The specific objectives of the study are to:

• Assess the prevalence of low back pain among health workers in a privately owned teaching hospital in Nigeria
• Investigate the prevalence of low back pain interference with the activity of daily living among health workers in a privately owned teaching hospital in Nigeria, and
• Identify the strategies adopted in the management of low back pain among health workers in a privately owned teaching hospital in Nigeria.

Associations between variables: (a) sociodemographic variables (i.e., age, gender) and prevalence of low back pain, and (b) interference with activities of daily living across different categories of health workers, were evaluated.

A cross-sectional research design was employed in this study. The study was conducted among healthcare workers in a privately owned teaching hospital in the Southwestern Region of Nigeria. The teaching hospital is one of the foremost private teaching hospitals in Nigeria. The medical centre that transformed into the teaching hospital has a history of existence for over a hundred years. A total of one hundred and ninety-seven (197) healthcare workers were recruited from the wards and units of the hospital using a simple random sampling technique. However, only one hundred and eighty-nine (189) healthcare workers eventually participated in the study. Nurses, doctors, pharmacists, laboratory scientists, technicians, physiotherapists, ward aids, and cleaners working in the hospital participated in the study.

All the categories of HCWs, namely nurses, doctors, pharmacists, laboratory scientists, technicians, physiothe-rapists, ward aids, and cleaners in the hospital, were included in the study. While those on any form of leave (maternity, study, and annual leave) were exempted from the study.

The LBP questionnaire [15] and the Nordic Muscu-loskeletal Questionnaire [28] were used in this study. The former has 16 items and two sections in total. The first section consists of six (6) items, asking questions about the socio-demographic characteristics of the participants. The socio-demographic data collected were gender, age, marital status, level of education, and professional years of service. The second section consists of 10 items, eliciting information about the prevalence of LBP.

The Nordic Musculoskeletal Questionnaire is a 29-item scale divided into two (2) sections. The first section has a 24-item all-answerable to “Yes or No” type of scale, assessing the interference of LBP with participants’ activities of daily living and work. The last section consists of 5 items scale, assessing strategies adopted in the management of LBP among participants. The LBP questionnaire [15] and the Nordic Musculoskeletal Questionnaire have been widely used in the assessment of prevalence, interference, and strategies adopted in the management of LBP among participants with good reliability and validity [28]. The internal consistency coefficient of this scale was tested, and the Cronbach alpha was reported to be 0.76.

In addressing the potential bias of the instrument, before the commencement of actual data collection, the questionnaire was pre-tested in 19 (10%) study subjects in another private teaching hospital, and necessary modifications were made to the instrument. Six bachelor of nursing science graduates with a research assistant were assigned for data collection. Furthermore, the self-administration technique was used for data collection. One of the authors and a research assistant (a registered nurse) were involved in data collection. A questionnaire was administered to prospective participants and retrieved the next day. Institutional permission and ethical approval (BUTH/REC/0002) were obtained from the appropriate research and ethical board for the study. Written informed consent was obtained from all healthcare workers that eventually participated in the study. Participation was made optional, and participants were duly informed that they could withdraw from the study at any time.

The sample size was determined using Cochran’s formula (n=z2 p (1-p)/e2) (Singh & Masuku, 2014). The prevalence rates of low back pain were between 53% to 87% among healthcare workers (Alnaami, et al., 2019; Mukhtad & Mohamed, 2018; Şimşek, et al., 2017; and Wong, et al., 2010). Using p = 70%, z=1.96, and e=0.05, the sample size was calculated as n= 323. The n was corrected using Taro Yamane's formula, n= N/ [1+N (e)2], where, n = sample size; N = population size - 323; e = sampling error – 0.05. Therefore, n = 179, with no response rate of 10%, n = 197 healthcare workers.

Self-administration technique was used for data collection. This was done face-to-face. One of the authors and a research assistant (a registered nurse) were involved in data collection. A questionnaire was administered to prospective participants in their offices and retrieved the next day. Informed consent was obtained from all healthcare workers that eventually participated in the study. Confidentiality of information was addressed by asking them not to put identifiers. Participation was optional, and participants were duly informed of their right to withdraw from the study. Recruitment of participants for the study started in October, 2019, and the process of data collection ended in February, 2020.

Data were checked for completeness. The cleaned and missing data were re-entered by cross-checking from the hard-copy questionnaires. The part of the scale assessing interference with the activity of daily living was recorded as “1” for “Yes” and ‘0” for “No”. The total mark obtainable was found to be 24 and the least “0”. The score was converted to a “0” to “10” scale to correspond with the visual analog pain scale. A score of “0” was regarded as no interference with activities of daily living, a score of “1” to “3” mild interference with activities of daily living, “4” to “6” moderate interference with the activity of daily living, and “7” to “10” severe interference with the activity of daily living. Descriptive (mean and percentages) and inferential (chi-square and ANOVA) statistics were used for data analysis. The level of significance was set at P <0.05. SPSS version 23 was used for all the analyses.

