Prevalence and Risk Factors for Neck Pain and Low Back Pain Among College Students in Nigeria

doi:10.21203/rs.3.rs-4969741/v1

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Prevalence and Risk Factors for Neck Pain and Low Back Pain Among College Students in Nigeria

https://doi.org/10.21203/rs.3.rs-4969741/v1

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Objective

Neck and back pain are common among healthcare students because they are exposed to prolonged hours of standing, inappropriate body posture while sitting, increased screen time- that is time spent on electronic gadgets, and decreased physical activities, all of which have adverse effects.The aim of this study is to determine the prevalence of neck pain and low back pain among the college of medicine students in Ibadan, Nigeria, also assessing the risk factors for the development of these musculoskeletal pains.

Materials and Methods

A minimum number of 420 students, studying Medicine and Surgery, Dentistry, and Physiotherapy, and who were in their clinical level in their respective course of study in the College of Medicine, the University of Ibadan, Ibadan participated in the study. Participants were recruited for the study by Stratified sampling method and data were collected through self-administered standardised online questionnaires.

Data Analysis

The data were subjected to descriptive statistics and the responses were compared across demographic groups. The association between the sociodemographic variables, risk factors, disability scores, and coping mechanisms was assessed. Also, correlation coefficient was performed to test for association between coping strategies, pain score, disability score and depressive symptoms using Pearson correlation coefficient analysis. The confidence level was set at 0.05.

Results

Four hundred and twenty students were recruited for the study. The lifetime prevalence of neck and back pain was 74.5% and 76.6%, 12-month prevalence of 60.8% and 66.1%, and point prevalence of 15.1% and 18.7% respectively. The associated risk factors found were: sitting without back support (p= 0.06), prolonged study time (p= 0.43), using the computer (p= 0.08), use of smart phones (p= 0.01), posture assumed during lectures (p= 0.4), posture assumed during practicals (p= 0.36), prolonged sitting (p= 0.49), prolonged standing (p= 0.07), carrying heavy backpacks (p= 0.69), engaging in physical activities (0.9) and waking up to low back pain (0.04).

Conclusion

The prevalence of neck and low back pain among healthcare students is high and affects their everyday life.

Pain is a major health problem globally (1). Musculoskeletal neck and back pain are some of the health challenges for healthcare professionals (2). Low back pain (LBP)is felt from the lowest border of the rib to the region of the gluteal fold which may radiate to the legs. It could be acute if less than six weeks or chronic if greater than six weeks (3). Neck pain (NP) is another culprit that has contributed to the rate of morbidity and also absenteeism from lectures worldwide.

Studies have shown that musculoskeletal pain is more prevalent among workers in the health care system and is responsible for frequent absenteeism (4). Having neck pain has a considerable effect on the various aspect of an individual; their personal life and their community (5). In a cross sectional study carried out on the university students in Finland, the prevalence of musculoskeletal pain was said to have increased from the year 2000 to 2012 with an increase in neck pain from 25–29% and lower back pain from 10–14%(6). They contribute to disability and morbidity which result in a reduction in the effectiveness or overall academic performance of students (2)(5).

Globally, neck and low back pain ranked the fourth leading cause of disability-adjusted life years (DALY). In 2015, over a third of a billion people worldwide had neck pain and about half a billion people had low back pain for more than three months duration (7). Among healthcare students, the prevalence of low back pain ranges from 38% to about 60% (8)(9)(10), and the 12-month prevalence ranges between 49–60%(11)(12). Similarly, the prevalence of neck pain among undergraduates ranges between 48–78% prevalence of neck pain(10)(13), and a 12-months prevalence of about 50% (5).

Some risk factors associated with low back Pain (LBP) among students include inappropriate body posture especially while sitting, high body mass index, decreased physical activity, stress, sport(11)(8)(9), prolonged standing or sitting (14), the weight of backpack(12)(15), duration of computer and smartphone use(16)(14)(17)(13). Others include the duration of reading, awkward neck posture, physical exercise and previous history of neck pain are significantly associated with neck pain(5). The persistence of these factors can also influence the chronicity of the pain (8).

