|Year : 2019 | Volume
| Issue : 1 | Page : 1-6
The prevalence of low back pain among Iranian hospital nurses: A systematic review and meta-analysis
Masoud Mohammadi, Ali Akbar Vaisi Raiegani
, Rostam Jalali
, Akram Ghobadi
, Nader Salari
Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
|Date of Web Publication||19-Dec-2018|
Ali Akbar Vaisi Raiegani
Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah
Source of Support: None, Conflict of Interest: None
Background: Low back pain (LBP) is common among nurses. Yet, studies reported contradictory results about its prevalence. Objectives: The aim of this study was to systematically evaluate the prevalence of LBP among Iranian hospital nurses. Methods: This was a systematic review and meta-analysis. Online databases such as Scientific Information Database, MEDLINE (PubMed), Scopus, ScienceDirect, and Google Scholar were searched for studies on Iranian hospital nurses' LBP published in 2000–2017. A meta-analysis was performed using the random effects model via the Comprehensive Meta-analysis software. The heterogeneity of the studies was assessed using the Cochran's Q test and I2 statistic. Results: In total, 17 studies were included. The overall prevalence of LBP among Iranian hospital nurses was 64.8% (95% confidence interval [CI]: 59.6%–69.7%). The lowest and the highest LBP prevalence rates were, respectively, 46.2% (95% CI: 43.5%–49%), among nurses in Tehran and 89.1% (95% CI: 82.2%–93.6%) among nurses in Isfahan. Meta-regression analysis revealed that increase in the sample size and the publication year of the reviewed studies were associated, respectively, with statistically significant decrease and increase in the prevalence of LBP (P < 0.05). Conclusion: With an overall prevalence of 64.8%, LBP is highly prevalent among Iranian hospital nurses. Health policymakers and hospital managers need to provide nurses with necessary educations about LBP prevention and management and make necessary modifications to their workplace in order to create an ergonomically appropriate environment for their practice.
Keywords: Hospital, Iran, Low back pain, Meta-analysis, Nurse
|How to cite this article:|
Mohammadi M, Vaisi Raiegani AA, Jalali R, Ghobadi A, Salari N. The prevalence of low back pain among Iranian hospital nurses: A systematic review and meta-analysis. Nurs Midwifery Stud 2019;8:1-6
|How to cite this URL:|
Mohammadi M, Vaisi Raiegani AA, Jalali R, Ghobadi A, Salari N. The prevalence of low back pain among Iranian hospital nurses: A systematic review and meta-analysis. Nurs Midwifery Stud [serial online] 2019 [cited 2020 Aug 3];8:1-6. Available from: http://www.nmsjournal.com/text.asp?2019/8/1/1/247928
| Introduction|| |
Low back pain (LBP) is a common problem in today's world. Its prevalence is increasing, so that currently, 40% of the general population suffers from LBP in their lives.,
LBP is one of the most common causes of physical disability, the second cause of medical visits after common cold, the third cause of surgery, and the fourth cause of hospitalization. The annual cost of LBP management in the United Kingdom is estimated to be around 10,688 million pounds.,
LBP is a symptom, rather than a disease, which occurs following affliction by different systemic, musculoskeletal, and neurological diseases. It can lead to problems such as debility, disability, invalidity, employment loss, sick leave, and unemployment compensation payment.,
LBP is mainly caused by activities that require lengthy standing or sitting, lifting heavy objects, bending, or frequent rotation because these activities cause imbalance and put heavy pressure on the lumbar region. All these activities are common during nursing practice and hence, nurses are at great risk for LBP. Studies show that LBP is the most common musculoskeletal problem among nurses, with a prevalence of 66%–77%.,,
Nurses in developed countries participate in occupational health surveillance programs, where their health and occupational safety are continuously monitored. Nonetheless, nurses in developing countries, like Iran, have no access to such programs and thus, they may be at risk for different work-related occupational problems such as LBP. However, there are no reliable data on the prevalence of musculoskeletal problems such as LBP among Iranian nurses. Of course, many cross-sectional studies examined LBP prevalence among nurses in Iran; however, their results are contradictory. For instance, studies on nurses in Tehran, Iran, reported a wide range of LBP prevalence from 46.2% to 77.9%.,,,, Moreover, the overall prevalence of LBP among Iranian hospital nurses is still unknown.