A total of 197 questionnaires were administered, and 189 were returned (95.9%). Most healthcare workers that participated in the study were female (72.9%), with one out of every four participants between the ages of 20 and 30 years (Table 1). Only 8 (4.3%) of the participants were above 50 years of age. Most of the participants were married (63.3%), and the majority completed a tertiary level of education (81.4%). Nurses (36.7%) and doctors (22.3%) accounted for more than half of the participants in this study. Also, results, as presented in the Table, revealed that 61.2% of the healthcare workers in this study were within their first 10 years of practice.

The findings of this study (Table 2) revealed the lifetime, 12-month, and 7-day prevalence rates of LBP among the healthcare workers in the study to be 87.3%, 84.7%, and 54.5%, respectively. However, only 9.0% and 11.1% had been hospitalized or changed jobs/duties because of LBP, respectively. Furthermore, 54.5% said LBP had reduced their work activities in the last 12 months, while 29.6% said LBP had resulted in their reduced leisure time. More than half (51.3%) of the healthcare workers said LBP had caused between one to seven days of work absenteeism and 21.2% said they had been absent from work for eight to thirty days in the last year.

Interference of LBP with activities of daily living among participants showed that 68.1% constantly changed positions to promote comfort because of LBP (Table 3). Forty-three (43%) opined that LBP makes them walk slowly; 15.4% said they could only walk a short distance because of LBP, while 35.6% mentioned they lie down very often because of LBP. Results further showed that 17.0% found it difficult to get out of the chair because of LBP, while 30.3% usually held something to get stand up. Fifty-four (28.7%) of participants in this study believed that LBP usually prevents them from doing their normal house chores, while 25.0% mentioned that they had to depend on people to do things for them because of their back pains.

Findings from this study further showed that LBP had prevented more than half (53.1%) of the health workers from performing their activities of daily living in the last month. About one-tenth (8.5%) had been hospitalised before because of LBP.

A summary of the interference of LBP with the activities of daily living of the participants showed that more than half (58.7%) of the participants had mild inferences of LBP with their activities of daily living. It was found that low back pain severely interfered with the activities of daily living of a few (4.2%) of the healthcare workers, while LBP did not interfere with the activities of daily living of 12.7% of the workers (Fig. 1).

Fig. (1). Severity of interference of LBP with activities of daily living.

Healthcare workers in this study adopted several strategies to manage LBP. Findings showed that the healthcare workers in this study adopted both pharmacological and non-pharmacological strategies to manage LBP. Results, as presented in Table 4, showed that 69.3% of healthcare workers use analgesics to relieve LBP. Interestingly the most used strategy was found to be the non-pharmacological. The majority (78.3%) of participants mentioned that they usually massage the back to relieve pain, while those that engage in exercise to manage LBP experiences were found to be 72%.

No significant relationship was found between gender (X² = 0.31, P>0.05), age (X² = 1.52, P>0.05), marital status (X² = 2.93, P>0.05) of HCWs, and prevalence of LBP among the healthcare workers in this study (Table 5).

A significant difference was found in the mean interference of LBP with activities of daily living across the different categories of healthcare workers that participated in the study [F= (7,181) 3.58, P = 0.01] (Table 6).

The findings of this study revealed the 12-month and 7-day prevalence rates of LBP among healthcare workers to be 87.3%, 84.7%, and 54.5%, respectively. Our finding was similar to the study carried out among healthcare workers in southwestern Saudi Arabia, where the overall prevalence of low back pain in 12 months was 73.9% [12]. It should be noted that prevalence data can differ from country to country. Shieh et al. [26] conducted a study among nurses in Taiwan, and a prevalence of 72% was found. In Turkey, LBP was found to be 53% among healthcare workers [14]. It was also established in a study in North-west Nigeria that low back pain among healthcare workers was 29% [32]. In Sokoto, Nigeria, the prevalence of low back pain among healthcare workers was 56.2%, 39.1%, and 17.2%, respectively [29]. These empirical data give insight into the global and local magnitude of low back pain among healthcare workers, which is of great concern. Furthermore, it has been reported in this study that HWCs had been hospitalised or changed jobs/duties because of LBP. In addition, respondents with LBP reduced their work activities in the last 12 months, and LBP has reduced the leisure time of the HCWs. More than half of the participants affirmed that LBP has caused between one to seven days of work absenteeism. Moreover, some took leave from work for eight to thirty days in the last year. Our findings were in agreement with that of Kotowski [33], where it was reported that HCWs take the least time off from work or lost time due to LBP. However, Abolfotouh et al. [34] conducted a study on nurses in Doha, Qatar, and reported individuals seeking medical care for LBP, possibly progressing to taking time off work for LBP, which culminated over time. Likewise, 13% of HWCs in Riyadh, Saudi Arabia, who had back pain took days off from work [35]. The increase in the prevalence of low back pain among the study participants could be that the nature of the work of each HWC contributed greatly to LBP. For instance, the doctors and physiotherapists sitting hours for consultation are long, while nurses work long hours without an adequate break during each shift.

