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Prevalence and Risk Factors for Low Back Pain Among Professional Drivers in Kano, Nigeria ab
ab
c
d
Adamu Ahmad Rufa’i , Isma’ila Adamu Sa’idu , Rufa’i Yusuf Ahmad , Omar Salad Elmi , a
b
e
Salamatu Umar Aliyu , Abdurrahman Mohammed Jajere & Abbas Abdullahi Digil a
Department of Physiotherapy, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria b
Department of Physiotherapy, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
c
Department of Physiotherapy, Faculty of Medicine, Bayero University Kano, Kano, Nigeria
d
Unit of Biostatistics and Research Methodology, School of Medical Sciences, University Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
Click for updates
e
Department of Orthopaedics and Traumatology, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria Accepted author version posted online: 12 Nov 2013.
To cite this article: Adamu Ahmad Rufa’i, Isma’ila Adamu Sa’idu, Rufa’i Yusuf Ahmad, Omar Salad Elmi, Salamatu Umar Aliyu, Abdurrahman Mohammed Jajere & Abbas Abdullahi Digil (2015) Prevalence and Risk Factors for Low Back Pain Among Professional Drivers in Kano, Nigeria, Archives of Environmental & Occupational Health, 70:5, 251-255, DOI: 10.1080/19338244.2013.845139 To link to this article: http://dx.doi.org/10.1080/19338244.2013.845139
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Archives of Environmental & Occupational Health (2015) 70, 251–255 C Taylor & Francis Group, LLC Copyright ISSN: 1933-8244 print / 2154-4700 online DOI: 10.1080/19338244.2013.845139
Prevalence and Risk Factors for Low Back Pain Among Professional Drivers in Kano, Nigeria ADAMU AHMAD RUFA’I1,2, ISMA’ILA ADAMU SA’IDU1,2, RUFA’I YUSUF AHMAD3, OMAR SALAD ELMI4, SALAMATU UMAR ALIYU1, ABDURRAHMAN MOHAMMED JAJERE2, and ABBAS ABDULLAHI DIGIL5 1
Department of Physiotherapy, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria Department of Physiotherapy, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria 3 Department of Physiotherapy, Faculty of Medicine, Bayero University Kano, Kano, Nigeria 4 Unit of Biostatistics and Research Methodology, School of Medical Sciences, University Sains Malaysia, Kubang Kerian, Kelantan, Malaysia 5 Department of Orthopaedics and Traumatology, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
Downloaded by [UNSW Library] at 12:10 19 August 2015
2
Received 18 April 2013, Accepted 4 August 2013
This study investigated the prevalence, risk factors, and impact of low back pain (LBP) among professional drivers in Nigeria. Two hundred male drivers aged 19–64 years were recruited in the study. Data regarding prevalence, individual risk factors, and impact of LBP were obtained. The prevalence rate of LBP was 73.5%, and LBP have affected the driving performance of up to 74% drivers. After adjustment for age, LBP prevalence was associated with driving for >15 hours/day (odds ratio [OR]; 95% confidence interval [CI]): (0.04; 0.01, 0.20), driving car (5.52; 1.55, 19.64), and driving bus (10.49; 2.63, 41.82). No association was found between LBP prevalence and years spent driving. The study found that high prevalence of LBP affected the performance of a substantial percentage of the participants. Keywords: long-distance driving, low back pain, prevalence, professional drivers
Low back pain (LBP) is well known as the most common musculoskeletal disorder affecting the general population, with estimated 80% incidence rate among the active population.1–6 It has also been recognized as one of the major causes for decreased efficiency and well-being in the working populace, with consequent financial, medical, and socioeconomic implications affecting individuals, employers of organizations, and society at large.7–9 Absence from work, change of work, restriction to work, low productivity, and loss of work were noted as the socioeconomic implications of LBP. LBP and its associated effects account for most of the regular outpatient hospital visits and casual sick leave among employees of organizations.1 In several instances, different kind of occupational activities and their related factors contribute significantly to the development of LBP or its exacerbation.10,11 High prevalence of LBP among professional drivers has been reported in many parts of the world. According to recent surveys conducted among professional drivers at Israel12 and the United Kingdom,13 prevalence of LBP was found to be 45% and 60%, respectively. However, in Nigeria, despite recognizing long-distance commercial driving as
