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© 2016 Indian Journal of Pain | Published by Wolters Kluwer - Medknow 111
Prevalence of low back pain and its relation
to quality of life and disability among women
in rural area of Puducherry, India
Introduction
A woman is the nucleus of the family, especially in
rural India. The daily work schedule of rural women
is very arduous and demanding in nature. In addition
to household and agriculture works, the other time
spends as energy‑demanding activity for rural women
is care of livestock, which is not only strenuous, but
also repetitive and makes them overburdened as well as
leading them a continuous health risk.[1] The nonneutral
posture of the trunk frequently adopted by women is
risk for developing a low back pain.[2] Lack of facilities
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DOI:
10.4103/0970-5333.186467
ABSTRACT
Background:Thelevelofqualityoflife(QOL)anddisabilityamongwomenwithlowbackpainisanimportanthealthissueatglobal
level.Objective:TondouttheprevalenceoflowbackpainandtoassesstherelationshipoflowbackpainwithdisabilityandQOL
among women. Materials and Methods:Acommunity‑basedcross‑sectionalstudywasconductedamong250womeninagegroupof
30‑65years residingineldpracticeareaofaTertiaryCareMedical Institution,Puducherry.Severityofthepainwasassessed using
NumericalPainScale.ModiedOswestryLowBackPainDisabilityQuestionnairewasusedtomeasurethedisabilitylevelandWHO‑
BREFscaletoassesstheQOLamongwomenwithlowbackpain.Results:Overall,theprevalenceoflowbackpainwasfoundtobe
42%.Themajorityofwomen(60.9%)withlowbackpainexperiencedmoderatedisability.Almost72%ofwomenwithlowbackpain
perceivedtheirQOLasgoodandoverallmeanQOLscorewas88.41(standarddeviation=12.9).Thelowbackpainwasinuencedbythe
demographicvariablesthatincludeage,maritalstatus,illiteracy,totalfamilyincome,typeofdelivery,numberofchildrenandhousehold
chores,menopausalstatus,andchronicillness(P<0.05).Disabilitywasinuencedbyage,education,andoccupation,whereasQOL
wasinuencedbyeducationofthewomenwithlowbackpain(P<0.05).Conclusions:Prevalenceoflowbackpainamongwomenwas
comparativelymorethanotherstudiesinIndia.Althoughmoderatedisabilitywasmoreamongthosewithlowbackpain,overallQOL
was good.
Key words:Disability,lowbackpain,qualityoflife
Guna Sankar Ahdhi, Revathi Subramanian, Ganesh Kumar Saya1, Thiruvanthipuram Venkatesan Yamuna
Departments of Community Health Nursing and 1Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical
Education and Research, Puducherry, India
with their traditional techniques like, drawing water
from the wells, carrying heavy loads on their back may
lead to back pain.[3]
Original Article
Address for correspondence:
Dr. Ganesh Kumar S,
Department of Social and Preventive Medicine, Jawaharlal
Institute of Postgraduate Medical Education and Research,
Puducherry - 605 006, India.
E-mail: sssgan@yahoo.com
This is an open access article distributed under the terms of the
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For reprints contact: reprints@medknow.com
How to cite this article: Ahdhi GS, Subramanian R, Saya GK,
Yamuna TV. Prevalence of low back pain and its relation to quality
of life and disability among women in rural area of Puducherry, India.
Indian J Pain 2016;30:111-5.
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Ahdhi, et al.: Prevalence of low back pain
112 Indian Journal of Pain | May-August 2016 | Vol 30 | Issue 2
International surveys of low back pain reported that
1‑month prevalence was 19‑43% and point prevalence
was 15‑30%. The estimated worldwide lifetime prevalence
of low back pain varies from 50% to 84%.[4] Studies
in developed countries have shown that the low back
pain point prevalence was 6.8% in North America, 13.7%
in Denmark, 12% in Sweden, 14% in the United Kingdom,
33% in Belgium, and 28.4% in Canada. Similarly, some
studies in developing countries have revealed much higher
incidence of 72.4% in Nigeria, 64% in China, and 56.2%
in Thailand.[5] The occurrence of low back pain in India is
also alarming with nearly 60% of the people in India have
suered from low back pain at some time during their
lifespan.[6]
Low back pain also restricts mobility, interferes
with normal functioning and results in lifelong pain
and permanent disability.[7] In India, most of the
low‑income group people are engaged in physically
demanding jobs which may increase the risk of low
back pain and disability.[8] Low back pain also affects
the quality of life (QOL) of not only the women
themselves, but their families as well.[9,10] In Indian,
very few studies have been done with regard to this.
