Low back pain,work overload,and associated factors among hospital caregivers

Abstract

BACKGROUND:

Caregivers assist patients in treatment based on their care needs and living activities. Very few studies have been conducted specifically on the occupational health and safety of hospital caregivers.

OBJECTİVE:

This study aimed to investigate the prevalence of excessive workload and low back pain among hospital caregivers and to identify potential associated factors.

METHODS:

This cross-sectional study included caregivers working at Gazi University Hospital. Socio-demographic and working-life characteristics were assessed. The Role Overload Scale was used to determine excessive workload and the Roland-Morris Disability Questionnaire was used to evaluate low back pain.

RESULTS:

The study included 528 participants. A total of 18.7% had work accidents in their department. 49.0% had sharp injuries. 68.9% of the participants performed tasks such as positioning, turning, lifting, or helping patients to walk. 72.2% stood for a long time during the workday. 52.8% thought that they worked under stress. 57.6% had low back pain in the last year and 38.6% in the last month, Significant differences exist in low back pain according to gender, body-mass index, standing for a long time and working under stress. Those who worked at night, had a work accident, positioned patients, stood for a long time, and worked under stress had higher mean scores on the Role Overload Scale.

CONCLUSION:

Tools should be used to lift and transport patients. In addition to occupational health and safety training, awareness of musculoskeletal risks should be increased. Employee well-being can be improved through exercise and stress reduction techniques.

Keywords

Caregivers health personnel low back pain workload occupational accidents wounds and injuries

1 Introduction

The concept of workload has been around for many years, and experts have proposed different definitions. According to one of these definitions, workload is the amount of work a person has to do, while excessive workload is a concept related to employees who have too many tasks to do [1]. The increased responsibilities per person and the need to do more work than employees can cope with are the basis of excessive workload [2]. Physical and mental disorders can be observed in workers exposed to excessive workloads. Stress, fatigue, headaches, irritability, and digestive disorders may occur, affecting motivation to work. Work-related accidents may increase due to distraction and inability to do the job properly [3–4]. In recent years, excessive workload has emerged as one of the risk factors for low back pain [5].

80% of people experience low back pain at some point [6]. Low back pain is one of the most common health problems among workers and a significant cause of disability and absenteeism [7]. Worldwide, it is estimated that 37% of cases of low back pain are work-related [8]. Every year, 25–50% of the working population report low back pain [9]. Physically demanding work, frequent bending and twisting, poor posture, mechanical pressure, heavy lifting, and job dissatisfaction are among the risk factors for low back pain [10]. Long working hours, physical inactivity, and psychological problems are some of the reasons for chronic low back pain [11].

Healthcare workers are an occupational group frequently exposed to risk factors associated with low back pain [12]. In European countries and the United States, low back pain is one of the most common and costly health problems among healthcare workers [13]. Caregivers are among the occupational groups with the highest incidence of work-related musculoskeletal disorders. The prevalence of low back pain in caregiving staff is relatively high, and they are more likely to claim compensation for problems caused by low back pain [14]. Risk factors for low back pain in healthcare workers include physical strain from manual lifting and moving patients, working night shifts, rest periods, and working environment conditions [15].

Caregivers in Turkey do not perform any procedures for the treatment process of patients. They fulfill the daily care requirements of people in need of treatment and help them in their life activities under the responsibility of the nurses. While there are many studies on the evaluation of other healthcare professionals working in hospitals, there has been a scarcity of studies specifically focused on the occupational health and safety of hospital caregivers, and more studies are needed. This study aimed to investigate the prevalence of low back pain due to excessive workload among caregivers in a university hospital and to determine the factors affecting this relationship. Our findings will help improve the working conditions of caregivers.

2 Materials and methods

2.1 Study design

This cross-sectional study was conducted at Gazi University Hospital. This hospital is one of the institutions providing qualified health services in Turkey. It is one of the essential health institutions in the country with regards to modern medical education. The population of the study is 541 caregivers working in this hospital. The sample size was calculated as 625 people with a 5% margin of error, 95% confidence interval and a neck pain prevalence of 37.9% in Turkey’s adult population [16].

2.2 Participants

Caregivers with a history of pregnancy, trauma, anatomical disorders, neurologic deficits and rheumatic diseases in the past year, and caregivers with a tenure of less than one month were excluded. All remaining caregivers were included in the study. No sampling was done, and the aim was to reach all caregivers who met the inclusion criteria. The questionnaires were administered to the participants by the researcher during the periodic health examinations. The average time for answering a questionnaire was 15 minutes. The study was conducted with 528 people. The access rate was 84.5%.

2.3 Measurement

The questionnaire used for data collection consists of three sections and 55 questions. The first section contains questions to determine the participants’ socio-demographic information and working-life characteristics. The second section contains the Role Overload Scale; the third contains questions about low back pain and the Roland-Morris Disability Questionnaire. Gender, age, marital status, level of education, body mass index, smoking, presence of chronic diseases, working unit, working duration, occupational accidents, ergonomic risk factors, excessive workload, low back pain, and related disability levels were analyzed in the study.

The Role Overload Scale was developed by Peterson et al. in 1995 to measure levels of work overload. The scale has one dimension and 11 items. It has a 5-point Likert scale ranging from ‘1: strongly disagree’ to ‘5: strongly agree’. One item is reverse scored. A high score on the scale indicates the presence of excessive workload. Derya adapted it into Turkish in 2008; its validity and reliability have been proven and used in many studies [17].

The Roland-Morris Disability Questionnaire was developed by Roland and Morris in 1983. It is a 24-item questionnaire that assesses the degree of physical ability and functional limitation in patients with low back pain. Each item is answered yes/no. A score of 1 is given for yes and 0 for no, and all scores are summed. High scores indicate severe disability and inadequate physical activity. The validity and reliability in Turkey were established by Küçükdeveci et al. in 2001 [18].

