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Iran J Public Health, Vol. 45, Suppl. Issue No. 1, Feb 2016, pp.85-92 Original Article
85 Available at: http://ijph.tums.ac.ir
Work Task and Job Satisfaction Predicting Low Back Pain
among Secondary School Teachers in Putrajaya
Nur Farahwahida MOHD ANUAR
1, *Irniza RASDI
1, Suhainizam M. SALILUDDIN
2,
Emilia ZAINAL ABIDIN
2
1. Dept. of Environmental and Occupational Health, Universiti Putra Malaysia, Selangor, Malaysia
2. Dept. of Community Health, Universiti Putra Malaysia, Selangor, Malaysia
*Corresponding Author: Email: irniza@upm.edu.my
(Received 20 Nov 2015; accepted 16 Jan 2016)
Introduction
Musculoskeletal Disorders (MSDs) is a global issue
and is considered as one of the most common and
expensive occupational health problem (1). MSDs
can be divided into eight body parts, which are one
or both thighs, one or both hands, one or both
legs, shoulder, elbow, neck, upper back pain and
LBP. Almost half of the adult population suffers
from low back pain, which lasts for more than two
days in a year (2). Those who have low back pain
were observed to develop other psychological, so-
cial and physical health problems (3). MSDs
among workers increase financial loss due to work
absences, medical treatment, early retirement and
poor work performances (4-6).
School teachers have been indicated in previous
studies to report high prevalence of MSDs (7).
This prevalence ranges between 39% and 95% (8).
MSDs is also reported as one of the main causes of
poor health among retired school teachers (4).
Some researchers believed that several work fac-
tors were significant in predicting musculoskeletal
disorders among school teachers such as lifting of
heavy load, prolonged sitting, improper posture,
walking up and down stairs, writing on board and
Abstract
Background: : This study aimed to quantify the prevalence of low back pain (LBP), analyze its associated risk factors
and explore on how LBP affects job satisfaction among 120 school teachers in Malaysia.
Method: A cross-sectional study was conducted among randomly selected teachers from four secondary schools in
Putrajaya from February to March 2015. The level of LBP was assessed using a standardized Nordic Questionnaire,
while Teachers’ Satisfaction Scale was used to determine teacher satisfaction level. The response rate for this study was
100% (120/120).
Results: The prevalence of LBP among respondents was 72.9%. Gender (P=0.016), prolonged sitting (0.015), walking
up and down stairs (0.012), and lifting loads with hands (0.030) were significantly associated with LBP among respon-
dents after controlling for other factors including age, marital status and other work tasks. The strongest predictor of
LBP among teachers was walking up and down stairs (OR = 9.45) indicating that respondents who reported having to
walk up and down stairs frequently were 9 times more likely to have low back pain compared to those who did not.
Conclusion: Prioritization of prevention and control measures should focus more on promoting healthier ergonomic
movement among teachers rather than providing knowledge and awareness on low back pain and job satisfaction level
among teachers.
Keywords: Low back pain, Secondary school teachers, Putrajaya, Occupational health
Mohd Anuar et al.: Work Task and Job Satisfaction Predicting Low Back Pain …
Available at: http://ijph.tums.ac.ir 86
prolonged computer use (9-11). Other significant
factors were gender, age, psychological framework
of teachers including anxiety and low job satisfac-
tion as well as psychosocial work factors such as
lack of social support and high psychologically
work demand (9-13).
Teachers form the majority of the government
workforce in Malaysia, thus their health and per-
formance are vital for the overall productivity of
the Malaysian government education service.
Good teachers’ performance encourages the pro-
duction of good students as well as increases the
education standard among Malaysian schoolchild-
ren. Although many studies have dealt with
MSDs among occupational groups in other coun-
tries, data on the exact nature and prevalence of
this important health problem is limited in Malay-
sia especially among teachers. A previous study on
low back pain was conducted only among primary
school teachers (9). Identifying the potential causes
of MSDs among school teachers is therefore im-
portant to assist in improving productivity among
teachers. Knowledge on the prevalence of LBP
and associated risk factors are important basic in-
formation that can provide practical guidance for
minimizing teachers’ exposure and in preventing
LBP among them.
This study aims to determine the prevalence of
LBP among secondary school teachers in Putrajaya
and its potential factors; a) socio-demographic fac-
tors b) teachers’ work factors c) teachers’ satisfac-
tion d) knowledge and awareness on LBP. Find-
ings of this study may help in identifying the main
factors for MSDs among school teachers which
may enhance the current preventive measures, if
available, to be more efficient and cost effective.
