Prevalence of Low Back Pain Related to Physiotherapy at BMC Hospital, BINUQ Hospital, and Civil Hospital Quetta

1         Chapter 1 Introduction

1.1       Background of the Study

Low back pain (LBP) is one of the most prevalent musculoskeletal conditions affecting individuals worldwide, with significant implications for public health. It is well known to be among the primary causes of disability and also a major issue of lost productivity along with healthcare costs around the globe. In developed nations, it is estimated that LBP will afflict about 6080% of people in its lifetime (Hartvigsen et al., 2018). LBP has emerged as a major healthcare issue in Pakistan that has been increasing because of different lifestyle modification, urbanization and ignorance related to preventative care. Specifically, LBP has become an increasingly burdensome experience among urban hospital patients, including BMC Hospital, BINUQ Hospital, and Civil Hospital Quetta, affecting their quality of life as well as longevity and achievement of recovery.

LBP is a multifactorial and multidimensional disease, with biological, psychological, and social aspects being the factors that play a role in it. Understanding these factors is essential for developing targeted interventions that improve patient outcomes. Different research studies have indicated that physical inactivity, poor posture, and ergonomics practices are some of the risk factors that culminate in the prevalence of LBP among patients in various hospitals, which are associated with modern sedentary lifestyles. Pakistan is the place of the coexistence between physical work and desk jobs, and a failure to introduce the right ergonomic measures into everyday life has been attributed to the rising number of LBP cases if and among working adults along with those in the general population (Ali et al., 2021).

In the hospital, patients with LBP experience even more deteriorated condition because of the bed rest, poor ergonomic strategies, and overall lack of movement or exercising rehabilitation. One of the well-documented risk factors predisposing people to LBP is sedentary behaviors since most studies have identified sedentarily as a contributing factor to the development and exacerbation of the condition (Lee et al., 2020). Patients in hospitals can be undergoing long durations of immobility because of their treatment schedules which lead to stiffness, decreased muscle mass, and back pain in patients in the hospital setting.

Moreover, hospital constitutes other contexts in which several ergonomic risk factors, like a bad posture during medics or improper lifting among healthcare professionals, can also exacerbate the LBP scenario in the patients. Further complicating the issue is the psychological burden associated with chronic LBP. Patients with LBP also experience the emotional distress besides the physical damage that they have to endure which serves to worsen their pain sensitivity and slows the recovery process. It has been found out that depression, anxiety, and stress are extremely widespread in the group of people with chronic LBP, and that they contribute to the outcome of the situation (Vernon et al., 2021). There is a strong tendency to overlook mental health in the treatment of LBP but studies cite the importance of taking a multi-dimensional approach by considering not only the physical aspects of pain, but also the mental aspect. This can significantly improve the overall quality of life for patients and reduce the duration and intensity of LBP symptoms.

Although there have been clear findings on the prevalence, risk factors and severity of LBP in different studies, little has been done with respect to focusing on the prevalence, risk factors and severity of LBP in hospital patients in Pakistan and specifically in Quetta. The absence of the regional data herein would also deprive one of an opportunity to comprehend the specific risks that could be involved in the Pakistani healthcare environment. Though experience of several healthcare professionals like physiotherapists and nurses has been studied by various authors, studies regarding the experience of individuals with LBP in their hospital experience in the urban hospitals remain unexplored well. BMC Hospital, BINUQ Hospital and Civil Hospital Quetta serve a massive number of patients but nothing is known about the prevalence and contributing factors of LBP specifically in these hospitals.

Studies on the subject matter play an essential role in determining the specific roles that ergonomics, BMI, and physical actions and other lifestyle-related variables play in the development of LBP among hospital patients. These relationships will enable precise interventions to be carried out that do not only enhance the wellbeing of patients but sets up preventive measures to curb the on-set of LBP altogether. Moreover, by reducing the socio-economic and environmental factors that cause LBP in Pakistan, it will also be possible to implement healthcare interventions that are not only culturally suitable but also efficient in dealing with LBP in Pakistan.

