Background Low Back Pain (LBP) is a major public health problem and is classified by the Global Burden of Disease Study among the ten diseases most responsible for Disability-Adjusted Life Years worldwide. All ages may be affected, mostly young adults, with a prevalence going up to 50%. Medical students may be particularly vulnerable due to sedentary lifestyle and high stress levels.
Objectives The primary objective is to evaluate the prevalence of LBP in Lebanese medical students. The secondary objective is to identify predictive factors associated with LBP and to identify prevalence and components of inflammatory back pain (IBP).
Methods PAX-I is a cross-sectional study, completed at the St-Joseph University of Beirut from April to June 2016. All students from the first to the sixth year of medicine were invited to fill a questionnaire about their demographic data, lifestyle habits, Patient Health Questionnaire for Depression and Anxiety (PHQ4) and LBP characteristics, including components of IBP as per ASAS criteria. Student test and ANOVA were used for quantitative variables, chi-square test was used for qualitative variables and logistic regression was used for predictive factors for low back pain. Analysis were performed on IBM SPSS Statistics 23.
Results Response rate was 51.3% (258/502). Mean age was 20.86 years (SD 1.92). 54.3% were female, 76.7% drank caffeine, 66.3% had a regular sports activity and 9.7% were smokers. 38% had the habit of walking while studying. All habits were similar across years of studying except for sports activities which decreased over the years (p 0.018). 80% were satisfied with their studies. Only 46% were satisfied with their quality of sleep. Mean PHQ4 score was 7.17 and increased with the years of studies (p 0.045).
55.8% of students reported a LBP event during the past year, with a mean number of 3.6 episodes per year. 91% of these students had LBP while studying, with high reported intensity (5.18/10), 62.5% reported LBP after exercise. 80% had episodes of less than one month and 7% of more than three months duration. 12% had IBP according to the ASAS criteria (Details of IBP in Figure 1). Predictive factors for LBP in univariate analysis were: smoking (p 0.040), alcohol consumption (p 0.005), caffeine consumption (p 0.041), television watching (p 0.042) –positive association-, and number of hours of sleep (p 0.011) and satisfaction with sleep quality–negative association- (p 0.017). Satisfaction with sleep quality remained the only significant association in multivariate analysis (p 0.014).
Conclusions LBP is a frequent problem among medical students with high intensity, especially when studying, and a high recurrence rate. The main predictive factor was poor satisfaction with sleep quality. A significant percentage fulfills IBP criteria by auto-questionnaire and should benefit from further investigation.
Hoy D et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 2014;968–74.
Sieper J et al. New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis International Society (ASAS). Ann Rheum Dis 2009;68:784–8.
Disclosure of Interest None declared