A CONTROLLED TRIAL OF AN EDUCATIONAL-PROGRAM TO PREVENT LOW-BACK INJURIES

Background Low back injuries are common and costly, accounting for 15 to 25 percent of injuries covered by workers' compensation and 30 to 4 0 percent of the payments made under that program. The high costs of i njury, the lack of effective treatment, and the evidence that there ar e behavioral risk factors have led to widespread use of employee educa tion programs that teach safe lifting and handling. The effectiveness of those programs, however, has received little rigorous evaluation. M ethods We evaluated an educational program designed to prevent low bac k injury in a randomized, controlled trial involving about 4000 postal workers. The program, similar to that in wide use in so-called back s chools, was taught by experienced physical therapists. Work units of w orkers and supervisors were trained in a two-session back school (thre e hours of training), followed by three to four reinforcement sessions over the succeeding few years. Injured subjects (from both the interv ention and the control groups) were randomized a second time to receiv e either training or no training after their return to work. Results P hysical therapists trained 2534 postal workers and 134 supervisors. Ov er 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 tim e 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, 7 5 workers were injured again. Our comparison of the intervention and c ontrol groups found that the education program did not reduce the rate of low back injury, the median cost per injury, the time off from wor k per injury, the rate of related musculoskeletal injuries, or the rat e of repeated injury after return to work; only the subjects' knowledg e of safe behavior was increased by the training. Conclusions A large- scale, randomized, controlled trial of an educational program to preve nt work-associated low back injury found no long-term benefits associa ted with training. (C) 1997, Massachusetts Medical Society.