|Year : 2016 | Volume
| Issue : 3 | Page : 205-209
Prevalence of low back pain among medical practitioners in a tertiary care hospital in Riyadh
Mohammad Almalki1, Mohammed H Alkhudhayri1, Ahmad A Batarfi2, Shorowk K Alrumaihi1, Shaker H Alshehri3, Sami I Aleissa2, Nader S Alkenani2
1 Research Unit, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
2 Research Unit, College of Medicine, King Saud bin Abdulaziz University for Health Sciences; Department of Surgery, Division of Orthopedics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
3 Department of Surgery, Division of Orthopedics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
|Date of Web Publication||02-Aug-2016|
Dr. Nader S Alkenani
King Abdulaziz Medical City, P.O. Box: 22490, Riyadh 11426
Context: Lower back pain (LBP) is one of the most common musculoskeletal symptoms among health care providers. Aims: This study aimed to determine the prevalence and the effects of LBP among medical practitioners in King Abdulaziz Medical City (KAMC) in Riyadh. Subjects and Methods: This cross-sectional study was conducted in KAMC in Riyadh, Saudi Arabia (over six months period of time). The study included a group of physicians, surgeons, nurses, paramedics, and other medical practitioners of different nationalities. A survey was sent to 174 conveniently selected participants to be filled and completed. Both descriptive and inferential tests were reported. Chi-square, t-test, and ANOVA tests were used when appropriate. A P < 0.05 was identified as statistically significant for all the tests. Results: The lifetime prevalence of back pain among all the participants was found to be 83.9% (146). The mean age of participants was 33.5 ± 9.6. Male participants were 121 (71.2%). The sample included 114 (65.9%) medical doctors. It has been found that 135 (92.5%) of the study participants had a minimal disability, 10 (6.8%) had moderate disability, and only 1 (0.7%) had severe disability. Conclusions: Work-related complaints are a major issue facing employees and employers worldwide. It varies according to the type of work. LBP is a common problem that many workers suffer from. It is recommended to conduct further researches to study the burden of this problem in different aspects, such as psychological and social.
انتشار آلام أسفل الظهر بين الممارسين الطبيين في مستشفى الرعايةالثالثية في الرياض
خلفية البحث: آلم أسفل الظهر (LBP) هو واحد من أعراض ضعف العضلات والعظام الأكثر شيوعا بين مقدمي الرعاية الصحية.
الأهداف: تهدف هذه الدراسة إلى تحديد مدى انتشار آثار آلام أسفل الظهر بين الأطباء الممارسين في مدينة الملك عبدالعزيز الطبية في العاصمة السعودية الرياض.
عينات الدراسة وطرقه: أجريت هذه الدراسة في مدينة الملك عبدالعزيز الطبية في الرياض، المملكة العربية السعودية (فى فترة أكثر من ستة أشهر). وشملت الدراسة مجموعة من الأطباء والجراحين، ممرضين ومسعفين، والأطباء الممارسين الآخرين من جنسيات مختلفة. وأرسلت استمارة الدراسة لعدد 174 مشاركين مختارين لتعبئتها و قد قدم تقرير وصفي واستنتاجي. ولقد استخدمت الاختبارات الاتية :مربع كاي، اختبار (ت)، واختبارات أنوفا. وP <0.05 عرف بأنه دلالة إحصائية لجميع الاختبارات.
النتائج: انتشار الألم بين جميع المشاركين على 83.9٪ (146). وكان متوسط عمر المشاركين 33.5 ± 9.6. كان الذكور المشاركون 121 (71.2٪). شملت العينة 114 (65.9٪) من الأطباء. وقد وجد أن 135 (92.5٪) من المشاركين في الدراسة
Keywords: Lower back pain, medical doctors, prevalence, Saudi Arabia
|How to cite this article:|
Almalki M, Alkhudhayri MH, Batarfi AA, Alrumaihi SK, Alshehri SH, Aleissa SI, Alkenani NS. Prevalence of low back pain among medical practitioners in a tertiary care hospital in Riyadh. Saudi J Sports Med 2016;16:205-9
|How to cite this URL:|
Almalki M, Alkhudhayri MH, Batarfi AA, Alrumaihi SK, Alshehri SH, Aleissa SI, Alkenani NS. Prevalence of low back pain among medical practitioners in a tertiary care hospital in Riyadh. Saudi J Sports Med [serial online] 2016 [cited 2019 Apr 25];16:205-9. Available from: http://www.sjosm.org/text.asp?2016/16/3/205/187556
| Introduction|| |
Work-related complaints are a major problem facing employees and employers, which have negative impact on their health and productivity. Medical practitioners are exposed to a range of work-related risk factors that may result in many occupational diseases. One of the most common work-related complaints is musculoskeletal symptoms which affect nearly a million workers each year in the United States according to the US Bureau of Labor Statistics and accounts for 85% of all workers' compensation claims. 
