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Prevalence of low back pain and its relation to quality of life and disability among women in rural area of Puducherry, India

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Abstract

Background: The level of quality of life (QOL) and disability among women with low back pain is an important health issue at global level. Objective: To find out the prevalence of low back pain and to assess the relationship of low back pain with disability and QOL among women. Materials and Methods: A community-based cross-sectional study was conducted among 250 women in age group of 30-65 years residing in field practice area of a Tertiary Care Medical Institution, Puducherry. Severity of the pain was assessed using Numerical Pain Scale. Modified Oswestry Low Back Pain Disability Questionnaire was used to measure the disability level and WHO-BREF scale to assess the QOL among women with low back pain. Results: Overall, the prevalence of low back pain was found to be 42%. The majority of women (60.9%) with low back pain experienced moderate disability. Almost 72% of women with low back pain perceived their QOL as good and overall mean QOL score was 88.41 (standard deviation = 12.9). The low back pain was influenced by the demographic variables that include age, marital status, illiteracy, total family income, type of delivery, number of children and household chores, menopausal status, and chronic illness ( P P Conclusions: Prevalence of low back pain among women was comparatively more than other studies in India. Although moderate disability was more among those with low back pain, overall QOL was good.
© 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:Thelevelofqualityoflife(QOL)anddisabilityamongwomenwithlowbackpainisanimportanthealthissueatglobal
level.Objective:TondouttheprevalenceoflowbackpainandtoassesstherelationshipoflowbackpainwithdisabilityandQOL
among women. Materials and Methods:Acommunity‑basedcross‑sectionalstudywasconductedamong250womeninagegroupof
30‑65years residingineldpracticeareaofaTertiaryCareMedical Institution,Puducherry.Severityofthepainwasassessed using
NumericalPainScale.ModiedOswestryLowBackPainDisabilityQuestionnairewasusedtomeasurethedisabilitylevelandWHO‑
BREFscaletoassesstheQOLamongwomenwithlowbackpain.Results:Overall,theprevalenceoflowbackpainwasfoundtobe
42%.Themajorityofwomen(60.9%)withlowbackpainexperiencedmoderatedisability.Almost72%ofwomenwithlowbackpain
perceivedtheirQOLasgoodandoverallmeanQOLscorewas88.41(standarddeviation=12.9).Thelowbackpainwasinuencedbythe
demographicvariablesthatincludeage,maritalstatus,illiteracy,totalfamilyincome,typeofdelivery,numberofchildrenandhousehold
chores,menopausalstatus,andchronicillness(P<0.05).Disabilitywasinuencedbyage,education,andoccupation,whereasQOL
wasinuencedbyeducationofthewomenwithlowbackpain(P<0.05).Conclusions:Prevalenceoflowbackpainamongwomenwas
comparativelymorethanotherstudiesinIndia.Althoughmoderatedisabilitywasmoreamongthosewithlowbackpain,overallQOL
was good.
Key words:Disability,lowbackpain,qualityoflife
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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License, which allows others to remix, tweak, and build upon the
work non-commercially, as long as the author is credited and the
new creations are licensed under the identical terms.
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
suered 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 seing
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 condentially 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 modied 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 signicance. 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 coecient.
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 signicant dierence between
the mean score of level of disability with age, education,
and occupation of the women (P < 0.05). A signicant
dierence 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 signicant positive correlation
between pain and disability and a negative correlation
between pain and QOL and also there was a signicant
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 suered 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, ***Pvalue<0.05isconsideredassignicant
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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 signicant 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 signicant 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 signicant 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 signicant 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 inuenced
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 stas 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
Table4:Thecorrelationcoefcientbetweenlowbackpain,
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.
Conicts of interest
There are no conicts of interest.