Therefore this study aims to investigate the prevalence of neck and low back pain, and explore risk factors that affect the prevalence of these musculoskeletal pain (MSP) among the healthcare students across the different departments and grades

Study Design and Participants

The study adopted the cross-sectional design using web-based survey, and the ethical approval was received from our institution, UI/UCH ethic review board. The students for the study were recruited from undergraduates in their 1st to 5th clinical year, studying Medicine and Surgery, Dentistry, and Physiotherapy at the College of Medicine, University of Ibadan Nigeria, which is one of the two largest college of medicine in the southwestern part of the country. The minimum sample size was determined to be 380 using the prevalence rate of 55% from Ayanniyi et al. and a confidence interval of 95%. The students were selected from each department at random using Excel. The survey was made anonymous and self-administered online with the link to the questionnaire sent to all the randomly selected students. WhatsApp (the most popular social media platform for students in the University) was used to send out the survey. Online informed consent was obtained from each participating student and they were informed that their participation would be totally voluntary. Students who met the following criteria were excluded from the study: History of neck or low back surgery in the past; History of trauma to the neck or lower back in the past; or History of mental or psychological illness.

Data collection involved an online self-administered structured questionnaire, created using Google Forms. The questionnaire was divided into sections focusing on demographic characteristics, prevalence of pain, and risk factors related to neck and low back pain.

Analysis was performed using STATA version 16.0. Descriptive statistics were executed on questionnaire items, including chi-square tests of independence to examine associations between demographic characteristics, knowledge of pain. The research instruments used included the Standardized Nordic Questionnaire for assessing the prevalence of pain. The Standardised Nordic Questionnaire assessed point prevalence (at the time of the questionnaire) and period prevalence (within the last 7 days of filling the questionnaire) for both neck pain and low back pain. The questions used to assess risk factors for neck pain and low back pain were adapted from questionnaires used by Ayanniyi et al.

Study variables included demographics, social factors, physical activity, underlying diseases, and psychosocial conditions. In addition, quality control measures comprised pretesting the questionnaire, ensuring comprehensibility with appropriate instructions, and conducting the study in English.

Of the 420 college students recruited for this study, 337 completed the questionnaires yielding a response rate of 80.2%. Social demographic characteristics of the study population are described in Table 1. Regarding the age of the participants; 168(49.9%) were below 23 years, 158(64.9%) were between 24-29 years and 11(3.3%) were 29 years and above. 193 (57.3%) of the respondents were males while 144 (42.7%) were females. Most of the respondents (323, 95.9%) in this study were single at the time of this study. Participants were recruited from three major departments: Dentistry (60, 19.6%), Medicine and surgery (246, 80.4%), and Physiotherapy (31, 9.2%). Regarding the study, students from 300-600 levels were assessed. 257 (76.3%) of the respondents were Yoruba, 47 (14.0%) were Igbo while other tribes constituted about 9.8%. 290 (86.1%) of respondents practised Christianity, 41 (12.2%) practised Islamic religion while other religions constituted about 1.8%.

Table 1 Sociodemographics N= 337

SOCIODEMOGRAPHICS	FREQUENCY (%)
Age group (years)
<=23	168 (49.9)
24-29	158 (46.9)
29 and above	11 (3.3)
Gender
Female	144 (42.7)
Male	193 (57.3)
Marital status
single	323 (95.9)
Not single	14 (4.2)
Department
Dentistry	60 (19.6)
Medicine and Surgery	246 (80.4)
Physiotherapy	31 (9.2)
Year of study
600 level	82 (24.3)
500 level	80 (23.7)
400 level	76 (22.6)
300 level	99 (29.4)
Tribe
Yoruba	257 (76.3)
Igbo	47 (14.0)
Others	33 (9.8)
Religion
Christian	290 (86.1)
Muslim	41 (12.2)
others	6 (1.8)

The lifetime prevalences (table 2) are 251 (74.5%) and 258 (76.6%) respectively while the point time prevalence of neck and low back pain are 51 (15.1%) and 63 (18.7%) respectively. Two hundred and five (60.8%) and 223 (66.1%) prevalence were observed in the last 12 months for neck and back pain respectively while in the last 7 months, 89 (26.4%) and 111 (32.9%) were observed respectively.

