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Economic Evaluation of an Extended Telehealth Worksite Exercise Intervention to Reduce Lost Work Time from Low Back Pain in Career Firefighters

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Abstract

Purpose Low back pain (LBP) is a leading cause of lost work time (LWT) in firefighters and is related to poor muscle endurance. Although exercise can improve muscle endurance, it must be continued to sustain benefits, and it is unknown if it can reduce LWT. This study conducted an economic evaluation of an extended worksite exercise intervention in career firefighters. Methods A randomized controlled trial allocated 264 firefighters to telehealth with remote instruction (“telehealth”), direct exercise supervision (“direct”), or brief education (“control”). The telehealth and direct groups performed worksite exercises twice weekly for 12 months. Outcomes included quality adjusted life years, LWT from LBP (24-h shifts), costs of LWT from LBP, and net monetary benefits. Results A total of 216 firefighters were included in the economic analysis (telehealth n = 71, direct n = 75, control n = 70). Sixteen experienced LWT from LBP (telehealth n = 4, direct n = 4, control n = 8). The mean number of 24-h shifts lost from LBP were 0.05 (telehealth), 0.28 (direct), and 0.43 (control). Mean study intervention costs per participant were $1984 (telehealth), $5269 (direct), and $384 (control). Net monetary benefit was $3573 for telehealth vs. direct, − $1113 for telehealth vs. control, and − $4686 for direct vs. control. Conclusions Worksite exercise reduced LWT from LBP in firefighters. Telehealth was less costly and more effective at reducing LWT from LBP than direct exercise supervision. If the costs of telehealth were further reduced, a positive net monetary benefit might also be achieved when compared to no intervention.

Clinical trial registration: (clinicaltrials.gov): NCT02362243.

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References

  1. Nuwayhid IA, Stewart W, Johnson JV. Work activities and the onset of first-time low back pain among New York City fire fighters. Am J Epidemiol. 1993;137(5):539–548.

    Article  CAS  Google Scholar 

  2. International Association of Fire Fighters. The fire service joint labor management wellness-fitness initiative. 3rd ed. Washington, D.C.: International Association of Fire Fighters; 2008.

    Google Scholar 

  3. Walton SM, Conrad KM, Furner SE, Samo DG. Cause, type, and workers’ compensation costs of injury to fire fighters. Am J Ind Med. 2003;43(4):454–458.

    Article  Google Scholar 

  4. Beaton R, Murphy S, Pike K. Work and nonwork stressors, negative affective states, and pain complaints among firefighters and paramedics. Int J Stress Manage. 1996;3(4):223–237.

    Article  Google Scholar 

  5. Damrongsak M, Prapanjaroensin A, Brown KC. Predictors of back pain in firefighters. Workplace Health Saf. 2018;66(2):61–69.

    Article  Google Scholar 

  6. Poplin GS, Harris RB, Pollack KM, Peate WF, Burgess JL. Beyond the fireground: injuries in the fire service. Inj Prev. 2012;18(4):228–233.

    Article  Google Scholar 

  7. Phelps SM, Drew-Nord DC, Neitzel RL, Wallhagen MI, Bates MN, Hong OS. Characteristics and predictors of occupational injury among career firefighters. Workplace Health Saf. 2018;66(6):291–301.

    Article  Google Scholar 

  8. Rissanen A, Heliövaara M, Alaranta H, Taimela S, Mälkiä E, Knekt P, et al. Does good trunk extensor performance protect against back-related work disability? J Rehabil Med. 2002;34(2):62–66.

    Article  Google Scholar 

  9. Biering-Sørensen F. Physical measurements as risk indicators for low-back trouble over a one-year period. Spine (Phila Pa 1976). 1984;9(2):106–119.

    Article  Google Scholar 

  10. Mayer JM, Quillen WS, Verna JL, Chen R, Lunseth P, Dagenais S. Impact of a supervised worksite exercise program on back and core muscular endurance in firefighters. Am J Health Promot. 2015;29(3):165–172.

    Article  Google Scholar 

  11. Martuscello JM, Nuzzo JL, Ashley CD, Campbell BI, Orriola JJ, Mayer JM. Systematic review of core muscle activity during physical fitness exercises. J Strength Cond Res. 2013;27(6):1684–1698.

