International Journal of Pharmaceutical and Phytopharmacological Research
ISSN (Print): 2250-1029
ISSN (Online): 2249-6084
Publish with eIJPPR Submission
2021   Volume 11   Issue 1

Prevalence of Low Back Pain among University Students in King Abdulaziz University, Saudi Arabia

Kholoud A. Althakafi1*, Fahad H. Abduljabbar2, Abdullah T. Mugharbel1, Noha A. Alzahrani1, Fawziah A Roublah1

 

1College of Medicine, King Abdulaziz University, Jeddah, KSA.

2Orthopedic Surgery, King Abdulaziz University, Jeddah, KSA.


ABSTRACT

Low back pain (LBP) is considered to affect both young and elderly adults. Med students appear to provide time-consuming curricula, likely perpetuating sedentary habits and a significant burden of LBP among med students. The primary aim of the present study was to evaluate the prevalence of LBP and to see if there is any association between LBP and sedentary lifestyle or (to identify the associated factors) among medical students in King Abdulaziz University. A quantitative cross-sectional study included 380 out of 2000 medical students from all years using a self-administered questionnaire in English distributed to a targeted sample adapted from previously published research by AlShayhan et al.

52.4% were females and 47.6% males. 26.3% of participants were 20 years or less, 37.3% were 21- 22 years. 19.3% were smokers. 34.6% practice exercises currently. The number of hours using computers or tablets was reported as 2-4 hours in 15.9%, 4-6 hours in 22.4%, 6-8 hours in 18.1%, and 8-10 hours in 12.7%. 7.9% reported a history of surgery or trauma to the back, 44.2% reported a history of back pain in family members and treated by a doctor, 49% had a history of low back trouble since joined the college (ache, pain, discomfort), 54.7% had a history of low back trouble once in life (ache, pain, discomfort), 3.7% reported a history of hospitalization because of low back pain and 9.3% reported skipping a day because of low back pain. Lower back pain is common among med school students in King Abdulaziz University, Saudi Arabia. It is significantly associated with age and the number of hours using computers or tablets. University students should be advised to avoid risk factors as much as possible.

Key Words: Lower back pain, Risk factors, Students, King Abdulaziz university, Saudi Arabia


INTRODUCTION

Low Back pain (LBP) is a prevalent health problem that affects people around the world; it can affect people during their lives [1]. Sixty to eighty percent of individuals have had low back pain during their lifetime [2, 3]. Usually, LBP is located in the lumbar region and its causes may include muscle tension (torn or pulled muscle and/or ligament), heavy lifting, poor posture over time such as sitting in a curved position, and sedentary behaviors [2, 4-6].

Sedentary lifestyle (SL) is becoming more prominent because of using computers for a long time, watching television for a few hours a day, reclining, sitting, and writing [7, 8]. We can define SL, as any behaviors that lead to low levels of energy expenditure (Equal or less than 1.6-2.9 METs) [9]. Sedentary behavior has a solid relationship with weight gain, blood sugar, heart diseases, and low back pain [10-14].

Quality of life becomes a problem with high concern for people with LBP because it affects them directly as it is one of the reasons for the lack of productivity during working hours, early retirement, and a considerable proportion of work absence as it impairs the worker performance significantly [15]. Various investigations have reported that between 24% and 87% of patients have frequent episodes of LBP within a year after their first time [16]. Because of its recurrent nature, there may be a financial burden on patients. A study in the US showed that the overall costs of LBP exceed $100 billion per year [17], So LBP is one of the most financially debilitating disorders.

A study reported a high prevalence of LBP Among medical students. It demonstrated that the overall prevalence of LBP among the students was up to 50%. This is attributed to poor study habits, style of living, and psychological causes [18].

A study focusing on the prevalence of LBP among health science students in King Saud University, Riyadh, Saudi Arabia during 2016-2017, found it to be 56.6% [19]. They found that LBP can be triggered by certain factors including: prolonged computer or tablet usage, being uncomfortable in bed during sleep, carrying a heavy backpack, sense of tiredness, feeling depressed, earlier exposure to trauma, and family history of LBP [19]. No studies have been done in our area to explore the prevalence of low back pain among university students nor to explore risk factors that can be associated with LBP.

