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Журнал «Боль. Суставы. Позвоночник» Том 15, №3, 2025

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Біль у нижній частині спини у будівельників: перехресне дослідження

Біль у нижній частині спини у будівельників: перехресне дослідження

Авторы: V. Moodley, J.D. Pillay
Durban University of Technology, Durban, South Africa

Рубрики: Ревматология, Травматология и ортопедия

Разделы: Клинические исследования

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Резюме

Актуальність. Біль у нижній частині спини (БНС), пов’язаний із професійною діяльністю, привертає все більше уваги, особливо щодо його негативного впливу на продуктивність праці та інвалідність. Будівельні робітники (БР) мають одну з найбільш фізично тяжких професій, що робить їх надзвичайно чутливими до БНС. Мета: вивчити поширеність БНС та визначити окремі фактори ризику серед БР у муніципалітеті Етеквіні (Квазулу-Натал, Південна Африка). ­Матеріали та методи. Перехресне опитування проведено серед БР за місцем роботи у відповідних компаніях. Анкета включала розділи щодо демографічних показників, способу життя, професійних факторів ризику та історії БНС. Для аналізу даних використовували програму IBM SPSS версії 28. Статистично значущі відмінності між групами підтверджували з використанням показника р < 0,05. Було проаналізовано поширеність БНС на момент обстеження та протягом останніх 6 міс. Результати. Поширеність БНС на момент обстеження та протягом останніх 6 міс. становила відповідно 16,8 та 26,2 %. За результатами аналізу виявлено, що 36,6 % курців, які палили на момент обстеження, мали БНС, а серед тих, хто курить понад 15 років, цей показник становив 73,3 %. Важливим фактором БНС був стрес: 54,8 % пацієнтів, які зазнали стресу внаслідок роботи, і 68,2 % осіб зі стресом, пов’язаним з особистими причинами, повідомляли про БНС на відміну від 22,8 % обстежених, які не відчували стресу. Монтажники риштувань продемонстрували більшу поширеність БНС (50 %), ніж різноробочі (43,2 %), монтажники (33,3 %) та муляри (30,5 %). Висновки. БНС продовжує залишатися значним тягарем для здоров’я БР, впливаючи на їхню повсякденну діяльність і спричиняючи інвалідність. Тому необхідна спільна стратегія втручання між медичними працівниками та будівельною галуззю. Це зменшить прогули, стрес, поліпшить продуктивність та обмеження активності.

Background. Occupational-related lower back pain (LBP) has received growing attention, especially regarding its effect on work productivity and disability. Construction workers (CWs) are involved in one of the most physically demanding occupations, making them exceedingly susceptible to LBP. The objective was to determine LBP’s prevalence and identify selected risk factors among CWs within the eThekwini Municipality in KwaZulu-Natal, South Africa. Materials and methods. A cross-sectional survey was conducted on 256 CWs, and questionnaires were provided to participants at their respective companies. The questionnaire included sections on demographics, lifestyle, occupational risk factors, and LBP history. IBM SPSS version 28 was used to analyze the data. A p-value of < 0.05 was used to indicate statistical significance. Both point prevalence (occurrence of LBP at the time of the survey) and period prevalence (occurrence of LBP over the past six months) were analyzed. Results. The point and period prevalences were 16.8 and 26.2 %, respectively. The results indicated that 36.6 % of current smokers reported LBP, with a higher incidence of 73.3 % among those smoking for over 15 years. Stress emerged as a significant factor; 54.8 % of subjects experiencing work-related stress and 68.2 % under personal stress reported LBP, contrasted with only 22.8 % of those experiencing no stress. Scaffolders exhibited a higher LBP prevalence (50 %) than general workers (43.2 %), erectors (33.3 %), and bricklayers (30.5 %). Conclusions. LBP continues to be a significant health burden for CWs, impacting their daily activities and causing disability. Therefore, a joint intervention strategy between health professionals and the construction industry is required. This will reduce absenteeism, stress, decreased productivity and activity limitations.