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... Low back ache (LBA) is a heterogeneous disorder involving patients with dominant nociceptive (e.g., myofascial), neuropathic, and central sensitization pain. 1 In Bharat, approximately 60% of people experience LBA at least once in their lifetime. 2 However, more than 69% of these individuals will have a recurrence of symptoms within a year of recovering from LBA. 3 Due to this high recurrence rate, LBA has become the fourth leading cause of disability worldwide, following ischemic heart disease, cerebrovascular pathologies, and lower respiratory tract infections. [4][5] In developing nations like Bharat, factors such as low socioeconomic status, low education levels, physical factors like repetitive heavy lifting, prolonged static or awkward postures, and psychosocial factors like anxiety, mood depression, job dissatisfaction, mental stress, irregular work periods, and obesity are closely linked to LBA. 2,6 Nerve root compression associated with LBA can cause pain radiating into the lower extremities in a dermatomal pattern, often accompanied by tingling, numbness, paresthesia, and occasionally shooting pain. ...
... 2 However, more than 69% of these individuals will have a recurrence of symptoms within a year of recovering from LBA. 3 Due to this high recurrence rate, LBA has become the fourth leading cause of disability worldwide, following ischemic heart disease, cerebrovascular pathologies, and lower respiratory tract infections. [4][5] In developing nations like Bharat, factors such as low socioeconomic status, low education levels, physical factors like repetitive heavy lifting, prolonged static or awkward postures, and psychosocial factors like anxiety, mood depression, job dissatisfaction, mental stress, irregular work periods, and obesity are closely linked to LBA. 2,6 Nerve root compression associated with LBA can cause pain radiating into the lower extremities in a dermatomal pattern, often accompanied by tingling, numbness, paresthesia, and occasionally shooting pain. The most commonly used clinical test for this is the 'Lasegue test', also known as the 'Straight Leg Raise Test' (Figure 1). ...
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Background Low back ache receives considerable attention in the medical field due to its high occurrence in civil society. Despite its high occurance rate there is no clear conservative treatment approach available. This has motivated many researchers to delve further into the study of lower back ache. Thus after an extensive review of literature this study has chosen non-chronic sciatica from the vast domain of low back ache to establish possible treatments so as to address the problem before it becomes chronic.Objectives To determine the effectiveness of cognitive pain management strategies in improving pain as determined by McGill pain questionnaire SF-MPQ-2 scores among non-chronic cases of sciatica.Methodology Thirty patients in the age group of 40 to 60 years who were clinically diagnosed with non-chronic sciatica and fulfilled inclusion and exclusion criteria were divided randomly into two equal groups. One group received a conventional physical therapy approach while the other group received cognitive pain management strategies along with conventional management for a two-week period and the outcome on pain was assessed.Results A paired t-test was used to find the difference between pre and post-treatment. It showed statistically relevant changes in the SF-MPQ-2 scores in the experimental group which used cognitive pain management strategies. T-value was 3.70557 and the P-value was 0.00092. The result was significant at P lt0.05.Conclusion This study concludes that adding cognitive pain management strategies into existing physical therapy practice provides better outcomes compared to the use of conventional physical therapy alone.
... Non-specific chronic low back pain is recognized as a significant concern in advanced nations. 1 In India also, there is a shocking rise, with almost 60% of the people having suffered from low back ache at some point during their lifespan. 2 Low back pain (LBP) is defined as pain between the twelfth ribs and the lower gluteal folds, with or without leg pain. In LBP cases, the main cause of the pain cannot be clearly specified, resulting in a diagnosis of non-specific low back pain (NSLBP). ...
... Week [1][2][3][4] PFM Exercise a. Women would be individually instructed in pelvic floor anatomy and how to contract the pelvic floor muscle correctly. b. ...
... The management of low back pain poses difficulties for both patients and healthcare practitioners [12] . Although The conventional medical system offers effective treatment options for low back pain, including rest, physiotherapy such as TENS and superficial thermotherapy, systemic or topical medications like NSAIDs, muscle relaxants, and corticosteroids; traction, lumbo-sacral belts, and surgery [13,14] . However, their results are unsatisfactory and have been dismissed due to adverse effects or surgical complications. ...
... 8 In India especially in rural areas, LBP is more common among women partly because of the multitasking that is required of women in managing a household involving taxing work schedules which tend to be strenuous and exhausting. 9 Women have a higher average prevalence of LBP than men. Many chronic pain disorders and debilitating musculoskeletal system conditions affect women in greater numbers than men. ...
