Mahmud1, Rahardjo Sri1, Mahendra Rama Iqbal3, Wicaksana Anggi Lukman4, Hertanti Nuzul Sri5
Author affiliations:
Office Department of Anesthesiology & Intensive Care Therapy: Jl Kesehatan No.1 Sekip Yogyakarta. Phone: +62274 587333 ext. 1.288; E-mail: anestesi_fk_ugm@yahoo.com
Abstract
Background: The study aimed to identify the prevalence and risk factors of LBP among the nurses at Sardjito Hospital.
Method: A cross-sectional study was conducted in Sardjito Hospital Yogyakarta. LBP was measured in nurses who had work for one year using the Keele Start Back Screening Tool (KSBT) and Orebro Musculoskeletal Pain Questionnaire (OMPQ). A simple and multiple logistic regression was used for analysis.
Results: Of 800 valid subjects, 324 (40.5%) have the history of LBP complaint, 88.9% were suffering the pain during the data collection. The most significant variables are the history of previous spinal complaints (p = 0.00), slide board use for lateral transfer (p=0.010), gender (p=0.026) and current work place (p=0.019). Nine of the 288 patients of LBP have high risk in line with the KSBT stratification, while 22 of 288 patients have High Estimated Risk of Future Work Disability that agrees with the stratification of performance prognosis using OMPQ.
Conclusion: The prevalence of LBP among the nurses at Sardjito Hospital reaches 40.5%, with 88.9% of whom still suffer from pain during the data collection. The risk factors of LBP among the nurses are previous spinal complaint, tools for lateral transfer, work place and gender.
Key words: Risk factor; Lower back pain; Nurses; Pain; Prevalence
Citation: Mahmud, Sri R, Iqbal MR, Lukman WA, Sri HN. The prevalence and risk factors of low back pain among the nurses at Sardjito Hospital, Yogyakarta, Indonesia. Anaesth. pain intensive care 2021;25(1):21–28;
DOI: 10.35975/apic.v25i1.1432
Received: 13 November 2020, Reviewed: 18 November 2020, Accepted: 16 December 2020
Introduction
Pain is an uncomfortable emotional condition that can be sensed by the mind but is identified to derive from a particular part of the body. It can be called a subjective sensation. Pain is a defense mechanism designed to make the subject protect the wounded part from further damage. Lower back pain (LBP) is accurately called lumbago pain or lumbosacral pain occurring below costa number 12 and above gluteal folds. The incidence of LBP is known to have resulted in morbidity in the industry. Some studies have reported the incidence of LBP in the general population and workplace setting. LBP is the common cause of the incidence of morbidity in health workers. Nurses are in the professional group in health services with a high risk of LBP incidence.
Sikiru et al. reported that such mechanic dangers as LBP in hospitals, resulting from the manual transfer of patients have affected the nurses. To describe the musculoskeletal damage among the nurses, the survey shows that the nurses have lost 75 days per year due to LBP.1 The study found that LBP is the most common cause of early retirement due to poor health, sick leaves, resignation, and slower work pace in the work population.
Nurses transfer and transport patients and medical tools. They are exposed to a difficult environment, especially in developing countries due to the lack of transfer or transport tools.
We conducted this study to find out the prevalence of LBP in the nurses of our hospital as well as the predisposing and aggravating risk factors.
Methodology
The study employs a cross-sectional method. The samples of the study are the nurses at Sardjito Hospital Yogyakarta, Indonesia, who work collaboratively with all departments at RSUP Dr. Sardjito. This study was conducted from April to October 2019. This study was approved by the ethics committee of FKKMK-UGM with the approval number of KE/FK/0765/EC/2019.
As suggested by Beaton et al., the studies use the KSBT and OMPQ and before the questionnaires are distributed, a transcultural process in the Indonesian language must be performed and translated into English by an independent professional translator.2
Definition of Variables
Lower back pain (LBP) is the pain at the dorsal area between the area below the margo costa 12 and gluteal folds and may radiate to legs.3
Nurses are defined as nurses at Sardjito Hospital Yogyakarta, Indonesia.
Data Source
Data were collected from all willing nurses of Data were collected from all nurses at Sardjito.
A questionnaire was distributed among the nurses to be filled by those interested in and willing to complete the questionnaire.
Subject of Study
The inclusion criteria in this study are all ward nurses who have worked for minimally 1 y. The nurses were excluded from the study if they are in either delivery leaves or annual leaves.
