Frequency of low back pain among nurses working in Jinnah hospital Lahore

Background Nursing is a healthcare profession that is concerned with maintaining and promoting the health of the patients. Because of their work environment and workload nurse are at the very high risk of many occupational health problems. Among all these; musculoskeletal problems are most common especially the low back pain. Methods A descriptive cross-sectional study design was used. A sample size of 92 nurses was calculated and questionnaires were distributed among them and information was collected on socio-demographic characteristics, job history, frequency, severity and pattern of low back pain. Data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 23 for windows and Microsoft Excel 2013. Descriptive statistics i.e., percentage, mean were used to interpret the data. Chi-square and P-value were used to find associations between dependent and independent variables. Results The frequency of low back pain among nurses was 65.1%. 12 months frequency was 57.8% and 7 days frequency was 32.5% with majority of nurses describing pain of Moderate intensity. The frequency of low back pain was high in nurses more than 30 years old, married, overweight/obese and those with more than 15 years of work experience. Conclusions About 65% of nurses working in Jinnah Hospital Lahore were suffering from low back pain which indicates high prevalence and is in line with prevalence of low back pain in the developed countries. Therefore, it is recommended to maintain the Body Mass Index in the normal ranges and also maintain proper body mechanics and posture and use assistive devices in lifting the patients.


Introduction
Low Back pain is the pain in area of the Back between the ribcage and the gluteal folds (Lumbar Spine) whether or not it extends into the legs (Sciatica). Low back pain is one of most common musculoskeletal disorders in the world and one of the most common causes of visits to the physicians in the developed countries. It is estimated that about 84% of population in the world suffers from low back Pain at least once in the life time with 23 % proceeding towards chronic low back pain and about 11-12% are disabled because of low back pain 1 . Low back pain has been shown to be a major health problem in the females and mostly affecting the individuals with 40 to 80 years of age 2 . Among the working individuals low back pain has been found to be one of the most common causes of less efficiency at work, absence from the job, changing the job, and early retirement from job (who retire because of sickness) 3 .
Nursing are one of the occupational groups that are most affected by the musculoskeletal disorders because of their work load i.e. standing for longer durations, frequent bending, lifting the patients etc. Among this professional group it has been found that low back Pain comprises about 44% of all the musculoskeletal disorders preceding disorders of neck (28%) and knee joint (22%) in the nurses 4 .
In the underdeveloped countries like Pakistan, the facilities provided by the hospitals are limited not only to the patients but also to doctors, nurses, and the other staff As far as Pakistani nurses are concerned, they are also at very high risk of developing musculoskeletal disorders and especially low back pain as the public sector hospitals of Pakistan are extremely short of facilities, equipment and assistive staff so that nurses have to perform all the nursing care work including patient lifting on their own. According to a study conducted at DHQ Faisalabad and Allied hospital Faisalabad, high percentage (47%) of nurses were found to be suffering from low back pain only secondary to headache (64%) 5 . Most prevalent causes of low Back Pain are frequent bending, standing for long time and carrying the patients 6 .
This topic was selected as researchers were unable to find reasonable amount of literature conducted on the frequency or prevalence of the low back pain among Pakistani Nurses. So the main objective of this study is to get an idea about the prevalence of low back pain in Pakistani nurses.

Study Setting
This study was conducted at Jinnah Hospital Lahore Pakistan which is a 1250 bedded hospital. Study Design: A descriptive cross-sectional study was conducted over a period of 3 months among nurses working in Jinnah Hospital Lahore to find out the prevalence of low back pain. Sampling: A pilot study was conducted on 20 nurses to estimate the prevalence that was found to be 60%. Using estimated proportion of 60%, 10% margin of error and CI of 95% a sample size of 92 was calculated.

Inclusion and exclusion Criteria:
Nurses with ages from 18-60 years with at least 1 year of work experience were included. Male nurses were considered excluded from the study as there were no male nurses found to be working in Jinnah hospital Lahore. In addition, pregnant nurses and those with serious pathological diseases were also excluded from the study.

Data Collection:
Using non-purposive convenient sampling technique; a questionnaire consisting of consent form, socio-demographic information and modified Nordic questionnaire 7 for the low back pain was distributed among the 92 participants. Data Analysis: Data was entered and analyzed using IBM SPSS (Statistical Package for Social Sciences) version 23. The categorical values were expressed in the form of frequency and proportion. Chi-square test and p-value were used to find out the relationship of Low Back Pain with Age, Body Mass Index, Marital Status and work experience in years. P-value of less than 0.05 were considered significant statistically.

