Dunleavy Kim, Radunovich Heidi Liss, Beneciuk Jason M, Hu Boyi, Yang Yang, Blythe Janeen McCormick, Gurka Kelly K
Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States.
Department of Family, Youth and Community Sciences, Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL, United States.
JMIR Res Protoc. 2025 Jan 28;14:e64817. doi: 10.2196/64817.
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.
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.
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 and use 1 self-management and 1 ergonomic strategy for 10 weeks. They will be randomly assigned to 2 implementation groups: video modules only or video + multimodal personalized support (checklist guidance, review of video feedback for ergonomic problem-solving, and text message reminders). Questionnaires will be administered at 3-month time points: baseline, pre- and postintervention, 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.
The project was funded on September 29, 2023 (Centers for Disease Control and Prevention National Institute of Occupational Health and Safety, 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.
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 the use of nonpharmacological 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.
ClinicalTrials.gov NCT06153199; http://clinicaltrials.gov/study/NCT06153199.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/64817.
腰痛（LBP）极为普遍且会导致身体残疾，在农业领域尤其如此。然而，在这些体力要求较高的职业中，腰痛预防和干预研究存在空白，迄今为止，尚无针对园艺工人的研究。鉴于对小企业员工实施干预措施存在挑战，自我管理为解决与工作相关的风险因素和管理腰痛提供了一个有吸引力且可行的选择。
本研究将（1）通过比较受试者自身的对照期和干预期，调查自我管理策略对苗圃和园林工人的有效性；（2）确定随机分配仅观看自我管理视频的参与者与同时接受多模式实施支持的参与者在采用率和有效性方面是否存在差异。我们还将确定影响有效性和实施的背景因素。
将采用务实的混合方法、混合有效性和实施设计，比较基线对照期和干预期之间的背痛与工作任务、残疾、药物和物质使用情况以及心理因素。我们的目标是招募122名讲英语和西班牙语的患有背痛的园艺工人、30名主管和12名焦点小组参与者。参与者将观看短视频模块，这些模块旨在提高对阿片类药物风险的认识，并介绍自我管理和人体工程学选择，并在10周内使用1种自我管理和1种人体工程学策略。他们将被随机分配到2个实施组：仅视频模块组或视频 + 多模式个性化支持组（清单指导、针对人体工程学问题解决的视频反馈审查以及短信提醒）。将在3个月的时间点进行问卷调查：基线、干预前和干预后，以及在3个月和6个月时。对实地记录、开放式评论和焦点小组进行定性分析，将通过对背景、障碍和促进因素以及采用原因的全面记录，加深对结果的理解。
该项目于2023年9月29日获得资助（疾病控制与预防中心国家职业健康与安全研究所，CDC NIOSH；U54OH011230 - 07S1），作为东南沿海农业健康与安全中心的一项核心研究资助。经过全面的形成性评估后，英语和西班牙语视频的设计、制作和编辑于2024年6月完成。招募工作于2024年6月开始，预计2027年完成。
我们假设两种自我管理干预措施都将减少工作任务引起的疼痛和残疾，并且与仅视频相比，多模式个性化支持增强的视频将带来更大程度的减少。如果自我管理有效，减轻疼痛将对生活质量、生产力和留用率产生积极影响，同时增加阿片类药物非药物替代品的使用可解决一个重要的公共卫生问题。实施目标将有助于说明结果的原因、障碍和促进因素，以及在这些以及其他有体力挑战的户外工作的类似行业中进行类似干预的可能性。
ClinicalTrials.gov NCT06153199；http://clinicaltrials.gov/study/NCT06153199。
国际注册报告识别码（IRRID）：DERR1 - 10.2196/64817。
