Nurses play an important role within the health care system, providing and assisting in the provision of primary, secondary and tertiary level health care. Typically, their work is physically demanding. Nurses frequently assist patients to mobilise, transfer between positions and perform other activities of daily living such as toileting and showering.
Nurses have an increased risk of back trouble. Compared with other professions, they have an increased risk of back pain1
and a six times higher prevalence of back injury.2
Nurses and related medical workers lead all other occupations for risk of herniated lumbar intervertebral discs requiring hospitalisation in women.3
Furthermore, hospitals and nursing and residential care facilities lead all industries for workplace injury and illness.4
Numerous factors have been found to increase nurses' risk of back pain.5
Physical load and work posture play a role, as do psychosocial factors such as personality and the presence of psychosomatic symptoms. Work task and work organisational factors have been shown to be significant risks in individual studies, although when all trials are considered the evidence is inconsistent. Nursing qualifications are important, with nursing assistants at greater risk for back pain than registered nurses. Years in the nursing profession may also be relevant, with a growing body of evidence suggesting that younger nurses are at greatest risk.5
Identification of individual physical predictors of back pain is more elusive. Prospective studies find predominantly non‐significant relationships or inconsistent results.6,7,8,9,10
However, reduced lateral bending of the spine has been identified as a risk factor in two studies.11,12
Back pain and injury have a major impact on the efficiency of the nursing workforce. Registered nurses rank seventh and nursing aides and orderlies are highest ranked across all occupations for back injuries involving days away from work in private industry.13
Back injuries and resultant workers' compensation claims in nurses are expensive. In long‐term care facilities in the United States, nurses' back injuries are estimated to cost over US$6 million in indemnity and medical payments. Nurses' compensation for back injury comprises 56.4% of all indemnity costs and 55.1% of all medical costs.2
In one Australian state, nurse back injury claims accounted for $A2.39 million expenditure in one financial year.14
Surprisingly, few systematic reviews have investigated the efficacy of interventions to prevent back pain and injury in nurses. One review which included trials over a 10‐year period up to 1998 provided a narrative summary but failed to score the methodological quality of trials or interpret findings in consideration of varying design flaws.15
A systematic review of interventions to reduce musculoskeletal injuries associated with handling patients included many relevant trials but was not focused on nurses and accepted low‐quality designs such as professional opinion.16
The primary objective of this study was to systematically review the literature to determine whether there are interventions with proven efficacy that prevent back pain and back injury in nurses. A review focusing specifically on nurses was considered necessary due to the unique nature of nursing work.