Results
A total of 92 questionnaires were distributed among the nurses. Out of those 83 nurses answered and returned the questionnaires. So, the response rate of 90.2% was recorded. The ages of respondents were between 19-59 years with the Mean and SD of 34.41 ± 10.71  Cross tabulation to find out the relationship between marital status of the nurses and life time frequency of low back pain shows that 43 (74.14%) of married and 11 (44%) of unmarried nurses suffered from low back pain while 15 (25.86%) of married and 14 (56%) of unmarried nurses didn't suffer from low back pain ever. So, it can be suggested that prevalence of low back pain is highly significant with the marital status of the nurses. Value of Chi-Square (6.980) and Pvalue (0.012) also shows the strong relationship between incidence of low back pain and marital status.
Cross tabulation to find out the relationship between work experience of the nurses and life time frequency of low back pain shows that 6 (50%) of respondents with less than 3 years of job experience had Low back pain while equally 6 (50%) didn't. 21 (52.5%) with job experience of 4-14 years suffered from low back pain while 19 (47.5%) didn't experience low back pain. While interestingly all 11 (100%) of nurses with more than 26 years of job experience had suffered from low back pain. So, it can be seen that prevalence of low back pain is highly significant with job experience of the nurses. Value of Chi-Square (11.844) and Pvalue (0.007) also shows the strong relationship between incidence of low back pain and work experience.

Discussion
A cross-sectional research study was carried out in the Jinnah hospital Lahore to find out life-time and 12 months and 1-week prevalence of low back pain among the nurses. The association between the characteristics of low back pain and factors such as age, number of years at work, body mass index and the marital status was also determined.
Life time prevalence of low back pain among nurses working in Jinnah hospital Lahore was found to be 65.1% which is very high and is comparable to findings in other previously conducted studies which found the life time prevalence of low back pain among female nurses to be 74.5% 8 , 73% 9 and 78% 10 .
12 months prevalence of low back pain found to be 88.89% is higher than the finding in another study which found the 12-month prevalence of low back pain among nurses to be 78% 4 . 7 days prevalence of low back pain was found to be 56.25% that is higher than the finding in another previously conducted study that showed point prevalence to be 36.2% 8 .
Low back pain is one the major causes of work hours losses and absence from the job in the whole world. Of all those nurses who  13 . 53.7% of nurses with low back pain took medicines (prescribed or self-medication), 20.4% were relieved by physiotherapy while 25.9% were relieved by taking rest. It has been found in a study in the nurses in a Nigerian hospital that 73% nurses with low back pain took medicines while 27% were relieved by physiotherapy 14 .
Some risk/causative factors have been found to be significantly associated with low back pain prevalence, and these are age, marital status, body weight and working experience. Majority of nurses (86%) who experienced low back pain were more than 32 years old. This finding can be supported by another study which found that more than 94% of nurses with more than 30 years of age happened to be suffering from low back pain 6 . So, this can be concluded that age is highly and significantly associated with low back pain.
Marital status has been found to be significantly associated with low back pain prevalence as more than 74% of married nurses were found to be suffering from low back pain as supported by another previous study that about 88% of married nurses were affected by low back pain 10 .
Most of the affected nurses have been found to be either overweight or obese, as suggested by a study conducted on Japanese nurses that the individuals with increasing body weight have 13 times higher risk of being affected from low back than those with normal bodyweight 15 .
Higher the age and work experience, higher is the chance of being suffered from low back pain as supported by a study conducted on the nurses in Taiwan 16 .
In our country Pakistan, where most of the public-sector hospitals and even private sector hospitals lack the necessary equipment to assist nurses in their work nurses are more prone to be affected by various health problems especially musculoskeletal problems. Also 70% people in our country belong to poor class, high expenses on low back pain are not affordable. General awareness program on need of proper posture correction, normal body weight can help reduce the chances of suffering from low back pain. Awareness of exercise habit not only in nurses but also in community is need of the hour. It not only decreases the cost of treatment but also enhance job quality, job satisfaction and functional level. So, awareness of body alignment and correct Standing/sitting posture is very important in the prevention of low back pain.

Conclusion
It is concluded that frequency of low back pain among nurses is high and in no way it is not comparable to nurses working in developed countries. Frequency of low back pain was found to be high in married nurses, in middle aged and overweight and obese nurses. To prevent incidence of low back pain it is essential to maintain proper and good body posture during work, also the reduction of weight and avoidance of heavy weight lifting are equally important. As majority of nurses experience low back pain due to long standing and frequent bending during nursing care so they should reduce standing and bending for long time.