Prevalence and Clinical Characteristics of Low Back Pain among Operating Room Personnel: A Cross-Sectional Study in South of Iran

Background: Low back pain is one of the most common musculoskeletal disorders and the most common cause of activity restriction in people younger than 45 years. Nurses have a high incidence and prevalence of low back pain in terms of physical and emotional factors among healthcare workers. This study aimed to evaluate the prevalence and clinical characteristics of low back pain.

Methods: This cross-sectional study was performed on 385 operating room personnel of the hospitals affiliated with Shiraz (the largest city in southern Iran) University of Medical Sciences. The data were collected via a research-made developed questionnaire. The questionnaire consisted of two parts, including the demographic information and prevalence and dimensions of low back pain.

Results: The results showed that the prevalence of low back pain was 74% among operating room personnel. There was a significant relationship among low back pain, education level, and marital status (p < 0.05).

Conclusion: Hospital managers should reduce the prevalence of this disorder among operating room staff by teaching preventative patient handling techniques via training courses.

Introduction

Low back pain (LBP) is one of the most common types of work-related musculoskeletal disorders (MSDs) (1, 2). LBP is an important public health subject with high prevalence and a considerable negative physical, psychological, social, and economic impact (3–5). In general, this disorder due to the duration of pain includes three categories: acute (less than 6 weeks), subacute (from 6 to 12 weeks), and chronic (more than 12 weeks) (6, 7).

The peak of LBP is in the third decade of life, and its incidence increases to 60–65 years and then gradually decreases (8, 9). Nearly more than half of the general population will experience LBP care at some point in their lives (10). The prevalence of LBP among the general population is estimated to be from 15% to 45% (11). Thirty-seven percent of LBP is related to occupations in which professionals are exposed to prolonged periods of standing, such as healthcare workers (3). LBP can be caused by various components of the spine, abdominal structures, or pelvic organ (12). Among healthcare workers, nurses have a high incidence of LBP (13) due to physical and emotional factors (14). Considering the prolonged standing, unpleasant physical conditions, and movement limitations during surgery (15), the prevalence of LBP was reported in 70.6% of operating room personnel (16) and most other parts of the hospital (17).

The purpose of this research was to determine the frequency of LBP and clinical features among operating room staff at Shiraz University of Medical Sciences. The findings of this research will be presented to hospital administrators and operating room directors, who will be able to design suitable initiatives to prevent, control and reduce the recurrence of low back pain in operating room staff.

Method

Study Design

This is a cross-sectional study performed in 2019 on operating room personnel working in hospitals affiliated with Shiraz (the largest city in southern Iran) University of Medical Sciences, including Faghihi, Namazi, Khalili, Rajaii, Chamran, and Amiralmomenin hospitals.

Population and Sample Size

A total of 385 operating room personnel were sampled, similar to prior research by Choobineh et al. (18), the sample size was determined with average prevalence of low back pain 50%, confidence estimates of 95%, and 0.05 accuracy.

Data Collection

The total number of operating room personnel in each hospital was first determined, and then, the personnel were recruited and selected for participation based on stratified random sampling. To this end, we referred to investigators who administered surveys in hospitals during different shifts after obtaining permission from the Ethics Committee, and the sampling was carried out based on the inclusion criteria mentioned in different shifts after obtaining informed and written consent from the personnel. The questionnaires were distributed among the personnel and collected at the end of the office time on the same day.

Inclusion and Exclusion Criteria

Participants’ inclusion criteria included a willingness to participate in the study and 2 years of work experience. Exclusion criteria were osteoporosis, acquired spinal diseases, and corticosteroid consumption.

