Moving backwards on backs
In 1997, the Victorian WorkCover Authority produced a major public health campaign to change community attitudes to back problems.
The centre piece of the campaign was a series of television advertisements, letting the community know that the spine was strong and that being overly cautious with the back was counter-productive.
The messages of the 1997 Victorian campaign were based on The Back Book, an evidence-based educational booklet for patients produced in the UK by a multidisciplinary team of authors.
In line with best practice guidelines, both the booklet and the campaign provided unambiguous advice directed towards improving common understanding of back problems. The campaign told the community the spine was strong and let people know they needed to remain active if they had a back problem.
The $6 million campaign's television commercials commenced airing in September 1997, and were supported by radio and billboard advertisements. Guidelines regarding back pain were sent to all doctors in Victoria, and an information booklet for patients was translated into 16 languages.
The commercials included international and national medical experts, as well as Australian sporting and television personalities, who had successfully managed back problems. All advertisements concluded with an endorsement by the relevant national professional bodies.
The 1997 campaign in Victoria was professionally evaluated and published in key journals, and I was involved in this process. The evaluation won international awards and the campaign has since been copied in other countries.
The evaluation results showed a reduction in back claims, a significant change in beliefs and understanding of back problems. Doctors indicated they would change their management. There was a reduction in days lost secondary to back problems, and in related medical expenses.
Research evidence over the last ten years has strengthened our understanding that the messages in the campaign were correct.
Here is one of the advertisements, in which a Melbourne-based spinal surgeon talks about the spine strength. (if you cannot see the video it is being blocked by your organisation's server)
No one can argue against work injuries being prevented wherever possible.
However, the current Victorian WorkSafe campaign to prevent musculoskeletal injuries now provides a completely contradictory message to the earlier campaign.
In the current advertisements, people are seen to lift things like a bag of cement, a computer monitor and a patient, followed by a graphic showing what looks like a mini explosion occurring in their spine.
Here is part of one of the current campaign's advertisements.
As a doctor treating patients with back problems, I believe the current campaign sends a shocking message.
People do get back problems and they may develop from lifting, however, back problems from lifts do not occur in the frightening and disastrous ways this campaign portrays.
The spine does not explode.
One of the worst things that can be done to patients is to suggest that a major damaging event will occur through any simple, even, heavy lift.
The European Back Pain Guidelines are a major review of the evidence, and include a review of prevention. They point out that there is little evidence that back pain can be prevented through ergonomic interventions.
This doesn’t mean we should ignore ergonomics. There is value in trying to prevent lifting injuries, even though research evidence does not support its effectiveness. But to package this aspiration into a frightening, incorrect, and negative message goes against a decade of medical evidence and a great deal of hard work that has been done to correct misunderstandings. This is highly regrettable.
It does not make sense for WorkSafe Victoria to spend millions on disseminating an important evidence-based message, and then reverse it, presumably spending further millions on the current campaign.
The current campaign is wrong, it creates negative beliefs, it will create disability, and it is harmful. It needs to stop.
Published 17 October, 2010