Occupational back pain in Iranian nurses: an epidemiological study I t is well documented that low back pain (LBP) is a common and costly condition (Leboeuf-Yde and Kyvik, 1998; Maniakis and Gray, 2000). LBP and its associated impairment and disability are significant medical and social problems (Waddell, 1998). A large number of people (60%–80%) will suffer at least one episode of LBP sometime in their life (Clinical Standards Advisory Group (CSAG), 1994) and some (30%–40%) will experience LBP each year (Worku, 2000; Waddell and Burton, 2001). While the majority of people with acute LBP improve regardless of the treatment they are given, a minority of patients remain resistant to treatment, which leads to chronic pain and disability (Twomey and Taylor, 1995; Koes et al, 1996). In the US, LBP is the leading cause of missed work and Most research done on LBP in nurses has been epidemiological, using questionnaires and interviews. Variations in prevalence rates may be a result of different methodologies used, variations in the definition of LBP, prevalence periods (such as point vs lifetime prevalence, small sample size, etc.) On the other hand, the research in Iran is very limited in this area. Therefore, a 4-year prospective study including a cross-sectional and a randomized controlled clinical trial was designed, targeting licensed nurses in 13 general hospitals in northern Iran to: a) Investigate the prevalence and risk factors for back injuries in the work conditions that are typical for nursing personnel b) Analyse how individual and occupational characteristics contribute to the risk of injuries c) Evaluate the effects of different interventions (such as an ergonomic advice programme, separately/combined with an exercise programme and a no-intervention control group) to set up preventive strategies for LBP in nurses. This article only addresses the data collected from the first part of the study concerning the epidemiological aspects of LBP in licensed nurses. Details and results of the interventions will be discussed later. Material and methods Following ethical approval from the Mazandaran University of Medical Sciences and Health Services Medical Ethics Board, 1300 licensed nurses from 13 general hospitals in northern Iran were randomly invited to participate. Nurses were included if they were currently working (for a period of at least 1 year) in general hospitals and willing to take part. The exclusion criteria were: Previous history of back surgery Back tumour Spinal deformities (e.g. scoliosis) Malignancy Osteoporosis Multiple sclerosis Pregnancy Unwilling to participate. n n n n n n n n Abstract The aim of this study was to identify the prevalence and risk factors for low back pain (LBP) in nursing personnel and to analyze how individual and occupational characteristics contribute to the risk of LBP. Following ethical approval, 1226 nurses were randomly recruited from 13 general hospitals in northern Iran. Different questionnaires were designed to cover personal and professional data, the prevalence, and associations of risk factors with LBP. Results indicated that prevalence of LBP in nurses was over 50%. Lifting was the most common mechanism for LBP (30.4%). Prolonged standing and rest were found to be the significant aggravating and relieving factors (57.6% and 59.2%, respectively). Absence from work because of LBP in the month before the questionnaire was completed was reported by 33.7% of the sample. The results demonstrate that the magnitude of LBP among nursing personnel appears to be high and therefore more resources should be allocated to prevent such an injury occuring in the nursing profession. Key words: Occupational injury n Low back pain n Nurses n Prevalence rate Mohammad A Mohseni-Bandpei is Assistant Professor, Rehabilitation Department, School of Medicine; Moulod Fakhri, Masumeh Bagheri- Nesami, Marjan Ahmad-Shirvani are Senior Lecturers, School of Nursing and Midwifery; Ali Reza Khalilian is Associate Professor, Medical Statistics Department, School of Medicine, and Masoud Shayesteh-Azar is Assistant Professor, Orthopedic Department, School of Medicine, Mazandaran University of Medical Sciences, Iran Accepted for publication: July 2006 activity restriction in those under 45 years old. It is responsible for more missed days than the common cold and is the second most common cause of referral to physician (Andersson, 1991). LBP has been estimated to cost over $80 billion annually in the US and over £6 billion in the UK in terms of medical, legal and lost production costs (Neal, 1997; Andersson, 1998; Waddell, 1998). Back injuries are a major category of occupational injuries and nursing personnel have a higher prevalence rate of back pain and a higher incidence of back injuries than most occupational groups in the healthcare sector, and in all other industries (van Doorn, 1995; Cromie et al, 2000; Trinkoff et al, 2002). Among nurses the lifetime prevalence of LBP was found to be slightly higher than in the general population, varying from 56%–90% (Smedley et al, 1995; Knibbe and Friele, 1996). Many studies have identified patient lifting and transferring tasks including heavy weights, forceful exertion and awkward and twisting postures as major factors associated with back injuries (Smedley, 1997; Ando and Ono, 2000; Fege and Herbison, 2000). Moreover, one UK study showed that back pain results in almost 30% more days of sickness absence annually in nurses than in the general population (Pheasant and Stubbs, 1992). MA Mohseni-Bandpei, M Fakhri, M Bagheri-Nesami, M Ahmad-Shirvani, AR Khalilian, M Shayesteh-Azar 914 British Journal of Nursing, 2006,Vol 15, No 17 BJN_15_17_914_7_Bandpei.indd 598 21/9/06 09:49:38