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    The epidemiology of work related back pain in full-time restaurant waitron staff within the eThekwini Municipality
    (2020-11-30) Wolff, Alexia Michaela; Haffejee, Firoza
    Background Low back pain (LBP) is one of the leading causes of morbidity in high-, middle- and lowincome populations and is one of the most common and most expensive occupational health problems in developed and developing countries. This affects the working population as LBP has a detrimental effect on work performance, therefore it is an important clinical, social, economic, and public health problem affecting the population. Internationally, risk factors in the development of LBP in the working population include prolonged standing, awkward posture and incorrect lifting. There is limited literature on prevalence of LBP, the risk factors associated with LBP and its impact on waitrons in South Africa. This study aims to determine the prevalence, clinical presentation, risk factors and impact of work-related LBP amongst full-time restaurant waitron staff within the eThekwini Municipality. Methodology This study was a mixed methods study comprising qualitative and quantitative components. The quantitative research tool consisted of a previously validated selfadministered questionnaire whilst the qualitative component consisted of voice recorded semi-structured interviews using an interview guide to obtain information on low back pain from participants. The data collected from the questionnaires were entered into an Excel spreadsheet and thereafter analysed using SPSS. Descriptive statistics were used to describe categorical outcomes, whilst Pearson’s chi square or Fisher’s exact tests in the case of categorical variables, and t-tests for continuous variables were used to assess factors associated with LBP. The audio recordings from the qualitative interviews were transcribed verbatim and exported into a Microsoft Word document. Thereafter, thematic analysis was used to analyse the qualitative data to identify common themes and subthemes. Results Of the 340 questionnaires which were distributed, a total of 180 questionnaires were completed by waitrons in the eThekwini Municipality, resulting in a 52.9% response rate. The point, three-month period and annual prevalence was recorded at 50.0%, 62.2% and 78.2%, respectively. Within this population, LBP was associated with the ethnicity of the participants (p=0.002) where Indians had a 7.7 times increase in the odds of prevalent LBP compared with Black Africans (OR = 7.713; 95% CI = 1.273-46.718; p = 0.026) and Whites a 5.9 times increase in the odds of prevalent LBP than Black Africans (OR = 5.891; 95% CI = 1.429-24.289; p = 0.014). Low back pain was associated with the education of the participants (p = 0.002) where participants with high school education had an almost 12 times increase in the odds of prevalent LBP than those with tertiary education (OR = 11.967; 95% CI = 1.399-102.387; p = 0.023). Prolonged standing or walking during a work shift was associated with LBP (OR = 42.808; 95% CI = 2.346-780.985; p = 0.011). Onset of LBP was common during a long single shift or when working a double shift and pain sessions tended to last between one to two hours. The frequency of LBP experienced averaged two to three times a week, where pain was at its worst in the evenings. Low back pain in waitrons commenced gradually without injury and the severity of LBP was unchanged since it initially started. Low back pain resulted in moderate impact on the work of waitron staff, sometimes resulting in absenteeism and bed rest. Eight in-depth, qualitative interviews were conducted. Two main themes emerged from the data: low back pain characteristics and type of treatment. Interviewees discussed pain, onset and duration, and relieving factors as part of LBP characteristics, where they reported first experiencing LBP as young adults. Their onset of LBP was common during a long single work shift or when working a double shift. They re-iterated that prolonged standing and lifting or carrying heavy objects aggravated their LBP. Various therapies were used by interviewees to relieve the pain which included analgesics, antiinflammatories, heat therapy and topical gels. Type of treatment included chiropractic. There was good knowledge of the services offered by chiropractors and various types of chiropractic treatment available. Conclusion The prevalence of LBP amongst waitron staff within the eThekwini Municipality was high. Work-related factors were associated with the onset of LBP. These included prolonged standing, constant walking for long periods of time, carrying heavy loads and falling. Low back pain negatively impacted on their work due to absenteeism as bed rest was required. Various treatment options, including chiropractic were utilized. Participants had some knowledge of what constitutes chiropractic treatment and the types of services offered.