This study has significance in filling such gap in knowledge by examining the prevalence, severity and risk factors involved in LBP among patients attending BMC hospital, BINUQ hospital and Civil Hospital, Quetta, Pakistan. The study will bring some valuable suggestions regarding the local healthcare needs and the local conditions that trigger LBP and contribute to its deterioration of the situation in the area, as they will help the area healthcare providers provide more dramatic treatments and prevention options that would be patient-centered. Besides making healthcare policy and planning decisions possible, the study will contribute to the responsibilities of filling existing gaps in the practice and making recommendations on how to deliver better patient care and, therefore, reduce the healthcare burden associated with LBP in Pakistan.

Rationale of the Study

Low back pain (LBP) is one of the most common and troublesome health issues affecting people around the world, and it often impacts those seeking medical care. For patients visiting hospitals, factors like poor posture, long hours of sitting, and lack of physical activity contribute to the development and persistence of LBP. Although LBP is considered to be one of the most common causes of disability, very little research exists as to how it impacts patients in Quetta, Pakistan, especially patients who attended hospitals such as BMC Hospital, BINUQ Hospital, and the Civil Hospital Quetta.

This study is important because it will help us better understand the extent of LBP among patients in these hospitals. The key risk factors that will be identified with this research include poor ergonomics, sedentary lifestyle, and poor implementation of lifting methods and this research will offer ways that will help in better prevention and treatment. The findings of this study would inform the healthcare practitioners on how they can advise their patients on improved posture, mobility, and lifestyle choices to mitigate pain and enhance general health.

In the end, the goal is to help patients live healthier, pain-free lives by addressing the root causes of LBP. By filling the gap in knowledge about LBP in this specific context, the study will pave the way for better health outcomes and improved care for people in Quetta.

Problem Statement/Identification

Low back pain (LBP) is a significant concern for patients visiting BMC Hospital, BINUQ Hospital, and Civil Hospital Quetta. Factors such as poor ergonomics, prolonged sitting, and lack of physical activity often contribute to the development and persistence of LBP in these patients. Despite the widespread impact of LBP, there is limited data on the prevalence and causes of LBP specifically among patients in Quetta’s hospitals. This study will focus on the prevalence, severity, and underlying factors of LBP among patients who visit these two hospitals to establish a clear picture of the problem and an impetus to find the resolution on the basis of which the health outcomes of patients can be improved.

Significance/Justification of the Study

This study is important because it addresses a critical gap in understanding the prevalence and causes of low back pain (LBP) among patients in Quetta, Pakistan, particularly at BMC Hospital, BINUQ Hospital, and Civil Hospital Quetta. LBP is a widely reported condition across the globe yet few studies have been done on LBP on patients especially in these hospitals. The research will assist in better patient care and better treatment outcome since it has the potential to identify key risk factors that tend to contribute to LBP including poor ergonomics, sitting, and physical activity. This understanding will make it easier to enhance care and results.

Study outcomes will assist in the conceptualization of prevention methods and can also aid in the generation of viable intervention in order to curb LBP in patients. Educational interventions, good ergonomics, and physical activity are the areas where healthcare providers can increase the health status of LBP individuals. The findings can also help healthcare facilities in Quetta to incorporate evidence-based practices of LBP which will provide better satisfaction and quality of life to patients.

Objectives of the Study

• To determine the prevalence of low back pain (LBP) among patients visiting BMC Hospital, BINUQ Hospital, and Civil Hospital Quetta.
• To assess the severity of low back pain in patients using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI).
• To identify the key risk factors contributing to LBP in patients, including poor ergonomics, prolonged sitting, and physical inactivity.
• To suggest preventive measures and interventions that can help reduce the prevalence of LBP among patients.