Prevention strategies against LBP can only be suc-
cessful if its contributory and associated risk fac-
tors are identified and better understood.
Methods
Study Location and Study Population
The selected locations were secondary schools in
Wilayah Persekutuan, Putrajaya. In Putrajaya from
February to March 2015, there were 11 secondary
schools of which two were boarding and religious
schools (14). Four schools in Putrajaya were se-
lected randomly from a list obtained from the Min-
istry of Education’s website. Thirty teachers were
selected randomly from the teachers’ name list ob-
tained for each selected school. One hundred and
twenty secondary school teachers participated in
this study with the inclusion criteria of full
time/permanent posts and minimum of one-year
teaching experience. This study location was cho-
sen because of the school facilities available, prox-
imity to town and their location in an urban area.
Urban schools normally have large number of pu-
pils. As a result, there is an increase in job demand
with extra responsibility and additional workload
among the teachers. The study population was sec-
ondary school teachers who have suffered and
who have not suffered LBP throughout their job
career from four secondary schools in Putrajaya.
Study Instrument and Data Collection Proce-
dure
A combination of self-adapted and modified stan-
dardized questionnaires was used for the research.
Two versions of the questionnaires in English and
Bahasa Malaysia were used. The questionnaires
consist of five parts with 39 questions. The ques-
tionnaires were collected after one week from the
date of the questionnaires given to the respond-
ents.
Part one of the questionnaire was on the respond-
ent’s demographic factors, which include age, gen-
der, marital status, height and weight to calculate
body mass index (BMI) of the respondents. Part
two of the questionnaire assesses teachers’ work
factors, which were based on the findings from
previous studies covering lifting loads, prolonged
standing and sitting, walking up and down stairs,
writing on white/black boards, and association
with the occurrence of low back pain (LBP) (9).
Direct observation of the teachers in school was
also made as a basis for identifying their work fac-
tors in LBPs. The Dutch Musculoskeletal Ques-
tionnaire (DMQ) was used for additional items
(15). Work tasks of teachers were measured using a
dichotomous scale (No/Yes) during an average
working day. Work was categorized into tasks in-
cluding lifting loads with hand, prolonged standing
Iran J Public Health, Vol. 45, Suppl. Issue No. 1, Feb 2016, pp.85-92
87 Available at: http://ijph.tums.ac.ir
(≤ 2 hours per day), sitting (≥ 4 hours per day),
walking up and down stairs and writing on boards.
Additional related questions, such as types of loads
they carry, reasons for prolonged standing and sit-
ting, frequency of walking up/ down stairs and
writing on boards were also asked. Teacher’s expe-
rience and job responsibility as were also assessed.
Questions on musculoskeletal pain were con-
structed according to a modified Nordic question-
naire in part three of the questionnaire (16). Nor-
dic is a group that developed standardized ques-
tionnaires for the analysis of musculoskeletal
symptoms. Standardized Nordic Questionnaire
consists of 2 types of questionnaires which are the
General Questionnaire and Specific Questionnaire.
The General Questionnaire consists of a diagram
in which the human body (viewed from the back)
is divided into nine anatomical regions, while the
Specific Questionnaire concentrates on anatomical
areas in which the muscular-skeletal symptoms are
most common (low back, neck and shoulder
symptoms).The main advantage in using these
questionnaires is that they analyze the severity of
the symptoms, their effect on activities at work
and during leisure time, total duration of symp-
toms and sick-leave during the preceding 12
months. In this study, the Specific Questionnaire
(Low Back Pain symptoms) was used and was ac-
companied by analytical diagrams depicting the
specific sites. Part four of the questionnaire as-
sesses the respondents’ knowledge on LBP as one
of the occupational hazards, as well as the sources
of information (fellow friends, seminar/trainings
and magazine/newspapers or articles). Other re-
lated questions asked were knowledge on LBP care
such as seeking treatment from specialist.
In the last part of the questionnaire, standardized
Teachers’ Satisfaction Scale (TSS) was used for the
assessment of the teachers’ overall satisfaction with
their profession (17). The section consists of five
items asking the teacher how he/she feels about
her/his level of job satisfaction in various ways by
changing the wordings to fit the teaching profes-
sion (18). For example, an item of the LSS is “In
most ways my life is close to my ideal. This item is
modified to “In most ways, being a teacher is close
to my ideal. For each item, the teachers respond
on a 5-point scale with the endpoints 1 = strongly
disagree to 5 = strongly agree. This questionnaire
was validated and translated previously to Malay
Language (17).
