Musculoskeletal pain symptoms among allied health professions’ students: Prevalence rates and associated factors

Abstract

BACKGROUND:

Very few articles, comprehensively, investigated musculoskeletal pain symptoms (MPS) among wide variety of allied health professions (AHP) students.

OBJECTIVES

: This study aimed to investigate the prevalence of MPS and their associated factors among different AHP majors’ students.

METHOD:

A cross-sectional design was conducted. A sample of AHP students from nine majors ( $n=$ 838, Mean age $=$ 21.3 years) completed a validated structured self-administrated questionnaires including Nordic Musculoskeletal Questionnaire, Depression Anxiety Stress Scale (DASS 21), and specific questions regarding demographics and life style. MPS prevalence rate were compared between males and females and between majors. Logistic regression was conducted to identify predictors of MPS.

RESULTS:

MPS in neck, lower back, and shoulder 12-month were the most prevalent (67.1%, and 61.4%, 58.8% respectively). MPS prevalence was significantly higher in females and statistically different among majors. MPS were significantly associated with increased clinical training load, mental stress symptoms, and smartphone average use time.

CONCLUSIONS:

MPS in AHP students are prevalent and statistically higher among females. Students are advised to adhere to different conservative precautions and follow prevention programs. Future studies are needed to assess actual mechanisms causing MPS among AHP students and designing effective prevention programs specific to AHP students.

Keywords

Occupational therapy occupational safety allied health musculoskeletal pain medical education

1. Introduction

Musculoskeletal disorders are dysfunctions or injuries that affect the musculoskeletal structures including muscles, bones, joints, tendons, nerves and ligaments [1]. Musculoskeletal pain symptoms (MPS) is one of the most important consequences of musculoskeletal disorders [2]. Work-related musculoskeletal disorders (WMSDs) are one class of musculoskeletal disorders linked in a causal relationship with physical exertion at work [2, 3]. WRMDs are the most expensive form of work-related injuries with about 40% of work-related injuries treatment cost [4]. Healthcare workers represent about 12% of the global work force [5]. Occupational-related stress, which is common among healthcare professionals, might cause physical and mental distress symptoms [6]. Previous studies demonstrated a high prevalence of WRMDs among allied health professions (AHP) workers [7, 8, 9]. Musculoskeletal pain symptoms (MPS) increase sick leaves and demand on healthcare services. Additionally, these symptoms decrease AHP workers’ productivity and quality of life [10, 11, 12]. AHP students’ clinical training activities simulate AHP work activities predisposing those students to similar MPS.

WRMDs result from repeated stress to the musculoskeletal structures including joints, muscles, tendons, and nerves [3]. They often occur in individuals performing repetitive movements either work-related or other daily activities. AHP students are expected to perform repetitive movements, maintain prolonged fixed postures, and encounter heavy physical workloads [13, 14]. Factors that contribute to development of WRMDs might be divided into two categories: individual risk factors (such as age, gender, and body mass index) and occupational risk factors such as work posture and physical load [15].

A study investigated WRMDs prevalence among 7,820 clinicians of 10 different medical professions. Physical therapists showed the significantly highest risk of developing WRMDs of eight musculoskeletal disorders. These WRMDs were documented less frequently among medical technologists, medical radio- graphers, and occupational therapists [16]. WRMDs were documented frequently in the literature among many AHP workers including physical therapists, occupational therapists, allied dental technicians, para- medics, and medical laboratory technicians [17, 18, 19, 20, 21].

MPS such as those of neck, shoulder, and back pain are common among college students and might be carried over to their work life [22]. In addition to regular study tasks such as reading and computer use, AHP curricula require significant physical effort during pre-clinical and clinical training [7]. MPS prevalence were documented in the literature among limited number of AHP students’ majors including radiography (1-year at any body site was 37%), occupational therapy (5-year low-back pain was 64.6%), and dental hygiene (acute neck and shoulder were 37% and 11% respectively) [13, 14, 23]. Our study targeted nine AHP academic majors’ students simultaneously to expand the findings to a larger population and compare MPS of different majors under more homogenous circumstances.

