IMPACT OF LOW BACK PAIN ON THE QUALITY OF LIFE AMONG ADULT PATIENTS ATTENDING THE GENERAL OUTPATIENT CLINIC OF UNIVERSITY OF UYO TEACHING HOSPITAL,UYO, NIGERIA.

SUMMARY

Background

Low back pain is a major musculoskeletal problem in the society, producing significant restrictions on daily activities, hence decrease in overall quality of life. Low back pain has considerable negative impact on the quality of life of affected persons and on their families. This study was  aimed to assess the impact of low back pain on  health-related quality of life among adult patients attending the General Outpatient Clinic of the University of Uyo Teaching Hospital, Uyo, Nigeria.

Methods

A cross-sectional study of four hundred (400) adults aged eighteen years and above , attending the General Outpatient Clinic of the University of Uyo Teaching Hospital, Uyo was carried out from May to July 2011. The subjects were administered questionnaires           (semi-structured and WHOQOL-Bref) which sought information on socio-demographic characteristics, presence or absence of low back pain and risk factors for low back pain as well as  Healthrelated quality of life.

Results

The results were analyzed using Epi info statistical software version 3.2.2. The mean age of the subjects was 38.5±14.2 years. There were 176 males and 224 females in ratio 1:1.3 respectively. The overall prevalence of low back pain was 31.0%. Statistically significant risk factors were age (X²= 103.3, p<0.0001), marital status (X²= 25.72, p<0.0001), educational level (X²= 13.82, p=0.0002), place of residence (X²=6.04, p=0.01), alcohol intake (X²= 11.96, p=0.0005), cigarette smoking (X²= 10.02, p=0.0015), body mass index (X²= 120.29, p<0.0001), lifting activity (X²= 27.52, p=0.0001) and stressful job (X² = 29.57, p<0.0001). However, gender (X²=1.96, p=0.16), low job satisfaction (X²= 1.22, p=0.26) and prolonged sitting or bending (X²= 0.28, p=0.50) were not statistically significant.  With multiple logistic regression analysis of statistically significant risk factors, lifting activity (O.R =3.16; 95% CI = 2.04 - 4.96; p<0.0001), body mass index (O.R = 2.13; 95% CI = 1.38 – 5.31; p<0.0001) and stressful job (O.R=3.61; 95% CI= 2.25- 5.89; p<0.0001 ) retained their  statistical significance.            Subjects who had low back pain in this study showed significant impairment in the overall quality of life (X²= 153.60, p<0.0001), general health satisfaction (X²= 130.60, p<0.001), psychological (X²= 48.11, p<0.0001), social relationship (X²= 64.16, p<0.0001) and physical (X²= 81.67, p<0.001) domains of their health-related quality of life compared to subjects without low back pain. However, subjects who had low back pain in this study, did not show significant impairment in the environmental domain (X²= 0.12, p= 0.73) of health-related quality of life when compared with those without low back pain.

Conclusion

There was significant impairment in the quality of life of subjects with low back pain in this study. The prevalence of low back pain in this study was 31.0%. Risk factors for low back pain in this study were Age, Marital status, Educational level, Place of residence, Alcohol intake, Cigarette smoking, Body mass index, Lifting activity, and Stressful job. With multiple logistic regression analysis independent risk factors for low back pain identified in this study were lifting activity, body mass index, and stressful job. Health education on proper lifting methods , life style modification and the reduction of stress at work should be encouraged. Improvement in Health-related quality of life especially with regards to the psychological, social and physical indices will enhance positive quality of life in patients with low back pain.

                           TABLE OF CONTENTS

Title:-----------------------------------------------------------------------------------------------------i

Declaration:--------------------------------------------------------------------------------------------ii

Certification:-------------------------------------------------------------------------------------------iii

Dedication:---------------------------------------------------------------------------------------------v

Acknowledgement:-----------------------------------------------------------------------------------vi

Table of contents:------------------------------------------------------------------------------------vii

List of tables and figures:----------------------------------------------------------------------------ix

Abbreviations:-----------------------------------------------------------------------------------------x

Summary:----------------------------------------------------------------------------------------------1

CHAPTER ONE

Introduction:-------------------------------------------------------------------------------------------4

Statement of the problem:----------------------------------------------------------------------------6

Relevance of the study:-------------------------------------------------------------------------------7

Objectives of the study:-------------------------------------------------------------------------------9

CHAPTER TWO

Review of Literature:--------------------------------------------------------------------------------10

CHAPTER THREE

Subjects, Materials and Method:-------------------------------------------------------------------38

CHAPTER FOUR

Results:-------------------------------------------------------------------------------------------------47

CHAPTER FIVE

Discussion:---------------------------------------------------------------------------------------------66

Limitation:----------------------------------------------------------------------------------------------76

Conclusion and Recommendations:-----------------------------------------------------------------77                                                               vii References:----------------------------------------------------------------------------------------------79

                                      CHAPTER ONE

                                                 INTRODUCTION

 

       Low back pain is a major musculoskeletal problem in the society, producing significant restrictions on daily activities,  hence decrease in overall quality of life.¹    Low back pain is defined as episodes of pain or discomfort occurring in the region between the 12^th rib and

gluteal folds, that interrupts daily activities and/or requires treatment or consultation.^1-5 Although Low back pain attracts a lot of attention in medical literature, researches seldom focus on assessing Health-related quality of life in patients with this disorder. Patients with low back pain suffer a myriad of psychological problems with impairment in dimensions of life directly affected by the overall state of health commonly referred to as Health-related quality

of life.⁶

Health-related quality of life (HRQOL) refers to how health impacts on an individual’s ability to function and his or her perceived well-being in physical, mental and social domains of life.⁷ The World Health Organization quality of life study group defines quality of life  as

an individual’s perception of their position in life in the context of the culture and the value system in which they live and in relation to their goals, expectation, standards and concerns.⁸