Data Collection
The sample in this study was collected using the total sampling technique. Therefore, all nurses interested in and willing to get involved in the study were required to complete the questionnaires.
The instruments used in the study are the demography questionnaires of the Keele Start Back Screening Tool (KSBT) and the Orebro Musculoskeletal Pain Questionnaire (OMPQ). The researchers have obtained the permit to use the questionnaires from the maker of the questionnaires. KSBST and OMPQ are the instruments frequently used to identify the incidence of lower back pain in the world, which has been proven to be valid in the application in different countries.
Demographic questionnaires consist of name (initial), age, gender, education level, ward/department name, position, and length of employment, the mean number of patients managed, frequency of patient transfer and transport in the last 2 weeks, pain complaint, pain quality, pain radiation, pain scale, and pain duration.
Questionnaires of KSBT have been proven valid and frequently used to identify and measure lower back pain. KSBT is a brief instrument to measure physical and psychological indicators of lower back pain. This instrument consists of nine items of questions that refer to physical aspects (items 1 – 3) and psychical aspects (items 4 – 9) due to lower back pain. Responses are available in two categories: agree (1) and disagree (0), except for the last item of question, which requires any of the five alternatives of response, i.e., not at all (0), a little (0), fairly (0), very (1), and extremely disturbing (1). To interpret, all items are summed with the range from 0 to 9, where 9 represents worsen the prognosis of lower back pain. The total scores were classified into three categories: low risk (score between 0 and 3), low risk (score ≥ 4 with the total response items of 5–9 less than 3), and high risk (score ≥ 4 with the total response item 5 − 9 ≥ 4). The stratification is proven to improve the clinical output, patients’ satisfaction and therapy effectiveness.2,4,5
Another instrument commonly used to measure lower back pain is OMPQ. This instrument aims at identifying the psychosocial risk of work disturbance due to back and neck pains. The brief-version instrument of OMPQ has been available as a valid and reliable 10-item instrument. The brief-version OMPQ consists of five concepts, i.e., pain (items 1 – 2), self-perception function (items 3 – 4), distress (items 5 – 6), expectation to return to work as usual (items 7 – 8), and fear-avoidance attempt (items 9 – 10). Item 1 (pain duration) has 10 responses from 0 – 1 week to longer than 52 weeks, with the scales from 1 to 10. Items 2 – 10 have responses from 0 to 10, indicating the condition from “totally disagree” to “totally agree” or “no pain” to “severe pain”. In the interpretation, items 3, 4 and 8 must be reversed and summed with other items. The total score was obtained by adding all items with a range of 1 to 100. The score range of 1 to 50 indicates low risk while the score of 51 to 100 indicates an estimated high risk of developing and suffering from work disturbance due to the pain.6,7
Statistical analysis
The codes in the questionnaires were input in the computer in the form of coding and were analyzed using the software of SPSS version 20. The most influential risk factors in this study were identified using the simple and multiple logistic regression multivariate analysis. The probability value of less or equivalent to 0.05 was used to determine the statistical significance.
Results
The study was conducted at Sardjito Hospital from June 2019 to November 2019. Data were collected from the subjects from 1 September 2019 to 31 October 2019. Eight hundred seventy-one responding nurses and midwives participating in the study met the inclusion criteria. After a consecutive data selection using the exclusion criteria, 800 respondents were validated and were accepted as eligible for further analysis. The baseline data are presented in Table 1.
Of the 800 respondents, 324 had a history of low back pain (LBP) with different onset and duration. Of 324 LBP patients, 288 respondents had sustainable pain during the data collection, while 36 respondents had no pain after medication or self-healing. Data on the distribution of LBP are available in Table 2.
The data underwent single or multiple logistic regressions for each independent variable to the dependent variable of LBP incidence. Single logistic regression is used to determine whether the independent variables can be included as candidates for multivariate analysis or not. The significance value of < 0.05 is eligible for multivariate analysis. Of the independent variables, 9 independent variables eligible for multivariate analysis with multiple logistic regression are; position, current workplace, gender, BMI classification, pregnancy history, delivery history, slide board use for lateral transfer of patients, not including the easy move or slide board use for lateral transfer of patients, and the time taken for exercise.
