A controlled trial of an educational program to prevent low back injuries

Lawren H. Daltroy, Brigham and Women's Hospital; Harvard Medical School; Harvard School of Public Health
Maura D. Iversen, Brigham and Women's Hospital; Northeastern University
Martin G. Larson, Brigham and Women's Hospital; Harvard School of Public Health; Boston University School of Medicine; The Framingham Heart Study
Robert Lew, Brigham and Women's Hospital; Harvard Medical School; Boston University School of Medicine
Elizabeth Wright, Brigham and Women's Hospital; Harvard Medical School
James Ryan, Harvard School of Public Health; U.S. Postal Service
Craig Zwerling, U.S. Postal Service; University of Iowa
Anne H. Fossel, Brigham and Women's Hospital
Matthew H. Liang, Brigham and Women's Hospital; Harvard Medical School; Harvard School of Public Health

Article comments

Originally published in the New England Journal of Medicine v.337 (2007), pp.322-328. http://www.nejm.org/doi/full/10.1056/NEJM199707313370507

Abstract

Background: Low back injuries are common and costly, accounting for 15 to 25 percent of injuries covered by workers’ compensation and 30 to 40 percent of the payments made under that program. The high costs of injury, the lack of effective treatment, and the evidence that there are behavioral risk factors have led to widespread use of employee education programs that teach safe lifting and handling. The effectiveness of those programs, however, has received little rigorous evaluation.

Methods: We evaluated an educational program designed to prevent low back injury in a randomized, controlled trial involving about 4000 postal workers. The program, similar to that in wide use in so-called back schools, was taught by experienced physical therapists. Work units of workers and supervisors were trained in a two-session back school (three hours of training), followed by three to four reinforcement sessions over the succeeding few years. Injured subjects (from both the intervention and the control groups) were randomized a second time to receive either training or no training after their return to work.

Results: Physical therapists trained 2534 postal workers and 134 supervisors. Over 5.5 years of follow-up, 360 workers reported low back injuries, for a rate of 21.2 injuries per 1000 worker-years of risk. The median time off from work per injury was 14 days (range, 0 to 1717); the median cost was $204 (range, zero to $190,380). After their return to work, 75 workers were injured again. Our comparison of the intervention and control groups found that the education program did not reduce the rate of low back injury, the median cost per injury, the time off from work per injury, the rate of related musculoskeletal injuries, or the rate of repeated injury after return to work; only the subjects’ knowledge of safe behavior was increased by the training.

Conclusions: A large-scale, randomized, controlled trial of an educational program to prevent work-associated low back injury found no long-term benefits associated with training.