Ключевые слова

біль у попереку; будівельники; спосіб життя; професійні фактори; Південна Африка

low back pain; construction workers; lifestyle; occupational factors; South Africa

doi: http://dx.doi.org/10.22141/pjs.15.3.2025.470

Introduction

Low back pain (LBP) is a global occupational health problem [1]. It has a complex aetiology and may happen due to irritation or injury of the muscles, ligaments, connective tissues, joints, intervertebral discs, or spinal nerve roots [2]. Construction workers are involved in one of the most physically demanding occupations, making them exceedingly susceptible to LBP [3]. Musculoskeletal symptoms (MSS) are highly prevalent among construction workers, with studies reporting 57.9–78 % of workers experiencing MSS in the past year [4, 5]. Despite the high prevalence, many workers do not seek medical treatment or miss work due to MSS [5].
Occupational factors significantly influence LBP prevalence, particularly among women. Key contributors include heavy lifting, prolonged standing or sitting in forward-leaning postures, and frequent computer use [6]. Furthermore, physiological occupational risks, elevated exertion levels, and work-related frustration exacerbate LBP prevalence [7]. Globally, occupational LBP is significantly more prevalent among construction workers than in other professions [8]. This increased prevalence is attributed to the job’s physical demands, including repetitive movements, awkward postures, and heavy lifting, which strain the musculoskeletal system considerably. Additionally, long working hours, especially those exceeding 44 hours per week, correlate with higher rates of LBP [9].
In Africa, LBP is a significant health issue, with prevalence rates higher than or comparable to global estimates [10]. In South Africa, a study found a lifetime LBP prevalence of 79.3 % among primary healthcare users [11]. The prevalence of chronic low back pain (CLBP) in the general population ranged from 18.1 to 28.2 % [12]. Risk factors for CLBP include biomechanical, psychological, socioeconomic, and lifestyle factors [12]. Pain intensity, work absence, and bowel/bladder dysfunction were associated with more significant disability in CLBP patients [13].
LBP in construction workers requires urgent attention [14]. Therefore, the study aimed to determine the prevalence of LBP in construction workers and identify some of the risks associated with its occurrence in the eThekwini Municipality in South Africa.

Materials and methods

Research design
A descriptive, quantitative, cross-sectional survey was conducted among construction workers from two of the largest commercial construction companies in the eThekwini Municipality.
 
Population and sample size
The population of this study was 590 construction workers from two companies. A sample of 256 was calculated using Power Analysis and Sample Size (PASS) 2021 Software, with a precision of 4 %, a proportion of 25 %, and a 95% confidence level. All construction workers had to meet the definition of a construction worker. These included manual labourers, such as bricklayers, carpenters, excavators, and scaffolders, who were involved in building structures on construction sites. Only subjects who were 16 years and older were allowed to participate in the study. The maximum age of participants was 65 years, which is the retirement age in the South African labour force.
Data collection tools and process
A self-administered questionnaire (Supplement 1) was adapted from previous studies that had been validated [15, 16]. Permission was sought and subsequently obtained from Adhikari B. et al. [15] and Dlungwane T. et al. [16] to adapt the questionnaire that they used in their studies. The adapted questionnaire included the following sections: demographics, lifestyle, occupational risk factors and LBP history. A panel of five experts evaluated the content validity through an expert focus group discussion, with relevant modifications made.
Data collection started after obtaining ethical approval, gatekeeper permission, and informed consent. Once the questionnaires were completed, they were placed into a box and then analysed by the researcher and the statistician.
Statistical analysis
The data was analysed using IBM SPSS version 28. Descriptive statistics, such as mean, standard deviation and range, were used to summarise continuous data. Frequency counts and percentages were used to summarise categorical data. Risk factors for LBP were assessed for those who reported LBP. Pearson’s Chi-square tests or Fisher’s exact tests were deemed appropriate and were used to assess categorical factors, while t-tests were used to assess mean differences for continuous variables. A p-value of < 0.05 was used to indicate statistical significance.
Ethical considerations
Ethical clearance was obtained from the Institutional Research Ethics Committee at the selected university (IREC 303/22). Relevant gatekeeper permission was sought from all construction companies before the questionnaires were distributed. All participants provided signed informed consent.

