Original Research
The
Prevalence and Impact of Low Back Pain Among
Anaesthesia Care Providers in South-South, Nigeria
Aku S. Akolokwu1,
*Fiekabo Hart1, Christie N. Mato1.
Port Harcourt, Nigeria.
Background: Low back pa=
in
(LBP) is a common musculoskeletal disorder, that significantly impedes
productivity. This study aims to ascertain the risk factors responsible for
developing low back pain and the impact on personal workplace service deliv=
ery
among Anesthetist’s practicing in Rivers and Bayelsa States of Nigeria.
Methodology: A cross-sectional survey was conducte=
d, A
self-administered questionnaire reflecting the modified Oswestry Disability
Index (ODI) was used to detect the risk factors and assess the severity and
impact of low back pain on this group of professionals. The prevalence of l=
ow
back pain was calculated and described by using frequency tables. A
multivariate logistic regression model was fitted to identify factors
associated with the prevalence of low back pain. Significance was considere=
d at
p<0.05 with a 95% confidence interval.
Results: =
A
total of 65 anesthetist’s responded, giving a response rate of 90%. There w=
ere
more males (52.3%) than females (47.7%). The majority (69.2%) of those who
responded had low back pain, more in females (53.3%) compared to males (46.=
7%)
although not significant. (P=3D0.994); Majority had moderate pain 58.6%, 22=
.7%
severe and 20.5% mild pain. There was no association between low back pain =
and
age (P=3D0.130), gender(P=3D0.994), marital status (P=3D0.333) and BMI (P=
=3D0.164).
Bending (P=3D0.032), lifting (P=3D0.024), and standing(P=3D0.016) were pred=
ictive
variables for low back pain and were statistically significant P<0.05.
Conclusion: Using the
Oswestry pain assessment tool for LBP, the estimated prevalence of low back
pain was more than fifty percent among the respondents. In this study, freq=
uent
bending and twisting, prolonged standing, and lifting were important
significant associated factors in the development of LBP among anesthetist’s.
Keywords: Low back pa=
in,
Oswestry disability index, Anaesthesiologist
*
Emailfiekabo=
ogan@yahoo.com.
This is an open access journal, and articles are distributed und=
er
the terms of the Creative Commons Attribution-Non-Commercial-Share Alike 4.0
License, which allows others to remix, tweak, and build upon the work non-c=
ommercially,
as long as appropriate credit is given and the new creations are licensed u=
nder
the identical terms.
How to cite this article:
Akolokwu AS, Hart F, Mato CN. The Prevalence and Impact =
of
Low Back Pain Among Anaesthesia Care Providers =
in
South-South, Nigeria. Niger Med J 2023; 64(4): 471-477. Accepted: August 21,
2023. Published: September 21, 2023.
Introduction
Pain which is
described by the International Association for the Study of Pain (IASP) as =
an
unpleasant sensory or emotional experience associated with actual or potent=
ial
tissue damage or described in terms of such damage [1] is a major cause of
disability. When this pain occurs in the lumbosacral region i.e. beneath th=
e 12th
rib up to the upper buttock, it is commonly referred to as low back pain.
A
cross-sectional survey was conducted to evaluate the prevalence, pattern, r=
isk
factors and impact of LBP on the physical well-being of anesthetist’s who w=
ork
in tertiary hospitals in Rivers and Bayelsa States of Nigeria. A modified
self-administered questionnaire reflecting the Oswestry Disability Index (O=
DI)[15]=
(See
Table 1)was used to detect the risk factors and assess the severity and imp=
act
of low back pain on this group of professionals.
Table
1: The modified Oswestry Disability Index (ODI), (Greenberg 2010).
Modified
ODI score (%) Level of disab=
ility
0-20 Min=
imal
disability
21-40 Moder=
ate
disability
41-60 Severe
disability
61-80 Cripp=
le,
pain impinges on all aspects of the patient’s life.
81-100 Patient=
s are
bed-bound or exaggerating their symptoms.
Measurements
were done using an electronic questionnaire that was divided into three main
sections: Demography (age, sex, gender, marital status); Risk factors (BMI,
exercise habits, duration of work, duration of employment, nature of work,
presence of co-existing illnesses like diabetes mellitus, hypertension etc, smoking; impact on work and personal life (thera=
py,
absenteeism, family life, financial burden and complications).
Statistical
Package for Social Sciences (SPSS) version 22 was used to analyze the data
obtained. Quantitative data was assessed using mean, standard deviation, and
qualitative data using frequencies and percentages. Chi-square was used for
comparison of proportions and regression analysis to determine variables th=
at
predict LBP. All statistical analysis was set at a 5% level of significance
(p<0.05).
