JMIR Publications

ABSTRACT

Background:

Low back pain (LBP) is highly prevalent and disabling, especially in agriculture sectors. However, there is a gap in LBP prevention and intervention studies in these physically demanding occupations, and to date no studies have focused on horticulture workers. Given the challenges of implementing interventions for those working in small businesses, self-management offers an attractive and feasible option to address work-related risk factors and manage LBP.

Objective:

This study will: 1) investigate the effectiveness of self-management strategies for nursery and landscape workers by comparing within-subject control and intervention periods, and 2) determine if adoption and effectiveness differs between participants randomly assigned to review self-management videos only and those who also receive multimodal implementation support. We will also identify contextual factors impacting effectiveness and implementation using the EPIS model.

Methods:

A pragmatic mixed methods hybrid effectiveness and implementation design will be used to compare back pain with work tasks, disability, medication and substance use, and psychological factors between a baseline control and intervention periods. We aim to recruit 122 English and Spanish speaking horticulture workers with back pain, 30 supervisors, and 12 focus group participants. Participants will review short video modules designed to increase awareness of opioid risk and introduce self-management and ergonomic choices for managing work-related disability and pain. They will be asked to use one self-management and one ergonomic strategy to manage pain for 10 weeks. They will be randomly assigned to two implementation groups: video modules only, or video + multimodal personalized support (check-list guidance, review of video feedback for ergonomic problem-solving, text message reminders). Questionnaires will be administered at 3-month timepoints: baseline, pre- and post-intervention, and at 3- and 6-months. Qualitative analysis of field notes, open-ended comments, and focus groups will expand understanding of results with comprehensive documentation of the context, barriers and facilitators and reasons for adoption.

Results:

The project was funded on September 29, 2023 (CDC NIOSH U54OH011230-07S1) as a core research grant for the Southeast Coastal Center for Agricultural Health and Safety. The design, creation, and editing of English and Spanish videos was completed in June 2024 after comprehensive formative evaluation. Enrollment began in June 2024 with anticipated completion in 2027.

Conclusions:

We hypothesize that both self-management interventions will result in reductions in work task pain and disability and that the video enhanced with multimodal personalized support will result in greater reductions than the video alone. If self-management is effective, mitigating pain positively impacts quality of life, productivity, and retention, while increasing use of non-pharmacological alternatives to opioids addresses an important public health issue. Implementation aims will help inform reasons for results, barriers and facilitators, and potential for similar interventions in these and similar industries with physically challenging outdoor work. Clinical Trial: ClinicalTrials.gov NCT06153199