Results

A total of 256 questionnaires were distributed to consenting participants, all completed and returned, resulting in a 100 % response rate. Most of the study population were men (90.6 %, n = 232), while women accounted for 9.4 % (n = 24). Female participants were slightly older than their male counterparts, with a mean age of 37.5 ± 8.1 years, compared to 34.2 ± 9.2 years for the men.
Prevalence and characteristics of LBP
The point prevalence of LBP was 16.8 % (n = 43), and the period prevalence was 26.2 % (n = 67). There was a slight increase in the risk of the older people compared with the younger subjects, as those aged ≤ 27 years old, 34.8 % (n = 24) had LBP, while of those 41+ years old, 45.6 % (n = 26) had LBP. No association was found between LBP and sex. LBP was equally likely in men and women (31 % (n = 72) of men and 37.5 % (n = 9) of women). None of the demographic factors were significantly associated with LBP.
The most significant findings from Table 1 on LBP characteristics show that most participants (54.3 %) experienced pain on both sides of their lower back, and 43.2 % reported daily pain. Mild pain was the most common, affecting 48.1 % of participants. Additionally, 37.5 % indicated that LBP impacted their job performance, and 37 % received treatment for LBP. Furthermore, results indicated that 29.6 % had missed work due to LBP, with most (83.3 %) missing 1–3 days.
The most frequently used health professional/treatment approach was a general practitioner, 56.7 %, followed by self-medication, 30 %. Thirty participants did not choose a chiropractor, neurologist, or orthopaedic surgeon.
Lifestyle factors associated with LBP
Lifestyle factors associated with LBP were identified (Table 2). Among smoking status, 36.6 % of current smokers reported LBP, with a higher incidence of 73.3 % among those smoking for over 15 years. The higher number of cigarettes smoked per day was significantly associated with LBP (p = 0.047). Alcohol consumption data indicated minimal variation, with 31.1 % of non-drinkers and 32.3 % of drinkers reporting LBP. However, LBP prevalence was notable among drinkers aged 11 to 15 years (54 %) and 6 to 10 years (45.2 %). These differences were statistically significant (p = 0.02).
Regular exercise showed a slightly elevated incidence of LBP, with 36.6 % of participants reporting pain, compared to 25.4 % of non-exercisers. Gym-goers exhibited a higher percentage of LBP at 47.6 %, while cyclists reported LBP at 50 %. Stress emerged as a significant factor; 54.8 % of individuals experiencing work-related stress and 68.2 % under personal stress reported LBP, contrasted with only 22.8 % of those experiencing no stress. These differences were statistically significant (p < 0.001).
Occupational factors associated with LBP
LBP was observed across various categories of work. Regarding the job performed, scaffolders exhibited a high prevalence of LBP, with 50 % reporting symptoms. In comparison, general workers experienced LBP at a rate of 42.2 %, followed by 34.7 % of the carpenters, erectors (33.3 %), bricklayers (30.5 %), formwork (27.3 %), and concrete mixers (25 %), and the excavators had a lower prevalence of 23.5 %. These differences were not statistically significant (p = 0.08).
Among individuals performing repetitive tasks, the LBP rate was 37.6 %, while those engaged in bending or twisting movements exhibited an LBP prevalence of 35.6 %. Additionally, 34.7 % of workers who stood or sat for prolonged periods and 34.3 % of those involved in heavy material lifting reported LBP.
In the cohort of workers booked off work in the last six months, 42.1 % reported LBP, compared to 30 % of those who had not been booked off. The prevalence of LBP increased with the number of days absent, with 30.4 % reporting LBP after 0–1 days of absence, with higher rates observed with more days off. LBP was more common among workers with less than one year of experience, at 37.5 %, decreasing to 26.9 % for those with 10 or more years of experience.
Regarding workload, 32.6 % of those working 3–5 days per week and 31.4 % working 6–7 days reported LBP. Workers logging 8–11 hours per day reported an LBP rate of 31.3 %, while those working more than 12 hours per day exhibited a lower prevalence of 25 %. Notably, although differences were observed between individuals experiencing LBP and those not related to occupational risk factor exposure, these differences were not statistically significant. Table 3 provides information on the occupational factors associated with LBP.