2.4 Statistical analysis

The research data was analyzed using the Statistical Package for the Social Sciences. Categorical variables were presented as numbers and percentages; numerical variables were presented as means, standard deviations, and medians. Pearson’s chi-squared test, Fisher’s exact test, and Yates’ correction were used to compare categorical variables. The Kolmogorov-Smirnov test was used to determine the normal distribution. As it was found that the variables did not show a normal distribution, they were evaluated with the Mann-Whitney U test.

3 Results

528 caregivers participated in the study. The mean age of the participants was 39.36±11.35 years (min: 19-max: 65). The participants had worked in the hospital for a mean of 12.73±8.90 years (max: 38) and in their current department for a mean of 7.70±7.65 years (max: 37). The mean body mass index was 26.95±4.66 (min: 15.82-max: 44.12).

Table 1 shows the distribution of some descriptive characteristics of the participants.

Table 1
Descriptive characteristics of the participants, ankara, 2022

Number (n) Percentage (%)

Gender (n = 528)

Female 176 33.3

Male 352 66.7

Age (n = 528)

under 30 years old 124 23.5

30–39 years old 93 17.6

40–49 years old 205 38.8

50 years and above 106 20.1

Marital status (n = 528)

Married 351 66.5

Single 143 27.1

Divorced/Widow 34 6.4

Graduation status (n = 528)

Primary school 59 11.2

Secondary school 97 18.4

High school 329 62.3

Junior college 34 6.4

College 9 1.7

Smoking (n = 528)

Yes 271 51.3

No 257 48.7

Chronic diseases (n = 528)

Yes 147 27.8

No 381 72.2

Body mass index (n = 528)

Weak 12 2,3

Normal 167 31.6

Pre-obese 215 40.7

Obese 134 25.4

Working time in the hospital (n = 528)

< 1 year 51 9.7

1–5 years 92 17.4

6–10 years 64 12.1

11–15 years 106 20.1

16–20 years 92 17.4

21–25 years 91 17.2

> 25 years 32 6.1

Working department in the hospital (n = 528)

Service 227 43.0

Intensive care 108 20.5

Outpatient clinic 53 10.0

Operating room 43 8.1

Administrative unit 28 5.3

Emergency room 25 4.7

Laboratory/imaging 21 4.0

Sterilization 12 2,3

Other^* 11th 2.1

Working time in the department (n = 528)

< 1 year 87 16.5

1–5 years 170 32.2

6–10 years 106 20.1

11–15 years 76 14.4

> 15 years 89 16.9

Night work (n = 528)

Yes 251 47.5

No 277 52.5

	Number (n)	Percentage (%)
Gender (n = 528)
Female	176	33.3
Male	352	66.7
Age (n = 528)
under 30 years old	124	23.5
30–39 years old	93	17.6
40–49 years old	205	38.8
50 years and above	106	20.1
Marital status (n = 528)
Married	351	66.5
Single	143	27.1
Divorced/Widow	34	6.4
Graduation status (n = 528)
Primary school	59	11.2
Secondary school	97	18.4
High school	329	62.3
Junior college	34	6.4
College	9	1.7
Smoking (n = 528)
Yes	271	51.3
No	257	48.7
Chronic diseases (n = 528)
Yes	147	27.8
No	381	72.2
Body mass index (n = 528)
Weak	12	2,3
Normal	167	31.6
Pre-obese	215	40.7
Obese	134	25.4
Working time in the hospital (n = 528)
< 1 year	51	9.7
1–5 years	92	17.4
6–10 years	64	12.1
11–15 years	106	20.1
16–20 years	92	17.4
21–25 years	91	17.2
> 25 years	32	6.1
Working department in the hospital (n = 528)
Service	227	43.0
Intensive care	108	20.5
Outpatient clinic	53	10.0
Operating room	43	8.1
Administrative unit	28	5.3
Emergency room	25	4.7
Laboratory/imaging	21	4.0
Sterilization	12	2,3
Other^*	11th	2.1
Working time in the department (n = 528)
< 1 year	87	16.5
1–5 years	170	32.2
6–10 years	106	20.1
11–15 years	76	14.4
> 15 years	89	16.9
Night work (n = 528)
Yes	251	47.5
No	277	52.5

^*Other: Pharmacy, blood center, information desk.

66.7% of participants were male. 38.8% were aged between 40 and 49 years. 66.5% were married. 62.3% were high school graduates. 51.3% were smokers. 27.8% had a chronic disease. According to body mass index, 25.4% of the participants were obese. The length of service in the hospital was≤10 years in 39.2%. 43.0% of the participants worked on the wards. 47.5% also worked nights. The length of service in the currently working unit was≤5 years for 48.7%.

Table 2 shows the characteristics of the participants in occupational accidents, the frequency of low back pain, and the distribution of related risk factors.

Table 2

Participants’ statements related to occupational accidents, low back pain, and associated risk factors, ankara, 2022

	Number (n)	Percentage (%)
Possibility of having a work accident (n = 528)
None	57	10.8
Low	160	30.3
Middle	191	36.2
High	120	22.7
Having a work accident (n = 528)
Yes	104	18.7
No	424	80.3
Type of work accident (n = 104)
Sharps injuries	51	49.0
Slip, trip, or fall	31	29.8
Food poisoning	18	17.3
Contact with blood or body fluids	12	11.5
Other*	8	7.7
Performing tasks such as positioning, turning, lifting,
and helping patients (n = 528)
Yes	364	68.9
No	164	31.1
Standing for long time (n = 528)
Yes	381	72.2
No	147	27.8
Working under stress (n = 528)
Yes	279	52.8
No	249	47.2
Roland-Morris disability index (n = 120)
Very low	29	24.2
Low	28	23.3
Average	39	32.5
High	22	18.3
Very high	2	1.7
Low back pain in the last 12 months (n = 528)
Yes	304	57.6
No	224	42.4
Low back pain in the last month (n = 528)
Yes	204	38.6
No	324	61.4
Low back pain in the last 24 hours (n = 528)
Yes	120	22.7
No	408	77.3

^*Other: Violence, chemical exposure, burning.