Quality Control and Data Analysis
Pre- testing of the questionnaire was conducted
on a group of respondents from other secondary
schools who are similar in characteristics to the re-
search population to observe their ability in under-
standing and answering the questionnaire. A relia-
bility test was performed using Statistical Package
for Social Sciences (SPSS) and the calculated
Cronbach alpha value was 0.75, which was consid-
ered acceptable for reliability testing (19). The data
analysis was done by using SPSS Version 21.0.
Chi-square test and correlation test were used in
the statistical analysis.
Ethical Consideration
The Ethical Committee for Research involving
Human Subjects of Universiti Putra Malaysia ap-
proved this study. The respondents were given
consent letters and a document describing the pro-
cedure of the study and its objectives. All the in-
formation and identity of respondents in this study
are kept confidential.
Results
The response rate for this study was 100%. Out of
120 sampled, 120 questionnaires and signed con-
sent forms were returned to the researcher. In
terms of socio demographic distribution, Table 1
shows that 8 (6.7%) were aged between 19-29
years old, 33 (27.5%) were aged between 30-39
years old, 49 (40.8%) were aged between 40-49
years old, and 30 (25.0%) were aged 50 years old
and above. Most of the respondents were females
(n = 108 (90%)) among them, 10 (8.30%) were
single, 110 (91.70%) were married. The Body Mass
Index (BMI) of most of the respondents was in the
obese category (n = 40 (33.83%)) which was more
than 28.0 kg/m2, followed by overweight (n = 38
(31.7%)) and normal (n = 42 (35.0%)). In sum-
mary, most of the respondents were aged between
40-49 years old, females, married and have normal
BMI.
Mohd Anuar et al.: Work Task and Job Satisfaction Predicting Low Back Pain …
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Table 1: Socio-demographic characteristics of respondents (n = 120)
Socio-Demographic Characteristics
Frequency (n)
Percentage
(%)
Mean ( SD)
Age
19-29 years old
8
6.7
42.32 ± 7.95
30-39 years old
33
27.5
40-49 years old
49
40.8
50 years old and above
30
25.0
Gender
Male
12
10.0
Female
108
90.0
Marital Status
Single
10
8.30
Married
110
91.7
Body Mass Index
(kg/m2) {(BMI)
Normal (≤ 23.9)
42
35.0
26.18 ± 5.42
Overweight (24.0 -27.9)
38
31.7
Obesity ( ≥ 28.0)
40
33.3
Prevalence of low back pain
Majority of the respondents (79.2%) experienced
low back pain or discomfort throughout their ca-
reer. Also 68 (56.7%) of the respondents suffered
from low back pain in the past 12 months. From
120 respondents, 42 (35.0%) of them suffered
from low back pain in the past 7 days. The num-
ber of respondents who suffered from low back
pain on the day of the study was 26 (21.7%), while
94 (78.3%) of respondents did not have such
problem.
Consequences of low back pain
The effects of having low back pain in the past
twelve months was asked in the questionnaire.
Out of 120 respondents, 6 (5.0%) of the respon-
dents have been admitted to hospital because of
their low back pain problems. However, only 1
person (0.8%) had to change jobs or duties due to
the problem. In the previous twelve months, 56
(46.7%) of the respondents reduced their daily ac-
tivities at home or away from home because of
the problems they face due to LBP. Twenty-eight
respondents (23.3%) took medicine to solve and
relieve their low back pain problem. Approximate-
ly 19 (15.8%) of respondents took medical leave
to rest due to low back pain.
Related Work Tasks among Respondents
Fourty-four percent of the respondents have
been teaching for less than 15 years, while 55.8%
have been teaching for more than 15 years. Most
of the respondents are subject coordinators
(92.5%), while 50.8% were classroom teachers,
and 45.0% of the respondents were both class-
room teacher and subject coordinator. With refer-
ence to teachers’ work tasks, 70.0% from 120
respondents stated that they lift loads with their
hands during work, 37.5% of them claimed to sit-
ting more than 4 hours per day, and 92.5% of res-
pondents stated that they stand for more than 2
hours per day during work. They sit for long dura-
tion to mark exam papers, students’ exercise and
complete their teaching plan. Prolonged standing
is involved while writing on white and black
board, monitoring students’ work and perfor-
mance at their desks and in teaching activities.
Around 93% of respondents claimed that they
have to walk up and down stairs at their
workplace 2 to 5 times per day and 95.0% of the
respondents reported that they always write on
white/ black board 2 to 5 times per day.
Knowledge and Awareness on Low Back Pain
Findings of this study indicated that 44 (36.7%)
of the respondents did not received any informa-
tion that LBP is one of the occupational hazards.