Address correspondence to Adamu Ahmad Rufa’i, Department of Physiotherapy, College of Medical Sciences, University of Maiduguri, PMB 1069, Maiduguri, Nigeria. E-mail: [email protected]
means of livelihood among the teeming population, we observed dearth of data on the prevalence of LBP and its associated risk factors among professional drivers. The concern is particularly high in the industrialized cities of northern Nigeria such as Kano metropolis, where increased prevalence of LBP among professional drivers cannot be ruled out. Several factors associated with driving vehicles were identified as reasons why driving was rated among the high-risk occupations predisposing most drivers to LBP. Among them is the nature of driver’s seat and its back rest that persistently exert pressure on the lumbar-vertebral spines due to prolonged hip position at 90 degrees.14 Other notable factors include age of the drivers, numbers of years of driving experience, prolonged hours of driving per day with constant vibrational forces, and frequent twisting of lumbar-vertebral spines, among others.12,15–17 Moreover, in Nigeria, the characteristic nature of roads and the condition of vehicles could add to the risk of LBP among professional long-distance drivers, because the roads are dilapidated and poorly maintained, whereas the vehicular road worthiness assessments are not strictly followed.18 The objectives of this study were to determine the prevalence of LBP and to identify the associated risk factors and its economic impact among professional drivers in Kano, Nigeria. Kano, the capital of Kano State, is the second largest commercial city in Nigeria. It is located in the northwestern
252 region Nigeria, with a population of 9,401,288 according to the 2006 Nigerian national census results.19
Rufa’i et al. Table 1. Demographic Characteristics and Impact of LBP Among Professional Drivers (N = 200) Variable
Methods
Downloaded by [UNSW Library] at 12:10 19 August 2015
Participants The participants surveyed in this cross-sectional study were male drivers recruited using the nonprobability sample of convenience from 4 selected motor parks in Kano metropolis, Nigeria. They include Unguwa Uku, Mariri, Kofar Ruwa, and Yan Kaba motor parks. The drivers eligible for the study were interstate long-distance drivers who have at least 1 year of driving experience and drive for a minimum of 5 hours/day, whereas those with previous history of traumatic injuries and those with high risk of developing LBP from other secondary activities were excluded. Using the Taro Yamane formula, a minimum of 310 participants was determined to be adequate.20 The time frame for this study lasted 5 months, between April and August 2011. Data Collection A modified Nordic Low Back (MNLB) questionnaire was used to obtain data on the prevalence of LBP and its impact.21 LBP was defined as any ache, pain, or discomfort, and the location was defined by the shaded area of a body diagram (T12 to gluteal folds).22 The participants were asked if they had experience LBP during the last 12 months for a day or longer, requiring checking a yes/no or multiple-response answer choice. Also, the impact of LBP was assessed using questions on medication consumption, requiring treatment, and modification of driving secondary to LBP in the preceding 12 months. The LBP is clinically significant if participants reported that their LBP required use of medication, or if they sought treatment, or if it required a reduction in activity of daily living.23 Basic demographic and occupational profiles, including drivers age, type of vehicle, number of driving hours per day, years of driving experience (years of professional exposure), nature and impact of LBP, as well as secondary activities (if any), were clearly obtained from the respondents.
Demographic characteristics Age (years) Driving experience (years) Duration of driving/day (hours) Type of vehicle Truck Car Bus Nature of LBP Onset of LBP Gradual Sudden Severity of LBP Mild Moderate Severe Impact of LBP Pain experience Was not serious Needed medication Needed hospital visit Effect of LBP Did not affect driving Reduced driving efficiency Reduced driving time Kept away from driving
Mean
SD
Range
42.45 17.75
11.06 7.91
19–64 1–30
13.35
6.28
5–24
n
%
34 51 115
17 25.5 57.5
91 56
61.9 38.1
31 72 44
21.1 48.9 30.0
81 36 30
55.1 24.5 20.4
39 31
26.0 21.0
33 44
24.0 29.0
in the respective motor parks. All questions were fully clarified to the participants, after which they filled in the questionnaires. Upon completion, the questionnaires were either retrieved on the same day of distribution (n = 189) or within 3–7 days after the distribution day (n = 113).
