|Year : 2021 | Volume
| Issue : 3 | Page : 296-302
Low back pain prevalence and associated risk factors among medical students at four major medical colleges in Saudi Arabia
Hamza M Alrabai1, Mohammed H Aladhayani2, Salem M Alshahrani2, Zaid K Alwethenani2, Mohammed J Alsahil2, Abdulrahman D Algarni1
1 Department of Orthopedics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
2 College of Medicine, King Saud University, Riyadh, Saudi Arabia
|Date of Submission||23-Oct-2020|
|Date of Decision||23-Dec-2020|
|Date of Acceptance||03-Jan-2021|
|Date of Web Publication||26-Jul-2021|
Hamza M Alrabai
Department of Orthopedics, College of Medicine, King Saud University, P.O. Box 7805, Riyadh 11472
Source of Support: None, Conflict of Interest: None
Aim: The aim of this study was to determine the prevalence of low back pain (LBP) and to identify risk factors associated with LBP among medical students. Materials and Methods: A cross-sectional study was conducted among 2021 medical students from four medical colleges in Saudi Arabia during the academic year 2019–2020. A self-administered questionnaire was conducted and included three sections: demographic data, risk factors of LBP, and prevalence of LBP (during lifetime, past 12 months, and past 7 days). Data were analyzed using SPSS. Results: A total of 2021 medical students responded to our survey. The participants were 57.1% female and 42.9% male. Most of the students' ages (76.3%) ranged from 20 to 24 years. Medical students younger than 20 and older than 24 were 21.8% and 1.9%, respectively. The prevalence of LBP was 80.7% at any time, 67.6% in the past 12 months, and 38.2% in the past 7 days. Females were found to have higher prevalence of LBP than males (P < 0.0001), 95% confidence interval (CI) (1.37, 2.04). History of physical trauma to the back was significantly associated with LBP (P < 0.0001), 95% CI (1.32, 2.40). A lack of daily exercise was also found to be associated with LBP (P = 0.015), 95% CI (1.05, 1.55). LBP affected the daily functions, such as walking and sleeping, of 30.1% of medical students. Around 11% of medical students sought medical care because of LBP. Conclusions: We conclude that the prevalence of LBP is high among Saudi medical students. LBP seemed to be higher in females and associated with history of back trauma. Back care awareness should be emphasized among medical students.
Keywords: Low back pain, medical students, orthopedic, prevalence, risk factors, Saudi Arabia
|How to cite this article:|
Alrabai HM, Aladhayani MH, Alshahrani SM, Alwethenani ZK, Alsahil MJ, Algarni AD. Low back pain prevalence and associated risk factors among medical students at four major medical colleges in Saudi Arabia. J Nat Sci Med 2021;4:296-302
|How to cite this URL:|
Alrabai HM, Aladhayani MH, Alshahrani SM, Alwethenani ZK, Alsahil MJ, Algarni AD. Low back pain prevalence and associated risk factors among medical students at four major medical colleges in Saudi Arabia. J Nat Sci Med [serial online] 2021 [cited 2021 Oct 19];4:296-302. Available from: https://www.jnsmonline.org/text.asp?2021/4/3/296/322318
| Introduction|| |
Low back pain (LBP) is a common musculoskeletal disorder that affects muscles and bones of the back among all age groups globally.,, In Saudi Arabia, the prevalence ranges from 53.2% to 79.17%., LBP is reported at a high rate among medical students, due to time-consuming curricula that lead to a sedentary lifestyle.
Multiple studies have reported a high prevalence of LBP among medical students. A study at Weill Cornell Medical College found that the overall prevalence of LBP was 47%. Another study at the Faculty of Medicine in Belgrade showed a lifetime prevalence of LBP of 75.8% in medical students, with a 12-month prevalence of 59.5%. A study carried out at Malaysian Medical College found that the prevalence of LBP in the past year was 46.1%, exceeding the prevalence of neck and shoulder pain (41.8% and 22.8%, respectively). Another study among Chinese medical students found that the lower back was the most commonly affected area in the previous year (40.1%).
In Saudi Arabia, a study conducted at university hospitals in central Saudi Arabia found that the 12-month prevalence of LBP was 67%. Another study at Umm Al-Qura University in Makkah showed a high prevalence of LBP during the past week and the past year (50.1% and 45.3%, respectively). A study conducted among male students at Taif University found that 35.5% of medical students suffered from LBP.
