PREVALENCE OF LOW BACK PAIN AND DISABILITY AMONG

PHYSIOTHERAPIST OF LAHORE,PAKISTAN

Submitted by
SANIA SAIFULLAH

In the partial fulfillment for the degree of

Doctor of Physical Therapy
SUPERVISOR : DR. RABIYA NOOR
BSPT, PPDPT,PHD*,PGD PE&TM

CO-SUPERVISORS : DR. SALMAN BASHIR

PHD -PT*, M.PHILL-PT, PP-DPT, BS-PT

BIOSTATICIAN : MR. KAMRAN HANIF
MS. APP. STATISTICS

University Institute of Physical Therapy (UIPT)

Faculty of Allied Health Sciences
THE UNIVERSITY OF LAHORE
(2012-2017)

1
 Title of the thesis:

The prevalence of low back pain and level of disability in physiotherapist of Lahore,

Pakistan.

Author's name: Sania Saifullah

Name of the degree: Doctor of Physical Therapy

Department of the author: University Institute of Physical therapy, the University of Lahore.

Session: 2012-2017

THE UNIVERSITY OF LAHORE

Faculty of Allied Health SciencesUniversity Institute of Physical Therapy (UIPT)

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 Supervisory Committee

We the supervisory Committee, certify that the contents and the form of thesis submitted by

Sania Saifulla have been found satisfactory and recommend it for the evaluation of the External

examiner for the award of degree of DPT.

Supervisor ________________________

Co-Supervisor ________________________

Member ________________________

HOD, University Institute of Physical Therapy ____________________

Dean Faculty of Allied Health Sciences ________________________

THE UNIVERSITY OF LAHORE

Faculty of Allied Health SciencesUniversity Institute of Physical Therapy (UIPT)

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 Examination Committee

The Thesis viva of DPT 02143271 was held on (2012-2017) at University Institute of Physical

Therapy, The University of Lahore. The Supervisory and Examination Committee gave

satisfactory remarks on the thesis and viva and were approved for the award of the degree of

DPT.

___________________ __________________

External Examiner Internal Examiner

________________________________

HOD, University Institute of Physical Therapy

_________________________________

Dean Faculty of Allied Health Sciences

THE UNIVERSITY OF LAHORE

Faculty of Allied Health SciencesUniversity Institute of Physical Therapy (UIPT)

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 Undertaking

I Sania Saifullah DPT02143271 declare that the contents of my thesis entitled PREVALENCE OF

LOW BACK PAIN AND DISABILITY IN PHYSIOTHERAPIST OF LAHORE are based on my own

research findings and have not been taken from any other work except the references and has

not been published before. I also undertake that I will be responsible for any plagerization in

this thesis.

___________________

Sania saifullah

THE UNIVERSITY OF LAHORE

Faculty of Allied Health Sciences

University Institute of Physical Therapy (UIPT)

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 Plagiarism evaluation report

This is to certify that I have examined the Turnitin report of the thesis entitled PREVALENCE OF

LOW BACK PAIN AND LEVEL OF DISABILITY IN PHYSIOTHERAPIST OF LAHORE

The thesis contains no text that can be regarded as Plagiarism.

The overall similarity index obtained from the Turnitin software is _________%

_______________

Supervisor

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 Dedication

To

My Parents

Mr. & Mrs. Saifullah Maan

My Teachers

Dr. Muhammad Salman Bashir

Dr. Rabiya Noor

My Friends

Muhammad.Azhar , Kehkashan shabeer

Everyone who helped me to learn new thingsI pray for all of them. May ALLAH Almighty bless

them with the best for each of them.

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 Acknowledgment

I would like to express my deep sense gratitude and appreciation towards my supervisor Dr.

Rabiya noor and Dr. Muhammad Salman Bashir (Associate professor) The University of Lahore

for this invaluable supervision, guidance and constant encouragement throughout the study

and assistance to bring this data in final shape and assisting in typing the study and analysis of

the data.

I acknowledge the efforts and advice of Dr. Ashfaq Ahmad (HOD, UIPT) and all my seniors and

fellow colleagues, for helping me during this project.

I am most grateful to Almighty Allah who provided me with this opportunity to conduct this

study. I am highly obliged and grateful to my honorable and respected supervisor, for

everything he did to make this a successful project

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 TABLE OF CONTENTS

Sr. No CONTENTS Page No.

1. TITLE 1

2. TITLE OF THESIS 2

3. SUPERVISORY COMMITTIEE 3

4. EXAMINATION COMMITTIEE 4

5. UNDERTAKING 5

6. PLAGIARISM 6

7. DEDICATION 7

8. ACKNOWLEDGEMENT 8

9. ABSTRACT 15

10. INTRODUCTION 16

11. LITERATURE REVIEW 20

12. OBJECTIVE 28

13. MATERIAL AND METHODS 29

14. RESULTS 31

15. TABLES AND GRAPHS 35

16. DISCUSSION 55

17. CONCLUSION 57

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18. RECOMMENDATION 58

19. LIMITATION 59

20. REFERENCES 60

21. DATA COLLECTION FORM 62

22. CONSENT FORM 63

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Table No. Table Name Page No.

1. Age frequency table 35

2. Total score frequency table 36

3. Gender frequency table 37

4. Statistical distribution of gender 38

5. Oswestry score table 39

6. VAS table 41

7. percentage grade table 43

8. Total scoring table 45

9. Statistical analysis of age 47

10. Percentage of total scoring table 49

11. Cross tabs ( Gender ,VAS) 51

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12. Cross tabs ( Gender percentage grade) 53

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 LIST OF GRAPHS

Graph no Graph name Page no

1 Gender distribution graph 38

2 Oswestry score graph 40

3 VAS graph 42

4 Oswestry percentage graph 44

5 Total score graph 46

6 Age graph 48

7 Percentage of total scoring graph 50

8 Cross tabs( Gender VAS ) 52

Bar chart

9 Cross tabs ( Gender percentage score) 54

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 LIST OF ABREVATIONS

LBP Low back pain

MSD Musculoskeletal disorders

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ABSTRACT

Purpose: In recent years, the prevalence of low back pain, disability had become widespread,
especially among physiotherapists. Diseases like disc buldge, herniation,stress injuries and work
related musculoskeletal disorder is the main cause of low back pain and disability. long term
work demands ,high muscular efforts, poor body mechanics, lack of rest had focused concern on
increase level of low back pain and among physiotherapist. Hence, the main aim of this research
is to indicate the prevalence of low back pain and level of disability in physiotherapists

Method: A questionnaire based survey was undertaken to detect the prevalence of low back
pain and level of disability in 351 physiotherapist ( 23- 35 years old) by using Oswestry and
VAS scale. Collected data treated statistically by SPSS.

