International Journal of Current Medical And Applied Sciences, 2017, June, 15(1),26--30.

IJCMAAS,E-ISSN:2321-9335,P-ISSN:2321-9327. Page | 26

Prevalence of Occupational Related Low Back Pain and Associated Risk Factors in Truck Drivers Halting At

Kalamboli Truck Terminal, Navi Mumbai. Ashima Bhaumik1 & Seema Anjenaya2

1Resident, 2Professor & HOD, Department of Community Medicine, MGM Medical College, Kamothe, Navi Mumbai [MS], India.

--------------------------------------------------------------------------------------------------------------------------------------- Abstract:

Introduction: Truck driving has been associated with high prevalence of low back pain (LBP) which takes toll on their health. Having knowledge about risk factors will help to prevent occupational related LBP. Objectives: 1) To find out prevalence of low back pain in truck drivers 2) To study risk factors associated with low back pain. Material and methods: A community based cross sectional study was carried out among truck drivers halting at Kalamboli Truck Terminal, Navi Mumbai during the period August to October 2014. A total of 232 truck drivers were selected using simple random sampling. After obtaining informed written consent they were interviewed personally using predesigned pretested questionnaire to assess the prevalence of LBP and association of risk factors like age, BMI, years of service and working conditions (average daily driving in kms, duration of driving per week). Roland-Morris Disability Questionnaire (RMDQ) was used to assess physical disability due to LBP. Analysis was done using mean, SD, percentage, chi-square test and unpaired student t’ test using SPSS 17.0. Results: Prevalence of LBP was found to be 62.5%. There was a significant association (p<0.001) of LBP with age (mean 37.06 years), BMI (mean 26.254kg/m

2 ),

mean duration of driving (41.86 hrs/week), daily average driving (mean 264.69 kms) and length of years in service (mean 16.262 years). In RMDQ 73.1% truckers said that they had to change position frequently to get their back comfortable and 68.9% said that they avoided heavy jobs around the house because of their back. Conclusion: The study revealed high prevalence (62.5%) of LBP in truck drivers and thus there is a need for their Pre job screening and periodic health check up. Keywords: Truck drivers, low back pain, Roland Morris Disability Questionnaire.

Introduction:Truck drivers comprise a large population that are exposed to major risks in the workplace particularly low back pain (LBP) when compared to individuals involved in other occupational activities. They are at risk of numerous preventable diseases such as myocardial infarction; musculoskeletal disorders mainly LBP, hypertension, ulcers and cancers of the lung, prostate and bladder when compared to people in other professions [1]. Truck driving has been associated with a high prevalence of LBP ranging from 45% to 81% [2],

leading to expensive treatments and high absenteeism rates [2]. In addition to physical threats, long driving hours is also a psychologically taxing occupation, which can aggravate existing health problems. In truckers, factors such as age, stress level, existing health conditions, obesity, prolonged sitting time, strained postures, driving for long hours and heavy traffic environment can result in occupational related LBP.

Address for correspondence: Dr. Ashima Bhaumik,

Resident, Department of Community Medicine, MGM Medical College & Hospital, Kamothe, Navi Mumbai [MS], India Email: ashimabhaumik2004@yahoo.com

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How to cite this article: Ashima Bhaumik & Seema Anjenaya : Prevalence of Occupational Related Low Back Pain and Associated Risk Factors in Truck Drivers Halting At Kalamboli Truck Terminal, Navi Mumbai. International Journal of current Medical and Applied sciences; 2017, 15(1),26--30.

Ashima Bhaumik & Seema Anjenaya

Logic Publications @ 2016, IJCMAAS, E-ISSN: 2321-9335,P-ISSN:2321-9327. Page | 27

Prolonged sitting exposes the driver to vibrations which can have a negative impact on spinal cord and organ health. Poor ergonomic design in some model of trucks has also been linked to neck and trunk pain [3]. Seats that do not accommodate the size and shape of an individual’s body will force the occupant into a poor sitting posture. Thus, lack of effective adjustable seats correlates with LBP in long-term drivers [4]. In India, considering the large number of people in the profession of truck driving it is very important to have knowledge about risks which will help to prevent occupational related LBP. Thus, the objective of this study was to investigate the prevalence of occupational low back pain (LBP) among truck drivers and to the risk factors associated with it. The findings of this research can benefit the drivers and also help to determine the impact of the disease on society and help to organize health services for them.

Objectives: 1) To find out prevalence of low back pain in

truck drivers halting at Kalamboli Truck Terminal, Navi Mumbai

2) To study risk factors associated with low back painin truck drivers

Materials and Methods: The present study was a Community based, Cross sectional study carried out at Kalamboli Truck Terminal at Kamothe, Navi Mumbai which is at the beginning of the Mumbai Pune Expressway. The study area was at a distance of 1km from the medical college. The study period was from August to October 2014.

