Prevalence and risk factors of low back pain and disability index among operating room nurses

Occupational LBP is a common health problem worldwide. Health care workers (HCWs) are at a higher risk of developing LBP due to a variety of factors6. This problem is associated with major consequences in terms of disability and frequent absence6. LBP may lead to activity limitation and sick leave for more than 50 per cent of nurses7. Female gender, advanced age and high Body Mass Index (BMI) are some examples of risk factors commonly associated with LBP8–13. Sport and regular physical activity were found to decrease LBP14. Working in the operating room (OR) carries its own risk for developing LBP due to exposure to additional risk factors such as prolonged standing and awkward posture during surgeries6,15–17.


Introduction
Low Back Pain (LBP) is one of the most common complaints requiring medical attention and is the most common form of musculoskeletal disorder 1,2 .It is estimated that over half of the general population will seek medical care for back pain at some point in their lives 3 .Globally, the prevalence of LBP among the general population ranges between 15 and 45 per cent 1,2,4,5 .
Occupational LBP is a common health problem worldwide.Health care workers (HCWs) are at a higher risk of developing LBP due to a variety of factors 6 .This problem is associated with major consequences in terms of disability and frequent absence 6 .LBP may lead to activity limitation and sick leave for more than 50 per cent of nurses 7 .Female gender, advanced age and high Body Mass Index (BMI) are some examples of risk factors commonly associated with LBP [8][9][10][11][12][13] .Sport and regular physical activity were found to decrease LBP 14 .Working in the operating room (OR) carries its own risk for developing LBP due to exposure to additional risk factors such as prolonged standing and awkward posture during surgeries 6,[15][16][17] .
There are several studies that have been carried out to assess the prevalence of and risk factors for LBP in OR personnel.Since the operating room is a dynamic place of work, research into risk factors for LBP in OR personnel must be comprehensive in terms of work environment, body mechanics and OR work routine.This will provide a panorama for risk factors for LBP.

Background
Work-related LBP poses a major health and socioeconomic problem in modern society.Globally, LBP is a significant occupational hazard in the health care profession.Among hospital-based health care workers, the cumulative life prevalence of LBP is 72.5 per cent and the yearly prevalence is 56.9 per cent 18 .Treatment is sought by 34. 1 per cent of health care workers suffering from LBP, out of which 7.3 per cent require sick leave or absences from work.
A study conducted to assess the prevalence of LBP among nurses in the same tertiary care centre in India revealed that 92 per cent of nurses had LBP and ten per cent of those had taken sick leave of more than 15 days per year due to LBP.
This study allows us to determine the prevalence of and risk factors for LBP among OR personnel and also provides an overall picture regarding the disability index among them.This study will also provide pilot data for future studies that will determine the effectiveness of interventions to reduce LBP among OR personnel.Our long-term goal is to modify these risk factors and improve the work productivity among OR nurses which will eventually positively influence the quality of patient care.

Peer-reviewed article Aim
The study aimed to: • assess the prevalence of LBP among OR nurses working at a tertiary care centre in a developing country • assess the risk factors for LBP specific to OR nurses in a developing country • identify the disability index among those OR nurses with LBP.

Participants/ethics
The study had institutional review board approval from Christian Medical College, Vellore, Tamil Nadu, South India.All levels of nurses working in the department of OR nursing were included for recruitment.Nurses with less than one year of experience were exempted from this study.Participant numbers identified those eligible nurses.All eligible nurses who completed the survey form consented to voluntarily participation in the study.

Survey/sampling
The During a weekly OR nurses meeting, the study was presented to the nurses.Volunteers who fitted the inclusion criteria and who were willing to take part were invited to register within a given deadline.At the end of the deadline 250 nurses had registered.The survey was administered to the participants for a week at the end of their shifts and data was gathered.

Data analysis
The coded response on the questionnaire was entered onto computer general purpose coding forms.The data were analysed using the Statistical Package for Social Sciences (SPSS) (Windows Version 10.0 Chicago IL, USA).The results were presented using simple percentage, mean and standard deviation (SD).
A chi-squared test (X 2 ) was used to determine the association between variables.A probability level of 0.05 or less was used to indicate statistical significance.

Results
The majority of the 250 respondents answered all of the questions on the questionnaire.Of the OR nurses who registered, 220 (88 per cent) were women, 108 (43.2 per cent) were between the ages of 20 and 30 years and 197 (78.8 per cent) were in scrubbing or circulating roles.OR nurses from the orthopaedic surgical unit were the highest in number with 36 respondents (14.4 per cent).The participants with one to five years of experience in OR made up the majority group.Demographics of the respondents are presented in Table 1.
As shown in Table 2, the mean height of the study population was 152.2 cm, with a standard deviation of 0.76, and the mean weight was 55.3 kg with a standard deviation of 1.20.

Prevalence of LPB among OR nurses working in a developing country
Among the 250 respondents, 210 (84 per cent) of them experienced LBP at least once during the past year.This study also brought out the surprising revelation that 79.6 per cent (199) of the respondents with LBP had developed it after joining nursing.

Risk factors for LBP in OR nurses in a developing country
The data analysis showed significant association between LBP and the following factors: • incorrect body mechanics (p < 0.01) • surgical unit where working (p < 0.05) • stressful work conditions (p < 0.05) • assisting in positioning patients for surgery (p < 0.01) • assisting in transferring patients (p < 0.05) • strenuous nature of work (p < 0.05) • fatigue in the workplace (p < 0.05) • work postures (like bending forward, twisting the torso while assisting), lifting heavy instrument sets and prolonged standing (p < 0.05) • stressful workplace (p < 0.01).

Level of disability due to LBP among OR nurses in a developing country
LBP causes an array of physical disabilities among those affected.The analysis of data gathered using the modified Oswestry questionnaire revealed that 50.4 per cent (126) of respondents were minimally disabled by LBP and 24 per cent (60) of them were moderately disabled.

Discussion
In this study 84 per cent of OR nurses reported to have mild, moderate or severe LBP over the past year.This concurs with the worldwide prevalence of LBP among the general population, which is reported to be around 84 per cent.It was also found that females in this study complained more of LBP when compared with males.This is supported by the literature.Globally, nurses are found to have the highest prevalence of LBP 17,19,20 .

Conclusion
The prevalence of LBP among the OR nurses surveyed was 84 per cent.
The Oswestry disability index score revealed that 24 per cent of the OR nurses were moderately disabled by LBP.It is anticipated that these findings will highlight the need for programs related to back muscle strengthening and correct body mechanics to help prevent this problem among OR nurses and, in turn, have a positive effect on patient outcomes.

Limitations
There are no known risks associated with participation in this study.
Participants became frustrated while completing the survey but were able to stop and complete the survey later.

Table 2 :
Distribution of study population according to height and weight (N = 250)