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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 30  |  Issue : 1  |  Page : 28-33

Low back pain among attendants to a Family Health Center in El-Dakahlia governorate, Egypt


1 Department of Community and Public Medicine, Ain Shams University, Cairo, Egypt
2 Department of Family Medicine, Ain Shams University, Cairo, Egypt
3 Department of Orthopedic, Ain Shams University, Cairo, Egypt
4 Department of Family Medicine, Faculty of Medicine, Ministry of Health, Menoufia University, Mansoura, Egypt

Date of Submission21-Mar-2016
Date of Acceptance04-Apr-2016
Date of Web Publication25-Jul-2017

Correspondence Address:
Aliaa F Ahmed
Department of Family Medicine, Faculty of Medicine, Menoufia University, Mansoura, El-Dakahlia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_170_16

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  Abstract 


Objective
The aim of the study was to assess prevalence and degree of disability due to low back pain (LBP) among attendants to a Family Health Center.
Background
LBP is a serious medical and social problem and one of the most common causes of disability. Nearly everyone at some point suffers from LBP that interferes with work and recreational activity. Risk factors for LBP are multifactorial, including physical, improper social habits, and psychological factors.
Patients and methods
This was a case–control study nested in cross-sectional study. The study was conducted in Nusa-Gheit Family Health Center (El-Dakahlia governorate, Egypt) and included 154 attendances aged 18–60 years during the period of the study. Every participant was assessed for LBP through history taking and examination. In addition, the participants were assessed for degree of disability due to LBP using the Roland–Morris Disability Questionnaire.
Results
Prevalence of LBP was 53.2%. It was more among female patients (62.8%) than among male patients (38.3%). There was a statistically significant relationship between LBP and being female (P = 0.003, odds ratio = 2.71), smokers (P = 0.01, odds ratio = 6.5), and with increasing BMI. Furthermore, there was a statistically significant relationship between degree of disability and both different age groups (P = 0.002, odds ratio = 0.19) and marital status (P = 0.009, odds ratio = 0.06). As regards age, it was more common among patients aged greater than or equal to 40 years (86.2%). Regarding the severity of disability, severe disability was noted among male patients (78.3%) and married patients (80.5%). LBP affected the regularity of attending work.
Conclusion
LBP is highly prevalent among women, divorcees/windows, elderly, smokers, and obese individuals.
Recommendation
Primary healthcare physicians should use the evidence-based strategy in diagnosing and management of LBP. Integration of topic-related to diagnosis, management referral indication in Egyptian national guideline for family physician. Moreover, LBP prevention programs among patients should focus on improved working environment and decreased risk factors of LBP.

Keywords: disability, low back pain, prevalence, risk factors


How to cite this article:
Mahrous OA, Shaheen HM, Hadhoud MM, Ahmed AF. Low back pain among attendants to a Family Health Center in El-Dakahlia governorate, Egypt . Menoufia Med J 2017;30:28-33

How to cite this URL:
Mahrous OA, Shaheen HM, Hadhoud MM, Ahmed AF. Low back pain among attendants to a Family Health Center in El-Dakahlia governorate, Egypt . Menoufia Med J [serial online] 2017 [cited 2019 Jun 19];30:28-33. Available from: http://www.mmj.eg.net/text.asp?2017/30/1/28/211485




  Introduction Top


Low back pain (LBP) is more accurately called lumbago or lumbosacral pain, which is defined as discomfort, tension, or stiffness below the costal margin and above the inferior gluteal folds [1]. In Egypt, patients with LBP constituted a high percentage of patients seeking medical care at outpatient's clinics. According to number and frequency of patients attending Abo Khalefa center, Ismailia governorate, the prevalence of LBP was 48% [2].

Risk factors for LBP are multifactorial, including exercise, obesity, smoking, age, and sex, and these can be grouped together as individual factors [3]. Other work-related lifestyle factors such as alcohol consumption and smoking have been found to contribute toward increased LBP levels [4].

A strong association can be made between lifetime occupational exposure to heavy and frequently lifting and severe LBP history [5]. In Egypt according to a El-Ghazaly et al. [6] study among nurses, the individual factors showed significant relation with LBP, which were age, marital status, and BMI.

LBP is one of the most common causes of disability in the working population. Self-related disability at work was strongly associated with the presence of musculoskeletal disorders or other musculoskeletal diseases. It has been reported that between 30 and 40% of the individuals with acute LBP never recover completely and develop chronic LBP [7].

In recent years, there have been a growing number of reports on the benefits of Pilates-based exercises for LBP that is creating a large socioeconomic burden in developed countries. Employees who are unable to work due to back pain spend a significant amount of time on sick leave, which impacts the productivity in the work place [8].