Ethical Consideration The study was approved by the institutional ethics committee (according to the Helsinki Declaration) of Bayero University Kano after duly obtaining permission from executives of the drivers union in the respective motor parks. Individual participants were properly counseled on the protocol of the study and were assured of the confidentiality of their respective information throughout the study. A signed informed consent was obtained from each participant for documentary and legal purposes. Flow of Work The MNLB questionnaires were distributed through personal contact with individual drivers and/or their union executives
Data Analysis Statistical Package for Social Sciences (SPSS; version 20.0.1; IBM, Armonk, NY, USA) was used for the data entry and analyses. The data were double checked and cleaned to ensure that all variables were properly documented and to detect any missing or erroneous values during data entry. Descriptive statistics of mean and standard deviation or frequency and percentage were used to summarize the demographic variables and nature and impact of reported LBP. Chi-square statistics was used to determine statistical difference between the predictors of LBP. Univariate logistic regression analysis was applied to determine the potential associated risk factors. Variables that were found to be statistically significant in the univariate anal-
Archives of Environmental & Occupational Health
253
Table 2. Prevalence of LBP in the Last 12 Months Among Professional Drivers (N = 200) LBP history Yes (n = 143)
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Variable Age (years) ≤24 25–44 45–60 >60 Driving experience (years) ≤10 11–20 >20 Duration of driving (hours) 15 Type of vehicle Truck Bus Car ∗ Significance
No (n = 57)
n
%
n
%
4 73 53 17
2.7 49.7 36.1 11.6
6 31 14 2
11.3 58.5 26.4 3.8
22 53 72
17.5 36.1 49
13 20 20
24.5 37.7 37.7
39 38 70
26.5 25.9 47.6
29 15 9
54.7 28.3 17.0
23 86 38
15.6 58.5 25.9
11 29 13
20.8 54.7 24.5
p value .019∗
.046∗
60 years with 0.09 times crude odds of having LBP (95% CI: 0.01, 0.54; p = .010). Likewise, those who drive for longer hours/day were more vulnerable, with 10–15 hours/day having 0.39 times crude odds of getting LBP (95% CI: 0.19, 0.81; p = .011). The multivariate analysis of independent risk factors showed the significant variables in Table 3. Duration of driving (hours/day) was found to be a significant risk factor for LBP in drivers; those driving for the duration >15 hours/day have 0.04 odd chances of LBP (95% CI: 0.01, 0.20; p = .001). Also found to be a significant risk factor for LBP in drivers is the type of vehicle driven, with those who drive cars having 5.52 times odds of LBP occurrence (95% CI: 1.55, 19.64; p = .008).
254
Rufa’i et al.
Table 3. Risk Factors for LBP Among Professional Drivers (N = 200)
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Variable Age (years) ≤24 25–44 45–60 >60 Driving experience (years) ≤10 10–20 >20 Driving duration (hours) 15 Type of vehicle Truck Car Bus
Crude odds ratio
95% CI
p value
Adjusted odds ratio
95% CI
p value
1 0.28 0.18 0.09
0.08, 1.07 0.40,0.71 0.01,0.54
.064 .015 .010
1 0.64 0.47
0.27,1.51 0.20,1.10
.305 .080
1 0.39 0.03
0.19,0.81 0.01,0.13
.011 .001
1 0.01 0.04
0.00, 0.06 0.01,0.20
.001 .001
1 0.71 0.72
0.31,1.62 0.28,1.86
.411 .492
1 5.52 10.49
1.55,19.64 2.63,41.82
.008 .001
Note. Backward LR multiple logistic regression was applied. Multicolinearity and interaction were checked and no interaction was found. Hosmer-Lemeshow test was p = .681. Classification table (overall correct classification percentage was 78.5%). Area under curve ROC (81.7%) was applied to check the final model.
Comment The prevalence of LBP was observed to continually rise in many countries. Several risk factors associated with different kinds of occupation, particularly in major commercial cities, were found to play a pivotal role in the development of LBP. In this cross-sectional survey, the burden of LBP among professional drivers in Kano metropolis, a major commercial city in Nigeria, was reported. Also, the individual potential risk factors for and the impact of LBP among the professional drivers are presented. Previous reports have shown that about 60%–80% of all adults have experienced or will experience LBP, and association between driving as an occupation and symptoms of low back pain have been documented.2,6,24 An overwhelming majority (73.5%) of the drivers in the present study reported LBP as a result of driving, and LBP prevalence increases with age, increasing number of years spent driving, number of driving hours per day, and the type of vehicle being driven. The findings of LBP prevalence in up to 74% long-distance drivers and its association with >20 years of driving experience were supported by similar data reported elsewhere.3,12 Studies conducted in the UK, Taipei, and Sweden reported LBP prevalence rates of 60%, 51%, and 81% among truck, taxi, and bus drivers, respectively.13,25,26 Similarly, prevalence rates of 67.7, 74.5%, and 74.8% for truck, car, and bus drivers, respectively, were found. The relatively lower prevalence among truck drivers in this study may be because unlike the bus and taxi drivers, truck drivers have several stopover places along their routes.27 Also, contrary to their counterparts in the Western world, truck drivers in this area do not take part in the manual work of loading and unloading trucks.