Many previous studies have defined risk factors associated with LBP in adults, including age, gender, obesity, sitting for a long time while using the computer, exercise, daily number of study hours, history of back problems, family history of back pain, and smoking.,,, The goal of this study was to assess the prevalence and associated risk factors of LBP in medical students and to determine the subsequent impact on their lifestyle.
| Materials and Methods|| |
The study proposal was approved by the institutional board review at King Saud University (E-19-4307). This cross-sectional study was conducted among medical students (2021) enrolled at the Colleges of Medicine at King Saud University, King Abdulaziz University, Umm Al-Qura University, and Imam Abdulrahman Bin Faisal University (all located in Saudi Arabia) during the period from October to November 2019. This study used an online self-administered questionnaire in the English language. An online questionnaire was formulated based on study objectives and available questionnaires used in previous studies with similar objectives.,,, The questionnaire included 20 questions and collected information on demographic characteristics (age, gender, height, weight, and academic year), risk factors (smoking, history of back trauma, family history of back pain, exercise, and coffee drinking), average hours of computer use, average hours of study at home, backpack use, prevalence of LBP (lifetime, past 12 months, and past 7 days), and the impact of pain on daily functioning (sleeping and walking). These items were included based on a literature review and the rate of consultation due to LBP. The online survey was designed using Google Forms (Google LLC, Mountain View, CA, USA) and distributed through WhatsApp groups (WhatsApp Inc., Menlo Park, CA, USA) to each year (from 1st to 5th year) of male and female medical students. The primary inclusion criterion was that participants must have been a male or female medical student at the College of Medicine at King Saud University, King Abdulaziz University, Umm Al-Qura University, or Imam Abdulrahman Bin Faisal University. The exclusion criteria were the following: (1) not a medical student, (2) a former medical student of the aforementioned universities, and (3) an established diagnosis of spine pathology. Informed consent was provided to indicate the purpose of the study and to affirm the right of the participant to withdraw at any time without any obligation toward the study team. We assured the anonymity of each participant and the confidentiality of the collected information. The obtained data were only used for the current study.
Data were analyzed using SPSS 24.0 version (IBM Inc., Chicago, IL, USA) statistical software. Descriptive statistics (mean, standard deviation, frequencies, and percentages) were used to describe the quantitative and categorical variables. Pearson's Chi-square test was used to observe the association between the categorical study variables and the prevalence of LBP. Unadjusted odds ratios with their 95% confidence intervals (CIs) were calculated to measure the association between the study variables and LBP. P ≤ 0.05 was used to report the statistical significance of results.
| Results|| |
A total of 2021 medical students responded to the survey. Overall, 57.1% were female and 42.9% were male. Most students (76.3%) ranged in age from 20 to 24 years, with 21.8% of participants younger than 20 years and 1.9% of participants older than 24 years. The students were evenly distributed among the four universities: 22.8% of participants were from King Saud University, 24.3% were from King Abdulaziz University, 25.0% were from Umm Al-Qura University, and 27.8% were from Imam Abdulrahman Bin Faisal University. Overall, there were 1302 clinical students (64.4%) and 719 preclinical students (35.6%). A majority of participants (57.8%) exercised daily and only 11.2% were smokers. The distribution of characteristics is shown in [Table 1].
The prevalence of LBP among medical students in the four colleges was 80.7% at any time, 67.6% in the past 12 months, and 38.2% in the past 7 days [Figure 1]. The study revealed that 30.1% of medical students with LBP had daily functions, such as walking and sleeping, affected. Of the medical students who suffered from LBP, 11.6% consulted a physician, physiotherapist, or other health professionals as a result [Figure 2]. The mean body mass index (BMI) of students who had LBP was not significantly different from the mean BMI of those who did not have LBP (t = −0.489, P = 0.625).
|Figure 1: Prevalence of back pain among medical students in specific points of time (n = 2021)|
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|Figure 2: Impact of back pain on medical students' daily activities and need for medical care (n = 1630)|
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There was no significant association between LBP and age (P = 0.963) or clinical years status (P = 0.083). There was a significant association between the prevalence of LBP and gender (P < 0.0001). There was a statistically significant association between gender, the subject's university, and LBP. Female subjects were 1.67 times more likely to have LBP compared to male subjects, and the odds of participants from Umm Al-Qura and King Abdulaziz universities having LBP were 1.65 and 1.67 times greater, respectively, when compared with subjects from King Saud University [Table 2].
|Table 2: Association between demographic characteristics and prevalence of low back pain in medical students (n=1630)|
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The findings showed a significant association between LBP and history of back trauma (P < 0.0001). There was no significant association between LBP and the duration of computer use per day (P = 0.635) or hours of studying at home (P = 0.057). Furthermore, carrying a backpack (P = 0.671), family history of LBP (P = 0.605), coffee intake (P = 0.668), and smoking (P = 0.074) were not significantly associated with the prevalence of LBP. Daily exercise was significantly associated with LBP (P = 0.015), meaning that students who did not exercise daily were 1.27 times more likely to have LBP when compared with those who did exercise daily [Table 3].
|Table 3: Association between daily activities and lifestyle habits and prevalence of low back pain in medical students (n=1630)|
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The bivariate analysis also shows a highly statistically significant association between the response of “lower back troubles in the past 12 months” and prevalence of LBP, where the odds of subjects with a history of lower back troubles in the past 12 months having LBP were 8.27 times greater when compared with those who did not have this history. In addition, the odds of participants who were not able to do their normal activities having LBP were 2.75 times higher when compared with those who were able to do their normal activities. There was also a statistically significant association between the response of “consult health professional” and LBP, with participants 2.89 times more likely to have LBP when a health professional was consulted [Table 4].
