Chronic low back pain prevalence in Federal Highway Police Officers: A cross-sectional study

Abstract

BACKGROUND:

Police officers are exposed to specific occupational tasks, which require lifting, trunk flexion and rotation, carrying weight, and frequent standing periods, which may be associated with an increased risk of experiencing low back pain (LBP).

OBJECTIVE:

To describe the prevalence and intensity of chronic LBP (CLBP) in Brazilian Federal Highway Police officers (FHPO) from the Rio Grande do Sul state and evaluate its associated factors.

METHODS:

A total of 208 FHPOs participated in this study. The participants answered an electronic questionnaire containing sociodemographic, behavioral, and occupational questions, and CLBP history. Data analysis comprises descriptive statistics and Poisson regression models.

RESULTS:

Most of the FHPO were male, aged 41 or more, lived with a partner and were physically active. Sixty-seven percent of FHPO had CLBP, and the median pain intensity was 3.0 (IQR = 0– 5). Participants who lived with a partner were less likely to report CLBP (PR = 0.80; 95% CI = 0.64; 0.99). On the other hand, those who worked as FHPO for more than 11 years were more likely to report CLPB (PR = 1.32; 95% CI = 1.06; 1.63), and high pain intensity (β= 0.95; 95% CI = 0.19; 1.71).

CONCLUSIONS:

The high CLBP prevalence among FHPO from Rio Grande do Sul state indicates a need to highlight the importance for police organizations to promote CLBP prevention and implement workplace management programs.

Keywords

Personal protective equipment injuries law enforcement job characteristics

1 Introduction

Low back pain (LBP) is one of the leading cause of years lived with disability [1] and is among some of the main health issue in the working population worldwide [2]. In Brazil, the higher prevalence of chronic LBP (CLBP) is in the southern region (23.3%). CLBP is higher in women, elderly, as well as those with low socioeconomic and poor health status [3]. Even though LBP is associated with personal, occupational, psychosocial factors, and might be caused by other underlying health issues, most of LBP episodes are related to non-specific causes [4].

LBP negatively affects workers’ health and well-being, resulting in higher rates of absenteeism, productivity losses and economic issues for employers and health systems [5, 6]. Moreover, consistent evidence indicates that occupations which expose workers to lifting, carrying weight, trunk flexion, rotation tasks, and frequent standing periods, all activities performed by police officers [7], increases the risk of experiencing LBP.

Police officers have one of the most dangerous, stressful, and physically challenging occupations [12 –14]. Federal highway police officers (FHPO) are responsible for carrying out a persistent patrolling of federal highways in Brazil. Among the occupational factors which might be associated with LBP in FHPO we can list: long periods of sitting/driving police vehicles; physical overload due to standing and sitting with heavy personal protective equipment (PPE) (e.g., ballistic vest and police belt) for long periods in different climatic conditions [7, 14]; long work shifts; lifting/pushing/pulling heavier objects [7]; and situations that generate mental stress [12].

Data from a cross-sectional study with police officers from Quebec, Canada, indicated a CLBP prevalence of 28.7% [15]. Also, a greater length of service as police officer was associated with an increased risk of LBP [15]. In Brazil, a cross-sectional survey conducted in FHPO from Pelotas, southern Brazil, revealed that 41.5% reported LBP in the previous 12 months [16]. However, there is a lack in literature regarding CLPB prevalence and its associated factors in this population [15, 17].

Therefore, the aim of this study was to describe the prevalence of CLBP among Brazilian FHPO. A secondary aim was to investigate possible associations with CLBP according to sociodemographic, behavioral, and occupational characteristics.

2 Materials and methods

2.1 Study design and participants

A cross-sectional descriptive-analytical study was conducted in 2019. All FHPOs from the Rio Grande do Sul state, southern Brazil, were invited to take part in the study. Eligible participants received an invitation via e-mail with a link to access the questionnaire. The data collection took part from March to December 2019. Ethical approval of the study was provided by the Research Ethics Committee (number 19921119.0.0000.5313).

Two authors of this study (EFM and FCF) were authorized by the Rio Grande do Sul FHP Superintendent to carry out the study. A list with all FHPO from Rio Grande do Sul was provided after the study had been authorized. Under those circumstances, an e-mail containing an invitation to participate in the study, as well as a consent form, and the questionnaire’s link was sent for eligible participants.