Longer duration of driving has been reported to be a major risk factor for LBP among drivers.28 The minimum duration of driving (hours/day) in this study was 5 hours/day. It was not surprising, therefore, that the prevalence of LBP was high, since continuous driving for 4 hours or more have been reported to increase the risk of LBP.29 Similarly, the present study found that LBP increased with increasing number of driving hours per day. This finding supported a study that reported a strong relationship between increased risk of occupational injuries and long working hours such as long-distance driving.30 The majority of the drivers reported LBP onset as gradual, which means it is the result of repeated trauma.31 A substantial number of drivers with LBP were either on self-prescribed medication or simply visit hospital as outpatients for medical advice. This finding supports the fact that LBP accounts for more sick leave and disabilities, thereby resulting in substantial economic loss to both individuals and community.32 LBP significantly affected the driving efficiency of the majority of long-distance drivers in several ways. These include reducing their driving time or keeping them away from driving for some time. This supports the assertion that LBP is a common cause of occupational injuries and absenteeism from work amongst the productive populations2 and buttresses further the economic implications of LBP. Study Limitations This study reported for the first time the prevalence and associated factors of LBP among professional long-distance drivers and its economic implications in Nigeria. However, the findings need to be interpreted with caution due to some
Archives of Environmental & Occupational Health limitations in the study. First, the causality of associations may not be concluded, as is the case with cross-sectional studies; likewise, information bias may occur due to recall bias, as is the case with self-reports. In addition, the validity of the inferential statistics may not be justified, since participants were recruited through sample of convenience.
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Conclusion There was high prevalence of LBP among professional longdistance drivers that had affected the drivers’ performance with attendant negative economic implications. The study found duration of driving and type of vehicle as risk factors for LBP among the participants. It is recommended that further studies should assess the ergonomic and psychosocial risk factors. Furthermore, awareness campaign program should be organized for drivers on the importance of proper ergonomics to reduce the risk of LBP. Also collaboration between health policy makers and road transport unions is highly important in order to initiate proper medical intervention at the right time when early symptoms of LBP manifest. This will surely assist in mitigating the potential hazards.
Acknowledgments The authors would like to sincerely acknowledge the road transport union executives for their kind permission and the drivers who voluntarily participated in this study.
References 1. Saidu IA, Utti VA, Jaiyesimi AO, et al. Prevalence of musculoskeletal injuries among factory workers in Kano Metropolis, Nigeria. Int J Occup Saf Ergon. 2011;17:99–102. 2. Alexopoulos EC, Tanagra D, Konstantinou E, Burdorf A. Musculoskeletal disorders in shipyard: prevalence, health care use, and absenteeism. BMC Musculoskelet Disord. 2006;7:88. 3. Szeto GP, Lam P. Work related musculoskeletal disorders in urban bus drivers of Hong Kong. J Occup Rehabil. 2007;17: 181–198. 4. Sanya AO, Ogwumike OO. Low back pain prevalence amongst industrial workers in the private sector in Oyo state, Nigeria. Afr J Med Med Sci. 2005;34:245–249. 5. Charizani F, Moysiadou I, Siarkos E, Alexopolous EC. Subjective risk assessment of industry employees. Rev Clin Pharmacol Pharmacokinet. 2005;19:87–92. 6. Urquhart DM, Hoving JL, Assendelft WW, Roland M, van Tulder MW. Antidepressants for non-specific low back pain. Cochrane Database Syst Rev. 2008;(1):CD001703. 7. Miyamoto M, Konno S, Gembun Y, et al. Epidemiological study of low back pain and occupational risk factors among taxi drivers. Ind Health. 2008;46:112–117. 8. Dagenais S, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine. 2008;8:8–20. 9. van Tulder MW, Koes BW, Bouter LM. A cost-of-illness study of back pain in The Netherlands. Pain. 1995;62:233–240. 10. Adigun N. Physiotherapy in the Management of Back Pain. Ikeja, Nigeria: Adtools; 1999.