The primary aim of the study was to determine the prevalence rate of MPS among a wide variety of AHP undergraduate students and identifying possible academic majors’ and gender’s prevalence differences. This study targeted students during their third and fourth (final) years of their curricula, as they are expected to get intensive laboratory-based pre-clinical and clinical field training. The secondary aims were to identify possible daily life activity limitation due to MPS and to identify potential factors associated with MPS including study related and non-study related variables.

Figure 1.

Prevalence of 12-month and 7-day musculoskeletal symptoms according to the Nordic questionnaire.

2. Materials and methods

2.1 Design and sample

A cross-sectional study using a self-administered questionnaire was conducted. Target population was students of nine AHP majors of a comprehensive faculty for applied medical sciences. This AHP institution offers 4-year Bachelor of Science programs. Clinical training at the target institution starts at the first semester of the third year and increases in terms of load as the student progresses toward graduation. These clinical training activities are mostly graded contributing to student’s GPA. We approached all third and fourth year undergraduate students of each of the following majors: Physical Therapy (PT), Occupational Therapy (OT), Audiology and Speech Pathology (ASP), Radiologic Technology (RT), Optometry (OPT), Paramedics (PA), Dental Technology (DT), Allied Dental Sciences (ADS), and Medical Laboratory Sciences (MLS). The study was approved by the host university institutional review board (IRB). Participants needed to be enrolled in third or fourth academic years in one of the targeted majors. Students with significant physical and/or mental illness (documented by a physician) and those who study part-time were excluded.

2.2 Outcome measures

The researchers developed a self-administered questionnaire including demographics and participants’ characteristics, life style, MPS, and mental health status.

The first section included a questionnaire developed for this study. It included socio-demographics data (including gender, age, and nationality) academic-related data (school major, GPA, study load per week, clinical training hours per week, and means of transportation to school), and life style data (including sleep patterns, employment, smartphone and computer use, diet self-evaluation, exercise habits, and smoking habits). This section was developed through intensive literature review and series of discussion among the research team members and experienced clinicians to ensure the validity of its content.

The second section included two standardized questionnaires, which have evidence of reliability and validity [24, 25]. MPS were measured using Nordic Musculoskeletal Questionnaire [24]. This is a valid assessment tool of MPS in the neck, shoulders and upper extremities, upper and lower back, and hips and lower extremities. In this questionnaire, the respondents indicate whether they had MPS in the past 12 months and the past week. Additionally they report daily life activity limitation due to these pain symptoms [26]. Mental stress symptoms were measured using Depression Anxiety Stress Scale (DASS 21). The DASS 21 is a 21-item self-report questionnaire designed to screen the presence of mental stress symptom over the previous week measuring the severity of depression, anxiety, and stress [27, 28].

The entire questionnaire was validated by an expert panel discussion and statistically by pilot study data of 39 students (their data were excluded from the main study). The pilot study indicated that DASS 21 was internally consistent (Cronbach’s alpha coefficient was 0.88 for depression domain, 0.91 for anxiety domain, and 0.87 for stress domain).

The questionnaires were distributed and collected by trained research assistants with occupational therapy diplomas. Participants were approached at the beginning of an afternoon lecture or a lab, and not during an examination period. Participants signed the IRB approved consent forms. Then participants responded to the questionnaires anonymously.

2.3 Statistical analysis

Data were analyzed using IBM SPSS (version 20). Means and proportions were used to describe data. The differences between proportions in gender and academic majors were analyzed using Chi-square test. Binary logistic regression was used to determine predictors of 12-month MPS in each body part. Gender-major interaction potential effect was accounted for in all regression models. A $p$ -value of less than 0.05 was considered statistically significant.