The likelihood of having an occupational accident on their job was considered medium by 36.2% and high by 22.7% of the participants. 18.7% of the participants had an occupational accident in their department. Of the accidents, 49.0% were caused by cutting or piercing tools, and 29.8% were caused by slipping, tripping, or falling. 68.9% of participants performed tasks such as positioning, turning, lifting, or assisting patients to walk. 72.2% had to stand for long periods. 52.8% believe they work under stress. According to the Roland-Morris Disability Scale, 32.5% of those who had low back pain in the last 24 hours had a moderate disability, 20.0% had a severe disability and 20.0% had a very severe disability. Of the participants, 57.6% had low back pain in the last 12 months, 38.6% in the last month and 22.7% in the last 24 hours.

Table 3 shows the distribution of low back pain prevalence according to some characteristics of the participants.

Table 3

Low back pain in the last 12 months, 1 month and 24 hours according to some characteristics of the participants, ankara, 2022

	Low back pain in the				Low back pain in the				Low back pain in the
	last 12 months				last 1 month				last 24 hours
	Yes		No		Yes		No		Yes		No
	(%)	(n)	(%)	(n)	(%)	(n)	(%)	(n)	(%)	(n)	(%)	(n)
Gender (n = 528)
Female (n = 176)	67.0	118	33.0	58	49.4	87	50.6	89	30.7	54	69.3	122
Male (n = 352)	52.8	186	47.2	166	33.5	118	66.5	234	18.7	66	81.3	286
	p = 0.002				p < 0.001				p = 0.002
Age (n = 528)
Under 40 years old (n = 217)	54.4	118	45.6	99	34.6	75	65.4	142	18.4	40	81.6	177
40 years and above (n = 311)	59.8	186	40.2	125	41.8	130	58.2	181	25.7	80	74.3	231
	p = 0.214				p = 0.093				p = 0.049
Body mass index (n = 528)
Not overweight (n = 179)	49.7	89	50.3	90	31.3	56	68.7	123	16.8	30	83.2	149
Overweight (n = 349)	61.6	215	38.4	134	42.7	149	57.3	200	25.8	90	74.2	259
	p = 0.009				p = 0.011				p = 0.019
Night work (n = 528)
yes (n = 251)	60.2	151	39.8	100	39.4	99	60.6	152	21.9	55	78.1	196
None (n = 277)	55.2	153	44.8	124	38.3	106	61.7	171	23.5	65	76.5	212
	p = 0.253				p = 0.782				p = 0.671
Positioning patients (n = 528)
Yes (n = 364)	58.5	213	41.5	151	40.4	147	59.6	217	23.1	84	76.9	280
No (n = 164)	55.5	91	44.5	73	35.4	58	64.6	106	22.0	36	78.0	128
	p = 0.515				p = 0.247				p = 0.775
Standing for extended periods (n = 528)
Yes (n = 381)	60.6	231	39.4	150	42.0	160	58.0	221	25.2	96	74.8	285
No (n = 147)	49.7	73	50.3	74	30.6	45	69.4	102	16.3	24	83.7	123
	p = 0.019				p = 0.016				p = 0.029
Working under stress (n = 528)
Yes (n = 279)	66.7	186	33.3	93	49.8	139	50.2	140	31.5	88	68.5	191
No (n = 249)	47.4	118	52.6	131	26.5	66	73.5	183	12.9	32	87.1	217
	p < 0.001				p < 0.001				p < 0.001

67.0% of women, 52.8% of men; 61.6% of overweight participants, 49.7% of non-overweight participants; 60.6% of those who stand for a long time while working, and 49.7% of those who do not stand for a long time while working; 66.7% of those who work under stress and 47.4% of those who do not work under stress complained of low back pain in the last 12 months.

49.4% of women, 33.5% of men, 31.3% of non-overweight participants, 42.7% of overweight participants, 42.0% of those who stand for a long time while working, and 30.6% of those who do not stand for a long time while working; 49.8% of those who work under stress and 26.5% of those who do not work under stress, complained of low back pain in the last month.

30.7% of women, 18.7% of men, 16.8% of non-overweight participants, 25.8% of overweight participants, 25.2% of those who stand for a long time while working, and 16.3% of those who do not stand for a long time while working; 31.5% of those who work under stress and 12.9% of those who do not work under stress, complained of back pain in the last 24 hours.

There are statistically significant differences in low back pain complaints in the last 12 months, the last month, and the last 24 hours according to gender, body mass index, standing for a long time while working, and working under stress (p < 0.05).

Table 4 compares the Roland-Morris Disability Questionnaire and Overload Scale score averages according to some characteristics of the participants.

Table 4

Roland-morris disability questionnaire and role overload scale scores by some characteristics of the participants, ankara, 2022

