Risk factors of non-specific low back pain in a rural community of Bangladesh: A case-control study

Md. Abu Shahin; Rijwan Bhuiyan; Rowsan Ara; Md. Nazrul Islam; Minhaj Rahim Choudhury; Syed Atiqul Haq; Mohammad Mostafa Zaman

doi:10.12688/f1000research.123396.1

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Research Article

Risk factors of non-specific low back pain in a rural community of Bangladesh: A case-control study

[version 1; peer review: 1 approved with reservations, 1 not approved]

Md. Abu Shahin ¹, Rijwan Bhuiyan², Rowsan Ara³, [...] Md. Nazrul Islam¹, Minhaj Rahim Choudhury¹, Syed Atiqul Haq¹, Mohammad Mostafa Zaman⁴

Md. Abu Shahin ¹, Rijwan Bhuiyan², [...] Rowsan Ara³, Md. Nazrul Islam¹, Minhaj Rahim Choudhury¹, Syed Atiqul Haq¹, Mohammad Mostafa Zaman⁴

PUBLISHED 29 Jul 2022

Author details Author details

¹ Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, 1000, Bangladesh
² Directorate General of Health Services, Dhaka, 1212, Bangladesh
³ Department of Medicine, Green Life Medical College, Dhaka, 1205, Bangladesh
⁴ Research and Publication unit, World Health Organization, Dhaka, 1212, Bangladesh

Md. Abu Shahin
Roles: Conceptualization, Investigation, Methodology, Project Administration, Validation, Writing – Original Draft Preparation, Writing – Review & Editing

Rijwan Bhuiyan
Roles: Data Curation, Formal Analysis, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Rowsan Ara
Roles: Writing – Review & Editing

Md. Nazrul Islam
Roles: Writing – Review & Editing

Minhaj Rahim Choudhury
Roles: Writing – Review & Editing

Syed Atiqul Haq
Roles: Writing – Review & Editing

Mohammad Mostafa Zaman
Roles: Formal Analysis, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

This article is included in the Global Public Health gateway.

Abstract

Background: Data pertaining to risk factors of nonspecific low back pain (NSLBP) among rural Bangladeshi is scarce. This study explored the risk factors associated with NSLBP among rural Bangladeshi adults.
Methods: A community-based study was done in Sonargaon Upazila of Narayanganj district of Bangladesh. A total of 343 NSLBP patients were recruited as cases, based on the Bangla version of Community oriented program for control of rheumatic diseases (COPCORD) questionnaire. An equal number of age and sex matched subjects without any rheumatic disease were recruited from the same community. A total of 15 probable factors were analyzed. Age-sex adjusted univariate and age-sex with 13 risk factors adjusted multivariate conditional logistic regression analyses were done.
Results: The mean age of the participants was 33.1 years old (standard deviation: 9.5). Out of 13 risk factors, history of chronic disease (OR 2.0, 95% CI 1.2 – 3.4), prolonged sitting (OR 4.6, 95% CI 2.0 – 11.0), squatting (OR 7.2, 95% CI 3.2 – 16.0), bending of the waist (OR 3.7, 95% CI 1.8 – 7.6), regular lifting or carrying a heavy load (OR 9.2, 95% CI 2.2 – 39.7), prolonged standing (OR 5.8, 95% CI 1.9 – 17.7), occupation related to strenuous physical activity (OR 0.2, 95% CI 0.1 – 0.8), overweight (body mass index >=25 kg/m²) (OR 3.1, 95% CI 1.8 – 5.2) and depression (OR 2.2, 95% CI 1.4 – 3.6) were found to be significantly associated with NSLBP.
Conclusions: The study generated knowledge on associated risk factors for NSLBP in rural people of Bangladesh that may facilitate an evidence-based intervention for the target group.

Keywords

Risk factors, nonspecific low back pain, rural, COPCORD, Bangladesh

Corresponding author: Md. Abu Shahin

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2022 Shahin MA et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Shahin MA, Bhuiyan R, Ara R et al. Risk factors of non-specific low back pain in a rural community of Bangladesh: A case-control study [version 1; peer review: 1 approved with reservations, 1 not approved]. F1000Research 2022, 11:871 (https://doi.org/10.12688/f1000research.123396.1) First published: 29 Jul 2022, 11:871 (https://doi.org/10.12688/f1000research.123396.1) Latest published: 29 Jul 2022, 11:871 (https://doi.org/10.12688/f1000research.123396.1)

Introduction

Low back pain (LBP) has become one of the major public health challenges¹ because of its high prevalence² and association with years lived with disability,³ job absenteeism⁴ and declining overall quality of life for decades. It imposes a significant medical burden and economic expense as well.⁵ Evidence support that most people have to suffer symptoms of back pain at some point in their lives.⁶ The prevalence of LBP in low- and middle-income countries (LMICs) has been identified as high.⁷ The national level survey of Bangladesh reported that the prevalence of LBP was 18.6%.⁸ However, in most of the (85%) cases a specific diagnosis of LBP cannot be obtained, as there are no recognizable pathologies such as infection, tumor, osteoporosis, fracture, structural deformity, and inflammatory diseases responsible for LBP. Such cases are referred to as non-specific low back pain (NSLBP).⁹^,¹⁰ The prevalence of NSLBP was reported to be 6.6, 9.9 and 9.2% in the rural, urban slum and urban affluent community, respectively, in another small-scale study.¹¹

Although the causes of NSLBP is unknown, but there are some known factors (modifiable or non-modifiable) that are associated with NSLBP. Addressing those factors are the primary concern to prevent NSLBP.¹²^,¹³ Data pertaining to risk factors of NSLBP among rural Bangladeshi is scarce. This study explored the risk factors associated with NSLBP among rural Bangladeshi adults.

Methods

Ethical approval and consent to participate

This study adhered to the Declaration of Helsinki, and we assured that the data would be used for scientific research only. Participants were informed in detail about the nature of the study. Spontaneous written consent was taken from the participants and Bangla informed consent form was attached with the questionnaire. Each participant enjoyed the right to participate or refuse to participation. They could withdraw their participations from the study at any stage by contacting the principal investigator and citing their ID number or name. Data taken from the participants were regarded as confidential and kept locked under the principal investigator. The participant’s data were kept anonymous in datasets and were tracked by using unique ID numbers. If any study subject became sick during the survey, proper advice and clinical management was given. Ethical clearance was obtained from the Ethical Review Committee of Bangabandhu Sheikh Mujib Medical University (BSMMU) in 2011 (Memo number: BSMMU/2011/6045) before starting data collection.

