Exploring Ambulance Officers' experiences of chronic low back pain and its treatment

Abstract

Low back pain (LBP) is a significant occupational related health condition which may cause difficulty with, or inability to lift. LBP is common in people of working age and can affect capacity for, and performance at work in turn threatening participation in employment. Ambulance officers (AOs) have physically demanding jobs which include standing, bending, lifting (patients and equipment), kneeling and crouching. AOs may be more likely to have episodic LBP, and for some this may become a chronic condition. Existing literature on LBP in AOs is scant; no qualitative study specifically of LBP experiences or treatment was found. The research aim was to explore AOs’ perceptions of LBP, its effects, their choice of musculoskeletal treatment, and treatment expectations.

Nine adult AOs who had experienced one or more episodes of chronic LBP while working as an AO and had sought musculoskeletal treatment (including chiropractic, physiotherapy or osteopathy) for LBP were recruited from the national ambulance service. Participation was invited via the organisation’s newsletter and potential participants contacted a thesis supervisor for eligibility screening and to address any questions about the study.

If verbal consent was given, the person’s contact details were given to the researcher, and a study information sheet, consent form, and the Brief Illness Perception Questionnaire (B-IPQ) were sent by post. After receipt of written informed consent a semi-structured interview was organised with the researcher. Interviews were digitally recorded and transcribed, and analysed using the six stages of thematic analysis described by Braun and Clarke (2006, 2012). The analytic focus was to understand the AO’s experience of back pain in the context of their employment, the perceived effects of LBP on their work, and musculoskeletal treatment choice and expectations.

The overarching theme was Frustration. Frustration was experienced in There is no magic potion, Finding the right treatment provider for me, Managing my way through and in What sort of industry am I in. In the context of being a working AO, the main source of frustration was the lack of control of many lifting situations and environments with the seemingly inevitable risk of further back injury. Frustration also accumulated from experiences including finding an understandable reason for the continuing pain; difficulties and delays finding a musculoskeletal practitioner who could ‘help’; receiving unhelpful treatments; making alterations at work in order to prevent further episodes of LBP; feeling that their job was constantly at risk as they could re-injure their back at any time.

This frustration can adversely affect performance at work as physical duties are altered to accommodate their LBP. Frustration can also have psychological effects as there is constant concern of having to leave their job. A possible consequence of this could be an organisation with a high but unrecognised prevalence of LBP.

Ambulance officer’s perceived back pain was a predictable consequence of their work. The impacts of chronic LBP on work and non-work activity were persistent and frustrating. Equally frustrating was trying to find treatment that helped and met their expectations for their ability to return to work and perform non-work activites at previous levels.

There is a need for St John ambulance service to recognise back pain as a current and potential threat to the health and wellbeing of their employees and implement strategies to prevent, assess, manage and mitigate this problem. The responsibility for this falls at all levels of organisation and may include the following: 1. ensuring that AOs are empowered to implement appropriate lifting techniques and managers are monitoring this regularly. 2. AOs should be encouraged and enabled to maintain their physical health and fitness 3. AOs, as the consumers, and General practitioners (GPs), as the first port of call for AOs, need to familiarise themselves with the various forms of musculoskeletal treatments. This is to ensure that AOs make an informed decision about who to consult after onset of LBP. This is also to encourage GPs to have more than one option of referral for LBP-related issues in order to avoid exposing AOs to possible dead-ends, unhelpful treatments or unmet expectations. The information gathered from this study will also be useful for musculoskeletal practitioners in developing an understanding about possible patient perceptions and the findings may benefit employers or other stakeholders.