It is a concept affected in a complex way by the person’s physical health, psychological state, personal beliefs, social relationship and their relationship to salient features of the environment.⁸

Individuals with low back pain might develop major physical, social and mental disruptions, which could affect their occupation.⁹ Physical impact includes loss of physical function and deteriorated general health while social impact includes decreased participation in social activities. Psychosocial impacts are manifested through insomnia, irritability, anxiety and

depression.¹⁰

An estimated five million of the World’s population are reported to be disabled by low back pain.¹¹ World-wide estimate of the prevalence of low back pain vary from 59 to 84 percent.¹² In Africa, one systematic review of multicentre studies reported a mean prevalence of 32

percent and one year prevalence of 50 percent.¹ In Nigeria, few community-based studies have

reported prevalence range of 20 to 44 percent.¹³

Low back pain can be acute (less than 12weeks) or chronic (more than 12weeks) with significant impairment in functioning. It can be mechanical (due to acute or cumulative traumatic events) or  non-mechanical ( due to infection or malignancy).¹⁴

Low back pain has been associated with certain risk factors. The risk factors include heavy physical work, frequent bending, twisting, lifting, static postures such as prolonged sitting, psychological factors related to work such as stress at work and low job satisfaction.^3,13,15-17

Pharmacological and non-pharmacological treatments have been used in the management of low back pain.¹⁴ Non-pharmacological treatments include staying active, behavioural therapy, acupuncture, spinal manipulation, massage therapy, traction, electromyographic biofeedback, lumbar support, temperature treatments ( diathermy, ice, heat) and transcutaneous nerve stimulation. Pharmacological treatments such as non-steroidal anti-inflammatory drugs, opioid analgesics, antidepressants, muscle relaxants and injection therapy (epidural, local and facet

joint) have been used.¹⁴

Of recent, there has been an increasing drive towards health-related quality of life studies in Africa. Several studies on quality of life have been carried out in the West African countries including Nigeria.^18-20 One of the major reasons for this increase in quality of life studies is because, measuring quality of life allows for a more comprehensive understanding of the burden of an illness. This study is therefore aimed at assessing the impact of low back pain on the quality of life of affected patients .

 

1.1   STATEMENT OF THE PROBLEM

Low back pain is a considerable health problem affecting people both in the developed and developing countries.²¹ It is reported that most people will experience one episode of low back pain during their life time.^21,22 Low back pain may worsen over time, becoming chronic and influenced by both physical and psychological factors.²³

Low back pain is the most prevalent musculoskeletal disorder and a common cause of disability and inability to work. Together with other musculoskeletal disorders, it accounts for about 4.3 percent disability life adjusted years( years living with disability) in the developed world, while it is reported to account for approximately 1.0 percent in the developing world.²⁴ It is also reported that less than 50 percent of people who have been off-work for six months due to low back pain will return to work but that after two years of work absenteeism the chance of returning to work is almost zero.¹⁴ 

Although several research work on low back pain exist, only few have been carried out in Sub-saharan Africa and in Nigeria. In addition, data on impact of low back pain on quality of life of patients with the disorder are scarce in medical literature.

 

1.2  RELEVANCE/JUSTIFICATION OF THE STUDY

The clinical assessment of low back pain traditionally focuses on function, with little attention given to its effect on quality of life of patients. Low back pain has significant negative impact on the patients, their families and communities. The economic impact of low back pain is also enormous since it is not only limited to cost of diagnosis and treatment but includes lost time at work, decreased productivity and indirect cost to the society.

Majority of Low back pain patients visit the Family Physicians often. Consequently, the Family Physician must include in his or her skills a systematic and reasonable approach to assessment and management of low back pain. The approach would  involve understanding the biopsychosocial factors aggravating low back pain and intervening in these areas, with the aim of getting the patient to function optimally and improving quality of life.

The result from this study would therefore help the clinician to better appreciate how low back pain impairs, or impacts on, the subjective well-being of affected patients, so that an improvement in treatment decisions can be made. It would also give an insight into the prevalence of low back pain and associated risk factors in the General Outpatient Clinic (GOPC) of the University of Uyo Teaching Hospital; so that recommendations can be made on how to apply those risk factors that are modifiable.

1.3  OBJECTIVES OF THE STUDY

General  Objective

To assess the impact of Low back pain on the quality of life among adult patients attending the General Outpatient Clinic (GOPC) of the University of Uyo Teaching Hospital (UUTH); with a view to recommending measures to apply on modifiable risk factors and improve quality of life in affected patients.

Specific Objectives

The specific objectives of this study were to:

(1)Determine the prevalence of low back pain among adult patients attending the GOPC of

the University of Uyo Teaching Hospital.

(2)Identify risk factors associated with low back pain among adults patients attending the        GOPC of the University of Uyo Teaching Hospital.

(3)Assess the impact of low back pain on the quality of life of adult patients  attending the           GOPC of the University of Uyo Teaching Hospital.

IMPACT OF LOW BACK PAIN ON THE QUALITY OF LIFE AMONG ADULT PATIENTS ATTENDING THE GENERAL OUTPATIENT CLINIC OF UNIVERSITY OF UYO TEACHING HOSPITAL,UYO, NIGERIA.

 

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