Table 3 shows the four variables involved in multivariate analysis to the final stage. The most dominant variable associated with LBP pain complaints is a history of spinal abnormalities. The predictive modeling results of the four variables using the formula P = 1 / (1 + exp (-y)) with exp = 2.7 and Y = constant + a1x1 + a2x2 + ...... aixi, are determined from the independent variables. If all four independent variables are involved in predicting the occurrence of dependent variables, the calculation of the probability is as follows:
Y = -4.847 + 1.830 (1) + 0.258 (1) + 0.473 (1) + 0.481 (1) = -1.805
P = 1 / (1 + 2.7 (−1.805)) = 0.143 or 14.3%.
This means that if the patient has a history of spinal abnormalities, a workplace of the emergency room (ER) or the like, male gender and has used a slide board, the likelihood of the reappearance of pain complaints is 14.3%. If the four independent variables are not involved in predicting the occurrence of the dependent variable, the calculation of the probability is as follows:
Y = -4.847 + 1.830 (0) + 0.258 (0) + 0.473 (0) + 0.481 (0) = -3.017
P = 1 / (1 + 2.7 (−3.017)) = 0.048 or 4.8%.
This means that if the patient meets the criteria of having a history of spinal abnormalities, non-ER & IC room, female gender, and never used a slide board, the likelihood of the reappearance of complaints of LBP pain is 4.8%.
Of the 324 respondents with a history of LBP complaint, 288 still had a complaint until the data collection. The analysis was performed to the 288 respondents to identify the dispersion of the incidence of LBP compliant with the instruments used in the study, i.e., KSBT and OMPQ. Results of the KSBT score are represented in 3 stratifications of LBP incidence. They are Low Risk and Medium-High Risk. Meanwhile, the final output of OMPQ was represented in 2 stratifications of prognosis. They are High Estimated Risk of Future Work Disability (HRWD) and Low Estimated Risk of Future Work Disability.
Table 4 describes the incidence of LBP with stratification of KSBT in each ward of patient treatment at Sardjito Hospital. Eight of 288 respondents have High Risk of the incidence of LBP, with the largest frequency of incidence in the outpatient care or non-emergency room (ER)-Ward Room. The data also show that females have a worse performance prognosis than males when they have LBP, which is 4/8 with high risk. Meanwhile, in the variable of lateral transfer of patient, the rate of high risk: medium risk: low risk reaches 8:55:225, respectively.
Table 5 describes the incidence of LBP compliant with stratification of prognosis using the OMPQ instrument. The results of the study show that 22/288 respondents had the prognosis of HRWD. The data also show that females had a worse performance prognosis than males when they have LBP, which is 11/22 with HRWD. Therefore, this study found that 22/288 respondents have HRWD due to the incidence of LBP.
Discussion
As a common phenomenon, LBP is believed to be suffered by approximately 70%-80% of the population, minimally one occurrence. LBP is associated with a high cost of life and may lead to lower productivity and absenteeism among workers. Mechanical stress damage among nurses in hospitals is prevalent due to the frequent transfer and transport of patients.1 LBP is also the cause of early retirement, absenteeism, resignation, and lower work speed among the workers.1 Ovayolu et al. found that LBP rates in nurses were very high and most of the nurses experienced low back pain.8 Previous study consisting of 931 healthcare workers (HCW), found that 57.8% HCW who suffered from LBP were nurses, including stuff and community nurses.9 Another study of 203 nurses also found the prevalence of LBP over a year was 58.1%.10 Nurses are prone to such pain due to some risk factors. Shieh et al. found that a high prevalence of LBP among nurses in developed countries, especially in some Asian countries might be due to their workload. Nurses worked in patient care, conducting advanced procedures that required prolonged standing or lifting weights. The number of this prevalence is significantly increased in nurses who have worked more than 2 y.11
This study employed LBP as the dependent variable and five variables of gender, pregnancy history, delivery history, use of slide board for patient lateral transfer, and lack of use of slide board or easy move. The results showed that the variables of gender and use of slide board, history of previous spinal complaints and current work place were significant.
