title: Biopsychosocial factors are associated with low back pain in female nursing students: a cross-sectional study.
abstract: BACKGROUND
  Occupational low back pain is a significant problem among nurses. Recent literature suggests current occupational preventative strategies for nurses have not been effective. Given low back pain is already prevalent before commencing employment, nursing students should be the target of preventative interventions. Modifiable personal factors which contribute to low back pain have proven difficult to identify, but are thought to play an important role in the biopsychosocial nature of low back pain.
  
  
  OBJECTIVE
  To evaluate the contribution of personal biopsychosocial factors to low back pain in nursing students.
  
  
  METHODS
  Cross-sectional study comprising physical testing and questionnaires.
  
  
  METHODS
  Two university undergraduate nursing schools in Western Australia.
  
  
  METHODS
  170 female undergraduate nursing students.
  
  
  METHODS
  Low back pain and control subjects were compared across social, lifestyle (physical activity), psychological (stress, anxiety, depression, back pain beliefs, coping strategies and catastrophising) and physical (spinal postures and spinal kinematics in functional tasks, leg and back muscle endurance, spinal repositioning error and cardiovascular fitness) characteristics. Low back pain was considered as either "minor" or "significant" depending upon pain severity, duration, impact and level of disability.
  
  
  RESULTS
  Over 30% of all subjects (mean age 22.5+/-4.5 years) reported "significant" low back pain in the preceding 12 months. Univariate analysis: social measures did not distinguish between groups. Subjects with "significant" low back pain were more physically active (p=0.04), had higher stress scores (p=0.01) and used passive coping strategies (p<0.001) more than other subjects. "Significant" low back pain subjects held their lower lumbar spine in a more extended posture during transfers at bed height than other subjects. No differences between groups were found for sagittal spinal mobility, static spinal posture, muscle endurance, spinal repositioning error, cardiovascular fitness or other psychological measures. Multivariate analysis: regression analysis revealed stress, coping, physical activity, spinal kinematics, and age all contributed independently to the presence of low back pain, representing a significant 23% of variance.
  
  
  CONCLUSIONS
  Modifiable lifestyle, psychological and physical factors were independently associated with low back pain in nursing students. Targeting personal factors associated with low back pain in nursing students, rather than occupational factors in working nurses may help improve the impact of low back pain in nurses. Prospective studies are required to confirm the relevance of these findings for risk of future low back pain in nurses.
authors.affiliation: School of Physiotherapy, Curtin University of Technology, Perth, Western Australia, Australia. ditim@ozemail.com.au
authors.forename: Tim
authors.initials: T
authors.lastname: Mitchell
authors.forename: Peter B
authors.initials: PB
authors.lastname: O'Sullivan
authors.forename: Anne
authors.initials: A
authors.lastname: Smith
authors.forename: Angus F
authors.initials: AF
authors.lastname: Burnett
authors.forename: Leon
authors.initials: L
authors.lastname: Straker
authors.forename: Jenny
authors.initials: J
authors.lastname: Thornton
authors.forename: Cobie J
authors.initials: CJ
authors.lastname: Rudd
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000523:psychology*; D013338:Students, Nursing / Q000523:psychology*; D011795:Surveys and Questionnaires