Measuring Instruments

Research-made developed questionnaire was used to evaluate and gather data on the prevalence and presence of LBP and its related dimensions. The validity and reliability of the questionnaire had already been examined. During the psychometric phase of instrument development, qualitative and quantitative methods were used to determine the face validity and content and construct validity evaluation. The face validity of qualitative data was checked by interviews with 20 professors and experts in this field, resulting in a modification of three items and the addition of two items. During the quantitative face validity phase, which assessed the importance of each item by using the item impact formula, all tool items received the least impact score. This was done by filling out the initial questionnaire by 20 operating room personnel. The content validity of the qualitative section was determined by the experts’ correction; three items were corrected, and one item was merged with the other items. Quantitative evaluation of the content validity was done using two indices of the content validity ratio and content validity index, by 14 and 10 professors and experts in this field, respectively. In this phase, two items failed to achieve the required score and were eliminated. The construct validity assessment was completed via the convergent and divergent validity, respectively, using the chronic pain questionnaire and General Health Questionnaire distributed among 30 operating room personnel. The correlation of the mentioned instruments was investigated with the research instrument. The relationship between the research instrument with the chronic pain questionnaire as a convergent tool and the General Health Questionnaire as a divergent instrument was 0.70 and −0.37, respectively, which was statistically significant (p < 0.05). The reliability and internal consistency of the instrument, determined by test–retest and Cronbach’s alpha coefficient, were found to be 0.77 and 0.60, respectively. The questionnaire consisted of two sections: “Demographic information and prevalence and dimensions of LBP.” This questionnaire assessed the prevalence and dimensions of LBP using 11 multiple-choice questions (18).

Data Analyses

After collecting the questionnaires, the data were entered into SPSS version 19 and then analyzed. Descriptive statistics calculated demographic data of the population, frequency distribution, mean, and standard deviation.

Ethical Considerations

The Institutional Review Board of Shiraz University approved this medical science study (ethical code: IR.SUMS.REC.1398.263) available link:https://ethics.research.ac.ir/EthicsProposalView.php?id = 57702.

All participants agreed to participate in the study and signed informed consent. The participants were assured that their information would remain confidential.

Results

A total of 385 operating room personnel working in six hospitals affiliated with Shiraz University of Medical Sciences were studied. Table 1 shows the frequency distribution of the demographic characteristics of the population under study. Among 385 participants, 240 (62.3%) were women. The mean and standard deviation of the age was 33.25 ± 7 7.96. Besides, the majorities of participants were undergraduates (85.7%) and married (57.4%).

TABLE 1

Table 1. Demographic characteristics of the operating room personnel.

The prevalence of LBP was reported at 75%. Therefore, it was found that the prevalence of LBP in hospitals varied, and the highest prevalence (84.2%) was in the hospital of burn and plastic (Table 2). Also, the highest prevalence of LBP was in married (61.05%) people.

TABLE 2

Table 2. Prevalence of LBP in the studied hospitals.

Table 3 shows the clinical characteristics of low back pain in the participants of this study. Most participants had a normal body mass index (BMI) (73.2%), work experience of less than 10 years (60.3%), rotating shifts (71.7%), and standing physical condition (54%). In addition, in 67.71% of participants, low back pain occurred less than 10 years after the start of work, and 81.40% of total low back pain was acute low back pain in nature. Sixty-seven percent of the patients reported pain only in the lumbar region, and according to the type of pain, intermittent pain was the most frequent, with 32.28%. Another criterion evaluated in this study was the severity of pain in the patients. Furthermore, transient mild pain that resolves spontaneously without using analgesics or rest was the highest, with 60.35%. The relationship between participant demographic information and clinical characteristics of low back pain showed that only sex (p-value = 0.023) and marital status (p-value = 0.017) had a significant relationship with pain area (Table 4).

TABLE 3

Table 3. Clinical characterization of low back pain among operating room personnel.

TABLE 4

Table 4. The relationship between clinical characteristics of low back pain and demographic characteristics of the operating room personnel.

Discussion

The present study was performed to evaluate the prevalence of LBP and its clinical characterization in operating room personnel of six hospitals affiliated with Shiraz University of Medical Sciences. This study’s results showed a high prevalence of low back pain (75%) in operating room personnel. LBP is one of the most common work-related MSDs (19), which has many detrimental consequences for the healthcare system and its personnel (20).

