Research Article
Phys Med Rehabil Int. 2021; 8(5): 1193.
Belief, Knowledge and Perception of Causes of Low Back Pain among Rural and Urban Dwellers in a Nigerian City
Ojoawo AO* and Ajibade AJ
Department of Medical Rehabilitation, Faculty of Basic Medical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile Ife, Nigeria
*Corresponding author: Adesola Ojo Ojoawo, Department of Medical Rehabilitation, Faculty of Basic Medical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile Ife, Nigeria
Received: November 26, 2021; Accepted: December 23, 2021; Published: December 30, 2021
Abstract
The study examined the belief, knowledge and perception of causes of low back pain among rural and urban dwellers in Nigeria. One hundred and ninety-two (192) participants (99 from rural and 93 from urban community) were recruited for this study. A modified questionnaire from a previous similar study from India was administered to each of the participants to complete. The completed questionnaire was collected immediately. Data was analyzed using descriptive and inferential statistics, alpha level, was set at 0.05.
Result showed that one hundred and thirty-three (71 urban and 62 rural) participants (133, 69.3%) perceived that pile was very important as a cause of low back pain. Considering the fear avoidance belief, 149 (69 urban and 80 rural) 77.6% agreed that low back pain get progressively worse in life. With regard to the knowledge of participants, 72 (45%) participants were able to answer two or three questions correctly and so were termed partially knowledgeable. Nature of work has significant association with each of the following perception, pile (X²=203.38) and poor mattresses (X²=237.830) as major cause of low back pain.
This study concluded that many residents in Ile-Ife are not adequately knowledgeable about LBP and had negative perception and beliefs regarding low back pain (LBP).
Keywords: Nigeria; Rural; Urban; Low back pain; Knowledge
Introduction
The Health seeking behavior of people who are suffering from musculoskeletal pain varies from one culture to another and cultural factors have been reported to have influence on attitude and perception to illnesses, such as defining what is regarded as “normal” and “abnormal”; determining the cause of the illness, decision making control in healthcare settings and impacting on health setting behavior [1]. The general public, including patients living with LBP, lack knowledge about the causes and contributing factors of LBP [2]. The biopsychosocial model of LBP acknowledges that cognitive, emotional, psychosocial, behavioral physical and social factors interact to perpetuate pain and should be addressed in integrated multimodal interventions [3]. In high-income countries, treatments have targeted the biopsychosocial factors associated with pain persistence and chronic low back pain (CLBP) disability in those contexts [4]. Psychological distress, fear avoidance beliefs, catastrophizing and illness perceptions have been associated with functional disability among LBP patients in such countries [4].
Most patients living with LBP lack knowledge and have negative perceptions regarding causes and contributing factors of LBP [5]. This is despite various treatment guidelines for LBP proposing that besides physical treatment and exercises, advice and health education should be part of the treatment plan [6]. Health education will not only enhance peoples’ knowledge about pain, but might also change their negative attitudes and beliefs regarding their pain, and thereby promote the achievement and the desired clinical outcomes [7]. This in turn may decrease the number of patients living with acute LBP and transitioning to living with chronic LBP [8].
In the rural African contexts where beliefs, culture and common activities such as fetch water, farming and carrying heavy objects prevail, combined with high levels of poverty these may increase the consequences of living with LBP [9]. The choice of management of LBP has been observed to be of broad mainly because of in adequate knowledge about the causes of LBL which has led to some uncertainties [10]. Most patients living with LBP lack knowledge and have negative perceptions regarding causes and contributing factors of LBP [5]. This is despite various treatment guidelines for LBP proposing that besides physical treatment and exercises, advice and health education should be part of the treatment plan [6].
The study was designed to examine the attitude, knowledge and perception of both urban and rural community dwellers in Ile Ife about the causes of low back pain.
Methodology
Respondents
The respondents for this study were recruited among residents in Iyanfoworogi and Odo-Ogbe, Osun State.
Inclusion criteria
The respondents that participated in this study met the following criteria:
• Be a resident of Iyanfoworogi or Odo-Ogbe community
• Respondents must be thirty (30) years old and above.
Exclusion criteria
• Residents with medical challenges e.g. loss of eyesight.
• Residents who did not give their consent.
• Non-literacy in English or Yoruba.
Research design
The study was a cross-sectional survey.
Sampling technique
Respondents were selected using purposive sampling technique.
Sample size determination
The sample size was determined by using the formula for calculating sample size to estimate a proportion at a given precision level posited by Lwamga and Lemeshow [11].
Where,
N=The minimum sample size
Z0=Standard normal deviate of 0 at 95% confidence level (i.e. probability of making a type 1 error)=1.96.
100(1-a)²%=Confidence level
P=Anticipated population proportion.
d=Absolute precision required on either side of the proportion (in percentage points).
Using this proportion;
Anticipated population proportion 10%, Confidence level 95%, Absolute precision (5%).
