Volume 8, Issue 4 (Summer 2023)                   Health in Emergencies and Disasters Quarterly 2023, 8(4): 347-356 | Back to browse issues page

XML Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Shirzad Cibni V, Nobahar M, Ghorbani R. Prevalence of Low Back Pain and Some Related Factors in the Iranian Field Staff of Prehospital Emergency Medical Services. Health in Emergencies and Disasters Quarterly 2023; 8 (4) :347-356
URL: http://hdq.uswr.ac.ir/article-1-459-en.html
Prevalence of Low Back Pain and Some Related Factors in the Iranian Field Staff of Prehospital Emergency Medical Services
Vahid Shirzad Cibni1 , Monir Nobahar * 2, Raheb Ghorbani3
1- Nursing Care Research Center, School of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran., Faculty of Nursing and Midwifery
2- Nursing Care Research Center, School of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran. , nobahar43@Semums.ac.ir
3- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran., Department of Epidemiology and Biostatistics
Keywords: Low back pain, Medical staff, Emergency care, Prehospital, Emergency medical services
Full-Text [PDF 563 kb]   (627 Downloads)     |   Abstract (HTML)  (1564 Views)
Full-Text:   (409 Views)
1. Introduction 
Low back pain (LBP) is a pain concentrated between the twelfth thoracic vertebra and the inferior gluteal fold, which may or may not be accompanied by leg pain and is non-specific in 90% of cases [1]. LBP is one of the most common health problems [2] and the most common disabling health condition and one of the most common reasons people seek medical care in the world [3]. Approximately 84% of adults experience LBP at some point in their life [4]. The global prevalence of LBP in the general population has been estimated to be 22-48% [5]. In another study, the global prevalence of LBP in the general population has been estimated to be 15 to 45% [6].
    The known risk factors for LBP include smoking, obesity, female gender, intense physical activity, high-stress work, low education level, lack of workers’ compensation, job dissatisfaction, psychological factors such as anxiety, depression, and disorders, and psychosomatic disorders [7].
    LBP is among the most common reasons for seeking medical care. The economic impact of LBP in the United States alone has been estimated to be 86 billion dollars [8]. The cost of treating and caring for LBP patients worldwide exceeds 400 billion dollars a year [9].
    Healthcare workers are at increased risk of musculoskeletal disorders and especially LBP, which is the most common work-related injury in this population [10]. People working in prehospital emergency medical services are one group of many healthcare workers who can be susceptible to such injuries [11]. Emergency medical services (EMS) is an essential part of the health care system responsible for the safe transfer of patients to emergency centers and for providing medical services that patients may need during transfer [12]. They are exposed to a variety of stressors such as work accidents, illnesses, musculoskeletal disorders, car accidents, injuries, trauma, stress syndrome, violence, exhaustion, burnout, and deaths [13]. In critical and dangerous health situations, EMS personnel are one of the major health groups for providing medical services to patients and are exposed to a variety of occupational hazards, including LBP [14]. EMS is an essential part of the health care system, which is focused on providing EMS while transferring an ill or injured patient to the hospital [11], lifting patients, carrying patients on stretchers, and transporting patients from the ambulance to the hospital are particularly, prone to LBP [15, 16]. The duties of EMS technicians include moving and carrying patients and performing cardiopulmonary resuscitation when required [11]. It has been estimated that the prevalence of work-related injuries or illnesses that cause workplace absence among EMS workers is 9.4%, with the annual prevalence rate being about 8.1 per 100 EMS workers [17]. In a study in Denmark, 42% of PE technicians reported experiencing musculoskeletal pains [18].
    Indeed, EMS technicians are exposed to a variety of occupational hazards [19]. However, musculoskeletal injuries, particularly in the lumbar region, are remarkably common in this population [20]. It can significantly lead to varying degrees of disability, long-term illness, high treatment costs, work restrictions, absenteeism, and impairs the quality of life [21]. LBP is one of the most common reasons a for job change, the main concern affecting work productivity, early retirement, and quality of life [22]. Past studies in this area have highlighted the need for further research on LBP in EMS workers, especially pain intensity over time, prevention and treatment methods, and causal relationships with general health and demographic characteristics [23]. In a study, the need for further studies on LBP in PE technicians was emphasized [23]. However, we are not aware of the prevalence of LBP among EMS workers. To address this research gap, this study investigated the prevalence of LBP among EMS workers and the factors associated with the prevalence of this pain in Gilan Province in northern Iran. Therefore, this study answers the following question: What is the prevalence of LBP and its related factors among EMS workers?