Result
There are a =
total
of 72 Anaesthesiologists in Rivers and Bayelsa
states. An electronic questionnaire was sent out; there were 65 respondents
giving a response rate of 90%. The socio-demographic variables of the study
participants are shown in Table 2. The ages of the respondents ranged from =
20
to >70 years, with a larger proportion (53.8%) within the 36-50 years age
bracket; 43.7% have worked for 5-10yrs in anaesthesia<=
/span>.
There were more males (52.3%) than females (47.7%).
The majority=
of
them were married (78.5%), and 50.8 % had a BMI of 25-29.9. The majority
(69.2%) of those who responded to the question reported suffering from low =
back
pain; LBP was higher in females (53.3%) compared to males (46.7%), although
there was no association between low back pain and age (P=3D0.130), gender(=
P=3D0.994),
marital status (P=3D0.333) and BMI (P=3D0.164). The maj=
ority of
respondents (40.9%) with LBP had it for a duration of 4-10 days.
Table 2: Socio-demographic characteris=
tics
of the study participants
VARIABLE FREQUENCY (%) TEST OF SIGNIFICANCE
Age
20-30 11(16.9)
36-50 35(53.8)
50-65 12(18.5) P=3D0.130, X
65-70 6(9.2)
>70
Gender
Male 34(52.3) P=3D0.994, X
Female 31(47.7)
Ms
Married
51(78.5) P=3D0.333, X
Single 14(21.5)
BMI
18.5-24.9 18(24.7)
25-29.9 33(50.8) P=3D0.164, X
>30 14(21.5) =
Visual
Analogue Score was used to assess the severity of pain. Of the 69.2% of res=
pondents
with LBP, the majority had moderate pain (56.8%), mild (20.5%) and severe
(22.7%). 26.4% admitted to missing at least one day of work due to LBP. Oral
analgesics were used in managing low back pain; 45.2% used only NSAIDS, 38.=
1%
paracetamol, 7.1% required both, 4% opioids, and 9.5% required NSAIDS, opio=
ids
and physiotherapy; none required surgical intervention.
Using
the multiple regression analysis, there was no association between low back
pain, regular exercise and co-morbidities. There was a significant associat=
ion
between bending (P=3D0.032), lifting (P=3D0.024), standing(P=3D0.016) and l=
ow back
pain.
Using
the Oswestry disability index score interpretation guidelines, of the 65
respondents 21 (32.3%) had mild disability 39 (60%) had moderate disability,
and 5 (7.7%) had a severe disability, but none was crippled or bedbound.
Table 3: Sho=
ws the
risk factors for Low Back Pain
RISK FACTORS FREQUENCY n=3D65(%) TEST OF SIGNIF=
ICANCE
Regular Exercise 22(33.8) P=3D0.241, X
Yes
No43(66.2)
Comorbidities
Hpt
5(33.3)
Dm 1(6.7) P=3D0.301, =
X2=3D11.52
Scdx -
Others 9(=
60.0)
Causes OfBackpain=
Lifting
14(21.5) P=3D0.024*
Bending
22(33.8) P=3D0.=
032*
Shifting 2(3.1=
) P=
=3D0.241
Standing 23(35.4) P=3D0=
.016*
Others
8(12.3) P=3D=
0.201
Table 4: Depicts the Modified Oswestry
Disability Score
OSWESTRY DISABILITY SCORE (n =3D 65)(%of n)
0-20%
(Minimal mild disability)
21 32.3
21-40%
(Moderate disability)
39 60.0
41-60%
(Severe disability) =
5 7.7
61-80%(Crippled)
81-100%(Bedbound)
Discussion
This study showed that more than 50% of <=
span
class=3DSpellE>anaesthetists working in Rivers and Bayelsa states of
Nigeria suffer from low back pain; a prevalence of 69% is significant and
unexpected. The
Oswestry disability score also revealed that 60% of the participants have
moderate disability. The prevalence in this study is low compared to the
findings of Bin Homaid et al[6] in w=
hich
the prevalence of LBP among anaesthesiologists =
was
82.4%, and other studies in Saudi Arabia and China with prevalence rates of
74.2% and 72.8%[6,16], respectively. In addition, the reported p=
revalence
in this study also did not exceed the worldwide prevalence, which is about =
84 %.[17,18,19] The results obtaine=
d in
this study might be due to the prolonged sitting time and psychological str=
ess
of working long hours in tertiary institutions, especially with the dearth =
of
qualified anaesthetists caused by the mass exod=
us of
health workers (brain drain) in Nigeria. The prevalence of low back pain am=
ong
health professionals in Bangladesh, Sokoto in Nigeria, and Ireland was 11.9=
%,
39.1%, and 30%, respectively[10,20,21] which is lower than the
result of this study. This difference might be due to different sampling
techniques, and the fact that these other studies were carried out among all
health workers, compared to this study which was exclusively among anaesthesiologists.
