A STUDY TO ASSESS THE KNOWLEDGE AND ATTITUDE

REGARDING OCCURRENCE AND PREVENTION OF LOW BACK PAIN

AMONG III YEAR AND IV YEAR B.Sc. NURSING STUDENTS IN
SELECTED COLLEGE AT BANGALORE.

M.Sc. Nursing Dissertation Protocol submitted to

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.

By

Mrs. ANITHA THOMAS

M.Sc NURSING 1ST YEAR

2009-2011

Under the Guidance of

HOD, Department of Medical Surgical Nursing

Anuradha College of Nursing

Gandhadakaval,

Hegganahalli Cross

Vishwaneedam Post

Magadi Road

Bangalore –91
 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE, KARNATAKA
CURRICULAM DEVELOPMENT CELL

CONFORMATION FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

Registration number :

Name of the candidate : Mrs. Anitha Thomas

Address : Gandhadakaval, Hegganahalli Cross,

Vishwaneedam Post, Magadi Road, B,lore-91 .
Name of the institution : Anuradha College of Nursing

Course of study and subject : M.Sc Nursing in Medical Surgical Nursing.

.
Date of admission to course : 15-05-2009

Title of the topic : A study to assess the knowledge and attitude

regarding occurrence and prevention of low back
pain among III Year and IV Year B.Sc Nursing
Students in Selected College at Bangalore

Brief resume of the intended work : Attached

Signature of the student :

Guide Name :
.
Remarks of the guide :

Signature of the guide :

Co-guide name :

Signature of co-guide :

HOD name :

Signature of HOD :

Principal Name : Mrs. Radhika K.

Principal Mobile No : 9945621112

Principal E-mail ID : radhu_prasad@rediffmail.com

Remarks of the Principal :

Principal signature :
 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION

1 NAME OF THE CANDIDATE MRS.ANITHA THOMAS

AND ADDRESS I YEAR M.Sc. NURSING,
ANURADHA COLLEGE OF NURING
GANDHADAKAVAL,
HEGGANAHALLI CROSS
VISHWANEEDAM POST, MAGADI ROAD
BANGALORE-91

2 NAME OF THE INSTITUTION ANURADHA COLLEGE OF NURING

GANDHADAKAVAL
HEGGANAHALLI CROSS
VISHWANEEDAM POST, MAGADI ROAD
BANGALORE-91

3 COURSE OF STUDY AND M.SC NURSING

SUBJECT MEDICAL SURGICAL NURSING

4 DATE OF ADMISSION TO
THE COURSE 15-05-2009

5 TITLE OF THE TOPIC:

“A STUDY TO ASSESS THE KNOWLEDGE AND

ATTITUDE REGARDING OCCURENCE AND

PREVENTION OF LOW BACK PAIN AMONG III YEAR
AND IV YEAR B.SC NURSING STUDENTS IN SELECTED
COLLEGE AT BANGALORE.”
6 BRIEF RESUME OF THE INTENDED WORK:

INTRODUCTION

Low Back pain (LBP) is one of the most common complaint of

people in most countries. It is estimated that 8 to 10 million people in the United

States experience back pain every year. The cervical (upper back ) vertebrae and

lumbo-sacral (lower back) vertebrae are most commonly affected. A majority of adults

(80% or more) experience at least one episode of low back pain(LBP) some time in

their lives. Low back pain causes 40% to 50% of all lost work days. The cost of low

back pain is at least 16 billion yearly in the United States.1

Back strain is an acute injury leading to low back pain. Back strain

occurs when the client flexes the back without bending the knees or makes rotating

movements creating significant stress on the inter-vertebral disk and muscles of the

lower back. Several risk factors are associated with low back pain , including lack of

muscle tone and excess weight, poor posture, smoking, stress and prolonged period of

sitting are also associated with low back pain.2

Most lower back pain is caused by one of many musculo skeletal

Problems including acute lumbo-sacral strain, unstable lumbo-sacral ligaments and

weak muscles, osteoarthritis of the spine, spinal stenosis, inter-vertebral disk problems

and unequal leg length.3

 There has been agreement on a number of points, in particular that

nursing is among the high risk occupations with respect to low back problems, with a

point prevalence of approximately 17%, an annual (period) prevalence of 40-50% and

a lifetime prevalence of 35-80%. When considering the contributing factors there is

some divergence, but one of the popular notion is generally proven that more frequent

patient handling appears to correlate with increased of low back pain.4

Recurring back pain resulting from improper body mechanics or other

non-traumatic causes is often preventable. A combination of exercises that don’t jolt or

strain the back, maintaining correct posture and lifting objects properly can help