		Roland-Morris Disability Questionnaire					Role Overload Scale
		M^*	SD^*	MRI^*	U^*	p ^*	M^*	SD^*	MRI^*	U^*	p ^*
Gender (n = 528)	Female (n = 176)	2.86	5.28	285.46	27287.0	0.002	29.85	7.72	271.53	29738.5	0.454
	Male (n = 352)	1.81	4.40	254.02			29.17	8,11	260.98
Age (n = 528)	40 years and above (n = 311)	2.53	5.00	272.67	31201.5	0.045	29.49	8.29	263.29	33482.0	0.879
	Under 40 years old (n = 217)	1.63	4.28	252.79			29,27	7.53	265.34
Graduation (n = 528)	Middle school and below (n = 156)	2.40	4.75	271.55	27915.5	0.348	30,35	7.91	283.01	26128.0	0.071
	High school and above (n = 372)	2.06	4.73	261.54			29.00	7.98	256.74
Body mass index (n = 528)	Overweight (n = 349)	2.56	5,10	272.03	28606.5	0.031	29.63	8.09	267.26	30272.0	0.561
	Not overweight (n = 179)	1.37	3.81	249.81			28.94	7.77	259.12
Chronic disease (n = 528)	Yes (n = 147)	3.07	5.74	277.34	26115.5	0.102	29,20	8.21	262.56	27718.0	0.856
	No (n = 381)	1.81	4.24	259.54			29.48	7.90	265.25
Night work (n = 528)	Yes (n = 251)	2.02	4.53	261.71	34062.0	0.585	31.15	7.42	300.26	25786.5	< 0.001
	No (n = 277)	2.29	4.91	267.03			27,18	8.15	232.09
Possibility of work accident (n = 528)	Medium/High (n = 311)	2.60	5.23	271.10	31435.5	0.082	31.78	7.37	312.45	18832.0	< 0.001
	None/Low (n = 217)	1.53	3.84	253.86			25.99	7.59	195.78
Having a work accident (n = 528)	Yes (n = 104)	3.63	5.91	291.06	19286.0	0.007	31.61	7.79	304.30	17909.0	0.003
	No (n = 414)	1.80	4.33	257.99			28.86	7.94	254.74
Positioning patients (n = 528)	Yes (n = 364)	2.15	4.74	265.89	29343.5	0.672	30.98	7.62	295.27	18649.5	< 0.001
	No (n = 164)	2.18	4.73	261.42			25.90	7.65	196.22
Standing for long time (n = 528)	Yes (n = 381)	2.41	4.94	268.47	26489.5	0.189	30.87	7.61	293.94	16786.0	< 0.001
	No (n = 147)	1.51	4.08	254.20			25.60	7.67	188.19
Working under stress (n = 528)	Yes (n = 279)	3.12	5.44	284.42	29176.5	< 0.001	32.88	7.63	331.92	15926.0	< 0.001
	No (n = 249)	1.09	3.50	242.17			25.50	6.41	188.96
Low back pain in the last 12 months (n = 528)	Yes (n = 304)						31.01	8.38	296.44	24338.5	< 0.001
	No (n = 224)						27,21	6.83	221.15
Low back pain in the last 1 month (n = 528)	Yes (n = 204)						32.21	8.48	317.34	22276.0	< 0.001
	No (n = 324)						27.62	7.10	230.97
Low back pain in the last 24 hours (n = 528)	Yes (n = 120)						32.93	8.87	327.58	16910.0	< 0.001
	No (n = 408)						28.36	7.39	245.95

*M: Average; SD: Standard deviation; MR: Rank average; U: Mann-Whitney U value.

Women (2.86±5.28), ≥40-year-olds (2.53±5.50), overweight participants (2.56±5.10), those who had a work accident in the unit they worked (3.63±5.91), and those who work under stress (3.12±5.44) had higher mean scores on the Roland-Morris Disability Questionnaire.

Those who work at night (31.15±7.42), those who evaluated the probability of having a work accident in their profession as medium/high (31.78±7.37), those who had a work accident (31.61±7.79) in the unit they worked, those who perform practices such as positioning, turning, lifting or helping patients to walk (30.98±7.62), those who stand for a long time while working (30.87±7.61), those who work under stress (32.88±7.63), those who had low back pain in the last 12 months (31.01±8.38), those who had low back pain in the last one month (32.21±8.48), and those who had low back pain in the last 24 hours (32.93±8.87) had higher mean scores on the Role Overload Scale. The differences were statistically significant (p < 0.05).

Table 5 shows the probability and the situation of having a work accident according to some characteristics of the participants.

Table 5

Possibility and current situation of having a work accident according to some characteristics of the participants, ankara, 2022

	Possibility of having a work accident				Having a work accident
	none/low		medium/high		Yes		No
	(%)	(n)	(%)	(n)	(%)	(n)	(%)	(n)
Gender (n = 528)
Female (n = 176)	37.5	66	62.5	110	23.3	41	76.7	135
Male (n = 352)	42.9	151	57.1	20	17.9	63	82.1	289
	p = 0.235				p = 0.142
Age (n = 528)
Under 40 years old (n = 217)	34.6	75	65.4	142	18.4	40	81.6	177
40 years and above (n = 311)	45.7	142	54.3	169	20.6	64	79.4	247
	p = 0.011				p = 0.542
Body mass index (n = 528)
Not overweight (n = 179)	40.8	73	59.2	106	14.5	26	85.5	153
Overweight (n = 349)	41.3	144	58.7	205	22.3	78	77.7	271
	p = 0.916				p = 0.032
Night work (n = 528)
Yes (n = 251)	35.1	88	64.9	163	23.5	59	76.5	192
No (n = 277)	46.6	129	53.4	148	16.2	45	83.8	232
	p = 0.007				p = 0.036
Positioning patients (n = 528)
Yes (n = 364)	32.7	119	67.3	245	22.5	82	77.5	282
No (n = 164)	59.8	98	40.2	66	13.4	22	86.6	142
	p < 0.001				p = 0.015
Standing for extended periods (n = 528)
Yes (n = 381)	32.8	125	67.2	256	21.3	81	78.7	300
No (n = 147)	62.6	92	37.4	55	15.6	23	84.4	124
	p < 0.001				p = 0.146
Working under stress (n = 528)
Yes (n = 279)	28.3	79	71.7	200	23.3	65	76.7	214
No (n = 249)	55.4	138	44.6	111	15.7	39	84.3	210
	p < 0.001				p = 0.028

65.4% of < 40-year-olds, 54.3% of≥40-year-olds, 64.9% of those who work at night, 53.4% of those who do not work at night; 67.3% of those who perform practices such as positioning, turning, lifting or helping patients walk, and 40.2% of those who do not perform practices such as these; 67.2% of those who stand for a long time while working, 37.4% of those who do not stand for a long time while working; 71.7% of those who work under stress and 44.6% of those who do not work under stress, thought that the probability of having a work accident in their profession is medium/high. There was a statistically significant difference in the probability of having a work accident according to age, working at night, positioning patients, standing for long periods while working, and working under stress (p < 0.05).