Study design and participants

This case control study was carried out during the period of June to September 2011 at Sonargaon Upazila, Narayanganj district, consisting of 19 small villages located approximately 35 km from the capital city. The data collection period was from July to August 2011. Due to the presence of some industries nearby this predominant rural area had some influence of urbanization. There were a diverse range of occupations represented, including agricultural workers, weavers, garment workers, salesmen, and so on. All adults aged 18 years old or above from both sexes were considered as eligible population.

Selection of cases and controls

All the eligible adults of the study area were requested to attend the satellite Community oriented program for control of rheumatic diseases (COPCORD) camp according to a roster. Out of 5,005 eligible adults aged 18 years old and above, 4,850 participated in the camp and the other 155 were non-responsive. At the camp, a Bangla version of the World Health Organization (WHO)-International League of Associations for Rheumatology (ILAR) COPCORD Core English questionnaire was administered by the field enumerators.¹⁴^,¹⁵ By using WHO-ILAR COPCORD questionnaire, 1,315 patients were identified who had any rheumatic condition and the rest of the 3,535 patients had no rheumatic conditions. Those who were identified as rheumatic patients, of them 494 had LBP and they were sent to the rheumatologists. The rest of the 821 patients had rheumatic conditions other than LBP and were excluded from the study. Among the 494 LBP patients, 343 were clinically diagnosed as NSLBP patients using Asia Pacific League of Associations for Rheumatology (APLAR)-COPCORD questionnaire for NSLBP¹⁶ by rheumatologists and considered as cases for the study. NSLBP is defined as low back pain not attributable to a recognizable, known specific pathology (e.g., infection, tumor, osteoporosis, lumbar spine fracture, structural deformity, inflammatory disorder, radicular syndrome, or cauda equina syndrome).¹⁷ To avoid any potential source of bias the diagnosis of NSLBP was made by exclusion of specific pathology with proper history taking, physical examination, imaging and sometimes opinion of expert rheumatologists. In case of any diagnostic difficulties investigators discussed among themselves to decide. Sometimes assistance of radiological investigations was taken. Those who had NSLBP but also had co-morbid illnesses such as symptomatic bronchial asthma, ischemic heart disease and intellectual disability were excluded. The rest of the 151 patients had LBP due to secondary causes and were excluded from the study.

From the patients who had no rheumatic conditions as confirmed by WHO-ILAR COPCORD questionnaire (n=3,535), 343 were recruited as controls of the study by matching with sex and age with ±5 years. A second recall of those who did not report to the camp was done to finally declare them as non-respondents. Details of the selection process is given in Figure 1. Questionnaires, blank consent forms and study information can be found as Extended data.¹⁸

Figure 1. Selection of cases and controls from a rural population of Bangladesh.

*WHO-ILAR COPCORD: World Health Organization-International League of Associations for Rheumatology Community oriented program for control of rheumatic diseases. **APLAR-COPCORD: Asia Pacific League of Associations for Rheumatology-Community oriented program for control of rheumatic diseases.

Variable ascertainment

We used community specific APLAR-COPCORD questionnaire validated by Siddiqui et al.¹⁶

History of chronic disease: Respondents were asked whether they are currently taking any medication for diabetes and/or hypertension, or have they ever been said to have raised blood glucose or blood pressure by any physician or qualified health care worker. If they said ‘yes’ to any of the above two then they were considered as having a history of chronic disease.¹⁶

History of trauma: Respondents were asked whether they had any major accident/physical trauma over the last 12 months.¹⁶

Prolonged continuous sitting: Respondents were asked whether they have to sit for ≥ 2 hours/day continuously irrespective of their daily activities or occupation over the last 12 months. Such as desk workers, driver, tailors.¹⁶

Squatting: Respondents were asked whether they have to squat or sit bending knee for ≥ 1 hours/day continuously irrespective of their daily activities or occupation over the last 12 months. Such activities include sitting without stool/floor or yard scraping/wiping/cooking etc.¹⁶

Bending of waist: Respondents were asked whether they have to bend their waist for ≥ 1 hours/day continuously irrespective of their daily activities or occupation over the last 12 months. Such as agricultural work (without lifting weight), manual weeding, gardening, fishing, laundering, cobbling, potter, blacksmith, weaving, manual brick crushing, carpenter, plasterer, corpse worker, manual brick maker, coppersmith etc.¹⁶

Regular lifting or carrying heavy load: Respondents were asked whether they have to lift or carry heavy load regularly irrespective of their daily activities or occupation over the last 12 months. Such as porters, day laborer, construction worker, agriculture work, lifting water filled jar, cultivation in hilly land, peddler, tea plucking, industrial worker, brick crushing etc.¹⁶

Prolong standing: Respondents were asked whether they have to stand for ≥ 2 hours/day continuously irrespective of their daily activities or occupation over the last 12 months. Such as seals man, nurse, street vendor, barber, security guards, bus helper/conductors, traffic police, teacher, receptionist, health worker, etc.¹⁶

Depression: Depression in respondents was measured using the General Health Questionnaire (GHQ-12)¹⁹ consisting of 12 items, each of which is evaluated by four indices. The GHQ-12 has satisfactory reliability with good sensitivity and specificity. Four-point Likert scoring method was used. Scoring ranged from 0 to 36. A score of >15 was considered as depressed.

Statistical analysis

Data were analyzed using Epi Info 7 software (RRID:SCR_021682). The sociodemographic characteristics and risk variables were presented in terms of numbers and percentages. Age and body mass index were described using the mean and standard deviation. A total of 12 factors such as, ‘age’, ‘sex’, ‘history of chronic disease’, ‘history of trauma’, ‘prolonged continuous sitting ≥ 2 hours/day’, ‘squatting ≥ 1 hour/day’, ‘bending of waist ≥ 1 hour/day’, ‘regular lifting or carrying heavy load’, ‘prolong standing ≥ 2 hours/day’, ‘Strenuous physical activity’, ‘overweight (body mass index ≥ 25 Kg/m²)’, and ‘depression’ were examined for their relationship with NSLBP. The risk factors were identified using conditional logistic regression analyses and are shown as odds ratios with 95% confidence intervals. All missing data were dropped from the analysis. STROBE checklist for case-control study was followed to prepare the manuscript.²⁰

Results

Among the 686 participants, 343 were cases (have NSLBP) and 343 were controls (no rheumatic diseases). The mean age of the participants was 33.2 years old (standard deviation: 9.4). Over two-thirds (69.1%) were women, four in 10 (40%) had no formal education and around 91% were married. Around 11% of participants had an occupation related to various laborious work and more than one-fifth (21%) used any form of tobacco (Table 1).²¹

Table 1. Results of conditional logistic regression for risk factors of non-specific low back pain in a rural Bangladeshi population.