 

Aim of the study

The primary aim of the present study was to investigate the prevalence of low back pain and to see if there is any association between LBP and sedentary lifestyle or (to identify the associated factors) among medical students in King Abdulaziz University.

MATERIALS AND METHODS

This is a quantitative cross-sectional study designed to evaluate the prevalence of low back pain among medical students and the risk factors associated with it at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. 380 out of 2000 medical students from all years were involved by calculating confidence level 95%, margin error 5%, and response distribution 50%. A self-administered questionnaire in English was distributed to our targeted sample. Verbal consent was taken from the students to complete the questionnaire. Data collection was done from September to December 2018 and the study has been approved by an institutional review board (IRB) of KAUH.

The study questionnaire was adapted from previous research by AlShayhan et al. [19], which consisted of 52 questions and was divided into 4 Sections; first, demographic details such as gender, age, height, weight, college, the year at college. Second, there are questions about risk factors included physical activity, whether smoker or not, consuming coffee, time spent using a computer, sleep duration, the comfort of the bed to back, position while studying, using a heavy backpack, position while studying, being overwhelmed, feeling tired and depressed. LBP was estimated using a Nordic musculoskeletal questionnaire. They were pre-tested for validity [20, 21].

The data were entered using Microsoft Excel 2016 (Microsoft Corporation, Seattle, WA, USA), then, it was analyzed using SPSS version 2. 

RESULTS AND DISCUSSION

The sociodemographic characteristics and smoking history among the studied students are shown in Table 1. About half (52.4%) were females and 47.6% males. 26.3% of participants were 20 years or less, 37.3% were 21- 22 years, 33.1% were 23- 24, and 2.8% were 25- 35 years old. The entire studied sample was medical students. Family monthly income was reported >15000 SAR in 66.6% of samples. 19.3% of samples were smokers.

Table 2 shows the coffee drinking, exercises, sports, using computers or tablets, sleeping, college furniture, overwhelmed, loss of energy, and sadness among the studied students. About one-fifth (19.5%) of samples reported taking coffee once daily, 23.5% more than one daily, and 28.9% 2-5 cups per week. 34.6% of participants exercise currently (35.2% 1-2 times weekly and 49.2% 3-4 times weekly). Of the participants practicing exercise, 41.8% practiced football, 10.7% volleyball, and 23% practiced basketball. The number of hours using computers or tablets was reported as 2-4 hours in 15.9%, 4-6 hours in 22.4%, 6-8 hours in 18.1%, and 8-10 hours in 12.7%. Regarding position during using computer or tablet; 16.1% reported recumbent position and 73.9% reported sitting position. 45% of participants sleep for 4-6 hours at night, 43.6% sleep for 6-8 hours, and 6.5% sleep more than 8 hours. More than one-fifth (23.8%) reported feeling discomfort on the bed, 38.5% reported that college furniture is comfortable to back, 27.5% reported using a heavy backpack, and 37.1% reported feeling overwhelmed. Regarding loss of energy; 44.5% can work about as well as before and 33.4% reported that it takes an extra effort to get started at doing something. 31.4% of the sample feel sad and 7.6% feel sad all the time and can't snap out of it.

Table 3 shows low back pain prevalence and characteristics among the studied students. Only 7.9% reported a history of trauma or surgery to back, 44.2% reported a history of back pain in family members and treated by a doctor, 49% had a history of low back trouble since joined the college (ache, pain, discomfort), 54.7% had a history of low back trouble once in life (ache, pain, discomfort), 3.7% reported a history of hospitalization because of LBP and 9.3% reported skipping a day because of LBP. About fifth (19.5%) reported that work activity affected with back pain during the last 12 months, 12.7% reported reduced activity during the last twelve months due to back pain, 18.7% reported that total length of time that low back trouble prevented them from doing normal work during the last twelve months as 1-7 hours,