The eligibility criteria for participants were: 1) Active FHPO; 2) Working at any FHP station at the Rio Grande do Sul state; and 3) Access to the institutional e-mail. Therefore, participants who were on sick leave during data collection did not have access to the institutional e-mail and were not included. In addition, workers in technical-administrative positions (non-police careers) were also excluded because they do not perform police duties activities, nor use firearms or wear a ballistic vest, thus their inclusion would affect the results.

2.2 Measurement tools and methods

The online-based data collection was conducted via an online-based semi-structured questionnaire designed and hosted in the Google Forms platform. Initially, participants were asked about their consent to take part in the study. If the participant answered “yes”, the whole questionnaire was displayed. In case of a negative answer, the form was closed and then sent directly to researchers. In order to avoid losses and refusals and increase the response rate a second e-mail was sent to those who did not answer the questionnaire 15 days after the first message [18].

We collected the estimates of CLBP prevalence and intensity, sociodemographic, behavioral, and occupational characteristics. Table 1 describes all characteristics assessed, how they were measured, and how they were coded in the analyzes.

Table 1
Description of the variables, data format at collection, and coding of data in the analysis

Variables Data format at collection Coding of data in the analysis

Gender Female or male Dichotomous: female, male

Age Age in years (continuous) Categorical:≤40; 41 to 45;≥46

Marital status With or without a partner Dichotomous: with a partner; without a partner

Educational level Elementary school, middle and high school, higher education, postgraduate university Categorical: high school; higher education or above

Smoking history Do you smoke? Categorical: yes; no

Physical activity level International Physical Activity Questionnaire (IPAQ) short form [19]: insufficiently active and active* Dichotomous: insufficiently active; active

Nutritional status Body mass index (BMI) calculated (body mass/(height)²) based on self-reported height and weight (continuous). Categorical: normal (18.5≤BMI≤24.9); overweight (25.0≤BMI≤29.9); obese (BMI≥30.0) [20]

Sick leave the last three months Have you been off work for the last three months (illness, training, maternity, etc)? Categorical: yes; no

Working time at FHP Working time at FHP in years (continuous) Dichotomous:≤10;≥11

Residence in city of work Do you live in the same city where you work? Categorical: yes; no

Shift work What kind of shift work do you do? (work × rest). Options: 1) 12 h × 36 h; 2) 24 h × 72 h; 3) 24 h × 96 h; 4) 8 h daily; 5) other. Categorical: 8 h; > 8 h (12 h × 36 h, 24 h × 72 h or 24 h × 96 h); other

Predominant activity “What is your predominant area of work?” Options: administrative; operational; both Categorical: administrative; operational; both

Discomfort in wearing a police belt when standing Do you experience physical discomfort from wearing a duty belt while walking and standing? 4-point response scale: 1) not at all; 2) mostly not; 3) mostly; 4) always. Dichotomous: no (not at all or mostly not); yes (often or always).

Discomfort in wearing a ballistic vest when standing Do you experience physical discomfort from wearing a ballistic vest while walking and standing? 4-point response scale: 1) not at all; 2) mostly not; 3) mostly; 4) always. Dichotomous: no (not at all or mostly not); yes (often or always).

Discomfort in wearing a police belt when seated at a police car Do you experience physical discomfort from wearing duty belt while seated in a fleet vehicle? 4-point response scale: 1) not at all; 2) mostly not; 3) mostly; 4) always. Dichotomous: no (not at all or mostly not); yes (often or always).

Discomfort in wearing a ballistic vest when seated at a police car Do you experience physical discomfort from wearing ballistic vest while seated in a fleet vehicle? 4-point response scale: 1) not at all; 2) mostly not; 3) mostly; 4) always. Dichotomous: no (not at all or mostly not); yes (often or always)

Weight of Personal Protective Equipment (PPE) What personal protective equipment do you use/carry on your body during your shift work? Response options included several PPE used by police officers (e.g., bulletproof vest, holster, handcuffs, guns, etc.)^$ Dichotomous:<10 kg; 2)≥10 kg

Time of PPE use How long (hours), on average, do you use your aforementioned equipment during your regular work shift? (continuous) Dichotomous:<12 h;≥12h