Result : Total physiotherapist are 351 ,with equal ratio of males (51%) and females(49%) . 29
year old and above 30 year physiotherapist are more prone to develop low back pain, 53
physiotherapist among 351 having 71% low back pain in age of 29 .distribution of pain among
351 physiotherapist in VAS 33(9.40%) female having severe low back pain and 28(7.98%) are
males with severe low back pain ,in percentage grade of Oswestry questionnaire 111(31.62%)
female physiotherapist with severe low back pain and 106(30.20%) are males with severe
disability

Conclusion: Physiotherapist are majorly at high risk of Low back pain and level of disability
.It is associated with heavy load shifting, job requirements, environmental and occupational
conditions and work for long duration without any rest . Low back pain is also related with age,
gender, BMI, and socio-demographic data of physiotherapist

Key words

Patients, back pain, disability, work related musculoskeletal disorder, physiotherapist

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CHAPTER 1:

Introduction:

Low back pain is one of the most presenting health problem and result in a remarkable
individual, community, and economical burden globally. because the population ages, the
worldwide variety of people with low back pain is probably going to extend consistently over
the approaching time decline. low back pain outlined as activity-limiting low back pain (+/
pain can feel and aggravate into lower region) that present for at least of 1 day(1)

The incidence of low back pain is highest within the third decade, above 50 years, and
overall presence rate will increase with age till the 6065 year cohort study, then step by step
declines. different ordinarily rumored risk factors embody low instructional standing, mental
stress, level of anxiety, depressive thoughts, withdraw from job, low level socio-economic
support within the living environment, and due to use of vibrating tools .low back pain have
great impact on individual life ,on family members, on social conditions govt., and
economics through the world. (2)

The main important aggravating factors, for work situation were psychological thought
towards society and working environment, whereas for activity limitations ,and pain,
mental conditions were more significant. Psychological and working conditions indicate
a high responsibility for the find out patients with LBP. Diagnostic tools are also used for
finding aggravating factors of low back pain in patient to show the these factors have least
involvement. Diagnostic tools for evaluation of risk factors of LBP may enhance to put the
patient with associated unfavorable findings.(3)

Work related low back pain has complicated causes and high rate of presence and have
high rate of presenting complaint. It is indicated as pain of different intensity and time
period and may also result in work inability and in validness. Low back pain causes
workers to suffer and will also result in increase demand of workers and their social safety
and care also keep in (4)

It is proved that the sort of suggestions were applied to the suffering peoples with low back
pain will change the incidence of assisted complaint of low back pain. Because of this, most

16
treatment tips suggest that peoples might have to confirm that the need of reasonable
recovery time period. This suggestion is usually associate with the fact that ninetieth of
suffering peoples recover inside six weeks .these type of conditions, however, may be too
extremists. however patients normally recover speedily, chance of development of severe
low back pain (that is, pain continuous over 3 months) is not sure that tips for low back pain
suggest for recognition of dangerous aggravating factors, most of the time they are termed
as yellow flags. samples of yellow flags embody concern of recurrent injuries, pain in
lower region, or minimum job interest. whereas all tips embrace with finding aggravating
factors (5)

Patient education was no more practical than alternative treatment options like psychological
feature behavioral psychotherapy, work-site visits, x-rays, treatment, , therapy, massage,
manual medical care, heat-wrap treatment maneuver, interferential therapy, spinal
stabilization, yoga, or Swedish back college. One study found that patient education and
consoling was more beneficial than exercises alone for a few time of performance.
individuals with chronic (long-term) low-back pain were less doubtless to profit from patient
education than individuals with acute (short-term) pain (6)

Primary incidence of low back low changes from (3%-15.4%) whereas the estimated
result of low back pain in those suffer from one year continuously are change between(5%-
36%) . hospital staff members or those who work in clinics have the incidence of low back
pain in range of 1 year may also alter as (50%-90%). Many social conditions, individual
factors may enhance the chance of occurrence of this complain. Previous studies find out the
occurrence rate of the complain is mostly observe in 50 above ages and it might be increase
with proceeding of age toward (60-70 year) of age and it may b decrease gradually with age.
Totally different clearly according risk factors embrace low tutorial standing, mentally
stressed, anxious,, depressed, poor job interest, and those who have minimum support from
society, and in peoples who use vibrating tools for long time are at a great risk of the
complain (7)

Hospital staff expertise high incidence of low back pain than several alternative completely
different groups, the possibilities of presences variable at country level. High Work demands

17
 involving bending, twisting, repeatedly doing work, uncomfortable static position and
psychological stress unit thought to be risk factors for variety of back injuries (8)

The World Health Organization's International Classification of Impairments, Disabilities

and Handicaps recognizes complain of the pain in lower back is identify as any abnormal
structural part of lumber spine , or lose of power and strength in the structures that are the
part of lower spine , due to any psychological ,physical or structural reasons or may b due to
insufficiency of any major structure that promote lumber spine functioning and result in lack
of performance done by physical activities. As Suggestions from distribution and
classification of low back pain may be proof of excessive use of, applied forced or
positional disorder, be concerned to muscle balance ability, lose of muscular strength,
decline in capacity or rhythm of movements, high level of sickness and weakness or trunk
instability

1. Working setups in which disease appear due to the reason that work is on priority and
work is only the main reason of disease and disorder like way an accident at work area it
is legally measured as professional disease.
2. Diseases for that doing work Is the part of factor that lead to appearance of disease
3. diseases in which work exhausted or enhance a previous disability

Acute level of low back pain, that is mostly associated with injury to ligaments, muscles and/or
intervertebral discs, is present as pain from quick appearance with a length of less than in 4
days. In number of main case complaints it is indicate that it is result in personal activity
restriction see from 1 to 7 days. ninetieth of peoples with pain may recover impromptu, hr come
back to figure inside one month and thirty to 50 of patients have pain that may be change from
acute to severe conditions after years18-20of onset. acute low back pain includes a length of (6-
12) weeks. In these conditions , it finally result in surgical options to treat it takes up to three
months21. Chronic low back pain happens in exactly V-day of cases, remain present til 12weeks,
reduce the working abilities and only small portion of the disease can be treat . 7,21 undertaking

18
students from Brazil, (76.7% )of individuals with chronic low back pain that are enough for
reducing work performance in work stations.(9)

Medical staff members need to evaluate the complain through different screening tools and by
performing confirmation test to predict the reasons and causes of low back pain. Once acute
condition is converted to the more severe condition due to lack of proper medical treatment or
because of any pathological conditions and any past history of other disease that lead to become
it more worse. Peoples having low back pain appear in tomography or signs of nerve irritation
or spinal pathology may confirm with other diagnostic tools(10)