Table 2 Prevalence of Neck Pain and Low Back Pain N=337

PREVALENCE OF NECK PAIN	YES (%)	95% confidence interval
Have you any time had trouble (such as ache, pain, numbness etc)	251 (74.5)	69.5 – 78.9
Have you any time during the last 12 months had trouble (such as ache, pain, numbness etc)	205 (60.8)	55.5 – 65.9
Have you any time during the last 7 days had trouble (such as ache, pain, numbness etc)	89 (26.4)	21.9 – 31.4
While filling this questionnaire, do you have ache, pain, discomfort	51 (15.1)	11.7 – 19.4
PREVALENCE OF BACK PAIN
Have you any time had trouble (such as ache, pain, numbness etc)	258 (76.6)	71.7 – 80.8
Have you any time during the last 12 months had trouble (such as ache, pain, numbness etc)	223 (66.1)	60.9 – 71.0
Have you any time during the last 7 days had trouble (such as ache, pain, numbness etc)	111 (32.9)	28.1 – 38.2
While filling this questionnaire, do you have ache, pain, discomfort	63 (18.7)	14.9 – 23.2

The perceived risk factors (table 3) for neck and low back pain observed among respondents include: sitting without back support (219, 78.8%), prolonged study time (217, 78.1%), using the computer (220, 79.1%), use of smartphones (189, 68.0%), the posture assumed during lectures (233, 80.2%), the posture assumed during practical (239, 84.0%), prolonged sitting (189, 68.0%), prolonged standing (216, 77.7%), carrying heavy backpacks (186, 66.9%), engaging in physical activities (164, 59.0%), waking up to the neck or low back pain (206, 74.1%) and smoking (27, 9.7%).

Table 3 Perceived Risk Factors For Neck And Low Back Pain N=278

RISK	YES (%)	95% confidence interval
Seats without back support	219 (78.8)	73.6 – 83.2
prolonged study time	217 (78.1)	72.8 – 82.6
using the computer	220 (79.1)	73.9 – 83.5
use of smart phone	189 (68.0)	62.2 – 73.2
posture assumed during lectures	233 (80.2)	75.1 – 84.5
posture assumed during practicals	239 (84.0)	81.4 – 89.6
prolonged sitting	189 (68.0)	62.2 – 73.2
prolonged standing	216 (77.7)	72.4 – 82.2
carrying heavy backpacks	186 (66.9)	61.1 – 72.2
engaging in physical activities	164 (59.0)	53.1 – 64.7
woken up to neck or low back pain	206 (74.1)	68.6 – 78.9
smoking	27 (9.7)	6.7 – 13.8

Factors associated with neck pain using the last 7 days pain are shown in table 4a; the prevalence of neck pain was highest among the respondents between the ages 24-29 (31.2%), female (39.8%), single (32.5%), physiotherapy students (46.2%), 400 level students (34.4%), respondents from tribes other than Yoruba and Igbo (37.0%) and Christians (34.2%). Other factors include sitting without back support (85.4%), prolonged study time (80.9%), using the computer (85.4%), use of smartphones (78.7%), the posture assumed during lectures (83.2%), the posture assumed during practicals (88.8%), prolonged sitting (65.2%), prolonged standing (84.3%), carrying heavy backpacks (68.5%), engaging in physical activities (58.4%) and waking up to neck pain (82.0%).

Factors associated with low back pain using the last 7 days pain are shown in table 4b; the prevalence of low back pain was highest among the respondents between the ages 29 and above (50%), female (46.1%), physiotherapy students (57.7%), 4th-year students (47.5%), respondents from tribes other than Yoruba and Igbo (48.2%) and religions other than Christianity and Islam (80.0%). Others include sitting without back support (84.7%), prolonged study time (82.9%), using the computer (84.7%), use of smartphones (76.6%), the posture assumed during lectures (86.5%), the posture assumed during practicals (90.1%), prolonged sitting (72.1%), prolonged standing (88.3%), carrying heavy backpacks (67.6%), engaging in physical activities (59.5%) and waking up to low back pain (79.3%). However, regarding marital status, there was no difference between the prevalence of low back pain between singles and non-singles (40.0% in both cases).

