Effectiveness of a Workplace-Based Core Stability Exercise Program in Reducing Occupational Low Back Pain Among Hospital Nurses: A Quasi-Experimental Study
This quasi-experimental study assessed the effectiveness of a structured, workplace-based core stability exercise program in reducing occupational low back pain (OLBP) among hospital nurses. Conducted at a tertiary care hospital in Islamabad, Pakistan, the study involved 146 registered nurses with OLBP, divided equally into an intervention group and a control group. The intervention group participated in a supervised core stability exercise regimen three times per week for four weeks, while the control group maintained routine occupational activities without structured exercise.
The core stability program emphasized neuromuscular control and strengthening of deep trunk stabilizing muscles, including the transversus abdominis, lumbar multifidus, pelvic floor muscles, diaphragm, and obliques. Each session incorporated warm-up, progressive core stability exercises, and cool-down phases, focusing on controlled movement quality over maximal effort. Exercises included abdominal drawing-in maneuvers, pelvic tilting, bridging, bird-dog, side bridge, and plank variations, with intensity progressively increased over the intervention period.
The study's rationale is grounded in Panjabi's spinal stability model, which identifies three interacting subsystems-passive (vertebrae, discs, ligaments), active (muscles, tendons), and neural control-that collectively maintain spinal stability. Occupational activities of nurses, such as manual patient handling, prolonged standing, and repetitive trunk movements, impose substantial biomechanical loads on the lumbar spine, often exceeding recommended safety limits and leading to cumulative tissue fatigue and injury. Core stability exercises target the active and neural control subsystems by enhancing deep trunk muscle activation and neuromuscular coordination, thereby improving spinal stiffness, load sharing, and movement efficiency, which collectively reduce mechanical stress on passive structures and alleviate pain.
The study's workplace-based intervention aligns with emerging evidence supporting exercise programs as effective non-pharmacological treatments for low back pain. While prior research has established core stability training benefits in chronic non-specific low back pain patients, this study addresses a gap by focusing on hospital nurses exposed to high occupational spinal loading. The pragmatic, supervised intervention demonstrated feasibility and safety, achieving full participant retention and no reported injuries.
Strengths include standardized intervention delivery, validated pain measurement, and comprehensive statistical analysis incorporating effect size estimation and sensitivity adjustment for confounders. Limitations consist of the non-randomized design, potential selection bias, imbalance in workplace department distribution, short intervention duration limiting long-term effect assessment, and reliance on self-reported pain without additional functional or biomechanical outcome measures.
Clinically, the findings advocate integrating structured core stability exercises into occupational health programs as a cost-effective strategy to mitigate OLBP, potentially reducing disability, absenteeism, and healthcare costs while enhancing nurse wellbeing and patient care quality. Future research should employ randomized controlled designs with extended follow-up and incorporate broader outcome measures such as functional capacity, muscle endurance, electromyographic activity, and quality of life to validate and extend these results.
Studie Overzicht
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Conditie
Gedetailleerde beschrijving
The study is a quasi-experimental investigation conducted at a tertiary care hospital in Islamabad, Pakistan, aimed at evaluating the effectiveness of a structured, workplace-based core stability exercise program in reducing occupational low back pain (OLBP) among hospital nurses. A total of 146 registered nurses experiencing OLBP were enrolled and allocated into two equal groups: an intervention group (n = 73) and a control group (n = 73). Allocation was based on departmental feasibility and work schedules rather than randomization to maintain clinical workflow, reflecting a pragmatic design.
Participants in the intervention group engaged in a supervised core stability exercise program three times per week over four consecutive weeks, totaling 12 sessions. Each session lasted approximately 30-40 minutes and included three phases: a 5-10 minute warm-up with low-intensity mobility and stretching exercises targeting the lumbar spine and lower extremities; a 20-25 minute core stability training phase focusing on neuromuscular activation and strengthening of deep trunk stabilizing muscles (transversus abdominis, lumbar multifidus, pelvic floor, diaphragm, obliques, and trunk extensors) through progressive static and dynamic exercises such as abdominal drawing-in maneuvers, pelvic tilting, bridging, bird-dog, side bridge, and plank variations; and a 5-minute cool-down with gentle stretching to promote recovery. Exercise intensity was progressively increased by modifying duration, repetitions, and complexity while maintaining correct technique under physiotherapist supervision. The control group continued routine occupational activities without structured exercise.
The primary outcome was pain intensity measured by the Numeric Pain Rating Scale (NPRS), a validated 11-point scale ranging from 0 (no pain) to 10 (worst pain imaginable). Pain was assessed at baseline and immediately post-intervention. Baseline characteristics of participants, including demographic and occupational variables, were comparable between groups except for a significant difference in workplace department distribution, which was controlled for in sensitivity analyses.
Statistical analyses employed non-parametric tests due to non-normal distribution of NPRS scores. Within-group changes were analyzed using the Wilcoxon signed-rank test, and between-group differences post-intervention were evaluated using the Mann-Whitney U test. Effect sizes (r) were calculated to quantify the magnitude of changes. A sensitivity analysis using ANCOVA adjusted for baseline pain intensity and workplace department to address potential confounding from the non-randomized design.