Hence, 108 (90.0%) respondents suggest that in-
Iran J Public Health, Vol. 45, Suppl. Issue No. 1, Feb 2016, pp.85-92
89 Available at: http://ijph.tums.ac.ir
formation about LBP as one of occupational ha-
zards should be disseminated among teachers.
Among them, 48 (40.0%) would like the informa-
tion on LBP to be made available in the mass me-
dia like television or radio. Thirty-six (30.0%) res-
pondents want the information to be disseminated
in seminars or extra training conducted for teach-
ers. While, 23 (19.2%) want it in the form of bro-
chures or pamphlet. However, only 33 (27.5%) of
them have received information about proper
LBP care and 106 (88.3%) of respondents think
that information about LBP care should be distri-
buted among school teachers. 38 (31.7%) of the
respondents want the information about proper
LBP to be taught in the form of seminars for
teachers, 37 (30.8%) in the media such as televi-
sion and radio, and 36 (30.0) of the respondents
want the information distributed in the form of
pamphlets.
Teacher Satisfaction Level
The mean score of the teachers’ satisfaction scale
(TSS) among the respondents is 22.13 with a
standard deviation of 2.5. Maximum and mini-
mum values of teacher satisfaction scale were 25
and 13. The scale consists of five items asking the
teachers how he/she feels about job satisfaction
in various ways. Results of this study indicate that
most of those respondents achieved high maxi-
mum score of teachers’ satisfaction with the range
from 22 to 25, thus indicating that they were high-
ly satisfied with their profession.
Bivariate Relationship between Independent
Variables and Low Back Pain (LBP) among
Secondary School Teachers in Putrajaya
Bivariate analyses were conducted between all in-
dependent variables and low back pain. Results on
significant relationships are shown in Table 2.
Findings indicated that the socio-demographic
variables on marital status and gender were signifi-
cantly associated with low back pain among re-
spondents. Four work tasks; namely lifting loads
with hands, prolonged sitting, prolonged standing
and walking up and down stairs were found to be
significantly associated with low back pain (χ2 =
4.87 to 9.02)
Table 2: Bivariate analyses between dependent variables and low-back pain among respondents
(N = *P-value <0.05)
Variables
Yes
No
χ2
P
- value
OR (95% CI)
n (%)
n (%)
Marital Status
Single
7 (70.0)
3 (30.0)
0.556
0.456*
1.714 (0.410-7.170)
Married
88 (80.0)
22 (20.0)
Gender
Male
6 (50.0)
6 (50.0)
6.877
0.009*
4.684 (1.362-16.110)
Female
89 (82.4)
19 (17.6)
Lifting loads with Hands
Yes
71 (84.5)
13 (15.5)
4.872
0.027*
2.731 (1.098-6.790)
No
24 (66.7)
12 (33.3)
Prolonged Sitting (> 4
hours)
Yes
42 (93.3)
0 (6.7)
8.761
0.003*
5.811 (1.628-20.743)
No
53 (70.7)
22 (29.3)
Prolonged Standing (>2
hours)
Yes
91 (82.0)
20 (18.0)
7.112
0.008*
5.688 (1.401-23.088)
No
4(44.4)
5(55.6)
Walking up and down stairs
Yes
92 (82.1)
20 (17.9)
9.023
0.003*
7.667 (1.692-34.734)
No
3 (37.5)
5 (62.5)
Mohd Anuar et al.: Work Task and Job Satisfaction Predicting Low Back Pain …
Available at: http://ijph.tums.ac.ir 90
Multivariate Analysis between Independent
Variables and Low Back Pain among Re-
spondents
Direct logistic regression was performed to assess
the impact of selected independent variables on
low back pain among respondents. The model
contains seven independent variables; age, gender,
marital status and the four types of teaching work
tasks (lifting loads with hands, prolonged sitting,
prolonged standing and walking up and down
stairs). The full model containing all predictors
were statistically significant, χ2 (7, N = 120) =
30.07, P < 0.001, indicating that the model was
able to distinguish between respondents who have
and did not have low back pain. The model as a
whole explained 22.2 – 34.6% of the variance in
low back pain and correctly classified 95.8% of
cases. Findings indicate that the significant predic-
tors of low back pain were gender, prolonged sit-
ting, walking up and down stairs and lofting loads
with hand. The strongest predictor for low back
pain was walking up and down stairs (OR = 9.45)
indicating that respondents who reported having
to walk-up and down stairs frequently were 9
times more likely to have low back pain compared
to those who did not have to, controlling for all
other factors in the model. See Table 3.
Table 3: Logistic Regression predicting low back pain among respondents (N = 120)
B
S.E.