255 11. Marras WS, Lavender SA, Leurgans SE, et al. The role of dynamic three-dimensional trunk motion in occupationally-related low back disorders: the effects of work place factors, trunk position, and trunk motion characteristics on risk of injury. Spine. 1993;18:617–628. 12. Alperovitch-Najenson D, Santo Y, Masharawi Y, Katz-Leurer M, Ushvaev D, Kalichman L. Low back pain among professional bus drivers: ergonomic and occupational-psychosocial risk factors. Isr Med Assoc J. 2010;12:26–31. 13. Robb MJM, Mansfield NJ. Self-reported musculoskeletal problems amongst professional truck drivers. Ergonomics. 2007;50:814–827. 14. Boshuizen HC, Bongers PM, Hulshof CT. Self-reported back pain in tractor drivers exposed to whole-body vibration. Int Arch Occup Environ Health. 1990;62:109–115. 15. Odebiyi DO, Ogwezi DC, Adegoke BOA. The prevalence of LBP in commercial motor drivers & private automobile drivers. Niger J Med Rehabil. 2007;12:21–24. 16. Bovenzi M. A longitudinal study of low back pain and daily vibration exposure in professional drivers. Ind Health. 2010;48:584–595. 17. Tamarin SB, Yokoyama K, Jalaludin J, et al. The association between risk factors and Low Back Pain among commercial vehicle drivers in Peninsular Malaysia: a preliminary result. Ind Health. 2007;45:268–278. 18. Akinpelu AO, Oyewole, OO, Odole AC, Olukoya, RO. Prevalence of musculoskeletal pain and health seeking behaviour among occupational drivers in Ibadan, Nigeria. Afr J Biomed Res. 2011;14:89–94. 19. National Bureau of Statistics, Nigeria. Provisional results of the 2006 population census. Annual Abstr Stat. 2010;17–63. Available at: www.nigerianstat.gov.ng/pages/download/71. 20. Okeke AO. Foundation Statistics for Business Decisions. Enugu: High Mega System; 1995:25. 21. Kuorinka I, Jonsson B, Kilbom A, et al. Standardized Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon. 1987;18:233–237. 22. Mitchell T, O’Sullivan PB, Burnett AF, Straker L, Rudd C. Low back pain characteristics from undergraduate student to working nurse in Australia: a cross-sectional survey. Int J Nurs Stud. 2008;45:1636–1644. 23. Mitchell T, O’Sullivan PB, Burnett AF, Straker L, Smith A. Regional differences in lumbar spinal posture and the influence of low back pain. BMC Musculoskelet Disord. 2008;9:152. 24. Salminen JJ, Erkintalo M, Laine M, Pentti J. Low back pain in the young: a prospective three-year follow-up study of subjects with and without low back pain. Spine. 1995;19:2101–2108. 25. Chen JC, Chang WR, Chang W, Christiani D. Occupational factors associated with low back pain in Urban taxi drivers. Occup Med. 2005;55:535–540. 26. Magnusson ML, Pope MH, Wilder DG, Areskoug B. Are occupational drivers at an increased risk for developing musculoskeletal disorders? Spine. 1996;21:710–717. 27. Erhabor O, Azuonwu O, Frank-Peterside, N. Malaria parasitaemia among long distance truck drivers in the Niger delta of Nigeria. Afr Health Sci. 2012;12:98–103. 28. Pietri F, Leclerc A, Boitel L, Chastang JF, Morcet JF, Blondet M. Low back pain in commercial travellers. Scand J Work Environ Health. 1992;18:52–58. 29. Porter GM, Gyi GE. The prevalence of musculoskeletal troubles among car drivers. Occup Med. 2002;52:4–12. 30. Dembe AE, Erickson JB, Delbos RG, Banks SM. The impact of overtime and long work hours on occupational injuries and illnesses: new evidence from the United States. Occup Environ Med. 2005;62:588–597. 31. Lis AM, Black KM, Korn H, Nordin M. Association between sitting and occupational LBP. Eur Spine J. 2007;16:283–298. 32. Anderson, R. The back pain of bus drivers; prevalence in an urban area of California. Spine. 1992;17:1481–1488.
Archives of Environmental & Occupational Health Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/vaeh20
Prevalence and Risk Factors for Low Back Pain Among Professional Drivers in Kano, Nigeria ab
ab
c
d
Adamu Ahmad Rufa’i , Isma’ila Adamu Sa’idu , Rufa’i Yusuf Ahmad , Omar Salad Elmi , a
b
e
Salamatu Umar Aliyu , Abdurrahman Mohammed Jajere & Abbas Abdullahi Digil a
Department of Physiotherapy, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria b
Department of Physiotherapy, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
c
Department of Physiotherapy, Faculty of Medicine, Bayero University Kano, Kano, Nigeria
d
Unit of Biostatistics and Research Methodology, School of Medical Sciences, University Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
Click for updates
e
Department of Orthopaedics and Traumatology, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria Accepted author version posted online: 12 Nov 2013.
