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To cite this article: Adamu Ahmad Rufai, Ismaila Adamu Saidu, Rufai Yusuf Ahmad, Omar Salad Elmi, Salamatu Umar
Aliyu, Abdurrahman Mohammed Jajere & Abbas Abdullahi Digil (2015) Prevalence and Risk Factors for Low Back Pain
Among Professional Drivers in Kano, Nigeria, Archives of Environmental & Occupational Health, 70:5, 251-255, DOI:
10.1080/19338244.2013.845139
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Archives of Environmental & Occupational Health (2015) 70, 251255
Copyright C Taylor & Francis Group, LLC
This study investigated the prevalence, risk factors, and impact of low back pain (LBP) among professional drivers in Nigeria. Two
hundred male drivers aged 1964 years were recruited in the study. Data regarding prevalence, individual risk factors, and impact of
LBP were obtained. The prevalence rate of LBP was 73.5%, and LBP have affected the driving performance of up to 74% drivers.
After adjustment for age, LBP prevalence was associated with driving for >15 hours/day (odds ratio [OR]; 95% confidence interval
[CI]): (0.04; 0.01, 0.20), driving car (5.52; 1.55, 19.64), and driving bus (10.49; 2.63, 41.82). No association was found between LBP
prevalence and years spent driving. The study found that high prevalence of LBP affected the performance of a substantial percentage
of the participants.
Keywords: long-distance driving, low back pain, prevalence, professional drivers
Low back pain (LBP) is well known as the most common mus- means of livelihood among the teeming population, we
culoskeletal disorder affecting the general population, with observed dearth of data on the prevalence of LBP and
estimated 80% incidence rate among the active population.16 its associated risk factors among professional drivers. The
It has also been recognized as one of the major causes for concern is particularly high in the industrialized cities of
decreased efficiency and well-being in the working populace, northern Nigeria such as Kano metropolis, where increased
with consequent financial, medical, and socioeconomic im- prevalence of LBP among professional drivers cannot be ruled
plications affecting individuals, employers of organizations, out.
and society at large.79 Absence from work, change of work, Several factors associated with driving vehicles were iden-
restriction to work, low productivity, and loss of work were tified as reasons why driving was rated among the high-risk
noted as the socioeconomic implications of LBP. LBP and its occupations predisposing most drivers to LBP. Among them
associated effects account for most of the regular outpatient is the nature of drivers seat and its back rest that persis-
hospital visits and casual sick leave among employees of orga- tently exert pressure on the lumbar-vertebral spines due to
nizations.1 In several instances, different kind of occupational prolonged hip position at 90 degrees.14 Other notable factors
activities and their related factors contribute significantly to include age of the drivers, numbers of years of driving ex-
the development of LBP or its exacerbation.10,11 perience, prolonged hours of driving per day with constant
High prevalence of LBP among professional drivers has vibrational forces, and frequent twisting of lumbar-vertebral
been reported in many parts of the world. According to spines, among others.12,1517 Moreover, in Nigeria, the charac-
recent surveys conducted among professional drivers at teristic nature of roads and the condition of vehicles could
Israel12 and the United Kingdom,13 prevalence of LBP was add to the risk of LBP among professional long-distance
found to be 45% and 60%, respectively. However, in Nigeria, drivers, because the roads are dilapidated and poorly main-
despite recognizing long-distance commercial driving as tained, whereas the vehicular road worthiness assessments are
not strictly followed.18
The objectives of this study were to determine the preva-
Address correspondence to Adamu Ahmad Rufai, Department lence of LBP and to identify the associated risk factors and its
of Physiotherapy, College of Medical Sciences, University of economic impact among professional drivers in Kano, Nige-
Maiduguri, PMB 1069, Maiduguri, Nigeria. E-mail: adamuar- ria. Kano, the capital of Kano State, is the second largest