prevent injuries. The use of wide elastic belts that can be tightened to pull in lumbar

and abdominal muscles to prevent low back pain is controversial. The use of back

support belt worn by persons who lift or move merchandise found no evidence that the

belts reduce back injury or back pain.5

6.1 NEED FOR STUDY

Back Pain is such a common health condition that an estimated 8 out of

10 people experience it at least once during their life time. Pain felt in the low or upper

back. There are many causes of back pain. Pain in the low back can relate to the bony

lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal

cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen

and the skin covering the lumbar area.6

 According to survey conducted during the year 2005-2009, the Worldwide

incidence of LBP among nurses was reported as 1 to 10 of about 1,840 and that in

India it was 1 to 10 of about 1,390. In the case of Karnataka it was reported to be 1 to

10 of about 54, while in Bangalore it constituted 1 to 10 of about 54,900, during the

same year. Where as the incidence of low back pain among nurses in Worldwide, the

year 2009 was reported as 1 to 10 of about 273,000 and it was 1 to 10 of about 349,000

in India. In Karnataka and Bangalore, it was reported as 1 to 10 of about 5,230 and 1 to

10 of about 57,400 respectively, during the same year.7

The study was conducted on “Majority of Health workers have Chronic

backache”, two researchers has brought to light the prevalence of lower backache as a

common occupational problem among nurses. More than 50 per cent of the health

workers were selected from government and private hospitals. In this study the results

were while 50 per cent of them were found to have minimal level of disability and 35

per cent had moderate level of lower backache. And the most of the nurses working in

the wards that include heavy workload like Intensive Care Unit (ICU) or casualty units

had a high prevalence and extent of lower backache and those having high Body Mass

Index(BMI) or those who are overweight have still higher level of low backache as it

leads to compression and narrowing of the disk.8

The study was conducted on “Study of low back pain in student

nurses”,199 student nurses were taken for this study. The results of this study were

37% reported back pain which lasted for at least 3 consecutive days. A combination of

personal characteristics are also coincided with back pain reports, within this group of
nurses. Recommendations of this study were: (1) the consideration of a modified

training programme for lifting and handling; and (2) the need for a standardized system

of recording back problems as suggested by the DHSS- commissioned Robens

Institute Report.9

The study was conducted on “Functional movement training for

recurrent low back pain.” 61 participants were taken for this study. The result showed

that, of the participants 67% provided data at 2 months and 44% provided information

at 12 months.The scores were evaluated at 2,6& 12 months. In particular, at 2 months

the CS-PFP (Continuous Scale Physical Functional Performance) changes scores

revealed a trend (P=.072) toward greater improvement in groups 2 and 3 compared

with group 1.CS-PFP scores also trended toward significance for group 2 and 3 (P=.7

and .9, respectively.) 10

Low Back Pain is one of the important problem in the nursing field.

Nurses are at high risk of developing low back pain. Nursing staff has shown the

connection between lifts and transfers of patient’s on one hand and low back problem

on the other. Even though good body mechanics and exercises can be done to prevent

low back pain, the incidence rate is seen high among nurses. So the investigator is very

much interested in doing the research in this topic.11

6.2 REVIEW OF LITERATURE

Review of literature is a key step in research process. The typical purpose for

analyzing a review existing literature is to generate research question to identify what is

known and what is not known about the topic. The major goals of review of literature are

to develop a strong knowledge base to carry out research and non -research scholarly

activity.12

Review of literature from the study is been divided in to:

STUDIES RELATED TO CAUSES AND RISK FACTORS OF LOW BACK PAIN

A study was conducted on “A Study of the Back Pain beliefs of Female

Undergraduate Healthcare Students”. Three hundred and 82 female undergraduate nursing

and physiotherapy students were taken for this study .The results showed that, differences

were evident in the future consequence of low back pain between countries (P<0.001),

undergraduate course (P<0.001), and low back pain status(P=0.021).Healthcare provider

beliefs were found to be (P<0.001). Fear avoidance beliefs related to physical activity

were influenced by country (P=0.002) and undergraduate course (P<0.001). Nursing

students had more negative back pain beliefs than physiotherapy students (P<0.001) and

the experience of low back pain was associated with more positive beliefs on the future

consequence of back trouble (P0.021).13

The study was conducted on “Musculoskeletal disorders self-reported by

female nursing students in Central Japan”. Sample is 222 female nursing students.The

result showed that one third of nursing students (36.9%) reported Musculo Skeletal
Disorders ( MSD). Musculoskeletal disorders of the lower back was (13.5%). However,

previous hospital work was found to increase the risk of MSD by a factor of 4.4 (OR 4.4,

95% CI 1.3-13.3, P=0.0107).14

The study was conducted on “Occupational back pain in Iranian nurses”.