Variables	Data format at collection	Coding of data in the analysis
Gender	Female or male	Dichotomous: female, male
Age	Age in years (continuous)	Categorical:≤40; 41 to 45;≥46
Marital status	With or without a partner	Dichotomous: with a partner; without a partner
Educational level	Elementary school, middle and high school, higher education, postgraduate university	Categorical: high school; higher education or above
Smoking history	Do you smoke?	Categorical: yes; no
Physical activity level	International Physical Activity Questionnaire (IPAQ) short form [19]: insufficiently active and active*	Dichotomous: insufficiently active; active
Nutritional status	Body mass index (BMI) calculated (body mass/(height)²) based on self-reported height and weight (continuous).	Categorical: normal (18.5≤BMI≤24.9); overweight (25.0≤BMI≤29.9); obese (BMI≥30.0) [20]
Sick leave the last three months	Have you been off work for the last three months (illness, training, maternity, etc)?	Categorical: yes; no
Working time at FHP	Working time at FHP in years (continuous)	Dichotomous:≤10;≥11
Residence in city of work	Do you live in the same city where you work?	Categorical: yes; no
Shift work	What kind of shift work do you do? (work × rest). Options: 1) 12 h × 36 h; 2) 24 h × 72 h; 3) 24 h × 96 h; 4) 8 h daily; 5) other.	Categorical: 8 h; > 8 h (12 h × 36 h, 24 h × 72 h or 24 h × 96 h); other
Predominant activity	“What is your predominant area of work?” Options: administrative; operational; both	Categorical: administrative; operational; both
Discomfort in wearing a police belt when standing	Do you experience physical discomfort from wearing a duty belt while walking and standing? 4-point response scale: 1) not at all; 2) mostly not; 3) mostly; 4) always.	Dichotomous: no (not at all or mostly not); yes (often or always).
Discomfort in wearing a ballistic vest when standing	Do you experience physical discomfort from wearing a ballistic vest while walking and standing? 4-point response scale: 1) not at all; 2) mostly not; 3) mostly; 4) always.	Dichotomous: no (not at all or mostly not); yes (often or always).
Discomfort in wearing a police belt when seated at a police car	Do you experience physical discomfort from wearing duty belt while seated in a fleet vehicle? 4-point response scale: 1) not at all; 2) mostly not; 3) mostly; 4) always.	Dichotomous: no (not at all or mostly not); yes (often or always).
Discomfort in wearing a ballistic vest when seated at a police car	Do you experience physical discomfort from wearing ballistic vest while seated in a fleet vehicle? 4-point response scale: 1) not at all; 2) mostly not; 3) mostly; 4) always.	Dichotomous: no (not at all or mostly not); yes (often or always)
Weight of Personal Protective Equipment (PPE)	What personal protective equipment do you use/carry on your body during your shift work? Response options included several PPE used by police officers (e.g., bulletproof vest, holster, handcuffs, guns, etc.)^$	Dichotomous:<10 kg; 2)≥10 kg
Time of PPE use	How long (hours), on average, do you use your aforementioned equipment during your regular work shift? (continuous)	Dichotomous:<12 h;≥12h

* Participants were classified as active (participants who performed at least 150 minutes per week of physical activity), or insufficiently active (participants who performed less than 150 minutes per week). Physical activity scores were calculated based on the product between the days and minutes, and by adding them up for each type of activity (moderate, vigorous and walking). ^$The weights of each PPE used were consulted in an official document of the police institution and added together.

CLBP experience, as well as pain intensity, were the two main outcomes assessed. First, participants were asked about any pain or discomfort: “Have you had any issue (such as ache, pain, discomfort, numbness) in a regular basis for more than 3 months in the lower back?” [21]. Those participants who indicated LBP were asked about pain intensity. Response alternatives were provided on a 10-point numerical rating scale (NRS): 0 = no pain; 10 = worst pain [22]. The definition of LBP used in this study was “ache, pain, or discomfort in the lower back region” (an image of a human body in supine position, with the low back area highlighted was presented together with the question). Such definition was based on previous studies which aimed to investigate CLBP in police officers [15, 17].

2.3 Statistical analysis

Descriptive data are presented as relative and absolute frequencies. Crude and adjusted Poisson regression analyzes were used to evaluate the relationship between CLBP and exposure variables (sociodemographic, behavioral, and occupational). Similarly, crude and adjusted linear regression analyzes were conducted for CLBP intensity. All variables were included in the adjusted analyzes, regardless of their p-value in crude analyzes, and a p < 0.2 was adopted to retain the variable in the model. The results were presented as prevalence ratio (PR) and their respective 95% confidence intervals (CI). All analyzes were conducted in Stata (version 15.1) statistical software for Windows, and a p < 0.05 was adopted for statistical significance.