Table 1
The difference in prevalence rates between males and females of 12-month and 7-day musculoskeletal symptoms according to the Nordic questionnaire

	12-month musculoskeletal symptoms							7-day musculoskeletal symptoms
Body part	Males		Females		Total		$p$ -value	Males		Females		Total		$p$ -value
	$n$	%	$n$	%	$N$	%		$n$	%	$n$	%	$N$	%
Neck	111	58.7	451	69.6	562	67.1	0.005	68	36.0	333	51.4	401	47.9	$<$ 0.005
Shoulder	85	45.0	402	62.0	487	58.2	$<$ 0.005	51	27.0	283	43.7	334	39.9	$<$ 0.005
Elbow	31	16.4	107	16.5	138	16.5	0.971	21	11.1	74	11.4	95	11.4	0.906
Wrists/hands	41	21.7	245	37.8	286	34.2	$<$ 0.005	23	12.2	146	22.5	169	20.2	0.002
Upper back	86	45.5	390	60.2	476	56.9	$<$ 0.005	54	28.6	279	43.1	333	39.8	$<$ 0.005
Lower back	107	56.6	407	62.8	514	61.4	0.124	72	38.1	304	46.9	376	44.9	0.032
Hips/thighs	31	16.4	151	23.3	182	21.7	0.043	23	12.2	95	14.7	118	14.1	0.387
Knee	60	31.7	219	33.8	279	33.3	0.599	36	19.0	154	23.8	190	22.7	0.173
Ankles/feet	54	28.6	213	32.9	267	31.9	0.265	26	13.8	154	23.8	180	21.5	0.003

Table 2

Prevalence of 12-month musculoskeletal symptoms according to the Nordic questionnaire by academic major

Major	Neck*	Shoulder	Elbow	Wrist/hands*	Upper back*	Lower back*	Hips/thighs*	Knees*	Ankles/feet
Physical therapy	66.7%	58.0%	11.6%	17.4%	50.7%	68.1%	11.6%	29.0%	21.7%
Occupational therapy	73.4%	59.5%	22.8%	54.4%	49.4%	72.2%	20.3%	38.0%	32.9%
Audiology and speech pathology	64.3%	53.6%	13.1%	31.0%	54.8%	58.3%	20.2%	34.5%	26.2%
Radiologic technology	64.0%	55.3%	17.5%	33.3%	53.5%	59.6%	26.3%	43.0%	37.7%
Optometry	60.6%	54.5%	12.1%	25.8%	56.1%	48.5%	9.1%	25.8%	22.7%
Paramedics	67.4%	54.3%	17.4%	35.9%	52.2%	69.6%	31.5%	34.8%	34.8%
Dental technology	70.9%	63.1%	24.3%	46.6%	68.9%	65.0%	29.1%	37.9%	39.8%
Allied dental sciences	41.2%	50.0%	2.9%	29.4%	41.2%	44.1%	14.7%	11.8%	23.5%
Medical laboratory sciences	72.4%	63.3%	15.8%	30.1%	63.8%	58.7%	20.9%	30.1%	33.2%
$P$ value among all majors	0.028	0.612	0.072	$<$ 0.001	0.022	0.019	0.006	0.033	0.095
(Chi-square test)

*Significant body site pain difference between academic majors using Chi-square test.

3. Results

3.1 Participants’ characteristics

Of the total of 1038 invited AHP students, 838 students (77.3% females and 22.7% males; 69 PT, 79 OT, 84 SP, 114 RT, 66 OPT, 92 PA, 103 DT, 34 ADS, and 197 MLS) agreed to participate, and completed the questionnaire with an overall response rate of 80.7%. The average age of the participants was 21.3 (1.8 SD) years. About 76% of participants were domestic (Jordanian) and 24% were international (non-Jordanian) students.

