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Prevalence of Low Back Pain Among DPT Students in Peshawar

Research Article                                          Vol:1,Issue:2

Aatik Arsh, Abid Jan

Abstract

Most physiotherapists suffer from some type of Low back pain (LBP) during their career1. Students of Physical therapy are exposed to same risk factors for developing LBP as qualified physical therapy clinicians are, such as working in faulty positions for long hours, frequent manual handling activities and performing repetitive movements. The aim of this study was to determine the prevalence of LBP among Doctor of Physical Therapy (DPT) students in PeshawarA cross-sectional prevalence study was carried out using previously validated questionnaire. The questionnaire was distributed among DPT students in Peshawar using Google doc system/email services and self-approach. The questionnaire which was provided to subjects consists of two parts. 1st part was related to the subject study habits, study hours, posture, clinical duties and clinical practice. 2nd part was related to the pain, in which questions were asked about pain from which the subject suffers. About 220 questionnaires were distributed among DPT students studying in Peshawar and 158 questionnaires were returned. The response rate was 71.81 %. Out of the total 158 respondents, 147 were considered valid. Among these 147 physical therapy students 51.7% were males while 48.3% were females. Out of the total 147 students, 17.7% (n=26) were of 1st year,16.3%(n= 24) of 2nd year,22.4%(n= 33) of 3rd year, 21.8%(n=32) of 4th year and 21.8%(n= 32) of 5th year (final year). Lifetime prevalence of LBP among DPT students was 48.3% (n=71). 12 month, 1 month and 1 week prevalence reported by these71 students were 81.60%, 57.74%, 39.43% respectively. Only 23.07% (n=6) students of 1st year report LBP while 71.87% student of final year report LBP. Increased LBP prevalence among 3rd year, 4th year and final year students was noticed as compared to 1st and 2nd year student. Students who use Laptops or computer more than 5 hours in a day report increased prevalence of LBP. Students involved in Academic activities (lectures and private study) of more than 50 hours in a month report high prevalence of LBP. Those students who were involved in clinical practice and treating patients more than 30 hours in one month had increased prevalence of LBP as compared to other students. Clinical practice, long study hours, increase use of computers and laptops are major contributing factors for development of LBP in DPT student.

SAJMED.2016; 1(2):29-34                                                                  PDF Download