ufai@gmail.com commercial city in Nigeria. It is located in the northwestern
252 Rufai et al.
region Nigeria, with a population of 9,401,288 according to Table 1. Demographic Characteristics and Impact of LBP Among
the 2006 Nigerian national census results.19 Professional Drivers (N = 200)
quate.20 The time frame for this study lasted 5 months, between Onset of LBP
April and August 2011. Gradual 91 61.9
Sudden 56 38.1
Severity of LBP
Data Collection Mild 31 21.1
Moderate 72 48.9
A modified Nordic Low Back (MNLB) questionnaire was Severe 44 30.0
used to obtain data on the prevalence of LBP and its im- Impact of LBP
pact.21 LBP was defined as any ache, pain, or discomfort, and Pain experience
the location was defined by the shaded area of a body dia- Was not serious 81 55.1
gram (T12 to gluteal folds).22 The participants were asked if Needed medication 36 24.5
they had experience LBP during the last 12 months for a day Needed hospital visit 30 20.4
or longer, requiring checking a yes/no or multiple-response Effect of LBP
answer choice. Also, the impact of LBP was assessed using Did not affect driving 39 26.0
questions on medication consumption, requiring treatment, Reduced driving 31 21.0
and modification of driving secondary to LBP in the pre- efficiency
ceding 12 months. The LBP is clinically significant if partici- Reduced driving time 33 24.0
pants reported that their LBP required use of medication, or Kept away from driving 44 29.0
if they sought treatment, or if it required a reduction in ac-
tivity of daily living.23 Basic demographic and occupational
profiles, including drivers age, type of vehicle, number of driv-
ing hours per day, years of driving experience (years of pro- in the respective motor parks. All questions were fully clarified
fessional exposure), nature and impact of LBP, as well as to the participants, after which they filled in the questionnaires.
secondary activities (if any), were clearly obtained from the Upon completion, the questionnaires were either retrieved on
respondents. the same day of distribution (n = 189) or within 37 days after
the distribution day (n = 113).
Ethical Consideration
The study was approved by the institutional ethics committee Data Analysis
(according to the Helsinki Declaration) of Bayero University Statistical Package for Social Sciences (SPSS; version 20.0.1;
Kano after duly obtaining permission from executives of the IBM, Armonk, NY, USA) was used for the data entry and
drivers union in the respective motor parks. Individual partic- analyses. The data were double checked and cleaned to en-
ipants were properly counseled on the protocol of the study sure that all variables were properly documented and to detect
and were assured of the confidentiality of their respective in- any missing or erroneous values during data entry. Descrip-
formation throughout the study. A signed informed consent tive statistics of mean and standard deviation or frequency and
was obtained from each participant for documentary and legal percentage were used to summarize the demographic variables
purposes. and nature and impact of reported LBP. Chi-square statistics
was used to determine statistical difference between the pre-
dictors of LBP.
Flow of Work
Univariate logistic regression analysis was applied to de-
The MNLB questionnaires were distributed through personal termine the potential associated risk factors. Variables that
contact with individual drivers and/or their union executives were found to be statistically significant in the univariate anal-
Archives of Environmental & Occupational Health 253
Table 2. Prevalence of LBP in the Last 12 Months Among Professional Drivers (N = 200)
LBP history
ysis (p < .05) and also proven to be biologically significant 61.9% of the respondents had LBP of gradual onset with ei-
and clinically important were included in the multivariate ther mild pain (21.1%) or pain moderate in severity (48.9%).
analysis. Generally, the LBP was found to reduce driving efficiency
For the multivariate logistic regression analysis, backward in about 74% of the respondents, although only 20.4% vis-
stepwise logistic regression was applied to determine the ited hospitals as outpatients, whereas 55.1% were free of any
significance of the model and the enter method was applied to medication.
process the preliminary main effect model. Multicolinearity Table 2 shows the 12-month prevalence rate of LBP and
and interaction terms were checked; for the biologically the differences among potential associated risk factors of its
meaningful variable, 2-way interactions was applied and was occurrence. Out of 73.5% (147) drivers with LBP, 49% (72) had
not found significant. The Hosmer-Lemeshow test (p = .984) 20 years driving experience and 47.6% (70) had history of
classification table (overall correctly classified percentage >15 hours driving per day. In addition, up to 58.5% (86) were
= 80.5%) and area under the curve and receiver operating found to be bus drivers, in contrast to the car or truck drivers.