Risk factors	Total (n=686)	Case (n=343)	Control (n=343)	Odds ratio (95% confidence interval)
Risk factors	n (%)	n (%)	n (%)	Adjusted for age and sex	Adjusted for age and sex plus other variables^a
Sex
Women	474 (69.1)	237 (69.1)	237 (69.1)	-	-
Men	212 (30.9)	106 (30.9)	106 (30.9)	-	-
Age group in years
31-55	354 (51.6)	182 (53.1)	172 (50.1)	-	-
18-30	332 (48.4)	161 (46.9)	171 (49.9)	-	-
Educational status
No formal education	275 (40.1)	158 (46.1)	117 (34.1)	1.7 (1.2-2.4)**	1.4 (0.8-2.3)
Primary and above	411 (59.9)	185(53.9)	226 (65.9)	Reference	Reference
Marital status
Married	623 (90.8)	323 (94.2)	300 (87.5)	3.3 (1.6-6.7)**	1.6 (0.6-4.3)
Unmarried	63 (9.2)	20 (5.8)	43 (12.5)	Reference	Reference
History of chronic disease^b
Yes	157 (22.9)	111 (32.4)	46 (13.4)	3.3 (2.2-5.1)**	2.0 (1.2-3.4)**
No	529 (77.1)	232 (67.6)	297 (86.6)	Reference	Reference
History of trauma (n=615)
Yes	21 (3.4)	18 (5.6)	3 (1.0)	5.7 (1.7-19.3)**	2.8 (0.7-11.2)
No	594 (96.6)	302 (94.4)	292 (99.0)	Reference	Reference
Prolonged continuous sitting ≥2 hours/day^c
Yes	95 (13.8)	56 (16.3)	39 (11.4)	1.7 (1.0-2.7)*	4.6 (2.0-11.0)**
No	591 (86.2)	287 (83.7)	304 (88.6)	Reference	Reference
Squatting ≥1 hour/day^d
Yes	424 (61.8)	229 (66.8)	195 (56.9)	2.3 (1.5-3.7)**	7.2 (3.2-16.0)**
No	262 (38.2)	114 (33.2)	148 (43.1)	Reference	Reference
Bending of waist ≥1 hour/day^e
Yes	150 (21.9)	92 (26.8)	58 (16.9)	1.9 (1.3-2.8)**	3.7 (1.8-7.6)**
No	536 (78.1)	251 (73.2)	285 (83.1)	Reference	Reference
Regular lifting or carrying heavy load
Yes	35 (5.1)	25 (7.3)	10 (2.9)	2.7 (1.2-5.7)**	9.2 (2.2-39.7)**
No	651 (94.9)	318 (92.7)	333 (97.1)	Reference	Reference
Prolong standing ≥2 hours/day^f
Yes	56 (8.2)	36 (10.5)	20 (5.8)	2.1 (1.1-3.8)*	5.8 (1.9-17.7)**
No	630 (91.8)	307 (89.5)	323 (94.2)	Reference	Reference
Occupation related to strenuous physical activity
Laborious job^g	72 (10.5)	31 (9.0)	41 (12.0)	0.7 (0.4-1.2)	0.2 (0.1-0.8)*
Others	614 (89.5)	312 (91.0)	302 (88.0)	Reference	Reference
Tobacco use
Yes	142 (20.7)	69 (20.1)	73 (21.3)	0.9 (0.6-1.4)	1.4 (0.7-2.5)
No	544 (79.3)	274 (79.9)	270 (78.7)	Reference	Reference
Overweight (body mass index ≥ 25 kg/m²)
Yes	213 (31.1)	139 (40.5)	74 (21.6)	2.7 (1.8-3.9)**	3.1 (1.8-5.2)**
No	473 (68.9)	204 (59.5)	269 (78.4)	Reference	Reference
Depression^h
Distress	230 (33.5)	140 (40.8)	90 (26.2)	2.0 (1.4-2.9)**	2.2 (1.4-3.6)**
Normal	456 (66.5)	203 (59.2)	253 (73.8)	Reference	Reference

* P < 0.05.

** P < 0.01.

a All the risk factors mentioned in the table were entered into the model simultaneously age and sex were entered as matching variables.

b Diabetes and hypertension.

c Desk workers, driver, tailors etc.

d Sitting without stool or on floor or yard scraping/swapping floor/cooking etc.

e Agricultural work (without lifting weight), manual weeding, gardening, fishing, laundering, cobbling, potter, blacksmith, weaving, manual brick crushing, carpenter, plasterer, corpse worker, manual brick maker, coppersmith etc.

f Salesman, nurse, street vendor, barber, security guards, bus helper/conductors, traffic police, schoolteacher, etc.

g Cultivator, day laborer, mason, rickshaw/van driver or any other hard worker.

h General Health Questionnaire (GHQ-12): score ≤15 normal and >15 depressed out of 36.

Overall, 23% of participants had a history of chronic disease and around 3.4% had a history of trauma. One in every 10 were involved in prolonged continuous sitting (>2 hours/day) and six out of 10 individuals engaged in prolonged squatting position (≥1 hour/day). More than one-fifth (22%) were bent at the waist at least 1 hour/day. Around 5% and 8% were involved in regular lifting or carrying heavy load and prolonged standing (at least 2 hours/day), respectively. Over a quarter (31%) were overweight (body mass index ≥25 kg/m²). Around one-third reported experiencing ‘distress’ in general health question (GHQ-12) (Table 1).

From the univariate analysis (age-sex matched) 11 of the 13 risk factors, such as education (OR 1.7, 95% CI 1.2 – 2.4), marital status (OR 3.3, 95% CI 1.6 – 6.7), history of chronic disease (OR 3.3, 95% CI 2.2 – 5.1), history of trauma (OR 5.7, 95% CI 1.7 – 19.3), prolonged continuous sitting (OR 1.7, 95% CI 1.0 – 2.7), squatting (OR 2.3, 95% CI 1.5 – 3.7), bending of waist (OR 1.9, 95% CI 1.3 – 2.8), regular lifting or carrying heavy load (OR 2.7, 95% CI 1.2 – 5.7), prolonged standing (OR 2.1, 95% CI 1.1 – 3.8), overweight (body mass index ≥25 kg/m²) (OR 2.7, 95% CI 1.8 – 3.9) and depression (OR 2.0, 95% CI 1.4 – 2.9) were found to be significantly associated. However, after adding 13 other risk factors to the statistical model, nine risk factors were found to be significantly associated with NSLBP. These were history of chronic disease (OR 2.0, 95% CI 1.2 – 3.4), prolonged sitting (OR 4.6, 95% CI 2.0 – 11.0), squatting (OR 7.2, 95% CI 3.2 – 16.0), bending of waist (OR 3.7, 95% CI 1.8 – 7.6), regular lifting or carrying heavy load (OR 9.2, 95% CI 2.2 – 39.7), prolonged standing (OR 5.8, 95% CI 1.9 – 17.7), occupation related to strenuous physical activity (OR 0.2, 95% CI 0.1 – 0.8), overweight (body mass index ≥25 kg/m²) (OR 3.1, 95% CI 1.8 – 5.2) and depression (OR 2.2, 95% CI 1.4 – 3.6) were found to be significantly associated with NSLBP (Table 1).

