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

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

JAROMI ET AL.

cs, Faculty of Health Sciences, Institute of Physio-
University of Pe
therapy and Sports Sciences, and was approved by the Regional

cs, Hungary (No.:
Research Committee of the Clinical Centre, Pe
6145).
The participants were collected from January–march 2015. All
subjects signed the consent form to participate based on the Decla-
ration of Helsinki.
Inclusion criteria: nurses with diagnosed cnsLBP (persistent pain
for at least 13 weeks prior the study), nurses currently employed in
a healthcare setting and who had worked as bedside nurses for at
least 3 years prior the study.
Exclusion criteria: nurses with one or more diagnoses of the fol-
lowing: acute or subacute low back pain, spondylolisthesis, ankylos-
ing spondylitis, fracture, central or peripheral neurological disorders,
cauda syndrome, herniated spinal disc, had received surgical recom-
mendations to correct the reason for back pain, tumour, failed back
syndrome, rheumatic or musculoskeletal disease that narrows joint
motion by 30%, depression and other psychiatric diseases (based on
medical documentation), chronic pain syndrome, gynaecological and
urological diseases resulting in lumbosacral pain, pregnancy, were
receiving current or were within 3 months of receiving physical ther-
apy, or had undergone spine surgery within the last 6 months
(Table 2).
3.2 | Sample size calculation
The sample size was calculated to have a confidence interval (CI) of
95%, with a significance level of 5% (visual analogue scale [VAS] val-
ues after 3-month physiotherapy, as reported in previous studies of
CLBP). We required 73 participants per group (Sahin, Albayrak, Dur-
mus, & Ugurlu, 2011).
3.3 | Randomisation
Nurses who met the inclusion criteria were included in the study.
Subjects were randomly assigned to either the experimental or con-
trol groups by drawing lots using the group numbers. Individuals
who drew the number “1” were assigned to the experimental group
and those who drew number “2” were assigned to the control group.
The trial was a single-blind study. The survey was conducted by
a physiotherapist who has experience in using the Zebris system,
who did not take part in the Back School programme and who did
not know which participant belongs to the study group and which to
the control group (Figure 1).
3.4 | Outcome measurements
Lifting techniques were assessed by Zebris WinSpine Triple Lumbar
biomechanical motion analysis (Zebris Medical GmbH). During the
triple lumbar biomechanical study, two triplets, microphones with
three fixed positions, were placed at the height of the lumbar one
and the lumbar five vertebrae’s processus spinosus. The participant
was standing in front of the camera at a distance of 80 cm. The
| e897
camera and the longitudinal axis of the triplet were at a 45-degree
angle. The nurses were asked to perform two types of patient han-
dling tasks: vertical lifting, facilitating the patient from a seated to a
standing position, and a horizontal lifting, transfer. The examination
was carried out by a physiotherapist who was trained in the use of
ZEBRIS Systems. VAS was used to measure pain level (0–100 ranked
VAS scale; 0 = “no pain” 100 = “unbearable pain”). The participants
were asked to report the average cnsLBP pain experienced during
the previous week (before the study began and again after the
experiment).
3.5 | Intervention
In our research, the Back School programme called Spine Care for
Nurses (Jaromi et al., 2012) was applied to the experimental
group. The programme was performed twice a week for 12 weeks
in 60-min session each (total 24 sessions). The study participants
were advised to carry out on a daily basis the learned exercises
at home, with a frequency of at least five times a week, for
20 min per day. Additionally, we recommended that they applied
the learned exercises and patient lifting techniques in their daily
routines and work. Written materials were disseminated among
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-
style guidance.
3.6 | Statistical analysis
A randomised, controlled, prospective, quantitative, longitudinal clini-
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
for comparison within groups for continuous scales, Mann–Whitney
U test was assessed to compare the intervention and control group
results or chi-square test was used to examine further differences
between the intervention and control group. Time-dependent
changes in VAS score for both groups were evaluated by rank analy-
sis of covariance. Analyses were adjusted for baseline data of VAS
score and age, BMI, year of work in health care. The results were
considered significant at the level of p < .05, and Bonferroni correc-
tion was applied to reduce type I error in interpreting the data
(a = 0.025).
4 | RESULTS
The final study population consisted of 137 nurses (nine male, 128
female) with chronic LBP syndrome. The nurses’ average age was
41.4 years (range: 29–52 years.). They had been employed in a
healthcare setting for an average of 18.1 years (range: 5.5–28 years).
The average time from cnsLBP diagnosis was 25.8 weeks (range:
14–49 weeks).