The
incidence of LBP has been reported to be highest in the third decade of life
with the overall prevalence increasing with age until the 60–65-year age gr=
oup
and then gradually declining.[22] In our study, 53.8% of those w=
ith
low back pain were between 36-50 years. The association between younger age=
and
ODI scores found in this study is similar to the findings by Anson et al, <=
sup>[8]
as injured young practitioners may be in the “acute phase,” while older
clinicians may be in the “stable” phase with less expected pain. The occurr=
ence
of LBP in the older age group could be due to physiological changes and
cumulative occupational risk factors at the workplace over the years. Howev=
er,
the observed decline between 50-65, 18%, 65-70, 9.2% and >70, 1.5% may be
because these groups of workers are not likely to be exposed to the risk
factors at the workplace any longer as they may have either retired or
progressed into administrative / management cadre.
In this
study, the number of female anaesthetists (32.9=
%)
with LBP was more compared with males (28.8%) although not statistically
significant. This could be attributed to the anatomical, physiological, and
structural differences between women and men,[2] and the fact th=
at
females tend to do extra-professional activities in the household and
childbearing.[23] although two studies conducted in Kuwait and
Uganda disproved this theory.[24,25]
Among
those with LBP, 40.9% of pain occurred for a duration of 4-10 days, followe=
d by
29.5% for 1-3 days. This differs from the study by El Soud et al[26]
in which 76.5% of respondents had chronic LBP and 5.9% had acute LBP; thoug=
h El
Soud et al[26] used all categories of health workers, while this
study was only amongst anaesthetists. Using the=
VAS,
56.8% of those with LBP had moderate pain scores, and about 20.5% were mild=
. A
study by Karahan et al [24] observed mild cases to be about 65.3%
and moderate cases at 63%. These differences may be attributed to the
subjective nature of pain.
Low
back pain is a common reason to be absent from work.[5] In this
study, about 26.4% of those with LBP obtained excuse duty because of the pa=
in.
This reveals that the pain was serious and severe enough to interfere with =
the work
schedule and warrant taking time off while recovering from the acute onset =
of
the illness. They may likely rest or self-medicate hence majority (45.2%) w=
ere
on NSAIDS, and 38.1% on Paracetamol.
Prolonged
standing and sitting, awkward posture during surgeries, work overload,
psychological stress, physical hard work, and long working hours may predis=
pose
to LBP. Smoking, high BMI, advancing age, female gender, inactivity, long-s=
tanding
time, and perceived stress were significantly associated with the presence =
of
LBP worldwide.[6,25,27,28] However, we did not find a statistica=
lly
significant relationship (p>0.05)between LBP and gender, age, BMI, regul=
ar
exercise, shifting, and work experience in this study. This may be due to t=
he
fact that 53.8% of anaesthetists in this study =
were
between 35-50years.
<=
span
lang=3DEN-US style=3D'font-size:12.0pt;font-family:"Times New Roman",serif'=
>Anaesthetists
usually perform some risky activities daily that were found to be significa=
ntly
associated with LBP.[24] This may include lifting heavy objects
above the waist, transferring patients onto a bed or chair, transferring
patients onto a stretcher, ambulating a patient, repositioning patients,
pulling a patient up the bed, and rotating the torso while bearing some wei=
ght.[24]
In the present study, we found that some of such activities as lifting (0.0=
24),
bending (0.032), and standing (0.016) were significantly associated with the
presence of LBP. This can be improved by health education on posture, exercise and correct lifting techniques.[5]=
The
provision of ergonomically sound chairs with back support rather than backl=
ess
stools is necessary in the workplace and workers can interrupt prolonged
sitting or standing and walk around occasionally while at work.
Conclusion
Using the Os=
westry
pain assessment tool for LBP, the estimated prevalence of low back pain was
found to be high. We also found that frequent bending, twisting, prolonged
standing, and lifting were important significant associated factors with LBP
among Anaesthetists; age, gender BMI and number=
of
work years in anaesthesia were not significant
factors, but LBP was severe and serious enough to cause anaesthetists
to ask to be excused from work.
Abbreviations
BMI: Body Mass Index. ; ODI; Oswestry
Disability Index. LBP: Low Back Pa=
in;
SD: Standard Deviation. VAS; Visual Analogue Score.MS; Marital status.NSAIDS; Non-Steroidal Anti-Inflammatory Drug.TENS; TranscuteneousElectri=
cal
Nerve Stimulation, UPTH; University of Port Har=
court
Teaching Hospital.
Conflicting Interest
The authors
declare that there are no conflicting interests.
Acknowledgements
We
acknowledge all anaesthesiologists in Rivers and
Bayelsa state for their cooperation and support during the study.
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