The study's rationale is based on Panjabi's spinal stability model, which describes spinal stability as a function of the passive (vertebrae, discs, ligaments), active (muscles, tendons), and neural control subsystems. Occupational activities of nurses, including manual patient handling and prolonged static postures, impose repetitive biomechanical loading on the lumbar spine, risking tissue fatigue and injury. Core stability exercises target the active and neural subsystems by enhancing deep trunk muscle activation and neuromuscular coordination, improving spinal stiffness, load sharing, and movement efficiency, thereby reducing mechanical stress on passive structures and alleviating pain.
Strengths of the study include standardized, supervised intervention delivery, 100% participant retention, validated pain measurement, and comprehensive statistical analysis with effect size reporting and sensitivity adjustment. Limitations include the quasi-experimental non-randomized design with potential selection bias, imbalance in workplace department distribution, short intervention duration limiting assessment of long-term effects, and reliance solely on self-reported pain without functional or biomechanical outcome measures.
The study was approved by the Institutional Review Board and Ethics Committee of Shifa International Hospitals, Islamabad, Pakistan, and conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants. No external funding was received, and the authors declared no conflicts of interest.
Studietype
Inschrijving (Werkelijk)
Fase
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Contacten en locaties
Studie Locaties
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ICT
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Islamabad, ICT, Pakistan, 44000
- Shifa Tameer e Millat University
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Deelname Criteria
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Accepteert gezonde vrijwilligers
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Beschrijving
Inclusion Criteria:
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Eligible participants were registered nurses who met the following inclusion criteria:
- aged between 20 and 60 years;
- employed as full-time nursing staff;
- had experienced occupational low back pain for at least three months;
- reported a pain intensity of 3 or greater on the Numerical Rating Scale (NRS);
- were able to participate safely in light-to-moderate physical exercise; and
- provided written informed consent before participation.
Exclusion Criteria:
Participants were excluded if they:
- had undergone spinal surgery within the previous year;
- had a history of spinal fracture, malignancy, inflammatory spinal disease, or severe neurological disorders;
- were pregnant;
- had acute traumatic musculoskeletal injuries;
- were currently participating in another structured rehabilitation or exercise program targeting low back pain; or
- had any medical condition that contraindicated participation in therapeutic exercise.
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Ondersteunende zorg
- Toewijzing: Niet-gerandomiseerd
- Interventioneel model: Parallelle opdracht
- Masker: Geen (open label)
Wapens en interventies
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Geen tussenkomst: Control Group
The control group in this quasi-experimental study consisted of 73 registered nurses who continued their routine occupational activities without participating in any structured exercise program targeting low back pain. Throughout the four-week study period, these participants maintained their usual work duties in the hospital setting without receiving any supervised core stability exercises or other intervention. They were specifically instructed not to engage in any additional structured exercise programs aimed at managing low back pain during the intervention period. Pain intensity in the control group was measured at baseline and immediately post-intervention using the Numeric Pain Rating Scale (NPRS). The control group showed minimal change in pain intensity over the study period, with median NPRS scores remaining largely unchanged (from 4 at baseline to 4 post-intervention). No adverse events or injuries were reported. The control group's role was to serve as a comparator to asse |
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Experimenteel: Structured Workplace-Based Core Stability Exercise Program
The intervention consisted of a structured, workplace-based core stability exercise program aimed at improving neuromuscular control of the lumbopelvic region, enhancing spinal stability, and reducing occupational low back pain among hospital nurses. Participants in the intervention group undertook this supervised exercise regimen three times per week for four consecutive weeks, totaling 12 sessions. Each session lasted approximately 30 to 40 minutes and was overseen by a trained physiotherapist to ensure correct technique, safety, and adherence. Each session comprised three phases:
This phase focused on activating and strengthening the deep trunk stabilizing muscles, including the |
This intervention is distinguished from other clinical studies by several key features based on the provided document:
Participants were allocated based on departmental feasibility and work schedules rather than randomization, preserving clinical workflow and minimizing disruption to patient care. This pragmatic approach reflects real-world occupational health program implementation challenges, distinguishing it from more controlled randomized tri |
Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
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pain score
Tijdsspanne: Baseline (prior to the intervention) Five weeks post-baseline, corresponding to one week after completion of the four-week intervention period.
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Pain intensity was measured using the Numeric Pain Rating Scale (NPRS), an 11-point validated and reliable patient-reported measure ranging from 0 ("no pain") to 10 ("worst pain imaginable"). Participants rated the average intensity of their occupational low back pain experienced during routine work activities. Pain assessments were conducted at two specific time points: baseline (prior to the intervention) and at five weeks post-baseline, which corresponds to one week after completing the four-week intervention period. |
Baseline (prior to the intervention) Five weeks post-baseline, corresponding to one week after completion of the four-week intervention period.
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Meer informatie
Termen gerelateerd aan deze studie
Aanvullende relevante MeSH-voorwaarden
Andere studie-ID-nummers
- STMU- LBP-2026-1
Plan Individuele Deelnemersgegevens (IPD)
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Beschrijving IPD-plan
this was not consented thats why we can relook by approaching to the participants
Informatie over medicijnen en apparaten, studiedocumenten
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