|Table 4: Association between history, consequences, and prevalence of low back pain in medical students (n=1630)|
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The multivariate binary logistic regression analysis showed that the independent factors associated with LBP were gender (female), lower back trouble for the past 12 months (yes), prevent normal activities (yes), consult physician (yes), and university attended (Umm Al-Qura and King Abdulaziz). The adjusted odds ratios and their 95% CIs are shown in [Table 5].
|Table 5: Independent associated factors of low back pain among medical students (by multivariate stepwise logistic regression)|
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| Discussion|| |
Our results have demonstrated a lifetime prevalence of LBP among medical students of 80.7%, with 67.6% of these participants reporting LBP in the past 12 months, and 38.2% of these participants reporting LBP in the past 7 days. Our study findings were relatively comparable to similar studies conducted in other countries. A study among medical students in Belgrade showed a point prevalence of LBP of 17.2%, a 12-month prevalence of 59.5%, and a lifetime prevalence of 75.8%. A Malaysian study found that 27.2% of medical students had experienced LBP in the past 7 days and 46.1% of students had experienced LBP in the past 12 months. A study among Chinese medical students found the prevalence of LBP over the past 7 days and 12 months to be 20.8% and 40.1%, respectively. In a study in Delhi, the overall prevalence of LBP among students over the past 12 months was 47.5%. Another study of students at Saudi Arabian universities showed a lifetime prevalence among medical students of 72.1%.
The results of the present study revealed a significant association between LBP and gender, with a high prevalence of LBP reported among females; a similar association has been frequently reported in the literature., A systematic review of the global prevalence of LBP showed that the highest prevalence is among females. However, gender predilection for LBP is still a controversial issue. Our study also found a high prevalence of LBP among students with a history of back trauma, a finding that has also been supported by the literature.
The present study demonstrated a significant association between exercise and LBP. This finding was consistent with a previous study conducted among medical students, which showed that exercising weekly significantly improves LBP. Another study demonstrated that hours of exercise per week were linearly and inversely related to the risk of LBP.
In previous studies, carrying a backpack, family history of LBP, and hours of study at home found a positive correlation with LBP.,, However, the results of this study showed no statistically significant association between these factors and LBP. Similarly, a study conducted among medical students in Pakistan showed that there was no correlation between study hours per day or family history of musculoskeletal disorders with the incidence of neck, shoulder, or lower back pain. Our study did not recognize any significant difference in BMI among students who suffered from LBP and their peers who had no LBP. Several studies have reported variable data about the possible contribution of BMI to the development of LBP.,,
In contrast to our results, previous studies have found that those with LBP are more likely to report higher computer usage. A study conducted among occupational therapy students in Northern Queensland reported a correlation between students who spent 16–20 h per week on the computer and LBP. Another study revealed that daily computer use of more than 4 h was significantly associated with LBP. However, similar to our results, two studies have also found no statistically significant relationship between computer use and LBP.,
Regarding smoking, several previous studies have indicated an association between smoking and LBP, with smokers having a higher risk of LBP than nonsmokers., This is contrary to our results, which showed no association between smoking and LBP. A Brazilian study also found no correlation between smoking and LBP.
Previous studies have found a higher prevalence of LBP among medical students in the clinical years compared to students in the preclinical years.,, This is inconsistent with our results, which found no significant association. This could be related to the recent introduction of clinical aspects into the first 2 years of medical study.
In our results, there was no association between coffee drinking and LBP. This finding was in agreement with findings indicating that caffeine consumption is not related to the global experience of pain., On the other hand, an Indian study found a significant association between coffee consumption and LBP among medical students.
In our research, the daily function was affected due to LBP in 30.1% of participants. Two previous studies among university students reported that LBP influenced daily activities such as sleeping, walking, sitting, standing, and other everyday functions.,
Only 11.6% of medical students consulted a physician, physiotherapist, or other health professionals because of back pain. A previous study conducted among medical students at Saudi Arabian colleges found that 13.4% of students consulted a medical professional, and a Brazilian study reported that 17.6% of medical students sought care because of LBP. In the general population, up to 25% of individuals with back pain seek help from a health-care provider.
The present study has some limitations. Due to the cross-sectional study design, it was not possible to determine cause and effect. Lack of comparison group made it hard to tell whether being a medical student is a risk factor of having LBP. Recall bias is also a known limitation of the use of a self-reported questionnaire as a study instrument. Also, some disadvantages of online surveys that should be considered include limited open-ended questions and possible cooperation problems.
| Conclusions|| |
We conclude that the prevalence of LBP is high among Saudi medical students. Higher rates of LBP were reported among female students and students with a history of back trauma. Back care awareness should be emphasized among medical students.
The authors extend their appreciation to the Deanship of Scientific Research at King Saud University for supporting this work through research group No. (RG-1441-359).
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]