ORIGINAL RESEARCH Low back pain: prevalence and associated risk factors among hospital staff Azize Karahan, Sultan Kav, Aysel Abbasoglu & Nevin Dogan Accepted for publication 24 October 2008 Correspondence to S. Kav: e-mail: skav@baskent.edu.tr or sultan.kav@excite.com Azize Karahan PhD RN Assistant Professor Department of Nursing, Baskent University Faculty of Health Sciences, Baglica, Ankara, Turkey Sultan Kav PhD RN Assistant Professor Department of Nursing, Baskent University Faculty of Health Sciences, Baglica, Ankara, Turkey Aysel Abbasoglu MSN RN Instructor Department of Nursing, Baskent University Faculty of Health Sciences, Ankara, and Nursing Director Baskent University Ankara Hospital Nursing Administration, Bahcelievler, Turkey Nevin Dogan MSN RN Instructor Department of Nursing, Baskent University Faculty of Health Sciences, Baglica, Ankara, Turkey KARAHAN A., KAV S., ABBASOGLU A. & DOGAN N. (2009) KARAHAN A., KAV S., ABBASOGLU A. & DOGAN N. (2009) Low back pain: prevalence and associated risk factors among hospital staff. Journal of Advanced Nursing 65(3), 516���524 doi: 10.1111/j.1365-2648.2008.04905.x Abstract Title. Low back pain: prevalence and associated risk factors among hospital staff. Aim. This paper is a report of a study conducted to describe the prevalence and risk factors for lower back pain amongst a variety of Turkish hospital workers including nurses, physicians, physical therapists, technicians, secretaries and hospital aides. Background. Hospital workers experience more low back pain than many other groups, the incidence varies among countries. Work activities involving bending, twisting, frequent heavy lifting, awkward static posture and psychological stress are regarded as causal factors for many back injuries. Method. A 44-item questionnaire was completed by 1600 employees in six hospi- tals associated with one Turkish university using a cross-sectional survey design. Data were collected over nine months from December 2005 to August 2006 and analysed using Chi square and multivariate logistic regression techniques. Findings. Most respondents (65��8%) had experienced low back pain, with 61��3% reporting an occurrence within the last 12 months. The highest prevalence was reported by nurses (77��1%) and the lowest amongst secretaries (54��1%) and hospital aides (53��5%). In the majority of cases (78��3%), low back pain began after respondents started working in the hospital, 33��3% of respondents seeking medical care for ���moderate��� low back pain while 53��8% (n = 143) had been diagnosed with a herniated lumbar disc. Age, female gender, smoking, occupation, perceived work stress and heavy lifting were statistically significant risk-factors when multivariate logistic regression techniques were conducted (P 0��05). Conclusion. Preventive measures should be taken to reduce the risk of lower back pain, such as arranging proper rest periods, educational programmes to teach the proper use of body mechanics and smoking cessation programmes. Keywords: hospital staff, low back pain, occupational risk, prevalence, question- naire, risk factors, Turkey 516 �� 2009 The Authors. Journal compilation �� 2009 Blackwell Publishing Ltd JAN JOURNAL OF ADVANCED NURSING

Introduction Hospital workers experience more occupational health problems than other professional groups, the most common being low back pain (LBP), which is the commonest reason for hospitalization amongst this group of workers (Lahad et al. 1994, Retsas 1998, Omokhodion et al. 2000, Yip 2001, Lusk & Raymond 2002). However, the prevalence of reported LBP among hospital workers varies between differ- ent countries. For instance, the lifetime prevalence of LBP is reported as 76% in the Netherlands (Bos et al. 2007), 70��9% in Kuwait (Landry et al. 2008), 57��7% in Tunisia (Bejia et al. 2005), 46% in Ireland and Nigeria (Omokhodion et al. 2000, Cunningham et al. 2006) and 39% in Hong Kong (Yip 2004). Besides individual factors, work activities involving joint loading, extreme flexion of the trunk, frequent heavy lifting, maintaining an awkward or static posture, bending, twisting, hard physical work and psychological stress are reported as causal factors for back injuries in a number of studies (Engels et al. 1994, 1996, Lagerstrom �� & Hagberg 1997, Smedley et al. 1997, Trinkoff et al. 2003, Yip 2004). Background Low back pain has been described as one of the main occupational problems among healthcare workers and nurses frequently have the highest incidence (Bejia et al. 2005, Bos et al. 2007, Landry et al. 2008). Nurses frequently have to lift or transfer patients who may move suddenly and carry out repetitive procedures with incorrect or poor body posture, which subsequently cause LBP (Engkvist et al. 1998, Ando et al. 2000, Karahan & Bayraktar 2004, Yip 2004). Based on a review of more than 80 papers on LBP in nurses, Hignett (1996) reported an annual incidence of LBP of between 40% and 50%, while a review of various studies conducted in Italy showed a 12-month LBP prevalence ranging from 33% to 86% among Italian nurses (Lorusso et al. 2007). The higher range reported in Lorusso et al.���s paper is consistent with a number of Turkish studies, which suggest that approximately 65% to 88% of nurses have LBP (Karadag 1994, Karahan & Bayraktar 2004, Karahan 2005, Tezel 2005). The working lives and psychological state of hospital workers are severely affected by LBP as their productivity and job-satisfaction decrease and some may experience financial loss as a result of their injury (Duguesnoy et al. 1998, Oksuz 2006). These problems are reflected in the work environment and may lead to deficiencies in care (French et al. 1997, Scheldenfrei 1998, Karahan & Bayraktar 2004). Individuals with LBP also have difficulty fulfilling their responsibilities and meeting their own needs and may feel inadequate in the workplace (Duguesnoy et al. 1998, Karahan & Bayraktar 2004). LBP has been studied most frequently amongst nurses, nursing aides and other direct caregivers (Yassi et al. 1995, French et al. 1997, Omokhodion et al. 2000, Yip 2001, Bejia et al. 2005, Bos et al. 2007, Feng et al. 2007), but despite the high reported prevalence of LBP among hospital staff in these studies, very little information is available on the comparative prevalence of LBP among different hospital workers in Turkey. Specific information on risk factors and LBP in different professional groups is needed for preventive inter- ventions to aim at reducing musculoskeletal complaints to be better targeted. The study Aim The aim of the study was to describe the prevalence and risk factors for lower back pain amongst a variety of Turkish hospital workers including nurses, physicians, physical ther- apists, technicians, secretaries and hospital aides. Design A cross-sectional survey design was adopted. Questionnaires were administered between December 2005 and August 2006. Participants Participants were drawn from a total of six hospitals in four Turkish cities using a convenience sampling method. All hospital staffs at risk for LBP, including nurses, physicians, physical therapists, technicians, secretaries and hospital aides, were eligible to complete the questionnaire. Researchers explained the study to the managers of each team/profes- sional group and asked them to identify the number of staff who was not on holiday or sick leave. Available staffs were then invited to participate in the study. Written consent was obtained from each of those replying in the affirmative and they were then asked to return the questionnaires to the researcher after completion. Data collection Researchers visited each hospital to collect data. The ques- tionnaires were hand-delivered to each member of staff and collected the next day. Completed questionnaires were checked by the researchers on receipt and respondents were invited to answer any questions, which remained unanswered. JAN: ORIGINAL RESEARCH Prevalence and associated risk factors of low back pain �� 2009 The Authors. Journal compilation �� 2009 Blackwell Publishing Ltd 517