EVALUATION OF THE EFFECT OF TWO KINDS OF HEALTH EDUCATION
ON THE DEGREE OF DISABILITY, BELIEFS RELATING TO BACK PAIN
AND ABSENTEEISM AMONG HOTEL AND RESTAURANT WORKERS
Title.
Effect of two kinds of health education on
occupational health and absenteeism due to non-specific low
back pain: a controlled clinical trial randomized in clusters.
Background.
Non-specific low back pain is one of the
leading causes of work sick leave (absenteeism) in industrialized
countries. Traditionally in health education programs aimed
at workers, concepts of ergonomics and healthy posture have
been included. However, there is no scientific evidence of
their effectiveness in terms of improvement of occupational
health or reduction of absenteeism.
On the other hand, in recent years several studies made in
Anglo-Saxon countries have shown that health education centered
on reducing fear, discouraging bed rest and encouraging the
highest degree of activity the pain allows ("health education
in active coping") has a positive effect on the general
population. In fact, it generates a more positive effect,
in terms of reducing mistaken beliefs and improving the degree
of disability, than traditional health education centered
on ergonomics and healthy posture.
However, available scientific evidence shows that cultural
and psychosocial factors have an influence on these effects,
and it has not been shown whether the demonstrated results
are valid in Mediterranean countries. Also, the comparative
effect of the two kinds of health education on the working
population has not been evaluated, nor whether it is known
if the apparent advantage of health education in active coping
is due to its positive effect or to the counterproductive
effect of the classic programs.
For that reason, it was decided to evaluate the effect of
the two different kinds of health education on the degree
of disability and the beliefs regarding back pain on the working
population, and to establish a pure control group (that does
not receive health education on back problems).
Objective.
To evaluate the effect that two different kinds of health
education have on the degree of disability, beliefs regarding
back pain and work absenteeism.
Methodology.
It was a controlled clinical trial randomized
by clusters, blind in the randomization, evaluation and analysis
of the results. The subjects were blind in regard to the kind
of education they received. The follow-up was 365 days.
600 workers from 20 hotels on the Balearic Islands, excluding
those who were unable to complete the measuring instruments
of the variables of evolution (for example, the visual analog
scale of pain), or who suffered inflammatory rheumatoid illnesses
(spondylitis, rheumatoid arthritis, Reiter's illness, psoriatic
rheumatism), cancer or fibromyalgia.
The subjects included were randomly assigned to groups A,
B or C. In groups A and B, the education consisted of a 25-minute
lecture with handed out printed literature. In group A, the
lecture centered on concepts of healthy posture and a pamphlet
on the subject was handed out at the end of the talk. In group
B, the lecture focused on the need to maintain an active attitude
towards back pain, and a similar looking pamphlet to that
given to group A was handed out on that subject. In group
C (control), health education lectures unrelated to the back
and its problems were given.
Using previously validated instruments, the patients' evolution
was appraised over the course of a year in terms of pain intensity,
disability (degree of limitation of daily activities), fear
and avoidance beliefs effecting physical activity, the use
of medications and work absenteeism. These variables were
evaluated immediately after the patient entered the study
and at 60 and 365 days.
Participants, along with the Foundation's
Science Department.
Doctors at the participating hotels and Confederation
of Business Associations of the Balearic Islands (CAEB).
The study was co-funded by the Kovacs Foundation and the
CAEB.
Status.
A pilot program has been begun to assess
the study's viability and the recruiting rhythm of the sample.
|
Home