3 Results

Overall, 651 FHPO from Rio Grande do Sul police stations were invited to participate in the study, of which 208 (32%) consented and answered the online questionnaire. Most participants were male (92.8%), aged 41 or more (62.0%), lived with a partner (88.0%), had a higher education degree (83.7%), and 60.1% and 13.9% were classified as overweight and obese, respectively. Regarding behavioral characteristics, most participants did not smoke (95.7%) and were physically active (81.7%), with a median of 355 (IQR 200–600) minutes/week. The prevalence of CLBP was 67.8% and the median pain intensity was 3 (IQR 0–5) (Table 2).

Table 2
Sociodemographic and behavioral characteristics of federal highway police officers from Rio Grande do Sul police stations, Brazil (n = 208)

Variables N (%)

Gender

Female 15 (7.2)

Male 193 (92.8)

Age (years)

≤40 79 (38.0)

41 to 45 53 (25.5)

≥46 76 (36.5)

Marital status

Without partner 25 (12.0)

With a partner 183 (88.0)

Education level

High school 34 (16.4)

Higher education or above 174 (83.7)

BMI

Normal 54 (26.0)

Overweight 125 (60.1)

Obese 29 (13.9)

Smoke

No 199 (95.7)

Yes 9 (4.3)

PA (min/w)

<150 38 (18.3)

≥150 170 (81.7)

Chronic LBP

No 67 (32.2)

Yes 141 (67.8)

Chronic LBP intensity (0–10) 3 (IQR 0–5)*

Variables	N (%)
Gender
Female	15 (7.2)
Male	193 (92.8)
Age (years)
≤40	79 (38.0)
41 to 45	53 (25.5)
≥46	76 (36.5)
Marital status
Without partner	25 (12.0)
With a partner	183 (88.0)
Education level
High school	34 (16.4)
Higher education or above	174 (83.7)
BMI
Normal	54 (26.0)
Overweight	125 (60.1)
Obese	29 (13.9)
Smoke
No	199 (95.7)
Yes	9 (4.3)
PA (min/w)
<150	38 (18.3)
≥150	170 (81.7)
Chronic LBP
No	67 (32.2)
Yes	141 (67.8)
Chronic LBP intensity (0–10)	3 (IQR 0–5)*

*Median (IQR: Interquartile Range). BMI: Body Mass Index; LBP: Low Back Pain; PA: Physical Activity; min/w = minutes per week.

The occupational characteristics of participants are displayed in Table 3. Most participants did not have a work leave in the past 3 months (84.6%), had been working as a FHPO for 11 years or more (62.0%), with a mean work time of 13.4±7.5 years and were performing an operational working activity (77.9%), with a shift of more than 8 h (71.1%). Regarding PPE, most participants reported using less than 10 kg of PPE (67.8%) and using it for 12 or more hours per shift (58.2%).

Table 3

Occupational characteristics of federal highway police officers from Rio Grande do Sul police stations, Brazil (n = 208)

Variables	N (%)
Work leave past 3 months
No	176 (84.6)
Yes	32 (15.4)
Working time at FHP (years)
≤10	79 (38.0)
≥11	129 (62.0)
Lives in the same city that works
No	105 (50.5)
Yes	103 (49.5)
Shift
Other	13 (6.3)
8 hours	47 (22.6)
≥8 hours	148 (71.1)
Predominant working activity
Administrative	29 (13.9)
Operational	162 (77.9)
Both	17 (8.2)
Discomfort in wearing a police belt
Standing
No	131 (63.0)
Yes	77 (37.0)
Sitting
No	138 (66.4)
Yes	70 (33.6)
Discomfort from wearing the ballistic vest
Standing
No	138 (66.4)
Yes	70 (33.6)
Sitting
No	127 (61.1)
Yes	81 (38.9)
PPE weight (kg)
<10	141 (67.8)
≥10 kg	67 (32.2)
Time of PPE use (hours)
<12	87 (41.8)
≥12	121 (58.2)

FHP: Federal Highway Police; PPE: Personal Protective Equipment.

Table 4 shows the results of crude and adjusted analyzes between sociodemographic and behavioral variables and CLBP. Participants who lived with a partner were 20% (95% CI 0.64; 0.99) less likely to report CLBP when compared to their peers who lived alone. Even though the relationship between pain intensity and BMI and physical activity were in an expected direction (β 0.14, 95% CI –0.74; 1.02; β 1.21, 95% CI –0.03; 2.46; for overweight and obesity, respectively) and (β –0.92, 95% CI –1.89; 0.05), no significant association in adjusted analyzes was observed between these variables.