Discussion

In this community-based case control study, several risk factors were found to be associated with LBP. Several studies reported LBP as one of the most common causes of hospital visits and the leading cause of work absences.³ Multiple studies worked with different cohorts suffering from LBP and reported causal relationships.² The prevalence of NSLBP was 6.6–9.2% in different communities of Bangladesh.¹¹ There are many proposed risk factors associated with LBP in the general population.²²

LBP is a common problem in diabetic patients in terms of intensity, frequency and functional level of disability.²³ The current study observed that chronic diseases, such as diabetes mellitus and hypertension, had an increased risk of developing NSLBP. LBP in diabetic individuals may be due to diabetic neuropathy, resulting in symptoms such as pain, tingling, or numbness. It is a problem that may affect as many as 50% of people with diabetes and can lead to chronic back pain.²⁴ In addition, acute trauma can contribute the development of LBP.²⁵ Its contribution can be up to 7%. Our findings in the present study are also similar in nature.

Various body postures like prolonged sitting, standing, bending of waist, pulling/pushing, frequent weightlifting have been revealed as statistically significant risk factors for back pain.²⁶ One study showed body positions like sitting more than 2 hours per day, squatting more than 30 minutes are associated with LBP.²⁷ Bidassie et al., found that work-related postures like prolonged squatting or bending of the waist were significantly associated with LBP.²⁸ Occupational exposure is a highly preventable risk factor common in working populations with high physical loading on the back and possibly also high psychosocial strain.²⁹ Studies reporting on manual material handling, such as lifting and carrying loads without mechanical assistance, have shown them as risk factors for LBP.³⁰ The meta-analysis and subsequent pooled risk estimates demonstrated that intensity and frequency of lifting were significantly associated with annual incidence of LBP.³¹ Another study has also shown that workers who perform repetitive weightlifting experienced LBP more frequently.³² In this study, we also found that regular lifting or load carrying were significantly associated with LBP. This association may be due to repeated heavy lifting, or a sudden awkward movement that can strain back muscles and spinal ligaments. A previous study found that prolonged standing without freedom to sit was associated with LBP.³³ In this study, we also found that prolonged standing >2 hours were significantly associated with LBP.

A previous study found that LBP is more common in jobs that require heavy physical activity.³⁴ Different studies have found significant relationships between body mass index and LBP.³⁵ This study also found a significant association between obesity and LBP. Pain may be because the pelvis of an obese individual is pulled forward, and thus the lower back becomes strained. A strained lower back will produce symptoms such as pain, soreness, and tightness.³⁶ Another study done on work history and work environment factors showed that work dissatisfaction and life stress were important factors influencing LBP prevalence.³⁷^–³⁹ In this study we found that subjects with evidence of psychological distress had a higher risk of developing NSLBP.

Strength and weakness of the study

To the best of our knowledge, so far, our study is the first community-based case-control study on NSLBP conducted in Bangladesh. This study attempted to cover all possible aspects of etiological factors. Age and sex matched cases and control subjects were enrolled. Culturally adapted and validated tools were used. However, this study also has weaknesses. The study area was selected purposively and its proximity to the BSMMU may not represent rural Bangladeshi population at large. Furthermore, the population was selected purposively. Performing imaging was very difficult because the diagnostic centers were far away from the study area, and we were limited by fund constraints. Thus, X-rays were only performed in a few of the cases.

Conclusions

In this study, some risk factors were found to be strongly associated with LBP, including history of trauma, history of chronic disease, and prolonged continuous sitting, squatting, bending, standing, regular lifting and carrying load. While some variables were weakly associated with NSLBP, such as marital status, vigorous physical activity and obesity. Some factors were not associated with LBP, including religion status, smoking history, and previous history of cesarean section. The results of this study generated knowledge about different risk factors associated with NSLBP and open up possibilities for evidence-based intervention programs to prevent the development of NSLBP. A non-communicable disease control program may finally help to reduce the burden of NSLBP in the community.

Data availability

Underlying data

Zenodo: Risk Factors of Non-specific Low Back Pain in a Rural Community of Bangladesh. https://doi.org/10.5281/zenodo.6709850.²¹

Extended data

Zenodo: Risk Factors of Non-specific Low Back Pain in a Rural Community of Bangladesh (extended data). https://doi.org/10.5281/zenodo.6824159.¹⁸

This project contains the following extended data:

- Questionnaire Part 1.pdf
- Questionnaire Part 2.pdf
- Questionnaire Part 3.pdf
- Copcord Ph I English.pdf
- Copcord Ph II English.pdf

Reporting guidelines

Zenodo: STROBE checklist for ‘Risk factors of non-specific low back pain in a rural community of Bangladesh: A case-control study’. https://doi.org/10.5281/zenodo.6823445.²⁰

Data are available under the terms of the Creative Commons Zero “No rights reserved” data waiver (CC0 1.0 Public domain dedication).

Acknowledgements

We acknowledge the local health administrations of the survey area, local people of the survey area, and the participants of the survey.