Discussion

The results from this study provided insight into the prevalence, characteristics of LBP, and factors associated with LBP, such as lifestyle and occupational factors. The study revealed that the point prevalence of LBP was 16.8 %, and the period prevalence was 26.2 %. There was a slight increase in risk for older people compared with younger people. LBP is a prevalent global health issue with significant personal and societal impacts. Studies report varying prevalence rates, with point prevalence ranging from 1.0 to 58.1 % (mean: 18.1 %), 1-month prevalence from 12 to 33 %, and 1-year prevalence from 0.8 to 82.5 % (mean: 38.1 %) [17–19]. Chronic LBP prevalence increases with age, peaking between 40–80 years, and is more common in women [20, 21].
A significant association between smoking and LBP was observed, with prolonged smoking (15 years or more) linked to a markedly higher prevalence of LBP (73.3 %). Additionally, the number of cigarettes smoked per day was also found to have a significant association with LBP. Recent studies demonstrate a strong association between smoking and an elevated risk of LBP and spinal disorders. Smokers have higher odds of developing LBP, intervertebral disc disease, spinal stenosis, and spondylolisthesis compared to non-smokers [22, 23]. Mendelian randomisation analysis indicates a causal link between smoking initiation and LBP risk [24]. A study conducted by Pirouzi S. et al. [25] found that the prevalence of LBP was highest among long-term smokers, particularly those who have been smoking for 9 to 13 years.
Similarly, a higher cigarette consumption increases the likelihood and severity of reported pain [25, 26]. Yang Q.H. et al. [27] argue that smoking correlates with increased pain intensity, functional disability, and psychological distress in chronic LBP patients. Smoking significantly contributes to the global health and economic burden of LBP and rheumatoid arthritis [28].
In contrast to smoking, no significant association was found between alcohol consumption and LBP. The incidence of LBP among drinkers (32.3 %) and non-drinkers (31.1 %) was relatively similar, with no statistically significant differences observed. However, a slightly higher prevalence of LBP was noted among individuals who had been drinking for more extended periods, specifically those who had been consuming alcohol for 11 to 15 years (54 %). Research indicates a complex interplay between alcohol consumption and LBP. While some studies report no causal link between alcohol and LBP risk [24], others suggest that moderate alcohol intake correlates with reduced pain severity and enhanced physical function in chronic pain patients [29].
Conversely, a large-scale study identified an association between current or former alcohol use and LBP [30]. A meta-analysis indicated a non-linear inverse relationship between alcohol consumption and chronic pain prevalence [31]. In contrast, individuals with alcohol use disorder exhibit an elevated risk of developing pain disorders and increased analgesic consumption [32]. Additionally, pain-related anxiety is linked to a higher likelihood of concurrent alcohol and prescription opioid use [33]. The interaction between alcohol and pain is bidirectional and involves intricate neurobiological mechanisms [34], necessitating further investigation to elucidate this relationship.
The relationship between physical activity (PA) and LBP was interesting. Regular exercisers reported a slightly higher incidence of LBP (36.6 %) than non-exercisers (25.4 %). Furthermore, gym-goers (47.6 %) and cyclists (50 %) exhibited notably higher rates of LBP. This contrasts with the common assumption that regular PA, particularly exercise, helps to prevent musculoskeletal disorders by improving muscle strength, flexibility, and overall physical conditioning. Research on the association between PA and LBP presents mixed results. Moderate total and leisure-time PA correlates with a reduced risk of LBP in adults [35, 36]. Conversely, both low and high PA levels may elevate LBP risk in children and adolescents [37]. In older adults, higher engagement in sports, leisure time, and total PA is inversely related to chronic LBP [38]. Occupational PA, incredibly strenuous tasks, may heighten the chronic LBP risk [39]. Sedentary behaviours can modulate the PA-LBP relationship [36]. While overall sitting time may not correlate with LBP, moderate and vigorous PA could increase the risk relative to light PA [40]. Understanding how diverse PA levels and types influence LBP can guide the formulation of PA recommendations and pain management strategies across age demographics.
