This study aimed to objectively measure the prevalence of LBP and its risk factors among nurses in Qassim . This research is potentially the first comprehensive analysis of LBP involving four major public health facilities in Qassim. We aimed to measure the prevalence of LBP of nurses during their working life. The study found the prevalence of LBP was 65.5%. The literature shows a wide variation in LBP prevalence. However, the numbers are invariably high as reported in previous intentional studies conducted among nurses in Switzerland [24], Nigeria [25] , Slovenia [26], Jordan [27], and South Africa [28] .Nationally, LBP prevalence was reported as 74.2 % , and 48.4% among operating room staff in Makkah & Taif respectively [29,30] . In addition, a study showed a prevalence of 53.2 % among nurses in Sudayr region [31]. Those findings reflect the burden of LBP among an important healthcare workforce. However, no significant gender-related differences in prevalence were reported. This finding is inconsistent with previous studies that showed a higher prevalence of LBP among females compared to males [25, 32] . Nurses are at the heart of healthcare systems worldwide and have indispensible role in the delivery of healthcare. Our results also showed that 61.8% of nurses who reported LBP had suffered from pain spreading to below their knees and over 38% of them had sought treatment for LBP. In addition, over 31% of nurses in the study reported absence from work due to LBP .This finding is in agreement with a previous Saudi study indicating that almost 44% of nurses reported considering changing their job due to LBP [33].
In depth analysis of the potential risk factors for LBP, shows that occupation-related back pain is a complex phenomenon and its underlying causes are multifactorial. In the literature A web of causation of LBP was described which includes; demographical factors, lifestyle factors, occupational factors, and psychological factors [34].
Regarding the demographic characteristics and based on the logistic regression analyses, our study found that age had significant different odds for the study participants with LBP when compared with those without LBP. Nurses aged over 40 years were less likely to develop LBP when compared to nurses of younger age. Specifically, they had 64% less likely odds of developing LBP. Our result is in contrast with other studies which show LBP is associated with older age [25, 35, 36]. On other hand, however, this result is supported by past evidence which indicate that younger nurses between 20-30 years had the highest prevalence of LBP [37]. This might be due to the fact that younger nurses are more likely to be involved in heavy workload as healthcare assistants or staff nurses. This type of workload involves assistance mobilizing of patients or instruments and hence requires more musculoskeletal effort. While older, probably senior nurses are expected to be responsible for organizational or supervisory jobs with less musculoskeletal strains. This finding could also be attributed to training. Older nursing staff would have received extensive training on health and occupational safety and had developed awareness and skills on safe posture technique over time and so less likely to adopt faulty postures. Additionally, younger nurses with limited work experience and high job demand may suffer more from psychological stress compared to older nurses who might have already developed effective strategies to cope with work and personal stress. This explanation is supported by a previous study which indicates that younger nurses have higher job-related stress [37]. Another plausible explanation for the decreased odds for LBP among older nurses is the healthy worker effect. LBP sufferers tend to change their employment or quit their jobs, whereas healthy nurses are more likely to stay in their jobs [38].
This study also investigated the effect of life style factors on LBP. Evidence from the literature suggests a strong association between smoking and LBP confirming that smokers are more prone to LBP [39]. It has been found that nicotine significantly decreases the amount of oxygen reaching the muscles resulting in increased likelihood for muscular injury and degenerative changes [40]. Additionally, it is plausible that smoking induces coughing reflexes which may further increase the risk among smokers for LBP. However, no significant effect of smoking could be detected in this study. A previous study showed similar results [41]. Historically, females in the Arab world are less likely to report their smoking habits for cultural reasons. Over 90% of the study participants were females and therefore under-reporting could be the reason why smoking couldn`t be detected as a significant predicator for LBP in this study. Similarly, no significant association was found between physical activity and LBP in this study. Interestingly, past evidence detected that physical exercise such as pilates intervention reduces LBP [42]. Some authors, however, described the relationship between physical activity and LBP as U-shaped, where moderate increased risk was exclusively found for those engaged in strenuous activities and those living a sedentary lifestyle [43].
Beside their professional duties nurses are expected to assist in other ancillary services such as mobilizing patients or equipment. Five occupation-related risk factors were tested in this study, those were; working hours per week, work duration, additional work hours per week, type of ward and number of patients requiring mobilization. Of those, only the factor “type of ward” remained statistically significant after adjusting for potential cofounders. Prior evidence has shown that LBP prevalence among nurses working in intensive care units was particularly high [44]. Another study showed that nurses working in the Obstetrics and Gynecology had a high prevalence of LBP exceeding 26% [25]. A different study revealed that the prevalence of LBP was higher among nurses working in surgical wards.[45]. Surprisingly, our study found that nurses working in the general surgery ward have 61% less odds for LBP compared to other departments. Surgical nurses are expected to be more exposed to back pain and injuries due to the nature of the work compared to nursing duties in other wards. Examples of risk include working with dependent patients, standing in one position during lengthy surgical operations, holding patient extremities, moving anesthetized patients, lifting equipment, carrying heavy trays, etc . However, nurses working in surgical departments might have already developed better awareness of this particular risk and hence have become well prepared for their jobs. They might have better skills related to body mechanics and ergonomics compared to nurses working in other wards resulting in lower risk among them. Alternatively, the significant association between working in a surgical ward and lower risk for LBP might indirectly be related to the perceived amount of workload in terms of less number of patients, and a shorter hospital stay of patients in surgical wards. In fact, it is not clear from our data the length of work experience in wards for nurses at the time of the study and its relation to the onset of LBP. Nurses typically rotate between wards during their working life and it is difficult to determine the temporal association between the type of ward and development of LBP in this study. Psychological factors were documented by other studies to have significant association with LBP [16,33,34], however stress and low mood were not identified as risk factors of LBP in this study.