Table 4a Factors Associated With Neck Pain (Using The Last 7 Days Pain) N= 278

FACTOR	NO (%)	YES (%)	P value
Age (years)
<=23	99 (68.8)	45 (31.2)	0.85
24-29	84 (66.7)	42 (33.3)
29 and above	6 (75.0)	2 (25.0)
Gender
Female	77 (60.2)	51 (39.8)	0.01
Male	112 (74.7)	38 (25.3)	0.01
Marital status
single	181 (67.5)	87 (32.5)	0.41
Not single	8 (80.0)	2 (20.0)	0.41
Department
Dentistry	29 (63.0)	17 (37.0)	0.16
Medicine and Surgery	146 (70.9)	60 (29.1)
Physiotherapy	14 (53.9)	12 (46.2)
Year of study
600 level	45 (67.2)	22 (32.8)	0.90
500 level	48 (71.6)	19 (28.4)
400 level	40 (65.6)	21 (34.4)
300 level	56 (67.5)	27 (32.5)
Tribe
Yoruba	141 (66.8)	70 (33.2)	0.35
Igbo	31 (77.5)	9 (22.5)
Others	17 (63.0)	10 (37.0)
Religion
Christian	158 (65.8)	82 (34.2)	0.15
Muslim	27 (81.8)	6 (18.2)
others	4 (80.0)	1 (20.0)
Seats without back support
No	46 (24.3)	13 (14.6)	0.06
Yes	143 (75.7)	76 (85.4)	0.06
prolonged study time
No	44 (23.3)	17 (19.1)	0.43
Yes	145 (76.7)	72 (80.9)	0.43
using the computer
No	45 (23.8)	13 (14.6)	0.08
Yes	144 (76.2)	76 (85.4)	0.08
use of smart phone
No	70 (37.0)	19 (21.4)	0.01
Yes	119 (63.0)	70 (78.7)	0.01
posture assumed during lectures
No	40 (21.2)	15 (16.7)	0.40
Yes	149 (78.8)	74 (83.2)	0.40
prolonged standing
No	48 (25.4)	14 (15.7)	0.07
Yes	141 (74.6)	75 (84.3)	0.07
Engaging in physical activities
No	77 (40.7)	37 (41.6)	0.90
Yes	112 (59.3)	52 (58.4)	0.90
smoking
No	171 (90.5)	80 (89.9)	0.88
Yes	18 (9.5)	9 (10.1)	0.88
posture assumed during practicals
No	29 (15.3)	10 (11.2)	0.36
Yes	160 (84.7)	179 (88.8)	0.36
prolonged sitting
No	58 (30.7)	31 (34.8)	0.49
Yes	131 (69.3)	58 (65.2)	0.49
carrying heavy backpacks
No	64 (33.9)	28 (31.5)	0.69
Yes	125 (66.1)	61 (68.5)	0.69
woken up to neck pain in the last 7 days
No	56 (29.6)	16 (18.0)	0.04
Yes	133 (70.4)	73 (82.0)	0.04

TABLE 4b Factors Associated With Low Back Pain (Using The Last 7 Days Pain) N=278

FACTOR	NO (%)	YES (%)	P value
Age (years)
<=23	86 (59.7)	58 (40.3)	0.82
24-29	77 (61.1)	49 (38.9)
29 and above	4 (50.0)	4(50.0)
Gender
Female	69 (53.9)	59 (46.1)	0.052
Male	98 (65.3)	52 (34.5)	0.052
Marital status
single	161 (60.1)	107 (40.0)	1.00
Not single	6 (60.0)	4 (40.0)	1.00
Department
Dentistry	22 (47.8)	24 (52.2)	0.02
Medicine and Surgery	134 (65.1)	72 (35.0)	0.02
Year of study
600 level	44 (65.7)	23 (34.3)	0.19
500 level	36 (53.7)	31 (46.3)
400 level	32 (52.5)	29 (47.5)
300 level	55 (66.3)	28 (33.7)
Tribe
Yoruba	126 (59.7)	85 (40.3)	0.43
Igbo	27 (67.5)	13 (32.5)
Others	14 (51.9)	13 (48.2)
Religion
Christian	142 (59.2)	98 (40.8)	0.06
Muslim	24 (72.3)	9 (27.3)
others	1 (20.0)	4 (80.0)
Seats without back support
No	42 (25.2)	17 (15.3)	0.05
Yes	125 (74.9)	94 (84.7)	0.05
prolonged study time
No	42 (25.2)	19 (17.1)	0.11
Yes	125 (74.9)	92 (82.9)	0.11
using the computer
No	41 (24.6)	17 (15.3)	0.06
Yes	126 (75.5)	94 (84.7)	0.06
use of smart phone
No	63 (37.7)	26 (23.4)	0.012
Yes	104 (62.3)	85 (76.6)	0.012
posture assumed during lectures
No	40 (24.0)	15 (13.5)	0.032
Yes	127 (76.1)	96 (86.5)	0.032
prolonged standing
No	49 (29.3)	13 (11.7)	0.001
Yes	118 (70.7)	98 (88.3)	0.001
Engaging in physical activities
No	69 (41.3)	45 (40.5)	0.90
Yes	98 (58.7)	66 (59.5)	0.90
smoking
No	153 (91.6)	98 (88.3)	0.34
Yes	14 (8.4)	13 (11.7)	0.34
posture assumed during practicals
No	28 (16.8)	11 (9.9)	0.11
Yes	139 (83.2)	100 (90.1)	0.11
prolonged sitting
No	58 (34.7)	31 (27.9)	0.23
Yes	109 (65.3)	80 (72.1)	0.23
carrying heavy backpacks
No	56 (33.5)	36 (32.4)	0.85
Yes	111 (66.5)	75 (67.6)	0.85
woken up to neck pain in the last 7 days
No	49 (29.3)	23 (20.7)	0.11
Yes	118 (70.7)	88 (79.3)	0.11

