Working with low back pain: problem-solving orientation and function

Abstract

A number of ergonomic, workplace and individual psychosocial factors and health behaviors have been associated with the onset, exacerbation and/or maintenance of low back pain (LBP). The functional impact of these factors may be influenced by how a worker approaches problems in general. The present study was conducted to determine whether problem-solving orientation was associated with physical and mental health outcomes in fully employed workers (soldiers) reporting a history of LBP in the past year. The sample consisted of 475 soldiers (446 male, 29 female; mean age 24.5 years) who worked in jobs identified as high risk for LBP-related disability and reported LBP symptoms in the past 12 months. The Social Problem-Solving Inventory and the Standard Form-12 (SF-12) were completed by all subjects. Hierarchical multiple regression analyses were used to predict the SF-12 physical health summary scale from interactions of LBP symptoms with each of five problem-solving subscales. Low scores on positive problem-solving orientation (F(1,457)=4.49), and high scores on impulsivity/carelessness (F(1,457)=9.11) were associated with a steeper gradient in functional loss related to LBP. Among those with a longer history of low-grade LBP, an avoidant approach to problem-solving was also associated with a steeper gradient of functional loss (three-way interaction; F(1,458)=4.58). These results suggest that the prolonged impact of LBP on daily function may be reduced by assisting affected workers to conceptualize LBP as a problem that can be overcome and using strategies that promote taking an active role in reducing risks for LBP. Secondary prevention efforts may be improved by addressing these factors.

Using Video Assessment for Clients with Chronic Low Back Pain: Is it Reliable?

“…This is particularly true of the problem-solving subscale, where both intrarater and interrater reliability were lower, especially at the first assessment. Although it is necessary to demonstrate that good problem-solving strategies have been learned, so that functional performance can increase in spite of continued pain (Shaw et al 2001), a better definition of 'good' needs to be addressed so that the programme can show optimum efficacy. Clients have previously learned to avoid activities perceived to increase their pain and the reversal of this strategy, by practising more adaptive activities, is the fundamental goal of the treatment.…”

“…Posture was defined as using good alignment of the spine during sitting, standing, walking, bending and lifting. The characteristics evaluated by the observers on problem solving were those recommended by Shaw et al (2001), who described effective problem solving as being able to select appropriate information, set goals and find alternative solutions to problems. Movement was characterised as fluid, cautious or stiff.…”

Job stress reactivity and work-related musculoskeletal symptoms

“…Additionally, in workers with longer histories of low back pain, the tendency to utilize a problem-solving style characterized by attempts to procrastinate or shift responsibility was also associated with poorer 89 function. Although the results from Shaw et al (2001) are indicative of problem-solving style in workers with low back pain (a group that has been shown to be empirically different from workers with upper extremity pain) and do not elucidate the specific mechanism(s) by which problem-solving may impact functional status, it suggests that problem-solving may moderate objective outcomes in workers with work-related musculoskeletal symptoms. Replication and further investigation of these findings are necessary in order to glean a better understanding of the nature of this relationship.…”

“…Recent support for this cognitive processing interpretation was reported by Shaw, Feuerstein, Haufler, Berkowitz, and Lopez (2001). In a sample of U.S. Army soldiers working with low back pain, differences in problem-solving style, specifically the tendency to view problems as significant threats to well-being and the tendency toward narrow, harried, and incomplete solutions were associated with loss in pain-related physical function.…”

Bedeutung des Bildungsniveaus für die Wirksamkeit der multimodalen Schmerztherapie

“…B. in der Studie von Shaw et al [29] einen deutlich besseren physischen und psychischen Heilungsverlauf als schlechte "Problemlöser".…”