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18. Shahin MA, Bhuiyan R, Ara R, et al.: Risk Factors of Non-specific Low Back Pain in a Rural Community of Bangladesh (extended data). [Dataset]. Zenodo.2022. Publisher Full Text
19. Liang Y, Wang L, Yin X: The factor structure of the 12-item general health questionnaire (GHQ-12) in young Chinese civil servants. Health Qual. Life Outcomes. 2016 Dec; 14(1): 136–136. Publisher Full Text
20. Shahin MA, Bhuiyan R, Ara R, et al.: STROBE Checklist of Risk factors of non-specific low back pain in a rural community of Bangladesh: A case-control study. [Dataset]. Zenodo.2022. Publisher Full Text
21. Shahin MA, Bhuiyan R, Ara R, et al.: Risk Factors of Non-specific Low Back Pain in a Rural Community of Bangladesh. [Dataset]. Zenodo.2022. Publisher Full Text
22. Hartvigsen J:Risk factors for low back and neck pain: an introduction to clinical epidemiology and review of commonly suspected risk factors. Principles and practice of chiropractic. 3rd ed.New York:McGraw-Hill;2005; p. 471–478.
23. Eivazi M, Abadi L: Low back pain in diabetes mellitus and importance of preventive approach. Health Promot. Perspect. 2012; 2(1): 80–88.
24. Rinaldo L, McCutcheon BA, Gilder H, et al.: Diabetes and Back Pain: Markers of Diabetes Disease Progression Are Associated With Chronic Back Pain. Clinical Diabetes. 2017 Jul; 35(3): 126–131. PubMed Abstract | Publisher Full Text
25. Hincapié CA, Cassidy JD, Côté P: Is a history of work-related low back injury associated with prevalent low back pain and depression in the general population? BMC Musculoskelet. Disord. 2008 Dec; 9(1): 22–22. PubMed Abstract | Publisher Full Text
26. Dave VR, Khanpara HJ, Shukla RP, et al.: Risk factors of occupation related back pain and neck pain among patients attending tertiary care hospital, Ahmedabad, India. J. Prev. Med. Hyg. 2019 Dec; 60(4): E419–E427.
27. Sweetman BJ, Anderson JAD, Dalton ER: The relationships between little-finger mobility, lumbar mobility, straight-leg raising, and low-back pain. Rheumatology. 1974; 13(4): 161–166. PubMed Abstract | Publisher Full Text
28. Bidassie B, McGlothlin JD, Mena I, et al.: Evaluation of lifestyle risk factors and job status associated with back injuries among employees at a mid-western university. Appl. Ergon. 2010 Jan; 41(1): 106–114. PubMed Abstract | Publisher Full Text
29. Punnett L, Prüss-Ütün A, Nelson DI, et al.: Estimating the global burden of low back pain attributable to combined occupational exposures. Am. J. Ind. Med. 2005 Dec; 48(6): 459–469. PubMed Abstract | Publisher Full Text
30. Astrand NE: Medical, psychological, and social factors associated with back abnormalities and self reported back pain: a cross sectional study of male employees in a Swedish pulp and paper industry. Occup. Environ. Med. 1987 May; 44(5): 327–336. PubMed Abstract | Publisher Full Text | Free Full Text
31. Coenen P, Gouttebarge V, van der Burght ASAM , et al.: The effect of lifting during work on low back pain: a health impact assessment based on a meta-analysis. Occup. Environ. Med. 2014 Dec; 71(12): 871–877. PubMed Abstract | Publisher Full Text
32. Bergquist-Ullman M, Larsson U: Acute Low Back Pain in Industry: A Controlled Prospective Study with Special Reference to Therapy and Confounding Factors. Acta Orthop. Scand. 1977 Dec; 48(sup170): 1–117. PubMed Abstract | Publisher Full Text
33. Tissot F, Messing K, Stock S: Studying the relationship between low back pain and working postures among those who stand and those who sit most of the working day. Ergonomics. 2009 Nov; 52(11): 1402–1418. PubMed Abstract | Publisher Full Text
34. Amorim AB, Simic M, Pappas E, et al.: Is occupational or leisure physical activity associated with low back pain? Insights from a cross-sectional study of 1059 participants. Braz. J. Phys. Ther. 2019 May; 23(3): 257–265. PubMed Abstract | Publisher Full Text
35. Taylor ED, Theim KR, Mirch MC, et al.: Orthopedic Complications of Overweight in Children and Adolescents. Pediatrics. 2006 Jun; 117(6): 2167–2174. PubMed Abstract | Publisher Full Text
36. IbrahimiKacuri D, Murtezani A, Rrecaj S, et al.: Low Back Pain and Obesity. Med. Arch. 2015; 69(2): 114–114.
37. Tucer B, Yalcin BM, Ozturk A, et al.: Risk factors for low back pain and its relation with pain related disability and depression in a Turkish sample. Turk. Neurosurg. 2009 Oct; 19(4): 327–332. PubMed Abstract
38. Hung CI, Liu CY, Fu TS: Depression: An important factor associated with disability among patients with chronic low back pain. Int. J. Psychiatry Med. 2015 Apr; 49(3): 187–198. Publisher Full Text
39. Feyer AM, Herbison P, Williamson AM, et al.: The role of physical and psychological factors in occupational low back pain: a prospective cohort study. Occup. Environ. Med. 2000 Feb; 57(2): 116–120. PubMed Abstract | Publisher Full Text | Free Full Text

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Version 1

VERSION 1 PUBLISHED 29 Jul 2022

Author details Author details

¹ Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, 1000, Bangladesh
² Directorate General of Health Services, Dhaka, 1212, Bangladesh
³ Department of Medicine, Green Life Medical College, Dhaka, 1205, Bangladesh
⁴ Research and Publication unit, World Health Organization, Dhaka, 1212, Bangladesh

Md. Abu Shahin
Roles: Conceptualization, Investigation, Methodology, Project Administration, Validation, Writing – Original Draft Preparation, Writing – Review & Editing

Rijwan Bhuiyan
Roles: Data Curation, Formal Analysis, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Rowsan Ara
Roles: Writing – Review & Editing

Md. Nazrul Islam
Roles: Writing – Review & Editing

Minhaj Rahim Choudhury
Roles: Writing – Review & Editing

Syed Atiqul Haq
Roles: Writing – Review & Editing

Mohammad Mostafa Zaman
Roles: Formal Analysis, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

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Published: 29 Jul 2022, 11:871

https://doi.org/10.12688/f1000research.123396.1

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Shahin MA, Bhuiyan R, Ara R et al. Risk factors of non-specific low back pain in a rural community of Bangladesh: A case-control study [version 1; peer review: 1 approved with reservations, 1 not approved]. F1000Research 2022, 11:871 (https://doi.org/10.12688/f1000research.123396.1)

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Reviewer Report 30 Jul 2024

Solomon Berhanu Mogas, Department of Epidemiology, Jimma University, Jimma, Ethiopia

Not Approved

https://doi.org/10.5256/f1000research.135498.r297348

The issue raised in the manuscript is a significant public health importance condition
A community based age-sex matched case control study was conducted in a rural community of Bangladesh to assess the risk factors of non-specific LBP in 2011.
... Continue reading