With this background, the present study aimed to
assess the prevalence of low back pain, and disability
and QOL among women with low back pain in rural
Puducherry, India.
Materials and Methods
Study design and seing
A community‑based cross‑sectional study was conducted
in a field practice area of a Tertiary Care Medical
Institution during the period from July 2013 to December
2013. The target population was the women in age group
of 30‑65 years residing in Ramanathapuram Village of
Puducherry, India.
Sample size estimation and sampling technique
Among four villages present in rural eld practice area
of the Medical Institution, Ramanathapuram Village
was selected for feasibility purpose. Considering 22.5%
prevalence of low back pain,[11] 25% relative precision,
and 10% of nonresponse error, a minimum of 250 subjects
were included in this study. The total number, name, and
address of women in age group 30‑65 years were obtained
from the Rural Health Centre records. The total number of
women in the age group of 30‑65 years in Ramanathapuram
Village was 518. Out of these, 250 women were selected by
simple random technique.
Ethical issues
Institutional ethical clearance was obtained before starting
the study. Permission from concerned authorities was
sought after explaining the objectives as well as the method
of study. Informed written permission was obtained from
the study subjects.
Method of data collection
The interview was conducted by the principle investigator
in the houses of the subjects. Initially rapport was
developed with the study subjects. The written informed
consent was obtained and the purpose of an interview
was explained to each study subject. Each participant was
interviewed condentially in Tamil language.
In the rst step, sociodemographic factors were collected
and low back pain among women was assessed in the
preceding month based on Numerical Pain Scale rating
from 0 to 10. Body height and weight of each subject was
taken by standard methods. A modied Oswestry Low
Back Pain Disability Questionnaire was used to measure
the disability level and WHO‑BREF questionnaire was used
to assess the QOL among women who reported low back
pain. The interview lasted for 30‑45 min for each study
subject. Average of 6‑8 women was interviewed each day.
Statistical analysis
All the statistical analyses were done using IBM PASW
Statistics (SPSS)‑19.0 version and was carried out at 5%
level of signicance. The data on subjects’ background
variables was expressed as frequencies and percentages.
The data on the level of disability and QOL was expressed
as a percentage and mean with standard deviation (SD).
The relationship among low back pain, disability, and QOL
was analyzed using Karl Pearson’s correlation coecient.
Association between the prevalence of low back pain,
disability and QOL between the sociodemographic factors
was assessed by analysis of variance or independent t‑test.
Results
All the 250 subjects participated in the study. Out of 250
study subjects, 35.6% (n = 89) of the women were in the age
group of 30‑40 years. Regarding education, 50% (n = 125)
of participants had education up to secondary level and
19.6% (n = 49) of them were illiterate. By occupation, 56.8%
(n = 142) were housewives. With regard to menopausal
status, 64.8% of women did not attain menopause.
Regarding body mass index (BMI), 39.2% of them were
overweight. In relation to co‑morbid conditions, only 14.1%
of them were having chronic illness.
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Ahdhi, et al.: Prevalence of low back pain
Indian Journal of Pain | May-August 2016 | Vol 30 | Issue 2 113
The 1‑month period prevalence of low back pain among
women was 42% (105). Majority of women (60%, 63/105)
had moderate pain followed by severe (23.8%, 25/105) and
mild (16.2%, 17/105) pain. Subjects with low back pain
experienced moderate disability (60.1%, 64/105) followed
by severe disability (23.8%, 25/105), minimal disability
(12.4%, 13/105), and crippled (2.8%, 3/105). About 72.4%
(76/105) of women perceived their QOL as good, 21.9%
(23/105) of them were perceived as neither poor nor good
and only 5.7% (6/105) perceived as poor.
The significant associations were found between low
back pain and demographic variables such as age, lower
education, marital status, less income, delivery type, and
number of children, durations of sweeping the house,
washing clothes and washing vessels per day, menopausal
status, and co‑morbid condition [Tables 1 and 2].