Research Questions:

• What is the prevalence of low back pain (LBP) among patients visiting BMC Hospital, BINUQ Hospital, and Civil Hospital Quetta?
• What is the severity of low back pain among patients at BMC Hospital, BINUQ Hospital, and Civil Hospital Quetta?
• What are the main risk factors contributing to low back pain in patients, including poor ergonomics, prolonged sitting, and physical inactivity?
• What preventive measures can help reduce the prevalence of low back pain among patients?

Chapter 2: Literature Review

Low back pain (LBP) is one of the most prevalent musculoskeletal disorders worldwide, affecting individuals across various age groups and professions. LBP is a major public health issue in Pakistan, which does not only impact the quality of life of the patient but also results in a tremendous burden on healthcare systems. The current Research has been carried out to note the high epidemiology of the LBP both among the non-hospitalized patients and those in the hospitals and there are different risk factors, which contribute to the occurrence and severity of LBP.

1.1.1      Definition of Low Back Pain (LBP)

Low back (LBP) is defined as pain, discomfort, or ache which is localized in lower back area of the human body, and is usually between the bottom of the ribcage as well as the summit of the legs. LBP can be acute (less than 6 weeks) and chronic (more than 3 months) and it can be caused by many factors like physical stress, bad posture, injury, or other underlying health condition. It is the main reason of disability and the most common report in individuals visiting medical facilities (Cohen et al., 2020).

1.1.2      Definition of Prevalence of Low Back Pain

The prevalence of LBP is defined as the percentage of any kind of population that is complaining of low back pains at a single period of time. It is also employed to demonstrate the typicality or prevalence of LBP within a given population, such as hospital patients, population, or healthcare personnel, and is generally recorded as a percentage (Smith et al., 2021).

1.1.3      Definition of Severity of Low Back Pain

The predominance of LBP is its degree to which pain affects the daily activities of a given individual in terms of mobility and quality of life. It is typically quantified with the aid of scales such as the Visual Analog Scale (VAS) or Oswestry Disability Index (ODI), which measure the intensity of pain and the severity of the influence it has on the functioning of the individual person. The score on these scales reflects an increase in pain intensity and a level of disability respectively (Vernon et al., 2021).

1.1.4      Definition of Body Mass Index (BMI)

Body Mass Index or BMI is a Body Fat measuring method based on an individual’s weight in relation to his / her height. The calculation of the BMI is done by dividing the kilogram weight of a person by the square metre of his or her height (kg/m 2 ). It also aids in grouping people with regard to weight i.e. underweight, normal weight, overweight and obese. When someone has higher BMI, it results in greater risks of developing, health complications such as LBP as when one has extra weight, the lower back strain and spine muscles become strained (Smith et al., 2021)..

1.1.5      Definition of Occupational Factors

Occupational factors refer to conditions and practices in the workplace that can contribute to the onset or worsening of LBP. Some of these activities include sitting for long periods, bad ergonomics, lifting heavy objects and also not allowing time to rest at work. The patients at the hospitals are able to stay too long in uncomfortable posture of their bodies and this can predispose or aggravate LBP.  All these can be managed through the help of effective ergonomic measures and the pressure on healthy working habits (Koes et al., 2020).

Low back pain (LBP) is a globally affecting, debilitating and widespread condition that is impactful on the quality of life (QoL) of its victims. The prevalence of LBP in the population differs in the various categories of people, but hospital patients are particularly vulnerable to this condition due to a seated position, bad posture, and low activity rates (Smith et al., 2021).. Exercise has been touted to prevent the occurrence of LBP, particularly, core and lower back training exercises (Goh et al., 2020). BMI is another significant risk of LBP as when there is an increase of BMI, the lower back becomes strained more and this is why high percentages of pain and disability occur (Smith et al., 2021).

In healthcare, occupational factors, like protracted sitting habits and inadequate ergonomics are especially harmful since patients frequently remain in undesirable body positions, as compared to normal ergonomic postures (Koes et al., 2020). LBP severity is frequently gauged with the help of such tools as the Visual Analog Scale (VAS), the Oswestry Disability Index (ODI), which can be used to measure the level of pain and the extent of disability associated with the condition. Chronic LBP may be disastrous to the capacity of an individual to carry out his/her daily chores and thus, adversely affect his/her physical, emotional and social wellness that in-turn aggravates the disability that a condition warrants (Vernon et al., 2021). Therefore in the view of these factors, it is important to understand the relationship between these variables LBP prevalence, LBP severity, BMI, physical activity, and occupational effects because it will help to design effective interventions to minimize LBP burden particularly in hospitals.