The issue raised in the manuscript is a significant public health importance condition
A community based age-sex matched case control study was conducted in a rural community of Bangladesh to assess the risk factors of non-specific LBP in 2011.
The study was conducted in 2011 but, submitted for publication is too late, which is after more than 10 years. the literatures used must consider the time variation and some lacks these issue.
The findings were not interpreted well and the discussion needs detail and specific approach for separate factors to show the possible explanation and implication of the factors.
Overall, the importance of considering the paper for indexing is not significant due to late for submission for publication. There might be a lot change in those time periods.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: I have experience and interest on chronic disease, epidemiological and public health researches

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

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Reviewer Report 17 Mar 2023

Abhay Bang, Society for Education Action and Research in Community Health, Gadchiroli, Maharashtra, India

Supriyalaxmi Totiger, Society for Education Action and Research in Community Health, Gadchiroli, Maharashtra, India

Approved with Reservations

https://doi.org/10.5256/f1000research.135498.r164964

We congratulate the authors for conducting a much-needed study addressing a disease that is a significant public health issue.

Summary of the article:
A community-based case-control study was conducted in 2011, with non-specific low back pain ... Continue reading

We congratulate the authors for conducting a much-needed study addressing a disease that is a significant public health issue.

Summary of the article:
A community-based case-control study was conducted in 2011, with non-specific low back pain as cases and age and gender-matched controls. Cases to control ratio is 1:1. Selection and exclusion criteria of the cases and controls are mentioned. Exposure variable ascertainment is appropriate with variables like chronic diseases, history of trauma, prolonged sitting and standing, squatting, bending at the waist, tobacco use, overweight, distress, strenuous physical activity, and carrying a heavy load. Study population aged between 18-55 years. The odds ratio from conditional logistic regression is significantly higher among the cases than the controls establishing the risk factors of non-specific low back pain.

The methods and analysis provided have some gaps:

The sample size calculation for the study is not mentioned.
Co-morbid conditions like bronchial asthma and ischemic heart diseases are excluded in selecting cases. However, these conditions can also contribute to chronic illness in any individual.
In the exposure ascertainment variable, “Depression” is measured using General Health Questionnaire 12; the same is mentioned the table one results. In the textual interpretation of results, the term 'distress' is used. The terms 'depression' and 'distress' are used interchangeably. GHQ 12 measures nonpsychotic mental health problems associated with depression, anxiety, somatic symptoms, and social dysfunction, indicating psychological distress.
The comprehensive clinical examination used to diagnose the cases is commendable. Use of radiological investigation when in need might have led to nonuniformity in the diagnosis. Laboratory tests were not used to identify secondary causes of low back pain.

Statistical analysis and its interpretation:

In table one, the variable “Occupation related to strenuous physical activity” Odds Ratio is 0.2 [0.1-0.8] for the laborious job against the reference of Other jobs [non-laborious jobs]. In the textual interpretation part of the results, the authors have presented laborious jobs needing strenuous physical activity as one of the risk factors of non-specific LBP.

An odds ratio of less than one indicates that the exposure variable is protective against the outcome or negates the variable being the risk factors. For example, the odds ratio of 0.2, interpreted as strenuous physical activity, is not a risk factor for non-specific back pain compared to non-laborious jobs. Authors must check the possibility of a typo or suitably discuss the results and interpretation.

Some odd Features need explanations:

How was a participation rate of 97% (4850/5005) achieved especially of the asymptomatics?
Why was publication delayed, when the data were collected in 2011?
The age group {33 years, SD 9.5] is lower than expected. Backache is more common in old age.
Nearly 10% is the prevalence of LBP in this community [494 cases of LBP], which is much lesser than 18% in Bangladesh [as mentioned in the Introduction].
Among the listed authors, four have contributed only to writing, reviewing, and editing. If they did not play any role in planning, data collection, or analysis - are they eligible to be included as the authors?
How was the list of population size (5,005) selected? What is the source of the numbers?

If feasible, there are additional pointers for authors to incorporate for the better utility of the peers interested in the topics:

To mention the severity of the low back pain and the strength of its association with the risk factors.
As the occupation and activities indulged are diverse across the age groups, subgroup analysis of different age groups can help plan interventions targeting the specific risk factors.
Similarly, gender-based subgroup analysis helps to identify risk factors gender specific.
The number of risk factors per individual helps understand the severity and existence of multiple risk factors in a single individual and their relationship with the severity of low back pain.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Mother and child health, Tribal Health, Alcohol and Tobacco control, Musculoskeletal diseases, Youth training towards social change making, Low back pain.

We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however we have significant reservations, as outlined above.

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VERSION 1 PUBLISHED 29 Jul 2022

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Version 1 29 Jul 22	read	read

Abhay Bang, Society for Education Action and Research in Community Health, Gadchiroli, India

Supriyalaxmi Totiger, Society for Education Action and Research in Community Health, Gadchiroli, India
Solomon Berhanu Mogas, Jimma University, Jimma, Ethiopia

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Reviewer Report

3 Views

30 Jul 2024 | for Version 1

Solomon Berhanu Mogas, Department of Epidemiology, Jimma University, Jimma, Ethiopia

3 Views Cite this report Responses(0)

Not Approved

The issue raised in the manuscript is a significant public health importance condition
A community based age-sex matched case control study was conducted in a rural community of Bangladesh to assess the risk factors of non-specific LBP in 2011.
The study was conducted in 2011 but, submitted for publication is too late, which is after more than 10 years. the literatures used must consider the time variation and some lacks these issue.
The findings were not interpreted well and the discussion needs detail and specific approach for separate factors to show the possible explanation and implication of the factors.
Overall, the importance of considering the paper for indexing is not significant due to late for submission for publication. There might be a lot change in those time periods.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

I have experience and interest on chronic disease, epidemiological and public health researches

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

Respond to this report

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Reviewer Report

18 Views

17 Mar 2023 | for Version 1

Abhay Bang, Society for Education Action and Research in Community Health, Gadchiroli, Maharashtra, India

Supriyalaxmi Totiger, Society for Education Action and Research in Community Health, Gadchiroli, Maharashtra, India

18 Views Cite this report Responses(0)

Approved With Reservations

We congratulate the authors for conducting a much-needed study addressing a disease that is a significant public health issue.

Summary of the article:
A community-based case-control study was conducted in 2011, with non-specific low back pain as cases and age and gender-matched controls. Cases to control ratio is 1:1. Selection and exclusion criteria of the cases and controls are mentioned. Exposure variable ascertainment is appropriate with variables like chronic diseases, history of trauma, prolonged sitting and standing, squatting, bending at the waist, tobacco use, overweight, distress, strenuous physical activity, and carrying a heavy load. Study population aged between 18-55 years. The odds ratio from conditional logistic regression is significantly higher among the cases than the controls establishing the risk factors of non-specific low back pain.

