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The authors seek to better understand the critical incidents and factors that influence the switching behaviours of back pain sufferers who use mainstream and/or complementary and alternative medicine (Edvardsson, 1998). That is, the purpose of this paper is to uncover how they switch between treatments and treatment providers; in particular, this research investigates two issues: the triggers of their switching and their switching paths, and how their emotions are involved in that switching. The contribution is the first empirical foundation for an understanding of these two issues in the context of back pain.

The qualitative technique of convergent interviewing was used. It involved conducting a series of long, initially rather unstructured interviews to converge on the important topic areas to the back pain sufferers and why they engage in their treatment behaviour.

This study investigated the triggers and categories of triggers that impact upon switching behaviours between bio-medical and CAT healthcare. Four main areas of findings were identified. First, although the literature identified four categories of triggers for switching, namely, situational, reactional, influential and personal characteristics, the findings of this research confirmed only two of these: reactional and situational triggers. The influential category of triggers was found to be more of a moderating factor between switching triggers and switching behaviours rather than a trigger factor on its own. Further, no evidence came to light that could confirm or disconfirm the roles of personal characteristics on switching behaviour and so this issue remains unresolved.

The methodology used in this research was an exploratory one and so the findings must be used with caution. Further research, using a more quantitative methodology, is warranted to confirm the findings of this research. Also, this research focused on a subset of switching issues and so might not provide a holistic framework. Future investigations should therefore consider and clarify the role of emotion, time and voice in the switching model devised from this study.

This paper provides new evidence on the reasons for back pain sufferers consuming different treatment modes and the reasons for their switching and includes an exploratory investigation of the role of emotions in this decision making.

In the medical world, statistical visualisation has largely been confined to the realm of relatively simple geographical applications. This remains the case, even though hospitals have been collecting spatial data relating to patients. In particular, hospitals have a wealth of back pain information, which includes pain drawings, usually detailing the spatial distribution and type of pain suffered by back‐pain patients. Proposes several technological solutions, which permit data within back‐pain datasets to be digitally linked to the pain drawings in order to provide methods of computer‐based data management and analysis. In particular, proposes the use of geographical information systems (GIS), up till now a tool used mainly in the geographic and cartographic domains, to provide novel and powerful ways of visualising and managing back‐pain data. A comparative evaluation of the proposed solutions shows that, although adding complexity and cost, the GIS‐based solution is the one most appropriate for visualisation and analysis of back‐pain datasets.

The purpose of this paper is to report findings from qualitative interviews with physiotherapists to demonstrate why even minor changes to clinical work resulting from the introduction of new interventions, are often difficult to implement. The paper seeks to illustrate how some of the obstacles to implementing change were managed by physiotherapists.

A total of 32 qualitative interviews with participating physiotherapists were conducted, 12 interviews prior to the introduction of the new system, and 20 afterwards. The interviews were coded and analysed thematically.

The findings reveal a number of perceived limitations of current management of low back pain and identify key themes around convergence with the new approach, such as willingness by physiotherapists to adopt the new approach, the perception of benefits to adopting the new approach, as well as some difficulty in adjusting to it. The authors refer to the positive and negative elements as “soft” and “hard” disruption. The adoption of the new approach is explored with reference to the “situated” dimensions of physiotherapy practice and normalisation process theory.

The study raises the need to conduct future observational research to support the interview findings.

The study describes the “situated” components of physiotherapy work, which have received limited research attention. The value of the study lies less in its ability to explain specifically why physiotherapists adopted or rejected the new system, but in describing the conditions and consequences of change that might be translated to other professions, contexts and interventions.

Acute and chronic pain affects more Americans than heart disease, diabetes, and cancer combined. Conservative estimates suggest the total economic cost of pain in the United States is $600 billion, and more than half of this cost is due to lost productivity, such as absenteeism, presenteeism, and turnover. In addition, an escalating opioid epidemic in the United States and abroad spurred by a lack of safe and effective pain management has magnified challenges to address pain in the workforce, particularly the military. Thus, it is imperative to investigate the organizational antecedents and consequences of pain and prescription opioid misuse (POM). This chapter provides a brief introduction to pain processing and the biopsychosocial model of pain, emphasizing the relationship between stress, emotional well-being, and pain in the military workforce. We review personal and organizational risk and protective factors for pain, such as post-traumatic stress disorder, optimism, perceived organizational support, and job strain. Further, we discuss the potential adverse impact of pain on organizational outcomes, the rise of POM in military personnel, and risk factors for POM in civilian and military populations. Lastly, we propose potential organizational interventions to mitigate pain and provide the future directions for work, stress, and pain research.

The purpose of this paper is to evaluate the impact of educating adolescents in practical ways of looking after their backs to reduce the incidence of back‐pain, with particular focus on the use and carrying method of ergonomically designed schoolbags.

An educational leaflet containing a range of back care information was designed specifically for a target population group of Year 7 schoolchildren, aged 11 to 12 years, and distributed to Year 7 students (n=682) attending three main secondary education schools in West Sussex during September 2004. A feedback form was used to evaluate the impact of the leaflet on one class in each school (total n=81).

The main findings in this paper indicated education had immediate positive impact on students' awareness of the importance of looking after their backs, and achieving positive back‐health. Information gained was likely to influence future choice of schoolbag type, and intention to change to more back‐health aware schoolbook and equipment carrying behaviours.

The paper shows that long‐term impact was not evaluated, and is a limitation of this study. Further research is required to evaluate the long‐term impact of education on back care in adolescents, and at which age optimum educational impact in this area is gained.

This paper contributes evidence, which could be used to inform national and international health agendas, focusing on the specific area of healthy back education for adolescents through a school‐based health promotion initiative.