3.2 Prevalence rates of musculoskeletal pain symptoms

The overall 12-month and 7-day prevalence rates of MPS in different body parts are shown in Fig. 1. The 12-month highest prevalence rates were in neck (67.1%), lower back (61.4%), shoulders (58.8%), and upper back (56.9%). In all cases, the 7-day prevalence rates were lower than the 12-month rates. Table 1 demonstrates gender prevalence rates differences of 12-month and 7-day MPS. Overall, females were more likely than males to report 12-month MPS in most body sites. For example, 12-month musculoskeletal pain was significantly more common in females in neck ( $p=$ 0.005) and shoulder ( $p<$ 0.005). Similarly, females 7-day MPS were significantly greater than males as well as seen in neck ( $p=$ 0.005) and shoulder ( $p<$ 0.005). More MPS between gender significant differences in other body sites can be seen in Table 1.

Table 2 demonstrates the prevalence of 12-month MPS using the Nordic questionnaire according to academic majors. There were significant differences among the academic majors in MPS of neck ( $p=$ 0.028), wrist/hands ( $p<$ 0.001), upper back ( $p=$ 0.022), lower back ( $p=$ 0.019), hips/thighs ( $p=$ 0.006), and knees ( $p=$ 0.033).

Table 3
The proportion of participants who experienced limitations in doing normal work (at home or away from home) due to musculoskeletal symptoms that have limited them during the last 12 months

Body part	Males		Females		Total		$p$ -value
	$n$	%	$n$	%	$N$	%
Neck	57	30.2	263	40.6	320	38.2	0.009
Shoulder	43	22.8	227	35.0	270	32.3	0.001
Elbow	23	12.2	71	11.0	94	11.2	0.642
Wrists/hands	25	13.2	142	21.9	167	20.0	0.009
Upper back	44	23.3	247	38.1	291	34.8	$<$ 0.005
Lower back	57	30.2	280	43.2	337	40.3	0.001
Hips/thighs	22	11.6	97	15.0	119	14.2	0.249
Knee	35	18.5	145	22.4	180	21.5	0.256
Ankles/feet	33	17.5	148	22.8	181	21.6	0.114

3.3 Musculoskeletal pain symptoms related functional limitations

As measured by Nordic questionnaire, functional limitations due to MPS in last 12-month are demonstrated in Table 3. About 40.3% of students reported difficulties in daily life activities due to lower back MPS. The second largest activity limitation was due to neck pain which was reported by 38.2% of the students. Consistent with having the lowest MPS prevalence; elbow was identified as the least reason for activity limitation as reported by 11.2% of the sample only. As compared with males, females significantly reported more activity limitation due to MPS in neck ( $p=$ 0.009), shoulders ( $p=$ 0.001), wrist/hands ( $p=$ 0.009), and upper back ( $p<$ 0.005), and lower back ( $p=$ 0.001).

3.4 Multivariate analysis of factors associated with musculoskeletal pain symptoms

Predictors of 12-month MPS in each body part are shown in Table 4. In all models, there were no significant gender-major interaction effects ( $P$ values were $>$ 0.05). Increased DASS scores (depression, anxiety, and/or stress) were significantly associated with increased odds of having MPS in all body parts. School academic load (clinical training load, average time spent in school, and average study time at home) had significant associations with increased odds of 12-month MPS. Higher clinical training load was significantly associated with MPS in shoulder, lower back, and hips/thighs. Time spent in school was significantly associated with MPS in upper back while studying time at home was significantly associated with MPS at elbow. Gender was significantly associated with MPS in wrists/hands in the multivariate analysis. Females had about a double likelihood to develop wrist/hands MPS as compared with males (OR $=$ 2.223, $P<$ 0.001). Using PT major as a reference group, the highest odds of developing wrist/hands MPS were seen among OT (OR $=$ 5.450, $P<$ 0.001) and DT (OR $=$ 4.356, $P\leqslant$ 0.001) students. While international students were less likely to report MPS in shoulder (OR $=$ 0.568, $P=$ 0.001), they were more likely to report MPS in hips/thighs as compared with domestic students (OR $=$ 1.677, $P=$ 0.008). Mobile phone average time use was significantly associated with MPS in lower back (OR $=$ 1.046, $P=$ 0.001). Finally, students reported unhealthy diet had significantly higher odds of MPS in knee (OR $=$ 1.305, $P=$ 0.047) compared to those reported healthy diet.

