Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Jo Lynne Robins, Ph.D., RN, ANP-BC, CHTP, AHN-C

Second Advisor

Jeanne Salyer, PhD, Associate Professor, VCU SON (Retired)

Third Advisor

Leroy Thacker, PhD, Associate Professor, VCU Department of Biostatistics

Fourth Advisor

D. S. Blaise Williams, III, PhD, Principal Researcher, NIKE



Purpose: Worldwide the incidence and prevalence of acute low back injury with pain (ALBIP) is increasing in healthcare workers (HCW). Approximately 27% of ALBIP result in chronic low back pain (CLBP). The primary aim of this study was to identify biopsychosocial factors that contribute to the development of CLBP. A secondary aim was to examine the predictive value of reliable and valid screening instruments to identify individuals at highest risk for CLBP.

Significance: Low back pain is the second most commonly reported pain condition in the United States, one of the leading causes of sick leave and is associated with cost estimates between $100 and $300 billion annually. While emerging evidence suggests that stress and work-related psychosocial factors play a role, it remains unclear which factors are the most significant. Use of a biopsychosocial conceptual model may illuminate the relationships among commonly co-occurring factors that contribute to the development of CLBP.

Methods: Using a descriptive repeated measures study design, HCW with an ALBIP were recruited from two healthcare systems. Data were collected on demographic, biological, and psychosocial variables, as well as screening instruments at enrollment and 12-weeks later.

Results: Results from this study contribute to the growing body of evidence regarding factors associated with the development of CLBP following an ALBIP occurrence in HCW. The participants in this study (N =21), fared better than anticipated following ALBIP. The majority did not miss time from work related to their injury, experienced minimal pain and disability and did not develop CLBP. Factors that may be associated with this include healthier lifestyles, the use of lift equipment in the workplace and high job satisfaction. Psychometric evaluation of two predictive screening instruments in this study evidenced strong reliability and validity.

Conclusion: This study contributes to elucidation of biopsychosocial variables associated with the development of CLBP following ALBIP as well as psychometric evaluation of two CLBP screening instruments to identify those at highest risk. Based on these results, additional research is needed to further examine factors that contribute to, as well as, prevent CLBP in HCW following ALBIP.


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