Evaluation of low back pain status and affecting factors in drivers in Turkey: A cross-sectional study 1

Abstract

BACKGROUND:

Low back pain (LBP) is a common public health problem resulting in workforce loss.

OBJECTIVE:

This study aims to evaluate the LBP status and its affecting factors among drivers in a city in southeast Turkey.

METHODS:

This cross-sectional questionnaire survey study was conducted among 323 drivers. The chi-square test and logistic regression analysis were used to analyze the data.

RESULTS:

The mean age of the drivers was 41.7±11.5 years (min: 19, max: 70), and 83.9% were married, and all were men. LBP was found in 59.4% of drivers. It was significantly higher in drivers with poor socioeconomic status, dissatisfied with their life, having a chronic illness, physically inactive, having sleep disorders, exposed to bad road conditions, prolonged vibration, high physical- psychological workload, and a family history of LBP (p < 0.05). There was no significant association between age, education level, and BMI with LBP (p > 0.05).

CONCLUSION:

There is limited study on this subject in Turkey. Further studies can raise awareness about this issue and create an educational plan.

Keywords

Low back pain musculoskeletal pain occupational exposure occupational health vibration workload

1 Introduction

Low back pain (LBP) is defined as pain, muscle tension, and stiffness in the area between the lower border of the 12th rib and the lower gluteal fold on the proximal thigh, with or without leg pain [1]. LBP, among the most important causes of disability globally, causes functional loss, reduces life quality, and significantly affects society due to workforce losses [2]. The prevalence of chronic LBP in the general population was reported as 18.1% to 28.2% [3]. The prevalence of LBP in drivers varies between 17 and 82.9% [4]. According to the U.S. Bureau of Labor Statistics 2018 data, drivers are among the top three occupations with the highest musculoskeletal discomfort rates, and the highest prevalence of discomfort has been reported in the back [5]. A study evaluating the pain in the body parts of drivers revealed that the most painful area is the lumbar region [6].

There are physical, chemical, biological, and psychosocial factors that affect work-related LBP. The main risks associated with driving are as follows: age, sex, height, weight, body mass index (BMI), prolonged sitting time, whole-body vibration, type of vehicle seat, faulty postures, heavy lifting, excessive workload, job dissatisfaction, stress, and inflammatory/algesic chemicals [7, 8]. LBP is more common in drivers with awkward postures while driving [9]. In addition, high-vibration exposure in the vehicle increases users’ muscle activity, causing muscle fatigue and increasing the incidence of LBP [10]. Drivers often stay in a restricted driving cabin with no room for body movement, resulting in a permanent, static position. This position leads to spasms and musculoskeletal complaints. In drivers, musculoskeletal problems account for 50% of work-related disorders [11].

Low back pain has a direct impact on drivers’ quality of life and job performance. It is one of the leading causes of absenteeism. It also imposes substantial financial burdens on companies, society, and individuals [12].

Low back pain is a public health problem for occupational health. Although there are numerous studies in the literature investigating LBP in drivers, there are few in Turkey. As a result, this study aims to evaluate LBP status and affecting factors among drivers in Diyarbakır city in southeastern Turkey.

2 Materials and methods

2.1 Design and procedure

This cross-sectional questionnaire survey was conducted in Diyarbakır, a city in southeast Turkey with a population of 1.8 million, between March and June 2019. At the time of the research, there were 3700 drivers registered in the Diyarbakır Chauffeurs Chamber of Commerce. The sample size was calculated using the formula n = Nt²pq/d²(N-1) + t²pq [13].