Lower back pain (LBP) is one of the most common musculoskeletal complaints. Many studies showed that LBP has higher prevalence among medical practitioners than any other musculoskeletal symptoms. ,, In 1998, the direct health care cost of back pain, in the United Kingdom, was ͳ1632 million. Moreover, the cost of informal care and related production losses was ͳ10668 million. 
One study was conducted in Tunisia showed that the lifetime prevalence of LBP was 57% and the annual prevalence was 50% among all the hospital staff.  One meta-analysis of 13 articles studied the annual prevalence of LBP in physicians, and there was discrepancy in prevalence between the articles: 44%, 63%, and 67%.  In a study done in Shijiazhuang in China, the prevalence of LBP in physicians was found to be 44%.  Among nurses, 71% reported LBP in a study conducted in Kurume in Japan.  In Ljubljana in Slovenia, 73% of physiotherapists had experienced back pain at least once.  In another study conducted in the United Kingdom, 19% of ear, nose, and throat consultants had back pain.  Surgeons had a prevalence of 68% in a study done in China. 
LBP is associated with many potential risk factors. Age is one of the factors. The prevalence and disability increase with increasing age. Furthermore, the recovery time increases in with increasing age.  Physical activity has also shown to be a risk factor along with abnormal posture, bending, twisting, gardening, and lack of exercise. , Psychosocial factors such as high mental pressure, too much overtime, and inadequate work support could contribute to LBP. ,, High body mass index (BMI), smoking, alcohol drinking, and female gender could also be associated with LBP. ,,
This study aimed to determine the prevalence of LBP and how it affects the social, personal, and professional life of the medical practitioners in King Fahad Hospital (KFH) at King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia. This helps to identify the burden of low back pain on the population and then to minimize its effect.
| Subjects and methods|| |
A descriptive, cross-sectional study, using self-administered questionnaire, was conducted in KAMC in Riyadh, Saudi Arabia. This hospital is a tertiary care center which employs approximately 8000 employees. Saudi employees make up 40% while the other 60% are of different nationalities such as North Americans, South Africans, Middle Eastern, and others. The study included physicians, surgeons, nurses, paramedics, and other medical practitioners. Retired medical practitioners and those who are not practicing clinical work at KAMC were excluded from the study.
A list of all employees who met the inclusion criteria was obtained. Physicians, surgeons, nurses, paramedics, and other medical practitioners were selected by convenience sampling method.
Based on the previous assumptions, with a 5% margin of error, 95% confidence interval, and 0.05 absolute precision; the estimated sample size was 204. The response rate was 85.2%.
The Oswestry Disability Index was used to measure the disability and the effect of low back pain on the participants. Demographic data, information about lifestyle, work environment, and information about back pain were included in the questionnaire.
Microsoft Excel was used in data entering to establish the database. SPSS (IBM, SPSS v20)package was used for statistical analysis for both descriptive (mean, median, range, percentage, variance, standard deviation) and inferential tests. In the inferential tests, the Chi-square test was used for categorized variables and t-test/ANOVA for the numerical variables. A P < 0.05 was identified as statistically significant for all the tests.