Furthermore, there was a signicant dierence between
the mean score of level of disability with age, education,
and occupation of the women (P < 0.05). A signicant
dierence was also found between mean scores of QOL
and education (P < 0.05).
The overall mean score of QOL of women with low back
pain was 88.41 (SD = 12.9) and comparable across all the
four domains. The mean scores of physical domain of
QOL were higher when compared to other domains of
QOL [Table 3]. There was a signicant positive correlation
between pain and disability and a negative correlation
between pain and QOL and also there was a signicant
negative correlation between the level of disability and
QOL [Table 4].
Discussion
There is a paucity of literature on community‑based
studies regarding the assessment of the prevalence of low
back pain among women in India. This study showed that
1‑month period prevalence of low back pain among women
was 42%, which is much higher when compared to study
ndings of Badley et al.[4] This study in United States found
that low back pain point prevalence among the general
population was 15‑30%, and pain in the last 30 days was
found between 19% and 43%. Similarly, Stranjalis et al.[12]
reported that 32% of adults had suered from low back
pain for 1‑month period in Greece. Furthermore, Sadigi,
et al.[13] revealed that among the populations under study,
28.4% of them had low back pain in the last 14 days. A
study was conducted by Mathew et al.[14] to estimate the
prevalence and correlates of low back pain among adults
aged 20 years and above in Coimbatore, Tamil Nadu
revealed that 1‑year prevalence of low back pain among
women was 52.9% with highest prevalence (50%) among
age group of 41‑50 years.
The present study ndings found that the most (60.9%)
of the women with low back pain experienced moderate
disability and 12.3% of them with minimal disability and
23.8% of them experienced severe disability, only 2.8% of
them experienced crippled. These ndings are consistent
with the study conducted by Koley S and Sandhu NS
(2009).[6]
In this study, 72% of women with low back pain had
perceived the QOL as good and 21% of them perceived
as neither poor nor good. 5.7% of them perceived the
QOL as very good and none of them perceived as poor
or very poor. A study conducted by Sultana (2012)[15] in
Bangladesh to explore the QOL among 70 low back pain
patients aged 18‑70 years reported that, 17.6% participants
had no problem in their QOL and 82.4% participants had
a problem in their QOL.
Table 1: Association of low back pain with sociodemographic
factors among women (
n
= 250)
Background variables
n
Low back pain
t
or
F P
Mean SD
Age (in years)
30‑40 89 1.55 2.624 7.451 0.001***
40‑50 84 1.98 2.527
50‑65 77 3.14 3.012
Marital status
Unmarried 0 0.0 0.0 −2.646 0.009***
Married 211 1.99 2.670
Others (widow,
separated)
39 3.26 3.185
Education
Illiterate 49 3.41 2.986 7.047 0.001***
Primary/secondary 178 1.98 2.708
Higher secondary/
college
23 1.17 2.188
Religion
Hindu 241 2.17 2.802 −0.407 0.685
Christian 9 2.56 2.506
Income (Rs./month)
5156 and above 13 2.23 3.032 5.931 0.001***
2578‑5155 151 1.62 2.503
1547‑2577 61 3.21 2.916
773‑1546 25 3.04 3.195
Occupation
Housewives 142 2.00 2.788 0.727 0.484
Coolie 66 2.47 2.673
Others 42 2.35 2.975
Family type
Nuclear 191 2.02 2.752 −1.724 0.086
Joint 59 2.73 2.858
SD: Standard deviation, ***Pvalue<0.05isconsideredassignicant
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Ahdhi, et al.: Prevalence of low back pain
114 Indian Journal of Pain | May-August 2016 | Vol 30 | Issue 2
The present study revealed that signicant correlations
were found among the low back pain, QOL, and disability.
These ndings were supported by a study conducted by
Darzinaghibi, et al., (2012)[16] which demonstrated that
there was a signicant correlation between all aspects
of QOL and functional disability except environment
health. Correlation between functional disability and
all aspects of QOL was negative. The study concluded
that higher functional disability can lead to lower QOL
and vice versa.
