|Year : 2016 | Volume
| Issue : 2 | Page : 111-115
Prevalence of low back pain and its relation to quality of life and disability among women in rural area of Puducherry, India
Guna Sankar Ahdhi1, Revathi Subramanian1, Ganesh Kumar Saya2, Thiruvanthipuram Venkatesan Yamuna1
1 Department of Community Health Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
2 Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
|Date of Web Publication||18-Jul-2016|
Ganesh Kumar Saya
Department of Social and Preventive Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry - 605 006
Source of Support: None, Conflict of Interest: None
Background: The level of quality of life (QOL) and disability among women with low back pain is an important health issue at global level. Objective: To find out the prevalence of low back pain and to assess the relationship of low back pain with disability and QOL among women. Materials and Methods: A community-based cross-sectional study was conducted among 250 women in age group of 30-65 years residing in field practice area of a Tertiary Care Medical Institution, Puducherry. Severity of the pain was assessed using Numerical Pain Scale. Modified Oswestry Low Back Pain Disability Questionnaire was used to measure the disability level and WHO-BREF scale to assess the QOL among women with low back pain. Results: Overall, the prevalence of low back pain was found to be 42%. The majority of women (60.9%) with low back pain experienced moderate disability. Almost 72% of women with low back pain perceived their QOL as good and overall mean QOL score was 88.41 (standard deviation = 12.9). The low back pain was influenced by the demographic variables that include age, marital status, illiteracy, total family income, type of delivery, number of children and household chores, menopausal status, and chronic illness (P < 0.05). Disability was influenced by age, education, and occupation, whereas QOL was influenced by education of the women with low back pain (P < 0.05). Conclusions: Prevalence of low back pain among women was comparatively more than other studies in India. Although moderate disability was more among those with low back pain, overall QOL was good.
Keywords: Disability, low back pain, quality of life
|How to cite this article:|
Ahdhi GS, Subramanian R, Saya GK, Yamuna TV. Prevalence of low back pain and its relation to quality of life and disability among women in rural area of Puducherry, India. Indian J Pain 2016;30:111-5
|How to cite this URL:|
Ahdhi GS, Subramanian R, Saya GK, Yamuna TV. Prevalence of low back pain and its relation to quality of life and disability among women in rural area of Puducherry, India. Indian J Pain [serial online] 2016 [cited 2019 May 22];30:111-5. Available from: http://www.indianjpain.org/text.asp?2016/30/2/111/186467
| Introduction|| |
A woman is the nucleus of the family, especially in rural India. The daily work schedule of rural women is very arduous and demanding in nature. In addition to household and agriculture works, the other time spends as energy-demanding activity for rural women is care of livestock, which is not only strenuous, but also repetitive and makes them overburdened as well as leading them a continuous health risk.  The nonneutral posture of the trunk frequently adopted by women is risk for developing a low back pain.  Lack of facilities with their traditional techniques like, drawing water from the wells, carrying heavy loads on their back may lead to back pain. 
International surveys of low back pain reported that 1-month prevalence was 19-43% and point prevalence was 15-30%. The estimated worldwide lifetime prevalence of low back pain varies from 50% to 84%.  Studies in developed countries have shown that the low back pain point prevalence was 6.8% in North America, 13.7% in Denmark, 12% in Sweden, 14% in the United Kingdom, 33% in Belgium, and 28.4% in Canada. Similarly, some studies in developing countries have revealed much higher incidence of 72.4% in Nigeria, 64% in China, and 56.2% in Thailand.  The occurrence of low back pain in India is also alarming with nearly 60% of the people in India have suffered from low back pain at some time during their lifespan. 