LBP had a high prevalence among participants. In a study conducted by Choobineh et al. to investigate the prevalence of MSDs in the Shiraz operating room nurses, it was found that more than half of the participants had LBP during the past year, which was the most prevalent among other MSDs (18). High prevalence can be attributed to working in a stressful operating room environment and specific activities. In another study, Trinkoff et al. reported LBP as the most common musculoskeletal disorder in nurses at the University of Maryland, USA (21). The prevalence of LBP was higher in women, indicating the impact of the female sex on the development of low back pain (8).

The other additional results of this study revealed differentiated pain duration. Consistent with this finding, 167 patients had acute LBP and a few suffered from chronic LBP. In the study by La Torre et al., LBP was identified as the most important musculoskeletal disorder among operating room nurses in Rome, and acute LBP was the most prevalent (23). The high prevalence of acute LBP in these studies may be in terms of the heavy and risky transient activity during surgical operations, such as stretching and specific physical postures in operating room personnel. Besides, in a study conducted by Barkhordari et al. to evaluate the prevalence of LBP in nurses of hospitals in Yazd, the duration of pain in LBP patients was in two-thirds cases less than two weeks and in others at least two weeks during the past 12 months (24).

Other results of this study indicated the absence of work in one-third of the affected people. Moreover, about two-thirds of patients did not see a doctor. Among those who were referred to a physician, most people underwent diagnostic or therapeutic measures. Drug therapy and X-rays were the most prevalent diagnostic modality among these measures. In a similar study, Bejia et al. reported the prevalence of LBP in more than half of Monastir Tunisian hospital staff. About one-quarter of patients in this study suffered from chronic low back pain. Thus, it was found that most patients needed medical care, and about half of them needed radiologic diagnoses. Hence, in a significant number of participants, LBP led to absence from work (25). Regarding the high rate of chronic LBP in the study of Bejia compared to the present study, there may be an increased need for patients with medical care and radiological diagnoses, as well as an increased absence of work related to this type of LBP.

Another notable result of this study was determining the severity of LBP and its impact on participants’ daily life activities. The results showed that more than half of the patients had transient and permanent mild pain, about two-fifths of them had moderate pain that prevented heavy physical activity or heavy work, and only a few suffered severe pain that prevented them from doing their daily activities. In a study conducted by Awosan et al. to investigate the prevalence of LBP among healthcare workers in Sokoto, Nigeria, most participants experienced LBP after work. Among the patients, about half had mild pain, a significant number had moderate pain, and a small number had severe pain (26). By comparing the results of the Awosan study and the present study, it was found that most patients had mild pain. High-risk activities are probably the reason for increased pain over time, while rest leads to decreased pain intensity and less progression towards chronic forms.

Limitations

The limitations of this study include no evaluation of students and operating room personnel of private hospitals. Therefore, evaluating other risk factors such as mental status and occupational stress can provide better results among operating room personnel. Besides, it is recommended that other studies should evaluate students and private hospitals. The self-reported surveys were completed by the study subjects and are subject to recall and response bias. Subjects may not have recalled events or characteristics accurately or may have been reluctant to report the truth. This is because of the fact that some people believe that one with LBP lacks a normal life, leading to their decreased self-confidence. This can be due to factors such as old age, high BMI, low education level, and so on, which are related to LBP.

Conclusions

The present study showed a high prevalence of low back pain among the operating room personnel. By examining the different factors and characteristics of participants, there was a significant relationship among LBP, education level, and marital status. Therefore, more attention is needed to these cases, and the increase in awareness among operating room staff via taking classes and courses has partly reduced the prevalence of the disorder.

Data Availability Statement

The raw data supporting the conclusions of this article will be made available by the authors without undue reservation.

Ethics Statement

The studies involving human participants were reviewed and approved by The Institutional Review Board of Shiraz University of Medical Science (ethical code: IR.SUMS.REC.1398.263) available at https://ethics.research.ac.ir/EthicsProposalView.php?id=57702. The patients/participants provided their written informed consent to participate in this study.