The study showed that there was a signicant association
between the mean score of low back pain and age, marital
status, education, total family income, type of delivery,
number of children, hours of sweeping house, washing
clothes and washing vessels per day, menopause status, and
chronic illness (P < 0.001). These ndings were consistent
with the study conducted by Gourmelen, et al. (2007),[17]
Liu, et al., (2012)[18] and Cho et al., (2012)[19] in France, China,
and Korea, respectively, which reported that advanced
age and females sex were associated with low back pain.
Similarly, a study conducted by Sadigi, et al.,[13] in Tabriz
found that there was a signicant association between
marital status, housewives, number of pregnancy and
delivery type, and low back pain. Furthermore, these
ndings were corroborated with the study carried out by
Biglarian, et al. (2012)[20] in Iran and it was reported that
as factors such as age, females, marital status, obesity,
low family income, smoking, and lower education were
associated to low back pain.
This study showed that there was no association between
BMI and low back pain. This nding was consistent with
the study carried out by Birabi, et al. (2012)[21] in Nigeria
and Mathew, et al.[14] in India.
Limitations and Conclusions
The intensity of the low back pain might have inuenced
by the recall bias of women. Similarly, there may be
subjective bias while assessing the disability and QOL. It
was concluded that prevalence was comparatively more
than other studies in India. Although moderate disability
was more among those with low back pain, overall QOL
was good. Disability intervention measures may help in
reducing the impact of low back pain and improving the
QOL among women with low back pain.
Acknowledgments
We sincerely acknowledge the support provided by the stas at
Rural Health Centre and also all women for their participation
in this study.
Table 2: Prevalence of low back pain with associated factors
among women
Background variables
n
Low back pain
t
or
F P
Mean SD
Type of delivery
Normal 232 2.01 2.765 −3.658 0.000***
LSCS 18 4.44 2.036
Number of children
No children 0 0 0 −4.650 0.000***
≤2 children 195 1.77 2.657
>2 children 55 3.69 2.760
Duration of sweeping house (min/day)
Nil 3 1.06 1.732 5.759 0.004**
≤10 185 1.86 2.664
>10 62 3.19 2.969
Duration of washing
clothes (min/day)
Nil 3 2.33 4.041 5.818 0.001***
<15 15 1.80 2.783
15‑30 118 1.48 2.538
>30 114 2.96 2.842
Duration of washing vessels (min/day)
Nil 3 4.00 3.606 2.718 0.045*
<10 105 1.68 2.574
10‑15 50 2.18 2.960
>15 92 2.71 2.831
Menopause
Yes 88 3.06 2.969 3.742 0.000***
No 162 1.71 2.572
BMI
<18.5 8 0.75 2.121 1.135 0.336
18.6‑24.9 127 2.08 2.727
25‑29.9 98 2.47 2.912
>30 17 2.00 2.716
Chronic illness
No 214 1.88 2.691 4.303 0.000***
Yes (DM, HTN, asthma) 36 3.97 2.720
*P < 0.05, **P < 0.01, ***P < 0.001. BMI: Body mass index, LSCS: Lower
segment caesarean section, DM: Diabetes mellitus, HTN: Hypertension
Table 3: Mean scores of domains of QOL of women among low
back pain subjects (
n
= 105)
Domains Mean (SD) Possible
range
Minimum-
maximum
Overall QOL 88.41 (12.90) 1‑130 54‑109
Physical domain 61.88 (7.77) 0‑100 38‑81
Psychological domain 61.19 (13.55) 0‑100 31‑100
Social domain 61.33 (15.99) 0‑100 25‑94
Environmental domain 57.16 (13.39) 0‑100 19‑81
SD: Standard deviation, QOL: Quality of life
Table4:Thecorrelationcoefcientbetweenlowbackpain,
disability, and QOL of women with low back pain (
n
= 105)
Variables Low back pain Disability QOL
Low back pain — 0.78** −0.59**
Disability 0.78** — −0.77**
QOL −0.59** −0.77** —
**P < 0.01 level. QOL: Quality of life
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Ahdhi, et al.: Prevalence of low back pain
Indian Journal of Pain | May-August 2016 | Vol 30 | Issue 2 115
Financial support and sponsorship
Nil.
Conicts of interest
There are no conicts of interest.
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