The South Asian Journal of Medicine
Research Article PREVALENCE OF LOW BACK PAIN AMONG DPT STUDENTS IN PESHAWAR Aatik Arsh, D.P.T, M.S.P.T¹, Abid Jan, M.P.H, M.Phil²
¹Institute of Physical Medicine & Rehabilitation, Khyber Medical University Peshawar, Pakistan ²Institute of Basic Medical Sciences, Khyber Medical University Peshawar, Pakistan. Volume: 1-Issue: 2
ESTABLISHED IN: 2015
ABSTRACT Introduction: Most physiotherapists suffer from some type of Low back pain (LBP) during their career1. Students
Contact: Dr. Aatik arsh
of Physical therapy are exposed to same risk factors for developing LBP as qualified physical therapy clinicians are, such as working in faulty positions for long hours, frequent manual handling activities
Email:
among Doctor of Physical Therapy (DPT) students in Peshawar.
[email protected], Phone: +92-344-6997046
Methodology:
SAJMED.2016; 1(2).
A cross sectional prevalence study was carried out using previously validated questionnaire.
Copyright © 2016 South Asian Journal of Medicine.
and performing repetitive movements. The aim of this study was to determine the prevalence of LBP
Questionnaire was distributed among DPT students in Peshawar using Google doc system/email services and self-approach. The questionnaire which was provided to subjects, consist of two parts. 1st part was related to the subject study habits, study hours, posture, clinical duties and clinical practice. 2nd part was related to the pain, in which questions were asked about pain from which the subject suffers.
Results: About 220 questionnaires were distributed among DPT students studying in Peshawar and 158 questionnaires were returned. The response rate was 71.81 %. Out of the total 158 respondents, 147 were considered valid. Among these 147 physical therapy students 51.7% were males while 48.3% were females. Out of the total 147 students, 17.7% (n=26) were of 1st year,16.3%(n= 24) of 2nd year,22.4%(n= 33) of 3rd year, 21.8%(n=32) of 4th year and 21.8%(n= 32) of 5th year (final year). Lifetime prevalence of LBP among DPT students was 48.3% (n=71). 12 month, 1 month and 1 week prevalence reported by these71 students were 81.60%, 57.74%, 39.43% respectively. Only 23.07% (n=6) students of 1st year report LBP while 71.87% student of final year report LBP. Increased LBP prevalence among 3rd year, 4th year and final year students was noticed as compared to 1st and 2nd year student. Students who use Laptops or computer more than 5 hours in a day report increased prevalence of LBP. Students involved in Academic activities (lectures and private study) of more than 50 hours in a month report high prevalence of LBP. Those students who were involved in clinical practice and treating patients more than 30 hours in one month had increased prevalence of LBP as compared to other students.
Conclusion: Clinical practice, long study hours, increase use of computers and laptops are major contributing factors for development of LBP in DPT student.
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The South Asian Journal of Medicine for more than 20 hours per week, predispose
INTRODUCTION
physiotherapy students to LBP. In Students
L
BP is common complaint among
with age 20 and 21 year, LBP was more
Doctors, nurses, physical therapists
common (9). kimelman et al, report in their
and other hospital employees(1). 12-
study that 83% physical therapy students in
month prevalence of LBP among health care
Israel suffer from some type of
workers is about 60% while in other professions
complaints in the last 1-year. According to
it is closer to 45% (2). Due to work nature,
kimelman, 1-year prevalence of LBP among
Physical therapists have high prevalence of
them was 49% (1). Asdrubal Falavigna et al,
LBP as compared to other health care workers
reports in their study that physiotherapy
(3). Most physiotherapists suffer from some
students in Brazil were 2.51 times more likely
type of LBP during their career (1). Though in
to suffer from LBP as compared to other
LBP treatment, physical therapist are directly
medical students. Life time prevalence of LBP
involved yet studies done in UK, USA, Canada,
in Brazilian physical therapy students was 82%,
Australia, Pakistan and many other countries
while 12-month and point prevalence were 73%
reports high prevalence of LBP among Physical
and 19% respectively. 17.7% students of
therapists(4). LBP prevalence among physical
physical therapy report that they never suffer
therapists ranged from 29% to 80% (5). LBP
from LBP. The same study shows that Life time
prevalence among physiotherapists ranged
prevalence of LBP in Brazilian medical
from 45% to 62% in US(3), from 58% to 68%
students was 73% while 12-month and point
in UK(5) while LBP prevalence in Canada was
prevalence were 59% and 9% respectively.