Author Contributions

Study conception and design: RT, RF, AK, AF and BI. Data collection: RT. Statistical analysis: RT. Interpretation of results: RT, RF. Drafting of the manuscript: All authors. Revision of the final manuscript: RT. All authors approved the final version of the manuscript, including the authorship list.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Acknowledgments

The authors thank Dr. Abdollahpour-Alitappeh for editing the manuscript.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

References

1. Nair RS. Prevalence and risk factors associated with low back pain among nurses in a tertiary care hospital in south India. Int J Orthop. (2020) 6(1):301–6. doi: 10.22271/ortho.2020.v6.i1f.1878

CrossRef Full Text | Google Scholar

2. Tavakkol R, Kavi E, Hassanipour S, Rabiei H, Malakoutikhah M. The global prevalence of musculoskeletal disorders among operating room personnel: a systematic review and meta-analysis. Clin Epidemiol Global Health. (2020c) 8(4):1053–61. doi: 10.1016/j.cegh.2020.03.019

CrossRef Full Text | Google Scholar

3. Manzini F, Cesana G, Manzini C, Riva MA. A pioneering patient lift: prevention of low back pain in health care workers in the 18th century. Spine. (2015) 40(2):126–7. doi: 10.1097/BRS.0000000000000688

PubMed Abstract | CrossRef Full Text | Google Scholar

4. Baberi F, Jahandideh Z, Akbari M, Shakerian M, Choobineh A. Relationship between personality types and musculoskeletal disorders among office staff. Med Lav. (2019) 110(4):293–303. doi: 10.23749/mdl.v110i4.7820

PubMed Abstract | CrossRef Full Text | Google Scholar

5. Minghelli B, Ettro N, Simão J, Maurício K. Work-related self-reported musculoskeletal disorders in hypermarket cashiers: a study in south of Portugal. Med Lav. (2019) 110(3):191–201. doi: 10.23749/mdl.v110i3.7771

PubMed Abstract | CrossRef Full Text | Google Scholar

6. Bope E.T., and Kellerman R.D. (2015). Conn’s current therapy 2016. Elsevier: Philadelphia, PA.

7. Tavakkol R, Karimi A, Hassanipour S, Gharahzadeh A, Fayzi R. A multidisciplinary focus review of musculoskeletal disorders among operating room personnel. J Multidiscipl Healthcare. (2020b) 13:735–41. doi: 10.2147/JMDH.S259245

CrossRef Full Text | Google Scholar

8. Bin Homaid M, Abdelmoety D, Alshareef W, Alghamdi A, Alhozali F, Alfahmi N, et al. Prevalence and risk factors of low back pain among operation room staff at a Tertiary Care Center, Makkah, Saudi Arabia: a cross-sectional study. Ann. Occup. Environ. Med. (2016) 28(1):1–8. doi: 10.1186%2Fs40557-016-0089-0

PubMed Abstract | CrossRef Full Text | Google Scholar

9. Tavakkol R, Eslami J, Amiri A, Zarshenas L. Survey of awareness about the risk factors of low back pain among operating room personnel of Shiraz hospitals: a cross-sectional study. Clin Epidemiol Global Health. (2020a) 8(4):1172–6. doi: 10.1016/j.cegh.2020.04.010

CrossRef Full Text | Google Scholar

10. Alnaami I, Awadalla NJ, Alkhairy M, Alburidy S, Alqarni A, Algarni A, et al. Prevalence and factors associated with low back pain among health care workers in southwestern Saudi Arabia. BMC Musculoskelet Disord. (2019) 20(1):1–7. doi: 10.1186/s12891-019-2431-5

PubMed Abstract | CrossRef Full Text | Google Scholar

11. Parreira P, Maher CG, Steffens D, Hancock MJ, Ferreira ML. Risk factors for low back pain and sciatica: an umbrella review. Spine J. (2018) 18(9):1715–21. doi: 10.1016/j.spinee.2018.05.018