Participation in the study was voluntary, and each participant was able to withdraw from the study at any time. The investigators explained the aims of the study to the participants. Agreement to fill the questionnaire was considered as consent to participate in the study. The study protocol received ethical approval from the Institutional Review Board of the Saudi National Guard Health Affairs, Riyadh, Saudi Arabia.
| Results|| |
Out of 204 employees, 174 completed questionnaires from various healthcare professions. The mean age of participants was 33.5 9.6 years. The males were 121 (71.2%) and the females were 49 (28.8%). The sample contained 114 (65.9%) questionnaires from physicians and 59 (34.1%) from other healthcare professionals.
The lifetime prevalence of back pain among all the participants was found to be 83.9% (146). Of those participants who had back pain, 99 (67.8%) never had back pain before work and 19 (13%) had taken days off from work because of the back pain. Thirty-five (24%) of the participants have sought medical help because of the LBP. In addition, 103 (70.5%) believed that their back pain is because of their work. When measuring the disability caused by back pain, we found that 135 (92.5%) had minimal disability, 10 (6.8%) had moderate disability, and only 1 (0.7%) had severe disability.
From the 114 doctors who participated in the study, 100 (87.7%) had back pain [Table 1] and from those 100, there was 94 (94%) who had a minimal disability, 6 (6%) had a moderate disability, and no one suffered from a severe disability because of back pain [Table 2]. Physicians who had back pain and seek medical help for that were 18 (18%) and 10 (10%) had days off from work because of it. Most of the physicians, 67 (67.7%), believed that their pain is related to their work; 32 (32.3%) said it is not related to their work and 1 did not answer [Table 3].
The study sample included 59 of other professionals, and 45 (76.3%) of them had low back pain [Table 1]. From the 45 who reported back pain, there were 40 (88.9%) who had minimal disability, 4 (8.9%) had a moderate disability, and only 1 (2.2%) had a severe disability from the back pain [Table 2]. Of those, 17 (37.8%) seek medical help and 9 (20%) took days off because of the pain. The participants who said that their back pain is related to their work were 35 (77.8%), and the other 10 (22.2%) said that it is not related to their work [Table 3].
The participants included 121 males and 49 females. From the 121 males, 101 (83.5%) had back pain at least once in their life and from the 49 females, 43 (87.8%) reported back pain [Table 1]. Of all participants, 93 (92.1%) males and 40 (93%) females had minimal disability, 8 (7.9%) males and 2 (4.7%) females had moderate disability, and only 1 (2.3%) female had severe disability [Table 2].
The study sample was categorized according to the participants BMI to underweight, normal, and overweight. There were 3 underweight participants, 52 of normal weight, and 79 of overweight. All of the underweight participants have experienced back pain with minimal disability. Of the normal weight participants, 44 (84.6%) had back pain, and 42 (95.5%) of them experienced it with minimal disability, and only 2 (4.5%) with moderate disability. In addition, 72 (91.1%) of the overweight participants had back pain. Of those, 67 (93.1%) were minimally disabled and the other 5 (6.9%) had moderate disability [Table 1] and [Table 2].
| Discussion|| |
Prevalence of LBP has been assessed in many countries worldwide, which later on help in determining the causes, risk factors, and interventions to prevent it. The prevalence was significant in most of the studies. This study aimed to determine the prevalence and the effects of LBP among medical practitioners at KAMC in Riyadh. In the present study, 83.9% of all healthcare practitioners experienced LBP. After using the Oswestry LBP Disability Index, it has been found that the majority (92.5%) had only a minimal disability. A minimal disability means that the participants who had the back pain can do most of activities of daily living with no difficulties, and there is usually no treatment indicated except some advice about lifting, sitting, and exercises. There are 6.8% of all the healthcare practitioners who had a moderate disability. The moderate disability is when there are more pain and difficulty with sitting, lifting, and standing. Travel and social life are more difficult, and the affected participants may be disabled from work. Personal care and sexual activity are not affected much. In the moderate disability, they need conservative treatment with advice also. Only 1 (0.7%) had severe disability which means there is severe pain and all activities of daily living are affected and they need more investigations to find the cause and manage patients accordingly. Interventions to manage severe back pain vary and some patients may need surgery to control and relieve their pain. That is why it is important to determine the severity of LBP.