2. Materials and Methods
Study design
This study was a multi-center, cross-sectional descriptive correlational study.

Setting
This study was conducted in 2019 on male EMS technicians working in 68 centers as the field staff of prehospital emergency medical centers in Gilan Province, northern Iran. Out of 460 EMS technicians working in the prehospital emergency medical centers of the area, 156 who were eligible for entering the study were chosen by convenience sampling.

Participants/Population 
Sample size estimation
The sample size was determined using the Equation 1:



1. Sample size
 (N, population size, p, an estimate of people with LBP in the community, q=1-p, d=margin of error, Z is the critical value of the normal distribution at α/2) for 95% confidence, 6.5% margin of error, and P=0.5. Using this formula, the sample size was calculated to be 152 people. The criterion for the definition of LBP was any pain concentrated between the twelfth thoracic vertebra and the inferior gluteal fold, with or without leg pain [1, 24]. 

Inclusion criteria
The inclusion criteria were male EMS technicians working as the field staff of prehospital emergency medical centers, the age 25-55 years and the absence of congenital disorders and defects in the spine, and those who were willing to participate in the study.

Exclusion criteria 
The exclusion criteria were the long-term use of steroids, having infectious diseases, chronic pelvic inflammatory diseases, prostatitis, malignancy, or abdominal and pelvic vascular problems, and being on leave during the study.

Instrumentation 
Data were collected with a pain measurement inventory and a questionnaire of demographic information including age, level of education, marital status, income, family size, number of children, place of residence, body mass index, smoking, medication, illnesses, physical activity, the number of calls (missions) per shift, job satisfaction, the type of station (urban/extra-urban), work experience, and the persistence of LBP. Pain intensity is measured with a numeric rating scale national readership survey (NRS) from 0–10, zero (no pain) to ten (worst pain). NRS were originally developed by NRS, but are now used by many other organizations for wider applications and have become a standard for research. The NRS questionnaire is a valid and reliable tool for measuring LBP [25]. 


Procedures 
In this study, necessary coordination was made with the Semnan University of Medical Sciences and the Medical Emergency and Accident Management Center in Gilan Province. Firstly, the objectives of the study and the method of work were explained to participants and if they accepted to participate in the study, they were asked to read and sign the informed consent form. All subjects were informed about the aims, objectives, procedures, and outcomes of the study. The questionnaires were distributed by the first researcher. The researcher answered the participants’ questions. Then, they completed a questionnaire of demographic information and NRS. They return the questionnaires to the researcher after completion. Completed questionnaires were checked by the researcher.

Data analysis 
Data analysis was performed in SPSS software, version 24 via unvaried logistic regression at 5% and multiple logistic regression at the 10% significance level.

3. Results
Characteristics of study subjects
The Mean±SD of the age of participants was 39.5±8.2 (median=38) years. Of all the participants, 50% had a bachelor’s or higher degree, 90.4% were married, and 66.7% had an average or higher income. The Mean±SD of the number of calls per shift was 5.5±2.5. The Mean±SD of the number of children was 1.3±0.9, the body mass index was (27.0±3.8), and the number of years of work experience was (13.3±6.3). Of the participants, 8.3% (n=13) had a history of underlying diseases, 80.8% of low-income participants, 63.2% of middle-income participants, and 77.8% of good-income participants had LBP. Other variables including marital status, location, job satisfaction, and emergency type of station had no significant relationship with the prevalence of LBP (P>0.05) (Table 1). 