The prevalence of LBP is high among female nurses than male nurses. Hoy et al. found that both the mean and median prevalences of LBP in women were higher than men. Other studies also found a higher prevalence of LBP in older women than older men.15,16 Women are more frequent to have LBP, probably due to lower pain threshold and physical changes resulting from menstruation.17 Other studies observed that women likely had more symptoms, but the physician found approximately equal abnormalities in women and men. It may also be associated with the small number of male nurses in this study. Weak back muscles and incidence of sprain and strain in the lower back are expected to result in lower back pain.1,8
Boughattas et al. found that the factors significantly associated with LBP were high BMI, number of pregnancies, arthritis, poor physical condition, daily frequency of performing activities with inappropriate posture, and the layout material in the workplace.10 Moving or lifting patients and other heavy physical activities are the most important risk factor for LBP in nurses.12 A prospective cohort study among 5017 Danish HCW found that daily patient transfer increased risk factor for LBP. It was also found that the use of an assistive device for patient transfer could reduce the risk of LBP.13 Vinstrup et al. found that the use of assistive devices had various degrees of muscle activity and trunk flexion during patient transfer. Some assistive devices could decrease the physical workload that could also decrease the risk of LBP.14
Limitation and Suggestion
It is advisable that multicenter research in all hospitals connected with Sardjito Hospital may be conducted in the future. It is necessary to provide easy move tools and training for the lateral transfer of patients as the largest risk factor for this study, and service comfort is improved through policy formulation. Finally, the data can be a reference for managing Sardjito Hospital to improve empathy for caregivers, such as nurses, midwives, and other medical staff, particularly those with a high risk of the incidence of LBP and risk of poor performance prognosis.
A limitation is that the study primarily collected the data of nurses and midwives, and therefore, the findings may not be generalizable in other caregivers.
Conclusion
This study describes the prevalence and risk factors of the incidence of LBP among the nurses who have worked for minimum one year in Sardjito Hospital. It was found that risk factors for gender and lack of easy move and slide board for lateral transfer of the patients are one of the causes of LBP among nurses at Sardjito Hospital, in addition to other factors such as multiparity, increased age, and high BMI. With the instrument of KSBT, we can see the incidence of LBP with a high-risk of 9/288, medium risk of 54/288, and the remaining low risk. The instrument of OMPQ improves the performance prognosis for nurses in the future if LBP is not seriously managed.
Conflict of incidence
No conflict of interest declared by the authors.
Authors’ contribution
MM: Manuscript writing
SR: Research supervision
RM: Data sampling
AW: Transcultural adaptation process
NS: Ethical clearance management
References
Author affiliations:
- Department of Anesthesiology & Intensive Care Therapy, Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing Universitas Gajah Mada (Indonesia)
- School of Medicine, Faculty of Medicine, Public Health and Nursing Universitas Gajah Mada (Indonesia)
- Department of Medical Surgical Nursing, Faculty of Medicine, Public Health and Nursing Universitas Gajah Mada (Indonesia).
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing Universitas Gajah Mada (Indonesia).
Office Department of Anesthesiology & Intensive Care Therapy: Jl Kesehatan No.1 Sekip Yogyakarta. Phone: +62274 587333 ext. 1.288; E-mail: anestesi_fk_ugm@yahoo.com
Abstract
Background: The study aimed to identify the prevalence and risk factors of LBP among the nurses at Sardjito Hospital.
Method: A cross-sectional study was conducted in Sardjito Hospital Yogyakarta. LBP was measured in nurses who had work for one year using the Keele Start Back Screening Tool (KSBT) and Orebro Musculoskeletal Pain Questionnaire (OMPQ). A simple and multiple logistic regression was used for analysis.
Results: Of 800 valid subjects, 324 (40.5%) have the history of LBP complaint, 88.9% were suffering the pain during the data collection. The most significant variables are the history of previous spinal complaints (p = 0.00), slide board use for lateral transfer (p=0.010), gender (p=0.026) and current work place (p=0.019). Nine of the 288 patients of LBP have high risk in line with the KSBT stratification, while 22 of 288 patients have High Estimated Risk of Future Work Disability that agrees with the stratification of performance prognosis using OMPQ.
Conclusion: The prevalence of LBP among the nurses at Sardjito Hospital reaches 40.5%, with 88.9% of whom still suffer from pain during the data collection. The risk factors of LBP among the nurses are previous spinal complaint, tools for lateral transfer, work place and gender.