Table 4 illustrates the low back pain diagnosis and treatment characteristics among the studied students. 5.1% were seen by a chiropractor, physiotherapist, doctor, or other such people because of low back trouble during the last twelve months and 21.2% had back trouble at any time during the last 7 days. When asked participants to score pain from 1 to 10 (0 = none and 10 = maximum) 60.6% of 145 participants scored it as 0, 2.0% as 1, 4.2% as 2, 9.3% as 3, 8.2% as 4, 6.2% as 5, 2.8% as 6, and 4.0% as 7.

Table 5 shows the relationship between LBP and age, gender, BMI, smoking, exercises, and the number of hours using computers or tablets among the studied students. Age and number of hours using computers or tablets are significantly associated with LBP (P >0.05) while exercises, smoking, BMI, and gender were not (P <0.05).                                                 

Table 1. Sociodemographic characteristics and smoking history among the studied students

Parameter

Frequency

Percent

Age group:

18-20

93

26.3

21-22

133

37.7

23-24

117

33.1

25-35

10

2.8

Gender:

Male

168

47.6

Female

185

52.4

Weigh:

36-50

61

17.3

51-60

89

25.2

61-70

74

21.0

71-80

60

17.0

81-90

35

9.9

91-130

34

9.6

Height:

145-160

105

29.7

161-170

127

36.0

171-180

100

28.3

181-190

21

5.9

College (specialty):

medical student

353

100.0

Academic year:

2nd

51

14.4

3rd

97

27.5

4th

53

15.0

5th

74

21.0

6th

71

20.1

7th

7

2.0

Family monthly income:

<5000

15

4.2

5000-10000

25

7.1

11000-15000

70

19.8

>15000

235

66.6

Other than that

8

2.3

Total duration of the studied program (in years)

6

22

6.2

7

328

92.9

8

3

.8

Type of years:

Basics years

124

35.1

Clinical/practice years

229

64.9

Smoking:

Yes

68

19.3

No

273

77.3

Ex-smoker

12

3.4

Duration of smoking (in years):              )N = 68 )

< 1 year

8

11.8

2-3 years

44

64.7

≥ 4 years

17

28.0

Table 2. Coffee drinking, exercises, sports, using computers or tablets, sleeping, college furniture, overwhelmed, loss of energy, and sadness among the studied students

Parameter

Frequency (No.)

Percent (%)

Coffee drinking:

Once daily

69

19.5

More than once daily

83

23.5

Once a week

55

15.6

2-5 per week

102

28.9

None

44

12.5

Practicing exercises currently:

Yes

122

34.6

No

231

65.4

Times of practicing per week (if the last answer was year):                  )N=122)

1-2

43

35.2

3-4

60

49.2

5-7

19

15.6

Duration of practicing per week:                            (N=122)

<30 minutes

29

23.8

30-60 minuets

68

55.7

1-2 hours

19

15.6

>2 hours

6

4.9

Practicing recreational sports:

Ballet

4

3.2

Basketball

28

23.0

Football

51

41.8

Squash

3

2.5

Skate

4

3.3

Swimming

10

8.2

Tennis

4

3.2

Volleyball

13

10.7

weight lifting

5

4.1

Number of daily hours using computers or tablets:

1-2 hours

24

6.8

2-4 hours

56

15.9

4-6 hours

79

22.4

6-8 hours

64

18.1

8-10 hours

45

12.7

10-12 hours

20

5.7

>12 hours

26

7.4

Other than that

39

11.0

Position during using computer or tablet:

Recumbent position

57

16.1

Sitting and lying down

13

3.7

Sitting and walking

4

1.1

Sitting position

261

73.9

Both

18

5.1

Sleeping hours per night:

<4 hours

17

5.0

4-6 hours

159

45.0

6-8 hours

154

43.6

>8 hours

23

6.5

Feeling discomfort on bed:

Yes

84

23.8

No

269

76.2

College furniture is comfortable to back:

Yes

136

38.5

No

217

61.5

Using a heavy backpack:

Yes

97

27.5

No

256

72.5

Feeling overwhelmed (stressed to the level that can’t manage the situation):

Yes

131

37.1

No

222

62.8

Loss of energy:

I can work about as well as before

157

44.5

I can’t do any work at all

9

2.5

I have to push myself very hard to do anything

69

19.5

it takes an extra effort to get started at doing something

118

33.4

Sadness:

sad all the time and cant snap out of it

27

7.6

so sad and unhappy that can’t stand it

5

1.4

do not feel sad

210

59.5

feel sad

111

31.4

 

Table 3. Low back pain prevalence and characteristics among the studied students

Parameter

Frequency (No.)

Percent (%)

Yes

28

7.9

No

325

92.1

History of back pain in family members and treated by a doctor:

Yes

156

44.2

No

197

55.8

History of low back trouble since joined the college (ache, pain, discomfort)

Yes

173

49.0

No

180

51.0

History of low back trouble once in life (ache, pain, discomfort)

Yes

193

54.7

No

152

43.1

History of hospitalization because of low back pain:

Yes

13

3.7

No

340

96.3

Skipping a day because of low back pain:

Yes

33

9.3

No

320

90.7

The total length of time with low back trouble during the last 12 months

0 days

200

56.6

1-7 days

75

21.2

8-30 days

40

11.3

Everyday

7

2.0

>30 days< but not every day

31

8.8

Work activity affected with back pain during the last 12 months (at home or in college)

Yes

69

19.5

No

284

80.5

Reduced activity during the last 12 months due to back pain? (Leisure activity )

Yes

45

12.7

No

308

87.3

Total length of time that low back trouble prevented from doing normal work (at home or away from home) during the last 12 month

0

278

78.7

1-7

66

18.7

8-30

7

2.0

>30

2

.6

Low back trouble at any time during the last 7 days:

Yes

75

21.2

No

278

78.8

Pain Score: (0 = none and 10 = maximum)                            (n=145)

0

214

60.6

1

7

2.0

2

15

4.2

3

33

9.3

4

29

8.2

5

22

6.2

6

10

2.8

7

14

4.0

Radiation of pain to legs

 

 

Yes

38

10.8

No

315

89.2

       

 

Table 4. Low back pain diagnosis and treatment characteristics among the studied students

Parameter

Frequency (No.)

Percent (%)

Seen by a doctor, physiotherapist, chiropractor, or other such person because of low back trouble during the last 12 months

Yes

18

5.1

No

335

94.9

Analgesia requirement:

Occasional

18

5.1

Regular

7

2.0

None

328

92.9

Analgesia route:

Oral

15

4.2

IM

2

.6

None

336

95.2

Analgesia type:

And IV also

1

.3

Lower p

1

.3

NSAIDs

1

.3

Paracetamol

12

3.4

Upper part

1

.3

None

337

95.5

 

0.00%

221

62.6

1 – 10 %

66

18.7

11 – 20 %

43

12.3

21- 30 %

9

2.5

31- 40%

11

3.1

41 – 80 %

3

0.8

 

Table 5. The relationship between low back pain and age, gender, BMI, smoking, exercises, and number of hours using computers or tablets among the studied students

Parameters

Low back pain

Total (N=353)