The aim of this study was to systematically evaluate the prevalence of LBP among nurses in hospital settings in Iran.
| Methods|| |
This was a systematic review and meta-analysis. The study was conducted on articles published in national and international journals in Persian and English from April 2000 to March 2017. Accordingly, online databases such as Scientific Information Database, MEDLINE (PubMed), Scopus, ScienceDirect, and Google Scholar were searched. Search key terms were “low back pain,” “nurse,” and “Iran.” The Boolean operators “AND” and “OR” were used to combine search results. Keywords were selected from the Medical Subject Headings. Inclusion criteria were cross-sectional study on LBP prevalence among Iranian nurses and publication in Persian or English. We excluded review studies; studies on musculoskeletal disorders; studies on the relationship of LBP with other problems; studies on the causes and the risk factors of LBP; and studies with interventional, cohort, and case–control designs. Besides, in order to find gray literature–i.e., studies which had not scientifically been published–we used the Google search engine and reviewed websites on the study subject.
After completing document search, a list was created of all documents with “LBP in nurses” in their titles. Then, the title pages of these documents (which included authors' names and journal titles) were removed and their full-texts were blindly reviewed by two reviewers using the Strengthening and Reporting of Observational Studies (STROB) in Epidemiology checklist. The items of the checklist were responded as “Present,” “Not present,” or “Not applicable.” For documents which were rejected, the reasons for rejection were provided. Moreover, in case of any disagreement on a document between the two reviewers, the document was judged by a third reviewer. Finally, a data collection form was used to collect data on the specifications of the included studies. The form included items on study title, authors' names, year and place of the study, sample size, and LBP prevalence.
The heterogeneity of the studies was assessed using the Cochran's Q test, where I2 statistic was interpreted as follows: <25%: low heterogeneity; 25%–75%: moderate heterogeneity; and >75%: high heterogeneity. The results of the test revealed an I2 of 97%. Thus, the random effects model was used to combine the results of the included studies. Publication bias was evaluated via funnel plot and Egger's test at a significance level of <0.05. Data analysis was done using the Comprehensive Meta-analysis software v. 3.0 (Biostat, Englewood, NJ, USA).
| Results|| |
The articles of 17 studies were eligible and included in the study [Table 1] and [Figure 1]. The total number of nurses in these 17 studies was 8539, while nurses' age ranged between 20 and 53 years.,,,,,,,,,,,,,,,, The result of the Egger's test was not statistically significant (P = 0.157), indicating that there was no publication bias [Figure 2]. [Figure 3] shows LBP prevalence among Iranian hospital nurses based on the random effects model. In this figure, each black square and the length of the line on the square, respectively, show LBP prevalence and its 95% confidence interval (95% CI), while the black diamond shows the overall prevalence of LBP among Iranian hospital nurses, which was 64.8% (95% CI: 59.6%–69.7%). As this figure shows, the lowest LBP prevalence rate, i.e., 46.2% (95% CI: 43.5%–49%), was observed among nurses who were working in Tehran, while the highest LPB prevalence rate, i.e., 89.1% (95% CI: 82.2%–93.6%), was observed among nurses in Isfahan.
|Figure 2: Funnel plot for the results of low back pain prevalence among Iranian hospital nurses|
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|Figure 3: The prevalence of low back pain among Iranian nurses based on the random effects model|
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We used meta-regression analysis in order to investigate the effects of factors which could potentially affect heterogeneity in LBP prevalence. These factors were sample size and publication year. Accordingly, the results of meta-regression analysis illustrated that any increase in sample size was associated with statistically significant decrease in LBP prevalence. In other words, studies with larger samples reported significantly lower LBP prevalence [P < 0.05; [Figure 4]. Moreover, increase in publication year of the studies was associated with significant increase in LBP prevalence, so that studies which had been published in recent years had reported significantly higher LBP prevalence compared with older studies [P < 0.05; [Figure 5].