characteristic (ROC) curve (70.5%) were performed to check Significant differences were found in LBP prevalence for all
the model adequacy and fitness. Multiple logistic regressions the predictors except type of vehicle ( 2 = 0.72, p = .697).
were applied to present the final model with adjusted odds Similarly, results of risk factors interaction in Table 3
ratio. Alpha level of significance was set at <.05. indicated that older drivers had higher risk of developing
LBP, with ages 4560 years having 0.18 odds of developing
LBP (95% confidence interval [CI]: 0.40, 0.71; p = .015) and
Results >60 years with 0.09 times crude odds of having LBP (95%
CI: 0.01, 0.54; p = .010). Likewise, those who drive for longer
A total of 350 questionnaires were distributed; however, only hours/day were more vulnerable, with 1015 hours/day hav-
86.3% were successfully retrieved. Out of these, only 66.2% ing 0.39 times crude odds of getting LBP (95% CI: 0.19, 0.81;
(200) met the inclusion criteria and were thus enrolled in p = .011). The multivariate analysis of independent risk factors
the study. The remaining respondents were excluded from showed the significant variables in Table 3. Duration of driv-
the data analysis for various reasons: 31 (10.3%) had other ing (hours/day) was found to be a significant risk factor for
jobs/activities risk for LBP, 38 (12.6%) had previous history LBP in drivers; those driving for the duration >15 hours/day
of traumatic injury, 14 (4.6%) had inconsistency of response, have 0.04 odd chances of LBP (95% CI: 0.01, 0.20; p = .001).
and 19 (6.3%) had missing data. Also found to be a significant risk factor for LBP in drivers
As shown in Table 1, the participants had mean age of is the type of vehicle driven, with those who drive cars hav-
42.45 (11.6) years and driving experience between 1 and ing 5.52 times odds of LBP occurrence (95% CI: 1.55, 19.64;
30 years and duration of driving about 524 hours/day. About p = .008).
254 Rufai et al.
Variable Crude odds ratio 95% CI p value Adjusted odds ratio 95% CI p value
Age (years)
24 1
2544 0.28 0.08, 1.07 .064
4560 0.18 0.40,0.71 .015
>60 0.09 0.01,0.54 .010
Driving experience (years)
10 1
1020 0.64 0.27,1.51 .305
>20 0.47 0.20,1.10 .080
Driving duration (hours)
<10 1 1
1015 0.39 0.19,0.81 .011 0.01 0.00, 0.06 .001
>15 0.03 0.01,0.13 .001 0.04 0.01,0.20 .001
Type of vehicle
Truck 1 1 .008
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may not be concluded, as is the case with cross-sectional three-dimensional trunk motion in occupationally-related low back
studies; likewise, information bias may occur due to recall disorders: the effects of work place factors, trunk position, and trunk
motion characteristics on risk of injury. Spine. 1993;18:617628.
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12. Alperovitch-Najenson D, Santo Y, Masharawi Y, Katz-Leurer M,
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were recruited through sample of convenience. drivers: ergonomic and occupational-psychosocial risk factors. Isr
Med Assoc J. 2010;12:2631.
13. Robb MJM, Mansfield NJ. Self-reported musculoskeletal problems
Conclusion amongst professional truck drivers. Ergonomics. 2007;50:814827.
There was high prevalence of LBP among professional long- 14. Boshuizen HC, Bongers PM, Hulshof CT. Self-reported back pain
in tractor drivers exposed to whole-body vibration. Int Arch Occup
distance drivers that had affected the drivers performance Environ Health. 1990;62:109115.
with attendant negative economic implications. The study 15. Odebiyi DO, Ogwezi DC, Adegoke BOA. The prevalence of LBP
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17. Tamarin SB, Yokoyama K, Jalaludin J, et al. The association be-
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