Complaints in Lower BACK ranks second it is only one that are associated with higher level of
breathing disorder due to environmental must go for treatment..1 regarding seventieth of adults
have low back pain at a fifty, beside alone Bastille Day have an episode that lasts over time
period. About (1.5%) have such appearance with choices of nerve irritation.2,3 main reasons of
of back pain answer through symptoms and physical measurement, but some area unit surgically
can be treat and some area unit general diseases (cancer or disseminated infection) need specific
treatment, so careful diagnostic appraisal is important. selection of the clinical history and
physical examination had impact not alone therapeutic options but jointly decisions regarding
finding imaging, laboratory testing, and specialist referral. Low back pain may occurred due to
problem in many parts of spine that involve in making structure of lower(11)

Back pain Common suggestion are the diagnostic sorting of patients with normally these tips
offer similar recommendation on the treatment of pain present in lower back minimum use of
radiographs, recommend on early and progressively increase activity of patients, and also the
connected withdrawal of bed rest. the popularity of psychosocial issues as a provocation factor
for severity is additionally consistent across all tips, although with varied stress and detail (12)

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CHAPTER 2:

Literature review

WRMDs among Nigerian physiotherapists was ninety one.3%. Prevalence of WRMDs was
considerably higher in feminine physiotherapists (p = zero.007) and people with lower body
mass index (p = zero.045). The low back (69.8%) was the foremost usually affected piece,
followed by the neck (34.1%). half of the physiotherapists initial intimate their WRMDs among
5 years of graduation and also the highest preva.BOA in all they work on musculoskeletal
disorders ,in 2008 Reported that 12- month prevalence of lence (61.7%) was found among
physiotherapists younger than thirty years. Treating sizable amount of patients in an exceedingly
day was cited by most (83.5%) of the respondents because the most vital work issue for his or
her WRMDs. the foremost usually adopted brick strategy known was for the therapists to switch
their position and/or the patient's position (64.3%). Majority of the respondents (87.0%) didn't
leave the profession however sixty two.6% modified and/or changed their treatment as a result of
their WRMDs(13)

J Dan, in all Physiotherapy work in 2010 they find that world wide prevalence of WRMD was
eighty three. the best incidence of WRMD was within the lower spinal region space (80%).
many treatment options was related to an multiplied risk of lower back (odds magnitude relation
= one.05) and shoulder symptoms (OR = one.04); manual treatment was related to associate
exaggerated factors of wrist/thumb pain = one.11).who work in RCs was related to chance of
enhanced prevalence of lower back/shoulder symptoms, whereas those involved in OPCs was
related to associate multiplied prevalence of thumb/wrist symptoms. PT's used completely
different ways minimize the risk of WRMD, as well as fixing follow technique(14).

ER Vieira - American journal of industrial work in 2016 their research shows that The body
components with the very best prevalence of symptoms were the low back (66%) and also the
neck (61%). For PTs specialized in acute care, gerontology and pediatric medicine, the area that
most typically affected was the low back, whereas for PTs specialist in bone and muscle
treatment and neurology, the part most ordinarily affected was the neck relating to work settings,

20
the low back was the foremost usually affected for PTs operating in accomplished nursing
facilities, outdoor patient in clinics and hospitals, and therefore the neck in PTs operating in
educational and residential health settings. MSDs are common among physiotherapist MSDs are
common among PTs; the body components most frequently affected were the low back and
neck. The prevalence and body components affected varied by observe setting and specialty
concerns. (15)

Johannes Andreas they work in 2011 and For lower back pain in physiotherapist who work in
orthopedically manual medical aid techniques ; operating in awkward or uncomfortable positions
; and high psychological job demands . (16)

Liao JC, all in Aug 2016 their results shows that , 1682 activity therapists [OTs], and 3724 work
as medicine specialist) with or while in new term incidence related to spine al disorder
estimated. The complicated value for The overall proportion of new-term incidence of SRMD
for physiotherapists is thirty two to twelve. The predicted time for peoples to developed SRMD
is one.ninty four years. The larger number check to showed that therapists have the minimum
chances of occurrence of SRMD-it is estimated that physiotherapist at increase risk of getting
development of SRMD in one year study with comparison to medicine specialist and any other
surgical specialist Physiotherapists operating in clinical setups have a pair of.40-time increase
chances of getting involve in SRMD) relative to surgeon and medicine specialist . this is first
related study that cover the disorder occurring du to SRMD. To find out that therapist operating
in work stations have increase chance of pain Therefore, we recommend that physiotherapists
ought to pay additional care to the present complain to stop the event of disorder in spine(17)

NA, Leonard JH, in 2011 they found that the general 71.6% of incidence of pain related to
working conditions throughout from last 12 months feminine therapists estimated a
considerably increase risk of occurrence of contractor disorders related to work than the
male(gender) therapists. important variations were need to find out among different amount of
therapist that are failed with proper body fat to muscle ratio higher than ratio of (18-25 ). Manual
medical aid (58.6%) and heavy loading/shifting work demand (41.3%) were the 2 physical
methods that almost all typically concerned with contractor disorders related to work. Work-
related injuries area unit considerably more higher values in physiotherapists who live in Asian
nation as related to those with several alternative countries. Feminine therapists is indicate as the

21
higher rate odf occurrence of injuries and disabilities during their work in this study, and work-
related contractor disorders were a lot of most presenting complaint in therapists operating
within the medical specific area. This study relate to knew that disability in working peoples of
physiotherapist from southeast Asian with regarding to their work demand and their exceeding
step of progress (18)

Vieira ER in March 2010they conduct study predict and find that the appearance and incidence
of systemic pathology of muscles due to work were arrange and classify in the manner with the
respect of body portion that were most affected ,number of aggravating factors (body
positioning, social ,personal) and set of proof (powerful, logical, or inadequate proofs). Elements
that become the reason with a minimum of affordable proof of a causative co-relation for the
event of systemic pathology related to work include: complex physical workout, smoking, high
fat to muscle ratio highly frustrated work situation, and also due to the presence of related other
disorder in the. the foremost usually reportable force on body are the aggravating element with a
minimum of affordable proof for inflicting WMSD embody .highly repeated activity, bad body
position and posture during work. Further high method quality studies are required to any
perceive and supply stronger proof of the causative co-relation between aggravating element and
systemic pathology related to work . the knowledge provided during this article is also helpful to
care suppliers, researchers, and study of body positioning during work interested on risk
evaluation and style of treatment options cut back the rates of work-related system disorder. (19)

Andersen JH1,n April 2007 they revealed that high rate of activity performance for more than 1
time result in pain in upper limb region, pain in lower back region of spine is due to long term
standing and high force work ,lower limb pain is result due to pulling and pushing .minimum
interest in work expect pain in upper portion of spine and in shoulder girdle. only a few
employees are entirely freed from pain in muscular region of body , thats why studies are
conducted to find the causative agents of pain in muscular portion of body the conversion of
from minimum level to maximum level of pain was enhance by complex body activity, frustrated
situations during work , alongside personal and issues related to health. (20)