|Figure 4: The meta-regression diagram for low back pain prevalence among Iranian hospital nurses based on the sample size of the reviewed studies|
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|Figure 5: The meta-regression diagram for low back pain prevalence among Iranian hospital nurses based on the publication year of the reviewed studies|
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| Discussion|| |
The results of this study showed an overall LBP prevalence of 64.8% among Iranian hospital nurses. The highest and the lowest LBP prevalence rates were 89.1% among nurses in Isfahan and 46.2% among nurses in Tehran, respectively.
LBP among nurses has varying prevalence rates in different settings and countries, probably due to the variations in workplace facilities, job specifications, and work-related factors; yet, most studies reported a high prevalence. For instance, a study in Japan reported that 54.7% of nurses suffered from LBP mostly due to poor body posture. LBP prevalence in a study in Dutch was 36%, with lifting heavy things such as patients as the major cause. A study in Turkey also reported that the total LBP prevalence was 65.8%, while LBP prevalence after 1 year of nursing practice was 85.7%. Moreover, LBP rate among nurses was reported to be 90% in China, 71.3% in Japan, 48.4% in Saudi Arabia, 78.1% in Nigeria, 61.5% in Thailand, >90% in Australia, 73%–76% in Germany, and 86% in Italy. All these results imply that nurses are highly susceptible to LBP. The major causes of such high LBP prevalence among nurses may be heavy workload, standing for long hours, and patient positioning.,,,, LBP can negatively affect different aspects of life, including quality of life. Therefore, nurses need to pay special attentions to the principles of ergonomics and safety during their daily practice.
Meta-regression analysis in the present study also showed that increase in the sample size and the publication year of the reviewed studies were associated, respectively, with statistically significant decrease and increase in LBP prevalence. Significantly higher LBP prevalence in studies published in the last years can be attributed to the ineffectiveness of LPB prevention and management programs for nurses. Nurses make up 80% of health-care providers in Iran. They play different roles in care delivery; counseling hospital and ward management; disease prevention; and personal, family, and public health promotion. Moreover, as family members, they need to manage their household and perform a wide variety of familial roles. Such role multiplicity and heavy workload prevent them from paying adequate attention to personal health and thereby, predispose them to different health problems such as LBP. Yet, they have limited knowledge, if any, about the principles of ergonomics and proper corrective exercises for LBP management. Therefore, specific training courses are needed to improve their knowledge about LBP, its risk factors, its management strategies, safe positioning and right lifting techniques, and use of proper body mechanics. Health-care managers can also reduce LBP prevalence through making environmental modifications to nurses' workplace, reducing nurses' work hours and workload, using age-appropriate work schedules, and providing nurses with easily accessible physical exercise facilities.
Study strengths and limitations
One of the strengths of the present study was the provision of an overall estimate for LBP prevalence among Iranian hospital nurses for the first time. Moreover, meta-regression analysis was used in this study for the two factors of sample size and publication year. On the other hand, the most important limitations of the study were related to the inaccessibility of the full text of some retrieved studies as well as the low quality of some studies due to reporting little details about LBP prevalence.
| Conclusion|| |
With an overall prevalence of 64.8%, LBP is a highly prevalent musculoskeletal problem among Iranian hospital nurses. Therefore, health policymakers and hospital managers need to pay closer attention to the health status of Iranian hospital nurses and employ strategies to prevent and manage LBP among them. Moreover, interventional studies are recommended to evaluate the effects of ergonomic interventions on LBP prevalence among hospital nurses.
Financial support and sponsorship
This study was financially supported by Kermanshah University of Medical Sciences.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Hoy D, Brooks P, Blyth F, Buchbinder R. The epidemiology of low back pain. Best Pract Res Clin Rheumatol 2010;24:769-81.