Sample is 1226. Results were , that prevalence of low back pain in nurses was over 50%.

Lifting was the most common mechanism for low back pain (30.4%). Prolonged standing

and rest were (57.6% and 59.2%) respectively.15

The study was conducted on “New low back pain in nurses: work activities,

work stress and sedentary lifestyle”.144 nurses were selected for this study. The result of

this study were, 38% nurses reported new low back pain. Sedentary leisure time activity

was not associated with new low back pain. Being comparatively new on a ward (adjusted

relative risk 2.90), working in bending postures (adjusted relative risk 2.76) and poor work

relationship with colleagues (adjusted relative risk 2.52) were independent predictors of

new low back pain.16

The study was conducted on “Patient – handling skill, back injuries, and

back pain. An intervention study in nursing”. Sample size is 255 nurses. Result of this

intervention study showed that the major risk indicators for back injuries were poor

patient-handling skill, low numbers of repetitions in the sit-up test, and high work-load

scores.17

The study was conducted on “Biopsychosocial factors are associated with low

back pain in female nursing students”. Participants were 170 female undergraduate
nursing students. Results were, over 30% of students reported significant low back pain.

Significant low back pain were physically active (P=0.04), had higher scores (P=0.01) and

used passive coping strategies (P<0.001).18

The study was conducted on “Factors predicting dropout in student nursing

assistants”. Sample is 790 subjects. The result of this study were, about 83% of women

had low back pain were other factors( a history of previous exposure to heavy physical

workload, etc.) associated with risk of dropout, OR (95% CI)=2.5(1.2-5.3).19

STUDIES RELATED TO OCCURRENCE AND PREVENTION OF LOW BACK

PAIN

The study was conducted on “Low back problems and possible

improvements in nursing jobs.” Participants were 47 nurses (23 orthopaedic and 24

intensive care nurses. In this study the results were, the life time incidence and point

prevalence of low back pain were 65% and 30%, respectively, in orthopaedic nurses.

Scoring scale was used to assess the pain. According to the Visual Analogue Scale, and

the Borg scores and force effort on the Visual Analogue Scale were moderately correlated

(r=0.53,P<0.01 for both comparisons.20

The study was conducted on “Determination of the usage of body mechanics in

clinical setting and the occurrence of low back pain in nurses”. Sample is 56 nurses who

work on the medical, surgical emergency, and intensive care units. The results of this

study were, the majority of the nurses (87.5%) experienced low back pain at some time in

their lives. The majority of the nurses used body mechanics correctly while sitting

(53.6%),standing(58.7%),carrying(64.3%),pulling or pushing(79.4%),moving the patient

 to the side of the bed without an assistant(53.4%),moving the patient to a sitting position

in bed (71.4%) and assisting the patient to a standing position(66.6%).51.1% of the nurses

lifted and 82% extended incorrectly.21

The study was conducted on “Exercise for the primary, secondary, and

tertiary prevention of low back pain in the workplace”. 15 were selected for analysis. The

results of this study was strong evidence that exercise was effective in reducing the

severity and activity interference from low back pain. Poor methodological studies

showed that only limited evidence supporting the use of exercise to prevent low back

pain. But high methodological quality of studies showed significant reductions in low

back pain intensity with exercise.22

The study was conducted on “Graded exercise for recurrent low back pain”.

Participants were 36 men and 35 women. The results showed that, of the participants 83%

provided date at the 12-month follow-up and 79% at 36 months. At 12-months, between

group comparison showed a reduction in perceived disability in favor of the exercise

group. Ratings of physical health and self-efficacy beliefs also improved in the exercise

group over the long term.23

6.3 STATEMENT OF THE PROBLEM

“A study to assess the knowledge and attitude regarding occurence and

prevention of Low Back Pain among III year and IV year B.Sc Nursing students in

selected colleges at Bangalore”.

6.4 OBJECTIVES OF THE STUDY

 The objectives of the study are:

 To assess the knowledge level regarding occurrence and prevention of low back

pain among III year and IV year B.Sc Nursing students.

 To assess the attitude regarding occurrence and prevention of low back pain among

III year and IV year B.Sc . Nursing students.

 To compare the knowledge and attitude regarding occurrence and prevention of low

back pain among III year and IV year B.Sc Nursing students.

 To find the association between the knowledge regarding occurrence and prevention

of low back pain with selected demographic variables (age, sex, education, parent’s

education, place of residence, occupation of the father).

 To find the association between the attitude regarding occurrence and prevention of

low back pain with selected demographic variables ( age, sex, education, parent’s

education, place of residence, occupation of the father). .