AR1, Campo M, King P in 2012 they collect knowledge to examined across OT and pt apply
normally, and additionally by applying place. Manual medical aid and transfers/lifts were related
to fifty four percent of all injuries. Different activities related to injury were distinct to applying

22
area, for example: floor work in pediatrics; useful activities in acute care; patient falls in skilful
nursing facilities; and automobile activities in home care. Injury interference activities should
address transfers and manual medical aid, however additionally should examine setting-specific
activities influenced by setting and patient. .(21)

QI, AA .in NOV 2016 they revealed that Working hours/week and WRMDs were considerably
related to pain in lower spine is 46.5percentage and pain in upper portion of spine
26.6percentage pain were most typically can be minimize. WRMDs were considerably related to
with different working demands and activity. The incidence rate of disorder due to work in
physiotherapist was forty seven. seven% with a big distinction between full- and part-time job
requirements. Manually adopted bed and sofas (20%) and supporting mattress (18%) were the
foremost ordinarily used helpful electronics. Physical therapists are particularly at risk of
WRMDs with a prevalence of forty seven. Seven percentage . Disorder due to work are
influence by long standing or sitting during performing tasks. Pain in low back is that typical
sort of rejection of bad work addictions , multiplied technology awareness and applying of care
that are significantly important to minimize pain during work. ((22)

D Hogan in July 2016 they study on number of peoples work according to nations therapists
were highly at the extreme of pain in lower region of spine with respect to any other worker in
society. Nearly. Worker who work for long time without any routine for economic benefits
having high chances of occurrence (86.6%) than the peoples who work for other with a gradual
routine (76.8% )Conversely, once involves disabling pain complain in limbs in therapist who
take money after work can predict to more severe pain presence than the therapist who work
without any pressure In respect to great pain in in the body regions , not being easy during work
,an external helper was seen to help them during work and save them from fatigue ,and low level
of supervisor help may result as predicting factor of occurrence of pain in limbs. (23)

Pranji N, July 2012 their results shows that 836 people who take part in the research were free
from signs of any pain throughout the gradual increase in year, 33 (3.9%) reportable pain in
lower back with incapacity throughout the 2-year of continuous work . In ultimate estimation,
"causes of pain in lower back," "massive wait lifting ," "personal mental distress in work station,

23
and repeatedly performing same task all were significant risk elements for low back pain
occurrence. All of those elements were significantly very necessary with involvement of age
and gender also important .each ergonomics and depressing thoughts during work might also
become reason of the disorder among antecedently symptomless Japanese employees. Thus,
changing in work environment aimed to minimize the occurrence of pain might b specialize in
each engineering and psychosocial stress. (24)

King P1, and all In sep 2009 their results shows therapist how are older and experienced posses
the same chances of occurrence rate of any injury and disability but more day far from work is
more seen in older individual due to recurrent injuries , younger and older therapist are same but
totally different with many aspects particularly with regard to attitude toward work aged
therapist attend result that shows they suffer with a lot of symptoms of more severe pain than
physiotherapist of minimum age and were 2 and a 0.5 folds additional probably to present that
they modified jobs as a result of their pain . aged and young physiotherapist at the same rate of
injuries due to work Older staff is also additional susceptible to lost period of time and should
expertise additional severe sign of pain . several treatment options were suggest and to stop
injuries and pathologies and a lot of planes within the great thanks to integrate these treatment
(e.g.,force based elevating instruments ) into medical care follow is required. (25)

Bugajska J et al. in 2011 they revealed that the workers who acting serious body work out or
operating in bad, compressive body positioning. it's additionally been in mind that stress during
work due to numerous frustrated work elements will considerably may enhance their
occurrence. it had been shown that restricted social and cultural difference (e.g., work
requirement and management, personal differences, personal values, job ,cluster cultures) could
represent activity force agents and, once associated with physical load elements, as a high job
requirement ,lack of management during performance or lose of help from society are the
foremost most repeating cause of injuries during work (26)

Alrowayeh HN,and his fellows in jan,2010 their results shows that annual incidence rate of
pathology due to work was higher from yearly record, from which complaint arising from pain in

24
lower back is thirty two percentage .this is reported by body regions distributions of twenty
one% of pain in portion of neck ,nineteen% complaints in upper back ,thirteen percent pain
present in shoulder regions, eleven percent pain indicate in the radio ulner joint, and in knee
with same as wrist, six percent pain arise in ankle ,four percent pain complaint present in elbow,
and buttock are having pain of three percentage. The incidence of injuries due to work was not
mainly associated with gender but have some relation with gender , age difference among
worker, working conditions, operating time period, spot of specialty ,and physical exertion,
injuries due to work in physiotherapist of Kuwait were more common with the mainly
complaints in lower region,, and upper portion of the. more analysis is required to research the
impact of risk element as body burden, mental burden, and commonly presenting health
problems related with muscular dis functioning. (27)

D. A. M. in July 2016 they reported that the incidence rate of pain occurring in lower back was
forty ninth with no important distinction by workers condition of standing. Therapists had a far
high rate of incidence related to any other national operating worker observer all over the living
history and records, with therapists nearly 5 folds a lot of probably to have pain in low back
when it is compared with social ,living differences are adjusted just only keep in notice the
physical ,and mental exertion as a provocation elements (28)

P Torres, in - 2015 -. The results indicate that, in our sample, 72.5% of physiotherapists already
had some quite MSD within the last twelve months. the foremost affected body region was the
lower back and therefore the most typically cited causative activity of MSD was operating within
the same posture for long periods of your time. the information analysis appears to point that
these characteristics and therefore the nature of the work activities of physiotherapists ar related
to the onset of MSD. (29)

.GR Siqueira, l , in 2008 The results of this research gives the proof that physiotherapist
belong from urben centers increasing in this study, mostly having high rate of pain in lower back
as the occurrence rate of the pathology was concerned with the time of touch with work place
spend in a 6 days of week , the portion of their skilled expertise, and the age distribution of
peoples. . These finding shows that therapy apply might lead to a high chance complications in

25
the muscular region of the peoples who work as a professional, principally owing to the intensive
range of time period the therapists have to be compelled to perform tasks with respect to week
Therefore, described discussions, with a lot of analytic approaches are needed. a lot of
specifically, discussions associated with themes like interference and ergonomics, in others, that
purpose to relate the authenticity of the part of recovery and to push higher individual and
skilled properties of life area unit that are need for these professionals. (30)

L Passier,l - British Journal of Occupational , in 2011 results shows thatThe incidence of