Table 4

Crude and adjusted analyzes for chronic LBP and sociodemographic and behavioral factors in federal highway police officers from Rio Grande do Sul police stations, Brazil (n = 208)

	Chronic LBP				Pain intensity
	Crude	P-value	Adjusted	P-value	Crude	P-value	Adjusted	P-value
	PR (95% CI)		PR (95% CI)		β (95% CI)		β (95% CI)
Gender		0.924		0.789		0.224		0.511
Female	1.00		1.00		Ref		Ref
Male	1.02 (0.70; 1.48)		0.95 (0.66; 1.37)		0.90 (–0.56; 2.35)		0.50 (–0.99; 2.00)
Age (years)		0.162		0.099		0.060		0.312
≤40	1.00		1.00		Ref		Ref
41 to 45	0.97 (0.74; 1.25)		0.99 (0.76; 1.29)		–0.29 (–1.25; 0.66)		–0.52 (–1.48; 0.44)
≥46 or more	1.16 (0.94; 1.43)		1.19 (0.97; 1.47)		0.84 (–0.02; 1.70)		0.59 (–0.42; 1.41)
Marital status		0.093		0.042		0.914		0.591
Without partner	1.00		1.00		Ref		Ref
With a partner	0.83 (0.66; 1.03)		0.80 (0.64; 0.99)		–0.06 (–1.23; 1.10)		–0.32 (–1.48; 0.85)
Education level		0.693		0.881		0.055		0.127
High school	1.00		1.00		Ref		Ref
Higher education or above	0.95 (0.75; 1.21)		1.02 (0.79; 1.31)		–0.99 (–2.01; 0.02)		–0.79 (–1.82; 0.23)
BMI		0.251		0.433		0.054		0.147
Normal	1.00		1.00		Ref		Ref
Overweight	0.95 (0.76; 1.18)		0.92 (0.73; 1.15)		0.14 (–0.74; 1.02)		0.14 (–0.73; 1.02)
Obese	1.16 (0.89; 1.50)		1.10 (0.84; 1.44)		1.21 (–0.03; 2.46)		0.93 (–0.33; 2.20)
Smoke		0.437		0.537		0.700		0.596
No	1.00		1.00		Ref		Ref
Yes	1.16 (0.80; 1.66)		1.12 (0.78; 1.61)		–0.36 (–2.22; 1.49)		–0.50 (–2.38; 1.37)
PA (min/w)		0.355		0.358		0.062		0.103
<150	1.00		1.00		Ref		Ref
≥150	0.90 (0.73; 1.12)		0.90 (0.61; 1.14)		–0.92 (–1.89; 0.05)		–0.80 (–1.77. 0.16)

BMI: Body mass index; min/w = minutes per week; PA: Physical Activity.

Associations between occupational factors and CLBP outcomes are displayed in Table 5. Participants who worked for 11 years or more in the FHP were 32% more likely to report CLBP (CI95% 1.06; 1.63). Also, a high working time in FHP was associated with an increased pain intensity (β 0.95; 95% CI 0.19; 1.71). Furthermore, no significant association was observed in both crude and adjusted analyzes for pain intensity and work shift, even though the relationship between these variables were in an expected direction.

Table 5

Crude and adjusted analyzes for occupational factors in federal highway police officers from Rio Grande do Sul police stations, Brazil (n = 208)