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Background: Low back pain is one of the most common health issues encountered worldwide. About 80% of the global population would have had an episode of LBP at some stage of life. Many of the musculoskeletal disorders develop in middle age and can be chronic lasting years, necessitating contact with health care providers. Methods: A community-based cross-sectional study was conducted among 360 women in the age group of 45-65 years residing in Ernakulam (Kochi Corporation) for the past 6 months. Low back pain among women was assessed based on the Orebro musculoskeletal pain questionnaire. A modified Oswestry Low Back Pain Disability Questionnaire was used to measure the disability level. Participants were selected using cluster sampling (proportionate probability sampling). Data was analysed using IBM SPSS software version 20, Chicago USA. Results: The mean age of study subjects was 55.49±7.01. Overall, the prevalence of low back pain was found to be 53.1%. Many women with low back pain experienced moderate disability (79.2%). The low back pain was influenced by socio-demographic variables that include age, diabetic status, presence of dyslipidaemia, presence of trauma (p<0.05). Disability was influenced by age, history of trauma, history of dyslipidemia, family type (joint) (p<0.05). Conclusions: Prevalence of low back pain among women was comparatively higher than reported in other studies from India and was associated with a moderate degree of disability.
... Low back pain (LBP) is a common health condition characterized by pain and discomfort below the costal margin and above the inferior gluteal folds, with or without leg pain [1]. The estimated prevalence of LBP in India ranges between 42% and 83% [2][3][4]. LBP is defined as pain in the back from the level of the lowest rib down to the gluteal fold, with or without radiation into the legs [5]. Based on the duration of symptoms, back pain is labeled as acute back pain if it occurs for the first time in the patient's life or if there has been a pain-free duration of six months after the previous episode and lasts for no more than six weeks [5]. ...
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Background: Low back pain (LBP) is a common health condition with an estimated prevalence of 42-83% in India. Clinicians usually measure lumbar lordotic angle (LLA) and lumbosacral angle (LSA) in sagittal radiographs even though the normal range of lordosis has not yet been agreed upon. Hence, the radiographic measurement of these angles needs to be re-evaluated. We aimed to study the difference in LLA and LSA in those with and without non-specific acute LBP and to analyze the correlation and association of confounding factors like age, gender, BMI, and pain severity with LLA and LSA. Methods: LLA and LSA in those with and those without non-specific acute LBP in 200 individuals were recorded and analyzed statistically. Results: In age, gender, and BMI-matched groups, the LSA in the cases group (34.44 ± 5.93) was significantly less than in controls (36.9 ± 6.8) (p = 0.007). LLA in the non-specific acute LBP group (50.51 ± 8.78) and those without non-specific acute LBP (50.05 ± 9.86) was statistically similar (p = 0.727). LSA was significantly less in patients than in healthy subjects. Both LLA and LSA were not associated withback pain and showed a weak or very weak correlation with age, gender, BMI, and severity of pain in both groups. Conclusion: Lumbar lordosis didn’t show any association or correlation with age, gender, BMI, and VAS in non-specific acute LBP patients. Hence, measuring LSA and LLA in sagittal radiographs does not provide any additional information regarding the cause of pain in non-specific acute LBP patients.
... Lack of judiciously selected curative exercises can also be considered as causes of this disease. Highest incidence of low back 5 pain was observed among female gender . Therapeutic options within conventional medical practice are limited to analgesics and physical therapy. ...