Sezgin D, Esin MN. Predisposing factors for musculoskeletal symptoms in Intensive Care Unit nurses. Int Nurs Rev 2015;62:92-101.
Rajapakse D, Liossi C, Howard RF. Presentation and management of chronic pain. Arch Dis Child 2014;99:474-80.
Uhl RL, Roberts TT, Papaliodis DN, Mulligan MT, Dubin AH. Management of chronic musculoskeletal pain. J Am Acad Orthop Surg 2014;22:101-10.
Golob AL, Wipf JE. Low back pain. Med Clin North Am 2014;98:405-28.
Nachemson A, Waddell G, Norlund AL. Epidemiology of neck and low back pain. The scientific evidence of causes, diagnosis, and treatment. Philadelphia: Lippincott Williams & Wilkins; 2004.
Tan BK, Smith A, O'Sullivan P, Chen G, Burnett A. Low back pain beliefs and their relationships with low back pain-related disability in nurses working in Mainland China and in Australia. J Cult Divers 2015;22:71-81.
Onishi T, Kurimoto S, Suzuki M, Imaeda T, Hirata H. Work-related musculoskeletal disorders in the upper extremity among the staff of a Japanese university hospital. Int Arch Occup Environ Health 2014;87:547-55.
Mehrabi T, Parvin N, Yazdani M, Asemanrafat N. The study of the severity of some occupational stressors in nurses. Nurs Midwifery Stud 2004;27:34-9.
Eftekhar Sadat B, Babaei A, Amidfar N, Jedari Eslami MR. [Prevalence and risk factors for low back pain in nursing staffs of Tabriz hospitals in 2008]. J Urmia Nurs Midwifery Fac 2013;11:659-66.
Ali Abadi Z, Kafaie S, Sarchahi K, Poor Sadegh A, Kazemi M. Prevalence of herniated lumbar disk among nurses working in two educational hospitals of Birjand university of medical sciences. Mod Care J 2010;7:25-9.
Chobineh AR, Taghipourkazeroni MB, Tabatabaei SH, Kamalinia M. Study of nurses' knowledge on low back pain risk factors in Hospitals of Shiraz University of Medical Sciences. Q J Occup Health Saf 2012;3:55-62.
Ghasemi GA, Rahimi N, Eshaghian M, Aghayari A. The prevalence of low back pain and its correlation with some occupational factors and demographic characteristics of the nurses working in the hospitals affiliated with social security organization in Isfahan 2011. J Res Dev Nurs Midwifery 2013;10:69-76.
Mohseni Bandpai MA, Fakhri M, Ahmadshirvani M, [Bagheri Nesami M, Khlilian AR. Evaluation of low back pain related factors in nurses working in hospitals in Mazandaran province]. Mazandaran J Med Sci 2005;15:118-24.
Nasiry Zarrin Ghabaee D, Haresabadi M, Bagheri Nesami M, Talebpour Amiri F. [Work-related musculoskeletal disorders and their relationships with the quality of life in nurses]. J Ergon 2016;4:39-46.
Sharifnia SM, Haghdoost AK, Hajihosseini F, Hojjati H. [Relationship between the musculoskeletal disorders with the ergonomic factors in nurses]. Komesh 2011;12:372-9.
Sadeghin F, Klianmoghadam H, Javanmard M, Khosravi A, Adelnia S. [An epidemiological survey of Low back pain and its relationship with occupational and personal factors among nursing personnel at hospitals of Shahrood Faculty of Medical Sciences]. Iran South Med J 2005;8:75-82.
Faraz R, Kalroozi F, Pishgooie A, Taheriyan A, Lak M. [Prevalence of spinal pain (upper and lower) and its related factors in nurses of AJA]. J Military Care 2014;1:36-42.
Aghayari A, Ghasemi GA, Eshaghian M, Ghojoghi M, Haghverdian S. [Prevalence of low back pain and its association with anxiety and depression in male and female nurses]. J Res Sports Med Technol 2014;4:39-47.