To cite this article: Adamu Ahmad Rufa’i, Isma’ila Adamu Sa’idu, Rufa’i Yusuf Ahmad, Omar Salad Elmi, Salamatu Umar Aliyu, Abdurrahman Mohammed Jajere & Abbas Abdullahi Digil (2015) Prevalence and Risk Factors for Low Back Pain Among Professional Drivers in Kano, Nigeria, Archives of Environmental & Occupational Health, 70:5, 251-255, DOI: 10.1080/19338244.2013.845139 To link to this article: http://dx.doi.org/10.1080/19338244.2013.845139
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Archives of Environmental & Occupational Health (2015) 70, 251–255 C Taylor & Francis Group, LLC Copyright ISSN: 1933-8244 print / 2154-4700 online DOI: 10.1080/19338244.2013.845139
Prevalence and Risk Factors for Low Back Pain Among Professional Drivers in Kano, Nigeria ADAMU AHMAD RUFA’I1,2, ISMA’ILA ADAMU SA’IDU1,2, RUFA’I YUSUF AHMAD3, OMAR SALAD ELMI4, SALAMATU UMAR ALIYU1, ABDURRAHMAN MOHAMMED JAJERE2, and ABBAS ABDULLAHI DIGIL5 1
Department of Physiotherapy, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria Department of Physiotherapy, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria 3 Department of Physiotherapy, Faculty of Medicine, Bayero University Kano, Kano, Nigeria 4 Unit of Biostatistics and Research Methodology, School of Medical Sciences, University Sains Malaysia, Kubang Kerian, Kelantan, Malaysia 5 Department of Orthopaedics and Traumatology, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
Downloaded by [UNSW Library] at 12:10 19 August 2015
2
Received 18 April 2013, Accepted 4 August 2013
This study investigated the prevalence, risk factors, and impact of low back pain (LBP) among professional drivers in Nigeria. Two hundred male drivers aged 19–64 years were recruited in the study. Data regarding prevalence, individual risk factors, and impact of LBP were obtained. The prevalence rate of LBP was 73.5%, and LBP have affected the driving performance of up to 74% drivers. After adjustment for age, LBP prevalence was associated with driving for >15 hours/day (odds ratio [OR]; 95% confidence interval [CI]): (0.04; 0.01, 0.20), driving car (5.52; 1.55, 19.64), and driving bus (10.49; 2.63, 41.82). No association was found between LBP prevalence and years spent driving. The study found that high prevalence of LBP affected the performance of a substantial percentage of the participants. Keywords: long-distance driving, low back pain, prevalence, professional drivers
Low back pain (LBP) is well known as the most common musculoskeletal disorder affecting the general population, with estimated 80% incidence rate among the active population.1–6 It has also been recognized as one of the major causes for decreased efficiency and well-being in the working populace, with consequent financial, medical, and socioeconomic implications affecting individuals, employers of organizations, and society at large.7–9 Absence from work, change of work, restriction to work, low productivity, and loss of work were noted as the socioeconomic implications of LBP. LBP and its associated effects account for most of the regular outpatient hospital visits and casual sick leave among employees of organizations.1 In several instances, different kind of occupational activities and their related factors contribute significantly to the development of LBP or its exacerbation.10,11 High prevalence of LBP among professional drivers has been reported in many parts of the world. According to recent surveys conducted among professional drivers at Israel12 and the United Kingdom,13 prevalence of LBP was found to be 45% and 60%, respectively. However, in Nigeria, despite recognizing long-distance commercial driving as
Address correspondence to Adamu Ahmad Rufa’i, Department of Physiotherapy, College of Medical Sciences, University of Maiduguri, PMB 1069, Maiduguri, Nigeria. E-mail: [email protected]
means of livelihood among the teeming population, we observed dearth of data on the prevalence of LBP and its associated risk factors among professional drivers. The concern is particularly high in the industrialized cities of northern Nigeria such as Kano metropolis, where increased prevalence of LBP among professional drivers cannot be ruled out. Several factors associated with driving vehicles were identified as reasons why driving was rated among the high-risk occupations predisposing most drivers to LBP. Among them is the nature of driver’s seat and its back rest that persistently exert pressure on the lumbar-vertebral spines due to prolonged hip position at 90 degrees.14 Other notable factors include age of the drivers, numbers of years of driving experience, prolonged hours of driving per day with constant vibrational forces, and frequent twisting of lumbar-vertebral spines, among others.12,15–17 Moreover, in Nigeria, the characteristic nature of roads and the condition of vehicles could add to the risk of LBP among professional long-distance drivers, because the roads are dilapidated and poorly maintained, whereas the vehicular road worthiness assessments are not strictly followed.18 The objectives of this study were to determine the prevalence of LBP and to identify the associated risk factors and its economic impact among professional drivers in Kano, Nigeria. Kano, the capital of Kano State, is the second largest commercial city in Nigeria. It is located in the northwestern
252 region Nigeria, with a population of 9,401,288 according to the 2006 Nigerian national census results.19
Rufa’i et al. Table 1. Demographic Characteristics and Impact of LBP Among Professional Drivers (N = 200) Variable
Methods
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Participants The participants surveyed in this cross-sectional study were male drivers recruited using the nonprobability sample of convenience from 4 selected motor parks in Kano metropolis, Nigeria. They include Unguwa Uku, Mariri, Kofar Ruwa, and Yan Kaba motor parks. The drivers eligible for the study were interstate long-distance drivers who have at least 1 year of driving experience and drive for a minimum of 5 hours/day, whereas those with previous history of traumatic injuries and those with high risk of developing LBP from other secondary activities were excluded. Using the Taro Yamane formula, a minimum of 310 participants was determined to be adequate.20 The time frame for this study lasted 5 months, between April and August 2011. Data Collection A modified Nordic Low Back (MNLB) questionnaire was used to obtain data on the prevalence of LBP and its impact.21 LBP was defined as any ache, pain, or discomfort, and the location was defined by the shaded area of a body diagram (T12 to gluteal folds).22 The participants were asked if they had experience LBP during the last 12 months for a day or longer, requiring checking a yes/no or multiple-response answer choice. Also, the impact of LBP was assessed using questions on medication consumption, requiring treatment, and modification of driving secondary to LBP in the preceding 12 months. The LBP is clinically significant if participants reported that their LBP required use of medication, or if they sought treatment, or if it required a reduction in activity of daily living.23 Basic demographic and occupational profiles, including drivers age, type of vehicle, number of driving hours per day, years of driving experience (years of professional exposure), nature and impact of LBP, as well as secondary activities (if any), were clearly obtained from the respondents.