Permission to conduct the study was taken from the management of the Truck Stop and informed written consent was taken from the participating truckers after explaining the objectives of the study

and its advantages to the health and drivers’ wellness. Ethical clearance was obtained from the Institutional Ethics Committee. Based on the prevalence of LBP as 60% from a previous study by Amod Borle et al [5] the sample size was calculated to be 232. Truck drivers from all trucking companies including government, nongovernment, petrochemical companies formed the source population. A convenient sampling technique was used. The inclusion criteria were that the drivers must be fulltime permanent drivers, driving for more than twelve months and must be willing to participate in the study. The exclusion criteria were drivers having a history of LBP prior to entering the driving profession or having LBP as a result of trauma (i.e. motor vehicle accident, sporting activity etc). In this study LBP was defined as pain or discomfort below the lower ribs and above the gluteal folds with or without leg pain [5]. Prevalence of LBP is defined as rate of truckers in the study who had LBP in the past one year [6].

Data was collected using the Standard Nordic Questionnaire [7] and Standard Roland Morris Questionnaire [8] to record responses of low back pain and suitable changes were made in them after pilot study. The study variables analysed were demographic features (age, marital status, education, years of employment, physique of drivers (BMI) and working conditions (daily average driving in kilometers, duration of driving in hours/week, degree of seating comfort) and severity of LBP. The data was entered in Microsoft Excel and analysed using SPSS 17.0. Analysis was done using Mean, Standard deviation, Percentages, Chi square test and Unpaired student t test. The level of significance was at 5%, all p values<0.05 was treated as significant.

Results: Prevalence of LBP was 62.5% (145/232) among truck drivers in the study. Table 1 : Comparison of quantitative data of age, years in service and BMI between drivers with and without low back pain

Group N Mean SD t-stat df p-value

Age With LBP 145 37.062 6.035 15.0153 230 < 0.001

Without LBP 87 24.805 5.994

Years in Service

With LBP 145 16.262 5.251 14.5445 230 < 0.001

Without LBP 87 6.023 5.090

BMI With LBP 145 26.254 1.692 9.64615 230 < 0.001

Without LBP 87 24.289 1.117 *Statistically significant Statistically significant relationship was observed with age. Mean age was significantly higher in LBP group (mean age 37.062yrs, S.D 6.035) as compared to the non LBP group. (mean age 37.062 yrs, S.D 6.035)

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International Journal of Current Medical And Applied Sciences [IJCMAAS], Volume: 15, Issue: 1. Page | 28

Length of years in service in LBP group was significantly higher (mean years in service 16.262 years, S.D.5.251) than the non LBP group (mean 6.023years S.D.5.090). BMI was significantly higher in LBP group( mean 26.254 kg/m2 ,S.D.1.692) than in non LBP group( mean BMI 24.289 kg/m2 ,S.D.1.117) , p<0.001.

Table 2::Comparison of quantitative variables of duration of driving and average daily driving between drivers with and without low back pain

Working Conditions Group N Mean SD t-stat df p-value Duration of driving /wk in hrs

With LBP 145 41.862 9.584 6.543

230

<0.001 Without LBP 87 34.287 6.408

Average daily driving in Kms.

With LBP 145 264.690 54.094 17.299

230

<0.001 Without LBP 87 157.701 25.743

*statistically significant With regard to duration of driving in hours/week there was a statistically significant difference (p<0.001.) between truckers with LBP (mean 41.862 hrs/wk, S.D. 9.584) and truckers without LBP (mean 34.287 hrs/wk, S.D. 6.408, ) p<0.001. Average mean daily driving in kms was significantly higher among LBP truckers as compared to non the LBP group. In this study there was statistically no significant difference between alcohol and tobacco consumption among truckers with and without LBP.

Graph 1 : Disabilities reported by truck drivers with low back pain as per Roland Morris Disability Questionnaire:

0% 20% 40% 60% 80%

Because of my back I get other people to do things for me

I get dressed with help,because of my back pain

My appetite is not very good because of my back pain

I have trouble putting on my socks because of pain in my back

I stay in bed most of the time because of my back

Because of my back I am not doing any of the jobs that I usually …

I get dressed more slowly than usual because of my back

Because of my back I use a handrail to get upstairs

Because of my back I have to hold on to something to get up

I find it difficult to get out of a chair because of my back

I sit down for most of the day because of my back pain

I stay at home most of the time because of my back

I walk more slowly than usual because of my back

I find it difficult to turn over in bed because of my backk

I am more bad tempered/irritable than usual because of my back

Because of my back I go upstairs more slowly than usual

I only stand for short periods of time because of my back

I only walk short distances because of my back

I sleep less well because of my back

My back is painful almost all the time

Because of my back I try not to bend or kneel down

Because of my back I lie down to rest more often

I avoid heavy jobs around the house because of my back

I change position frequently to try and get my back comfortable

0.00%

0.00%

4.14%

4.14%

4.14%

4.83%

4.83%

6.90%

6.90%

6.90%

12.41%

13.10%

13.10%

13.79%

19.31%

19.31%

20.69%

20.69%

22.07%

24.83%

31.72%

54.48%

68.97%

73.10%

Graph 1 shows the various response rates to the 24 standard questions in RMDQ among truckers wih LBP. 73.2% responded that they changed their position frequently to try and get their back comfortable, 68.9 % responded that they avoided heavy jobs around the house due to LBP, 54.48 % said that they had to lie down to rest more often because of LBP and 31.72% said because of their back they tried not to bend or kneel down.