Work-related musculoskeletal disorders constitute a severe problem in the construction industry. Workers' lower backs are often affected by heavy or repetitive lifting and prolonged awkward postures. Exoskeletal interventions are effective for tasks involving manual lifting and repetitive movements. This study aims to examine the potential of a postural-assist exoskeleton (a passive exoskeleton) for manual material handling tasks.

From an experimental observation of participants, the effects of postural-assist exoskeleton on tasks and workers were measured. Associated benefits of the exoskeleton were assessed through task performance, range of motion and discomfort.

Findings suggest that the exoskeleton influenced discomfort significantly, however range of motion decreased with lifting tasks. The reduced back flexion and increased hip flexion were also indicatives of the participants' responsiveness to the feedback from the exoskeleton. In addition, task completion time increased by 20%, and participants' back pain did not reduce.

The work tasks were performed in a controlled laboratory environment and only wearable inertia measurement units (IMUs) were used to assess the risk exposures of the body parts.

This study opens a practical pathway to human-exoskeleton integration, artificial regeneration or enablement of impaired workforce and a window toward a new order of productivity scaling. Results from this study provide preliminary insights to designers and innovators on the influence of postural assist exoskeleton on construction work. Project stakeholders can be informed of the suitability of the postural assist exoskeletons for manual material handling tasks.

Little has been reported on the benefits and impact of exoskeletons on tasks' physical demands and construction workers' performance. This study adds value to the existing literature, in particular by providing insights into the effectiveness and consequences of the postural-assist exoskeleton for manual material handling tasks.

Work-related low back disorders (LBDs) are prevalent among rebar workers although their causes remain uncertain. The purpose of this study is to examine the self-reported discomfort and spinal biomechanics (muscle activity and spinal kinematics) experienced by rebar workers.

In all, 20 healthy male participants performed simulated repetitive rebar lifting tasks with three different lifting weights, using either a stoop (n = 10) or a squat (n = 10) lifting posture, until subjective fatigue was reached. During these tasks, trunk muscle activity and spinal kinematics were recorded using surface electromyography and motion sensors, respectively.

A mixed-model, repeated measures analysis of variance revealed that an increase in lifting weight significantly increased lower back muscle activity at L3 level but decreased fatigue and time to fatigue (endurance time) (p < 0.05). Lifting postures had no significant effect on spinal biomechanics (p < 0.05). Test results revealed that lifting different weights causes disproportional loading upon muscles, which shortens the time to reach working endurance and increases the risk of developing LBDs among rebar workers.

Future research is required to: broaden the research scope to include other trades; investigate the effects of using assistive lifting devices to reduce manual handling risks posed; and develop automated human condition-based solutions to monitor trunk muscle activity and spinal kinematics.

This study fulfils an identified need to study laboratory-based simulated task conducted to investigate the risk of developing LBDs among rebar workers primarily caused by repetitive rebar lifting.

Clinical specialist physiotherapy (CSP)-led musculoskeletal triage clinics have been established in the UK as a means of managing patients referred for outpatient orthopaedic consultation. The purpose of this paper is to determine if a CSP could allocate patients into distinct diagnostic triage categories in line with national and international guidelines. A second aim was to describe the CSPs clinical decision making.

A review of 100 spinal patients, consecutively referred between February and April 2013 to a CSP spinal triage clinic was undertaken. Patient demographics (age, gender, employment status), clinical diagnosis and diagnostic triage categories selected for each patient were recorded. Subsequently, if clinical triage led to further investigation or a consultant opinion then the onward management pathway was followed to calculate conversion to consultant surgical intervention.

In total, 69 per cent of patients were independently managed by the CSP and discharged back to the General Practitioner or on to therapy. In total, 30 per cent of patients (n=30) were referred for consultant opinion, of these 12 underwent intervention. This represents a conversion rate to consultant intervention of 40 per cent.

Findings suggest that a significant number of spinal patients referred for an orthopaedic consultation may be managed independently by a CSP. Referral for consultant review was deemed appropriate in terms of conversion to intervention, advice on further imaging, referral to other medical disciplines and patient counselling. This study suggests that CSPs can manage a significant number of patients with spinal conditions whilst providing high-quality referrals to surgical colleagues. This audit provides a novel insight into practitioner behaviour that supports the development of advanced practice for non-medical clinicians.

The purpose of this paper is to evaluate existing evidence on whether return to work interventions achieve employment outcomes and are cost effective in order to better inform those needing accommodations at work, as well as their line managers and trade union representatives, occupational health specialists and HR managers.

The paper uses a systematic narrative review to evaluate the evidence on the employment outcomes and cost effectiveness of return to work initiatives.

Evidence on interventions for musculoskeletal conditions such as lower back pain indicates that certain forms of intervention such as vocational rehabilitation and workplace-based rehabilitation facilitate outcomes such as employment, reduced sick leave and effective return to work. However, there is very little evidence on whether these interventions are cost effective. More generally there are glaring gaps in evidence on cardio-respiratory (heart and breathing) and mental health conditions with regard to both employment outcomes and the cost of interventions.

This systematic review has critical and timely implications for both knowledge development and practice. While highlighting methodological limitations in the existing research base, it also presents avenues for further research on return work strategies and the factors inhibiting and facilitating their adoption and effective operation.

Although there is much existent literature on the return to work process, far less attention has been paid to the employment outcomes and cost effectiveness of interventions. This paper highlights the interventions for musculoskeletal conditions such as lower back conditions that may result in positive employment outcomes, with implications for practice. However, it also highlights gaps in evidence on the employment outcomes and cost effectiveness of interventions for cardio-respiratory (heart and breathing) and mental health conditions.