WRMDs was high, with twenty nine (63%) respondents experiencing one or additional WRMDs
at intervals the previous twelve months and thirty eight (80.4%) over the course of their career.
Of the seventy six WRMDs delineate, 37 (48.7%) weren't according in the slightest degree and
solely five (6.5%) were according through official coverage systems. The findings from this
study indicate that this news of WRMDs is poor which WRMDs have an impression on
individuals' work and leisure activities/ (31)

M Campo, - Physical therapy, in 2010 results shows that each one of the therapists were
involved regarding their passion to work for long period of time in clinical setup. the skilled
domain sophisticated these elements by high force applying therapist into an ideally expert. Pain
due to work affect therapist in individual and skilled portion of their work.. It additionally might
have an effect on career plans methods to cut back the danger of pathology and physical
exertion for maintaining job is needed (32)

SH Chung, JG Her, - Journal of Physical therapy in 2013 - results shows that physical
therapist have high rate of incidence of pain arising due to work . feminine therapist are at high
chance of occurrence from all of them, therapist who give treatment plane to a large number of
patient in one day having high chances of occurrence of pain due to excessive work demands
,most of the therapist make uncomfortable positioning and posture by changing their area of
support or through changing patient positions they dont get support to apply high force
demanding hand maneuver of manipulation that put a large pressure on the body result in
pathology of(53.5%) most commonly present in therapist in country of Korea . (33)

26
TM Gropelli,, 2010 - studied shows the result according to that . when interview is conducted
from number of nurses staff and from physiotherapist to find out their concern regarding the
activities that cause pain in muscular region of the body .interpretation of the response its come
to knew that ,together with feelings of concern and fade-up; complicated pathologies, and job
requirement, crazy for work and considerations concerning continued within the work increase
chance of injury , more adherent with recovery ,bad impact on daily livings and on health
domain; and academic desires. A theory summaries that to save the job and for continue the job
therapist ignore and adjust all the pathologies related to work and not took it in focus to treat and
recover the injury. The study indicates a necessity for awareness and higher level of sharing (34)

27
OBJECTIVE:

The purpose of This study is to find out the low back pain and level of disability among
physiotherapist of Lahore.

28
CHAPTER 3:

MATERIAL AND METHODOLOGY

1.1. Design of study:

It was a cross sectional study to find out the level of low back pain and disability among
physiotherapist

1.2 Sample:

The calculated sample size was 340 by the following formula.

1.3 Sampling technique :

purposive technique were used to collect data
1.4. Settings:
Sheikh zayed hospital
Jinnah hospital
Meow hospital
Fatima memorial hospital
Gulab Devi hospital
Children hospital
Nawaz shareef social security hospital
Doctors hospital
Farooqe hospital
1.3.1 Time duration:
It was one month only (Date 28 June 2017-31 July 2017)

29
1.4 Inclusion criteria:
Patient having low back pain, disability, functional inability, physiotherapist from
different hospitals :

Age 24-35 years

Occupational physiotherapist
Clinical administrator
Academic demonstrator
Sports physiotherapist
Government employee physiotherapist
Private clinician
Neonates physiotherapist
Experienced physiotherapist
1.5 Exclusion criteria:
Depression
Fracture / dislocation
genetic disability
Ankylosing spondylitis/ disc herniation
1.6 Patient selection criteria:
Low back pain
Disability
1.7 Data Collection procedure:
Oswestry questionnaire for low back pain and disability(12)
Visual analogue scale
1.8 Data analysis: SPSS: from this software quantitative data were analyzed by making
cross tabulation, histogram ,and through bar chart

30
ETHICAL APPROVAL

1. Primarily it was prior to get permission from ethical staff of hospital before
2. Information consent farm in written were taken from all the patient.
3. All the information and recorded data were kept in secret from all others.
4. Participation were remain keep in knowledge during the study.
5. The participants were given confirmation that there were no harm and drawback of this
study.
6. They were also kept in notice that they have choice to cut off from study any time during
this study.

31
CHAPTER 4

RESULTS:

From total 351 physiotherapist wit age range of ( 22-35years) , 53 physiotherapist that responds
having age 29 years, 6 having 21 year age and only 3 physiotherapist having 36 year age that
respond to questionnaire (Table1)

From total scoring of questionnaire (45) only 1 pysiotherapist having 5(4.8 %) total score.and
out of them 10 physiotherapist have 45( 100%) total scoring, and 35 physiotherapist having
22(54%) total scoring(Table2)

Total 351 physiotherapist were asked to fill the questionnaire, 179 ( 51%) are males and 172
(49%) are females. (table3)

The statistical description of gender shows The minimum number of gender is 1.00, the
maximum amount is 2.00, the mean and S.D IS (1.49OO-O.50061) (table4)

This table shows the distribution of Oswestry questionnaire that shows (10.85%) having no pain
,(14.2%) having mild pain ,(27.1%) suffer with moderate disability, (22%) physiotherapist
having severe disability,(15.7%) are crippled, and (9.4%0 are bed bounded (table5), (graph1)

Among 351 physiotherapist 80 physiotherapist having severe disability3( 74.9 %) with

oswestry questionnaire grading pain, according to that 95 physiotherapist having moderate pain
(2 score) ,55 physiotherapist are crippled (4 score) and 38 cannot move due to pain (5 score)
(graph 2)

The frequency of pain according to visual analogue scale table shows that,137 respondent have
mild pain,138 having moderate pain,61 suffering from severe pain and only 15 out 0f 351
having no pain at all (table6)

According to visual analogue scale of pain (4.3%) physiotherapist having no pain ,(39%)
having mild pain , (39%) physiotherapist having moderate pain and (61.82%) physiotherapist
having high rate of severe disability (graph3)

32
Percentage grade of oswestery questionnaire shows that (3%) having no disability,(5.4%)
having minimal disability,(17.7%) suffer with moderate disability,(14%)are crippled, (9%) are
bed bounded (61%) physiotherapist suffer with severe disability (table7)
The percentage grade of Oswestry questionnaire that shows only 5.413 % having minimal
disability,17.66% having moderate disability,61.82% with severe disability,13.96% are crippled
and o.855% are bed bounded (graph4)
Total population of 351 minimum number with total score is 00%,maximum number is
45%,mean and S.D is (21.886-7.887) ( table8)

Histogram of total scoring shows the most of the therapist suffer with moderate pain according to
total scoring of questionnaire, mean and St. deviation of total score (21.89_7.254) (graph5 )

From total population of 351 maximum value is 36%,minimum value is 21%, with mean and S.D
IS (28.168-2.4871) (table9)

The graph represent that most of the therapist who respond to have severe pain complaint is
under age of 22 year , maximum age of respondent is 35 year mean and S.D of age is (28.17-
2.493) ( graph 6)

Minimum value in percentage of total score is 0%, maximum value is 100% S.D is (17.6179)
from total population of 351 (table10)
The graph shows the Percentage grade with mean and S.D is (48.38-17.618) (graph7)

This table shows the relation of gender and visual analogue scale, ,according to this, total 179
males responds the VAS and 172 females are involve.7 males having no pain ,76 having mild
pain,63 suffer with moderate pain, and 33 males having severe pain in VAS, females response
are quietly different according to this table 8 females having no pain,61 females having mild
pain,75 females having moderate pain and 28 females suffer with severe pain.(table11)

Correlation of gender and visual analogue scale 75 (21.37%) females having moderate pain
and 63 (17.95%) males having moderate pain,33 (9.40%) females having severe pain and
28(7.98%) males having severe pain (graph According to Correlation of gender and percentage

33
,12 male physiotherapist having minimal disability,35 having moderate disability,106 having
severe disability,23 are crippled,2 are bed bounded from 179 of total amount ,from 172 females
7 having minimal disability, 27,have moderate disability, 111 ,having severe disability,23 are
crippled, 1 were bed bounded( table 12).