Of the 14.5% of non-overweight participants and 22.3% of overweight participants; 23.5% of those who work at night; 16.2% of those who do not work at night; 22.5% of those who perform practices such as positioning, turning, lifting or helping patients walk, and 13.4% of those who do not perform practices such like these; 23.3% of those who work under stress and 15.7% of those who do not work under stress had a work accident in the unit they worked. There was a statistically significant difference in body mass index, night work, positioning patients, and working under stress (p < 0.05).

4 Discussion

This study obtained some descriptive characteristics of the participants, their occupational injury status, the prevalence of excessive workload and low back pain, and the factors affecting them in caregiving staff.

Smoking is thought to be one of the causes of low back pain. Half of the caregivers in this study were smokers. One-fifth of healthcare workers were smokers in a meta-analysis conducted in 63 countries [19]. In a study investigating change in smoking among healthcare workers in Greece, three-fifths of participants were smokers before the COVID-19 pandemic [20]. Although the smoking prevalence in our study was considerably higher than worldwide among healthcare workers, the study results in Greece were similar with ours. This is because smoking varies between countries with different socioeconomic and cultural conditions. In Turkey, two-fifths of people aged 25–55 smoke [21]. Although the predominance of men among our participants was also a factor, the smoking prevalence of our participants is higher than it should be in the same age group of the Turkish population. It may be due to the intense and stressful working conditions in healthcare in general. In addition, these results show that caregivers in Turkey have a long way to go in terms of education and awareness of the health hazards of smoking.

Obesity is one of the common risk factors for low back pain. In this study, two-fifths of participants were pre-obese, and a quarter were obese. A study in a university hospital in Belgium found that one-third of caregiving staff were pre-obese, one-fifth were obese, and pre-obesity and obesity were more common than in all other healthcare workers [22]. One-third of all nurses in England were found to be pre-obese, and a quarter were obese [23]. In Malaysia, one-third of health workers were pre-obese and one-fifth obese [24]. In Scotland, seven out of ten nurses were found to be overweight or obese, and obesity was found to be significantly higher in nurses compared to all other occupational groups in the healthcare services [25]. In a study conducted among nurses in Turkey, more than half of the study group were overweight or obese [26]. It is seen that the prevalence of obesity in caregiving staff varies among studies in the literature. In the Turkish population, two-fifths of those aged 31–50 are pre-obese, and three-tenths are obese [27]. The majority of caregivers working in the hospital where our study was conducted were in this age group, and the prevalence of overweight and obesity was found to be similar to the population. Considering that the participants’ height and body weight results are based on their statements and that people tend to overestimate their height and underestimate their weight, it is evident that these results are alarming regarding public health. Differences in the prevalence of pre-obesity and obesity among healthcare workers providing patient care services in different countries may be due to diversity in dietary habits, physical activity levels, working conditions, economic status, and socio-cultural factors between societies.

Almost one-fifth of the caregivers in our study said they had an occupational injury, and more than one-fifth said they were likely to have it. Sharp injuries occurred in half of the participants and slipping, tripping or falling accidents in one-third of the participants. Some results suggest that many caregivers had occupational accidents and consider themselves in the high-risk group for occupational accidents [28–30]. According to a study conducted in Turkey, among healthcare workers, more than half of those who had occupational injuries had sharp injuries [31]. In a retrospective analysis of sharp injuries among healthcare workers in Turkey, nurses constituted the majority of the applicants to the Infection Control Committee with a frequency of close to two-fifths, followed by caregivers and cleaners with a frequency of more than one-fifth [32]. Sharp injuries are an issue of concern because of blood-borne infectious diseases. Although they do not carry out interventional procedures like doctors and nurses, a significant proportion of caregivers who had occupational accidents reported that they had experienced sharp injuries. Factors such as an irregular working environment, lack of training and awareness, excessive workload, and fast-paced working conditions may have led to sharp injuries in caregivers.

In our study, 58% of the participants had back pain in the last 12 months, 39% in the last month, and 23% in the last 24 hours. In a study conducted among patient care workers in hospitals in the United States, two-thirds of the employees had low back pain in the last three months [33]. In a study by Terzi et al., approximately three-fifths of the participants complained of low back pain in the last year [34]. In a study by Karaca et al., 65% of operating room and intensive care personnel had back pain in the last year, 53% in the last month, and 30% in the last day [35]. In different studies on caregivers and nurses, it was found that more than half of the participants complained of low back pain [36–38]. Prolonged working in an uncomfortable posture, working in the same posture for an extended period, exerting great force on tools, often bending and twisting the trunk, causing work-related musculoskeletal diseases [39]. The fact that caregivers are constantly exposed to ergonomic risk factors such as heavy lifting and standing for long periods may be the reason for low back pain. Working department and patient group are also associated with the frequency of low back pain. Although low back pain has a multifactorial etiology, the high prevalence may indicate inadequate ergonomic arrangements in hospitals.

Two-thirds of the women and half of the men in the study complained of low back pain in the last 12 months. There was a significant difference between genders in terms of the presence of low back pain in the last 12 months. In a study conducted in Turkey, it was found that pain intensity was higher in females [40]. In a study conducted in Saudi Arabia, the prevalence of low back pain among nurses was significantly higher in women than in men [41]. According to a meta-analysis study conducted on Iranian nurses, there was a high frequency of low back pain, especially in female nurses [42]. A study conducted on nurses in Ethiopia concluded that females affected the development of lower back pain [43]. Pain is a subjective concept. Extensive research investigating the difference in pain threshold between the genders may help to explain the higher prevalence of low back pain in women. In addition to the structural, anatomical, and physiological differences in the bodies of men and women, low back pain may be more common in women due to the workload of female employees regarding housework.