	Chronic LBP				Pain intensity
	Crude	P-value	Adjusted	P-value	Crude	P-value	Adjusted	P-value
	PR (95% CI)	PR (95% CI)	β (95% CI)	β (95% CI)
Work leave past 3 months		0.898		0.909		0.081		0.071
No	1.00		1.00		Ref		Ref
Yes	1.02 (0.79; 1.31)		0.98 (0.77; 1.27)		0.93 (–0.12; 1.96)		0.96 (–0.08; 1.99)
Working time at FHP (years)		0.016		0.012		0.014		0.015
<10	1.00		1.00		Ref		Ref
≥11	1.31 (1.05; 1.62)		1.32 (1.06; 1.63)		0.97 (0.20; 1.74)		0.95 (0.19; 1.71)
Lives in the same city that works		0.808		0.971		0.314		0.475
No	1.00		1.00		Ref		Ref
Yes	0.98 (0.81; 1.18)		1.01 (0.84; 1.21)		–0.39 (–1.14; 0.37)		–0.27 (–1.03; 0.48)
Shift		0.306		0.167		0.151		0.092
Other	1.00		1.00		Ref		Ref
8 hours	1.52 (0.82; 2.82)		1.40 (0.75; 2.62)		1.40 (–0.30; 3.09)		1.01 (–0.69; 2.69)
≥8 hours	1.49 (0.82; 2.71)		1.49 (0.81; 2.73)		1.47 (–0.09; 3.04)		1.34 (–0.20; 2.89)
Predominant working activity		0.4467^a		0.5463^a		0.8077^a		0.7866^a
Administrative	1.00		1.00		Ref		Ref
Operational	0.89 (0.70; 1.12)		0.83 (0.59; 1.18)		–0.29 (–1.39; 0.81)		–0.37 (–1.70; 0.95)
Both	0.76 (0.49; 1.21)		0.85 (0.53; 1.35)		–0.53 (–2.19; 1.14)		0.07 (–1.63; 1.78)
Discomfort in wearing a police belt
Standing		0.952		0.296		0.694		0.306
No	1.00		1.00		Ref		Ref
Yes	0.99 (0.82; 1.21)		0.88 (0.69; 1.12)		–0.16 (–0.94; 0.63)		–0.51 (–1.49; 0.47)
Sitting		0.622		0.357		0.989		0.335
No	1.00		1.00		Ref		1.00
Yes	1.05 (0.86; 1.27)		1.11 (0.87; 1.40)		–0.01 (–0.81; 0.79)		0.46 (–0.48; 1.41)
Discomfort from wearing the ballistic vest
Standing		0.412		0.308		0.802		0.260
No	1.00		1.00		Ref		Ref
Yes	1.08 (0.89; 1.31)		1.10 (0.91; 1.34)		0.10 (–0.69; 0.90)		0.56 (–0.42; 1.54)
Sitting		0.784		0.325		0.276		0.158
No	1.00		1.00		Ref		Ref
Yes	0.97 (0.80; 1.18)		0.88 (0.69; 1.13)		–0.43 (–1.20; 0.34)		–055 (–1.32; 0.22)
PPE weight (kg)		0.300		0.188		0.117		0.244
<10	1.00		1.00		Ref		Ref
≥10	0.89 (0.72; 1.11)		0.87 (0.70; 1.07)		–0.39 (–1.20; 0.42)		–0.48 (–1.29; 0.33)
Time of PPE use (hours)		0.540		0.610		0.378		0.403
<12	1.00		1.00		Ref		Ref
≥12	0.94 (0.78; 1.13)		0.95 (0.79; 1.15)		–0.34 (–1.11; 0.42)		–0.34 (–1.14; 0.46)

^ap for heterogeneity; FHP: Federal Highway Police; PPE: Personal Protective Equipment; LBP: Low Back Pain.

4 Discussion

Overall, around two out of three FHPO in Rio Grande do Sul state reported CLBP. Living with a partner reduces the likelihood of experiencing CLBP. However, regarding occupational characteristics, those participants who worked 11 years or more were more likely to experience CLBP, as well as higher levels of pain, when compared to those who worked less than 10 years.

The prevalence of CLBP in our study was higher (67.8%) than the study conducted in Quebec (Canada) with a convenience sample of 3589 police officers, which described a CLBP prevalence of 28.7% [15]. A recent systematic review [23] investigated prevalence estimates of musculoskeletal symptoms in police officers, found only three studies that described CLBP prevalence ranging from 28.7% to 54.9% [15 , 24]. This discrepancy may be explained by the heterogeneity of police samples in distinct studies, such as different ages, as well as the heterogeneity in CLBP definitions used [15, 17]. Also, although our results revealed a higher prevalence of CLBP in Brazilian FHPO from Rio Grande do Sul state, it is important to acknowledge that methodological differences may limit directcomparisons.

The association found between marital status and CLBP experience might be explained by the social support role of partners regarding the adoption of healthy behaviors (e.g., physical activity, adequate nutrition). In other words, those participants who lived with a partner are more likely to have a healthier lifestyle, which reduces their likelihood to experience CLBP [25]. It should be noted that the concerned concern for a healthier lifestyle generally comes from female partners, and as the majority of the study sample is composed of men this might explain the association found [25].

Working as a FHPO for 11 years or more was associated with CLPB, as well as an increased pain intensity. Studies conducted with tactical population samples (i.e., police officers, members of the armed forces) also showed an increased risk of experiencing LBP in participants who worked longer in the force [26, 27]. Being exposed to physically demanding work activities increases the likelihood of experiencing LBP [28, 29]. The cumulative load in the lumbar spine accelerates lumbar disc narrowing which causes the pain. FHPO are highly exposed to risk factors such as physical stress on the spine (e.g., vibration when driving a police vehicle) and psychological stress (e.g., depression, post-traumatic stress disorder), which also increases the likelihood of experiencing LBP [30].