Correlation of gender and percentage grade of Oswestry questionnaire showes111(31.62%)

females having severe pain and 106(30.20%) males suffer with severe pain with grade 5
(graph10)

34
Table 1:

Frequency of age:
Age in year Frequenc Valid
y Percent
21.00 2 .6
22.00 3 .9
23.00 4 1.1
24.00 2 .6
25.00 24 6.8
26.00 65 18.5
27.00 52 14.8
28.00 45 12.8
Valid 29.00 53 15.1
30.00 51 14.5
31.00 18 5.1
32.00 10 2.8
33.00 12 3.4
34.00 5 1.4
35.00 4 1.1
36.00 1 .3
Total 351 100.0

This table shows the distribution of age from(21-36) age range.the valid age is 29 with 53
number of physiotherapist from total number of 35

35
Table 2: frequency of total score Table 2: frequency of total score

Total score Frequency Valid Percent

.00 16 4.6

5.00 1 .3

8.00 2 .6

9.00 1 .3

11.00 2 .6

12.00 6 1.7

13.00 3 .9

14.00 5 1.4

15.00 8 2.3

16.00 6 1.7

17.00 10 2.8

18.00 16 4.6

19.00 22 6.3

20.00 27 7.7

21.00 32 9.1

Valid 22.00 35 10.0

23.00 31 8.8

24.00 23 6.6

25.00 20 5.7

26.00 26 7.4

27.00 15 4.3

28.00 6 1.7

29.00 7 2.0

30.00 10 2.8

32.00 3 .9

34.00 2 .6

35.00 1 .3

37.00 1 .3

43.00 4 1.1

45.00 10 2.8

Total 351 100.0

Table shows the distribution of total score the valid score is 22 of 35 physiotherapist with
percentage of (10%)

36
Table 3 :
Gender distribution

Frequency Percent

Male 179 51.0

Female 172 49.0

Valid

Total 351 100.0

According to this table gender distribution of males is 179(51%) and females are 172(49%) from
total number of 351.

37
TABLE 4:

Descriptive analysis of gender:

Descriptive Statistics

N Minimum Maximum Mean Std. Deviation

Gender 351 1.00 2.00 1.4900 .50061

Valid N (listwise) 351

This table of statistical description shows The minimum number of gender is 1.00, the
maximum amount is 2.00, the mean and S.D IS (1.49OO-O.50061)

Graph 1 : Distribution of gender

This pie chart shows the distribution of gender according to this total no.of respondent is
351.from which female is 51.00% and males are 49.00

38
Table 5:
pain score of oswestry question

Total Oswestry Frequency Valid Percent

question score

.00 38 10.8

1.00 50 14.2
2.00 95 27.1
Valid 3.00 80 22.8
4.00 55 15.7
5.00 33 9.4
Total 351 100.0

This table shows the distribution of Oswestry questionnaire that shows (10.85%) having no pain
,(14.2%) having mild pain ,(27.1%) suffer with moderate disability, (22%) physiotherapist
having severe disability,(15.7%) are crippled, and (9.4%0 are bed bounded

39
Graph 2:
pain score distribution of oswetry question

According to the results, most of the respondents who having mild pain are 95 frm total
population of 351 and out of them 33 respondent having severe pain.

40
 Table 6:
visual analogue scale

VAS
Frequency Percent Valid Percent Cumulative
Percent

no pain 15 4.3 4.3 4.3

Mild 137 39.0 39.0 43.3
Valid Moderate 138 39.3 39.3 82.6
Severe 61 17.4 17.4 100.0
Total 351 100.0 100.0

According to VAS , 1(54.3%) having no pain,137 (39%) having mild pain,

138(39%)physiotherapist having moderate pain,61 (17.4%) suffer with severe pain.

41
Graph 3:
Distribution of scale

The graph and frequency table shows that,137 respondent have mild pain,138 having moderate
pain,61 suffering from severe pain and only 15 out 0f 351 having no pain at all

42
Table 7:

percentage grade

Percentage grade
Frequenc Percent Valid Cumulative
y Percent Percent
no pain 1 .3 .3 .3
minimal
19 5.4 5.4 5.7
disability
Moderate
62 17.7 17.7 23.4
Valid Disability
Severe Disability 217 61.8 61.8 85.2
Crippled 49 14.0 14.0 99.1
Bed bound 3 .9 .9 100.0
Total 351 100.0 100.0

Table of percentage grade of oswestery questionnaire shows that (3%) having no

disability,(5.4%) having minimal disability,(17.7%) suffer with moderate disability,(14%)are
crippled, (9%) are bed bounded (61%) physiotherapist suffer with severe disability

43
Graph 4:
Distribution of percentage grade

Graph represent the distribution of respondent according to the percentage grade of Oswestry
questionnaire that shows only 5.413 % having minimal disability,17.66% having moderate
disability,61.82% with severe disability,13.96% are crippled and o.855% are bed bounded.

44
TABLE :
8 Descriptive analysis of total score

Descriptive Statistics

N Minimum Maximum Mean Std. Deviation

Total score 351 .00 45.00 21.8860 7.88768

Valid N (listwise) 351

Total population of 351 minimum number with total score is 00%,maximum number is
45%,mean and S.D is (21.886-7.887)

45
Graph 5 : distribution of total score

From the above table and graph the most of the therapist suffer with moderate pain according to
total scoring of questionnaire, mean and St.deviation of total score (21.89_7.254)

46
TABLE 9:

Descriptive analysis of age

Descriptive Statistics

N Minimum Maximum Mean Std.