e898 | JAROMI
T A B L E 1 The structure of the applied educational programme and movement therapy
Back School theoretical training
Week 1 • Anatomy, biomechanical and body mechanical knowledge
about spine
• Compression, bending, torsion and shear forces influencing
the spine and intervertebral discs
• Biomechanical parameters of correct body posture
Week 2 • Spine-friendly working situations
• Ergonomics of manual handling
• Ergonomics of work in front of screen
Week 3 • Emergence of spine diseases, causes of pain
• Prevention of spine diseases
Week 4 • Motion elements loading the spine, correct spine usage
• Vertical lifting techniques
Week 5 • Motion elements loading the spine
• Horizontal lifting
• Atraumatic patient handling
• 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
action, efficiency, indication, contraindication
Week 7 • The elements of spine-friendly lifestyle
Week 8 • Spine-friendly lifestyle during everyday activities
Week 9 • Spine-friendly lifestyle during free-time activities
Week 10 • Spine-friendly sports
Week 11 • Spine protection and recreation
Week 12 • Spine protection in fitness
Kempf (2000), Zatsiorsky (2000), Jordan (2002).
The experimental group included 67 nurses (five male, 62 female,
average age: 41.7 years, range: 31–51 years; employed in health
care for 17.3 years, range: 6–26 years), and there were three fewer
nurses in this group than in the control group (they resigned from
participation during the study because of health problems). The aver-
age time from cnsLBP diagnosis was 25.9 weeks (range: 15–48
weeks). The control group included 70 nurses (four male, 66 female).
The average age was 41.1 years (range: 29–50 years); employed
in health care: 19.8 years (range: 5.5–28 years). Time elapsed since
the diagnosis of the cnsLBP was 27.2 (17–59) weeks.
4.1 | Examination of lifting techniques
Before the experiment, vertical lifting was correctly performed by
8.95% and 8.57% in the experimental and control group, respec-
tively. After the Back School programme, 97.01% of the members of


ET AL.
Back School practical training
• Elongation exercises
• Isometric trunk muscle strengthening exercises in lying posi-
tion
• Exercises for correct body posture
• Development of correct body posture in sitting position
• Isometric muscle strengthening exercises in sitting position
• Elongation exercises
• Adequate and inadequate lifting techniques
• Isometric muscle strengthening exercises in sitting and stand-
ing positions
• Practising correct spine usage
• Relaxation and breathing exercises
• Exercises for trunk strengthening
• Stretching exercises
• Practising correct spine usage
• Static stabilisation exercises
• Patient handling exercises in case of inactive patients
• Static stabilisation exercises
• Patient handling exercises in case of partially active patients
• Static stabilisation exercises with tools
• Patient handling according to the method of Dotte
• Patient handling according to the method of Bobath
• Dynamic stabilisation exercises
• Patient handling according to the method of Bobath
• Trunk muscle strengthening exercises in a gym
• Profession-specific motions
• Progressive strength training on the basis of biomechanics
• Profession-specific motions
• Trunk muscle strengthening exercises in yoga and Pilates
• Profession-specific motions
• Trunk muscle strengthening exercises in fitness, low-impact
aerobic
the experimental group carried out vertical lifting correctly. In the
control group, only 11.42% of the nurse participants performed ver-
tical lifting correctly (Table 3).
The range of motion (ROM) value of the trunk flexion during ver-
tical lifting significantly decreased in the experimental group
(p ˂ .001) after the Spine Care for Nurses programme, which was
contrary to the control group results where significant change in the
ROM value of the trunk flexion (p = .95) did not occur (Table 4).
At baseline, horizontal lifting was performed correctly by 10.44%
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.
During horizontal lifting, the rotation measured at the lumbar
spine had significantly decreased in the experimental group
(p ˂ .001) after the study, whereas there was no significant dif-
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
(n = 73)
Received allocated intervention (n = 67)
Did not receive allocated intervention (n = 6)
4 private problems, 1 trauma, 1 pregnancy
Allocated to intervention: written lifestyle guidance
(n = 73)
Received allocated intervention (n = 70)
Did not receive allocated intervention (n = 3)
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)
during horizontal lifting between the experimental and the
control groups when compared pre- and postintervention
(Table 4).
Hypotheses (1) confirmed: nurses do not use appropriate patient
handling/lifting techniques. Hypotheses (2) confirmed: nurses, while
lifting patients, use techniques of major trunk flexion and improper
rotational movements. Hypotheses (3) confirmed: after the Spine
School Programme, handling and lifting techniques improved, flexion
and rotational movements decreased during lifting patients.
4.2 | Low back pain
The average intensity of the low back pain in the experimental group
pre-intervention was 49 (based on the VAS 0–100), and postinter-
vention, the intensity decreased to 7 (p ˂ .001). In the control group,
the pain intensity did not change (p = .870). The between-group dif-
ference for pain intensity score postintervention was significant
(p ˂ .001) (Table 5). Then, we performed rank analysis of covariance
where we adjusted the post-VAS scores for age, BMI and years of
work in health care. We found significant difference between the
intervention and control group’s VAS score (F = 281.620, p < .001).
Hypotheses (3) confirmed: after the Spine School Programme,
the intensity of low back pain decreased among nurses.
5 | DISCUSSION
In several countries, nurses use regularly used preventive Directives,
to handle LBP and manual patient lifting (Dawson et al., 2007; Edlich
et al., 2004; Trinkoff, Brady, & Nielsen, 2003; Yassi et al., 2001). In
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’
work and their work is supported less by patient handling equip-
ment; low back pain is common among nurses.
Low back pain is multifactorial. Physical factors are (Bernal et al.,
2015; Feng, Chen, & Mao, 2007; Freimann, Paasuke, & Merisalu,
2016) ergonomically poor posture (Cmar-Medeni, Elbasan, & Duzgun,
2016; Suni et al., 2016) and vertical and horizontal lifting of patients
that are the most common risk factors among nurses, that develops
LBP (Al-Eisa & Al-Abbad, 2013).
Trunk flexion and rotation is an adverse moving for the spine
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-
ducted a survey, and they observed that 57,1%–82% of the nurses
do not use body mechanics correctly (Karahan & Bayaraktar, 2004).
In our survey, we received similar results; nurses tested by us did
not use vertical lifting in 91% and horizontal lifting in 89% correctly.
Several intervention programmes (back pain counselling, neuro-
muscular exercise, Back School programme, ergonomics programme)
were published for nurses, with the aim of increasing their ergo-
nomic knowledge, their physical ability and with the aim of reduc-
ing work-related low back pain. Intervention programmes have
different contents as well as their efficiency is tested in different
ways (Karahan & Bayaraktar, 2013; Rasmussen, Holtermann, Mor-
tensen, Sogaard, & Jorgensen, 2013; Suni et al., 2016; Vieira, Shra-
wan, Helenice, & Jogesh, 2006).