Pain assessment 
The collected data showed that 69.9% (n=109) of the participating workers had LBP. The Mean±SD of the pain intensity rating was 4.77±1.35 (median=5). 
In the univariate analysis using logistic regression, none of the variables had a significant relationship with the prevalence of LBP (P>0.05) (Table 1).
    In the multiple logistic regression analysis conducted to examine the simultaneous association of the examined factors on the prevalence of LPB, the results showed that EMS workers with a higher number of calls per shift (90% Confidence Interval (CI), 1.01%-1.32%, OR=1.15, P=0.088), history of underlying diseases (90% CI, 1.40%-54.12%, OR=8.71, P=0.051) and low-income levels (P=0.016), and level of education with bachelor’s degree or higher (P=0.077), were more likely to have LBP (Table 2).



4. Discussion
In this study, the prevalence of LBP among the male EMS technicians working as the field staff of prehospital emergency medical centers in Gilan Province, Iran, was 67.3%. Research has shown that people working in prehospital EMS experience more musculoskeletal disorders than the general workforce [26, 27]. For example, in a nationwide study in Denmark, a significant portion (42%) of 1689 ambulance workers reported musculoskeletal pain, which was significantly higher than the 29% ratio observed among the other 14,175 workers questioned [18]. In Australia, between 2003 and 2012, ambulance staff and EMS technicians had the highest rate of musculoskeletal injury among healthcare workers [28]. In a study in Portugal, Davison et al. found that 90.2% of EMS personnel suffered from LBP [29]. The results of a systematic review and meta-analysis study by Sahebi et al. showed that the prevalence of LBP among EMS personnel was 50.30% (95% CI, 37.98-62.62, I2=99.1%) [30]. Results of a systematic review and meta-analysis study by Azizpour et al indicated that the prevalence of LBP in Iranian nurses during their working life and during the last year was estimated at 63% (95% CI, 57.4%–68.5%) and 61.2% (95% CI, 55.7%–66.7%), respectively [31]. Therefore, the findings of this study seem to be consistent with the results of other studies that show the high prevalence of LBP among the personnel of prehospital EMS.
    The results of this study showed a significant relationship between the prevalence of LBP and the number of calls per shift, in the sense that people running more calls in their shifts increase the prevalence of LBP. The relationship between workload and LBP has been the subject of many studies. For example, a study by Truszczynska et al. (2013) on air force pilots in Poland also showed a significant relationship between LBP and increased flight time [32]. A study by Zhang et al. (2019) in China also showed the increased prevalence of LBP in ambulance workers who were doing more overtime [33]. In a study by Trinkoff et al. (2006) on nurses in the United States, there was a significant relationship between workdays and musculoskeletal problems in the lower back [34]. Several other studies have also shown a significant relationship between LBP and work hours [35, 36]. Since the duties of EMS personnel often involve carrying the patients, performing cardiopulmonary resuscitation, and remaining in a standing position for prolonged periods, their work often puts significant pressure on their lumbar region and spine. Research has shown that doing tasks that put pressure on the lower back is often considered a normal part of the job of prehospital emergency workers [20]. Therefore, for these workers, putting in longer work hours and running more calls per shift, which means applying more pressure on the spine, can be expected to increase musculoskeletal disorders, especially in the lumbar region.
    The results of this study showed a significant relationship between LBP and income level, in the sense that people with low income increase the prevalence of LBP. This is consistent with the results of other studies [37]. To explain this relationship, one can argue that people with lower income are less willing or able to spend money on retraining and sports and exercise classes, a tendency that increases musculoskeletal disorders. Indeed, studies have shown a significant relationship between LBP and training [38] and sports activity [39]. Also, these people have to do more overtime to compensate for their low base income, which means they have to run more calls and put more pressure on their spines. This argument is consistent with other results of this study.
    In this study, the multiple logistic regression analysis of the factors associated with LBP showed a significant relationship between the prevalence of LBP and the level of education. In another study, a relationship was found between education and LBP [37, 40].
In this study, the multiple logistic regression analysis of the factors associated with LBP showed a significant relationship between the prevalence of this pain and the history of underlying diseases. Overall, not many studies have been performed on the relationship of LBP with the history of underlying diseases. In a study by Stewart Williams et al. (2007-2010), where they analyzed the data of LBP patients in different countries and examined the risk factors associated with this pain in adults, it was reported that chronic diseases do increase the prevalence of LBP [41]. A study by Alexopoulos et al. (2005) also showed that poor general health is a significant risk factor for developing LBP [42]. Taken together, these findings suggest that there is a two-way relationship between musculoskeletal health and the general health of individuals, with problems in each hurting the other. Therefore, operations, guidelines, and research priorities of EMS should be planned with due attention to the general health of EMS workers as well as their musculoskeletal disorders.
During emergencies and disasters, EMS personnel face numerous stressful and dangerous situations and have a vital role in saving patients’ lives, so their physical health can affect the quality of their performance. Lack of management support, poor communication with management, fatigue, and inadequate staff factors can be influencing EMS personnel. Therefore, managers and planners must prevent the creation of unsuitable conditions and work pressures on them by planning and preparing suitable facilities, tools, and work equipment. In summary, the results of this study show the significant prevalence of LBP among EMS personnel, indicating this problem is a major occupational threat in this profession. Therefore, the significant prevalence of LBP among EMS personnel and the devastating impact of this problem on the employees’ physical and mental health of worker poses a major challenge for the healthcare system. To manage the LBP, proper stretcher lifting methods are recommended. Learning to carry patients and equipment, including regular exercise and strengthening physical strength building in the work schedule prevents LBP and redefines the tasks of the staff with a history of LBP. Also, the results of this study suggest that the number of calls per shift, income level, and history of underlying diseases is among the most important factors that predispose EMS workers to LBP and should be the basis of strategies and guidelines for prehospital EMS to reduce the prevalence of LBP among people working in this field. According to these results, raising the income of EMS workers, recruiting extra workforce, and expanding the number of prehospital emergency medical centers to reduce the work pressure resulting from a large number of calls, and monitoring the general health of EMS workers to prevent and control chronic and work-related diseases can reduce the prevalence of LBP in the field staff of prehospital EMS. 