49%(6), in Australia 35%(7), in Pakistan
They also concluded that those students who
72.9%(4).
studied
Approximately 60% newly graduated physical therapists with age less than 30 years, experience some type of back pain in first five years of job after completion of their graduation
5
or
more
semesters
MSK
of
their
undergraduate course, had 2.55 times more chance to suffer from LBP because those students were more involved in practical activities (8).
(8). Many studies showed that prevalence of
According to Karachi et al, 60% physical
LBP among young physical therapists is higher
therapy students suffer from some type of LBP
as compared to general population (9).
after
In
1-year
of
clinical
activities.
Australian physical therapy students, Life time
Approximately 32% after 1-week and 43% after
prevalence of LBP was about 69%, 1-week
1 month of clinical duties report LBP11.
prevalence of LBP was 28 percent, 1-month
According to Salmina Magdalena Burger, life
prevalence was 44% and 1-year prevalence was
time prevalence of LBP among physiotherapy
approximately 63%. LBP prevalence among
students at Witwatersrand University South
final year (4th year) students was 81.7%, 3rd
Africa was 35.6%. According to her study,
year student was 67.6%, 2nd year student was
there were important relations between LBP
72.4% and 1st year student was 57.5%, which
and hours of practical work while hours spent
shows that LBP is more common among final
in theoretical learning did not play important
year students. Sitting in bad posture for long
role in developing LBP in physiotherapy
hours in class for lectures and clinical practice 30
The South Asian Journal of Medicine student. About 24.6% students with LBP, suffer
LBP among Doctor of Physical Therapy (DPT)
from pain at least one time in a week (11).
students
Students of Physical therapy, are exposed to
understanding prevalence and risk factors of
same risk factors for developing LBP as
LBP among DPT students, preventive schemes
qualified physical therapy clinicians are, such
can be developed to reduce LBP prevalence
as working in faulty positions for long hours,
among students in future.
frequent
manual
performing
handling
repetitive
activities
movements
and
Peshawar.
Moreover,
by
MATERIALS AND METHODS
(12).
Activities during practical training such as Soft tissue mobilization, techniques of manual therapy, transfer of patients who are dependent and lifting and transfer of heavy equipment etc. increases the chances of LBP during their student life (13). Educational activities such as attending regular classes, sitting in awkward positions for long hours in class for lectures, and “sitting looking down” while studying ( private study),
in
also prone physical therapy
A cross sectional prevalence study was carried out using previously validated questionnaire. Questionnaire was taken from the study carried out by Nyland and Grimmer. The questionnaire which was provided to subjects, consist of two parts. 1st part was related to the subject study habits, study hours, posture, clinical duties and clinical practice. 2nd part was related to the pain, in which questions were asked about pain from which the subject suffers.
students to LBP (9). Studies report that
The participants in research were Students of
combination of factors such as long study
DPT who were studying in any public or private
hours,
consuming
institute of Peshawar. Consecutive sampling
curriculum, practical work (14), clinical
was used for this research study. After
practice in hospitals, Use of computers and
obtaining ethical clearance from ethical board,
laptops for long hours (15) and sedentary life
permission was taken from director/principal
style predispose students to MSK injuries in
IPMR KMU and from principals of respective
their low back area (16). Among physical
institutes. Data was collected from DPT
therapy students, there is significant increase in
students, who fulfill the eligibility criteria for
prevalence of LBP from 1st year to final year
the study. The self-administered questionnaire
(4th year). Studies show that “the length of
was distributed among eligible subjects using
study years” was prominent risk factor for
following ways:
LBP9. Physical therapy students need to take
Hard copy of questionnaire was provided to
strict
subjects directly by hands. Soft copy of
intensive
prophylactic
and
time
measures
to
prevent
themselves from developing LBP.
questionnaire was provided to subjects using
Doctor of physical therapy students are more
email services, Facebook, twitter etc.
vulnerable to LBP because during clinical work
To each eligible participant, study was
and study, most of the time they are in flexed
explained in detail. From each subject,
posture. In Pakistan, research data on LBP
informed consent was taken prior to the study.
prevalence among medical and nursing students is available but researches on LBP prevalence among DPT students are not available. The aim of this study was to determine the prevalence of
RESULTS About 220 questionnaires were distributed among DPT students studying in Peshawar and 31
The South Asian Journal of Medicine 158 questionnaires were returned.
