Occupational low back pain is not simply caused by physical demands of the job—a great number of studies have demonstrated the role of social and psychological issues in the problem of chronic back pain. As Hadler contends, "Measures of psychological stress and disaffection generally overwhelm ergonometric assessments of a wide range of physical demands in the workplace when the effect on health results in disabling regional back injury."1 After evaluating an educational program dedicated to preventing low back injuries in 4000 postal workers, the following study2 appears to agree with the previous findings and assessments.
The program, which resembled the well-known "Back Schools" in format, was taught by experienced physical therapists. The subjects had three hours of training that was concentrated on safe handling and lifting techniques. In succeeding years, follow-up sessions were implemented. All of the study participants were followed to evaluate the occurrence of back pain episodes.
Of the 2,668 postal workers that received training, 360 reported low back injuries at the 5.5 years follow-up. After returning to work 75 postal workers were injured again. Overall, injury rates increased in the intervention group as compared to the controls.
Also, the educational program did not reduce the rate of low back injury, the cost per worker, time off from the job per injury, rate of related injuries, or the rate of repeated injuries. Knowledge of safe behavior increased, but no long-term benefits resulted.
Since there was no increase of practice of desirable behavior, the authors state:
"The failure to change behavior reflects complex factors such as the workers' level of job satisfaction and negative perception of what supervisors and coworkers were doing to improve back safety. Our program included substantial efforts to maintain and reinforce the practice of learned behavior. If such reinforcement is in fact ineffective, it represents a key weakness in educational programs directed at individual workers and small groups at the work site. Larger economic and social factors, and management-labor issues, may ultimately determine the success or failure of such programs."
While the authors do not dismiss the possible benefits of educational programs entirely, they suggest that they are not effective as a sole method of prevention.