N: Size of the universe (3700)

n: Size of the sample (348)

p: The prevalence of LBP, which was approximated as % 50 (17–82.9%) based on studies by Joseph et al. [4].

q: Frequency of absence of the LBP (50%)

d: Confidence interval, which was accepted as 5%.

t: 1.96

The study sample was determined as 348 people, with a 95% confidence interval and a 5% margin of error. Being a taxi, minibus, bus, or truck driver registered with the Diyarbakır Chamber of Drivers, having been a driver for at least one year, and volunteering to participate in the research were accepted as inclusion criteria. Those with less than one year of driving experience, acute trauma, or psychiatric illness were accepted as exclusion criteria. Among the drivers in the sample, 18 had less than 1 year of working experience, and 7 of them declined to participate in the study. Out of the 348 drivers that were selected for sampling, 323 of them, which accounts for 92.8% of the total, were successfully contacted.

Prior to the administration of the questionnaire, a pre-test was conducted on 10 drivers employed at the institutions where the researchers were affiliated. The study did not involve pretest data. In this study, researchers recruited people who suitable the inclusion criteria by visiting taxi and minibus stops. The average time for completing the questionnaire was 15 minutes for each participant. The questionnaire was applied face-to-face.

2.2 Data collection tools

The data were collected by a survey form prepared by the researchers by scanning the literature [14 –16]. The questionnaire consisted of 43 questions, and the names of the participants were not included in the questionnaire.

2.2.1 Sociodemographic information form

There were 15 questions about sociodemographic characteristics such as age, height, weight, marital status, socioeconomic status, education level, smoking-alcohol use, and chronic disease.

The BMI evaluation was based on the World Health Organization (WHO) criteria. Those with a BMI below 18.5 kg/m² were categorized as underweight, with a BMI of 18.5–24.9 kg/m² as normal, a BMI of 25.0–29.9 kg/m² as overweight, and over 30 kg/m² as obese [17]. The physical activity criteria of the World Health Organization for adults were used. Those who did 150 minutes or more of moderate-intensity physical activity per week were categorized active, and those who did less than 150 minutes of physical activity per week were categorized inactive [18].

2.2.2 Occupational information form

There were 17 questions about driving patterns, such as type of vehicle, road condition, and occupational exposure. Perceived physical and psychological workload (good-moderate-bad), prolonged driving, prolonged vibration, prolonged sitting, the comfort of the driver’s seat (comfort/discomfort) was questioned as a self-report based. According to the regulations established by the Turkish Ministry of Labor and Social Security, drivers working for commercial transportation of passengers and cargo are prohibited from driving continuously for more than four and a half hours [19]. Participants were questioned about their prolonged sitting, driving, and exposure to vibration for a minimum of four and a half hours without any breaks.

2.2.3 Low back pain information form

There were 11 questions based on self-report about LBP. In the questionnaire, LBP was defined as pain, muscle tension, and stiffness in the area between the lower border of the 12th rib and the lower gluteal fold of the proximal thigh, with or without leg pain [1]). The assessment of LBP included assessing the participant’s current experience of LBP, lifetime LBP frequency, perceived LBP severity, complaints related to LBP, LBP treatment-surgery history was conducted.

2.3 Statistical analysis

IBM SPSS 22.0 package program was used for data analysis. Depending on the characteristics of the variables, we calculated percentage, mean, chi-square, and logistic regression analyses. Means were demonstrated with standard deviation, and p < 0.05 was considered significant.

3 Results

3.1 Sociodemographic and occupational characteristics

The mean age of the drivers was 41.7±11.5 years (min: 19, max: 70), and all of them were male. The average BMI of the participants was 26.3±3.7 kg/m², and the mean years of work as a driver was 18.9±11.5. Additionally, 61.9% (n = 200) were smokers, and 9.3% (n = 30) were using alcohol. The mean smoking duration of the smokers was 20.1±10.8 (min: 1, max: 55) years. The average number of cigarettes smoked per day was 22.6±12.9 (min: 1, max: 80). Table 1 demonstrates the sociodemographic and occupational characteristics of the participants.