Introduction

LBP is common complaint among Doctors, nurses, physical therapistsand other hospital employees(1). 12-month prevalence of LBP among health care workers is about 60% while in other professions it is closer to 45% (2). Due to work nature, Physical therapists have high prevalence of LBP as compared to other health care workers (3). Most physiotherapists suffer from some type of LBP during their career (1). Though in LBP treatment, physical therapist are directly involved yet studies done in UK, USA, Canada, Australia, Pakistan and many other countries reports high prevalence of LBP among Physical therapists(4). LBP prevalence among physical therapists ranged from 29% to 80% (5). LBP prevalence among physiotherapists ranged from 45% to 62% in US(3), from 58% to 68% in UK(5) while LBP prevalence in Canada was 49%(6), in Australia 35%(7), in Pakistan 72.9%(4). Approximately 60% newly graduated physical
therapists with age less than 30 years, experience some type of back pain in first five years of job after completion of their graduation
(8). Many studies showed that prevalence of LBP among young physical therapists is higher as compared to general population (9). In
Australian physical therapy students, Life time prevalence of LBP was about 69%, 1-week prevalence of LBP was 28 percent, 1-month
prevalence was 44% and 1-year prevalence was approximately 63%. LBP prevalence among final year (4th year) students was 81.7%, 3rd year student was 67.6%, 2nd year student was 72.4% and 1st year student was 57.5%, which shows that LBP is more common among final year students. Sitting in bad posture for long hours in class for lectures and clinical practice for more than 20 hours per week, predispose physiotherapy students to LBP. In Students with age 20 and 21 year, LBP was more common (9). kimelman et al, report in their study that 83% physical therapy students in Israel suffer from some type of MSK complaints in the last 1-year. According to kimelman, 1-year prevalence of LBP among them was 49% (1). Asdrubal Falavigna et al, reports in their study that physiotherapy students in Brazil were 2.51 times more likely to suffer from LBP as compared to other medical students. Lifetime prevalence of LBP in Brazilian physical therapy students was 82%, while 12-month and point prevalence were 73% and 19% respectively. 17.7% students of physical therapy report that they never suffer from LBP. The same study shows that Lifetime
prevalence of LBP in Brazilian medical students was 73% while 12-month and point prevalence were 59% and 9% respectively. They also concluded that those students who studied 5 or more semesters of their undergraduate course, had 2.55 times more chance to suffer from LBP because those students were more involved in practical activities (8). According to Karachi et al, 60% physical therapy students suffer from some type of LBP after 1-year of clinical activities. Approximately 32% after 1-week and 43% after 1 month of clinical duties report LBP11. According to Salmina Magdalena Burger, life time prevalence of LBP among physiotherapy students at Witwatersrand University South Africa was 35.6%. According to her study, there were important relations between LBP and hours of practical work while hours spent in theoretical learning did not play important role in developing LBP in physiotherapy student. About 24.6% students with LBP, suffer from pain at least one time in a week (11). Students of Physical therapy, are exposed to same risk factors for developing LBP as qualified physical therapy clinicians are, such as working in faulty positions for long hours, frequent manual handling activities and performing repetitive movements (12). Activities during practical training such as Soft tissue mobilization, techniques of manual therapy, transfer of patients who are dependent and lifting and transfer of heavy equipment etc.
increases the chances of LBP during their student life (13). Educational activities such as attending regular classes, sitting in awkward
positions for long hours in class for lectures, and “sitting looking down” while studying (private study), also prone physical therapy
students to LBP (9). Studies report that combination of factors such as long study hours, intensive and time-consuming curriculum, practical work (14), clinical practice in hospitals, Use of computers and laptops for long hours (15) and sedentary lifestyle predispose students to MSK injuries in their low back area (16). Among physical therapy students, there is significant increase in prevalence of LBP from 1st year to final year (4th year). Studies show that “the length of study years” was prominent risk factor for LBP9. Physical therapy students need to take strict prophylactic measures to prevent themselves from developing LBP. Doctor of physical therapy students are more vulnerable to LBP because during clinical work and study, most of the time they are in flexed posture. In Pakistan, research data on LBP prevalence among medical and nursing students is available but research on LBP prevalence among DPT students are not available. The aim of this study was to determine the prevalence of LBP among Doctor of Physical Therapy (DPT)
students in Peshawar. Moreover, by understanding prevalence and risk factors of LBP among DPT students, preventive schemes can be developed to reduce LBP prevalence among students in future.

Materials And Methods

A cross-sectional prevalence study was carried out using previously validated questionnaire. Questionnaire was taken from the study carried out by Nyland and Grimmer. The questionnaire which was provided to subjects, consist of two parts. 1st part was related to the subject study habits, study hours, posture, clinical duties and clinical practice. 2nd part was related to the pain, in which questions were asked about pain from which the subject suffers. The participants in research were Students of DPT who were studying in any public or private institute of Peshawar. Consecutive sampling was used for this research study. After obtaining ethical clearance from ethical board, permission was taken from director/principal IPMR KMU and from principals of respective institutes. Data was collected from DPT students, who fulfill the eligibility criteria for the study. The self-administered questionnaire was distributed among eligible subjects using following ways: Hard copy of questionnaire was provided to subjects directly by hands. Soft copy of questionnaire was provided to subjects using email services, Facebook, twitter etc. To each eligible participant, study was explained in detail. From each subject, informed consent was taken prior to the study.