The impact of neck and low back pain is shown in table 5a. 34.8% of respondents with neck pain and 30.6% of respondents with low back pain report having depressive symptoms. The impact of neck and low back pain on disability shown in table 5b; neck pain caused mild (88.8%), moderate (10.1%) and severe disabilities (1.1%) while back pain also caused mild (88.3%), moderate (10.3) and severe disabilities (0.9%) among respondents.

Table 5a Impact On Depression N=278

Neck pain depression score	No	Yes	P value
No depressive symptoms	155 (82.0)	58 (65.2)	0.002
Depressive Symptoms	34 (18.0)	31 (34.8)	0.002
Back pain depression score
No depressive symptoms	136 (81.4)	77 (69.4)	0.02
Depressive Symptoms	31 (18.6)	34 (30.6)	0.02

Table 5b Impact On Disability N=278

Neck pain score	No	Yes	P value
Mild	184 (97.4)	79 (88.8)	0.01
Moderate	5 (2.7)	9 (10.1)
Severe	0 (0.0)	1 (1.1)
Back pain score
Mild	165 (98.8)	98 (88.3)	0.001
Moderate	2 (1.2)	12 (10.8)
Severe	0 (0.0)	1 (0.9)

Despite the Global Burden of Disease (GBD) 2019 and World Health Organization (WHO) reports (18), and coupled with the high prevalence of low back pain and neck pain in Africa (19), LBP and other musculoskeletal conditions remain less prioritized in LMICs, due to more pressing health issues like HIV/AIDS, enteric infections, tuberculosis, and the recent Coronavirus-19 pandemic (18). Of concern is that due to various epidemiologic challenges faced in various LMICs in Africa and the subsequent lack of accurate data, the true burden of low back and neck pain is still not well known.

The prevalence of LBP and NP is high among healthcare students. A study examined musculoskeletal pain (MSP) prevalence among Chinese medical and dental students, and revealed high rates of NP at 44.4% and LBP at 30.6%. Despite limited trauma history, moderate pain frequency and severity were noted, significantly impacting daily life. Compared to earlier studies, the current research suggests an increased prevalence of NP in modern medical students, attributed to factors like reduced physical activity and prolonged smartphone use. Notably, senior-year medical students reported higher LBP rates, possibly linked to changes in study and work modes during clinical years (20).

Dental students exhibited significantly higher MSP rates compared to medical students across NP, LBP, and joint pain (JP). This aligns with findings from international studies on dental professionals, attributing this trend to prolonged seated positions and fixed postures during clinical work. Risk factors for MSP encompassed age, sex, academic year, psychological conditions, and major, with joint pain notably affected by alcohol consumption. However, lifestyle factors like extended study hours and computer or phone usage didn't exhibit significant associations with MSP (20). Another cross-sectional study by Du et al conducted at an American medical school accredited by the LCME revealed a notably high prevalence of NP and LBP among medical students, reaching 54% (21). This prevalence is substantially higher when compared to the general population, where Strine et al. reported an NP prevalence of 1.8–3.7% and LBP prevalence of 15.0-15.9% in individuals aged 18–34 (21). Medical students reported various quality of life (QOL) issues associated with NP and LBP, including headaches and pain during activities like reading, standing, and sitting (21).