Table 1
Distribution of participants by sociodemographic and occupational characteristics

Sociodemographic and occupational n %

characteristics (n = 323)

Educational status

Illiterate 10 3.1

Literate 19 5.9

Primary school 68 21.1

Secondary school 76 23.5

High school 116 35.9

University 34 10.5

Socioeconomic status

Good 51 15.8

Moderate 215 66.6

Poor 57 17.6

Body mass index

Underweight 1 0.3

Normal 116 35.9

Overweight 161 49.8

Obese 45 13.9

Chronic disease

Yes 35 10.8

No 288 89.2

Physically active

Yes 140 43.3

No 183 56.7

Sleeping disorder

Yes 99 30.7

No 224 69.3

Type of vehicle used

Truck 107 33.0

Minibus 85 26.3

Taxi 81 25.1

Bus 50 15.5

Driver seat

Comfortable 207 64.1

Uncomfortable 116 35.9

Road condition

Good 117 36.2

Moderate 154 47.7

Bad 52 16.1

Situation after work day

Comfortable 144 44.6

Uncomfortable 179 55.4

Perceived physical workload

Good 38 11.8

Moderate 188 58.2

Bad 97 30.0

Perceived psychological workload

Good 45 13.9

Moderate 205 63.5

Bad 73 22.6

Occupational exposure*

Prolonged sitting 221 68.4

Prolonged driving 132 40.9

Stressful working environment 127 39.3

Extreme cold or hot 81 25.1

Prolonged standing 50 15.5

Heavy lifting 49 15.2

Prolonged vibration 47 14.6

Uncomfortable position 36 11.1

Sociodemographic and occupational	n	%
Educational status
Illiterate	10	3.1
Literate	19	5.9
Primary school	68	21.1
Secondary school	76	23.5
High school	116	35.9
University	34	10.5
Socioeconomic status
Good	51	15.8
Moderate	215	66.6
Poor	57	17.6
Body mass index
Underweight	1	0.3
Normal	116	35.9
Overweight	161	49.8
Obese	45	13.9
Chronic disease
Yes	35	10.8
No	288	89.2
Physically active
Yes	140	43.3
No	183	56.7
Sleeping disorder
Yes	99	30.7
No	224	69.3
Type of vehicle used
Truck	107	33.0
Minibus	85	26.3
Taxi	81	25.1
Bus	50	15.5
Driver seat
Comfortable	207	64.1
Uncomfortable	116	35.9
Road condition
Good	117	36.2
Moderate	154	47.7
Bad	52	16.1
Situation after work day
Comfortable	144	44.6
Uncomfortable	179	55.4
Perceived physical workload
Good	38	11.8
Moderate	188	58.2
Bad	97	30.0
Perceived psychological workload
Good	45	13.9
Moderate	205	63.5
Bad	73	22.6
Occupational exposure*
Prolonged sitting	221	68.4
Prolonged driving	132	40.9
Stressful working environment	127	39.3
Extreme cold or hot	81	25.1
Prolonged standing	50	15.5
Heavy lifting	49	15.2
Prolonged vibration	47	14.6
Uncomfortable position	36	11.1

*More than one answer possible.

The mean daily working time of the participants was 8.5±2.7 (min: 2, max: 19) hours, and the daily sleep time was 7.1±1.5 (min: 1, max: 12) hours. Of the participants, 45.5% (n = 147) slept in the car to rest, and 35.9% perceived the driver’s seat as uncomfortable. Of the participants, 33.0% (n = 107) drove trucks, 26.3% (n = 85) minibusses, 25.1% (n = 81) taxis, and 15.5% (n = 50) buses. Occupational exposures according to participants’ self-reports were as follows: 68.4% (n = 221) reported prolonged sitting, 40.9% (n = 132) were prolonged driving, 39.3% (n = 127) were in a stressful working environment, 25.1% (n = 81) were exposed to extreme cold or heat, 15.5% (n = 50) were prolonged standing, 15.2% (n = 49) heavy lifting, 14.6% (n = 47) were exposed to prolonged vibration, 11.1% (n = 36) were working in an uncomfortable position. 56.3% of the participants were satisfied with their life.

3.2 Low back pain and related characteristics

LBP was found in 59.4% (n = 192) of the drivers. The distribution of the participants with LBP according to LBP-related characteristics is shown in Table 2.