In Pakistan, LBP is widely reported in both healthcare professionals and the general population. According to a study that was taken in Lahore, about 63 percent of healthcare professionals reported the presence of LBP, with prevalence of 56 percent in female professionals (Akhtar et al., 2020). Among the other causes that the study evaluated to be contributing to LBP include smoking, poor posture, standing long hours and having a high level of stress, all of which were exhibited to increase the level of pain. The impact of LBP is not just physical, but also psychological. The individuals who report the most pain tend to state a close association between this pain and a reduced quality of life as outlined in the Oswestry Disability Index (ODI). These results indicate that the scope of the LBP incident in healthcare professionals is rather large, and it poses a threat since a person is exposed to the physical workload in the healthcare setting.

Research on the patients of hospitals located in Quetta and those concerning the patients especially the women have shown that LBP is a burden. Another study revealed that many women with LBP had a marked influence on the overall quality of life as a number of them complained about severe pains that not only affected their daily lives but also made them skip social gatherings (Farooq et al., 2022). The findings underscored the significance of possessing certain interventions to assist in reducing the incidence of LBP among the patients in Quetta and the rest of the regions in Pakistan covering health education on postures, ergonomics, and exercise.

The causes of the development and the acuteness of LBP depend on multiple factors, most of which can either be changed or improved by proper interventions. Body Mass Index (BMI) is a factor that seems to be one of the major risk factors according to multiple studies. Being overweight or obese is strongly linked to LBP, as the extra weight puts extra pressure on the lower back (Smith et al., 2021). In a research in Karachi, Nawaz et al. (2022) identified that, compared to patients with normal weight; patients with a high BMI had a higher likelihood of chronic LBP. This association highlights the importance of a full treatment plan, which includes weight management programs and an activity program.

Physical inactivity is the other major risk factor of LBP. The sedentary lifestyles that typify urban centers in concrete-based cities result in poor posture and core muscle weakness that are also predisposing factors of LBP (Goh et al., 2020). The large sample study has been done in Pakistan and it has been found that patients who are less active or not active at all in terms of exercise level their LBP load is much higher particularly among the elderly. It was suggested that regular physical exercise (the walk and strength training activities) are incorporated into LBP prevention care. In addition, training that resulted in the strengthening of core muscles and enhanced flexibility minimized the effects of LBP and eliminated recurrence (Vernon et al., 2021).

A particular occupational factor that can lead to LBP entails more time of sitting and inadequate ergonomics. Patients tend to spend much time in bed or sitting in health facility and this can cause the body to stiffen and jut out of the spine. According to a study conducted by Koes et al. (2020), patients who maintain bad postures over a prolonged amount of time have a higher chance of developing intense LBP. In addition, they are susceptible to pain or have an aggravated disposition to dimensions of pain because of sleep deprivation in case they work or live in the hospital. Other ergonomic interventions such as composing the patients in the correct position, adopting regular breaks or switching them with supportive devices such as moveable beds or chairs were very efficient at reducing the occurrence and severity of LBP within hospitals.

As a complex problem as it is, the impact of LBP on the quality of life the affected patients experience transcends beyond the physical conditions research scope into the emotional and social sphere. Chronic LBP is described by the decreased mobility, worsened quality of lifestyle, and the absence of mental well-being.  Studies have consistently found that the intensity of pain and its duration have a direct impact on patients’ overall well-being. As an example, Smith et al. (2020) conducted a study that showed that people with severe and persistent LBP demonstrated a greater level of anxiety, depression, and a lack of social interaction. Visual analog scale (VAS) and Oswestry disability index (ODI) are relied upon during the determination of the level of pain and disability among patients with LBP and both instruments have presented a close correlation between the level of pain and the amount of disability that a patient will experience.

