Prevalence of Lower Back Pain and its Relationship with Driving Postures among Drivers in Taif, Saudi Arabia.

Background: Lower back pain (LBP) is well-known as the most common musculoskeletal condition with 80% of lifetime prevalence. The effects of LBP on cultural, social, and public health continue to increase. It brings in billions of dollars of medical costs. This study assessed the prevalence of LBP among car drivers with the wrong driving position in Taif. Methodology: A cross-sectional study using an electronic questionnaire in English translated to Arabic, which included questions about driving with wrong postures, lower back pain, and its correlation.
Results: 91.1% of participants satisfied our inclusion criteria for the data analysis. The prevalence of lower back pain in this study was about 44.1% (n = 659). It was more among those aged >40 years (50.9%) compared to other age groups, which showed a statistically significant association (P < 0.001). It was found that 54.4% (n = 813) had been driving in a wrong posture, and there was a strong association observed between this wrong posture and LBP (51.8%) (P < 0.001).
Conclusion: The prevalence of LBP was high among drivers. This study calls for implanting health education and awareness programs about LBP and its risk factors. Copyright:

INTRODUCTION

Lower back pain (LBP) is well known as the most common musculoskeletal condition with an 80% of lifetime prevalence. Nevertheless, its prevalence ranges across cultures, geographic regions, and age groups. It is the world's leading cause of impairment. The effects of LBP on cultural, social, and public health continue to increase. It brings in billions of dollars of medical costs.[1] Many studies confirmed that 70% of people are more likely to experience LBP at any point in their lives, with recurrence rates of up to 85%.[23] The estimated annual prevalence of LBP in the general population varies from 25% to 60%.[45]

A review of published studies revealed that low back pain (LBP) is one of the most important causes of hospital visits, and in many countries, it has considerable economic effects on the health-care system.[67] A study done in Bangladesh has found that LBP is common among professional car drivers in relation to their working hours, body mass index (BMI), and years of driving. Age is also a risk factor for the development of LBP, and it is reported that for drivers over 40 years of age, LBP prevalence was 4.67 times higher compared to drivers 25–40 years of age.[8] Another study conducted in Ghana showed that 70.5% of taxi drivers have complaints of musculoskeletal disorders (MSD).[9] Many factors were contributing to LBP, including driver's seat, driver's age, driving years, driving hours per day, and movement of the lumbar vertebrae.[1011] LBP was found to have a higher impact on social and professional lives, mainly affecting sitting, posture, standing, and lifting.[12] There is a lack of studies in Saudi Arabia that assessed the prevalence of LBP among drivers. Hence, this study aims to determine the prevalence of LBP among car drivers with a wrong driving position in Taif, Saudi Arabia.

METHODOLOGY

This is a cross-sectional analytic descriptive study that started in March 2021 and was conducted in Taif city, which is located in the Western part of Saudi Arabia. The study population included all drivers from Taif city. Participants were recruited during April and May 2021 from the general population of Taif. The number of participants is 384, estimated by the sample size calculator, with a 95% confidence level and 5% margin of error. The inclusion criteria are all drivers aged more than 18 years who are residents of Taif city. The instrument used was an electronic questionnaire in English, which included questions about lower back pain and its associated factors. After reviewing relevant studies conducted in Saudi Arabia and elsewhere, this tool was developed. The questionnaire was divided into three main sections: the first section was for demographic data, the second section consisted of questions regarding the diagnosis of mechanical lower back pain, and the third section consisted of questions about driving postures where participants were asked to identify the correct posture from a set of pictures developed by the authors [Figure 1].

Figure 1

Driving postures shown to participants

Data were entered in Microsoft Office Excel and statistically analyzed using the Social Science Software Statistical Package (SPSS), version 20 (IBM SPSS Statistics for Windows version 20.0 Armonk, NY, USA: IBM Corp).

RESULTS

We received responses from 1639 people and found that 1494 (91.1%) participants satisfied our inclusion criteria for the data analysis. The sociodemographic details showed that most of the participants were males (88.8%), and 66.4% belonged to 18–40 years [Table 1]. The analysis showed that the prevalence of lower back pain in this study was about 44.1% (n = 659). When we assessed the relationship of LBP with the age of the participants, it was found the prevalence of LBP was more among those aged >40 years (50.9%) compared to other age groups, which showed a statistically significant association (P < 0.001). Married people had a significantly higher prevalence of LBP than unmarried (P < 0.001). LBP was significantly higher among those who were driving for 10–15 years (48.2%) and more than 15 years (47.4%) (P = 0.003). Wrong posture and poor asphalt were significantly associated with LBP (P < 0.001). The LBP prevalence was found to be comparatively more among those who drive slowly (P < 0.001) [Table 2].