Table 2
Distribution of participants with low back pain according to low back pain-related characteristics

Variables (n = 192) n %

Lifetime low back pain frequency

1–5 times 88 45.8

6–10 times 28 14.6

>10 times 37 19.3

Constant pain 39 20.3

Perceived low back pain severity

Light 42 21.9

Medium 127 66.1

Severe 23 12.0

Complaints related to low back pain*

Pain in the lumbar region 149 77.6

Pain in the leg 68 35.4

Stiffness 48 25.0

Numbness in the leg or foot 47 24.5

Loss of strength 27 14.1

Incontinence 9 4.7

Drop foot 4 2.1

Low back surgery status

Yes 15 7.8

No 177 92.2

Low back pain treatment history

Yes 64 33.3

No 128 66.7

Type of treatment (n = 64)*

Physiotherapy 41 64.1

Medication 36 56.2

Spa treatment 29 45.3

Traditional methods 19 29.7

Low back pain-related disability

Yes 11 5.7

No 181 94.3

Variables (n = 192)	n	%
Lifetime low back pain frequency
1–5 times	88	45.8
6–10 times	28	14.6
>10 times	37	19.3
Constant pain	39	20.3
Perceived low back pain severity
Light	42	21.9
Medium	127	66.1
Severe	23	12.0
Complaints related to low back pain*
Pain in the lumbar region	149	77.6
Pain in the leg	68	35.4
Stiffness	48	25.0
Numbness in the leg or foot	47	24.5
Loss of strength	27	14.1
Incontinence	9	4.7
Drop foot	4	2.1
Low back surgery status
Yes	15	7.8
No	177	92.2
Low back pain treatment history
Yes	64	33.3
No	128	66.7
Type of treatment (n = 64)*
Physiotherapy	41	64.1
Medication	36	56.2
Spa treatment	29	45.3
Traditional methods	19	29.7
Low back pain-related disability
Yes	11	5.7
No	181	94.3

*More than one answer possible.

The distribution of participants’ LBP status by sociodemographic characteristics is given in Table 3. LBP was more common in participants who were physically inactive and slept in their vehicle (p < 0.05). Age, education level, and BMI were not associated with LBP (p > 0.05).

Table 3

Distribution of participants’ low back pain status by sociodemographic characteristics

Sociodemographic	The group with low		The group without		Statistics*
characteristics (n = 323)	back pain (n = 192)		low back pain (n = 131)
Age	n	%	n	%
≤35	66	62.3	40	37.7	χ² = 2.058
36–50	77	55.0	63	45.0	p = 0.357
≥51	49	63.6	28	36.4
Educational status
<Literate	18	62.1	11	37.9	χ² = 0.094
Primary-secondary school	85	59.0	59	41.0	p = 0.954
>High school	89	59.3	61	40.7
Marital status
Married	166	61.3	105	38.7	χ² = 2.292
Single	26	50.0	26	50.0	p = 0.165
Socioeconomic status					χ² = 11.954
Good	23	45.1	28	54.9	p = 0.003
Moderate	125	58.1	90	41.9
Poor	44	77.2	13	22.8
Body mass index
Underweight-normal	64	54.7	53	45.3	χ² = 1.838
Overweight	99	61.5	62	38.5	p: 0.399
Obese	29	64.4	16	35.6
Smoking status
Yes	122	61.0	78	39.0	χ² = 0.528
No	70	56.9	53	43.1	p = 0.486
Alcohol use
Yes	20	66.7	10	33.3	χ² = 0.716
No	172	58.7	121	41.3	p = 0.441
Chronic disease
Yes	28	80.0	7	20.0	χ² = 6.881
No	164	56.9	124	43.1	p = 0.010
Physically active
Yes	73	52.1	67	47.9	χ² = 5.462
No	119	65.0	64	35.0	p = 0.022
Sleep disorder
Yes	70	70.7	29	29.3	χ² = 7.513
No	122	54.5	102	45.5	p = 0.007
Resting/sleeing in the vehicle
Yes	99	67.3	48	32.7	χ² = 6.991
No	93	52.8	83	47.2	p = 0.009

*Row percentages.