Table 4
Multivariate analysis of 12-month musculoskeletal symptoms associated factors in each body part

		B	S.E.	OR	Confidence interval		$P$ -value
Neck	DASS stress score	0.045	0.007	1.046	1.031	1.061	$<$ 0.001
Shoulder	Clinical training load	0.030	0.011	1.031	1.009	1.054	0.006
	DASS Depression score	0.030	0.007	1.031	1.016	1.045	$<$ 0.001
	Nationality (International $>$ Domestic)	$-$ 0.566	0.177	0.568	0.402	0.803	0.001
	High school GPA	0.033	0.011	1.034	1.012	1.056	0.002
Elbow	DASS anxiety score	0.026	0.009	1.027	1.009	1.044	0.002
	Average studying hours at home	$-$ 0.031	0.014	0.970	0.944	0.996	0.024
Wrists/hands	DASS stress score	0.047	0.007	1.048	1.033	1.063	$<$ 0.001
	Gender (female $>$ male)	0.799	0.214	2.223	1.461	3.382	$<$ 0.001
	Study major						$<$ 0.001
	Physical therapy (reference)			1.00
	Occupational therapy	1.696	0.402	5.450	2.479	11.983	$<$ 0.001
	Audiology and speech pathology	0.592	0.408	1.807	0.812	4.021	0.147
	Radiologic technology	0.694	0.391	2.001	0.930	4.305	0.076
	Optometry	0.385	0.439	1.469	0.622	3.472	0.381
	Paramedics	1.099	0.405	3.001	1.358	6.632	0.007
	Dental technology	1.472	0.388	4.356	2.035	9.325	$<$ 0.001
	Allied dental sciences	0.504	0.509	1.655	0.611	4.485	0.322
	Medical laboratory sciences	0.401	0.366	1.494	0.729	3.059	0.273
Upper back	DASS stress score	0.039	0.007	1.040	1.026	1.054	$<$ 0.001
	Average daily hours spent in the school	0.015	0.006	1.016	1.004	1.027	0.007
Hips/thighs	Clinical training load	0.028	0.012	1.028	1.004	1.053	0.024
	DASS anxiety score	0.056	0.008	1.058	1.040	1.075	$<$ 0.001
	Nationality (international $>$ domestic)	0.517	0.194	1.677	1.146	2.453	0.008
Knee	DASS anxiety score	0.035	0.007	1.036	1.021	1.051	$<$ 0.001
	Self-evaluation of diet (unhealthy $>$ healthy)	0.266	0.134	1.305	1.003	1.699	0.047
Ankles/feet	DASS anxiety score	0.030	0.011	1.030	1.009	1.052	0.005
	DASS depression score	0.038	0.010	1.038	1.018	1.059	$<$ 0.001
Lower back	Clinical training load	0.037	0.007	1.037	1.022	1.053	$<$ 0.001
	DASS stress score	0.044	0.012	1.045	1.021	1.070	$<$ 0.001
	Average hours of using mobiles	0.045	0.013	1.046	1.019	1.073	0.001

4. Discussion

We believe that this is the most comprehensive evaluation of MPS conducted on AHP students because it included nine academic majors. Factors might explain MPS were also considered including mental health, demographics, and life style. The study targeted students during their 3 ${}^{\rm rd}$ and 4 ${}^{\rm th}$ year academic training because they undergo significant mental and physical stress during this time.