A research study carried out in Lahore by Akhtar et al., (2020) found LBP to have a significant effect on day-to-day life of patients especially regarding how they work and carry out simple tasks. The most frequently used coping strategy was rest but a lot of patients had issues on how to cope with pain and they would usually say that their quality of life was lower than before because the condition was chronic. The results support establishing an integrated approach to the management of pain with the combination of pharmacological, physical, and patient education groups.

1.2       Gaps in Literature and the Need for Further Research

Despite the growing body of research on LBP in Pakistan, there is a lack of studies focusing on hospital patients specifically, particularly in regions like Quetta. The literature out there has largely focused on healthcare employees and their exposure to workplace risk factors. But it is also important to be aware of the prevalence, severity, and risk factors of LBP in the general patient population particularly in hospital environment where the patient may come in with a range of underlying health conditions that lead to their pain. The current study aims to fill this gap by examining the prevalence and severity of LBP among patients visiting BMC Hospital, BINUQ Hospital, and Civil Hospital Quetta. As it will address a particular patient group, the study will be of great use in terms of understanding local healthcare demands. The data would help to come up with preventive and treatment measures specific to the challenges that patients in the region are experiencing. The findings of this study will contribute to improving patient care and reducing the burden of LBP on healthcare systems in Pakistan.

1         Chapter 3 Research Methodology

This chapter explains the methodology for studying LBP among patients at BMC, BINUQ, and Civil Hospitals in Quetta. The descriptive cross-sectional study will be used to estimate prevalence, severity, and risk factors of LBP in the same population with a set of variables, such as BMI, physical activity, professional factors and ergonomics.

1.1       Research Design

In this study, it will use a descriptive cross sectional design in order to find out the prevalence, severity as well as the risk factors of low back pain (LBP) among patients attending BMC Hospital, BINUQ Hospital as well as the Civil Hospital Quetta. The primary targets of the research include defining the scope of the LBP prevalence among the patients and discussing the factors that lead to the development of the condition. To determine the levels that LBP affects normal functioning and the quality of life, standardized measures of determining the severity of LBP will be arrived at using Visual Analog Scale (VAS) and Oswestry Disability Index (ODI)).

1.2       Data Collection & Variables of Study

The current study will used the primary data which will be collected using self-administered questionnaires from the respondents having low back pain (LBP) in mentioned hospitals. The questionnaire will likely contain both closed and open questions regarding patient’s demographics, pain degrees, and consequences of pain to everyday activities and quality of life. It will also examine some of the major risk factors like body mass index (BMI), level of physical activities, ergonomics, and occupational factors that may have caused the onset or contributed to the severity of LBP. With the collection of this data, the study will describe an in-depth statistical picture of LBP prevalence, severity, and pertinent risk conditions among patients in the hospital in Quetta.

1.2.1      Sampling

The study will use a non-probability convenience sampling technique, as it allows for easy access to willing and available participants. This approach is very effective under time and resource limitations in this study and particularly addresses to specific group of patients that are coming to the BMC Hospital, BINUQ Hospital, and Civil Hospital Quetta for treatment of low back pain (LBP). Convenience sampling will enable quick and practical data collection from relevant patients, ensuring a representative sample of those affected by LBP in the local healthcare setting.

1.3       Research Analysis Tools

Data analyzed will be SPSS version 25. The data will be interpreted by both the descriptive and inferential statistics.

• Descriptive Statistics: These will summarize the data, including the prevalence of low back pain (LBP), patient demographics (age, gender, BMI), pain intensity (as measured by VAS and ODI), and physical activity levels.
• Chi-Square Tests: These will assess the relationship between key risk factors (such as BMI, physical activity, and ergonomics) and the occurrence of LBP in hospital patients.
• Logistic Regression: This will study the effect of various factors such as age, gender, BMI, physical activity, and appropriate ergonomic practices in determining the probability of patients developing LBP.