Demographic characteristics Age (years) Driving experience (years) Duration of driving/day (hours) Type of vehicle Truck Car Bus Nature of LBP Onset of LBP Gradual Sudden Severity of LBP Mild Moderate Severe Impact of LBP Pain experience Was not serious Needed medication Needed hospital visit Effect of LBP Did not affect driving Reduced driving efficiency Reduced driving time Kept away from driving
Mean
SD
Range
42.45 17.75
11.06 7.91
19–64 1–30
13.35
6.28
5–24
n
%
34 51 115
17 25.5 57.5
91 56
61.9 38.1
31 72 44
21.1 48.9 30.0
81 36 30
55.1 24.5 20.4
39 31
26.0 21.0
33 44
24.0 29.0
in the respective motor parks. All questions were fully clarified to the participants, after which they filled in the questionnaires. Upon completion, the questionnaires were either retrieved on the same day of distribution (n = 189) or within 3–7 days after the distribution day (n = 113).
Ethical Consideration The study was approved by the institutional ethics committee (according to the Helsinki Declaration) of Bayero University Kano after duly obtaining permission from executives of the drivers union in the respective motor parks. Individual participants were properly counseled on the protocol of the study and were assured of the confidentiality of their respective information throughout the study. A signed informed consent was obtained from each participant for documentary and legal purposes. Flow of Work The MNLB questionnaires were distributed through personal contact with individual drivers and/or their union executives
Data Analysis Statistical Package for Social Sciences (SPSS; version 20.0.1; IBM, Armonk, NY, USA) was used for the data entry and analyses. The data were double checked and cleaned to ensure that all variables were properly documented and to detect any missing or erroneous values during data entry. Descriptive statistics of mean and standard deviation or frequency and percentage were used to summarize the demographic variables and nature and impact of reported LBP. Chi-square statistics was used to determine statistical difference between the predictors of LBP. Univariate logistic regression analysis was applied to determine the potential associated risk factors. Variables that were found to be statistically significant in the univariate anal-
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Table 2. Prevalence of LBP in the Last 12 Months Among Professional Drivers (N = 200) LBP history Yes (n = 143)
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Variable Age (years) ≤24 25–44 45–60 >60 Driving experience (years) ≤10 11–20 >20 Duration of driving (hours) 15 Type of vehicle Truck Bus Car ∗ Significance
No (n = 57)
n
%
n
%
4 73 53 17
2.7 49.7 36.1 11.6
6 31 14 2
11.3 58.5 26.4 3.8
22 53 72
17.5 36.1 49
13 20 20
24.5 37.7 37.7
39 38 70
26.5 25.9 47.6
29 15 9
54.7 28.3 17.0
23 86 38
15.6 58.5 25.9
11 29 13
20.8 54.7 24.5
p value .019∗
.046∗
60 years with 0.09 times crude odds of having LBP (95% CI: 0.01, 0.54; p = .010). Likewise, those who drive for longer hours/day were more vulnerable, with 10–15 hours/day having 0.39 times crude odds of getting LBP (95% CI: 0.19, 0.81; p = .011). The multivariate analysis of independent risk factors showed the significant variables in Table 3. Duration of driving (hours/day) was found to be a significant risk factor for LBP in drivers; those driving for the duration >15 hours/day have 0.04 odd chances of LBP (95% CI: 0.01, 0.20; p = .001). Also found to be a significant risk factor for LBP in drivers is the type of vehicle driven, with those who drive cars having 5.52 times odds of LBP occurrence (95% CI: 1.55, 19.64; p = .008).
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Rufa’i et al.