Low back pain also restricts mobility, interferes with normal functioning and results in lifelong pain and permanent disability.  In India, most of the low-income group people are engaged in physically demanding jobs which may increase the risk of low back pain and disability.  Low back pain also affects the quality of life (QOL) of not only the women themselves, but their families as well. , In Indian, very few studies have been done with regard to this. With this background, the present study aimed to assess the prevalence of low back pain, and disability and QOL among women with low back pain in rural Puducherry, India.
| Materials and Methods|| |
Study design and setting
A community-based cross-sectional study was conducted in a field practice area of a Tertiary Care Medical Institution during the period from July 2013 to December 2013. The target population was the women in age group of 30-65 years residing in Ramanathapuram Village of Puducherry, India.
Sample size estimation and sampling technique
Among four villages present in rural field practice area of the Medical Institution, Ramanathapuram Village was selected for feasibility purpose. Considering 22.5% prevalence of low back pain,  25% relative precision, and 10% of nonresponse error, a minimum of 250 subjects were included in this study. The total number, name, and address of women in age group 30-65 years were obtained from the Rural Health Centre records. The total number of women in the age group of 30-65 years in Ramanathapuram Village was 518. Out of these, 250 women were selected by simple random technique.
Institutional ethical clearance was obtained before starting the study. Permission from concerned authorities was sought after explaining the objectives as well as the method of study. Informed written permission was obtained from the study subjects.
Method of data collection
The interview was conducted by the principle investigator in the houses of the subjects. Initially rapport was developed with the study subjects. The written informed consent was obtained and the purpose of an interview was explained to each study subject. Each participant was interviewed confidentially in Tamil language.
In the first step, sociodemographic factors were collected and low back pain among women was assessed in the preceding month based on Numerical Pain Scale rating from 0 to 10. Body height and weight of each subject was taken by standard methods. A modified Oswestry Low Back Pain Disability Questionnaire was used to measure the disability level and WHO-BREF questionnaire was used to assess the QOL among women who reported low back pain. The interview lasted for 30-45 min for each study subject. Average of 6-8 women was interviewed each day.
All the statistical analyses were done using IBM PASW Statistics (SPSS)-19.0 version and was carried out at 5% level of significance. The data on subjects' background variables was expressed as frequencies and percentages. The data on the level of disability and QOL was expressed as a percentage and mean with standard deviation (SD). The relationship among low back pain, disability, and QOL was analyzed using Karl Pearson's correlation coefficient. Association between the prevalence of low back pain, disability and QOL between the sociodemographic factors was assessed by analysis of variance or independent t-test.
| Results|| |
All the 250 subjects participated in the study. Out of 250 study subjects, 35.6% (n = 89) of the women were in the age group of 30-40 years. Regarding education, 50% (n = 125) of participants had education up to secondary level and 19.6% (n = 49) of them were illiterate. By occupation, 56.8% (n = 142) were housewives. With regard to menopausal status, 64.8% of women did not attain menopause. Regarding body mass index (BMI), 39.2% of them were overweight. In relation to co-morbid conditions, only 14.1% of them were having chronic illness.
The 1-month period prevalence of low back pain among women was 42% (105). Majority of women (60%, 63/105) had moderate pain followed by severe (23.8%, 25/105) and mild (16.2%, 17/105) pain. Subjects with low back pain experienced moderate disability (60.1%, 64/105) followed by severe disability (23.8%, 25/105), minimal disability (12.4%, 13/105), and crippled (2.8%, 3/105). About 72.4% (76/105) of women perceived their QOL as good, 21.9% (23/105) of them were perceived as neither poor nor good and only 5.7% (6/105) perceived as poor.
The significant associations were found between low back pain and demographic variables such as age, lower education, marital status, less income, delivery type, and number of children, durations of sweeping the house, washing clothes and washing vessels per day, menopausal status, and co-morbid condition [Table 1] and [Table 2]. Furthermore, there was a significant difference between the mean score of level of disability with age, education, and occupation of the women (P < 0.05). A significant difference was also found between mean scores of QOL and education (P < 0.05).