In this study, half of non-overweight people and three-fifths of overweight and obese people reported low back pain in the past 12 months. The difference was statistically significant. A meta-analysis study analyzing low back pain and risk factors found that half of the healthcare workers had low back pain and that body mass index was one of the risk factors [44]. In a field study conducted in Turkey to determine the prevalence of low back pain and the factors affecting it, it was found that an increase in body mass index increased the incidence of low back pain [45]. A study of nurses working in a university hospital in Portugal concluded that overweight and obesity, found in two-thirds of participants with low back pain, may contribute to the chronicity of low back pain [46]. Obesity can lead to increased adipose tissue in the abdominal region. Excess fat can put pressure on the muscles around the waist and spine. It can cause pain and discomfort in the lumbar region.

In this study, 66.7% of the participants work under stress and 47.4% of those do not complain of low back pain in the last 12 months. The difference was statistically significant. In a cohort study in Belgium investigating the relationship between low back pain and stress, causality was found between low back pain and stress [47]. Studies conducted among nurses in Slovenia and Yemen revealed that workplace stress was significantly associated with the prevalence of low back pain [48–49]. According to a study of caregivers in Japan, addressing subjective psychological stress is essential to reducing chronic low back pain [50]. In a study conducted on healthcare personnel in Turkey, seven out of ten of those with low back pain thought they were working in a highly stressful job, while this frequency was four out of ten among those without low back pain [51]. Stress can cause low back pain by tightening the muscles or can trigger low back pain by causing hormonal changes. Also, stress can cause people to feel more discomfort and perceive problems such as lower back pain more intensely.

Among the participating caregivers, those who had work accidents in the unit where they worked had higher mean scores on the Excessive Workload Scale than those who had no work accidents. The difference was significant. Various studies conducted among nurses in Iran found a significant positive correlation between psychological workload and occupational accidents [52–54]. In a study conducted in Ghana among healthcare workers who had suffered work-related accidents, almost half of the participants reported excessive workload as the cause of their work-related accidents [55]. A study conducted in Turkey concluded that heavy working conditions increased the number of occupational accidents among nurses [56]. It is thought that excessive workload may increase the risk of occupational accidents by causing physical fatigue, psychological stress, time pressure, and lack of attention in caregivers. In addition, overburdened workers may not follow training or instructions correctly. Workers with excessive workloads may be forced to make quick decisions. This can lead to risky situations by overthinking and overlooking details.

This is a cross-sectional study, so the strength of causality is low. A limitation of the study is the fact that people themselves reported height and weight. Associated results may be biased. It did also not examine physical activity, which is one of the risk factors for low back pain. However, to our knowledge, our study is the most widely participated study conducted on caregivers working in hospitals. We reached all caregivers working in the determined hospital and investigated the prevalence of low back pain and excessive workload, significant problems among them, and identified factors that may be associated. Our results will be guiding for future studies.

5 Conclusion

Daily, monthly, and yearly, low back pain prevalence was high among the caregivers in our study. It was observed that a significant proportion of the workers stood for long periods during the day, performed tasks such as positioning, turning, lifting, and walking patients, worked under excessive workloads and stress, and had a significant number of accidents at work.

Technological devices for lifting and transporting patients, rapidly becoming more widespread worldwide, should be ensured to eliminate these problems for caregivers. Workers’ awareness of the risk factors for musculoskeletal disorders should be increased. Occupational health and safety training will help teach correct body mechanics and posture and minimize errors under challenging movements. Such training should also inform caregivers how to prevent workplace accidents and recognize hazards. Hospitals should conduct regular risk assessments to reduce workplace accidents, provide appropriate personal protective equipment, and encourage regular use. Where caregiving staff work standing for long periods, they should take regular breaks and rest often. Short exercises that strengthen the lower back muscles during these breaks can reduce back pain. Activities that improve flexibility and balance, such as Pilates, can be beneficial. Yoga and meditation can help reduce work stress. One solution to reduce excessive workload and stress is to consider increasing the number of staff within certain limits. As the occupational health units recommended, employees with serious health problems should be transferred to jobs with lower ergonomic risks. It should be remembered that all this is possible with administrative arrangements, and hospital administrations have a critical duty in this respect.

Footnotes

Ethical approval

The study was approved by the Gazi University Ethics Committee on 22/02/2022 (approval number E-77082166-604.01.02-302278). Data was collected in March 2022.

Informed consent

Informed consent was obtained from all participants, in accordance with institutional guidelines, prior to their participation in the study.

Conflict of interest

The authors have no conflict of interest to report.

Acknowledgments

None to report.

Funding

The authors did not receive funding, grants, or support from any organization for the submitted work.

References

Ahmad

, Lee

, Othman

ABA

, Shaminan

, Heng

, Sumilan

, et al.The Impact of Workload on Job Performance among Doctors in Malaysian Public Hospitals. A Case Study. International Journal of Business and Society. 2019;20(3):1276–93.

Karasek

. Job demands, job decision latitude, and mental strain: Implications for job redesign. Administrative Science Quarterly. 1979;24(2):285–308.

Aryee

, Srinivas

, Tan

. Rhythms of life: Antecedents and outcomes of work–family balance in employed parents, Journal of Applied Psychology. 2005;90(1):132–46.

Hidayat

, Situmorang

. Analysis Of The Effect Of Work Loads On Employee Performance Of The Production Operator In Pem Plant Pt. Schneider Electric Manufacturing Batam. Advances in Social Science, Education and Humanities Research. 2019;377, 220–6.