Wald
df
P
Odds
Ratio
95% C.I. for
EXP(B)
Lower
Upper
Age (yr)
-0.045
0.038
1.385
1
0.239
0.956
0.887
1.030
Marital status
1.090
0.911
1.432
1
0.231
2.974
0.499
17.722
Gender
1.805
0.750
5.799
1
0.016*
6.080
1.399
26.419
Prolonged Sitting (> 4 hours)
1.737
0.712
5.950
1
0.015*
5.679
1.407
22.925
Prolonged Standing (> 2 hours)
0.794
0.897
0.784
1
0.376
2.213
0.381
12.840
Walking Up and Down Stairs
2.247
0.899
6.249
1
0.012*
9.459
1.625
55.072
Lifting Loads With Hand
1.231
0.566
4.728
1
0.030*
3.424
1.129
10.386
Constant
-3.237
1.922
2.837
1
0.092
0.039
*P < 0.05
Discussion
The first aim of this study was to determine the
prevalence of low back pain among secondary
school teachers in Putrajaya. The prevalence of
low back pain in this study was 79.2%. The preva-
lence of self-reported LBP among teachers found
in countries such as Saudi Arabia, Hong Kong and
Brazil ranged between 39% and 95% (1). Based
on the findings in this study, it was found that the
prevalence of low back pain among secondary
school teachers in Putrajaya could be considered
as particularly high. This study also showed a
higher prevalence of low-back pain compared to
the study conducted in Ethiopia (53.8) (20), Bots-
wana (55.7%) (1) and China (45.6%) (8). One of
the possible reasons causing the difference in the
prevalence could be the facility provided for the
teachers at their institution or social and economic
differences between Malaysia and the countries
mentioned, the way in which work was organized
may contribute to the differences observed in
comparison to this study.
Findings of this study showed that four independ-
ent variables were significantly associated with the
prevalence of low back pain among respondents,
which were gender, prolonged sitting, walking up
and down stairs, and lifting loads with hands. Data
from the Ministry of Education stated that female
teachers constitute the majority of school teachers
in Malaysia (69.1%) and their participation in this
study (90.0%) is in agreement with the provided
statistics (9). In this study, female teachers showed
a significantly higher prevalence of low back pain
(82.4%) than men (50.0%). Female teachers were
four times more likely to experience low back pain
Iran J Public Health, Vol. 45, Suppl. Issue No. 1, Feb 2016, pp.85-92
91 Available at: http://ijph.tums.ac.ir
(OR 95% CI = 4.684 (1.362-16.110). A study on
low back pain among secondary school teachers in
Klang Valley, Malaysia also showed similar result
(48.1%) of a higher prevalence among women (9)
Work activities, which involve heavy lifting, pro-
longed sitting, and prolonged standing, contribute
to the development of musculoskeletal disorders
(21, 22). Activities of sustained sitting of frequent
reading, marking assignment, and standing up
teaching in class are unsafe acts and favour the de-
velopment of neck/shoulder pain, low back pain
and upper limb pain found in teachers (9, 5, 21).
Studies have also confirmed that sitting for more
than 3 hours daily could be a risk factor for low
back pain (23-25).
Conclusion
The prevalence of LBP among respondents was
considered high and a few factors such as gender,
prolonged sitting, walking up and down stairs and
lifting loads with hands were identified as the sig-
nificant factors predicting low back pain among
respondents. Other independent variables includ-
ing job satisfaction, and knowledge and awareness
about low back pain were not found to be signifi-
cant. Therefore, findings of this study suggest that
prioritization of prevention and control measures
should focus more on promoting healthier ergo-
nomic movement among teachers. Currently, pro-
cedures and guidelines on good ergonomic move-
ments for industrial workers involved with manual
handlings are readily available but not for teachers.
Detailed and specific guidelines on good ergo-
nomic movement for teachers are worth develop-
ing to minimize the prevalence and effects of low
back pain among them. Future intervention stu-
dies on how to reduce back pain among teachers
is therefore warranted. Future studies investigating
the prevalence of low back pain among teachers
need to consider a larger sample of randomly se-
lect subjects to increase the power of the study. In
addition, inclusion of more instrumental measure-
ments will provide a more convincing result to
strengthen further the argument that low back
pain is of great concern among the teaching popu-
lation.
Ethical considerations
Ethical issues (Including plagiarism, informed
consent, misconduct, data fabrication and/or fal-
sification, double publication and/or submission,
redundancy, etc.) have been completely observed
by the authors.
Acknowledgements
The authors declare that there is no conflict of in-
terests.
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