5. Conclusion
There was a high prevalence of LBP among the field staff of prehospital EMS, which can lead to significant professional, psychological, social, and medico-economic consequences. In this study, the number of calls per shift, income level, history of underlying diseases, and bachelor’s degree or higher education level was significantly associated with LBP. Findings can be used to develop guidelines to reduce the prevalence of LBP among the field staff of prehospital EMS. Reducing the disability caused by the high prevalence of LBP among the field staff of prehospital EMS requires the participation of managers and multidisciplinary planning.

Limitations
The most important limitation of this study was its cross-sectional nature, which cannot establish the causative relationship between occupational exposure and LBP. Also in the study, self-reported data were gathered. The use of sample participants from a population who experienced similar work nature, sitting arrangement, and homogeneous work environment is the strength of this study. The authors recommend further studies on the relationship between musculoskeletal disorders, especially in the lumbar region, and the number of calls per shift, income level, history of underlying diseases, and general health.

Ethical Considerations
Compliance with ethical guidelines
This research was carried out in full compliance with all pertinent ethical guidelines, which included gaining approval from the Ethics Committee of Semnan University of Medical Sciences (Code: IR.SEMUMS.REC.1397.271), obtaining informed consent, protecting the confidentiality of participants’ information, and obtaining a letter of introduction for the study.

Funding
This study has been adapted from MSc thesis of Vahid Shirzad Cibni, approved by Department of Nursing, Semnan University of Medical Sciences.

Authors' contributions
Conceptualization: All authors; Data collection: Monir Nobahar and Vahid Shirzad Cibni; Data analysis: Monir Nobahar and Raheb Ghorbani; Drafting of the manuscript, critical revision for important intellectual content, and supervision: Monir Nobahar.

Conflict of interest
All authors declared no conflict of interest.

Acknowledgments
The authors would like to thank the Nursing Care Research Center and the Deputy of Research and Technology at Semnan University of Medical Sciences. We would also like to thank the officials and the Pre-hospital Emergency Center and Incident Management in Gilan Province, especially Sajed Bakhshi.