The study found a significant association between stress and LBP, with subjects experiencing work-related stress (54.8 %) and personal stress (68.2 %) reporting significantly higher rates of LBP compared to those who reported no stress (22.8 %). Numerous studies have established a correlation between elevated perceived stress levels and an increased incidence of LBP [41–44]. This association is evident across diverse populations, including eldercare workers, healthcare professionals, and students [42, 43, 45]. Chronic stress, work-related stressors, and psychosocial factors significantly contribute to the onset and aggravation of LBP [46, 47]. Furthermore, stress is linked to a symptom triad comprising chronic pain, fatigue, and depression [46]. Chung et al. [44] argued that stress management interventions, such as sleep enhancement programs, could mitigate LBP by reducing psychological and physical stressors.
The study’s results indicated that certain occupational groups, particularly scaffolders (50 %) and general workers (43.2 %), experience higher LBP rates than other workers. These findings are consistent with the studies by Chung J.W. et al. [44] and Anwer S. et al. [48], highlighting the physically strenuous tasks performed by scaffolders and general workers as significant contributors to LBP. The tasks required in these jobs, such as heavy lifting, manual handling of materials, and repetitive movements, are known to increase the risk of musculoskeletal disorders, including LBP. In response, the literature suggests several ergonomic interventions to mitigate these risks. For instance, Yin Z. and Caldas C. [49] recommend reducing the weight of materials lifted and promoting mechanical lifting devices. Other suggestions include team lifting and the use of adjustable workstations to improve posture and reduce the physical strain on workers [50]. These interventions are critical in addressing the occupational risk factors for LBP and should be incorporated into workplace health and safety protocols.
The study exhibits several strengths, notably its focus on construction workers at high risk for LBP due to the physically demanding nature of their occupations. It analyses various factors, including age, lifestyle choices, and work-related risks, enhancing the understanding of LBP influences. The study employs robust statistical methodologies, ensuring the reliability of the results. It identifies significant risk factors, such as smoking and stress, which could inform workplace health initiatives.
However, certain limitations should be acknowledged. The study’s design facilitates the observation of correlations between risk factors and LBP but does not establish causation. Furthermore, the research is limited to workers from two construction companies in a single location, potentially restricting the generalizability of the findings to the broader construction workforce. The reliance on self-reported data regarding smoking and stress levels may also introduce inaccuracies.
To address these limitations, future research should adopt longitudinal approaches to elucidate the temporal relationships between risk factors and LBP. Expanding the sample to include a diverse range of workers from various regions and companies would enhance the applicability of findings across the construction sector. The study advocates for intervention research to evaluate the effectiveness of strategies such as ergonomic training, workplace modifications, and stress management programs. Collaboration between employers and policymakers is crucial for developing comprehensive health and safety programs that encompass ergonomic assessments, preventive health screenings, and educational initiatives regarding the risks associated with smoking and stress. Implementing wellness programs that promote smoking cessation, mental health support, and tailored fitness initiatives could significantly mitigate the risk of LBP among construction workers.

Conclusions

This study found a high prevalence of LBP among construction workers, significantly associated with smoking and stress. Scaffolders, general workers, and erectors were most affected, highlighting job-related physical demands. Effective interventions require a comprehensive approach addressing both ergonomic and lifestyle factors. Employers and policymakers should collaborate on workplace health programs including ergonomic evaluations, training, and stress/smoking cessation support to improve worker well-being.
 
Received 18.01.2025
Revised 21.06.2025
Accepted 30.07.2025

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