    Article  Google Scholar 

  12. Busija L, Pausenberger E, Haines TP, Haymes S, Buchbinder R, Osborne RH. Adult measures of general health and health-related quality of life: Medical Outcomes Study Short Form 36-Item (SF-36) and Short Form 12-Item (SF-12) Health Surveys, Nottingham Health Profile (NHP), Sickness Impact Profile (SIP), Medical Outcomes Study Short Form 6D (SF-6D), Health Utilities Index Mark 3 (HUI3), Quality of Well-Being Scale (QWB), and Assessment of Quality of Life (AQoL). Arthritis Care Res (Hoboken). 2011;63(Suppl 11):S383-S412.

    Article  Google Scholar 

  13. Campbell MK, Torgerson DJ. Bootstrapping: estimating confidence intervals for cost-effectiveness ratios. QJM. 1999;92(3):177–182.

    Article  CAS  Google Scholar 

  14. Manek NJ, MacGregor AJ. Epidemiology of back disorders: prevalence, risk factors, and prognosis. Curr Opin Rheumatol. 2005;17(2):134–140.

    PubMed  Google Scholar 

  15. Udermann BE, Mayer JM, Graves JE, Murray SR. Quantitative assessment of lumbar paraspinal muscle endurance. J Athl Train. 2003;38(3):259–262.

    PubMed  PubMed Central  Google Scholar 

  16. Schellenberg KL, Lang JM, Chan KM, Burnham RS. A clinical tool for office assessment of lumbar spine stabilization endurance: prone and supine bridge maneuvers. Am J Phys Med Rehabil. 2007;86(5):380–386.

    Article  Google Scholar 

  17. Luo X, George ML, Kakouras I, Edwards CL, Pietrobon R, Richardson W, Hey L. Reliability, validity, and responsiveness of the short form 12-item survey (SF-12) in patients with back pain. Spine (Phila Pa 1976). 2003;28(15):1739–1745.

    Google Scholar 

  18. Mayer JM, Lane CL, Brady O, Chen H, Lu Y, Johnson BVB, et al. Comparison of supervised and telehealth delivery of worksite exercise for prevention of low back pain in firefighters: a cluster randomized tria. J Occup Environ Med. 2020;62:e586-e592.

    Article  Google Scholar 

  19. Kim P, Hayden JA, Mior SA. The cost-effectiveness of a back education program for firefighters: a case study. J Can Chiropr Assoc. 2004;48(1):13–19.

    PubMed  PubMed Central  Google Scholar 

  20. Moon TY, Kim JH, Gwon HJ, Hwan BS, Kim GY, Smith N, et al. Effects of exercise therapy on muscular strength in firefighters with back pain. J Phys Ther Sci. 2015;27(3):581–583.

    Article  Google Scholar 

  21. Hilyer JC, Brown KC, Sirles AT, Peoples L. A flexibility intervention to reduce the incidence and severity of joint injuries among municipal firefighters. J Occup Med. 1990;32(7):631–637.

    Article  CAS  Google Scholar 

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Acknowledgements

We thank the Federal Emergency Management Agency, U.S. Department of Homeland Security, for financially supporting this study (Grant # EMW-2013-FP-00723). We are grateful to the firefighters and management of Hillsborough County Fire Rescue, St. Petersburg Fire & Rescue, Tampa Fire Rescue, and Temple Terrace Fire Department for collaborating on this project. We thank the numerous study staff for assistance with this project.

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Authors and Affiliations

  1. Spine Research LLC, 94 Hillcrest Parkway, Winchester, MA, 01890, USA

    Simon Dagenais

  2. Hayflinger Analytical Services, Ardentown, DE, USA

    D. Cortney Hayflinger

  3. U.S. Spine & Sport Foundation, San Diego, CA, USA

    John M. Mayer

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  1. Simon Dagenais
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  2. D. Cortney Hayflinger
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  3. John M. Mayer
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Correspondence to Simon Dagenais.

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The senior author (JMM) was part of a research team that developed the telehealth exercise system discussed in this manuscript but does not derive any financial benefit from it.

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Dagenais, S., Hayflinger, D.C. & Mayer, J.M. Economic Evaluation of an Extended Telehealth Worksite Exercise Intervention to Reduce Lost Work Time from Low Back Pain in Career Firefighters. J Occup Rehabil 31, 431–443 (2021). https://doi.org/10.1007/s10926-020-09933-8

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