6.5 HYPOTHESIS

The hypothesis will be tested at 0.05 level of significance.

 H1: There will be significant association between the knowledge and attitude

regarding occurrence and prevention of low back pain among III year and IV year

B.Sc. Nursing students.

 H2: There will be significant association between the knowledge regarding

 occurrence and prevention of low back pain with selected demographic variables

(age, sex, education, parent’s education, place of residence, occupation of the father).

 H3: There will be significant association between attitude regarding occurrence and

prevention of low back pain with selected demographic variables (age, sex,

education, parent’s education, place of residence, occupation of father).

OPERATIONAL DEFINITIONS

6.6
KNOWLEDGE

 “Knowledge is the information or the awareness gained through the experience or

education”

ATTITUDE

 “An attitude is any belief or opinion that includes an evaluation of some object,

person or event along a continuum from negative to positive”.

BACK PAIN

 “Backache is any pain in the back, usually in the lower part. Causes are often

physical, including mechanical issues (usually related to disc problems), injuries

(from a fall, heavy lifting or accident), certain medical conditions or diseases (such

as scoliosis), infections and tumors.”

OCCURENCE

 “In this study, it refers to the incident or happening of Low Back Pain.”

PREVENTION

 “In this study, it refers to stop or reduce low back pain and good body mechanics
 should be maintained to prevent low back pain.”

B.Sc NURSING STUDENTS

 “In this study, it refers to the students who are studying III year and IV year Nursing

programme in selected college, Bangalore”.

ASSUMPTIONS

 Student nurses will have knowledge regarding occurrence and prevention of low
6.7
back pain.

 Student nurses will have positive attitude regarding occurrence and prevention of

low back pain.

 Student nurses will take the preventive measures (good body mechanics and

exercises) in the aspect of low back pain prevention.

DELIMITATIONS

The study is delimited to:

6.8
 Study is limited to 100 samples.

 Study is limited to only III year and IV year B.Sc Nursing students who are

studying in K.T.G College of Nursing, Bangalore.

 Study is limited to only student nurses who are willing to participate in this

study.

 The study is limited for 4 weeks.

PROJECTED OUTCOME

 The present study will help the B.Sc Nursing students who understand about low

6.9
 back pain and hence to decrease the occurrence of low back pain.

MATERIALS AND METHODS

7.0 SOURCE OF DATA

7.1 RESEARCH DESIGN

 Descriptive design will be used for this study.

7.1.1
RESEARCH APPROACH

 Survey approach will be used for this study.

SETTING

 The selected setting is K.T.G College of Nursing, Bangalore. It is 2km away

7.1.2
from the college.

POPULATION

 Comprises of students who are studying III year and IV year B.Sc Nursing.
7.1.3

METHOD OF COLLECTION OF DATA

 Interview will be conducted between 9am to 2pm. Data will be collected

7.2
from 5 samples per day. The duration of the study will be 4 weeks. The

duration of 30 minute will be spent per each subject.

SAMPLING PROCEDURE

 Convenient sampling will be used for this study.

7.2.1

SAMPLE SIZE:

 The sample size is 100.

7.2.2

INCLUSION CRITERIA FOR SAMPLING

The criteria for the sample selections are:

7.2.3  Third year and fourth year B.Sc Nursing students who are willing to

participate in this study.

 Third year and fourth year B.Sc Nursing students who are available during

data collection.

EXCLUSION CRITERIA FOR SAMPLING

 Those who are sick.

7.2.4  Nursing students who are studying I year and II year.

INSTRUMENT INTENDED TO BE USED

SELECTION OF TOOL

7.2.5 This consists of 3 parts,

PART-I :- Consists of demographic variables such as age, sex, education, parent’s

education, place of residence, occupation of the father.

PART-II:- Questionnaire will be used to assess the knowledge. 25 questions will be

used.

PART-III:- Questionnaire will be used to assess the attitude. 20 questions will be

used.

SCORING PROCEDURE

For Answers, If answer is YES - 1

If answer is NO - 0

DATA COLLECTION METHOD:

 Prior permission will be obtained by the significant authorities and from

7.2.6 the subjects. The investigator will use questionnaires to assess the knowledge and attitude

regarding LBP among III year and IV year B.Sc Nursing students. Interview will be

conducted between 9am to 2pm. Data will be collected from 5 samples per day. The

duration of the study will be 4 weeks. /the duration of 30 minutes will be spent per each

subject.

PILOT STUDY

Six samples will be selected and study will be conducted to find out the

7.2.7 feasibility.