The methods and analysis provided have some gaps:

The sample size calculation for the study is not mentioned.
Co-morbid conditions like bronchial asthma and ischemic heart diseases are excluded in selecting cases. However, these conditions can also contribute to chronic illness in any individual.
In the exposure ascertainment variable, “Depression” is measured using General Health Questionnaire 12; the same is mentioned the table one results. In the textual interpretation of results, the term 'distress' is used. The terms 'depression' and 'distress' are used interchangeably. GHQ 12 measures nonpsychotic mental health problems associated with depression, anxiety, somatic symptoms, and social dysfunction, indicating psychological distress.
The comprehensive clinical examination used to diagnose the cases is commendable. Use of radiological investigation when in need might have led to nonuniformity in the diagnosis. Laboratory tests were not used to identify secondary causes of low back pain.

Statistical analysis and its interpretation:

In table one, the variable “Occupation related to strenuous physical activity” Odds Ratio is 0.2 [0.1-0.8] for the laborious job against the reference of Other jobs [non-laborious jobs]. In the textual interpretation part of the results, the authors have presented laborious jobs needing strenuous physical activity as one of the risk factors of non-specific LBP.

An odds ratio of less than one indicates that the exposure variable is protective against the outcome or negates the variable being the risk factors. For example, the odds ratio of 0.2, interpreted as strenuous physical activity, is not a risk factor for non-specific back pain compared to non-laborious jobs. Authors must check the possibility of a typo or suitably discuss the results and interpretation.

Some odd Features need explanations:

How was a participation rate of 97% (4850/5005) achieved especially of the asymptomatics?
Why was publication delayed, when the data were collected in 2011?
The age group {33 years, SD 9.5] is lower than expected. Backache is more common in old age.
Nearly 10% is the prevalence of LBP in this community [494 cases of LBP], which is much lesser than 18% in Bangladesh [as mentioned in the Introduction].
Among the listed authors, four have contributed only to writing, reviewing, and editing. If they did not play any role in planning, data collection, or analysis - are they eligible to be included as the authors?
How was the list of population size (5,005) selected? What is the source of the numbers?

If feasible, there are additional pointers for authors to incorporate for the better utility of the peers interested in the topics:

To mention the severity of the low back pain and the strength of its association with the risk factors.
As the occupation and activities indulged are diverse across the age groups, subgroup analysis of different age groups can help plan interventions targeting the specific risk factors.
Similarly, gender-based subgroup analysis helps to identify risk factors gender specific.
The number of risk factors per individual helps understand the severity and existence of multiple risk factors in a single individual and their relationship with the severity of low back pain.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Mother and child health, Tribal Health, Alcohol and Tobacco control, Musculoskeletal diseases, Youth training towards social change making, Low back pain.

We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however we have significant reservations, as outlined above.

Respond to this report

Responses (0)

[1] 1. Buchbinder R, van Tulder M , Öberg B, et al.: Low back pain: a call for action. Lancet. 2018 Jun; 391(10137): 2384–2388. Publisher Full Text

[2] 2. Hoy D, Bain C, Williams G, et al.: A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012 Jun; 64(6): 2028–2037. Publisher Full Text

[3] 3. Vos T, Flaxman AD, Naghavi M, et al.: Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012 Dec; 380(9859): 2163–2196. PubMed Abstract | Publisher Full Text

[4] 4. Driscoll T, Jacklyn G, Orchard J, et al.: The global burden of occupationally related low back pain: estimates from the Global Burden of Disease 2010 study. Ann. Rheum. Dis. 2014 Jun; 73(6): 975–981. PubMed Abstract | Publisher Full Text

[5] 5. Hoy D, March L, Brooks P, et al.: The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann. Rheum. Dis. 2014 Jun; 73(6): 968–974. PubMed Abstract | Publisher Full Text

[6] 6. Fatoye F, Gebrye T, Odeyemi I: Real-world incidence and prevalence of low back pain using routinely collected data. Rheumatol. Int. 2019 Apr; 39(4): 619–626. PubMed Abstract | Publisher Full Text

[7] 7. Sharma S, McAuley JH: Low Back Pain in Low- and Middle-Income Countries, Part 1: The Problem. J. Orthop. Sports Phys. Ther. 2022 May; 52(5): 233–235. PubMed Abstract | Publisher Full Text

[8] 8. Zahid-Al-Quadir A, Zaman MM, Ahmed S, et al.: Prevalence of musculoskeletal conditions and related disabilities in Bangladeshi adults: a cross-sectional national survey. BMC Rheumatology. 2020 Dec; 4(1): 69–69. PubMed Abstract | Publisher Full Text

[9] 9. O’Sullivan P: Diagnosis and classification of chronic low back pain disorders: Maladaptive movement and motor control impairments as underlying mechanism. Man. Ther. 2005 Nov; 10(4): 242–255. PubMed Abstract | Publisher Full Text

[10] 10. Maher C, Underwood M, Buchbinder R: Non-specific low back pain. Lancet. 2017 Feb; 389(10070): 736–747. Publisher Full Text

[11] 11. Haq SA, Darmawan J, Islam MN, et al.: Prevalence of rheumatic diseases and associated outcomes in rural and urban communities in Bangladesh: a COPCORD study. J. Rheumatol. 2005 Feb; 32(2): 348–353. PubMed Abstract

[12] 12. Sidiq M, Alenazi W, Kashoo FZ, et al.: Prevalence of non-specific chronic low-back pain and risk factors among male soldiers in Saudi Arabia. PeerJ. 2021 Oct; 9: e12249–e12249. PubMed Abstract | Publisher Full Text

[13] 13. Manchikanti L: Epidemiology of low back pain. Pain Physician. 2000 Apr; 3(2): 167–192. PubMed Abstract | Publisher Full Text

[14] 14. Islam ME, Ahmed S, Shahin MA, et al.: Cross-cultural adaptation and validation of revised WHO-ILAR-COPCORD core English questionnaire translated to Bangla. Int. J. Rheum. Dis. 2021 Sep; 24(9): 1153–1166.

[15] 15. WHO-ILAR: Community Oriented Programme for Control of Rheumatic Diseases.