P-value

Yes

No

Age

18-20

63

29

92

0.005

32.8%

18.0%

26.1%

21-22

67

66

133

34.9%

41.0%

37.7%

23-24

54

63

117

28.1%

39.1%

33.1%

25-35

8

3

11

4.2%

1.9%

3.1%

Gender

Male

90

79

169

0.681

46.9%

49.1%

47.9%

Female

102

82

184

53.1%

51.2%

52.3%

BMI

Under weight

22

17

39

0.314

11.5%

10.6%

11.0%

normal

146

135

281

76.0%

83.9%

79.6%

over weight

1

0

1

0.5%

0.0%

0.3%

obesity class 1

16

7

23

8.3%

4.3%

6.5%

obesity class 2

6

2

8

3.1%

1.2%

2.3%

obesity class 3

1

0

1

0.5%

0.0%

0.3%

Smoking

Yes

31

37

68

0.241

16.1%

23.0%

19.3%

No

155

118

273

80.7%

73.3%

77.3%

Ex-smoker

6

6

12

3.1%

3.7%

3.4%

Exercises

Yes

68

55

123

0.805

35.4%

34.2%

34.8%

No

124

106

230

64.6%

65.8%

65.2%

Number of hours using computers or tablets

1-2 hours

12

17

29

0.006

6.3%

10.6%

8.2%

2-4 hours

25

40

65

13.0%

24.8%

18.4%

4-6 hours

47

46

93

24.5%

28.6%

26.3%

6-8 hours

43

28

71

22.4%

17.4%

20.1%

8-10 hours

32

15

47

16.7%

9.3%

13.3%

10-12 hours

15

6

21

7.8%

3.7%

5.9%

>12 hours

18

9

27

9.4%

5.6%

7.6%

 

Low back pain is a major health concern and is most commonly treated in primary health care settings. A major number of previous medical studies and systematic reviews have been published on the topic and clinical recommendations have been available [22]. This cross-sectional study aimed at evaluating the prevalence of LBP and to see if there is any association between LBP and sedentary lifestyle or (to identify the associated factors) among medical students in King Abdulaziz University.

According to our results; 44.2% reported a history of back pain in family members and treated by a doctor, 49% had a history of low back trouble since joined the college (ache, pain, discomfort), 54.7% had a history of low back trouble once in life (ache, pain, discomfort), 3.7% reported a history of hospitalization because of LBP and 9.3% reported skipping a day because of LBP. A study on medical students by Amelot, Aymeric et al. reported that 72.1% of students suffered from LBP [23]. Another study reported that the 12-month prevalence of chronic and subacute LBP among medical students was 53.4% [24]. Another study on medical students reported that the lifetime, 12-month, and point prevalence of LBP was 75.8%, 59.5%, and 17.2%, respectively. Chronic LBP was experienced by 12.4% of the students [25].

The prevalence of low back pain among middle-aged and elderly Japanese individuals was 15.4% [26] while Walker in his systematic literature review has reported that the point prevalence of LBP in general ranges from 12% to 33%, whereas its lifetime prevalence range 11-84% [27]. A global study of the prevalence of LBP in the general adult population showed its point prevalence to be approximately 12%, with a one-month, one-year, and lifetime prevalence of 23%, 38%, and 40%, respectively [28]. In a large French population survey Overall, 38.3% of adults reported chronic back pain [29]. In the French portion of the World Mental Health Survey, the chronic back pain prevalence was reported 21.3% [30]. Another study reported the prevalence of LBP ranged from 21% to 75% in elderlies [31]. A study showed that 70-85% of the population will have an episode of LBP at some point and 90% of them will experience more than one episode [32]. A systematic review of the spinal pain prevalence among elderly people, including studies conducted in developed countries, reported a 20% prevalence (≥60 years) [33]. The point, annual, and lifetime prevalence of LBP in the participants of another survey was 17.2%, 39.1%, and 56.2%, respectively [34]. In a study conducted on Irish healthcare workers including allied health workers, administrative, general support, nurses, and doctors, the lifetime LBP prevalence was 46% with an annual prevalence of 30%, and a point prevalence of 15.5% [35]. In other studies LBP prevalence was reported to be 33% in Belgium, 28.4% in Canada, 14% in the UK, 13.7% in Denmark, 6.8% in North America, and 12% in Sweden [36]. Prevalence or incidence data from the Netherlands, Israel, Finland, Belgium, Sweden, USA, and Canada ranged from 0.024-7.0% and 1.4-20.0%, respectively [37]. Bressler et al. systematically reviewed studies on the prevalence of LBP in elderly individuals concluded that its prevalence in elderly population is not known with certainty [38]. Another study on chronic impairing LBP significantly increased over the 14-year interval, from 3.9% in 1992 to 10.2% in 2006 [39].