4.1 Musculoskeletal pain symptoms prevalence

A high prevalence of MPS among AHP students was reported in this study. Neck, lower back, shoulder, and upper back MPS had the highest acute and chronic prevalence rates (last week and last 12 months). Studying is the main productivity occupation for most college students. Target institution AHP study during third and fourth year emphasizes academic and pre-clinical training. AHP students’ pre-clinical training simulates real AHP workers’ activities; therefore, pre-clinical training could predispose students to MPS similar to WRMDs. High prevalence of MPS in this study and most affected body sites are consistent with similar findings among AHP workers [16, 21]. One study documented WRMDs prevalence among healthcare workers as 72.2%, 59.9% and 59.9% in the neck, shoulder and lower back sites, respectively [12]. Investigating occupational and physical therapists, it was suggested that work-related pain and discomfort prevalence in young healthcare workers (47%) are similar to those among older ones (43%). WRMDs most common sites among younger occupational and physical therapists were low back, neck, and shoulder [29]. In our study, OT students highest MPS prevalence were in neck followed by lower back, shoulder, and wrist/hands. PT students highest MPS was lower back followed by neck, shoulder, and upper back.

Previous studies documented MPS among various AHP students including occupational therapy (64.6% in low back), radiography (27% Low back, 16% neck, shoulder 11%), dental hygiene (43% in neck and 20% in shoulder) [13, 14, 23]. MPS prevalence found in our study is relatively higher than these cited studies; however, these studies had low sample sizes and investigated one profession only. Comparing AHP students MPS prevalence across different institutions might be subject to cultural and curricular bias, it seems helpful to compare AHP professions MPS in one institution as what we did in our study. This is the first study offering simultaneous comparisons of MPS among nine different AHP majors’ students.

4.2 Gender and musculoskeletal pain symptoms

In this study, females reported significantly higher MPS as compared with males in Neck, shoulder, wrist/hands and upper and lower back. Numerous previous studies showed that females had significantly higher incidences of various types of WRMDs than males [1, 30]. This finding is consistent in most studies including those based on self-reports or medical/insurance records with and without physical examinations and after adjusting for potential confoun- ders [31, 32, 33]. Reviewing about 56 articles of working and general populations, as compared with males, females odd ratio of self-reported musculoskeletal disorders prevalence ranged from 0.85 to 10.05 [31]. In our study, females significantly reported higher MPS in wrist/hands as compared with men with an odd ratio of 2.08. In another study focused on upper extremities, when compared with males, working females reported significantly higher WRMDS of the neck, shoulder, elbow, and wrist [32]. This is similar to our study, however, the between gender difference in elbow pain was not significant in our study.

One possible explanation for gender effects on MPS is that females might have a higher sensitivity to pain and therefore usually report more pain complaints [1, 34, 35], while males tend to under-report MPS and seek less medical care compared to females [31]. In this study, female gender was also significantly associated with higher odds of wrist/hands pain. This finding might be explained by that certain repetitive stress trauma with pain and sensory symptoms in hand/wrist such as carpal tunnel syndrome are more common in women compared to men [36].

4.3 Academic major and musculoskeletal pain symptoms

In this study, 12-month prevalence of MPS was statistically different across the nine AHP academic majors. This result was expected due to the different training nature of each AHP specialty in terms of physical requirement, used tools, posture, and stressed body parts. Other studies demonstrated that WRMDs affecting back and upper extremities have many occupational risk factors such as improper postures, repetitive movements, forceful exertions, and use of hand-held vibrating tools [37, 38]. Literature suggested that AHP workers might be exposed to sustained awkward postures, heavy work-load, handling and transferring patients, repetitive upper extremity movements, and constrained postures of neck and shoulders. These work requirements are significantly related to various WRMDs including wrist, neck, and shoulder pain [7, 18, 20, 39, 40]. Previous studies found that developing MPS was related to clinical training activities in undergraduate dentistry and dental hygienist students [23, 41]. In another study, dental hygiene students with no clinical exposure had significantly less MPS compared with students exposed to clinical training as seen in neck pain (37%, 43% respectively), and shoulder pain (11%, 20% respectively). Risk factors associated with MPS including bending neck, static posture, precise motions, and movements’ repetition were significantly higher among students with more exposure to clinical training. Interestingly, students with more clinical supervisors’ support reported less MPS (OR $=$ 0.5) [23]. These findings of previous research studies are consistent with our findings. Our targeted students received average clinical training of 13.7 hours/week for third year students and 17 hours/week for fourth year students. In this study, the clinical training load and the average time spent in school were significant predictors of 12-month MPS in upper and lower back, and hips/thighs. This study results also indicated that developing wrist/hands MPS had the highest significant odd ratio among OT and DT students. Previous studies documented that DT and OT use a lot of repetitive and accurate hand movements during therapy and fabricating splints for OT students and dental implants fabrication for DT students [42, 43].