The distribution of participants’ LBP by occupational characteristics is given in Table 4. LBP was significantly higher in participants dissatisfied with their lives and working under bad road conditions. Participants who perceived the driver’s seat as uncomfortable had more LBP, but the difference was not significant (p = 0.100).

Table 4

Distribution of participants’ low back pain by occupational characteristics

Occupational characteristics (n = 323)	With low back pain		Without low back		Statistics*
	(n = 192)		(n = 131)
Type of vehicle used	n	%	n	%
Taxi, minibus	90	54.2	76	45.8	χ² = 3.869
Bus, truck	102	65.0	55	35.0	p = 0.054
Road condition
Good	62	53.0	55	47.0	χ² = 10.315
Moderate	89	57.8	65	42.2	p = 0.006
Bad	41	78.8	11	21.2
Number of years working
≤5 years	26	63.4	15	36.6	χ² = 0.380
6–10 years	38	58.5	27	41.5	p = 0.944
11–20 years	61	58.1	44	41.9
≥21 years	67	59.8	45	40.2
Prolonged driving
Yes	89	67.4	43	32.6	χ² = 5.899
No	103	53.9	88	46.1	p = 0.016
The situation after work day
Comfortable	69	47.9	75	52.1	χ² = 14.319
Uncomfortable	123	68.7	56	31.3	p < 0.001
The situation driver seat
Comfort	116	56.0	91	65.5	χ² = 2.770
Discomfort	76	65.5	40	34.5	p = 0.100
Perceived physical workload
Good	17	44.7	21	55.3	χ² = 9.638
Moderate	106	56.4	82	43.6	p = 0.008
Bad	69	71.1	28	28.9
Perceived prolonged vibration
Yes	157	56.9	119	43.1	χ² = 5.151
No	35	74.5	12	25.5	p = 0.025
Perceived psychological workload
Good	18	40.0	27	60.0	χ² = 10.370
Moderate	123	60.0	82	40.0	p = 0.006
Bad	51	69.9	22	30.1
Life satisfaction
Yes	91	50.0	91	50.0	χ² = 15.420
No	101	71.6	40	28.4	p < 0.001
Low back pain in the family
Yes	78	73.6	28	26.4	χ² = 13.089
No	114	52.5	103	47.5	p < 0.001

^*Row percentages.

Low back pain was significantly higher in participants exposed to prolonged driving (p = 0.016) and perceived prolonged vibration (p = 0.025). The logistic regression analysis of participants’ LBP according to sociodemographic and occupational variables is shown in Table 5.

Table 5

Logistic regression analysis of sociodemographic and occupational characteristics with low back pain as the outcome variable

Factor	Odds ratio	95% Confidence	p
		Interval
Socioeconomic status
Poor	1
Moderate	0.516	0.243–1.097	0.086
Good	0.398	0.152–1.041	0.060
Chronic disease
Yes	1
No	0.949	0.300–3.004	0.929
Continuous medication use
Yes	1
No	0.512	0.197–1.329	0.169
Road condition
Bad	1
Moderate	0.415	0.183–0.941	0.035
Good	0.449	0.190–1.065	0.069
Physically active
No	1
Yes	0.814	0.485–1.367	0.437
Sleep disorder
Yes	1
No	1.140	0.615–2.113	0.677
Resting in the car
Yes	1
No	0.613	0.371–1.013	0.056
The situation after work day
Uncomfortable	1
Comfortable	0.801	0.434–1.479	0.478
Physical workload
Bad	1
Moderate	0.995	0.496–1.996	0.988
Good	1.157	0.421–3.176	0.778
Psychological workload
Bad	1
Moderate	0.796	0.286–2.215	0.663
Good	1.352	0.621–2.943	0.447
Life satisfaction
No	1
Yes	0.766	0.409–1.434	0.404
Low back pain status in the family
Yes	1
No	0.535	0.305–0.938	0.029

4 Discussion

This study is the first research conducted on drivers in the Southeastern Anatolia Region of Turkey. There is a scarcity of research on the prevalence of LBP among drivers in Turkey. Drivers in Turkey are generally male, start working professionally at the age of 20, and often stay in their profession until their late 70 s. This study is a cross-sectional study that involves a questionnaire to assess the prevalence of LBP in drivers and the factors affecting it.