Key words: Risk factor; Lower back pain; Nurses; Pain; Prevalence
Citation: Mahmud, Sri R, Iqbal MR, Lukman WA, Sri HN. The prevalence and risk factors of low back pain among the nurses at Sardjito Hospital, Yogyakarta, Indonesia. Anaesth. pain intensive care 2021;25(1):21–28;
DOI: 10.35975/apic.v25i1.1432
Received: 13 November 2020, Reviewed: 18 November 2020, Accepted: 16 December 2020
Introduction
Pain is an uncomfortable emotional condition that can be sensed by the mind but is identified to derive from a particular part of the body. It can be called a subjective sensation. Pain is a defense mechanism designed to make the subject protect the wounded part from further damage. Lower back pain (LBP) is accurately called lumbago pain or lumbosacral pain occurring below costa number 12 and above gluteal folds. The incidence of LBP is known to have resulted in morbidity in the industry. Some studies have reported the incidence of LBP in the general population and workplace setting. LBP is the common cause of the incidence of morbidity in health workers. Nurses are in the professional group in health services with a high risk of LBP incidence.
Sikiru et al. reported that such mechanic dangers as LBP in hospitals, resulting from the manual transfer of patients have affected the nurses. To describe the musculoskeletal damage among the nurses, the survey shows that the nurses have lost 75 days per year due to LBP.1 The study found that LBP is the most common cause of early retirement due to poor health, sick leaves, resignation, and slower work pace in the work population.
Nurses transfer and transport patients and medical tools. They are exposed to a difficult environment, especially in developing countries due to the lack of transfer or transport tools.
We conducted this study to find out the prevalence of LBP in the nurses of our hospital as well as the predisposing and aggravating risk factors.
Methodology
The study employs a cross-sectional method. The samples of the study are the nurses at Sardjito Hospital Yogyakarta, Indonesia, who work collaboratively with all departments at RSUP Dr. Sardjito. This study was conducted from April to October 2019. This study was approved by the ethics committee of FKKMK-UGM with the approval number of KE/FK/0765/EC/2019.
As suggested by Beaton et al., the studies use the KSBT and OMPQ and before the questionnaires are distributed, a transcultural process in the Indonesian language must be performed and translated into English by an independent professional translator.2
Definition of Variables
Lower back pain (LBP) is the pain at the dorsal area between the area below the margo costa 12 and gluteal folds and may radiate to legs.3
Nurses are defined as nurses at Sardjito Hospital Yogyakarta, Indonesia.
Data Source
Data were collected from all willing nurses of Data were collected from all nurses at Sardjito.
A questionnaire was distributed among the nurses to be filled by those interested in and willing to complete the questionnaire.
Subject of Study
The inclusion criteria in this study are all ward nurses who have worked for minimally 1 y. The nurses were excluded from the study if they are in either delivery leaves or annual leaves.
Data Collection
The sample in this study was collected using the total sampling technique. Therefore, all nurses interested in and willing to get involved in the study were required to complete the questionnaires.
The instruments used in the study are the demography questionnaires of the Keele Start Back Screening Tool (KSBT) and the Orebro Musculoskeletal Pain Questionnaire (OMPQ). The researchers have obtained the permit to use the questionnaires from the maker of the questionnaires. KSBST and OMPQ are the instruments frequently used to identify the incidence of lower back pain in the world, which has been proven to be valid in the application in different countries.
Demographic questionnaires consist of name (initial), age, gender, education level, ward/department name, position, and length of employment, the mean number of patients managed, frequency of patient transfer and transport in the last 2 weeks, pain complaint, pain quality, pain radiation, pain scale, and pain duration.
Questionnaires of KSBT have been proven valid and frequently used to identify and measure lower back pain. KSBT is a brief instrument to measure physical and psychological indicators of lower back pain. This instrument consists of nine items of questions that refer to physical aspects (items 1 – 3) and psychical aspects (items 4 – 9) due to lower back pain. Responses are available in two categories: agree (1) and disagree (0), except for the last item of question, which requires any of the five alternatives of response, i.e., not at all (0), a little (0), fairly (0), very (1), and extremely disturbing (1). To interpret, all items are summed with the range from 0 to 9, where 9 represents worsen the prognosis of lower back pain. The total scores were classified into three categories: low risk (score between 0 and 3), low risk (score ≥ 4 with the total response items of 5–9 less than 3), and high risk (score ≥ 4 with the total response item 5 − 9 ≥ 4). The stratification is proven to improve the clinical output, patients’ satisfaction and therapy effectiveness.2,4,5
Another instrument commonly used to measure lower back pain is OMPQ. This instrument aims at identifying the psychosocial risk of work disturbance due to back and neck pains. The brief-version instrument of OMPQ has been available as a valid and reliable 10-item instrument. The brief-version OMPQ consists of five concepts, i.e., pain (items 1 – 2), self-perception function (items 3 – 4), distress (items 5 – 6), expectation to return to work as usual (items 7 – 8), and fear-avoidance attempt (items 9 – 10). Item 1 (pain duration) has 10 responses from 0 – 1 week to longer than 52 weeks, with the scales from 1 to 10. Items 2 – 10 have responses from 0 to 10, indicating the condition from “totally disagree” to “totally agree” or “no pain” to “severe pain”. In the interpretation, items 3, 4 and 8 must be reversed and summed with other items. The total score was obtained by adding all items with a range of 1 to 100. The score range of 1 to 50 indicates low risk while the score of 51 to 100 indicates an estimated high risk of developing and suffering from work disturbance due to the pain.6,7
Statistical analysis
The codes in the questionnaires were input in the computer in the form of coding and were analyzed using the software of SPSS version 20. The most influential risk factors in this study were identified using the simple and multiple logistic regression multivariate analysis. The probability value of less or equivalent to 0.05 was used to determine the statistical significance.