DATA ANALYSIS PLAN

Descriptive statistics such as mean deviation will be used for assessing the

7.2.8 knowledge and attitude. Inferential statistics such as chi-square and t test will be used to

compare within demographical variables.

DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO

BE CONDUCTED ON PATIENT’S OR OTHER HUMANS OR ANIMALS?

7.3 --YES--

HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN

CASE OF 7.3?

YES, ethical clearance will be obtained from the Research Committee of

7.4
ANURADHA College of Nursing and Permission was obtained from Principal of K.T.G

College of nursing, Bangalore, to conduct the study.

Consent will be taken from III year and IV year B.Sc Nursing students who

are willing to participate in this study.

LIST OF REFERENCES:

1.Brunner and Suddarth’s. “Text Book of Medical-Surgical Nursing”. 11th ed. NewYork:
8.0 Lippincott; 2008. P no. 2392.

2. Black Joyce M. “Medical-Surgical Nursing”. 7th ed. St.Louis: Saunders Elsevier

Publications; 2005. P no. 2140.

3. Donna D Ignatavicius. “Medical-Surgical Nursing”. 2nd ed. Philadelphia: Saunders

Company; 1995. P no. 1170

4. Hignett S. “Work-related back pain in Nurses”. 1996 Jun; 23(6): 1238-46.

5. Kondo A, Misawa T. “Low back pain: Tips on pain relief and prevention”. 1979 Mar;

23(2): 164-70.

6. Van Nieuwenhuyse, et al. “A prospective study about Back Pain”. 2009 Nov.

7. Sharma SC, Mittal R. “Incidence of low back pain among Nurses”. 2009 Nov.

8. Sameer Kumar Sharma. “Majority of health workers have chronic backache”. 2009 Feb.

9. Klaber Moffett JA, Hughes, et al. “A longitudinal study of low back pain in student

Nurses”. 1993 Jun; 30(3): 197-212.

10. Schenkman ML, Roman M, et al. “Functional movement training for recurrent low back

pain”. 2009 Feb; 1(2): 137-46.

11. Lagerstrom M, Hansson T. “Work related low back problems in Nursing”. 1998 Dec;

24(6): 449-64.

12. Basavanthappa BT. “Nursing Research”. 2nd ed. New Delhi: Jaypee Brothers. P no.

155,177.

13. Burnett A, Tam SM, et al. “A study of the Back Pain Beliefs of Female Undergraduate

Healthcare Students”. 2009 Jan; 25(1): 20-8.

14. Smith DR, Mizutani T. “Musculoskeletal disorders self-reported by female nursing

students in Central Japan”. 2003 Sep; 40(7): 725-9.

15. Mohseni-Bandepel MA, Fakhri M, et al. “Occupational back pain in Iranian Nurses”.

2006 Sep 28-Oct 11; 15(17): 914-7.

16. Yip VY. “New low back pain in nurses: work activities, work stress and sedentary

lifestyle”. 2004 May; 46(4): 430-40.

17. Videman T, Rauhala H, et al. “Patient – handling skill, back injuries, and back pain. An

intervention study in nursing”. 1989 Feb; 14(2): 148-56.

18. Mitchell T, Smith A, et al. “Biopsychosocial factors are associated with low back pain in

female nursing students”. 2009 May; 46(5): 678-88.

 19. Svensson AL, Mortensen OS. “Factors predicting dropout in student nursing assistants”.

2008 Dec; 58(8): 527-33.

20. Vieira ER, Kumar S, Narayan Y. “Low back problems and possible improvements in

nursing jobs”. 2006 Jul; 55(1): 79-89.

21. Karahan A, Bayraktar N. “Determination of the usage of body mechanics in clinical

setting and the occurrence of low back pain in nurses”. 2004 Jan; 41(1): 67-75.

22. Bell JA, Burnett A. “Exercise for the primary, secondary and tertiary prevention of low

back pain in the workplace”. 2009 Mar; 19(1): 8-24.

23.Aust J Physiother. “Graded exercise for recurrent low back pain”. 2009 Feb; 34(3):221-8.

9. NAME & SIGNATURE OF THE Anitha Thomas

CANDIDATE

10. REMARKS OF THE GUIDE The study is suitable & feasible

11. NAME AND DESIGNATION OF

11.1 GUIDE R. Prasanna Kumari

11.2 SIGNATURE
 11.3CO-GUIDE

11.4SIGNATURE

11.5 HEAD OF DEPARTMENT R. Prasanna Kumari

11.6 SIGNATURE

12 12.1 REMARKS OF THE PRINCIPAL The study is suitable & feasible

12.2 NAME & SIGNATURE OF THE Radhika .K

PRINCIPAL