A majority of drivers (trucks, minibuses, taxis, buses) reported having LBP. The percentage of drivers with LBP in selected countries were as follows: 49.7% of taxi drivers in Turkey [16], 27.9% of taxi drivers in Ethiopia [14], 50.7% in America [20], 53.0% of bus drivers in Thailand [21], 54% of taxi drivers in China [15], 44.1% of drivers in Saudi Arabia [22], 65.0% of truck drivers in Ethiopia [23] and 75.0% of heavy vehicle drivers in Turkey [6]. The differences in the prevalence of LBP among various studies may be due to factors such as differences between study populations, time of the study, type of vehicle driven, or differences in the definitionof LBP.

Low back pain is significantly higher in participants with poor socioeconomic status. People with a lower socioeconomic status are at a higher risk of experiencing LBP compared to those with a higher socioeconomic status [23 –25]. Poor socioeconomic conditions and financial situation can lead to a person experiencing economic stress and LBP.

Although participants with obesity had a higher prevalence of LBP, the difference was not statistically significant. Similar to our study, no significant relationship was found between BMI and LBP [7, 26]. On the contrary, a study of ambulance drivers, showed that LBP increases with BMI [27]. The high prevalence of LBP in obese persons may be due to loading more weight on the vertebralcolumn [28].

Although not statistically significant, LBP was more common in smokers. Our study was consistent with the literature [6, 15]. In a study of taxi drivers, LBP was 1.7 times more common in smokers [29]. Moreover, research conducted on truck drivers in Ethiopia and bus drivers in Bangladesh revealed that smokers had a greater prevalence of LBP [23, 30]. Some studies found no relationship between smoking and LBP [16, 22]. Since smoking can cause disc degeneration, it can be considered a risk factor that increases LBP [31].

Low back pain was significantly higher in participants with chronic disease. A study in Ethiopia agrees with our study [23]. Similarly, in a study conducted in Japan, LBP was 1.6 times higher in patients with chronic diseases [29]. In contrast, the study conducted in Bangladesh did not find any association between chronic disease and LBP [30]. Specific LBP pain may be explained by an underlying disease [32]. Chronic disease is a significant factor that affects the occurrence of specific LBP.

The prevalence of LBP in physically inactive participants was significantly higher. LBP has been found to be high in those who are physically inactive in Ethiopia [23]. In a study conducted in Turkey, LBP was 1.9 times higher in those who did not do physical activity [16]. Similarly, a study conducted in China found a significant negative relationship between physical activity and LBP. The literature accepts physical activity as a protective factor for LBP [15]. In a study of taxi drivers, LBP was significantly more common in those who had insufficient physical activity [29]. The driving profession requires long hours of sitting in a sedentary job, which limits physical activity opportunities.

In our study, the LBP prevalence of participants with sleep disorders has been found to be significantly higher. Miyamoto et al. found that the prevalence of LBP is 2.2 times higher in drivers who did not sleep well [29]. Moreover, Wang et al. identified good sleep as a preventive factor against LBP [15]. Good sleep can be considered important for general health.

Low back pain was more common in drivers who drive heavy vehicles such as buses, and trucks. According to literature heavy vehicle drivers risk LBP [33, 34]. The spine of people who drive heavy vehicles is exposed to constant and sudden movements. Therefore, since the forces generated from these movements are transferred to the spine, the spine’s risk of injury is higher [6]. Exposure to vibrations around the lower spine’s resonance frequency may cause this [33, 34].