Results
The study was conducted at Sardjito Hospital from June 2019 to November 2019. Data were collected from the subjects from 1 September 2019 to 31 October 2019. Eight hundred seventy-one responding nurses and midwives participating in the study met the inclusion criteria. After a consecutive data selection using the exclusion criteria, 800 respondents were validated and were accepted as eligible for further analysis. The baseline data are presented in Table 1.
Of the 800 respondents, 324 had a history of low back pain (LBP) with different onset and duration. Of 324 LBP patients, 288 respondents had sustainable pain during the data collection, while 36 respondents had no pain after medication or self-healing. Data on the distribution of LBP are available in Table 2.
The data underwent single or multiple logistic regressions for each independent variable to the dependent variable of LBP incidence. Single logistic regression is used to determine whether the independent variables can be included as candidates for multivariate analysis or not. The significance value of < 0.05 is eligible for multivariate analysis. Of the independent variables, 9 independent variables eligible for multivariate analysis with multiple logistic regression are; position, current workplace, gender, BMI classification, pregnancy history, delivery history, slide board use for lateral transfer of patients, not including the easy move or slide board use for lateral transfer of patients, and the time taken for exercise.
Table 3 shows the four variables involved in multivariate analysis to the final stage. The most dominant variable associated with LBP pain complaints is a history of spinal abnormalities. The predictive modeling results of the four variables using the formula P = 1 / (1 + exp (-y)) with exp = 2.7 and Y = constant + a1x1 + a2x2 + ...... aixi, are determined from the independent variables. If all four independent variables are involved in predicting the occurrence of dependent variables, the calculation of the probability is as follows:
Y = -4.847 + 1.830 (1) + 0.258 (1) + 0.473 (1) + 0.481 (1) = -1.805
P = 1 / (1 + 2.7 (−1.805)) = 0.143 or 14.3%.
This means that if the patient has a history of spinal abnormalities, a workplace of the emergency room (ER) or the like, male gender and has used a slide board, the likelihood of the reappearance of pain complaints is 14.3%. If the four independent variables are not involved in predicting the occurrence of the dependent variable, the calculation of the probability is as follows:
Y = -4.847 + 1.830 (0) + 0.258 (0) + 0.473 (0) + 0.481 (0) = -3.017
P = 1 / (1 + 2.7 (−3.017)) = 0.048 or 4.8%.
This means that if the patient meets the criteria of having a history of spinal abnormalities, non-ER & IC room, female gender, and never used a slide board, the likelihood of the reappearance of complaints of LBP pain is 4.8%.
Of the 324 respondents with a history of LBP complaint, 288 still had a complaint until the data collection. The analysis was performed to the 288 respondents to identify the dispersion of the incidence of LBP compliant with the instruments used in the study, i.e., KSBT and OMPQ. Results of the KSBT score are represented in 3 stratifications of LBP incidence. They are Low Risk and Medium-High Risk. Meanwhile, the final output of OMPQ was represented in 2 stratifications of prognosis. They are High Estimated Risk of Future Work Disability (HRWD) and Low Estimated Risk of Future Work Disability.
Table 4 describes the incidence of LBP with stratification of KSBT in each ward of patient treatment at Sardjito Hospital. Eight of 288 respondents have High Risk of the incidence of LBP, with the largest frequency of incidence in the outpatient care or non-emergency room (ER)-Ward Room. The data also show that females have a worse performance prognosis than males when they have LBP, which is 4/8 with high risk. Meanwhile, in the variable of lateral transfer of patient, the rate of high risk: medium risk: low risk reaches 8:55:225, respectively.