Results

About 220 questionnaires were distributed among DPT students studying in Peshawar and 158 questionnaires were returned. The
response rate was 71.81 %. Out of the total 158 respondents, 147 were considered valid whereas remaining 11 were considered non valid. These 11 were those participants who failed to attempt whole questionnaire of the study or who didn’t fulfill eligibility criteria.
Among these 147 physical therapy students 51.7% were males while 48.3% were females. 34.7%% of respondents were having age from
17 and 20 years and 63.3% were having age from 21 to 25 years. Out of the total 147 students, 17.7% (n=26) were of 1st year, 16.3
%(n= 24) of 2nd year, 22.4%(n= 33) of 3rd year, 21.8%(n=32) of 4th year and 21.8%(n=32) final year (Figure 1). Results of the current study showed that the lifetime prevalence of LBP among DPT students was 48.3%. Out of the total 147 students 71 reports that they suffer from some kind of LBP. A tendency towards increasing LBP prevalence was identified from 1st year to final year. Only 23.07% (n=6) students of 1st year report LBP while 71.87% student of final year report LBP. Increased LBP prevalence among 3rd year, 4th year and final year students was noticed as compared to 1st and 2nd year student.
Students who use Laptops or computer more
frequently report increased prevalence of LBP.62.85 %( n=22) physical therapy students who use Laptops or computer more than 5 hours in a day report LBP. Only 20% (n=5) physical therapy students who use Laptops or computer less than 1 hour report LBP.

Discussion

The response rate to the current study was 71.81 %. The response rate to the study carried out by Salmina Magdalena Burger was 93.3% and response rate to the study of Nyland and Grimmer was 72%. In the study carried out by Salmina Magdalena Burger students of
physiotherapy filled questionnaires in the presence of researcher while in the current study most of the questionnaires were distributed using Email services. This can be a possible reason for low response rate in the current study. The response rate to the current study was consistent to that of the study carried out by Nyland and Grimmer. Results of current study showed that lifetime prevalence of LBP
among DPT students was 48.3% and 12 month prevalence was 81.60%, 1 month prevalence was 57.74% and 1 week prevalence was
39.43%. Lifetime prevalence of LBP among physical therapy students in the study carried out by Salmina Magdalena Burger was 35.6% and prevalence of LBP in the study of Nyland and Grimmer was 69%. In the study of Nyland and Grimmer 1-week prevalence of LBP was 28 percent, 1-month prevalence was 44% and 1-year prevalence was approximately 63%. Nayland and Grimmer mostly included 3rd year and 4th year students in their study that’s why prevalence was high as compared to current study. In the current study, tendency towards increasing LBP prevalence was identified from 1st year to final year. Only 23.07% (n=6) students of 1st year report LBP while 71.87% student of final year report LBP. Increased LBP prevalence among 3rd year, 4th year and final year students was noticed as compared to 1st and 2nd year student. these results were consistent with the results reported by other studies. Nayland and Grimmer reported that LBP prevalence among final year( 4th year) students was 81.7%, 3rd year student was 67.6%, 2nd-year student was 72.4% and 1st year student was 57.5%, which shows that LBP is more common among final year students.
Results of current study showed that educational activities which include attending lectures and private study were also associated with the development of LBP in physical  therapy students. Those students who regularly attend class lectures and “sitting looking straight” more than 50 hours in one month had increased prevalence of LBP as compared to other students. Those students who did their private study more than 50 hours in one month had increased prevalence of LBP as compared to other students. Time spent during clinical Placement which includes clinical practice and treating patients was also associated with increased prevalence of LBP. Those students who were involved in clinical practice more than 30 hours in one month had increased prevalence of LBP as compared to other students. According to Nyland and Grimmer, sitting in bad posture for long hours in class for lectures and clinical practice for more than 20 hours per week, predispose physiotherapy students to LBP. While other research studies reported that differences in age, gender and BMI etc. were the main reasons for LBP (Bakker et al, 2009; Karachi et al, 2007; Nyland and Grimmer, 2003; Kirstensen et al, 2001), current research study reported that long hours of clinical practice and clinical duties during student life, long study hours and increase use of computers and laptops were some of the contributing factors for the LBP.