4.4 Mental health and musculoskeletal pain symptoms

In this study, DASS scores (depression, anxiety, and/ or stress) were significant predictors of 12-month MPS in all body sites. Mental health symptoms such as anxiety, stress, and depression are common among healthcare students [44, 45, 46]. Stressors affecting AHP students can be classified as exogenous (related to the study and training load) and endogenous (due to personality traits) [47]. Burnout, a reaction to chronic stress, can occur as a consequence of untreated occupational stress [48, 49]. Studies demonstrated that work-related stress and non-work-related stress reactions are associated with WRMDs [50, 51]. Using Life Stress Assessment Inventory, one study found significant association between college students’ level of stress and MPS in both genders [52]. Transitioning to clinical training is a very difficult period for many healthcare students which can hinder their academic progress [53]. AHP students might face uncertainties related to expected roles and behaviors. Adding the extreme increase in their workload and limited time available for studying, healthcare students tend to report challanges in applying theoretical knowledge in clinical practice [54]. Other difficulties include decreased opportunity to participate in patient care and lack of clinical supervisors’ understanding of trainee roles during clinical training [55]. These mental stress symptoms might be exacerbated among international students which can influence MPS [56]. Our study data was collected during an afternoon class at least one week away of university examinations. This was an attempt to avoid examinations effects on students physical and mental stress. This might suggest that the mental stress documented in this study is related to regular academic activities including clinical training more than examinations stress.

4.5 Students’ lifestyle and musculoskeletal pain symptoms

MPS in neck, shoulder, and back are not uncommon among college students and might carry on in the work life for many years [22]. One main common factor with all college students is heavy computer and smartphone use [57, 58, 59]. About 97.6% of our participants reported owning a smartphone where 81.8% reported checking phones every hour or less and 95.8% reported checking phones in bed before night sleep. Smartphone use was significantly associated with upper and lower back MPS among this study participants. Another study found a high prevalence of pain in the neck (69%), hand/wrist (53%), and shoulder (49%) among college students. In that study, MPS prevalence and their related factors (smartphone/computer use and lack of breaks) were higher among fourth-year students as compared with second-year ones [60]. MPS seemed to progress as students advance in their programs and practical training as more physical effort is required [23].

Healthcare students might be less physically active than other majors’ such as physical education due to their relatively increased curricula load. This might explain the increased level of MPS among AHP students [61]. Our study participants’ average time dedicated for exercise including walking was 4.7 hours per week. Additionally, our study participants reported an average of 6.75 sleep hours per night. However, in our study, exercise and sleep habits were not significantly associated with any MPS. Given that some of university students are employed, their MPS might be exacerbated by their work [62, 63]. Approximately 11.1% of our participants reported part-time or full-time employment; however, employment was not associated with any reported pain in any body part. Our study findings suggest that MPS found in this study are related to AHP students’ school activities more than other confounders.

4.6 Clinical implications

This study demonstrated that AHP students have significant level of MPS that might be related to their study activities. Although our findings were consistent with other studies, generalizability might be limited to undergraduate students and might be culturally specific. These pain complaints might affect AHP students’ quality of life and their learning quality. The identified study-related stressors should be carefully considered during curriculum development. Studies showed that overall knowledge of safe patient handling techniques and risk assessment is low among AHP students. It is suggested to put more emphasis on pre-clinical training safe patient handling and prevention of MPS in AHP academic curricula [64, 65, 66]. Given rehabilitation professionals availability, it seems important to establish MPS screening and treatment programs within AHP institutions or affiliated with them.

