PREVALENCE OF LOWER BACK PAIN AMONG TAIBAH UNIVERSITY STUDENTS

Maryam Alshanqiti, Mays Garah, Khulood Salem Alsenani and Sarah Khaled Alrasheed. Medical interns, Taibah University, Medina Saudi Arabia. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


(1), 1304-1313
1305 the deficiency of vitamin D was considered as a potential risk factor of Low back pain in the Gulf because of decreased adequate exposure to sunlight 1 . Finally poor general health and psychosocial factor are considered as significant risk factors as well 3 .
A remarkable number of preventive medicine literature has studied the influence of profession or lifestyle on the incidence of back pain 5 .University students however, usually have a demanding curricula, making the bulk of student's time consumed by long sitting hours spent either on studying or receiving lectures, hence leading to physical inactivity and a raising prevalence of lower back pain 4 .
According to recent studies, nearly 60-80% of individuals worldwide will suffer from LBP at a given time in their lives and 20-30% are already suffering from it 3 . Even though back pain in Arab countries presents at a much less frequency than some western nations, it still appears to be relatively common among its unindustrialized locations 1,4 . There are ongoing growing efforts aimed towards researching the prevalence of LBP in Saudi Arabia but reported data are still too limited to generalize such evidence 1 .
Our aim in this study is to determine the prevalence of lower back pain, assessing its impact on students' lives and detection of the most common risk factors of lower back pain among Taibah university students.

Methodology: -
A cross sectional study was carried out. The study was conducted in Al-medainh cityamong Taibah university students at any level and any faculty. (i.e. the sampling selection method was random) with nearly sample size of 500. A specially designed self-administered questionnaire in Arabic was used.
The electronic self-administrated questionnaire, consisted of 3 main sections: students' demographic data, prevalence of lower back pain and it is associated symptomatology, risk factors and related medical history. The statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS), version 20.0.Chi Square analysis applied to compare the differences between the groups included in the study and a P value < 0.05 considered statistically significant.

Results: -
The response rate of this survey was 85% (n=425/500). Most of the respondents (82.35%) were between 21 to 25 years of age (See figure 1).In figure 2 we can see that females responded more than males did (74.35%). Nearly half of the sample (41.2%) was comprised of medical students followed by students of applied medical science and science, respectively ( Figure 3). Ninety-five students were in their third academic year ( Figure 4). Lower back pain was significantly prevalent among Taibah University students as (56.47%) were complaining of it ( Figure 5).
Regarding the association between lower back pain and students' demographics, there was a statistically significant association between lower back pain and gender (P=0.010). Females reported back pain more than did males. Lower back pain was more prominent among underweight students (71.67%). Among the medical students, responded (45.71%) have lower back pain. Majority (62.5%) of first year university students have lower back pain (Table 1). Table 2 shows a statistically significant association between the lack of exercise and lower back pain (P=0.024). (61.54%) of the students that seldom exercise reported lower back pain. Long studying hours contributed to significant prevalence of lower back pain (P=0.039). Most of the students are usually studying on the floor which is significantly associated with lower back pain (P=0.002). Students that usually perform weight lifting exercises reported lower back pain less than those who don't do weight lifting with a statistically significant association with lower back pain (P=0.000). Many students are used to wear backpacks, among those (65.6%) are suffering from lower back pain with a significant association to the frequent backpack wearing (P=0.044). Drinking soft drinks is significantly associated with lower back pain (P=0.025). Among students who suffer from lower back pain (61.63%) have a positive family history (P=0.012). Anxiety and lower back pain are strongly associated among Taibah University (P=0.000). In our sample there is a strong evidence (P=0.000) that a bad body posture directly contributes to lower back pain with thoracic kyphosis being the most commonly associated with lower back pain (80.00%). Most commonly reported symptoms associated with back pain among the participant are pain that improves by sitting (139 students) and increases by walking (97 students) suggesting a musculoskeletal origin. Alarming symptoms that necessitate medical attention also reported such as; paresthesia (101 students), pain radiating from 1306 the back to the lower limb (82 students), urinary incontinence (29 students) and fecal incontinence (4 students) (See  table 3). Regarding the impact of lower back pain on Taibah University students', (15.36%) have absented from university due to lower back pain and (25.38%) of the students suffering from back pain used painkillers to relieve it.       Figure 6:-Absence from university due to back pain

Discussion: -
Lower back pain is a major problem throughout the world, and it is prevalent among adult population based on cross sectional study conducted in AlQassim(18.8%) 5 . Some studies have shown significant incidence in the rates of LBP between college students. As in Indian medical college revealed a LBP prevalence of 48% in medical students 6 , and 53% rate reported for medical students at Paracelsus Medical University in Austria 7 . Consistent with previous studies, we observed higher mean and median prevalence of lower back pain among Taibah university students approximately (56.74%). However, in the present study females reported LBP higher than males did, compatible with study done by Damian Hoy et al. 2 In our study, we observed that incidence of LBP high in underweight students (71.67%). In contrast to Han et al, reported that women who are overweight, have a significantly increased likelihood of lower back pain . 8 Lack of exercise is one of the main etiologies of LBP. In our study, we found significant association between prevalence of LBP and lack of exercise, a lower prevalence of lower back pain significantly found in students who usually perform weight lifting exercises. This finding supported by Damian Hoy et al 2 observed that low incidence of LBP in developing countries estimated to be attributable to higher levels of exercise .
On the other hand, long studying hours contributed to significant increase of lower back pain. Unlike Grace O et al 9 , they found no significant association between LBP and sitting for long time. However, (65.6%) among the students who complain of LBP used to wear backpacks and we found a significant association to the frequent backpack wearing consist with a study done by Heuscher et al. 10 Abnormal body posture observed to be significantly higher in students suffers from LBP according to Nupur Aggarwal et al 6 . Similar to our study we found that (80.0%) of our respondents who have thoracic kyphosis suffer from LBP. As a family history play, a significant risk factor for LBP based on Nupur Aggarwal et al 6 and other researches, among students who suffer from lower back pain (61.63%) have a positive family history. Several psychological factors contribute to the prevalence of low back pain such as depression, anxiety and stress. According to that, Nupur Aggarwal et al 6 suggested that mental stress and depression are predisposing factors to LBP. Therefore, significant association between anxiety and LBP observed in the present study. Furthermore, have an influence on student's attendance in which (15.36%) have absented from university due to lower back pain.

Limitation of the study: -
Using of a self-administered questionnaire might create a misunderstanding of some asked questions. Also, students were not interviewed personally to assess the exact impact of low back pain on their lives.

Conclusions: -
The prevalence of lower back pain among Taibah university students was approximately higher compared to other similar studies with a percentage of (56.74%). The commonest risk factors included female gender, low BMI, lack of exercise, long studying hours on the floor, psychological factors in the form of anxiety, positive family history and most importantly bad body postures especially thoracic kyphosis. The impact of lower back pain on the students though not major yet still lead to the absence of some of them from university and to the consumption of pain killers.

Recommendations: -
Since lower back pain prevalence was higher in comparison to other studies, we recommend raising awareness of its risk factors among students to help them take the right precautions in order to protect themselves from developing such a condition in the future. Also, to teach the ones who already suffer from a LBP how to cope and if possible alleviate their pain aiming to achieve a better life style.