Table 5 describes the incidence of LBP compliant with stratification of prognosis using the OMPQ instrument. The results of the study show that 22/288 respondents had the prognosis of HRWD. The data also show that females had a worse performance prognosis than males when they have LBP, which is 11/22 with HRWD. Therefore, this study found that 22/288 respondents have HRWD due to the incidence of LBP.
Discussion
As a common phenomenon, LBP is believed to be suffered by approximately 70%-80% of the population, minimally one occurrence. LBP is associated with a high cost of life and may lead to lower productivity and absenteeism among workers. Mechanical stress damage among nurses in hospitals is prevalent due to the frequent transfer and transport of patients.1 LBP is also the cause of early retirement, absenteeism, resignation, and lower work speed among the workers.1 Ovayolu et al. found that LBP rates in nurses were very high and most of the nurses experienced low back pain.8 Previous study consisting of 931 healthcare workers (HCW), found that 57.8% HCW who suffered from LBP were nurses, including stuff and community nurses.9 Another study of 203 nurses also found the prevalence of LBP over a year was 58.1%.10 Nurses are prone to such pain due to some risk factors. Shieh et al. found that a high prevalence of LBP among nurses in developed countries, especially in some Asian countries might be due to their workload. Nurses worked in patient care, conducting advanced procedures that required prolonged standing or lifting weights. The number of this prevalence is significantly increased in nurses who have worked more than 2 y.11
This study employed LBP as the dependent variable and five variables of gender, pregnancy history, delivery history, use of slide board for patient lateral transfer, and lack of use of slide board or easy move. The results showed that the variables of gender and use of slide board, history of previous spinal complaints and current work place were significant.
The prevalence of LBP is high among female nurses than male nurses. Hoy et al. found that both the mean and median prevalences of LBP in women were higher than men. Other studies also found a higher prevalence of LBP in older women than older men.15,16 Women are more frequent to have LBP, probably due to lower pain threshold and physical changes resulting from menstruation.17 Other studies observed that women likely had more symptoms, but the physician found approximately equal abnormalities in women and men. It may also be associated with the small number of male nurses in this study. Weak back muscles and incidence of sprain and strain in the lower back are expected to result in lower back pain.1,8
Boughattas et al. found that the factors significantly associated with LBP were high BMI, number of pregnancies, arthritis, poor physical condition, daily frequency of performing activities with inappropriate posture, and the layout material in the workplace.10 Moving or lifting patients and other heavy physical activities are the most important risk factor for LBP in nurses.12 A prospective cohort study among 5017 Danish HCW found that daily patient transfer increased risk factor for LBP. It was also found that the use of an assistive device for patient transfer could reduce the risk of LBP.13 Vinstrup et al. found that the use of assistive devices had various degrees of muscle activity and trunk flexion during patient transfer. Some assistive devices could decrease the physical workload that could also decrease the risk of LBP.14
Limitation and Suggestion
It is advisable that multicenter research in all hospitals connected with Sardjito Hospital may be conducted in the future. It is necessary to provide easy move tools and training for the lateral transfer of patients as the largest risk factor for this study, and service comfort is improved through policy formulation. Finally, the data can be a reference for managing Sardjito Hospital to improve empathy for caregivers, such as nurses, midwives, and other medical staff, particularly those with a high risk of the incidence of LBP and risk of poor performance prognosis.
A limitation is that the study primarily collected the data of nurses and midwives, and therefore, the findings may not be generalizable in other caregivers.
Conclusion
This study describes the prevalence and risk factors of the incidence of LBP among the nurses who have worked for minimum one year in Sardjito Hospital. It was found that risk factors for gender and lack of easy move and slide board for lateral transfer of the patients are one of the causes of LBP among nurses at Sardjito Hospital, in addition to other factors such as multiparity, increased age, and high BMI. With the instrument of KSBT, we can see the incidence of LBP with a high-risk of 9/288, medium risk of 54/288, and the remaining low risk. The instrument of OMPQ improves the performance prognosis for nurses in the future if LBP is not seriously managed.
Conflict of incidence
No conflict of interest declared by the authors.
