|Year : 2016 | Volume
| Issue : 3 | Page : 331-335
Prevalence of low back pain in salespersons and its association with ergonomic risk factors in Ahmedabad, Gujarat: A cross-sectional survey
Rutvik Shyamal Purani1, Neeta Jayprakash Vyas2, Megha Sandeep Sheth2
1 Khyati Institute of Physiotherapy, Shahibaug, Ahmedabad, Gujarat, India
2 SBB College of Physiotherapy, VS General Hospital, Ahmedabad, Gujarat, India
|Date of Web Publication||17-May-2016|
Rutvik Shyamal Purani
66-Ekatra, Vinay Vihar Society, Behrampura, Ahmedabad - 380 022, Gujarat
Source of Support: None, Conflict of Interest: None
Background: Work-related musculoskeletal disorders, especially low back pain (LBP), cause substantial economic loss to individuals as well as to the community. Salespersons in department stores are at an increased risk of developing musculoskeletal symptoms. Among these, LBP is most extensively reported. Their jobs involve prolonged standing and manual handling tasks such as lifting, carrying, pushing, and pulling which have been identified as risk factors for musculoskeletal symptoms. Objectives: To find out the prevalence of LBP in salespersons and its association with ergonomic risk factors. Materials and Methods: A cross-sectional survey consisting of 150 salespersons from different malls between 20 and 40 years with body mass index between 18 and 24 kg/m 2 , having at least 1-year working experience and standing for 5 h/day, was conducted in Ahmedabad. Those with a history of trauma, preexisting medical conditions, or musculoskeletal deformities were excluded. One-year prevalence of self-reported LBP was assessed using Standardized Nordic Pain Questionnaire. Individual factors and ergonomic risk factors were also assessed. The level of significance was set at 5%. Statistical software GraphPad Prism version 5 was used for analysis. Results: One-year prevalence of self-reported LBP was 58%. Frequency of prolonged forward bending and twisting the body was significantly associated with LBP (P < 0.001). Working in static posture for longer periods during work was also associated with LBP (P < 0.01). Conclusion: Prevalence of self-reported LBP in salespersons of Ahmedabad was 58%, and it has a significant association with ergonomic risk factors.
Keywords: Ergonomics, low back pain, Nordic questionnaire, risk factors, salespersons, work-related musculoskeletal disorders
|How to cite this article:|
Purani RS, Vyas NJ, Sheth MS. Prevalence of low back pain in salespersons and its association with ergonomic risk factors in Ahmedabad, Gujarat: A cross-sectional survey. Med J DY Patil Univ 2016;9:331-5
|How to cite this URL:|
Purani RS, Vyas NJ, Sheth MS. Prevalence of low back pain in salespersons and its association with ergonomic risk factors in Ahmedabad, Gujarat: A cross-sectional survey. Med J DY Patil Univ [serial online] 2016 [cited 2022 Dec 2];9:331-5. Available from: https://www.mjdrdypu.org/text.asp?2016/9/3/331/182503
| Introduction|| |
Work-related musculoskeletal disorders (WMSDs), are a common cause of work-related disability among workers with substantial financial consequences, due to workers' compensation and medical expenses. World Health Organization has defined a work-related disorder as one that results from a number of factors, and where the work environment and the performance of the work contribute significantly, but in varying magnitude, to the causation of the disease. , WMSDs represent a leading cause of occupational injury and disability in the developed and industrially developing countries such as India.  Salespersons in department stores are at an increased risk of developing musculoskeletal symptoms because they are exposed to various physical and psychological factors. Among these, low back pain (LBP) is most extensively reported.  Their jobs involve prolonged standing and manual handling tasks such as lifting, carrying, pushing, and pulling which have been previously identified as risk factors for musculoskeletal symptoms. Thus, they inevitably encounter various physical and psychological problems involving aspects of work content, organization, and interpersonal relationships. In India, a large number of salespersons are employed in department stores, of which there are many in large cities, especially in Ahmedabad. The study, therefore, aimed to determine the prevalence of LBP in salespersons in Ahmedabad and its association with ergonomic risk factors. Recognition of these factors, associated with musculoskeletal symptoms in salespersons, is necessary for rational decisions concerning the development of effective preventive measures, where ergonomics can play a very big role.
| Materials and Methods|| |
A pilot study was conducted on 50 subjects, and prevalence of LBP was found to be 50%. At confidence level (alpha) of 95%, power of study (beta) at 0.80, and confidence interval of 8, estimated sample size was found to be 150. A cross-sectional survey was then conducted in a sample of 150 salespersons from the different department stores (malls) of various areas in Ahmedabad. All participants were normal, healthy individuals of the age group of 20-40 years with body mass index ranging from 18 to 24 kg/m 2 . Those with working experience of at least 1-year and those who worked in standing posture for an average of 5 h or more were included. Those with a relevant history of trauma and preexisting medical conditions such as diabetes and hypertension or any obvious musculoskeletal deformities such as scoliosis and genu valgum were excluded. Institutional Ethics Committee approval was obtained. The study was explained to the subjects and written informed consent was obtained.