PubMed Abstract | CrossRef Full Text | Google Scholar

12. Bhandary AK, Chimes GP, Malanga GA. Investigational pharmacology for low back pain. J Pain Res. (2010) 3:169. doi: 10.2147/JPR.S9243

PubMed Abstract | CrossRef Full Text | Google Scholar

13. Johnson OE, Emmanuel E. Prevalence and risk factors of low back pain among workers in a health facility in South-South Nigeria. Br J Med Med Res. (2016) 11(8):1. doi: 10.9734/BJMMR/2016/20785

CrossRef Full Text | Google Scholar

14. Suliman M. Prevalence of low back pain and associated factors among nurses in Jordan. Nurs Forum. (2018) 53(4):425–31. doi: 10.1111/nuf.12269

15. Attar SM. Frequency and risk factors of musculoskeletal pain in nurses at a tertiary centre in Jeddah, Saudi Arabia: a cross sectional study. BMC Res Notes. (2014) 7(1):61. doi: 10.1186/1756-0500-7-61

PubMed Abstract | CrossRef Full Text | Google Scholar

16. Aljeesh YI, Nawajha S. Determinants of low back pain among operating room nurses in Gaza governmental hospitals. J Al Azhar Univ Gaza (Nat Sci). (2011) 13:41–54. http://hdl.handle.net/20.500.12358/26708

Google Scholar

17. Nützi M, Koch P, Baur H, Elfering A. Work–family conflict, task interruptions, and influence at work predict musculoskeletal pain in operating room nurses. Saf Health Work. (2015) 6(4):329–37. doi: 10.1016/j.shaw.2015.07.011

CrossRef Full Text | Google Scholar

18. Choobineh A, Movahed M, Tabatabaie SH, Kumashiro M. Perceived demands and musculoskeletal disorders in operating room nurses of Shiraz city hospitals. Ind Health. (2010) 48(1):74–84. doi: 10.2486/indhealth.48.74

PubMed Abstract | CrossRef Full Text | Google Scholar

19. Anap DB, Iyer C, Rao K. Work related musculoskeletal disorders among hospital nurses in rural Maharashtra, India: a multi centre survey. Int J Res Med Sci. (2017) 1(2):101–7. doi: 10.5455/2320-6012.ijrms20130513

CrossRef Full Text | Google Scholar

20. Cunningham C, Flynn T, Blake C. Low back pain and occupation among Irish health service workers. Occup Med. (2006) 56(7):447–54. doi: 10.1093/occmed/kql056

CrossRef Full Text | Google Scholar

21. Trinkoff AM, Lipscomb JA, Geiger-Brown J, Brady B. Musculoskeletal problems of the neck, shoulder, and back and functional consequences in nurses. Am J Ind Med. (2002) 41(3):170–8. doi: 10.1002/ajim.10048

PubMed Abstract | CrossRef Full Text | Google Scholar

23. Moscato U, Trinca D, Rega ML, Mannocci A, Chiaradia G, Grieco G, et al. Musculoskeletal injuries among the operating room nurses: results from a multicenter survey in Rome, Italy. J. Public Health. (2010) 18(5):453–9.

24. Barkhordari A, Halvani G, Barkhordari M. The prevalence of low back pain among nurses in Yazd, Southeast Iran. Int J Occup Hyg. (2015) 5(1):19–21.

Google Scholar

25. Bejia I, Younes M, Jamila HB, Khalfallah T, Salem KB, Touzi M, et al. Prevalence and factors associated to low back pain among hospital staff. Joint Bone Spine. (2005) 72(3):254–9. doi: 10.1016/j.jbspin.2004.06.001

PubMed Abstract | CrossRef Full Text | Google Scholar

26. Awosan KJ, Yikawe SS, Oche OM, Oboirien M. Prevalence, perception and correlates of low back pain among healthcare workers in tertiary health institutions in Sokoto, Nigeria. Ghana Med J. (2017) 51(4):164–74. doi: 10.4314/gmj.v51i4.4

PubMed Abstract | CrossRef Full Text | Google Scholar