LBP can be evaluated by absence from work of the practitioners. This study showed that 13% of those who had back pain had taken days off from work and which has consequences on their health and productivity. Furthermore, 67.8% of the participants who had back pain have never had back pain before joining their work. Hence, there may be an association between work and back pain.
In comparing doctors with other healthcare professionals, we can see that there is no significant difference between them in terms of prevalence of back pain, type of disability, and sick leaves. Although physicians may have slightly higher prevalence, it is not significant. There is a difference when it comes to seeking medical help as the other healthcare practitioners seem to seek medical help more than physicians. This could be because most of the physicians understand that most of LBP is mechanical and can be relieved by simple analgesia and heat and cold. When comparing males and females and the BMI categories, we find that there is no significant difference in terms of prevalence and disability.
This study showed slightly higher lifetime prevalence of LBP in comparison with other studies. The other studies showed prevalence from 57% to 73% ,,,, and this study showed 83.9%. Moreover, this study also has higher prevalence rate of seeking medical help 24% in comparing with other studies 18%.  In terms of taking sick leave from work, this study found that 13% of participants with back pain have taken days off from work while the other study suggested 15%. 
This study has some limitations; more number of participants is needed to represent the population of the healthcare practitioners. Because the participation was optional and not all doctors attended the activities, there is a possible important "no" missing. In addition, the sample should be equally distributed between physicians and other healthcare practitioners, also between males and females. Furthermore, because this is a cross-sectional study, risk factors for LBP could not be identified. Therefore, further study on case-control may reveal some risk factors and help in preventing back pain.
In summary, the prevalence of LBP among healthcare practitioners in KAMC was significant. Physicians suffer from LBP more than other health care workers. Moreover, most of the physicians experienced minimal disability and this has no effect on their activities of daily living and work. On the other hand, healthcare workers seek medical help more than physicians.
| Conclusion|| |
Work-related complaints are a major issue facing employees and employers worldwide. It varies according to the type of work. LBP is a common problem that many workers suffer from. It is recommended to conduct further researches to study the burden of this problem in different aspects, such as psychological and social.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Pransky G, Benjamin K, Hill-Fotouhi C, Himmelstein J, Fletcher KE, Katz JN, et al.
Outcomes in work-related upper extremity and low back injuries: Results of a retrospective study. Am J Ind Med 2000;37:400-9.
Daraiseh NM, Cronin SN, Davis LS, Shell RL, Karwowski W. Low back symptoms among hospital nurses, associations to individual factors and pain in multiple body regions. Int J Ind Ergon 2010;40:19-24.
Rugelj D. Low back pain and other work-related musculoskeletal problems among physiotherapists. Appl Ergon 2003;34:635-9.
Hengel KM, Visser B, Sluiter JK. The prevalence and incidence of musculoskeletal symptoms among hospital physicians: A systematic review. Int Arch Occup Environ Health 2011;84:115-9.
Maniadakis N, Gray A. The economic burden of back pain in the UK. Pain 2000;84:95-103.
Bejia I, Younes M, Jamila HB, Khalfallah T, Ben Salem K, Touzi M, et al.
Prevalence and factors associated to low back pain among hospital staff. Joint Bone Spine 2005;72:254-9.
Smith DR, Wei N, Zhang YJ, Wang RS. Musculoskeletal complaints and psychosocial risk factors among physicians in Mainland China. Int J Ind Ergon 2006;36:599-603.
Smith DR, Mihashi M, Adachi Y, Koga H, Ishitake T. A detailed analysis of musculoskeletal disorder risk factors among Japanese nurses. J Safety Res 2006;37:195-200.
Babar-Craig H, Banfield G, Knight J. Prevalence of back and neck pain amongst ENT consultants: National survey. J Laryngol Otol 2003;117:979-82.
Szeto GP, Ho P, Ting AC, Poon JT, Cheng SW, Tsang RC. Work-related musculoskeletal symptoms in surgeons. J Occup Rehabil 2009;19:175-84.
Snook SH. Work-related low back pain: Secondary intervention. J Electromyogr Kinesiol 2004;14:153-60.
Campbell C, Muncer SJ. The causes of low back pain: A network analysis. Soc Sci Med 2005;60:409-19.
[Table 1], [Table 2], [Table 3]