References
  1. Pradhan BB. Evidence-informed management of chronic low back pain with watchful waiting. The Spine Journal. 2008; 8(1):253-7. [DOI:10.1016/j.spinee.2007.10.028] [PMID]
  2. Carlson C. Axial back pain in the athlete: Pathophysiology and approach to rehabilitation. Current Reviews in Musculoskeletal Medicine. 2009; 2(2):88-93. [DOI:10.1007/s12178-009-9050-y] [PMID] [PMCID]
  3. Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, et al. Prevention and treatment of low back pain: Evidence, challenges, and promising directions. Lancet. 2018; 391(10137):2368-83. [DOI:10.1016/S0140-6736(18)30489-6] [PMID]
  4. Parvizi J, Pour AE, Hillibrand A, Goldberg G, Sharkey PF, Rothman RH. Back pain and total hip arthroplasty: A prospective natural history study. Clinical Orthopaedics and Related Research. 2010; 468(5):1325-30. [DOI:10.1007/s11999-010-1236-5] [PMID] [PMCID]
  5. Deyo RA, Mirza SK, Martin BI. Back pain prevalence and visit rates: Estimates from U.S. National Surveys, 2002. Spine. 2006; 31(23):2724-7. [DOI:10.1097/01.brs.0000244618.06877.cd] [PMID]
  6. Parreira P, Maher CG, Steffens D, Hancock MJ, Ferreira ML. Risk factors for low back pain and sciatica: An umbrella review. The Spine Journal. 2018; 18(9):1715-21. [DOI:10.1016/j.spinee.2018.05.018] [PMID]
  7. Steffens D, Ferreira ML, Latimer J, Ferreira PH, Koes BW, Blyth F, et al. What triggers an episode of acute low back pain? A case-crossover study. Arthritis Care & Research. 2015; 67(3):403-10. [DOI:10.10.1002/acr.22533] [PMID]
  8. Ivanova JI, Birnbaum HG, Schiller M, Kantor E, Johnstone BM, Swindle RW. Real-world practice patterns, health-care utilization, and costs in patients with low back pain: The long road to guideline-concordant care. The Spine Journal. 2011; 11(7):622-32. [DOI:10.1016/j.spinee.2011.03.017] [PMID]
  9. Manogharan S, Kongsted A, Ferreira M, Hancock M. Do older adults with chronic low back pain differ from younger adults in regards to baseline characteristics and prognosis? European Journal of Pain. 2017; 21(5):866-73. [DOI:10.1002/ejp.989] [PMID]
  10. Freimann T, Pääsuke M, Merisalu E. Work-related psychosocial factors and mental health problems associated with musculoskeletal pain in nurses: A cross-sectional study. Pain Research and Management. 2016; 2016:9361016. [DOI:10.1155/2016/9361016] [PMID] [PMCID]
  11. Studnek JR, Crawford JM. Factors associated with back problems among emergency medical technicians. American Journal of Industrial Medicine. 2007; 50(6):464-9. [DOI:10.1002/ajim.20463] [PMID]
  12. Xia T, Collie A. Work-related injury and illness in the Victorian healthcare sector: A retrospective analysis of workers’ compensation claim records. Australian Health Review. 2020; 44(1):24-30. [DOI:10.1071/AH18017] [PMID]
  13. Beyramijam M, Rasouli-Ghahfarokhi SM, Fathollahzadeh A, Rahimzadeh A, Shahabirabori MA, Aminizadeh M. The effect of education and implementation of “National Hospital Disaster Preparedness Plan” on an Iranian hospital preparedness: An interventional study. Journal of Education and Health Promotion. 2019; 8:1-5. [PMID]
  14. Sheikhbardsiri H, Afshar PJ, Baniasadi H, Farokhzadian J. Workplace violence against prehospital paramedic personnel (city and road) and factors related to this type of violence in Iran. Journal of Interpersonal Violence. 2022; 37(13-14):NP11683-98. [DOI:10.1177/0886260520967127] [PMID]
  15. Aljerian N, Alshehri S, Masudi E, Albawardi AM, Alzahrani F, Alanazi R. The prevalence of musculoskeletal disorders among EMS personnel in Saudi Arabia, Riyadh. The Egyptian Journal of Hospital Medicine. 2018; 73(1):5777-82. [DOI:10.21608/ejhm.2018.11879]