A three-part self-administered questionnaire concerning the musculoskeletal symptoms with information about the study was distributed to each salesperson by hand, and a contact number of a staff member was provided, in case further explanation would be required. The participants were asked to complete the questionnaire with no question left unanswered and return it at the moment itself, and hence there were no nonrespondents reported. Total time taken to complete the questionnaire was 10-15 min. Part 1 collected information regarding the participant's personal characteristics and included questions about age, gender, height, body weight, educational level, marital status, and number of children. It also included questions regarding level of education, duration of employment, and absenteeism from work. Part 2 collected information regarding ergonomic risk factors, which included the years of working experience, number of working days per week, number of working hours per day, and number of working hours requiring standing. Respondents were asked the frequency of performing various physical activities during working day (such as bending, twisting, climbing stairs, sitting, standing, lifting, pushing/pulling, and working in static posture) and frequency of rest breaks during work. Frequency of these activities was rated by the subject into four categories (1 = never, 2 = occasionally, 3 = often, and 4 = very often). For data analysis, the first two categories (almost never-occasionally) were combined as well as the last two categories (often and very often) were combined and converted into dichotomous variables. Part 3 assessed occurrence of LBP using a Standardized Nordic Questionnaire.  The questionnaire included a diagram with the anatomical region of low back, clearly marked. Participants were asked, whether they had or have had troubles in the indicated area during the preceding 12 months.
The level of significance was set at 5%. Data was analyzed using Statistical software Graph Pad Prism 5 for Windows [Version 5.03] by Software Mackiev. Prevalence of LBP was determined, and its association with ergonomic risk factors was analyzed using Chi-square in 2 × 2 contingency tables.
| Results|| |
One hundred and fifty salespersons participated in the study, of which, 90 (60%) were males and 60 (40%) were females, with a mean age of 32.02 ± 3.05 years. 20% of the participants had primary education, 40% had secondary education, and 32% had bachelor's degree while 10% were included in others. Fifty-four percent of the participants had children while 13% did not have. Years of working experience were divided into three groups: 1-5 years, 6-10 years, and 11-15 years. Forty-seven percent of the participants had working experience of 1-5 years, 35% of the participants who had experience of 6-10 years of working, and 18% of the participants who had experience of 11-15 years of working. The average working hours requiring standing per day was scaled into two classes: Standing for ≥5 h and standing for <5 h. There were 57% of the participants whose work required standing for ≥5 h and 43% of the participants whose work required standing for <5 h. [Table 1] shows the descriptive statistics of participants. [Table 2] shows the association of LBP with ergonomic risk factors and their odds ratio along with P value according to gender distribution. Prevalence of LBP in salespersons according to age distribution is shown in [Table 3]. The number of sick leaves taken (in days) by those with LBP is shown in [Table 4]. Treatment received by those with LBP in the form of drugs, physiotherapy, none, or both is displayed in [Table 5]. Chi-square test was applied to find their association of LBP with risk factors as shown in [Table 6].
The results revealed that the frequency of prolonged forward bending and twisting the body was significantly associated with musculoskeletal symptoms of the lower back. Also, working in static posture for longer periods during work was found to be associated with lower back symptoms. The subjects, who reported prolonged forward bending, were at a greater risk of experiencing such symptoms compared to those who never or occasionally worked in such posture (χ2 = 12.48, P < 0.001). Those whose work involved twisting the body also were at a greater risk (χ2 = 11.06, P < 0.001). The subjects working in static posture during work also reported lower back symptoms (χ2 = 8.97, P < 0.01).
| Discussion|| |
In this survey of 150 salespersons, 1-year prevalence rate of LBP was found to be 58 ± 7.9%. This is consistent with the findings reported by salespersons around the world.  The sustained muscle activity has been previously reported as a risk of developing musculoskeletal symptoms. Prolonged standing requires the continuous contraction of some muscles in the legs, pelvis, and spine to maintain posture and balance as well as to defy gravity.  Much in line with these findings, the present study shows a significant association between the frequency of working in static posture and LBP. The findings of this study were also similar to those reported by previous studies in other occupations that involve prolonged standing such as professional cooks  or nurses  or physical therapists.  Other studies identified LBP as the most prevalent type of WMSD among therapists, followed by injuries of the upper back and neck. The cause of the high incidence rate of LBP among them is directly related with activities such as lifting and transferring, prolonged standing, frequent twisting and bending.
Prevalence of LBP in females was 81.7% as compared to 42.2% in males (odds ratio: 0.17; P < 0.001), suggesting higher chances of females having LBP compared to males. In a study undertaken to identify the work stressors among male and female weavers in power-loom and handloom industries by Nag et al.  showed a significant relationship of dimensions of work aspects with pain and discomfort, substantiating that the WMSDs are the results of interaction of multiple stressors associated with work and work environment and other personal factors.