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Background: Low back pain (LBP) has been a global public health concern since 1990. The annual and lifetime prevalence of LBP in India is 51% and 66% respectively. The underlying cause of LBP may be due to errors like maintaining wrong body postures while working, sitting, standing, or sleeping. These errors can be restored or maintained by practicing yoga on daily basis. Therapeutic yoga being a scientic and cost-effective lifestyle modication for LBP, this study was planned to evaluate the add on effectiveness of therapeutic asanas in LBP. To evaluate the add-on effectiveness of a set of therap Aims: Methods eutic asanas in low backache. And Materials: A total of forty-six subjects (study group n=26, control group n=20) were recruited for this study from IPD and OPD departments of Sri Dharmasthala Manjunatheshwara college of ayurveda and hospital, Hassan. Back pain functional scale (BPFS) was used to assess the extent of pain before and after intervention. : This study found that subjects who adapte Results d 15 days of yoga package along with their regular therapies for low backache had statistically signicant reduction in pain (0.286±0.093) at the end of the study compared to control group (0.178 ±.055), t (41) =5.893, p=<0.05. Practicing the prescribed set of therapeutic asanas reg Conclusion: ularly for 15 days enhanced the exibility and strengthened the musculature & ligaments leading to the reduction in severity of pain. Hence it can be concluded that Asanas that have backward and lateral bending poses will benet the correction of spinal curvature, strengthens back muscles and spines which in turn reduce the pain in low back.
... According to reports, the estimated frequency in India falls between 42% and 83%. [4,5] Young Indian individuals aged between 18 and 35 years have a 42.4% annual and weekly prevalence of LBP. The prevalence increase and peaks between 35 and 55 years and has been reported to range from 6.2% to 92%, increasing with age and female preponderance. ...
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Background Lumbago is derived from the word “lumbar region.” This pain in the lower back/lumbar region is addressed low back pain (LBP). It is considered a major health issue causing disability, and associated with increased fatigue level, decreased abdominal strength, and poor cardiovascular fitness in the affected population. Objectives of the Study Isolate and configure combined effect of breathing exercise and core strengthening training on fatigue, abdominal strength, and cardiovascular fitness in mechanical nonspecific lumbago subjects using tele-physiotherapy. Methods A two-group online randomized control trial was conducted involving 60 participants. The duration of the study stretched for 4 weeks. Subjects recruited in accordance with the inclusion and exclusion criteria were split into two groups, i.e., experimental and control groups. The experimental group performed core strength training and breathing exercises, whereas the control group performed only core strength training. Before exercise and at the end of each week fatigue, abdominal strength, and VO 2max of the subjects were measured and evaluated. Results Results from the present study concluded significant improvement within each group fatigue, abdominal strength ( P < 0.05). However, no between groups difference was observed for VO 2max ( P > 0.05). Pain intensity perceived by the patients was improved in the group subjected to combined intervention involving core strengthening and breathing exercises as compared to the control group. Conclusion The study proposed a significant effect of breathing exercise along with core strength training on parameters of fatigue, abdominal strength, and cardiovascular fitness in subjects with lumbago.
... 63 Multiple studies have examined the occupational hazards affecting men and women of lower economic status in urban India. [64][65][66] For men in Southern India, lack of educational attainment is a significant risk factor for LBP. 61 For working women, the high incidence of LBP (70%-80%) has been attributed to a combination of prolonged hours in suboptimal working positions, occupational monotony, and inadequate income-highlighting the complex biopsychosocial model underpinnings of chronic pain. ...
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Internationally, the United States (U.S.) cites the highest cost burden of low back pain (LBP). The cost continues to rise, faster than the rate of inflation and overall growth of health expenditures. We performed a comprehensive literature review of peer-reviewed and non– peer-reviewed literature from PubMed, Scopus, and Google Scholar for contemporary data on prevalence, cost, and projected future costs. Policymakers in the U.S. have long attempted to address the high-cost burden of LBP through limiting low-value services and early imaging. Despite these efforts, costs (~40billion; 40 billion; ~2,000/patient/yr) continue to rise with increasing rates of unindicated imaging, high rates of surgery, and subsequent revision surgery without proper trial of non-pharmacologic measures and no corresponding reduction in LBP prevalence. Globally, the overall prevalence of LBP continues to rise largely secondary to a growing aging population. Cost containment methods should focus on careful and comprehensive clinical assessment of patients to better understand when more resource-intensive interventions are indicated.