There is a dearth of data addressing the prevalence of low back pain and/or neck pain and their associated risk factor in Africa. Studies have reported the prevalence of musculoskeletal pain in undergraduate medical students of Serbia, France, Malaysia, Saudi Arabia, Zimbabwe, South Africa, Ethiopia, and Nigeria (22–26). However, just a few studies from these explored the prevalence of neck pain and low back pain

This study paid attention to the prevalence and risk factors of these musculoskeletal pains among medical students within our locality. The prevalences of low back pain and neck pain during the past one year in this study were 66.1% and 60.8% respectively, and these prevalence rates were higher than those reported in Serbian, Malaysian, Arabian, and Zimbabwean medical students, with a range of about 30% (22–26). The broad range could be attributed to differences in study sample size formula used, sampling technique as well as recall bias. Females had a higher preponderance to both low back pain and neck pain as this could be due to heightened pain sensitivity ubiquitous among the female counterparts (27).

For the low back pain, we found no correlation between it and factors like age, gender, marital status, year of study, tribe, religion, seats without back support, prolonged study time, using the computer, engaging in physical activities, smoking, posture assumed during practicals, prolonged sitting, carrying heavy backpacks. This is similar to the findings reported by Vujcic et al (11) and Alshagga et al (26). Age, marital status, department, year of study, religion, seats without back support, prolonged study time, using the computer, posture assumed during lectures, prolonged standing, engaging in physical activities, smoking, posture assumed during practicals, prolonged sitting, carrying heavy backpacks, have no associations with the development of neck pain. In contrast, Ayanniyi et al (28) reported seats without back support during lectures, long reading hours, and posture assumed during lectures as the most perceived causes of neck pain among respondents.

In this study, although the prevalence of neck pain across all years was fairly constant, the prevalence of low back pain was least in the third year, which is the most junior class of clinical school. Prevalence increased in the fourth and fifth years and then declined in the sixth year. This finding is consistent with the study conducted among medical and dental students at Fujian Medical University, Fuzhou, China by Lin Y et al., which reported an increasing prevalence of MSP with increasing student class grade but contrasted the results of a study conducted at Harvard among medical students by Jerry et al. where there is no significant difference between MSP among medical students of different grades (20). While the exact cause for such a trend is difficult to be identified, we believe that the already increasing curriculum pressure, along with hectic clinical rotations and preparation for medical board exams might be responsible. The decrease in prevalence among the finalists could be attributed to better stress-coping strategies; however, this requires further investigation.

Associated Risk Factors with the Prevalence of Neck Pain and Low Back Pain

The finding that smartphone use was significantly associated with both low back pain and neck pain among the respondents in this study highlights an important aspect of modern lifestyle contributing to musculoskeletal discomfort. It is noteworthy that a substantial percentage (68%) of participants perceived smartphone use as a risk factor for these pains, indicating a growing awareness of the potential impact of technology on their well-being. However, it is interesting to observe that while computer use was perceived as a risk factor for pain, its association was not statistically significant. Similar findings were reported by Lin et al in their cross sectional study amongst Chinese medical and dental students (20). The diverse range of postures associated with smartphone usage, including prolonged and awkward positions like bending the head forward, can strain the neck and back muscles. This is in contrast to computer use, often in ergonomic setups, which may offer more structured support. Additionally, the widespread and frequent use of smartphones in daily life intensifies strain due to longer durations and greater frequency, potentially contributing to the cumulative burden on neck and back muscles over time (29).

Gender has been identified as a potential risk factor for neck pain in various studies (30, 31). In this study, the prevalence of neck pain differed between genders, with a higher percentage of females (39.8%) experiencing neck pain compared to males (25.3%) in the last 7 days. The data showed that 39.8% of females reported neck pain within the last 7 days, while the corresponding percentage for males was 25.3%. Moreover, low back pain has a predilection for females, although not statistically significant in this study. This gender difference could be attributed to various factors such as differences in biomechanics, hormonal influences, and probable possibly variations in daily activities or postures. Further research could delve into the specific mechanisms underlying this gender-based disparity in neck pain prevalence and explore strategies for tailored intervention and preventive measures.