The incidences of higher prevalence rate among women might be due to the physiological demand to perform the household activities, including taking care of the children and elderly at home. This reduces their physical recovery throughout the day. The females were exposed to pregnancy-related stress, which commonly affects the lower back region. Even though, the current study did not include any pregnant female salesperson, a previous study by Nordin et al.  and Bork et al.  stated that changes in spinal posture and weakening of joint structure related to a history of pregnancy increases the risk of musculoskeletal symptoms.
Prevalence of LBP was significantly associated with the frequency of prolonged forward leaning and twisting of body (P < 0.001). da Costa  concluded that a risk factor (e.g., forceful exertion) in the presence of another risk factor (e.g., repetitive work) or factors (e.g., high repetition in an awkward posture) will interact, resulting in musculoskeletal symptoms precipitation, even though definite multipliers for the interactions still needs to be defined. Karpansalo et al.  and Priya and Johnson  found strong evidence that heavy physical work with lifting, static muscular loading, and uncomfortable work positions are associated with an increased risk of occupational disability, particularly musculoskeletal disorders which is similar to the findings of this study. Limitations in this study include the possibility of overestimation or underestimation owing to the self-reported nature of questionnaire. It is also possible that some of the respondents in this study perceived their pain as work-related musculoskeletal pain regardless of whether they were caused by work or not. Finally, this study may be susceptible to the healthy worker effect, according to which, salespersons suffering from pain of musculoskeletal origin due to work, may have moved onto other jobs and, therefore, would have been missed during the present study.
| Conclusion|| |
Prevalence of the self-reported LBP was 58% among a population of salespersons in Ahmedabad, Gujarat. Certain ergonomic risk factors are significantly associated to the occurrence of LBP among salespersons.
The authors would like to thank Dr. Hemant Tiwari for valuable insight on statistics.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
World Health Organization, Protecting Workers′ Health Series No. 5, Preventing Musculoskeletal Disorders in the Workplace; 2003. [Internet] 2015. Available from: http://www.who.int/occupational_health/en/
[Last accessed on 2015 Dec 3].
Buckle P, David G. In: Magazine 3, Preventing Work-related Musculoskeletal Disorders. European Agency for Safety and Health at Work. Luxembourg: Publications Office of the European Union. EU-OSHA; 2000. p. 5. ISBN 978-92-9191-261-2. DOI: 10.2802/10952.
Shahnavaz H. Workplace injuries in the developing countries. Ergonomics 1987;30:397-404.
Pensri P, Janwantanakul P, Chaikumarn M. Prevalence of self-reported musculoskeletal symptoms in salespersons. Occup Med (Lond) 2009;59:499-501.
Kuorinka I, Jonsson B, Kilbom A, Vinterberg H, Biering-Sørensen F, Andersson G, et al.
Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon 1987;18:233-7.
Pensri P, Janwantanakul P, Chaikumarn M. Biopsychosocial risk factors for musculoskeletal symptoms of the spine in salespeople. Int J Occup Environ Health 2010;16:303-11.
Nagasu M, Sakai K, Ito A, Tomita S, Temmyo Y, Ueno M, et al.
Prevalence and risk factors for low back pain among professional cooks working in school lunch services. BMC Public Health 2007;7:171.
Smith DR, Wei N, Kang L, Wang RS. Musculoskeletal disorders among professional nurses in mainland China. J Prof Nurs 2004;20:390-5.
Mierzejewski M, Kumar S. Prevalence of low back pain among physical therapists in Edmonton, Canada. Disabil Rehabil 1997;19:309-17.
Nag A, Vyas H, Nag PK. Gender differences, work stressors and musculoskeletal disorders in weaving industries. Ind Health 2010;48:339-48.
Nordin NA, Leonard JH, Thye NC. Work-related injuries among physiotherapists in public hospitals: A Southeast Asian picture. Clinics (Sao Paulo) 2011;66:373-8.
Bork BE, Cook TM, Rosecrance JC, Engelhardt KA, Thomason ME, Wauford IJ, et al.
Work-related musculoskeletal disorders among physical therapists. Phys Ther 1996;76:827-35.
Da Costa BR, Vieira ER. Risk factors for work-related musculoskeletal disorders: a systematic review of recent longitudinal studies. Am J Ind Med 2010;53:285-323.
Karpansalo M, Manninen P, Lakka TA, Kauhanen J, Rauramaa R, Salonen JT. Physical workload and risk of early retirement: Prospective population-based study among middle-aged men. J Occup Environ Med 2002;44:930-9.
Priya DV, Johnson P. Evaluation of the relationship between workload and work capacity in petrochemical and tannery workers - A pilot study. Life Sci Med Res 2010;19:1-12.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]