Limitations of our study should be listed. First, although our study can inform the prevalence of CLBP and its associated factors, due to its cross-sectional design causality between exposure and outcomes cannot be inferred. Second, data were collected using a self-reported questionnaire, which may have impacted the estimates by recall bias. Third, as the eligibility criteria of this study excluded those who were on sick leave, health worker effect (bias) [31] cannot be ruled out. However, to the author’s knowledge, this is the first study to assess CLBP in a Brazilian police institution. Future studies on this population should focus on the causal relationship of CLBP and sociodemographic, working, psychological and physical factors.

We believe that our results can bring positive changes to the police in general, as our findings help to increase the interest of decision makers on the topic. Also, such results might aid the planning and implementation of scientific evidence-based occupational health policies, contributing to the reduction of this problem. In addition, our findings could also have a positive impact on society that would benefit from a higher quality security service. As for police officers, being aware of the factors associated with CLBP can make them more careful in relation to the performance of their work activities, therefore encouraging the adoption of healthier habits. The identification of the high prevalence of CLBP in FHPO can motivate researchers and occupational health sectors to develop effective prevention and treatment programs to reduce the incidence and frequency of this morbidity, thus reducing time off and treatment expenses, as well as promoting a safer return to work.

5 Conclusion

FHPO from southern Brazil presents a high prevalence of CLPB. Sociodemographic and work-related characteristics are associated with experiencing CLPB in this population. Further longitudinal studies are needed to understand the relationship of other characteristics (e.g., behavioral) and LBP in tactical populations. There is a need in police organizations to promote CLBP prevention and to implement workplace management programs, aiming to reduce the CLBP burden in this population.

Ethical approval

The study was approved by the ethics board of the Faculty of Physical Education, Federal University of Pelotas (CAAE: 31906920.7.0000.5313).

Informed consent

The first page (online) referred to the free and informed consent term, which guaranteed the confidentiality of the data and informed the participants about the objectives of the study and their voluntary participation.

Conflict of interest

The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Footnotes

Acknowledgments

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), finance code 001.

References

James

, Abate

, Abay

, Abbafati

, Abbasi

, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, – a systematic analysis for the Global Burden of Disease Study 2017. The Lancet, 2018; 392(10159):1789–858.

Garcia

JBS

. Prevalence of Low Back Pain in Latin America: A Systematic Literature Review. Pain Physician. 2014;17(5):379–91.

Romero

, Muzy

, Maia

, Marques

, de Souza Júnior

PRB

, Castanheira

. Chronic low back pain treatment in Brazil: inequalities and associated factors. Cien Saude Colet. 2019;24(11):4211–26.

Manek

, MacGregor

. Epidemiology of back disorders: prevalence, risk factors, and prognosis. Curr Opin Rheumatol. 2005;17(2):134–40.

Meziat Filho

, Silva

GA e

. Invalidez por dor nas costas entre segurados da Previdência Social do Brasil. Rev Saude Publica. 2011;45(3):494–502.

Carregaro

, Tottoli

, Rodrigues D da

, Bosmans

, da Silva

, van Tulder

. Low back pain should be considered a health and research priority in Brazil: Lost productivity and healthcare costs between 2012 to 2016. PLoS One. 2020;15(4):e0230902.

Marins

, Barbosa

, Machado

, Orr

, Dawes

, Del Vecchio

. Profile of Self-Reported Physical Tasks and Physical Training in Brazilian Special Operations Units: A Web-Based Cross-Sectional Study. Int J Environ Res Public Health. 2020;17(19):7135.

Garcia

JBS

, Hernandez-Castro

, Nunez

, Pazos

, Aguirre

, Jreige

, et al. Prevalence of low back pain in Latin America: a systematic literature review. Pain Physician. 2014;17(5):379–91.

Gonzalez

, da Silva

, Avanzi

, Macedo

, Alves

, Indini

, et al. Low back pain prevalence in Sao Paulo, Brazil: A cross-sectional study. Brazilian J Phys Ther. 2021;S-1413–3555(21)00082-4.

10.

Serranheira

, Sousa-Uva

, Heranz

, Kovacs

, Sousa-Uva

. Low Back Pain (LBP), work and absenteeism. Work. 2020;65(2):463–9.