  Patients and Methods Top


Patients

The study was a case–control study nested in a cross-sectional study. The study was conducted at Nusa-Gheit Family Health Center (El-Dakahlia governorate, Egypt). The sample was calculated on the basis of the highest prevalence of LBP from the previous literature, which was 78.6% [9], and the lowest prevalence, which was 25.34% [5]. The calculated sample was 138, which was then increased to 160 cases to avoid dropouts in the patients with incomplete examination (six patients did not complete examination; dropout rate: 3.7%). The studied population were selected through systemic random technique sample using 160 family files with every four family files chosen one. The calculated samples were selected from the patients attending the center 3 days/week until the calculated sample was achieved (6 months). The studied participants were selected from the patients aged 18–60 years (both men and women) attending the selected Family Health Center for primary healthcare services during the period of the study, with exclusion of patients having LBP secondary to other diseases, aged more than 60 years old, less than 18 years old, and those with red flags symptoms and signs including recent history of trauma, structural deformity of the spine, saddle anesthesia, previous or current cancer, neurological deficit, etc.

Method

Each participant was assessed through history taking and general and local examinations. History included personal history as marital status and socioeconomic factors, with assessment of the socioeconomic status according to El-Gillany et al. [10]. Complain and history of present illness onset, duration course, and associated manifestations were also assessed, which was followed by complete physical examination to confirm diagnosis. In addition, the degree of disability was assessed using the Roland–Morris Disability Questionnaire (RMDQ) [11].

Modified RMDQ version which is constructed by choosing statements from sickness impact profile, covering daily living about physical and mental functioning for evaluating back disability. The scale consists of 10 yes/no items. The physical functions are considered, including walking, bending over, sitting, lying down, dressing, sleeping, self-care, and daily activities, as patients were asked whether the statements applied to them that day (i.e., the last 24 h). In scale, one point is given for each item. RMDQ score can be obtained by adding up the number of items and the final score ranges from zero (no disability) to 10 (sever disability), with assessment of the effect of LBP on work regarding absentees and number of days missed from work.

The study was approved by the Ethical Committee of the Faculty of Medicine, Menoufia University. An official permission letter was obtained from the local health authorities in Nusa-Gheit Family Health Center, as well as from all participants after explaining the aim of the study.

Data were analyzed with SPSS (version 16.0, SPSS Inc., Chicago, Illinois, USA). Descriptive statistics were expressed as number and percent to summarize qualitative data. Continuous variables were summarized by mean and SD for parametric data. Independent t-test was used to compare between the two means. The categorical variables were compared with the χ2 test. Fisher's exact test was used when 50% of cells or more were less than 5. P value less than or equal to 0.05 was considered as statistically significant.


  Results Top


The study revealed that the prevalence of LBP was 53.2% [Figure 1]. The mean age was 39.7 ± 10.9 years and more than half of patients with LBP (62.8%) were females and the majority of patients with LBP (100%) were divorcees/windows. Finally, about 63.4% of patients with LBP had middle socioeconomic score [Table 1]. There was a statistically significant relationship between the prevalence of LBP and sex (P = 0.003, odds ratio = 2.71) [Table 1], and with increasing BMI for obesity class I (P = 0.002, odds ratio = 1.4), for obesity class II (P = 0.02, odds ratio = 6.5), for obesity class III (P = 0.03, odds ratio = 6.5) [Table 2]. Moreover, there was nonsignificant relationship between the prevalence of LBP and both age (P = 0.32, odds ratio = 0.59) and marital status (P = 0.45) [Table 1]. Regarding lifestyle factors, there was a significant relation between the prevalence of LBP and smoking (P = 0.01, odds ratio = 2.6) [Table 1]. In addition, there was a significant effect of LBP on work absentees, with 67.9% for absentees for more than 3 days [Figure 2].
Figure 1: Prevelance of low back pain (LBP) among studied patients.

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Table 1 Sociodemographic characteristics and smoking habit among studied patients

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Table 2 Body mass index among studied patients

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Figure 2: Work absentees due to low back pain (LBP) among studied patients.

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Regarding the RMDQ LBP in the present study, the mean of total score of LBP disability was 7.13 ± 1.9, ranging from 10 with sever disability to zero with no disability [Table 3]. Furthermore, the highest frequency of LBP was found among married individuals (80.5%), men (78.3%), and those aged greater than or equal to 40 years old (86.2%), with a statistical significance for both age (P = 0.002, odds ratio = 0.19) and marital status (P = 0.009, odds ratio = 0.06) [Table 4]. Moreover, the highest numbers (63 cases) were noted for patients with severe disability due to LBP [Figure 3]. There was positive correlation between the Roland–Morris score and both age and BMI (P = 0.549 and 0.323), with statistically significant difference (P < 0.05), and negative correlation with the El-Gillany socioeconomic score, with statistically significant difference (P < 0.05) [Table 5].
Table 3 Frequency of the items of the Roland–Morris Disability Questionnaire among studied participants with low back pain

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Table 4 Relation between degree of disability by Roland–Morris Disability Questionnaire and both sociodemographic factors and smoking habit

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Figure 3: Degree of disability severity among studied patients.