Table 1

Baseline characteristics

	Frequency (%)
Age (years)
<18	27 (1.8)
18-40	992 (66.4)
>40	475 (31.8)
Gender
Male	1342 (89.8)
Female	152 (10.2)
Marital status
Single	660 (44.2)
Married	811 (54.3)
Divorced	14 (0.9)
Widowed	9 (0.6)
Years of driving
<5	244 (16.3)
5-10	417 (27.9)
10-15	168 (11.2)
>15	665 (44.5)
Daily driving hours
<3	726 (48.6)
3-6	648 (43.4)
>6	120 (8.0)

Table 2

Prevalence of lower back pain and its relationship with sociodemographic and driving characteristics (n=1494)

	LBP		Total, n (%)	P
	No, n (%)	Yes, n (%)
Age (years)
<18	20 (74.1)	7 (25.9)	27 (1.8)	<0.001
18-40	582 (58.7)	410 (41.3)	992 (66.4)
>40	233 (49.1)	242 (50.9)	475 (31.8)
Gender
Male	759 (56.6)	583 (43.4)	1342 (89.8)	0.153
Female	76 (50.0)	76 (50.0)	152 (10.2)
Marital status
Single	415 (62.9)	245 (37.1)	660 (44.2)	<0.001
Married	414 (51.0)	397 (49.0)	811 (54.3)
Divorced	5 (35.7)	9 (64.3)	1 (0.9)
Widowed	1 (11.1)	8 (88.9)	9 (0.6)
Years of driving
<5	133 (54.5)	111 (45.5)	244 (16.3)	0.003
5-10	265 (63.5)	152 (36.5)	417 (27.9)
10-15	87 (51.8)	81 (48.2)	168 (11.2)
>15	350 (52.6)	315 (47.4)	665 (44.5)
Daily driving hours
<3	417 (57.4)	309 (42.6)	726 (48.6)	0.404
3-6	356 (54.9)	292 (45.1)	648 (43.4)
>6	62 (51.7)	58 (48.3)	120 (8.0)
Driving posture
Wrong posture	328 (48.2)	353 (51.8)	681 (45.6)	<0.001
Correct posture	507 (62.4)	306 (37.6)	813 (54.4)
Type of asphalt
Good asphalt	354 (64.7)	193 (35.3)	547 (36.6)	<0.001
Poor asphalt	317 (47.3)	353 (52.7)	670 (44.8)
Both	164 (59.2)	113 (40.8)	277 (18.5)
Type of roads commonly drive
Inside the city only	477 (56.8)	363 (43.2)	840 (56.2)	0.399
Highways	71 (54.2)	60 (45.8)	131 (8.8)
Off-road	11 (40.7)	16 (59.3)	27 (1.8)
More than two ways	276 (55.6)	220 (44.4)	496 (33.2)
Driving style
Fast	127 (51.6)	119 (48.4)	246 (16.5)	<0.001
Slow	61 (43.6)	79 (56.4)	140 (9.4)
Smooth	647 (58.4)	461 (41.6)	1108 (74.2)

LBP: Lower back pain

The mean LBP intensity in this study was found to be 5.0 ± 2.2. When we compared the intensity between different age groups, it was found that participants aged <18 years and >40 years had shown higher intensity of LBP (P = 0.003). LBP intensity was more among widowed participants than others (P = 0.016). Participants who had been driving for >15 years were found to have higher pain intensity (5.22 ± 2.2) than others (P = 0.031). Other sociodemographic and driving characteristics did not show significant differences in LBP intensity [Table 3]. Multivariate analysis of variance of the intensity of LPB showed that drivers who drove more than 6 h/day had significantly higher intensity of LBP (P = 0.015) [Table 4].

Table 3

Comparison of intensity of lower back pain with sociodemographic and driving characteristics (n=659)

	n	Mean±SD	P
Age (years)
<18	7	6.14±3.625	0.003
18-40	410	4.79±2.084
>40	242	5.33±2.303
Gender
Male	583	4.98±2.120	0.410
Female	76	5.20±2.757
Marital status
Single	245	4.70±2.016	0.016
Married	397	5.15±2.236
Divorced	9	5.44±2.833
Widowed	8	6.50±3.854
Years of driving
<5	111	5.03±2.524	0.031
5-10	152	4.59±1.924
10-15	81	4.89±2.031
>15	315	5.22±2.226
Daily driving hours
<3	309	4.99±2.303	0.058
3-6	292	4.88±2.012
>6	58	5.64±2.476
Driving posture
Wrong posture	353	4.86±2.037	0.073
Correct posture	306	5.17±2.370
Asphalt
Good asphalt	193	4.97±2.269	0.859
Poor asphalt	353	5.04±2.263
Both	113	4.92±1.881
Type of roads commonly drive
Inside the city only	363	5.02±2.308	0.692
Highways	60	5.27±2.321
Off-road	16	4.75±1.528
More than two ways	220	4.91±2.029
Driving style
Fast	119	4.84±2.042	0.412
Slow	79	5.27±2.269
Smooth	461	5.00±2.230