There are many suggested conservative interventions available for MPS. These interventions can be categorized into occupational and physical therapy exercises such as those for strength and flexibility, proper biomechanics and ergonomics for optimal working positions and best tools designs, and behavioral interventions [67, 68, 69]. These suggested treatments are advised to be directed by the severity of MPS among each individual AHP major. For example, as can be seen in Table 2, neck pain is prevalent among all AHP majors while wrist and hands pain is more prevalent in OT and DT students. Students can get training on proper ergonomic tools, taking enough breaks, and reducing working loads and forces on their joints. Another suggestion is designing a more gradual transition between pre-clinical and clinical education in terms of training load. Students with significant pain complaints should be referred to occupational and physical therapy and/or medical care to reduce the effects of study-related musculoskeletal disorders [70, 71, 72]. Female students should take more precautions to avoid potential study-related MPS.

5. Limitations

Self-reported data are subjective; participants might over- or under-estimate pain. However, this study questionnaire had no direct benefit to the participant, so there was no incentive to provide any inaccurate responses. This study could have been improved if an objective measure of musculoskeletal pain such as physical examination, nerve conductivity test or neurodynamic testing were used. However, testing such huge number of participants was not feasible. The study could have been improved with a more balanced sample in terms of academic majors and gender and a larger sample size. Future cohort studies are highly encouraged to evaluate students MPS severity and disability using objective measures (such as QuickDASH [73] and Neck Disability Index [74]) and evaluate potential prevention and treatment efficacy.

6. Conclusion

This study documented a high prevalence of MPS that might be related to study activities among AHP students. Neck, lower back, and shoulder were the most commonly affected body parts. Pain complains were significantly higher in female and significantly associated with clinical training load and mental symptoms including depression, anxiety, and stress. It is advised to encourage AHP students to adhere to different conservative precautions and treatments of study-related stress. Future studies are needed to investigate the actual mechanisms causing MPS among AHP students and their effective prevention strategies.

Conflict of interest

The authors declare no conflict of interest of any type.

Footnotes

Acknowledgments

This project was funded by Jordan University of Science and Technology, grant number: 20160034. We would like to thank participating students for their participation and cooperation during our study.

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Musculoskeletal pain symptoms among allied health professions’ students: Prevalence rates and associated factors

Abstract

BACKGROUND:

OBJECTIVES

METHOD:

RESULTS:

CONCLUSIONS:

Keywords

1. Introduction

2.1 Design and sample

2.2 Outcome measures

2.3 Statistical analysis

Table 1 The difference in prevalence rates between males and females of 12-month and 7-day musculoskeletal symptoms according to the Nordic questionnaire

3.1 Participants’ characteristics

3.2 Prevalence rates of musculoskeletal pain symptoms

Table 3 The proportion of participants who experienced limitations in doing normal work (at home or away from home) due to musculoskeletal symptoms that have limited them during the last 12 months

3.4 Multivariate analysis of factors associated with musculoskeletal pain symptoms

Table 4 Multivariate analysis of 12-month musculoskeletal symptoms associated factors in each body part

4.1 Musculoskeletal pain symptoms prevalence

4.2 Gender and musculoskeletal pain symptoms

4.3 Academic major and musculoskeletal pain symptoms

4.4 Mental health and musculoskeletal pain symptoms

4.5 Students’ lifestyle and musculoskeletal pain symptoms

4.6 Clinical implications

5. Limitations

6. Conclusion

Conflict of interest

Footnotes

Acknowledgments

References

Table 1
The difference in prevalence rates between males and females of 12-month and 7-day musculoskeletal symptoms according to the Nordic questionnaire

Table 3
The proportion of participants who experienced limitations in doing normal work (at home or away from home) due to musculoskeletal symptoms that have limited them during the last 12 months

Table 4
Multivariate analysis of 12-month musculoskeletal symptoms associated factors in each body part