Participants who perceived the road conditions to be bad were more common LBP, according to our study. Driving on roads with several potholes can be a fatiguing, leading to the exposure of whole-body vibration and causing LBP [23 , 33]. Research indicates that WBV is higher on bumpy roads and lower on flat roads, regardless of vehicle type or driving seat [23 , 34]. The quality of roads and the durability of vehicles in Turkey may reduce the likelihood of drivers experiencing LBP.

Low back pain was more common in participants with a daily working time of more than 8 hours, but the difference was not statistically significant. In a study conducted in Ethiopia, drivers who work more than 15 hours per day had more LBP, but the difference was not significant [23]. Yitayal et al. reported that drivers driving more than 12 hours per day were 2.3 times at greater risk for LBP [14]. In a study conducted in Saudi Arabia, drivers who work more than 6 hours per day had more LBP [22]. Prolonged working may lead to increased occupational exposure and a more frequent occurrence of LBP.

Low back pain was more common in participants who reported that the driver’s seat was uncomfortable, but it was not statistically significant. A study of bus drivers in Israel showed that LBP was 2.6 times more common in those with uncomfortable driver’s seats. The causes of LBP in drivers were mainly related to ergonomic factors such as uncomfortable seats and back supports [7]. It can be thought that the comfort of the driver’s seat is an effective factor for LBP.

Low back pain was significantly higher in drivers who perceived their physical and psychological workload as bad. Also, Bovenzi et al. found that physical workload was an essential determinant of LBP [35]. In addition, prolonged sitting behind the wheel has a cumulative effect on low back muscle fatigue and strain on the lumbar spine, which can lead to LBP [36]. Similar to our study, some studies have found a relationship between psychological workload and chronic LBP. In a cohort study conducted on the general population in Norway, the psychological workload was an essential determinant of LBP [37]. In a study of ambulance drivers, the risk of LBP was significantly higher in drivers with a high psychological workload [27]. The driver’s LBP status may be affected by both the physical and psychological workload experienced by thedriver.

Low back pain was significantly higher in prolonged driving. A study of ambulance drivers considered prolonged driving a significant risk factor for LBP [27]. A systematic review found that, sitting for more than half of the working day poses a greater risk for LBP [38, 39]. Prolonged periods of work such as driving can lead to a physical pain, including pain in the lower back [40].

Low back pain was higher in people exposed to prolonged vibration. Okunribido et al. found that urban bus drivers experience disturbing vibration events in 60% of their daily working hours [41]. Furthermore, a study conducted on commercial drivers found a direct association between the magnitude of vibration and the occurrence of LBP [9, 26]. Vibration might be regarded as a significant contributing cause to the occurrence of LBP.

4.1 Limitations

The limitations of our study are that the data were collected from the driver population in a specific region in southeastern Turkey. Therefore, multi-component, comprehensive studies are needed to further explore the prevalence and risk factors of LBP in drivers.

5 Conclusions

This study showed that LBP was common among drivers in a city in Southeast Turkey. Furthermore, LBP was significantly higher in drivers who work under bad road conditions, are dissatisfied with their lives, are not physically active, are negatively affected by the physical-psychological workload, have a chronic disease, and are exposed to prolonged vibration, with bad socioeconomic status, sleep disorders, and an LBP history in their family.

Following these results, to reduce the risk of LBP, we recommend drivers increase physical activity and stress management, provide ergonomic arrangements in the working environment, and provide training programs to increase knowledge and awareness for reducing occupational risks. Unfortunately, there were very few studies on this subject in Turkey. Further studies can raise awareness for this issue and develop an educational plan.

Ethical approval

This study obtained an ethics committee approval dated 14/02/2019, numbered 99. Furthermore, participants were informed about the study and agreed to participate voluntarily. Informed consent was obtained from all participants. This study was conducted per the Declaration of Helsinki.

Informed consent

Every participant involved in the study provided informed consent.

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Footnotes

Acknowledgments

We thank all the drivers who voluntarily participated in this study.

Funding

This research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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