Obesity, smoking, lack of exercise, increasing age, and lifestyle factors are considered as risk factors for low back pain [28, 40]. Women are at greater risk for chronic pain as compared to men, consistent with evidence that women of all ages experience chronic pain more often than men, which may be linked to the combination of social, psychological, and biological factors [41]. In our study, the number of hours using computers or tablets was reported as 2-4 hours in 15.9%, 4-6 hours in 22.4%, 6-8 hours in 18.1%, and 8-10 hours in 12.7%. Regarding position during using computer or tablet, 16.1% reported recumbent position and 73.9% reported sitting position. 45% of participants sleep for 4-6 hours at night, 43.6% sleep for 6-8 hours, and 6.5% sleep more than 8 hours. 19.5% of the sample reported taking coffee cups once daily, 23.5% more than once daily, and 28.9% 2-5 cups per week. 34.6% of participants practice exercises currently (35.2% 1-2 times a week and 49.2% 3-4 times a week). 19.3% of our sample were smokers. Multiple risk factors of LBP and lower-extremity pain include psychosocial factors, habits, social-demographic characteristics, and physical factors. This review discussed the epidemiology of LBP, with emphasis on consequences, causes, and frequency; the effect of genetics, morphologic characteristics, gender, and age; and the effect of psychological, habitual, social, mechanical, and occupational factors [42]. A recent systematic review showed that the prevalence of LBP seemed higher among middle-aged adults and women [43].

In our study; 5.1% were seen by a chiropractor, physiotherapist, doctor, or other such persons because of low back trouble during the last 12 months and 3.7% reported a history of hospitalization because of LBP. A systematic review of primary care patients in the U.S. showed that about 65% of patients with non-specific LBP still experienced pain one year after its onset; a proportion of 69% in Europe and 41% in Australia [44]. In a study of the clinical course of chronic lower back pain and related disability in the Netherlands, approximately 75% of patients whose pain had resolved before the end of their 12-month follow-up reported one or more relapses within the following year [45]

In our study age and the number of hours using computers or tablets are significantly associated with LBP (P > 0.05) while exercises, smoking, BMI, and gender were not (P < 0.05). In previous study smoking habits (p=0.049), LBP (p<0.001), lumbar function (p=0.001), and social function (p=0.023) in the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were significantly associated [26]. However, a systematic review conducted by Wai et al. [46] found that there is no evidence on whether smoking cessation relieves chronic LBP. In his systematic review, Leboeuf-Yde [47] concluded that smoking should be considered a weak indicator of LBP, as evidence of a causal link between smoking and LBP could not be found in a study using a large sample. In their systematic review, Goldberg et al. [48] associations with adjusted odds ratios (aORs) ≥2 including age 50-69, education level of less than high school, annual household income <$20000, income from medical comorbidities, sleep disturbances, depression, and disability. We also found a strong association between sleep disturbances and cLBP [49]. In another survey, population density, manual labor occupation, lower education, older age, and female gender were significantly associated with the distribution of chronic back pain [29]. In another study, lifting heavy patients/objects at work, older age, obesity/overweight, longer duration of practice, and female gender were significantly associated with LBP among the participants [34].

CONCLUSION

Lower back pain is common among med school students in King Abdulaziz University, Saudi Arabia. It is significantly associated with age and the number of hours using computers or tablets are. University students should be advised to avoid risk factors as much as possible. Awareness should also be raised about the causes and risk factors of this disorder among university students generally. Further studies are needed to evaluate LBP prevalence among non-medical students in other universities of Saudi Arabia.

Acknowledgments: The authors would like to acknowledge both; Mariam Yassin Mohammed Yassin and Fatima Hassan Ali AlJassas (students in the College of Medicine, King Abdulaziz University, Jeddah, KSA) for their continues help in all steps of the research work.

Conflict of interest: None

Financial support: None

Ethics statement: None

 

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