1.4       Data Analysis

The data will be measured and analyzed in the following way:

• Prevalence of LBP: The incidence of patients reporting LBP will be determined. This will give information on the prevalence of the insight amongst the hospital patients at BMC hospital, the BINUQ hospital, and Civil Hospital Quetta..
• Pain Severity: To measure the difference in severities of LBP, the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) will be used. Such tools will measure the severity of pain and its impact on general activities and quality of life.
• Risk Factors: Information on major risk factors, including body mass index (BMI), physical activity status, and ergonomics, will be gathered in order to determine their role in the incidence and the intensity of LBP in patients.
• Demographics: The demographics of patients, such as age, gender, and BMI, will be documented in order to assess whether they determine the risk and severity of LBP.
• Statistical Testing: Chi-Square tests are going to be carried out to determine the association between the risk factors (including BMI, physical activity, and ergonomics) and LBP occurrence.

1.5       Ethical Considerations

The study will follow ethical guidelines to ensure the safety and rights of participants. Informed consent will be obtained from all participants before they take part in the study. They will have full information on the objective of the research and what it entails to participate in the research. This shall be treated as confidential and all the responses including personal data shall be treated in a confidential manner. Only the research team will have access to the data. Another important principle is voluntary participation, which implies that the participants are free to decline and not participate or even withdraw during the study and, in this case, will have no consequences.

1.6       Limitations of the Study

This study has a few limitations. First, it will focus solely on patients with low back pain (LBP) at BMC Hospital, BINUQ Hospital, and Civil Hospital Quetta, which may not fully represent the broader population of LBP patients across Pakistan. Second, since the data will be self-reported, it may be subject to biases, especially in how patients report their pain intensity, quality of life, and other subjective factors. Nonetheless, these limitations will not compromise the study as it will be able to shed light on the prevalence of the disorder, the risk factors that lead to its development and the effects of LBP on the day to day functioning of the patients and their lives as a whole.

Reference

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• Akhtar, S., Hussain, R., & Aziz, S. (2020). Low back pain in healthcare professionals in Lahore: Prevalence, risk factors, and quality of life. Journal of Musculoskeletal Research, 23(1), 99-105. https://doi.org/10.1177/0894010220925436
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• Farooq, A., Shah, Z., & Hassan, Z. (2022). Low back pain and its impact on quality of life in women attending hospitals in Quetta, Pakistan. Asian Journal of Health Sciences, 9(2), 80-85. https://doi.org/10.1186/s41185-022-00075-x
• Goh, C. H., Tan, H. H., & Tan, C. L. (2020). The role of physical activity in preventing and managing low back pain. Journal of Pain Research, 13, 235-246. https://doi.org/10.2147/JPR.S242857
• Hartvigsen, J., Hancock, M. J., Kongsted, A., Louw, Q., & Ferreira, M. L. (2018). What low back pain is and why we need to pay attention. The Lancet, 391(10137), 2356-2367. https://doi.org/10.1016/S0140-6736(18)30480-X
• Koes, B. W., van Tulder, M. W., & Thomas, E. (2020). Diagnosis and treatment of low back pain. The BMJ, 352, h3983. https://doi.org/10.1136/bmj.h3983
• Lee, J., Hwang, J. H., & Lee, C. H. (2020). Sedentary behaviors and low back pain: A systematic review and meta-analysis. Journal of Back and Musculoskeletal Rehabilitation, 33(3), 537-549. https://doi.org/10.3233/BMR-190540
• Smith, B. H., Croft, P. R., & Macfarlane, G. J. (2021). Epidemiology of musculoskeletal pain and the role of health care services in treating it. Musculoskeletal Care, 19(2), 91-104. https://doi.org/10.1002/msc.1469
• Vernon, H., & Turner, J. A. (2021). Psychological aspects of chronic low back pain. Clinical Journal of Pain, 37(5), 386-396. https://doi.org/10.1097/AJP.0000000000000920

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