Article
Background The Quebec Back Pain Disability Scale (QBPDS) is a more commonly used measure to assess the disability in low back pain (LBP) patients. It is important to administer patient-reported outcomes in the patient’s native language to enhance successful outcomes. The objective of this study was to translate, culturally adapt, and validate QBPDS into Marathi language and establish psychometric properties in chronic LBP patients. A prospective, cross-sectional study was conducted in a tertiary health care center. Materials and Methods The QBPDS was translated and culturally adapted into Marathi (QBPDS-M) following standardized guidelines. A total of 75 chronic low back patients participated in the study. The construct validity of QBPDS-M was evaluated using exploratory factor analysis. Convergent validity was assessed using the Pearson correlation analysis between the QBPDS-M and Roland-Morris Disability Questionnaire (RMDQ) and the Numeric Pain Rating Scale (NPRS). Internal consistency and test–retest reliability was computed using Cronbach’s alpha and intra-class correlation coefficient (ICC), respectively. Results Construct validity was established revealing the 6-factor structure of QBPDS-M with 60.62% of the total variance. Content validity was confirmed with no floor or ceiling effects. Convergent validity showed a moderate correlation with RMDQ ( r = 0.68 and P = 0.000) and NPRS ( r = 0.345 and P = 0.002). The QBPDS-M demonstrated excellent internal consistency (Cronbach’s α = 0.893) and good test–retest reliability (ICC 2,1 = 0.862). Conclusion Psychometric analysis of QBPDS-M demonstrated satisfactory construct validity, internal consistency, and test–retest reliability. It can be utilized for clinical and research purposes to assess the functional disability in Marathi-speaking chronic LBP patients.
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A scrutiny of occupational profile of population in India where maximum population depends for their livelihood on agriculture only points out that women make up 46 percent of total agriculture work force and there is hardly any activity in agriculture except ploughing and household chores in which women are not actively involved. At the same time this sector is considered as the most hazardous occupation and reason of various health problems like MSPs and MSDs in women workers. Thus a study was conducted on sixty farm women to identify the extent of musculoskeletal problems in them. Incidence of musculoskeletal symptoms, information on causes of pain, work load and severity of pain were assessed by self structured questionnaire and body map technique. The findings of the study indicated that farm women remain fully occupied and over-burdened with three-fold responsibility of farm, home and livestock management before they attain the age sixteen. Awareness about musculoskeletal problems was found to be very low among female workers albeit these women workers they were suffering from discomforts/pain in various parts of the body. Education on health and awareness about developed women friendly technologies for farm, home and livestock would help in minimizing the extent of musculoskeletal problems among agricultural female workers.
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Low back pain is a major public health problem all over the world. It is generally assumed that overweight, height and low back pain are related. However, the scientific evidence to support this relationship is not fully conclusive. The aim of this study is to estimate the prevalence of low back pain and its association with height, fat distribution, reproductive history and socioeconomic influence. A representative sample of 401 men and 403 women aged 20 years and above were selected and studied. It is found that 28.4% and 52.9% respectively were having low back pain. Height and fat distribution were found to have no association with low back pain. Both men and women, whose household were in the lower socio economic status reported more back pain (Adjusted odds ratio (AOR) for men 1.61, 95% confidence interval (CI): 1.02, 2.55 and AOR for women 1.57, 95% CI: 1.02, 2.34). Men with lower educational qualification reported more back pain (AOR 1.89, 95% CI: 1.08, 3.31). In women, those who have undergone caesarean section (AOR 1.661, 95% CI: 1.02, 2.72) and sterilization (AOR 1.63, 95% CI: 1.09, 2.44) were found to be a positively associated with low back pain. The only socioeconomic link with back pain among women seemed to be manual occupation (AOR 3.33, 95% CI: 1.49, 7.4). The finding confirms the higher burden of back pain on the socially disadvantaged, but cannot yet be explained by known risk factors.
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Background. There are very few studies that had a sample size sufficient to explore the association between factors related to low back pain in a representative sample of the Iranian population. Objective. To examine the relationship between sociodemographic factors, smoking, obesity, and low back pain in Iranian people. Methods. We used Iranian adults respondents (n = 25307) from the National Health Survey. Adjusted odds ratios and 95% confidence intervals were estimated by using logistic regression. Results. The prevalence of low back pain was found in 29.3% of the studied sample. High age, female sex, being married, obesity, low-economic index, being smoker, in a rural residence, and low educational attainment, all increased the odds of low back pain. Conclusions. Our findings add to the evidence on the importance of obesity in relation to low back pain. These results can be used as a basis to reinforce health programs to prevent obesity.