SD: Standard deviation

Table 4

Multivariate analysis of variance of Intensity of lower back pain

Dependent variable: The level of intensity of LBP
Source	Type III sum of squares	df	Mean square	F	P
Corrected model	89.104a	6	14.851	3.124	0.005
Intercept	2700.213	1	2700.213	567.935	<0.001
Age >40 years	8.375	1	8.375	1.761	0.185
Male gender	7.214	1	7.214	1.517	0.218
Marital status	2.875	1	2.875	0.605	0.437
Driving >15 years	1.356	1	1.356	0.285	0.594
Drive >6 h/day	28.777	1	28.777	6.053	0.014
Wrong posture	6.143	1	6.143	1.292	0.256
Poor asphalt	0.000	0
Off-road drive	0.000	0
Slow speed drive	0.000	0
Error	3099.894	652	4.754
Total	19674.000	659
Corrected total	3188.998	658

aR2=0.028 (adjusted R2=0.019). LBP: Lower back pain

DISCUSSION

LBP is considered the top cause of disability among people younger than 45 years old, and the lifetime prevalence among the working population is found to be 60%–80%.[131415] To date, there are no studies conducted in the Kingdom of Saudi Arabia that evaluated the relationship of wrong driving position and LBP among the driving population. We included both male and female participants in the Taif region, KSA, which further signifies the uniqueness of this research. The study finding showed that nearly half (44.1%) of the participants had experienced LBP, which was comparatively more among people aged more than 40 years. Musculoskeletal problems are some of the commonly seen noncommunicable diseases as age advances, and epidemiological evidence shows that LBP prevalence gradually increases from teenage to 60 years of age and then declines.[1617] The majority of LBP cases below the age of 50 are nonspecific and are posture related or mechanical causes.[18]

Our findings showed that driving for more than 6 h a day was an independent risk factor LBP prevalence than others. These findings are consistent with many other studies, which reported that prolonged driving hours (>4 h/day) are associated with LBP occurrence.[192021] This could be due to the greater lumbar spine load accumulated as a result of log driving hours.[22] Evidence shows that wrong posture can cause increased mechanical load on the lower back region and may result in pelvic asymmetry, which in turn leads to chronic LBP.[23] Reduced physical activity can cause a decrease in hip muscle strength that can cause deterioration in postural control.[24] When sitting in a vehicle, the driver should adjust the seat by making the spine upright, and it is found that the least amount of lower back intervertebral disc pressure is when the seat is reclined around 25°–30°. It should be taken care not to sit too high or too low from the steering wheel with the back of the head on the headrest with the chin level and shoulders back.[25] Hands should be positioned in such a way that is restful for the shoulder and neck support, and the arms should be relaxed with a gentle bend in the elbow to reduce the mechanical load off from the shoulders and spine.[26] Our study showed the drivers who drove in poor asphalt and on off-roads showed a higher prevalence of LBP. Roads that are riddled with potholes make driving tiring, and these can cause exposure to whole-body vibration (WBV). There is sufficient evidence to support that exposure to WBV during occupational activities could increase the risk of LBP incidence.[27] A recent study reported that reduced physical activity was one of the contributing factors for LBP development among long-distance truck drivers.[1] However, LBP is addressed as a complex MSD, and accurate pain diagnosis is essential to initiate any treatment. In our study, the increased intensity of LBP was significantly associated with more years of driving, and this can further worsen if no appropriate corrective measures are not taken. In drivers, improper seating such as half buttock sitting, bending toward the steering wheel, lack of head support, and unnecessary lateral twisting can cause compression on a lumbar structure that can result in LBP.[28] Ergonomic evaluation of driving postures and preventive measures are needed among frequent drivers to reduce the incidence of MSDs. In Saudi Arabia, there is a need for countrywide implementation of policies and preventive programs that should signify the importance of correct driving posture and its significance on MSDs. Education regarding this topic should be given to new and young drivers when attending driving lessons at driving schools.

Our study had some limitations.First, the cause of LBP is diverse, and we have not included many other factors such as occupational-related activities, sitting positions in places other than in cars, physical activities, exposure to WBVs, diet, chronic diseases, BMI, socioeconomic status, sleep pattern, job dissatisfaction, and other psychological factors, which are contributing factors.[12930] Hence, this might have contributed to confounding bias. Second, the data were based on self-reported responses, which might have contributed to response bias and social desirability bias.

CONCLUSION

The prevalence of LBP was high among our study population. Many factors precipitated the pain, of which driving with the wrong posture was found to be one. People with long driving duration had more pain intensity. This study calls for implanting health education and awareness programs about LBP and its risk factors.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.