The
year, 21.8%(n=32) of 4th year and 21.8%(n=
response rate was 71.81 %. Out of the total 158
32) final year (Figure 1).
respondents,
valid
Results of the current study showed that the
whereas remaining 11 were considered non
lifetime prevalence of LBP among DPT
valid. These 11 were those participants who
students was 48.3%. Out of the total 147
failed to attempt whole questionnaire of the
students 71 reports that they suffer from some
study or who didn’t fulfill eligibility criteria.
kind of LBP. A tendency towards increasing
Among these 147 physical therapy students
LBP prevalence was identified from 1st year to
51.7% were males while 48.3% were females.
final year. Only 23.07% (n=6) students of 1st
34.7%% of respondents were having age from
year report LBP while 71.87% student of final
17 and 20 years and 63.3% were having age
year report LBP. Increased LBP prevalence
from 21 to 25 years. Out of the total 147
among 3rd year, 4th year and final year students
students, 17.7% (n=26) were of 1st year, 16.3
was noticed as compared to 1st and 2nd year
%(n= 24) of 2nd year, 22.4%(n= 33) of 3rd
student.
147
were
considered
Table 1: Table showing association of LBP with year level. Students who use Laptops or computer more
in a day report LBP. Only 20% (n=5) physical
frequently report increased prevalence of
therapy students who use Laptops or computer
LBP.62.85 %( n=22) physical therapy students
less than 1 hour report LBP.
who use Laptops or computer more than 5 hours
Table 2: Table showing association of LBP with attending class lectures
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DISCUSSION
Grimmer was 69%. In the study of Nyland and
The response rate to the current study was 71.81
Grimmer 1-week prevalence of LBP was 28
%. The response rate to the study carried out by
percent, 1-month prevalence was 44% and 1-
Salmina Magdalena Burger was 93.3% and
year prevalence was approximately 63%.
response rate to the study of Nyland and
Nayland and Grimmer mostly included 3rd year
Grimmer was 72%. In the study carried out by
and 4th year students in their study that’s why
Salmina
prevalence was high as compared to current
Magdalena
Burger
students
of
physiotherapy filled questionnaires in the
study.
presence of researcher while in the current
In the current study, tendency towards
study most
were
increasing LBP prevalence was identified from
distributed using Email services. This can be a
1st year to final year. Only 23.07% (n=6)
possible reason for low response rate in the
students of 1st year report LBP while 71.87%
current study. Response rate to the current study
student of final year report LBP. Increased LBP
was consistent to that of the study carried out
prevalence among 3rd year, 4th year and final
by Nyland and Grimmer. Results of current
year students was noticed as compared to 1st
study showed that lifetime prevalence of LBP
and 2nd year student. these results were
among DPT students was 48.3% and 12 month
consistent with the results reported by other
prevalence was 81.60%, 1 month prevalence
studies. Nayland and Grimmer reported that
was 57.74% and 1 week prevalence was
LBP prevalence among final year( 4th year)
39.43%.
students was 81.7%, 3rd year student was
Lifetime prevalence of LBP among physical
67.6%, 2nd year student was 72.4% and 1st
therapy students in the study carried out by
year student was 57.5%, which shows that LBP
Salmina Magdalena Burger was 35.6% and
is more common among final year students.
of the
questionnaires
prevalence of LBP in the study of Nyland and 81.60%
60.56%
57.74%
42.25%
39.43%
Yes No
18.30%
12 month prevalance
1month prevalance
1 week prevalance
Figure 1: 12 month, 1 month and 1 week LBP prevalence Results
of
current
study
showed
that
educational activities which include attending
lectures and private study were also associated with the development of LBP in physica
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The South Asian Journal of Medicine therapy students. Those students who regularly
current research study reported that long hours
attend class lectures and “sitting looking
of clinical practice and clinical duties during
straight” more than 50 hours in one month had
student life, long study hours and increase use
increased prevalence of LBP as compared to
of computers and laptops were some of the
other students. Those students who did their
contributing factors for the LBP.
private study more than 50 hours in one month had increased prevalence of LBP as compared to other students. Time spent during clinical Placement which includes clinical practice and treating patients was also associated with increased prevalence of LBP. Those students who were involved in clinical practice more than 30 hours in one month had increased prevalence of LBP as compared to other students. According to Nyland and Grimmer, sitting in bad posture for long hours in class for lectures and clinical practice for more than 20 hours per week, predispose physiotherapy students to LBP. While other research studies reported that differences in age, gender and BMI etc. were the main reasons for LBP (Bakker et al, 2009; Karachi et al, 2007; Nyland
CONCLUSION LBP was reported commonly by considerable number of DPT students. Increased risk of LBP was present among 3rd year, 4th year and final year students as compared to 1st and 2nd year student. Academic activities (attending lectures and private study), use of laptop and computers for long hours, and clinical practice during student life were major contributing factors for the development of LBP among physical therapy students. Physical therapy students must be sufficiently trained and make them conscious about LBP, with the intention that these students come into the workforce with reduced risk of LBP. Physical therapy students need to take strict prophylactic measures to prevent themselves from developing LBP.
and Grimmer, 2003; Kirstensen et al, 2001),
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