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This study was undertaken to assess the prevalence and predominant causes of low back pain (LBP) among peasant farmers in Ebubu community in South-south Nigeria. This was a community based cross-sectional study of 310 consenting, adult, full-time farmers, recruited using a two-stage cluster sampling scheme developed by WHO. Specially trained community health extension workers interviewed participants using a pre-tested questionnaire designed by the authors to solicit information on defined LBP. Socio-demographic characteristics were also obtained. A clinical history was recorded, including: duration of LBP and mode of onset, pain severity, knowledge of LBP causes and care-seeking practices. Participants' BMI were calculated. Data were entered into Microsoft Excel and analyzed using the Statistical Package for Social Sciences v15 (www.spss.com). Of the 310 apparently healthy farmers (age range 18-58 years [mean 36.71±8.98]; 132 males) sampled, 208 had LBP (67.10%). Low back pain was more prevalent in the 31-40 years age group (49.04%), females (50.96%), those who were non-obese (68.95%) or tall (73.2%) and those who had practiced farming for a long duration. Severe LBP was significantly (p<0.05) linked to aging (51-60 years group), low BMI and those above average height (1.60 m). This study indicates that LBP is a prevalent health problem among rural peasant farmers. It was more prevalent in the middle-aged groups, and among females, the non-obese and tall individuals, and those who had been farming for a long duration. Severe LBP was linked to aging, high BMI and those above average height.
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Work related musculoskeletal disorders are group of painful disorders of muscles, tendons and nerves. Work activities, which are frequent and repetitive or activities with awkward postures cause these disorders, which may be painful during work or at rest. In the home and farm where women performs tasks while sitting, standing, bending, twisting, awkward posture, duration of work and inadequate rest pause are associated with the occurrence of serious musculoskeletal problems and musculoskeletal disorders. In the current study, a sample of 30 tribal women was selected to draw the results of the study. Incidence of musculoskeletal symptoms, information on causes of pain, work load and severity of pain were assessed by self structured questionnaire and body map technique. Results indicated that work related musculoskeletal problems and disorders affect all the parts of body viz. hands, wrists, elbow, neck, shoulder and back in upper body region, hips, knees and calf muscles in lower body region.
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The purpose of the present study was to evaluate and correlate the various biological risk indicators of non-specific low back pain (NSLBP) in young adults. The study was based on a total of 100 purposively selected young adults (50 males and 50 females) aged 18 – 25 years with non-specific low back pain and 100 matched controls (50 males and 50 females) asymptomatic with no history of low back pain taken from Amritsar, Punjab, India. To solve the purpose, some anthropometric measurements, viz. height, weight, BMI, four skinfold measurements, (i.e. biceps, triceps, subscapular and suprailiac), back strength, flexibility measure and abdominal muscle endurance were taken on each subject. Results indicated statistically significant differences (p<0.05) in abdominal muscle endurance (t= 2.58) between NSLBP boys and controls and in weight (t=3.22), biceps skinfold (t=3.04), height (t=2.67), triceps skinfold (t=2.83), subscapular skinfold (t=2.32) and in percent lean body mass (t= 2.80) between NSLBP girls and controls. Both in boys and girls with non-specific low back pain, back strength has positively significant correlations (p<0.05) with height (r=0.487 and 0.360 respectively), weight (r=0.495 and 0.213 respectively), BMI (r=0.299 and 0.461 respectively) and flexibility measure (r=0.386 and 0.388 respectively) and negatively significant correlation (r=-0.417 only in NSLBP girls) with percent body fat.