Deviation

Age 351 21.00 36.00 28.1681 2.48716

Valid N
351
(listwise)

From total population of 351 maximum value is 36%,minimum value is 21%, with mean and S.D
IS (28.168-2.4871)

47
Graph 6:
Distribution of age

The graph represent that most of the therapist who respond to have severe pain complaint is
under age of 22 year , maximum age of respondent is 35 year mean and S.D of age is (28.17-
2.49

48
TABLE 10:

Descriptive analysis percentage of total score

Statistics

Percentage

Valid N 351

Missing N 0
Std. Deviation 17.61790

Minimum .00

Maximum 100.00

Minimum value in percentage of total score is 00%, maximum value is 100% S.D is (17.6179)
from total population of 351

49
Graph 7:
Distribution of percentage of total scoring

The graph shows the Percentage grade with mean and S.D is (48.38-17.618)

50
Table 10:
correlation of gender and visual analogue scale

gender * vas pain score

Count
Vas pain score Total

no pain mild moderate severe

male 7 76 63 33 179
Gender
female 8 61 75 28 172
Total 15 137 138 61 351

This table shows the relation of gender and visual analogue scale, ,according to this, total 179
males responds the VAS and 172 females are involve.7 males having no pain ,76 having mild
pain,63 suffer with moderate pain, and 33 males having severe pain in VAS, females response
are quietly different according to this table 8 females having no pain,61 females having mild
pain,75 females having moderate pain and 28 females suffer with severe pain

51
Graph 8:
VAS and GENDER

This graph shows that 76 (21.65%) males having mild pain according to VAS and 75(21,37) are
females with mild pain pain in VAS, severity rate also change I n males to female ration with
9.40% and 7.98% respectively

52
 Table 11 :
gender and percentage grade of Oswestry questionnaire correlation

Gender * percentagegrade Crosstabulation

Count
percentagegrade Total

no pain minimal Moderate Severe Crippled Bed bound

disability Disability Disability
Male 1 12 35 106 23 2 179
Gender
Female 0 7 27 111 26 1 172
Total 1 19 62 217 49 3 351

According to Correlation of gender and percentage ,12 male physiotherapist having minimal
disability,35 having moderate disability,106 having severe disability,23 are crippled,2 are bed
bounded from 179 of total amount ,from 172 females 7 having minimal disability, 27,have
moderate disability, 111 ,having severe disability,23 are crippled, 1 were bed bounded.

53
Graph 9:
Distribution of percentage grade with respect to gender

This graph and tab les shows that, 111 of female having severe disability, but 106 males suffer
with severe pain27 females are crippled and males are 35 greater than females

54
DISCUSSION:

lower back pain in physiotherapist who work in orthopedically manual medical aid techniques ;
operating in awkward or uncomfortable positions ; and high psychological job demands(16)

Current study high lightened the risk factors, and causes that concerned with the occurrence of
pain in lower back and disability among physiotherapists

Different activities related to injury were distinct to applying area, for example: floor work in
pediatrics; useful activities in acute care; patient falls in skilful nursing facilities; and automobile
activities in home care. Injury interference activities should address transfers and manual
medical aid, however additionally should examine setting-specific activities influenced by
setting and patient. (21)
The current study found out the occupational tasks, job requirements, and prolong physical
exertion without rest that majorly become the reason of low back pain in physiotherapist . they
can not skip out the job in case of any acute pain due to work demand that become worse over
the time.
Feminine therapists estimated a considerably increase risk of occurrence of contractor disorders
related to work than the male(gender) therapists. important variations were need to find out
among different amount of therapist that are failed with proper body fat to muscle ratio higher
than ratio of (18-25 ). Manual medical aid (58.6%) and heavy loading/shifting work demand
(41.3%) were the 2 physical methods that almost all typically concerned with contractor
disorders related to work. (18)

Current study also report this fact that female physiotherapist having higher prevalence rate of
low back pain than males due to high BMI in females , week musculature, low endurance and
heavy load shifting of patient may cause low back pain and disability
Older and experienced posses the same chances of occurrence rate of any injury and disability
but more day far from work is more seen in older individual due to recurrent injuries , younger
and older therapist are same but totally different with many aspects particularly with regard to
attitude toward work aged therapist attend result that shows they suffer with a lot of symptoms

55
of more severe pain than physiotherapist of minimum age and were 2 and a 0.5 folds additional
probably to present that they modified jobs as a result of their (25)

Current study also support the past researches that older physiotherapist having rate of work
related injuries including low back pain and disability, due to physical work out, environmental
and occupational situations and co-morbidity also a reason.
Therapists had a far highe rate of incidence related to any other national operating worker
observer all over the living history and records, with therapists nearly 5 folds a lot of probably to
have pain in low back when it is compared with social ,living differences are adjusted just only
keep in notice the physical ,and mental exertion as a provocation elements . (28)
Current study reveals the fact that physiotherapist are more prevalent to develop work related
musculoskeletal disorder and low back pain than any other professional .low back pain incidence
rare vary according to social conditions, work demands and job criteria. Asian therapist having
higher incidence rate than other countries
It is reportable pain in lower back with incapacity throughout the 2-year of continuous work . In
ultimate estimation, "causes of pain in lower back," "massive wait lifting ," "personal mental
distress in work station, and repeatedly performing same task all were significant risk elements
for low back pain occurrence. .(24)
Current study shows that low back pain is basically relate with poor body mechanics and
positioning during heavy load lifting and shifting , in performing repeated tasks. Any other
depressing thoughts also alter body load and mechanic during work that cause to develop pain

56
CONCLUSION:

According to oswestery questionnaire scoring the prevalence of low back pain and disability in
physiotherapist of Lahore, Pakistan is74.8% severe pain in 80 physiotherapist from total number
of 351 ,as job requirements, body mechanics ,heavy physical work and lack of rest interval are
associated with low back pain, an increase level of pain and disability worldwide in
physiotherapist is also result of frequent heavy loading, psychological conditions, old age co-
morbidity and socio-demographic history. The literature shows that there are significant result of
low back pain and disability in physiotherapist. female physiotherapist effect more because they
are tired more quickly than males during their heavy physical work demand .old age also related
with increase risk of incidence due to lost of stamina. week musculature and due to co-morbid
conditions .

57
RECOMMENDATION:

Low back pain and disability in physiotherapist is associated with heavy load shifting, physical
activity for long time , to treat the patient and fulfill the job requirements .poor body mechanics,
high work demands , psychological disturbance and early to fatigue due to weak musculature is
the main reason of pain in low back of physiotherapist. Low back pain force physiotherapist to
withdraw the job because low back pain may lead to severe disability. So, it is recommended to
conduct more studies to find out the ways how to overcome occurrence rate of pain in low back
and disability in physiotherapist.

58
LIMITATIONS:

The restriction that might have influence on outcome, The shortage of time due to which more
settings could not b included and I only took few settings in my study.