Table 3. Risk Factors for LBP Among Professional Drivers (N = 200)
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Variable Age (years) ≤24 25–44 45–60 >60 Driving experience (years) ≤10 10–20 >20 Driving duration (hours) 15 Type of vehicle Truck Car Bus
Crude odds ratio
95% CI
p value
Adjusted odds ratio
95% CI
p value
1 0.28 0.18 0.09
0.08, 1.07 0.40,0.71 0.01,0.54
.064 .015 .010
1 0.64 0.47
0.27,1.51 0.20,1.10
.305 .080
1 0.39 0.03
0.19,0.81 0.01,0.13
.011 .001
1 0.01 0.04
0.00, 0.06 0.01,0.20
.001 .001
1 0.71 0.72
0.31,1.62 0.28,1.86
.411 .492
1 5.52 10.49
1.55,19.64 2.63,41.82
.008 .001
Note. Backward LR multiple logistic regression was applied. Multicolinearity and interaction were checked and no interaction was found. Hosmer-Lemeshow test was p = .681. Classification table (overall correct classification percentage was 78.5%). Area under curve ROC (81.7%) was applied to check the final model.
Comment The prevalence of LBP was observed to continually rise in many countries. Several risk factors associated with different kinds of occupation, particularly in major commercial cities, were found to play a pivotal role in the development of LBP. In this cross-sectional survey, the burden of LBP among professional drivers in Kano metropolis, a major commercial city in Nigeria, was reported. Also, the individual potential risk factors for and the impact of LBP among the professional drivers are presented. Previous reports have shown that about 60%–80% of all adults have experienced or will experience LBP, and association between driving as an occupation and symptoms of low back pain have been documented.2,6,24 An overwhelming majority (73.5%) of the drivers in the present study reported LBP as a result of driving, and LBP prevalence increases with age, increasing number of years spent driving, number of driving hours per day, and the type of vehicle being driven. The findings of LBP prevalence in up to 74% long-distance drivers and its association with >20 years of driving experience were supported by similar data reported elsewhere.3,12 Studies conducted in the UK, Taipei, and Sweden reported LBP prevalence rates of 60%, 51%, and 81% among truck, taxi, and bus drivers, respectively.13,25,26 Similarly, prevalence rates of 67.7, 74.5%, and 74.8% for truck, car, and bus drivers, respectively, were found. The relatively lower prevalence among truck drivers in this study may be because unlike the bus and taxi drivers, truck drivers have several stopover places along their routes.27 Also, contrary to their counterparts in the Western world, truck drivers in this area do not take part in the manual work of loading and unloading trucks.
Longer duration of driving has been reported to be a major risk factor for LBP among drivers.28 The minimum duration of driving (hours/day) in this study was 5 hours/day. It was not surprising, therefore, that the prevalence of LBP was high, since continuous driving for 4 hours or more have been reported to increase the risk of LBP.29 Similarly, the present study found that LBP increased with increasing number of driving hours per day. This finding supported a study that reported a strong relationship between increased risk of occupational injuries and long working hours such as long-distance driving.30 The majority of the drivers reported LBP onset as gradual, which means it is the result of repeated trauma.31 A substantial number of drivers with LBP were either on self-prescribed medication or simply visit hospital as outpatients for medical advice. This finding supports the fact that LBP accounts for more sick leave and disabilities, thereby resulting in substantial economic loss to both individuals and community.32 LBP significantly affected the driving efficiency of the majority of long-distance drivers in several ways. These include reducing their driving time or keeping them away from driving for some time. This supports the assertion that LBP is a common cause of occupational injuries and absenteeism from work amongst the productive populations2 and buttresses further the economic implications of LBP. Study Limitations This study reported for the first time the prevalence and associated factors of LBP among professional long-distance drivers and its economic implications in Nigeria. However, the findings need to be interpreted with caution due to some
Archives of Environmental & Occupational Health limitations in the study. First, the causality of associations may not be concluded, as is the case with cross-sectional studies; likewise, information bias may occur due to recall bias, as is the case with self-reports. In addition, the validity of the inferential statistics may not be justified, since participants were recruited through sample of convenience.
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Conclusion There was high prevalence of LBP among professional longdistance drivers that had affected the drivers’ performance with attendant negative economic implications. The study found duration of driving and type of vehicle as risk factors for LBP among the participants. It is recommended that further studies should assess the ergonomic and psychosocial risk factors. Furthermore, awareness campaign program should be organized for drivers on the importance of proper ergonomics to reduce the risk of LBP. Also collaboration between health policy makers and road transport unions is highly important in order to initiate proper medical intervention at the right time when early symptoms of LBP manifest. This will surely assist in mitigating the potential hazards.
Acknowledgments The authors would like to sincerely acknowledge the road transport union executives for their kind permission and the drivers who voluntarily participated in this study.
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