Article
The present study deals with the association of menopausal status of 146 patients (74 pre- and 72 postmenopausal women) with low back pain aged 35-55 years residing in and around Tarn Taran, Punjab, India, and their body composition components, viz. percent body fat and percent lean body mass. The results indicate strong association of percent body fat with all the ten pain measuring variables, viz. pain intensity (r=0.668), personal care (r=0.519), lifting (r=0.620), walking (r=0.648), sitting (r= 0.515), standing (r=0.471), sleeping (r= 0.533), sex life (r= 0.255), social life (r=0.664) and travelling (0.583) in post-menopausal patients with low back pain.
Article
ABSTRACT A scrutiny of occupational profile of population in India where maximum population depends for their livelihood on agriculture only points out that women make up 46 percent of total agriculture work force and there is hardly any activity in agriculture except ploughing and household chores in which women are not actively involved. At the same time this sector is considered as the most hazardous occupation and reason of various health problems like MSPs and MSDs in women workers. Thus a study was conducted on sixty farm women to identify the extent of musculoskeletal problems in them. Incidence of musculoskeletal symptoms, information on causes of pain, work load and severity of pain were assessed by self structured questionnaire and body map technique. The findings of the study indicated that farm women remain fully occupied and over-burdened with three- fold responsibility of farm, home and livestock management before they attain the age sixteen. Awareness about musculoskeletal problems was found to be very low among female workers albeit these women workers they were suffering from discomforts/pain in various parts of the body. Education on health and awareness about developed women friendly technologies for farm, home and livestock would help in minimizing the extent of musculoskeletal problems among agricultural female workers.
Article
Study design: A community-based, cross-sectional study that is part of the prospective Korean Health and Genome Study. Objective: To determine the prevalence of low back pain (LBP) among middle-aged and elderly rural community residents in Korea and to examine the relevant risk factors, including activities reflecting the Asian lifestyle, and the relationship between radiographical features of degenerative changes in the lumbar spine and LBP. Summary of background data: The prevalence and implication of LBP among the elderly, particularly Asians, are under-represented in previous reports. Methods: Data for LBP were collected for 4181 subjects from a rural farming community. The point and cumulative lifetime prevalences of LBP were obtained in addition to measurement of the severity of LBP. Lateral lumbar spine radiographs were obtained according to a standard protocol. Results: The mean age of the study subjects was 56 years and 55% were women. The lifetime prevalence of LBP was 61.3%, with women having a higher prevalence. The point and 6-month prevalences were also higher among women. The lifetime, point, and 6-month prevalences increased with age in both sexes, except for lifetime prevalence in men. The prevalence of LBP of grade 3 or more was significantly higher in women and increased significantly with age, particularly in women. Both lifetime and point of prevalence of LBP were significantly associated with age, female sex, and time spent squatting. After adjusting for age and sex, the presence of disc space narrowing, osteophytes, and advanced Kellgren-Lawrence grade in lumbar radiograph was associated with LBP. Conclusion: The prevalence of LBP is comparable between these Korean community residents and other population groups. Risk factors associated with LBP included advanced age, female sex, squatting, the presence of osteophytes, joint space narrowing, and advanced Kellgren-Lawrence grading on lumbar radiograph.
Article
This was a population-based survey conducted in 2008 in a northern area of China. To investigate back pain prevalence and to examine the associations between potential risk factors and back pain among Chinese farmers. Few studies have investigated back pain and its associated risk factors among farmers in low-income and developing nations. Farmers ages 15 years and older were chosen from 800 families in Heilongjiang province of the People's Republic of China using cluster sampling methods. Complete survey data were obtained from 2045 farmers. The prevalence of self-reported back pain during the previous 3 months was reported. Associations between back pain and potential risk factors, which included age, gender, education levels, perceived stress, main farm activities, smoking, and drinking status, were examined in logistic regression models. A total of 786 (38.4%) farmers reported back pain. Two-thirds of those with back pain (66.0%) reported that back pain affected work quantity and quality. The adjusted odds ratios of reporting back pain increased with advancing age. Females and farmers who experienced stress regularly were also more likely to report back pain. Back pain is a common problem among Chinese farmers and is reported more frequently by females. Significant positive associations of gender, age, and perceived stress with back pain warrant additional study.