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Identification of Modifiable Personal Factors That Predict New-onset Low Back Pain: A Prospective Study of Female Nursing Students

Mitchell, Tim PhD*; O'Sullivan, Peter B. PhD*; Burnett, Angus PhD* †; Straker, Leon PhD*; Smith, Anne PhD*; Thornton, Jenny PhD; Rudd, Cobie J. PhD§

The Clinical Journal of Pain: May 2010 - Volume 26 - Issue 4 - p 275-283
doi: 10.1097/AJP.0b013e3181cd16e1
Original Articles

Objectives Prevention of occupational low back pain (LBP) in nurses is a research priority. Recent research suggests intervening before commencing nursing employment is ideal; however, identification of modifiable risk factors is required. The objective of this study was to investigate modifiable personal characteristics that predicted new-onset LBP in nursing students.

Methods This prospective study was conducted on female nursing students (n=117) without LBP at baseline to predict new-onset LBP (an episode of significant LBP during the follow-up period). At the 12-month follow-up, participants with (n=31) and without new-onset LBP (n=76) were compared across baseline social or lifestyle, psychologic (distress, back pain beliefs, coping strategies, and catastrophising), and physical (spinal postures and spinal kinematics in functional tasks, leg and back muscle endurance, spinal repositioning error, and cardiovascular fitness) characteristics.

Results Participants response rate at follow-up was excellent (91%). After controlling for earlier LBP, age, and BMI, regression analysis showed that modifiable social or lifestyle, psychologic and physical characteristics (namely, smoking, increased physical activity, higher stress, reduced back muscle endurance, greater posterior pelvic rotation in slump sitting, and more accurate spinal repositioning in sitting) were significant and independent predictors of new-onset LBP at follow-up. Inclusion of these factors in multivariate logistic regression analysis, with significant new-onset LBP as the outcome, resulted in a substantial model R 2 of 0.45.

Discussion Modifiable personal characteristics across multiple domains are associated with new-onset LBP in female nursing students. These findings may have implications for the development of prevention and management interventions for LBP in nurses.

*School of Physiotherapy

School of Psychology, Curtin University of Technology, Western Australia

School of Exercise, Biomedical, and Health Sciences

§School of Nursing, Midwifery and Postgraduate Medicine, Edith Cowan University, Western Australia

Funding Received: Nil.

Reprints: Tim Mitchell, PhD, Post: GPO Box U1987, Perth, Western Australia, 6845 (e-mail:

Received for publication November 12, 2008; revised July 7, 2009; accepted August 26, 2009

© 2010 Lippincott Williams & Wilkins, Inc.