Ashima Bhaumik & Seema Anjenaya

Logic Publications @ 2017, IJCMAAS, E-ISSN: 2321-9335,P-ISSN:2321-9327. Page | 29

Discussion: The low back pain experienced by truck drivers is due to driving for many hours in an unchanged posture , having to be exposed to whole-body vibration that does not allow them to adopt an optimum posture together with poor ergonomics of the truck cab. Hence, the purpose of this study was to investigate the selected risk factors associated with LBP among truck drivers. Prevalence of low back pain in this study is 62.5%. Study by Amod Borle et al in Nagpur city reported similar prevalence (62%) [5] and study by Robb and Mansfield (2007) in Longborough, UK, also reported a prevalence of (60%).(9)Similar study by Okunribido et al (2006) on delivery drivers established that LBP during preceding 12 months was 50%, [6] Miyamoto, Shirai and Nakayama (2000) in Japan [10] reportd a 50.3% prevalence of LBP in truck drivers in the preceding 1 month which was less prevalence than present study. The higher prevalence of LBP in present study might be due to higher duration of driving (hrs) and higher daily average driving (kms) observed in the present study. In a study on truck drivers in mountainous terrain by Goon et al in Sikkim, India, the prevalence of back pain was 73.52% [11]. This higher prevalence was probably because the study included drivers of hilly areas with rough terrains. In the study by Ramroop (2006) who evaluated the prevalence of LBP in refuse truck drivers in South Africa [2] found prevalence of LBP was 79% which was higher than the present study. The drivers in this study were required to also load and unload goods which was not part of job requirement of truck drivers in the present study and this was probably the reason for the higher prevalence. As regards age, in this study LBP in the truckers was more common with increasing age. In the general population after about 30 years of age the intervertebral discs degenerate with permanent narrowing of disc space. This aspect is corroborated by the finding that occupational related LBP occurs in middle aged people (Bridget 1995).(12) Jayson (1996) [13] states that most patients with LBP report that the onset of LBP usually occurs between 35-45years of age matching Bridget’s view. Age was also an important risk factor in back pain incidence in truck drivers in studies by Goon et al, [11] Jane Lyons (2002) [14] and Andrusaitis et al (2006) [15]. BMI and obesity have both been identified in this study as potential factors for LBP. Being overweight poses increased risk of LBP as there is excess load on the spine. This subsequently increases the pressure on the intervertebral discs and other spinal structures triggering pain. Individuals who due to their height, work under unfavourable ergonomic conditions are also at risk of developing low back pain as in studies by Andrusaitis et al and Han et al. [15,16]. In the present study, an increased number of daily working hours, total years of driving, daily average

driving in kilometres and the number of driving hours/week were all associated with LBP. Remaining in a seated position for long hours, being exposed to vibrations, excessively twisting and bending the trunk put the drivers at risk for LBP. A study by Kumar Adarsh (1999) on Tractor driving farmers of North India [17] corroborated these findings and Laxmaiah (2000) [18] stated that prolonged seated posture was also a risk factor for LBP in drivers. Similar findings were observed in a study carried out by Porter JM et al (2002) in bus drivers in London [4] who found that driving more than 20 hrs a week was significantly associated with higher prevalence of low back problems. Massaccesi et al (2003) [3] reported that professional truck drivers have a high incidence of spinal disorders resulting in early retirement ages and morbidity. A study of city bus drivers in Scotland by Okunbirido et al found that drivers spend around 60% of their time driving, often with the torso straight or unsupported and experience discomforting shock/jerking vibration events resulting in lower back pain [6].

Conclusion: Prevalence of LBP was 62% (145/232) among truck drivers in the study. Statistically significant relationship was observed with age, years in service, BMI, seat comfort, driving in hours per /week & average mean daily driving in kilometres. There is need for pre job training and periodic health check up of truck drivers. In the drivers with LBP in addition to a periodic medical check-up , consultation should be organised to prevent serious lumbar disorders. Truck drivers will continue working despite back pain and discomfort and so wide research into the causes and treatment of LBP is necessary. The research findings should be utilised to help design the driving position and training of drivers which could go a long way in reducing the morbidity and mortality among truck drivers. Truck stops should be built along all major haul roads so that the truckers may stop and rest. At these terminals the truck drivers should have access to medical monitoring of some basic health conditions. After all, the truck driver is more important than the goods being transported!!

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Conflict of interest: None declared Source of funding: None declared