Kalantari

, Arghami

, Ahmadi

, Garosi

, Farahani

. Relationship between workload and low back pain in assembly line workers, Journal of Kermanshah University of Medical Science. 2016;20(1):26–9.

The Burden of Musculoskeletal Conditions at the Start of the New Millennium. World Health Organization. Geneva, 2003.

El-Shafei

, Bolbol

, Nassar

. Low Back Pain among Workers in Offshore Oil Industry, Central European Journal of Occupational and Environmental Medicine. 2017;23(3-4):216–29.

Bryndal

, Glowinski

, Grochulska

. Influence of Occupation on the Prevalence of Spinal Pain among Physiotherapists and Nurses, Journal of Clinical Medicine. 2022;11(19):5600.

Kabataş

, Kocuk

, Küçükler

. Evaluation of Frequency and Factors Affecting Low Back Pain in Health Care Workers, Fırat University Medical Journal of Health Sciences. 2012;26(2):65–72. [Article in Turkish]

10.

Laštovková

, Nakládalová

, Fenclová

, Urban

, Gad’ourek

, Lebeda

et all.Low-Back Paın Dısorders As Occupatıonal Dıseases In The Czech Republıc And 22 European Countrıes: Comparıson Of Natıonal Systems, Related Dıagnoses And Evaluatıon Crıterıa. Central European Journal of Public Health. 2015;23(3):244–51.

11.

Helfenstein

Junior M

, Goldenfum

, Siena

. Occupational Low Back Pain. Revista da Associação Médica Brasileira. 2010;56(5):583–9.

12.

Özen

, Çakmak

. Prevalence of Chronic Low Back Pain and Associated Risk Factors in Healthcare Workers during the Covid-19 Pandemic. COJ Nursing & Healthcare. 2021;7(5):810–8.

13.

Almaghrabi

, Alsharif

. Prevalence of Low Back Pain and Associated Risk Factors among Nurses at King Abdulaziz University Hospital. International Journal of Environmental Research and Public Health. 2021;18(4):1567.

14.

Kamioka

, Okuizumi

, Okada

, Takahashi

, Handa

, Kitayuguchi

, et al.Effectiveness of intervention for low back pain in female caregivers in nursing homes: A pilot trial based on multicenter randomization. Environmental Health Preventive Medicine. 2011;16(2):97–105.

15.

Fujimura

, Yasuda

, Ohara

. Work-Related Factors Of Low Back Pain Among Nursing Aides İn Nursing Homes For The Elderly. Journal of Occupational Health. 1995;37(2):89–98.

16.

Eti

Aslan F

, Çınar

. Prevalence of pain in adult population in Turkey. Pain. 2023;35(2):83–95.

17.

Derya

. Crossover of work-family conflict: Antecedent and consequences of crossover process in dual-earner couples. Master’s Thesis. Koç University Graduate School of Social Sciences. 2008, İstanbul.

18.

Küçükdeveci

, Tennant

, Elhan

, Niyazoglu

. Validation of the Turkish version of the Roland-Morris Disability Questionnaire for use in low back pain. Spine (Phila Pa 1976). 2001;26(24):2738–43.

19.

Nilan

, McKeever

, McNeill

, Raw

, Murray

. Prevalence of tobacco use in healthcare workers: A systematic review and meta-analysis. PloS one. 2019;14(7):e0220168.

20.

Papakala

, Zarogiannis

, Hatzoglou

. Change in smoking behavior and burnout syndrome among healthcare workers during the COVID-19 pandemic. Pneumon. 2023;36(4):33.

21.

Health Statistics Yearbook 2020. The Ministry of Health of Turkey. Ankara, 2022.

22.

Fraeyman

, De Bacquer

, Fiers

, Godderis

, Verhaeghe

, Eeckloo

, et al.Body mass index and occupational accidents among health care workers in a large university hospital. Acta Clinica Belgica. 2022;78(2):128–34.

23.

Kyle

, Wills

, Mahoney

, Hoyle

, Kelly

, Atherton

. Obesity prevalence among healthcare professionals in England: A cross-sectional study using the Health Survey for England. 2017;7(12):e018498.

24.

Kunyahamu

, Daud

, Jusoh

. Obesity among Health-Care Workers: Which Occupations Are at Higher Risk of Being Obese?International Journal of Environmental Research and Public Health. 2021;18(8):4381.

25.

Kyle

, Neall

, Atherton

. Prevalence of overweight and obesity among nurses in Scotland: A cross-sectional study using the Scottish Health Survey. International Journal of Nursing Studies. 2016;53, 126–33.

26.

Fırıncı

, Pehlivan

, Durmuş

, Ali

. Lumbar Pain and Evaluated Life Quality in Patient Caregivers-Sample of Turgut Özal Medicine Center. Sakarya Medical Journal.292-302. [Article in Turkish]. 2018;8(2).

27.

Health Statistics Yearbook 2021. The Ministry of Health of Turkey. Ankara, 2023.

28.

Kaya

ŞD

, Arık

. The Evaluation of the Level of Experiencing Occupational Accidents among Housekeeping and Caregiving Personnel of a University Hospital. Journal of Continuing Medical Education.195-207. [Article in Turkish]. 2017;26(5).

29.

Yeşiltaş

, Gül

. Examınatıon of Occupational Safety Levels of Healthcare Professionals: A University Hospital Case. Nobel Medicus Journal. 2021;17(2):118–26. [Article in Turkish]

30.

Mahto

, Gautam

, Joshi

. Occupational injuries sustained by caregivers in geriatric care homes of Kathmandu valley. International Journal of Occupational Safety and Health. 2019;9(1):3–7.

31.

Uçak

, Kiper

, Karabekir

. Occupational Accidents Faced by Health Workers and the Effect of Training on Reducing Occupational Accidents. Bozok Medical Journal. 2011;1(3):7–15. [Article in Turkish]

32.