  1. Deros BM, Daruis DD, Thiruchelvam S, Othman R, Ismail D, Rabani NF, et al. Evaluation on ambulance design and musculoskeletal disorders risk factors among ambulance emergency medical service personnel. Iranian Journal of Public Health. 2016; 45(Supple 1):52-60. [Link]
  2. Studnek JR, Ferketich A, Crawford JM. On the job illness and injury resulting in lost work time among a national cohort of emergency medical services professionals. American Journal of Industrial Medicine. 2007; 50(12):921-31. [DOI:10.1002/ajim.20516] [PMID]
  3. Hansen CD, Rasmussen K, Kyed M, Nielsen KJ, Andersen JH. Physical and psychosocial work environment factors and their association with health outcomes in Danish ambulance personnel-a cross-sectional study. BMC Public Health. 2012; 12(534):1-13. [DOI:10.1186/1471-2458-12-534] [PMID] [PMCID]
  4. No Author. Ambulance crash-related injuries among emergency medical services workers--United States, 1991-2002. Morbidity and Mortality Weekly Report. 2003; 52(08):154-6. [Link]
  5. Jones AY, Lee RY. Cardiopulmonary resuscitation and back injury in ambulance officers. International Archives of Occupational and Environmental Health. 2005; 78(4):332-6. [DOI:10.1007/s00420-004-0577-3] [PMID]
  6. Clari M, Godono A, Garzaro G, Voglino G, Gualano MR, Migliaretti G, et al. Prevalence of musculoskeletal disorders among perioperative nurses: A systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2021; 22(226):1-12. [DOI:10.1186/s12891-021-04057-3] [PMID] [PMCID]
  7. Mukhtad AA, Mohamed HA. Lower back pain among health care workers in operating room at Al-Fateh Children’s Hospital: Prevalence and risk factors. Asian Journal of Research in Nursing and Health. 2018; 1(1):1-11. [Link]
  8. Studnek JR, Crawford JM, Wilkins JR 3rd, Pennell ML. Back problems among emergency medical services professionals: The LEADS health and wellness follow-up study. American Journal of Industrial Medicine. 2010; 53(1):12-22. [DOI:10.1002/ajim.20783] [PMID]
  9. Egle UT, Nickel R. [Chronic low back pain as a somatoform pain disorder (German)]. Der Orthopade. 2008; 37(4):280-4. [DOI:10.1007/s00132-008-1224-6] [PMID]
  10. Garg A, Pathak H, Churyukanov MV, Uppin RB, Slobodin TM. Low back pain: Critical assessment of various scales. European Spine Journal. 2020; 29(3):503-18. [DOI:10.1007/s00586-019-06279-5] [PMID]
  11. Broniecki M, Esterman A, May E, Grantham H. Musculoskeletal disorder prevalence and risk factors in ambulance officers. Journal of Back and Musculoskeletal Rehabilitation. 2010; 23(4):165-74. [DOI:10.3233/BMR-2010-0265] [PMID]
  12. Sterud T, Hem E, Ekeberg O, Lau B. Health problems and help-seeking in a nationwide sample of operational Norwegian ambulance personnel. BMC Public Health. 2008; 8(3):1-9. [DOI:10.1186/1471-2458-8-3] [PMID] [PMCID]
  13. Roberts MH, Sim MR, Black O, Smith P. Occupational injury risk among ambulance officers and paramedics compared with other healthcare workers in Victoria, Australia: Analysis of workers' compensation claims from 2003 to 2012. Occupational and Environmental Medicine. 2015; 72(7):489-95. [DOI:10.1136/oemed-2014-102574] [PMID]
  14. Davison C, Cotrim TP, Gonçalves S. Perception of musculoskeletal symptoms and psychosocial risk factors among a sample of Portuguese emergency medical technicians. In: Cotrim T, Serranheira F, Sousa P, Hignett S, Albolino S, Tartaglia R, editors. Health and social care systems of the future: Demographic changes, digital age and human factors. Cham: Springer Nature; 2019. [DOI:10.1007/978-3-030-24067-7]