[16] 16. Siddiqui MNA, Islam MN, Haq SA, et al.: Development of APLAR-COPCORD Core Questionnaire for Identification of Risk Factors for Non Specific Low Back Pain. TAJ: Journal of Teachers Association. 2018 Nov; 24(2): 85–90. Publisher Full Text

[17] 17. Nordin M, Balagué F, Cedraschi C: Nonspecific Lower-back Pain. Clin. Orthop. Relat. Res. 2006 Feb; 443: 156–167. Publisher Full Text

[18] 18. Shahin MA, Bhuiyan R, Ara R, et al.: Risk Factors of Non-specific Low Back Pain in a Rural Community of Bangladesh (extended data). [Dataset]. Zenodo.2022. Publisher Full Text

[19] 19. Liang Y, Wang L, Yin X: The factor structure of the 12-item general health questionnaire (GHQ-12) in young Chinese civil servants. Health Qual. Life Outcomes. 2016 Dec; 14(1): 136–136. Publisher Full Text

[20] 20. Shahin MA, Bhuiyan R, Ara R, et al.: STROBE Checklist of Risk factors of non-specific low back pain in a rural community of Bangladesh: A case-control study. [Dataset]. Zenodo.2022. Publisher Full Text

[21] 21. Shahin MA, Bhuiyan R, Ara R, et al.: Risk Factors of Non-specific Low Back Pain in a Rural Community of Bangladesh. [Dataset]. Zenodo.2022. Publisher Full Text

[22] 22. Hartvigsen J:Risk factors for low back and neck pain: an introduction to clinical epidemiology and review of commonly suspected risk factors. Principles and practice of chiropractic. 3rd ed.New York:McGraw-Hill;2005; p. 471–478.

[23] 23. Eivazi M, Abadi L: Low back pain in diabetes mellitus and importance of preventive approach. Health Promot. Perspect. 2012; 2(1): 80–88.

[24] 24. Rinaldo L, McCutcheon BA, Gilder H, et al.: Diabetes and Back Pain: Markers of Diabetes Disease Progression Are Associated With Chronic Back Pain. Clinical Diabetes. 2017 Jul; 35(3): 126–131. PubMed Abstract | Publisher Full Text

[25] 25. Hincapié CA, Cassidy JD, Côté P: Is a history of work-related low back injury associated with prevalent low back pain and depression in the general population? BMC Musculoskelet. Disord. 2008 Dec; 9(1): 22–22. PubMed Abstract | Publisher Full Text

[26] 26. Dave VR, Khanpara HJ, Shukla RP, et al.: Risk factors of occupation related back pain and neck pain among patients attending tertiary care hospital, Ahmedabad, India. J. Prev. Med. Hyg. 2019 Dec; 60(4): E419–E427.

[27] 27. Sweetman BJ, Anderson JAD, Dalton ER: The relationships between little-finger mobility, lumbar mobility, straight-leg raising, and low-back pain. Rheumatology. 1974; 13(4): 161–166. PubMed Abstract | Publisher Full Text

[28] 28. Bidassie B, McGlothlin JD, Mena I, et al.: Evaluation of lifestyle risk factors and job status associated with back injuries among employees at a mid-western university. Appl. Ergon. 2010 Jan; 41(1): 106–114. PubMed Abstract | Publisher Full Text

[29] 29. Punnett L, Prüss-Ütün A, Nelson DI, et al.: Estimating the global burden of low back pain attributable to combined occupational exposures. Am. J. Ind. Med. 2005 Dec; 48(6): 459–469. PubMed Abstract | Publisher Full Text

[30] 30. Astrand NE: Medical, psychological, and social factors associated with back abnormalities and self reported back pain: a cross sectional study of male employees in a Swedish pulp and paper industry. Occup. Environ. Med. 1987 May; 44(5): 327–336. PubMed Abstract | Publisher Full Text | Free Full Text

[31] 31. Coenen P, Gouttebarge V, van der Burght ASAM , et al.: The effect of lifting during work on low back pain: a health impact assessment based on a meta-analysis. Occup. Environ. Med. 2014 Dec; 71(12): 871–877. PubMed Abstract | Publisher Full Text

[32] 32. Bergquist-Ullman M, Larsson U: Acute Low Back Pain in Industry: A Controlled Prospective Study with Special Reference to Therapy and Confounding Factors. Acta Orthop. Scand. 1977 Dec; 48(sup170): 1–117. PubMed Abstract | Publisher Full Text

[33] 33. Tissot F, Messing K, Stock S: Studying the relationship between low back pain and working postures among those who stand and those who sit most of the working day. Ergonomics. 2009 Nov; 52(11): 1402–1418. PubMed Abstract | Publisher Full Text

[34] 34. Amorim AB, Simic M, Pappas E, et al.: Is occupational or leisure physical activity associated with low back pain? Insights from a cross-sectional study of 1059 participants. Braz. J. Phys. Ther. 2019 May; 23(3): 257–265. PubMed Abstract | Publisher Full Text

[35] 35. Taylor ED, Theim KR, Mirch MC, et al.: Orthopedic Complications of Overweight in Children and Adolescents. Pediatrics. 2006 Jun; 117(6): 2167–2174. PubMed Abstract | Publisher Full Text

[36] 36. IbrahimiKacuri D, Murtezani A, Rrecaj S, et al.: Low Back Pain and Obesity. Med. Arch. 2015; 69(2): 114–114.

[37] 37. Tucer B, Yalcin BM, Ozturk A, et al.: Risk factors for low back pain and its relation with pain related disability and depression in a Turkish sample. Turk. Neurosurg. 2009 Oct; 19(4): 327–332. PubMed Abstract

[38] 38. Hung CI, Liu CY, Fu TS: Depression: An important factor associated with disability among patients with chronic low back pain. Int. J. Psychiatry Med. 2015 Apr; 49(3): 187–198. Publisher Full Text

[39] 39. Feyer AM, Herbison P, Williamson AM, et al.: The role of physical and psychological factors in occupational low back pain: a prospective cohort study. Occup. Environ. Med. 2000 Feb; 57(2): 116–120. PubMed Abstract | Publisher Full Text | Free Full Text

Risk factors of non-specific low back pain in a rural community of Bangladesh: A case-control study

Abstract

Keywords

Introduction

Methods

Ethical approval and consent to participate

Study design and participants

Selection of cases and controls

Figure 1. Selection of cases and controls from a rural population of Bangladesh.

Variable ascertainment

Statistical analysis

Results

Table 1. Results of conditional logistic regression for risk factors of non-specific low back pain in a rural Bangladeshi population.

Discussion

Strength and weakness of the study

Conclusions

Data availability

Underlying data

Extended data

Reporting guidelines

Acknowledgements

References

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