 43 to 79%
(Cato et al. 1989, Harber et al. back pain. Although this
study showed a high prevalence in that particular group
of nurses, the small number of subjects (n=5) may make
questionnaire. The distribution of back pain by site is the observation unreliable.
shown in Figure 2. When comparing the two working groups, ‘2 to less than
Subjects had neither upper back nor neck pain. The larg- 5 years’ and ‘5 to less than 8 years’, the result showed a
est single category was ‘low back’, with 63·2% of the 38 decrease in percentage of back pain from 87·5% to 66·7%
analysable responses. The second largest category was ‘mul- (Table 1). One could argue that this reduction was due to
tiple sites’, with 29% of the responses; the majority of which increased skill due to experience. A more likely expla-
included ‘low back’. Four (10·5%) subjects had mid and nation is that it is possible that more of the nurses in the

Figure 2 Usual sites of back pain

(n=38). Site of pain n %

1. Upper back & neck 0 0

2. Mid back 1 2·63

3. Low back 24 63·16

4. Buttocks & legs 2 5·26

5. Multiple sites:

– Mid back & low back 4 10·53

– Low back, buttocks & legs 4 10·53
– Upper back, neck & low back 1 2·63
– Mid back, buttocks & legs 1 2·63
– Mid back, low back, buttocks & legs 1 2·63

Total 38 100

384 © 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 26, 380–388

category of ‘5 to less than 8 years’ were married and had
had children.
Childbirth
Earlier studies have found a marked increase in back pain
with number of childbirths (Videman et al. 1984, Stubbs
et al. 1986, Buckle 1987, Skovron et al. 1987). This sup-
ports the assertion that nurses may be leaving to take up
less strenuous work after experiencing a period of chronic
back pain which may be induced by nursing activities or
childbirth and exacerbated by the other (Field et al. 1982).
Childbirth may also explain the high incidence in sub-
jects in the ‘more than 8 years’ group. This group is more
likely to consist of nurses who are compelled to return to
nursing after multiple childbirth for economic reasons
regardless of the health consequences. This may provide
further support for the assertion that childbirth and nurs-
ing activities are implicated in the causation of chronic
back pain. This encourages the economically self-sucient
to leave nursing but the less well o
to stay or return to
nursing and endure the pain. This explanation is plausible
given the finding that 92·1% of the back pain su
erers did
not report the problem to their employers.
Given that the high prevalence of back pain has been
confirmed in this study, the frequency of back pain
becomes a crucial factor when considering the nurses’
health and working performance.
Chronic pain
The finding that one-third of the sample experience pain
more than once a month and that over-two thirds experi-
enced it at least twice a year indicates a serious chronic
back pain problem among nurses in Hong Kong. Acute
pain serves as a warning that something somewhere in the
body is amiss and requires immediate attention, whereas
chronic pain might never fully cease (Tollison 1987).
When pain lasts for 6 months or more in periodic or unre-
mitting episodes, it can be defined as chronic in nature
(Bond 1984, Landan 1986, Burckhardt 1990, Keane 1992).
The findings indicate that there is a great deal of physical
and psychological ill health associated with chronic back
pain in Hong Kong nurses.
Depression usually accompanies chronic pain, and this
has an adverse e
ect on the nurses’ morale and job per-
formance (Skevington 1983, Tollison 1987). The impact on
the nursing service should be taken seriously when one
considers that back pain is the leading cause of disability
and absenteeism in the working population (Haber 1971,
Goldberg et al. 1980). This is all the more worrying when
one considers that the size of the problem is being mini-
mized by the tendency for nurses not to report the inci-
dence of back pain to their employers. Some argue that
this is because nurses are socialized into the belief that it
© 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 26, 380–388
Occupational back pain
is part of the work of the nurse (Whitehead 1984, Harber
et al. 1988). Nurses seem to view back pain as a ‘normal’
phenomenon in the profession.
It has been found that complaints of back pain and injury
amongst junior nurses in particular are often ignored
(Bulaitis 1992). Given the idea that back pain is a com-
monly abused excuse for taking sick leave, it is possible
to understand that many nurses do not want to be seen to
be malingering and that this and/or the actual existence of
chronic back pain will lead to dismissal.
Lower back pain
The finding that 63% of the back pain su
erers were
experiencing lower back pain, and another 26% of pain
was related to multiple sites which included the lower
back, is not surprising given that the lower back is the
most susceptible site. The lower lumbar discs, L4–L5 and
L5–S1, are subject to the greatest mechanical stress, com-
pression force and the greatest degenerative changes
(Deede 1987, Smeltzer & Bare 1992). These compression
forces are generated by heavy physical work, manual lift-
ing and prolonged static work posture. This explains why
most subjects report stooping as the most likely static
factor contributing to their back pain.
Given that stooping is warned against in almost all train-
ing scenarios, there is some indication here that either
inadequate training or personal neglect is contributing to
the problem. There is other evidence that inappropriate
practices are taking place. Given that ‘transferring the
patient’ was the top dynamic factor contributing to the
back pain and that ‘lifting a heavy patient’ came close
second, there is some indication that suitable techniques
for lifting and carrying are not being adopted in practice.
The second most common finding that ‘lifting a patient
without assistance’ contributed to most nurses’ back pain
indicates that nurses are taking risks either necessarily or
unnecessarily. If they are taking risks unnecessarily then
they are guilty of neglect which puts themselves and the
patient at risk of injury. If it is necessarily incurred because
of sta
shortages then the health service management is
putting nurses and patients at risk of injury.
Other factors
The free responses at the end of the questionnaire give
some interesting insights into other contributing factors.
Some subjects mentioned that inadequate manpower and
inadequate education were the possible causes of back
injury. Two respondents thought that their uniform restric-
ted movement in the handling of patients. It has been
found that constricting uniforms place nurses at a higher
risk of back pain because they limit movement, proper
position and proper alignment of the spine (Marchette &
Marchette 1985).
385
P. French et al.
CONCLUSION
It is apparent from this study that nurses in Hong Kong
demonstrate one of the highest incidences of back pain
when compared with other studies. The incidence is
largely hidden and ignored because nurses in Hong Kong
seem to be more reluctant to report their back pain than
subjects in previously reported studies. Even if statistics
were collected in Hong Kong they would not give a true
indication of the size of the problem.
The high incidence of back pain is brought about
by factors which seem to be entirely preventable. It is
apparent that nurses are taking risks or are pursuing
questionable practices.
In this situation, initial nurse education will never be
sucient and the most obvious course of action seems to
be periodic and continuous in-service training. The costs
of training are easily justifiable in terms of savings made
by avoiding loss of nurses to the profession, absenteeism
and potential danger to the patient.
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 Occupational back pain

night . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . 2
APPENDIX: QUESTIONNAIRE which type of ward . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .
Please circle the appropriate number which matches your
answer.* Q7
How did it happen?
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . .
Section I . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . .
*Only choose one answer from each question.

Q8
Q1
Have you experienced back pain recently?
Age at 1 Jan. 1995 years
Yes . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . 1
No . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . 2
Q2
Experience in nursing after registration:
Q9
Less than 2 years. . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . 1
What frequency of back pain do you experience?
2 to less than 5 years . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . 2
Daily . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . 1
5 to less than 8 years . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . 3
Once a week . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . 2
More than 8 years. . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . 4
Once a month . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . 3
A few times a year . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . 4
Q3 Less than once a year. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . 5
Which area do you presently work in? Other. . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . 6
Medical . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . 1 (please specify)
Surgical. . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . 2
Intensive care unit . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . 3
Q10
Neonatal intensive care unit. . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . 4
Where was the usual site(s) of your back pain?
Renal unit . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . 5
A&E Department . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . 6
Geriatric . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . 7
Paediatric. . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . 8
Operation theatre . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . 9 Upper back & neck... 1
Obstetrics . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . .10
Gynaecology . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . .11 Mid back................... 2
Orthopaedic. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . .12 Low back.................. 3
Other. . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . .13 Buttocks & legs......... 4
( please specify)

Section II
*You can choose more than one answer which is appro-
priate to your feelings.
Q11
Q4 Have you ever reported the incidence of back pain?
Have you su
ered back pain before 1995? No . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . 1
Yes . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . 1 Yes (e.g. report to ward in-charge, nursing ocer, ward
No . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . 2 manager, etc.) . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . 2
If ‘yes’, please continue.
If ‘no’, you have finished this questionnaire. Thank you. Q12
Has your back pain caused you to:
Q5 leave nursing? . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . 1
When did you experience your first episode of back pain? transfer to another nursing position?. . . . . . . . . . . . . . . . . . . .. . . 2
Before commencing nursing . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . 1 restrict your activities? . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . 3
After commencing nursing . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . 2 Other. . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . 4
If your answer is ‘1’, you have finished this questionnaire. (please specify)
If your answer is ‘2’, please continue.

Section III
Q6
Did the first episode occur on: *You can choose more than one answer which is appro-
day duty?. . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . 1 priate to your feelings.

© 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 26, 380–388 387
P. French et al.
Q13
What precipitated your back pain?
Dynamic patient-oriented tasks
a. lifting patient within bed
$ with assistance . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . 1
$ without assistance. . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . 2
b. lifting patient from floor
$ with assistance . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . 3
$ without assistance. . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . 4
c. transferring patient (e.g. from bed to chair, chair to bed,
bed to bed) . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . 5
d. ambulating patient . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . 6
e. restraining struggling patient . . . . . . . . . . . .. . . . . . . . . . . . . . . . . 7
f. giving assistance when patient starts to fall . . . . . . . . . . . . 8
Static patient-oriented tasks
388 © 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 26, 380–388
a. leaning over patient (e.g. suctioning or adjusting drip
rate) . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . 9
b. stooping (e.g. performing dressing, giving injection or
tidying beds) . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .10
c. squatting (e.g. measuring urine output or observing bub-
bling of chest drain). .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .11
If you have any comments related to your back pain, please
feel free to write them below.
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . .
You have now finished the questionnaire.
Please use the enclosed envelope for returning the finished
questionnaire.
Thank you for contributing to this study.