The prevalence and risk factors of lower back pain among healthcare workers in Iraq: A cross sectional study

Background. Globally, the LBP prevalence among the general population varies from 15-45%. Work-related LBP is estimated to cause 818,000 disability-adjusted life years lost (DALYs) annually. Aim of study. To determine the prevalence and factors associated with LBP among Iraqi Healthcare workers. Methodology. This is a cross-sectional study that included 220 participants and was conducted at Baghdad during the period from 5/7/2023 to 25/11/2023. Lower back pain was assessed using an Arabic version of the Standardized Nordic Musculoskeletal Questionnaire (NMQ). Results. The life, annual, and weekly prevalence of LBP were 92.7%, 90.9%, and 58.2%, respectively. A statistically significant associated was detected between weekly prevalence of LBP and each of female gender, long working hours, BMI, and occupation. Conclusion . LBP is a highly prevalent condition among Iraqi HCWs and it caused considerable reduction to the quality of life and work performance. Risk factors for weekly prevalence were female gender, longer working hours, obesity, and working as a dentist.


INTRODUCTION
Pain is a physiological phenomenon that poses significant psychological challenges and has considerable relevance due to its impact on an individual's quality of life.It hinders productivity and may lead to sleep disturbances [1].
One of the most common conditions requiring medical attention is LBP.It is the most prevalent kind of musculoskeletal disorder (MSD) [2].LBP is indicative of a symptomatology rather than a distinct pathological condition, with a multitude of probable etiologies.The majority of LBP cases are attributed to musculoskeletal causes.Due to the diverse array of potential etiologies within the musculoskeletal domain and the often transient nature of most individuals' pain, it is estimated that only around 15% of patients may be definitively diagnosed with a particular condition to account for their lower back pain.While it is true that the majority of individuals suffering with LBP experience a temporary and limited duration of symptoms, it is worth noting that recurring episodes of pain are prevalent [3].Conventionally, LBP is thought to have its roots in an overabundance of mechanical stress on the lower back's muscles or structures [4].
The overall population's prevalence of LBP varies from 15% to 45% worldwide [5].LBP places a heavy financial strain on governments as a result of the quick shift to an industrial lifestyle, especially when it comes to health system expenses, missed workdays, decreased productivity, and elevated disability [6].It is estimated that 818,000 disability-adjusted life years lost (DALYs) are caused by work-re-lated LBP each year [7].
LBP is a significant public health concern, since it has a broad and substantial impact on social, psychological, and economic aspects.It is often observed that persons with demanding activities are more prone to experiencing this condition.Specifically, around 37% of cases of LBP worldwide may be attributed to occupations that include exposure to vibrations or lengthy periods of standing.Examples of such occupations include HCWs, and professional drivers.A higher percentage of LBP is associated with the recurrent or prolonged uncomfortable postures that are often assumed by professionals in these occupations [8].
Fortunately, a significant proportion of individuals, namely 90%, who have acute low back issues, exhibit signs of recovery within a one-month timeframe when subjected to appropriate conservative treatment methods.However, it is estimated that about 10% of patients with LBP progress to a chronic condition [3].This raises the need for both prevention and early treatment of lower back pain.Hence, it is evident that there exists a need to identify the risk factors linked to LBP among healthcare professionals in Iraq.

METHODS
A cross-sectional work that included 220 patients and was conducted at Baghdad during the period from 5/7/2023 to 25/11/2023.A questionnaire-based interview was used as the data collection method.The questionnaire consisted of 3 parts: 1. Basic characteristics: Age, gender, marital status, residence, occupation, presence of comorbid conditions, weight, BMI.

LBP prevalence: It was determined using the
Arabic version of the NMQ.The assessment comprises a set of eight questions pertaining to LBP, accompanied by an illustrative image depicting the potential anatomical location of LBP.The questionnaire provides an explanation of the annual prevalence, cumulative life prevalence and one-week prevalence LBP.Additionally, the questionnaire serves to illustrate the outcomes associated with LBP, including hospitalization, occupational changes or modifications, consultations with medical professionals or physiotherapists, and decreased levels of physical activity throughout the preceding 12-month period [9].

Statistical analysis
Fischer's exact test was used the test the association between studied parameters.A p value <0.05 was considered statistically significant.

Basic characters of the studied sample
The age distribution ranged from 21-69 years and the mean of 40.6 years ± 9.0 SD.The studied sample showed female predominance, as the male to female ratio was 0.44: 1.Most of the studied sample were married (92.7%) and resided in Baghdad (92.7%).Regarding occupation, 40.9% were doctors; as shown in Table 1.
In the present study, female gender was significantly connected with LBP.This is concordance with the findings by AlMaghrabi et al. in Saudi Arabia [12].This may be attributed to the fact that women are often engaged in physically demanding duties and domestic responsibilities, including both normal home chores and the care of their families, in addition to their job duties.As a result, their susceptibility to experiencing lower back pain is heightened.
The present study has shown an increased prevalence of LBP among overweight and obese HCWs.This is in concordance with the finding by Roffey et al. [13] and Ikeda et al. [14].
The present study has found that the weekly prevalence of LBP was significantly higher among dentists than other occupations.This can be explained by the fact that dentists are often subjected to a greater number of incidents involving improper use of the back mechanism, as well as the accumulation of back stress over an extended period of professional activity.Gaowgzeh [15].The imbalance in muscles between the lower back and abdominal muscles that results from the sitting posture of the dentistry profession may be a contributing factor to LBP among dentists at work.Repetitively bending towards the patient can weaken the deep abdominal stability muscles and cause tension and overexertion in the lower back extensor muscles.Research indicates that a strong transverse abdominis muscle reduces the severity of back discomfort.
Increased working hours per day was significantly linked with increased prevalence of LBP.The study done by Abolfotouh et al. shown a significant increase in the LBP prevalence rate among nurses working 12-hours shifts compared to those working 8-hours shifts [16].Ibrahim et al. discovered a strong association between nurses who working more than 7-hours/day and the occurrence of LBP [17].

CONCLUSION
LBP is highly prevalent condition among Iraqi HCWs and it caused considerable reduction to the quality of life and work performance.Risk factors for weekly prevalence were female gender, longer working hours, obesity, and working as a dentist.

TABLE 1 .
Basic characteristics of the studied sample

TABLE 2 .
Prevalence of LBP among the studied sample

TABLE 3 .
et al. revealed that Consequences of LBP among the studied sample

TABLE 4 .
Consequences of LBP among the studied sample