Project Summary
While low back pain (LBP) is highly prevalent and potentially disabling, few intervention studies to mitigate LBP have been conducted in the labor-intensive agriculture sectors, and no evidence-based intervention studies exist specific to horticulture workers. In a preliminary study, horticulture workers in Florida reported a high incidence of opioid use attributed to work-related injury or stress. Given the challenges of deploying interventions in small teams, self-management offers an attractive and feasible option to address work-related risk factors and more effectively manage LBP. The primary purpose of this hybrid comparative effectiveness and implementation study is to investigate the effectiveness of self-management strategies to increase awareness of opioid risk, manage pain, and adjust work-related ergonomic risk to address this high-priority public health problem. The specific aims align with 1) NIOSH strategic goals to reduce musculoskeletal disorders related to lifting and physical repetitive stress, and 2) Healthy People 2030 objectives to increase self-management of chronic pain that frequently limits work activities. Specific aim 1 is to determine if self-management plus individualized guided participatory ergonomic choices (SM+PE) is more effective than self-management (SM) alone for improving LBP among horticulture workers. We hypothesize that the combination of interventions will result in greater reductions in work task pain and disability than self-management modules alone. We will investigate changes in prevalence of high-impact chronic pain, pain with work tasks, medication and substance use, and psychological factors. We aim to recruit 120 English and Spanish-speaking horticulture workers in Florida and randomly assign clusters (teams) to the two intervention groups. Short self-management video modules will introduce risks of opioid use, self-management of pain, and simple ergonomic strategies for both groups. The SM+PE group will be asked to choose 1 self-management strategy and 1 workplace strategies using surveys with branching logic to guide choices matched to participant’s most difficult work activities. This group will also receive additional support for implementation. Surveys will be collected at baseline, pre- and post-intervention, with follow-ups at 3- and 6-months. Participants will be videoed performing work tasks at pre- and post-intervention to calculate the NIOSH lifting index and REBA risk factors. Specific aim 2 will identify contextual factors impacting engagement, adoption, effectiveness, and implementation. Interviews, focus groups, and field notes will be used to explain results and establish patterns to inform future translation. Ultimately if either intervention is effective, mitigating pain positively impacts quality of life, productivity, and retention, and increasing non-pharmacological self-management addresses an important public health issue.
