Back Pain in Medical Students at The University of the West Indies, Mona, Jamaica

Back Pain in Preclinical and Clinical Medical Students at The University of the West Indies, Mona, Jamaica

The purpose of this study is to identify the prevalence of back pain in preclinical second year and clinical fourth/fifth year medical students at the University of the West Indies; to assess their knowledge, attitude and practice of good spine health; and to determine the outcome of a standardize spine exercise program on one group, the clinical second year medical students, using a prospective randomized control design.

There is a surfeit of literature on musculoskeletal pain especially that of back pain, which are commonly associated with lifestyle practices including varied occupations that affect individuals of all ages. Medical students in the clinical years of training are more likely to be involved in strenuous activities such as prolonged standing for ward rounds, bending forward to examine patients and sometimes being engaged in manual handling of patients, as compared to medical students in the preclinical years. During the early period of preclinical training, medical students primarily sit for extended periods in lectures, use computers or tablets, or in the library, studying and completing assignments. These practices can all be attributable to the increased risk of developing low back among other musculoskeletal problems; especially in instances where the strength and stability of the spine is not maintained and safe spine precautions are not done. There is no published study in Jamaica or to the researcher's knowledge in the Caribbean which looks at the prevalence of musculoskeletal pain, specifically low back pain in medical students. This study is to determine the prevalence of low back pain in second and fourth/fifth year medical students at the University of the West Indies (UWI); assess their knowledge, attitude and practice toward good spine health in preventing back and neck pain; and using a prospective randomized control study model, evaluate the outcome of a standardized spine exercise program on back pain in the preclinical second year medical students over an eight (8) week period from September 7, 2015 to November 2, 2015. Both groups will be followed up over the stipulated period. The identity of all participants will be protected and will only be identified by an assigned study number. Basic demographics, presenting complaints and outcome information will be obtained for the purposes of the study. Questionnaires will be carefully constructed from the objectives of the study to determine the presence of back and neck pain in the medical students and their knowledge, attitude and practice towards the musculoskeletal problem of the back.

The preclinical second year medical students will be prospectively randomized into two (2) groups, a control group (Group A) and an intervention group (Group B) that will be given a standardized spine exercise program. They will be asked to complete a Questionnaire B to evaluate changes in knowledge, attitude and practice towards musculoskeletal problem of the back and neck pain after intervention; the numeric rating scale (NRS), and the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) at eight (8) weeks. The standardized spine exercise program will be provided in a handout and given only to the intervention Group B subjects, these are basic low back exercises to be done three (3) times per week for 20mins, as well as a few very brief stretching exercises to be done during periods of sitting for greater than sixty (60) minutes.

Spine exercises should be done 20 minutes/ 3 days per week Desk stretches should be done when exposed to prolonged sitting for greater than 60 mins

The Cornell Musculoskeletal Discomfort Questionnaire is an outcome measure used widely when examining musculoskeletal disorders in various occupational groups and students alike.The Cornell Musculoskeletal Discomfort Questionnaire was taken from the instruments provided by Human Factors and Ergonomics Laboratory at Cornell University. It is from public domains and permission for its use is not required.

It is a self-administered general questionnaire used to evaluate knowledge, attitude and practice towards musculoskeletal problem of back pain.

Questionnaire B will be used to evaluate changes in knowledge, attitude and practice towards musculoskeletal problem of the back after intervention

The Numeric Rating Scale is an 11-point scale for patient self reporting of pain. It is from public domains and permission for its use is not required.

Inclusion Criteria: All second and forth/fifth year students enrolled in the medical program at UWI, Jamaica during the period September 7, 2015 to November 2, 2015. Willingness to consent to the study. Preclinical medical students' willingness to adhere to standardized exercise program for the stipulated period. Exclusion Criteria: History of having spine surgery Previously diagnosed with spine pathology and currently receiving rehabilitation therapy. Unwillingness to participate in study

Division of Physical Medicine and Rehabilitation, Faculty of Medical Sciences, The University of the West Indies, Mona, Jamaica.

Division of Orthopaedics, Department of Surgery, Radiology, Anaesthesia and Intensive Care. University Hospital of the West Indies, Kingston 7, Jamaica.

Faculty of Medical Sciences Teaching and Research Complex,The University of the West Indies, University Hospital of the West Indies

Punnett L, Pruss-Utun A, Nelson DI, Fingerhut MA, Leigh J, Tak S, Phillips S. Estimating the global burden of low back pain attributable to combined occupational exposures. Am J Ind Med. 2005 Dec;48(6):459-69. doi: 10.1002/ajim.20232.

Lis AM, Black KM, Korn H, Nordin M. Association between sitting and occupational LBP. Eur Spine J. 2007 Feb;16(2):283-98. doi: 10.1007/s00586-006-0143-7. Epub 2006 May 31.

Smith DR, Wei N, Ishitake T, Wang RS. Musculoskeletal disorders among Chinese medical students. Kurume Med J. 2005;52(4):139-46. doi: 10.2739/kurumemedj.52.139.

Falavigna A, Teles AR, Mazzocchin T, de Braga GL, Kleber FD, Barreto F, Santin JT, Barazzetti D, Lazzaretti L, Steiner B, Beckenkamp NL. Increased prevalence of low back pain among physiotherapy students compared to medical students. Eur Spine J. 2011 Mar;20(3):500-5. doi: 10.1007/s00586-010-1646-9. Epub 2010 Dec 7.

Alshagga MA, Nimer AR, Yan LP, Ibrahim IA, Al-Ghamdi SS, Radman Al-Dubai SA. Prevalence and factors associated with neck, shoulder and low back pains among medical students in a Malaysian Medical College. BMC Res Notes. 2013 Jul 1;6:244. doi: 10.1186/1756-0500-6-244.

Smith DR, Leggat PA. Musculoskeletal disorders among rural Australian nursing students. Aust J Rural Health. 2004 Dec;12(6):241-5. doi: 10.1111/j.1440-1854.2004.00620.x.

Lorusso A, Vimercati L, L'abbate N. Musculoskeletal complaints among Italian X-ray technology students: a cross-sectional questionnaire survey. BMC Res Notes. 2010 Apr 24;3:114. doi: 10.1186/1756-0500-3-114.

Smith DR, Leggat PA, Walsh LJ. Workplace hazards among Australian dental students. Aust Dent J. 2009 Jun;54(2):186-8. doi: 10.1111/j.1834-7819.2009.01116_8.x. No abstract available.

Chou R, Huffman LH; American Pain Society; American College of Physicians. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007 Oct 2;147(7):492-504. doi: 10.7326/0003-4819-147-7-200710020-00007. Erratum In: Ann Intern Med. 2008 Feb 5;148(3):247-8.

O'Sullivan PB, Phyty GD, Twomey LT, Allison GT. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine (Phila Pa 1976). 1997 Dec 15;22(24):2959-67. doi: 10.1097/00007632-199712150-00020.

Mandel JH, Lohman W. Low back pain in nurses: the relative importance of medical history, work factors, exercise, and demographics. Res Nurs Health. 1987 Jun;10(3):165-70. doi: 10.1002/nur.4770100308.

Ariens GA, van Mechelen W, Bongers PM, Bouter LM, van der Wal G. Physical risk factors for neck pain. Scand J Work Environ Health. 2000 Feb;26(1):7-19. doi: 10.5271/sjweh.504.