The overall mean score of QOL of women with low back pain was 88.41 (SD = 12.9) and comparable across all the four domains. The mean scores of physical domain of QOL were higher when compared to other domains of QOL [Table 3]. There was a significant positive correlation between pain and disability and a negative correlation between pain and QOL and also there was a significant negative correlation between the level of disability and QOL [Table 4].
|Table 1: Association of low back pain with sociodemographic factors among women (n = 250) |
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|Table 2: Prevalence of low back pain with associated factors among women |
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|Table 3: Mean scores of domains of QOL of women among low back pain subjects (n = 105) |
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|Table 4: The correlation coefficient between low back pain, disability, and QOL of women with low back pain (n = 105) |
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| Discussion|| |
There is a paucity of literature on community-based studies regarding the assessment of the prevalence of low back pain among women in India. This study showed that 1-month period prevalence of low back pain among women was 42%, which is much higher when compared to study findings of Badley et al.  This study in United States found that low back pain point prevalence among the general population was 15-30%, and pain in the last 30 days was found between 19% and 43%. Similarly, Stranjalis et al. reported that 32% of adults had suffered from low back pain for 1-month period in Greece. Furthermore, Sadigi, et al.  revealed that among the populations under study, 28.4% of them had low back pain in the last 14 days. A study was conducted by Mathew et al.  to estimate the prevalence and correlates of low back pain among adults aged 20 years and above in Coimbatore, Tamil Nadu revealed that 1-year prevalence of low back pain among women was 52.9% with highest prevalence (50%) among age group of 41-50 years.
The present study findings found that the most (60.9%) of the women with low back pain experienced moderate disability and 12.3% of them with minimal disability and 23.8% of them experienced severe disability, only 2.8% of them experienced crippled. These findings are consistent with the study conducted by Koley S and Sandhu NS (2009). 
In this study, 72% of women with low back pain had perceived the QOL as good and 21% of them perceived as neither poor nor good. 5.7% of them perceived the QOL as very good and none of them perceived as poor or very poor. A study conducted by Sultana (2012)  in Bangladesh to explore the QOL among 70 low back pain patients aged 18-70 years reported that, 17.6% participants had no problem in their QOL and 82.4% participants had a problem in their QOL.
The present study revealed that significant correlations were found among the low back pain, QOL, and disability. These findings were supported by a study conducted by Darzinaghibi, et al., (2012)  which demonstrated that there was a significant correlation between all aspects of QOL and functional disability except environment health. Correlation between functional disability and all aspects of QOL was negative. The study concluded that higher functional disability can lead to lower QOL and vice versa.
The study showed that there was a significant association between the mean score of low back pain and age, marital status, education, total family income, type of delivery, number of children, hours of sweeping house, washing clothes and washing vessels per day, menopause status, and chronic illness (P < 0.001). These findings were consistent with the study conducted by Gourmelen, et al. (2007),  Liu, et al., (2012)  and Cho et al., (2012)  in France, China, and Korea, respectively, which reported that advanced age and females sex were associated with low back pain. Similarly, a study conducted by Sadigi, et al.,  in Tabriz found that there was a significant association between marital status, housewives, number of pregnancy and delivery type, and low back pain. Furthermore, these findings were corroborated with the study carried out by Biglarian, et al. (2012)  in Iran and it was reported that as factors such as age, females, marital status, obesity, low family income, smoking, and lower education were associated to low back pain.
This study showed that there was no association between BMI and low back pain. This finding was consistent with the study carried out by Birabi, et al. (2012)  in Nigeria and Mathew, et al.  in India.
| Limitations and Conclusions|| |
The intensity of the low back pain might have influenced by the recall bias of women. Similarly, there may be subjective bias while assessing the disability and QOL. It was concluded that prevalence was comparatively more than other studies in India. Although moderate disability was more among those with low back pain, overall QOL was good. Disability intervention measures may help in reducing the impact of low back pain and improving the QOL among women with low back pain.
We sincerely acknowledge the support provided by the staffs at Rural Health Centre and also all women for their participation in this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]