The current study reported that for participants suffering from LBP, their activities of daily living are interfered with, and they constantly change positions to promote comfort. Healthcare workers also reported that LBP makes them walk slowly and short distances; some participants mentioned they lie down very often because of LBP. Results further showed that participants find it difficult to get out of the chair, while they usually hold something to stand up. Participants also reported that LBP usually prevents them from doing their normal house chores, and they have to depend on people to do things for them because of their back pains. Our study aligns with that of Mekonnen [19], stating that the majority of HCWs in Western Ethiopia had limited activity due to low back disorder. Low back pain interfering with activities of daily living and constant change in the positions to promote comfort among HCWs could be a result of the severity of the pain they experience daily.

A summary of the interference of LBP with the activity of daily living showed that more than half of the participants had mild inference of LBP with their activities of daily living. This aligns with a study conducted by Yiengprugsawan [36], where difficulties in getting dressed, walking, climbing stairs, and bending/kneeling were reported to interfere with activities of daily living [36]. Moreover, 72.2% of HCWs in Western Ethiopia had limited activity due to low back disorder [19]. One can be concluded from the findings of this study that LBP is the most prevalent musculoskeletal condition, and this causes pain or discomfort. This leads to activity limitation that results in a significant loss in productivity at work.

Findings showed that the healthcare workers in this study adopted both pharmacological and non-pharmacological strategies to manage LBP. Interestingly, the most used strategy was found to be non-pharmacological, which includes massaging the back for relief and engagement in exercises. Studies have also shown that HCWs' coping strategies for LBP included praying, hopping, and increased behavioural activity [37, 38]. At variance with our study is that of Ayanniyi et al. [39], where it was reported that the most common intervention in the management of back pain among adolescents in Nigeria is the use of pharmacologic agents through self-medication [39]. The decision by HWCs in the present study to use non-pharmacological agents probably was that they weighed the long-term effect of the damage that pharmacology agents could cause systemically. Consequentially, there was no significant relationship between the gender, age, and marital status of HCWs and the prevalence of LBP among the healthcare workers in this study. This is similar to the study carried out in Nigeria, where it was reported that gender had no association with back pain [39]. At variance with our study, older age and female sex were found to be significantly associated with LBP among HCWs in Sokoto, Nigeria [2, 12]. Furthermore, a significant difference was reported in the mean interference of LBP with activities of daily living across the different categories of healthcare workers that participated in the study. Similar to the findings in this study, previous studies have shown that the LBP was significantly more prevalent among HCWs and interfered with activities of daily living of cleaners/ward attendants, medical doctors, nurses, and other categories of HCWs in Sokoto, Nigeria, and Iran [29, 11]. It could be inferred from our study that perhaps the nature of the job of these categories of HCWs, such as long hours at work, carrying patients, bending to work, and performing repetitive tasks, might have accounted for this finding.

Study limitations are mostly related to the fact that this study is a cross-sectional descriptive study. Moreover, there is an inability to generalise findings to men and HWCs over the age of 50 years. The management of low back pain instrument lists only five (5) strategies to manage low back pain in this study. However, many other strategies were not included that an open-ended question would have captured. Also, evaluating the correlation between the management of low back pain and other study variables is recommended for future studies. However, this study still provides empirical findings from a privately owned teaching hospital in a developing country, like Nigeria.

By leveraging on non-pharmacological management of LBP data, the health industry can transform how to conduct clinical research and provide maximum benefit to healthcare workers with LBP in the future. Incorporating non-pharmacological management in the health care system among HCWs in practice will stimulate critical thinking for educators, underscoring the importance of teaching students about non-pharmacological skills they need to support and prevent LBP while in practice. Adoption of non-pharmacological management of LBP among HCWs should be a critical decision; therefore, policymakers need to ensure its implementation in the healthcare sector. This is because it prevents the side effect of prolonged use of pharmacological agents.