Harman-Günerken

. Evaluation of sharps injuries of health professionals working in a tertiary care hospital during a five-year period. Klimik Journal. 2023;36(1):27–31. [Article in Turkish]

33.

Reme

, Dennerlein

, Hashimoto

, Sorensen

. Musculoskeletal pain and psychological distress in hospital patient care workers. Journal of Occupational Rehabilitation. 2012;22(4):503–10.

34.

Terzi

, Altın

. The prevalence of low back pain in hospital staff and its relationship with chronic fatigue syndrome and occupational factors. Pain. 2015;27(3):149–54. [Article in Turkish].

35.

Karaca

ŞB

, Aydın

. Musculoskeletal Pain Among Intensive Care Unit and Operating Room Staff. Medical Journal of Ankara Training and Research Hospital. 2019;52(3):196–200. [Article in Turkish]

36.

, Deng

, Zhang

, Yang

, Chen

, Hou

, et al.A Cross-Sectional Survey of Low Back Pain in Nurses Working in Orthopedic Departments. Workplace Health and Safety. 2019;67(5):218–30

37.

Duray

, Yağcı

. Determining the factors affecting muscoloskeletal pain of the allied health personnel at Pamukkale University Hospital. Pamukkale Medical Journal. 2017;10(2):144–51. [Article in Turkish]

38.

Tefera

, Zeleke

, Abate

, Abebe

, Mekonnen

, Sewale

. Magnitude and associated factors of low back pain among nurses working at intensive care unit of public hospitals in Amhara region, Ethiopia. PLoS ONE. 2021;16(12):e0260361.

39.

Tan

, Muniandy

, Vasanthi

. Prevalence Of Musculoskeletal Disorders And Associated Work-Related Risk Factors Among Pastry Chefs In Malacca, Malaysia. International Journal of Aging Health and Movement. 2021;3(2):20–30.

40.

Uyar

, Öztürk

, Duman

, Şahin

. Evaluation of Patient Caregivers’ Musculoskeletal System Health That Working in a Medical Faculty Hospital. Medical Records. 2020;2(2):20–7. [Article in Turkish]

41.

Keriri

. Prevalence and risk factors of low back pain among nurses in operating rooms, Taif, Saudi Arabia. American Journal of Research Communication. 2013;1(11):45–70.

42.

Azizpour

, Delpishes

, Montazeri

, Sayehmiri

. Prevalence of low back pain in Iranian nurses: A systematic review and meta-analysis. BMC Nursing. 2017;16, 50.

43.

Mijena

, Geda

, Dheresa

, Fage

. Low Back Pain Among Nurses Working at Public Hospitals in Eastern Ethiopia. Journal of Pain Research. 2020;13, 1349–57.

44.

Rezaei

, Mousavi

, Heshmati

, Asadi

. Low back pain and its related risk factors in health care providers at hospitals: A systematic review. Annals of Medicine and Surgery. 2021;70, 102903.

45.

Altınel

, Köse

KÇ

, Ergan

, Işık

, Aksoy

, Özdemir

, et al.The prevalence of low back pain and risk factors among adult population in Afyon region, Turkey. Acta Orthopaedica Traumatologica Turcica. 2008;42(5):328–33. [Article in Turkish]

46.

Henriques

, Sacadura-Leite

, Serranheira

. Low back pain among hospital nursing assistants. Revista Brasileira de Medicina do Trabalho. 2020;17(3):370–7.

47.

Clays

, De Bacquer

, Leynen

, Kornitzer

, Kittel

, De Backer

. The impact of psychosocial factors on low back pain: Longitudinal results from the Belstress study. Spine. 2007;32(2):262–8

48.

Skela-Savič

, Pesjak

, Hvalič-Touzery

. Low back pain among nurses in Slovenian hospitals: Cross-sectional study. International Nursing Review. 2017;64(4):544–51.

49.

Ghilan

, Al-Taiar

, Yousfi

, Zubaidi

, Awadh

, Al-Obeyed

. Low back pain among female nurses in Yemen. International Journal of Occupational Medicine and Environmental Health. 2013;26(4):605–14.

50.

Hasuo

, Shizuma

, Fukunaga

. Factors associated with chronic thoracic spine and low back pain in caregivers of cancer patients. Annals of Palliative Medicine. 2021;10(2):1224–36.

51.

Demirpolat

, Oğuzöncül

, Osman

. The Frequency of Low Back Pain and Factors Affecting Low Back Pain In Health Care Workers: A Cross-Sectional Study. Kocatepe Medical Journal. 2021;22(2):112–8. [Article in Turkish].

52.

Sarsangi

, Salehiniya

, Hannani

, Marzaleh

, Abadi

, Honarjoo

, et al.Assessment of workload effect on nursing occupational accidents in hospitals of Kashan, Iran. Biomedical Research and Therapy. 2017;4(8):1527–40.

53.

Samaei

, Vosoughi

, Taban

, Bagheri-Hosseinabadi

, Zia

, Beheshti

. The effect of mental workload on occupational accidents among nurses in hospitals of Kerman, Iran. International Journal of Hospital Research. 2017;6(4):63–75.

54.

Bagheri-Hosseinabadi

, Khanjani

, Etemadinezhad

, Samaei

, Raadabadi

, Mostafaee

. The associations of workload, individual and organisational factors on nurses’ occupational injuries. Journal of Clinical Nursing. 2019;28(5-6):902–11.

55.

Appiagyei

, Nakua

, Donkor

, Mock

. Occupational injuries among health care workers at a public hospital in Ghana. Pan African Medical Journal. 2021;39, 103.

56.

Çelikkalp

, Dilek

. Factors affecting the occupational accident rates among nurses. Revista da Escola de Enfermagem da USP.e. 2019;53, 03524.