JAROMI ET AL.
In University of Manitoba, Canada, Yassi and his colleagues used
preventive programme, “prevent patient lift and transfer injuries of
health care workers” (University of Manitoba, Canada), causing the
decrease of low back pain intensity, and the decrease of frequency
of manual patient handling tasks.
In Selcuk University Turkey, Sahin used exercise programme,
physical therapy (TENS, ultrasound, hot pack) and Back School pro-
gramme in his survey, causing the decrease of pain and the improve-
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
was as follows using ergonomic devices decreases the frequency of
manually lifting patients, and in patient transfer, the time spent in
awkward back posture decreases (Koppelaar, Knibbe, Miedema, &
Burdorf, 2011).
Szeto and his colleagues used multifaced ergonomic intervention
programme that consisted of ergonomic training, of regular exercise
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
intensity and patient lifting techniques among nurses during patient
handling/lifting. Correct lifting methods were taught as an interven-
tion in the Spine Care for Nurses programme. After the Spine Care
for Nurse programme, nurses used lifting methods that were biome-
chanically correct and reduced the load on the spine, resulting in the
reduction of intensity of the cnsLBP.
5.1 | Limitations and generalisability
The limitations of the study are a relative small sample size and the
sample was obtained with a convenience sampling method; there-
fore, generalisability is limited.
6 | CONCLUSION
CnsLBP among nurses is a result of improper patient lifting and
transferring techniques, and it constitutes a significant problem in
health care. The results of our study show that a Back School pro-
gramme effectively alters patient lifting methods in practice and can
reduce the intensity of pain in the lower lumbar region in nurses.
7 | RELEVANCE TO CLINICAL PRACTICE
The occurrence of cnsLBP is a common injury among nurses and is a
result of poor patient lifting techniques. Based on our research out-
comes, we recommend that healthcare organisations should consider
the implementation of regular Spine Care for Nurses programmes
(with a mixture of didactic and ergonomic exercise conducted at reg-
ular intervals and minimum set hours) as successful low back injury
prevention programmes.
| e901
ACKNOWLEDGEMENTS
The present scientific contribution is dedicated to the 650th anniver-

cs, Hungary.
sary of the foundation of the University of Pe
CONTRIBUTIONS
Study design: MJ, AK, BS, Á-SU, VKB, EL; data collection and analy-
sis: MJ, AM, PÁ, EL; and manuscript preparation: MJ, AK, BS, PL, EL.
CONFLICT OF INTEREST
The final version of the article has been read and approved by all
authors. The authors have no interests.
ORCID
Melinda J
aromi http://orcid.org/0000-0002-8931-3470
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How to cite this article: J
aromi M, Kukla A, Szil
agyi B, et al.
Back School programme for nurses has reduced low back
pain levels: A randomised controlled trial. J Clin Nurs.
2018;27:e895–e902. https://doi.org/10.1111/jocn.13981