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Table 5 Correlation between Roland–Morris disability score and age, body mass index, and socioeconomic score

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  Discussion Top


LBP is a multifactorial disorder with many possible etiologies. LBP is the most common health problem. This case–control study, nested in a cross-sectional study, focused on risk factors for LBP and attempted to analyze the sociodemographic characteristics and individual and physical factors such as sex, age, nationality, BMI, lifestyle habits, physical straining, heavy lifting, and postural stress aiming to estimate the prevalence, risk factors, and degree of disability of LBP among general population. This study was conducted at Nusa-Gheit primary healthcare center in El-Dakahlia governorate. The study was based on the following research question: What are the prevalence and risk factors of LBP among population attending Nusa-Gheit primary healthcare center, El-Dakahlia governorate?

The current study confirmed that LBP is a prevalent complaint, as LBP prevalence was found to be 53.2% [Figure 1]. This was in agreement with the results of a study by Ibrahim [12], conducted among Egyptian school girls and that of Peláez-Ballestas et al. [13], conducted among Mexican population; they stated that the prevalence of LBP was 46.3 and 51.4%, respectively. But the results of the present study differed from the results of Fouad et al. [9] who stated that the prevalence of LBP was 78.6%. The higher prevalence in the study of Fouad et al. [9] may be attributed to the fact that it was carried out in a paper factory.

The current study revealed significant correlation between the prevalence of LBP and sex (P = 0.003), with a higher prevalence in women (62.3%) compared with men (38.3%) [Table 1]. These results were in line with those of the previously reported studies that showed that LBP symptoms were consistently more common among women. Foster [7] and Shiri et al. [14] stated that the risk for LBP is higher among women due to the stress of hormonal changes, gynecological problems, and child birth. A door-to-door survey done by Coste et al. [15] reported that the prevalence of LBP in men was 55% and in women it was 45%. The difference may be attributed to the higher percentage of women in the study sample compared with men.

In the current study, the prevalence of LBP was higher among patients who were housewives/nonworking (55.1%) compared with workers (47.2%) [Table 1]. On the other hand, Fouad et al. [9] stated that the prevalence of LBP was more in workers (86.3%) than in officers (13.7%), and this may be attributed to the fact that the study was conducted in a paper factory where workers were more represented in the study sample than did officers.

Lifestyle factors

In the present study, a smoking habit was significantly higher in LBP patients (P = 0.01) [Table 1]. This was in the line with Bener et al. [16] and Biglarian et al. [17] who demonstrated that smoking was consistently associated with LBP.

Low back pain and quality of life

The current study reported a significant correlation between age and degree of disability (P = 0.002) [Table 4]. This was in agreement with Al-Disoky et al. [2] who showed that there was significant correlation between age and degree of disability (P < 0.001).

Recommendations

Primary healthcare physicians should use the evidence-based strategy in diagnosing and managing LBP. Integration of topic related to diagnosis, management referral indication in Egyptian national guideline for family physician. Furthermore, awareness should be raised about the magnitude of the problem, about the risk factors for LBP. LBP prevention programs among patients should focus on improved working environment and decreased risk factors of LBP.


  Conclusion Top


LBP is highly prevalent among women, widows/divorcees, older age, and obese individuals. In addition, smoking and lifting heavy objects, bending, prolonged standing or sitting, and work-related factors have a significant effect on LBP to the point that it compromises patients' daily lives, work habits, and work absentees significantly.

Moreover, this study showed that LBP is rarely fatal but profoundly affects functioning, and thus the health-related quality of life of the patients with LBP is significantly less compared with healthy persons in the physical and psychological domain.

Furthermore, the current study's findings support the fact that LBP continues to be an important clinical, social, and economic burden and a public health problem affecting the world population.

Recommendations

For physicians

  • Primary healthcare physicians should use the evidence-based strategy in diagnosing and managing LBP
  • Managements of LBP cases should be included in National Egyptian guideline for family physicians.


For patient

  • LBP prevention programs among patients should focus on improved working environment and decreased risk factors of LBP
  • Reducing BMI through regular exercise, eating fruits and vegetables, and the addition of exercise training to a diet program can add to the weight loss.


For researchers

Future research on the community prevalence of LBP should be conducted, which is needed before an accurate assessment of the social impact of LBP on society with respect to disability and cost can be determined.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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American Academy of Family Physician. Diagnosis and treatment of acute low back pain; 2012 Available at: http://unmfm.pbworks.com/w/file/fetch/68529143/Diagnosis%20and%20treatment%20of%20low%20back%20pain_AAFP.pdf. [Last accessed on 2016 Jan].  Back to cited text no. 1
    
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Shiri R, Solovieva S, Husgafvel-Pursiainen K, Taimela S, Saarikoski LA, Huupponen R, et al. The association between obesity and the prevalence of low back pain in young adults: the cardiovascular risk in young Finns study. Am J Epidemiol 2008; 167:1110–1119.  Back to cited text no. 14
    
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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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