59
REFERENCES:

1. Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, et al. A systematic review of the global
prevalence of low back pain. Arthritis & Rheumatology. 2012;64(6):2028-37.
2. Hoy D, Brooks P, Blyth F, Buchbinder R. The epidemiology of low back pain. Best practice &
research Clinical rheumatology. 2010;24(6):769-81.
3. Nicholas MK, Linton SJ, Watson PJ, Main CJ, Group DotFW. Early identification and
management of psychological risk factors (yellow flags) in patients with low back pain: a
reappraisal. Physical therapy. 2011;91(5):737-53.
4. Helfenstein JM, Goldenfum M, Siena C. Occupational low back pain. Revista da Associacao
Medica Brasileira (1992). 2010;56(5):583.
5. Henschke N, Maher CG, Refshauge KM, Herbert RD, Cumming RG, Bleasel J, et al. Prognosis in
patients with recent onset low back pain in Australian primary care: inception cohort study. Bmj.
2008;337:a171.
6. Engers AJ, Jellema P, Wensing M, van der Windt DA, Grol R, van Tulder MW. Individual patient
education for low back pain. The Cochrane Library.
7. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk
assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21
regions, 19902010: a systematic analysis for the Global Burden of Disease Study 2010. The lancet.
2013;380(9859):2224-60.
8. Karahan A, Kav S, Abbasoglu A, Dogan N. Low back pain: prevalence and associated risk
factors among hospital staff. Journal of advanced nursing. 2009;65(3):516-24.
9. Helfenstein Junior M, Goldenfum MA, Siena C. Occupational low back pain. Revista da
Associao Mdica Brasileira. 2010;56(5):583-9.
10. Chou R, Qaseem A, Snow V, Casey D, Cross JT, Shekelle P, et al. Diagnosis and Treatment of
Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the
American Pain SocietyDiagnosis and Treatment of Low Back Pain. Annals of internal medicine.
2007;147(7):478-91.
11. Deyo RA. The role of spinal manipulation in the treatment of low back pain. Jama.
2017;317(14):1418-9.
12. Koes BW, van Tulder M, Lin C-WC, Macedo LG, McAuley J, Maher C. An updated overview of
clinical guidelines for the management of non-specific low back pain in primary care. European Spine
Journal. 2010;19(12):2075-94.
13. Adegoke BO, Akodu AK, Oyeyemi AL. Work-related musculoskeletal disorders among Nigerian
physiotherapists. BMC musculoskeletal disorders. 2008;9(1):112.
14. Rozenfeld V, Ribak J, Danziger J, Tsamir J, Carmeli E. Prevalence, risk factors and preventive
strategies in workrelated musculoskeletal disorders among Israeli physical therapists. Physiotherapy
Research International. 2010;15(3):176-84.
15. Vieira ER, Svoboda S, Belniak A, Brunt D, Rose-St Prix C, Roberts L, et al. Work-related
musculoskeletal disorders among physical therapists: an online survey. Disability and rehabilitation.
2016;38(6):552-7.

60
16. Wilhelmus Johannes Andreas G, Wernstedt P, Campo M. Work-related musculoskeletal
disorders in female Swedish physical therapists with more than 15 years of job experience: prevalence
and associations with work exposures. Physiotherapy theory and practice. 2011;27(3):213-22.
17. Liao J-C, Ho C-H, Chiu H-Y, Wang Y-L, Kuo L-C, Liu C, et al. Physiotherapists working in clinics
have increased risk for new-onset spine disorders: a 12-year population-based study. Medicine.
2016;95(32).
18. Nordin NAM, Leonard JH, Thye NC. Work-related injuries among physiotherapists in public
hospitals: a Southeast Asian picture. Clinics. 2011;66(3):373-8.
19. da Costa BR, Vieira ER. Risk factors for workrelated musculoskeletal disorders: a systematic
review of recent longitudinal studies. American journal of industrial medicine. 2010;53(3):285-323.
20. Andersen JH, Haahr JP, Frost P. Risk factors for more severe regional musculoskeletal
symptoms: A twoyear prospective study of a general working population. Arthritis & Rheumatology.
2007;56(4):1355-64.
21. Darragh AR, Campo M, King P. Work-related activities associated with injury in occupational
and physical therapists. Work. 2012;42(3):373-84.
22. Muaidi QI, Shanb AA. Prevalence causes and impact of work related musculoskeletal disorders
among physical therapists. Journal of back and musculoskeletal rehabilitation. 2016;29(4):763-9.
23. Hogan D. Musculoskeletal symptoms in self-employed versus employed therapists: the role
of training and social support. 2017.
24. PRANJI N, MALE-BILI L. Low back pain at new working ambient in era of new economy: a
systematic review about occupational risk factors. acta medica croatica. 2015;69(1):49-57.
25. King P, Huddleston W, Darragh AR. Work-related musculoskeletal disorders and injuries:
differences among older and younger occupational and physical therapists. Journal of occupational
rehabilitation. 2009;19(3):274-83.
26. Bugajska J, Zonierczyk-Zreda D, Jedryka-Goral A. The role of psychosocial work factors in the
development of musculoskeletal disorders in workers. Medycyna pracy. 2011;62(6):653-8.
27. Alrowayeh HN, Alshatti TA, Aljadi SH, Fares M, Alshamire MM, Alwazan SS. Prevalence,
characteristics, and impacts of work-related musculoskeletal disorders: a survey among physical
therapists in the State of Kuwait. BMC musculoskeletal disorders. 2010;11(1):116.
28. Hogan D, OSullivan L, Nolan S, Greiner B. Are Irish therapists at heightened risk for low back
pain? Occupational Medicine. 2016;66(5):351-7.
29. Torres P, Marques PHd, Jesus Vd, Nunes IL. Preliminary results of a study about
musculoskeletal disorders in physiotherapists. 2015.
30. Siqueira G, Cah F, Vieira R. Occurrence of low back pain in physical therapists from the city of
Recife, Pernambuco, Brazil. Brazilian Journal of Physical Therapy. 2008;12(3):222-7.
31. Passier L, McPhail S. Work related musculoskeletal disorders amongst therapists in physically
demanding roles: qualitative analysis of risk factors and strategies for prevention. BMC
musculoskeletal disorders. 2011;12(1):24.
32. Campo M, Darragh AR. Impact of work-related pain on physical therapists and occupational
therapists. Physical therapy. 2010;90(6):905-20.
33. Chung SH, Her JG, Ko T, Ko J, Kim H, Lee JS, et al. Work-related musculoskeletal disorders
among Korean physical therapists. Journal of Physical Therapy Science. 2013;25(1):55-9.
34. Gropelli TM, Corle K. Nurses' and therapists' experiences with occupational musculoskeletal
injuries. AAOHN journal. 2010;58(4):159-66.
35. Joshi VD, Raiturker PPP, Kulkarni AA. Validity and reliability of English and Marathi Oswestry
Disability Index (version 2.1 a) in Indian population. Spine. 2013;38(11):E662-E8.

61
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