Indeed, the department in which students are enrolled, along with their posture during lectures and prolonged standing, have been identified as risk factors for low back pain in this study. The data showed that certain departments, such as dentistry, had higher prevalence rates of low back pain. This was found by Lin Y et al., where they found higher prevalence of neck and low back pain among the dental students compared to medical students NP (49.1 vs. 41.4%, P = 0.01), LBP (34.6 vs. 28.1%, P = 0.02. This might have been exaggerated because of their small class size, compared to respondents in medicine and surgery. This could potentially be attributed to the occupational characteristics of dental students, who frequently find themselves required to sit or stand for extended periods while maintaining a consistent posture, particularly during the clinical practice. Additionally, poor posture during lectures and prolonged standing were associated with increased prevalence of low back pain. These findings suggest that academic and occupational factors, as well as ergonomics and postural habits, play a significant role in the development of low back pain among college students. Addressing these factors through awareness campaigns, ergonomic interventions, and educational programs could potentially mitigate the risk of low back pain in the student population.

The inclusion of a large sample size of 420 college students (response rate of 80%) enhances the study’s generalizability to the entire students of the College of Medicine, University of Ibadan, and perhaps, what it is obtainable amongst healthcare students in the southwestern zone of Nigeria because of the shared educational characteristics. The study's comprehensive data collection and sampling technique, encompassing factors like demographics, risk variables, prevalence rates, and the consequences of pain on disability and mental health, furnishes a detailed and multifaceted perspective on the issue at hand. This holistic approach enriches the study's insights by encompassing a range of dimensions crucial to understanding pain prevalence among college students.

The study's strengths also extend to its diversified participant composition from different academic departments, a trait that bolsters the representation of various student populations. Moreover, the study's longitudinal analysis, which examines pain prevalence across different temporal periods, provides nuanced insights into the evolving patterns of pain experiences. This dynamic perspective enriches the understanding of pain's fluctuations over time. Lastly, the study's integration of statistical analysis fortifies the robustness of its findings by identifying associations between risk factors, demographics, and pain prevalence. Together, these strengths collectively underscore the study's credibility and enrich the understanding of the prevalence and implications of neck and low back pain among college students.

The study's limitations are also important to consider. Its cross-sectional design prevents the establishment of causal relationships between risk factors and pain outcomes, limiting the ability to determine whether identified factors directly contribute to neck and low back pain development or are merely correlated. Self-reported data reliance introduces the potential for recall and social desirability biases, possibly leading to inaccuracies in pain and risk factor reporting.

Sample selection from specific departments could introduce selection bias, restricting the findings' generalizability to other disciplines or institutions and potentially underrepresenting diverse student experiences. Moreover, the study's focus on a single institution limits external validity, as the findings may not universally apply to students from different universities or cultural contexts within the country. Variances in institutional policies, cultural norms, and unaccounted environmental factors may affect neck and low back pain prevalence differently.

Considering these limitations is crucial when interpreting the study's outcomes. Future research should explore causal relationships with longitudinal designs, address biases through objective measurements, broaden participant diversity, and include multiple institutions to yield a more comprehensive understanding of pain prevalence among college students. Also, further research should investigate the consequences of these MSP on the disability, mental health and academic performance of students as well as looking into the various coping strategies use by the students.

Conflict of interest

The authors do not have any conflicts of interest to declare concerning the content of the current manuscript.

Ethics approval and consent to participate

Ethical approval was approved by the Institutional Review Board of the University of Ibadan/University College Hospital (UI/UCH) Ethics Committee IRB number UI/EC/22/0314

Consent for publication

Consent was gotten from all participants

Availability of data and materials

All data generated or analysed during this study are included in this published article

Competing interests

The authors declare that they have no competing interests

Funding

No funding was received for this study.

Authors’ Contributions

SO conceptualized the study, S.O, T.O, A.O, A.F, D.O, E.O, S.O, A.A collected data, G.O analyzed the data. All authors wrote the first manuscript. All authors reviewed and approved the final manuscript.

Acknowledgments

Not applicable

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No competing interests reported.

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Prevalence and Risk Factors for Neck Pain and Low Back Pain Among College Students in Nigeria

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Abstract

INTRODUCTION

METHODS AND MATERIALS

Study Design and Participants

RESULTS

DISCUSSION

Associated Risk Factors with the Prevalence of Neck Pain and Low Back Pain

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References

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