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    The epidemiology of low back pain in male adolescent field hockey players in the eThekwini municipality
    (2019-09-05) De Wit, Dale Cameron; Pillay, Julian David; Ducray, Jennifer Frances
    Background: Field hockey is a popular international sport which is played in 132 countries across the world. Due to the nature of hockey, players repeatedly perform a combination of forward flexion and rotational movements of the spine in order to strike the ball. These movements have been shown to increase the risk for pain and injury to the lumbar spine. Due to the popularity of the sport of field hockey more empirical randomised controlled studies and/or observational studies need to be conducted to determine the pathomechanics of the nature of lower back pain and injury among players. Objectives: The objectives of this study were to determine the prevalence and incidence of low back pain in male adolescent field hockey players; to determine the characteristics of the low back pain in terms of location, chronicity, disability and treatment sought; and to determine the selected risk factors (demographics, equipment, health and lifestyle) of low back pain in male adolescent field hockey players. Method: A descriptive study of cross-sectional design, using a survey data collection tool was used on 112 male adolescent field hockey players in the eThekwini Municipality. The questionnaire data were then statistically analysed using IBM SPSS version 25 with statistical significance set at p value <0.05. Descriptive statistics such as mean and standard deviation, or median and inter-quartile range were used to summarise responses to continuous variables as appropriate. Categorical variables were described using frequency tables. Associations between risk factors and low back pain were tested using Pearson’s chi square test and t-tests as appropriate. Results: A total of 68 participants completed and returned their questionnaires yielding a participation rate of 60.7%. The period prevalence of low back pain was 63.2% and the incidence was 38.2%. Point prevalence at the beginning of the season, mid-season, and end of season was 25%, 32.4% and 22.1% respectively. The most common location for low back pain was the middle low back region (39.5%), and the most common duration of pain was a few hours (32.6%). Most participants (79.1%) did not classify their pain as a disability, and only 44.2% of participants received medical treatment for their low back pain. The results were found to be statistically significant between hydration and low back pain (p = 0.050) i.e. those individuals who did not hydrate frequently during matches and training were significantly more likely to experience low back pain. Conclusion: Low back pain in male adolescent field hockey players is a common phenomenon. The results of this study, although limited to a select group of adolescents, showed a slightly higher prevalence of LBP to that of previous studies. More importantly, even though most participants did not experience low back pain classified as a disability, low back pain still had a large impact on participants, as nearly half of participants consulted with a medical professional for treatment. The study further indicates the need for frequent hydration during matches and training as inadequate hydration was found to be significantly related to low back pain. We highlight this as a novel finding and recommend special consideration to this by athletes and coaches. Moreover, the need for the development of strategies in the prevention and management of low back pain in field hockey is further recommended.
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    The epidemiology of postpartum low back pain within the eThekwini Municipality area
    (2018) Bhoodram, Bhavna; Padayachy, Keseri
    Background Previous investigations into the epidemiology of low back pain (LBP) in South Africa were limited to various ethnic groups, student population and work-related activities. There have been many international studies on postpartum low back pain experienced by females which have shown varied results, largely attributed to the various time frames and risk factors. Consequently, there has been a remarkable increase in the use of epidural anaesthesia during delivery. Aim The aim of this study was to determine the prevalence of, and risk factors for, postpartum low back pain within the eThekwini Municipality. Method A quantitative paradigm and a cross sectional epidemiological design was used to survey 384 postpartum females in selected areas within the eThekwini Municipality, having 128 participants in each of the three suburbs (high-, medium- and low-income areas). A pre-validated questionnaire was used to collect data from the females who agreed to participate. The survey contained questions related to low back pain, pregnancy, socio-demographic, psycho-social, lifestyle and occupational factors. The data was analysed using the Statistical Program for the Social Sciences (SPSS) version 24.0. Results The prevalence of LBP was recorded as follows: Of the entire population a 41.1% prevalence for postpartum low back pain was reported, with 54.7% at La Lucia municipal clinic (high-income region), 36.7% at Bluff municipal clinic (low-income region) and 32% at Overport municipal clinic (middle-income region). 57% of the participants who experienced postpartum LBP reported that it had an effect on their daily tasks with 62% stating that the pain presented with a slow/gradual onset. The most common type of pain was described as “sharp/poking” with “dull ache” being the second most common. Non-progression of LBP was reported by 46% of participants, while 26% reported a decrease in pain, 18% noted an increase in pain and 10% were unsure. 28% of the participants noted that the individual episodes of pain they experienced were usually 60 minutes or longer. The population group was split almost uniformly in quarters with regards to how frequently the individual pain episodes occurred i.e.: daily (23%), twice a week (24%), weekly (26%) and monthly (27%). A logistic regression model was fitted in order to establish which variables are associated with lower back pain. The significant variables (p<0.05) were stress levels, type of birth, clinic, race and whether lower back pain was experienced before pregnancy. Conclusion More studies are warranted on this group of individuals as the factors associated with the predisposition of postpartum LBP were in some instances not in keeping with the existing literature. Postpartum LBP has a significant impact on females and their quality of life and therefore effective strategies to prevent and manage postpartum LBP in females are obligatory.
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    A comparison of the epidemiology of low back pain in Indian and Coloured communities in South Africa
    (1999) Docrat, Aadil; Till, H.
    In order to investigate low back pain in an Indian and a Coloured community in South Africa, a population-based epidemiological survey was carried out in which 1 000 subjects were interviewed (500 Indians and 500 Coloureds). Subjects were selected using the Systematic Random Sampling method. A pre-tested questionnaire, designed by the researcher, was used to elicit information about the subjects' demography, general characteristics and details regarding low back pain (incidence, prevalence, severity, disability, treatment). Only subjects 18 years or older who were permanent residents of the 2 suburbs were included in the study. The author carried out the interviews personally