Authors’ contribution
MM: Manuscript writing
SR: Research supervision
RM: Data sampling
AW: Transcultural adaptation process
NS: Ethical clearance management
References
- Sikiru L, Hanifa S. Prevalence, and risk factors of low back pain among nurses in a typical Nigerian hospital. Afr Health Sci. 2010;10(1):26–30. [PubMed]
- Betten C, Sandell C, Hill JC, Gutke A. Cross-cultural adaptation, and validation of the Swedish STarT Back Screening Tool. Eur J Physiother. 2015;17(1):29–36. DOI:10.3109/21679169.2014.1003962
- Tosunoz IK, Oztunc G. Low back pain in nurses. Int J Caring Sci Sept-Dec. 2017;10:1728-1732. [Free Full Text]
- Hill JC, Dunn KM, Lewis M, Mullis R, Main CJ, Foster NE, et al. A primary care back pain screening tool: Identifying patient subgroups for initial treatment. Arthritis Rheum. 2008;59(5):632–641. [PubMed] DOI: 10.1002/art.23563
- Hill JC, Dunn KM, Main CJ, Hay EM. Subgrouping low back pain: A comparison of the STarT Back Tool with the Örebro Musculoskeletal Pain Screening Questionnaire. Eur J Pain. 2010;14(1):83–89. [PubMed] DOI: 10.1016/j.ejpain.2009.01.003
- Linton SJ, Halldén K. Can we screen for problematic back pain? A screening questionnaire for predicting outcome in acute and subacute back pain. Clin J Pain. 1998;14(3):209–215. [PubMed] DOI: 10.1097/00002508-199809000-00007
- Linton SJ, Nicholas M, MacDonald S. Development of a short form of the Örebro musculoskeletal pain screening questionnaire. Spine. 2011;36(22):1891–1895. [PubMed] DOI: 10.1097/BRS.0b013e3181f8f775
- Ovayolu O, Ovayolu N, Genc M, Col-Araz N. Frequency and Severity of Low Back Pain in Nurses Working in Intensive Care Units and Influential Factors. Pak J Med Sci. 2014 Jan;30(1):70-6. [PubMed] PMCID: PMC3955545 DOI: 10.12669/pjms.301.3455
- Wong T, Teo N, Kyaw M. Prevalence and risk factors associated with low back pain among healthcare providers in a district hospital. Malays Orthop J. 2010;4(2):23-28. [Free Full Text] DOI: 10.5704/MOJ.1007.004
- Boughattas W, Maalel O, Maoua M, et al. Low back pain among nurses: prevalence, and occupational risk factors. Occup Dis Environ Med. 2017;05:26-37. [Free Full Text] DOI: 10.4236/odem.2017.51003
- Shieh SH, Sung FC, Su CH, Tsai Y, Hsieh VC. Increased low back pain risk in nurses with high workload for patient care: A questionnaire survey. Taiwan J Obstet Gynecol. 2016;55(4):525–529. [PubMed] DOI: 10.1016/j.tjog.2016.06.013
- Asadi P, Monsef Kasmaei V, Zia Ziabari SM, Zohrevandi B. The prevalence of low back pain among nurses working in Poursina hospital in Rasht, Iran. J Emerg Pract Trauma. 2016;2(1):11–15. [FreeFullText] DOI: 10.15171/jept.2015.01
- Andersen LL, Burdorf A, Fallentin N, Persson R, Jakobsen MD, Mortensen OS, et al. Patient transfers and assistive devices: a prospective cohort study on the risk for occupational back injury among healthcare workers. Scand J Work Environ Health. 2014;40(1):74–81. [PubMed] DOI: 10.5271/sjweh.3382
- Vinstrup J, Jakobsen MD, Madeleine P, Andersen LL. Biomechanical load during patient transfer with assistive devices: Cross-sectional study. Ergonomics. 2020;63(9):1164–1174. [PubMed] DOI: 10.1080/00140139.2020.1764113
- Hoy D, Brooks P, Blyth F, Buchbinder R. The Epidemiology of low back pain. Best Pract Res Clin Rheumatol. 2010;24(6):769–781. [PubMed] DOI: 10.1016/j.berh.2010.10.002
- Ramdas J, Jella V. Prevalence and risk factors of low back pain. Int J Adv Med. Published online August 8, 2018. [Free Full Text] DOI: 10.18203/2349–3933.ijam20183413
- Azizpour Y, Delpisheh A, Montazeri Z, Sayehmiri K. Prevalence of low back pain in Iranian nurses: A systematic review and meta-analysis. BMC Nurs. 2017;16(1):1–10. [PubMed] DOI: 10.1186/s12912-017-0243-1