  15. Sahebi A, Nateghinia S, Golitaleb M, Alizadeh S, Jahangiri K. The prevalence of low back pain in emergency medical services personnel: A systematic review and meta-analysis. Nursing Practice Today. 2022; 9(3):193-201. [DOI:10.18502/npt.v9i3.10221]
  16. Azizpour Y, Delpisheh A, Montazeri Z, Sayehmiri K. Prevalence of low back pain in Iranian nurses: A systematic review and meta-analysis. BMC Nursing. 2017; 16(50):1-10. [DOI:10.1186/s12912-017-0243-1] [PMID] [PMCID]
  17. Truszczyńska A, Lewkowicz R, Truszczyński O, Wojtkowiak M. Back pain and its consequences among Polish Air Force pilots flying high performance aircraft. International Journal of Occupational Medicine and Environmental Health. 2014; 27(2):243-51. [DOI:10.2478/s13382-014-0254-z] [PMID]
  18. Zhang Q, Dong H, Zhu C, Liu G. Low back pain in emergency ambulance workers in tertiary hospitals in China and its risk factors among ambulance nurses: A cross-sectional study. BMJ Open. 2019; 9(9):e029264. [DOI:10.1136/bmjopen-2019-029264] [PMID] [PMCID]
  19. Trinkoff AM, Le R, Geiger-Brown J, Lipscomb J, Lang G. Longitudinal relationship of work hours, mandatory overtime, and on-call to musculoskeletal problems in nurses. Am American Journal of Industrial Medicine. 2006; 49(11):964-71. [DOI:10.1002/ajim.20330] [PMID]
  20. Shieh SH, Sung FC, Su CH, Tsai Y, Hsieh VC. Increased low back pain risk in nurses with high workload for patient care: A questionnaire survey. Taiwanese Journal of Obstetrics & Gynecology. 2016; 55(4):525-9. [DOI:10.1016/j.tjog.2016.06.013] [PMID]
  21. 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(4):551-61. [DOI:10.3233/WOR-172526] [PMID]
  22. Suman A, Bostick GP, Schaafsma FG, Anema JR, Gross DP. Associations between measures of socio-economic status, beliefs about back pain, and exposure to a mass media campaign to improve back beliefs. BMC Public Health. 2017; 17(1):504. [DOI:10.1186/s12889-017-4387-4] [PMID] [PMCID]
  23. Fujii T, Matsudaira K. Prevalence of low back pain and factors associated with chronic disabling back pain in Japan. European Spine Journal. 2013; 22(2):432-8. [DOI:10.1007/s00586-012-2439-0] [PMID] [PMCID]
  24. Shariat A, Alizadeh R, Moradi V, Afsharnia E, Hakakzadeh A, Ansari NN, et al. The impact of modified exercise and relaxation therapy on chronic lower back pain in office workers: A randomized clinical trial. Journal of Exercise Rehabilitation. 2019; 15(5):703-8. [DOI:10.12965/jer.1938490.245] [PMID] [PMCID]
  25. Krismer M, van Tulder M; Low Back Pain Group of the Bone and Joint Health Strategies for Europe Project. Strategies for prevention and management of musculoskeletal conditions. low back pain (non-specific). Best Practice & Research Clinical Rheumatology. 2007; 21(1):77-91. [DOI:10.1016/j.berh.2006.08.004] [PMID]
  26. Stewart Williams J, Ng N, Peltzer K, Yawson A, Biritwum R, Maximova T, et al. Risk factors and disability associated with low back pain in older adults in low- and middle-income countries. Results from the WHO Study on Global Ageing and Adult Health (SAGE). PLoS One. 2015; 10(6):e0127880. [DOI:10.1371/journal.pone.0127880] [PMID] [PMCID]
  27. Alexopoulos EC, Burdorf A, Kalokerinou A. A comparative analysis on musculoskeletal disorders between Greek and Dutch nursing personnel. International Archives of Occupational and Environmental Health. 2006; 79(1):82-8. [DOI:10.1007/s00420-005-0033-z] [PMID]

 
Type of Study: Research | Subject: Special
Received: 2022/08/24 | Accepted: 2023/02/14 | Published: 2023/07/24
* Corresponding Author Address: Faculty of Nursing and Midwifery
Add your comments about this article : Your username or Email:
CAPTCHA
Send email to the article author

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Designed & Developed by : Yektaweb