Ramezanibdr F, Nikbakht Nasrabadi AR, Mohammadpour A. [Low-back pain prevalence and its risk factors in nurses]. Iran J Nurs Res 2006;1:37-42.
Samaei SE, Mostafaee M, Jafarpoor H, Hosseinabadi MB. Effects of patient-handling and individual factors on the prevalence of low back pain among nursing personnel. Work 2017;56:551-61.
Rezaee M, Ghasemi M. Prevalence of low back pain among nurses: Predisposing factors and role of work place violence. Trauma Mon 2014;19:e17926.
Sadeghian F, Hosseinzadeh S, Aliyari R. Do psychological factors increase the risk for low back pain among nurses? A comparing according to cross-sectional and prospective analysis. Saf Health Work 2014;5:13-6.
Barzideh M, Choobineh AR, Tabatabaee HR. Job stress dimensions and their relationship to musculoskeletal disorders in Iranian nurses. Work 2014;47:423-9.
Habibi E, Pourabdian S, Atabaki AK, Hoseini M. Evaluation of work-related psychosocial and ergonomics factors in relation to low back discomfort in emergency unit nurses. Int J Prev Med 2012;3:564-8.
Mohseni-Bandpei MA, Fakhri M, Bagheri-Nesami M, Ahmad-Shirvani M, Khalilian AR, Shayesteh-Azar M, et al.
Occupational back pain in Iranian nurses: An epidemiological study. Br J Nurs 2006;15:914-7.
Rasmussen CD, Holtermann A, Mortensen OS, Søgaard K, Jørgensen MB. Prevention of low back pain and its consequences among nurses' aides in elderly care: a stepped-wedge multi-faceted cluster-randomized controlled trial. BMC Public Health. 2013;13:1088.
van der Beek AJ. Primary preventive effects of a multifaceted workplace intervention on low back pain. Pain 2015;156:1583-4.
Karahan A, Kav S, Abbasoglu A, Dogan N. Low back pain: Prevalence and associated risk factors among hospital staff. J Adv Nurs 2009;65:516-24.
June KJ, Cho SH. Low back pain and work-related factors among nurses in Intensive Care Units. J Clin Nurs 2011;20:479-87.
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.
Keriri H. Prevalence and risk factors of low back pain among nurses in operating rooms, Taif, Saudi Arabia. Am J Res Commun 2013;2:45-70.
Hinmikaiye C, Bamishaiye E. The incidence of low back pain among theatre nurses: a case study of university of Ilorin and Obafemi Awolowo University Teaching Hospital. Int J Nurs Sci 2012;2:23-8.
Sopajareeya C, Viwatwongkasem C, Lapvongwatana P, Hong O, Kalampakorn S. Prevalence and risk factors of low back pain among nurses in a Thai public hospital. J Med Assoc Thai 2009;92 Suppl 7:S93-9.
Mitchell T, O'Sullivan PB, Burnett AF, Straker L, Rudd C. Low back pain characteristics from undergraduate student to working nurse in Australia: A cross-sectional survey. Int J Nurs Stud 2008;45:1636-44.
Maul I, Läubli T, Klipstein A, Krueger H. Course of low back pain among nurses: A longitudinal study across eight years. Occup Environ Med 2003;60:497-503.
Occhionero V, Korpinen L, Gobba F. Upper limb musculoskeletal disorders in healthcare personnel. Ergonomics 2014;57:1166-91.
Rebeiro G, Edward KL, Chapman R, Evans A. Interpersonal relationships between registered nurses and student nurses in the clinical setting – A systematic integrative review. Nurse Educ Today 2015;35:1206-11.
Bernal D, Campos-Serna J, Tobias A, Vargas-Prada S, Benavides FG, Serra C, et al.
Work-related psychosocial risk factors and musculoskeletal disorders in hospital nurses and nursing aides: A systematic review and meta-analysis. Int J Nurs Stud 2015;52:635-48.
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