11.

Corrêa Pinto

, Da Silva

, Caputo

, Domingues

. Low back pain prevalence and associated factors in nurses from Brazilian primary health units. Work. 2021;70(1):279–85.

12.

Violanti

, Charles

, McCanlies

, Hartley

, Baughman

, Andrew

, et al. Police stressors and health: a state-of-the-art review. Policing. 2017;40(4):642–56.

13.

Mona

, Chimbari

, Hongoro

. A systematic review on occupational hazards, injuries and diseases among police officers worldwide: Policy implications for the South African Police Service. J Occup Med Toxicol. 2019;14(3):1–15.

14.

Marins

, Cabistany

, Farias

, Dawes

, Del Vecchio

. Effects of Personal Protective Equipment on Metabolism and Performance During an Occupational Physical Ability Test for Federal Highway Police Officers. J Strength Cond Res. 2020;34(4):1093–102.

15.

Benyamina Douma

, Côté

, Lacasse

. Quebec Serve and Protect Low Back Pain Study. Spine (Phila Pa 1976). 2017;42(19):1485–93.

16.

Marins

, Del Vecchio

. Health’s Patrol Program: Health indicators from federal highway policemen. Sci Med (Porto Alegre). 2017;27(2). ID25855.

17.

Larsen

, Andersson

, Tranberg

, Ramstrand

. Multi-site musculoskeletal pain in Swedish police: associations with discomfort from wearing mandatory equipment and prolonged sitting. Int Arch Occup Environ Health. 2018;91(4):425–33.

18.

Schleyer

TKL

, Forrest

. Methods for the Design and Administration of Web-based Surveys. J Am Med Informatics Assoc. 2000;7(4):416–25.

19.

Matsudo

, Araujo

, Matsudo

, Andrade

, Oliveira

, et al. International Physical Activity Questionnaire (IPAQ): study of validity and reliability in Brazil. Rev Bras Ativ Fis Saúde. 2001;6(2):5–18.

20.

World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO Consultation. WHO Technical Report Series Geneva: WHO 2000.

21.

De Barros

ENC

, Alexandre

NMC

. Cross-cultural adaptation of the Nordic musculoskeletal questionnaire. Int Nurs Rev. 2003;50(2):101–8.

22.

Costa

LOP

, Maher

, Latimer

, Ferreira

, Pozzi

, et al. Clinimetric Testing of Three Self-report Outcome Measures for Low Back Pain Patients in Brazil. Spine (Phila Pa 1976). 2008;33(22:2459–63.

23.

Marins

, Andrade

, Peixoto

, Silva

MC da

. Frequency of musculoskeletal symptoms among police officers: systematic review. Brazilian J Pain. 2020;3(2):164–9.

24.

Brown

, Wells

, Trottier

, Bonneau

, Ferris

. Back Pain in a Large Canadian Police Force. Spine (Phila Pa 1976). 1998;23(7):821–7.

25.

Ferreira

, Domingues

. Can your partner influence your physical activity? The role of social support provided by partners. Rev Bras Ativ. Fís. Saúde. 2021;26:1–9.

26.

Benyamina

Douma N

, Côté

, Lacasse

. Occupational and Ergonomic Factors Associated With Low Back Pain Among Car-patrol Police Officers. Clin J Pain. 2018;34(10):960–6.

27.

Gun

, Banaag

, Khan

, Koehlmoos

. Prevalence and Risk Factors for Musculoskeletal Back Injury Among U.S. Army Personnel. Mil Med. 2021;0(1):1–7.

28.

Seidler

, Euler

, Bolm-Audorff

, Ellegast

, Grifka

, Haerting

, et al. Physical workload and accelerated occurrence of lumbar spine diseases: risk and rate advancement periods in a German multicenter case-control study. Scand J Work Environ Health. 2010;37(1):30–6.

29.

Oliv

, Noor

, Gustafsson

, Hagberg

. A Lower Level of Physically Demanding Work Is Associated with Excellent Work Ability in Men and Women with Neck Pain in Different Age Groups. Saf Health Work. 2017;8(4):356–63.

30.

Parreira

, Maher

, Steffens

, Hancock

, Ferreira

. Risk factors for low back pain and sciatica: an umbrella review. Spine J. 2018;18(9):1715–21.

31.

, Sung

. A review of the healthy worker effect in occupational epidemiology. Occup Med (Lond). 1999;49(4):225–9.