P=0.50
d=0.05
N=99.8
Hence, 99.8 * 2 = 199.6 [12]
Therefore, a total number of 192 respondents were enrolled in this study (99 respondents in Iyanfoworogi and 93 respondents in Odo-Ogbe.
Site of study
The study was conducted in Iyanfoworogi, and Odo-Ogbe, Osun State.
Instruments
The instrument used for this study was a modified questionnaire (back belief questionnaire by Symonds et al (1996) and Pain Attitude Questionnaire [13] used in a previous study by Tarimo and Diener [14].
The questionnaire was divided into four sections:
Section A: Examined personal information such as age gender occupation; Section B: Assessed information on history of back pain; Section C: Collated information on knowledge beliefs and attitudes towards low back pain; Section D: Evaluated response about expected recovery period following low back pain.
Procedure
Ethical approval was obtained from Health Research and Ethics Committee (HREC) of the Institute of Public Health, Obafemi Awolowo University, Ile-Ife. The purpose and procedures of the research work was explained to each of the respondents before they took part in the research and their consent was obtained prior to data collection. Each participant was given a copy of questionnaire to complete, the copy was collected as soon as it was completed.
Data analysis
Data was analyzed using descriptive statistics of mean, standard deviation, percentage and frequency. Chi Square was used to test the association of the variables.
Result
See Table 1-2c.
Variables
Urban
Rural
Total
Frequency
%
Frequency
%
Frequency
%
Sex
Male
48
51.8
52
52.1
100
51.6
Female
45
48.2
47
47.9
92
48.4
Marital Status
Single
7
8.4
13
13.5
20
10.4
Married
64
77.1
73
76
137
71.4
Widow
9
10.8
8
8.3
17
8.9
Divorced
3
3.6
2
2.1
5
2.6
Nature of work
Artisan
10
12
39
40.6
49
25.5
Civil Service
30
36.1
16
16.7
46
23.9
Trading
43
51.8
4
38.5
79
41.7
Farming
0
0
4
4.2
4
2.1
Table 1: Sociodemographic characteristics and occupational distribution of Respondents N=192.
Variable
Moderately Import
Not Import
Slightly Import
Very Import
Urban
Rural
Total
Urban
Rural
Total
Urban
Rural
Total
Urban
Rural
Total
Smoking
20
23
43
19
36
55
31
22
53
13
15
28
Food
18
32
50
8
8
16
15
12
27
40
44
84
Anxiety
9
0
9
58
91
149
13
5
18
3
0
3
Pile
10
21
31
1
0
1
1
13
14
71
62
133
Poor mattress quality
14
27
41
2
4
6
4
6
10
63
59
122
Witches
0
29
29
80
12
92
3
14
17
0
41
41
Herbalist
4
32
36
76
8
84
2
8
10
1
48
49
Sexual Intercourse
27
33
60
12
4
16
10
10
20
34
49
83
Co-morbid disease
10
11
21
49
58
107
24
27
51
0
0
0
Compensation situ
9
5
14
69
34
103
5
49
54
0
8
8
Birth defect
13
16
29
17
16
33
22
33
55
30
31
61
Degenerative joint
12
20
32
14
25
39
23
28
51
33
23
56
Depression
0
5
5
82
80
162
1
10
11
0
0
0
Fear avoidance beliefs
0
0
0
83
85
168
0
11
11
0
0
0
Bending
15
26
41
4
4
8
11
5
16
52
61
113
Table 2a: Perception of participants about the cause of low back pain N=192.
Variable
Moderately Import
Not Import
Slightly Import
Very Import
Urban
Rural
Total
Urban
Rural
Total
Urban
Rural
Total
Urban
Rural
Total
twisting and bending
18
34
52
23
10
33
12
8
20
30
44
74
Gender
4
9
13
78
61
139
1
22
23
0
4
4
Leg length discrepancy
12
9
21
42
46
88
10
22
32
19
19
38
Obesity
0
5
5
83
78
161
0
13
13
0
0
0
Age
26
6
32
45
63
108
4
14
18
8
13
21
lack of understanding of pathology
6
7
13
59
67
126
12
14
26
3
4
7
Perception on work
17
27
44
8
27
35
10
18
28
48
24
72
future problems
22
31
53
34
28
62
7
9
16
19
28
47
Physically demand wk
20
26
46
7
0
7
9
28
37
47
42
89
Posture
31
10
41
0
63
63
12
17
29
0
6
6
Pregnancy
19
46
65
1
1
2
13
13
26
50
36
86
History of back pain
35
24
55
9
38
47
19
34
53
20
0
20
Prolonged sitting
14
25
39
4
12
16
7
55
62
58
4
62
Repetitive heavy lifting
24
38
62
2
13
15
13
23
36
44
22
66
Table 2b: Perception of participants about the cause of low back pain N=192.
Variable
Moderately Import
Not Import
Slightly Import
Very Import
Urban
Rural
Total
Urban
Rural
Total
Urban
Rural
Total
Urban
Rural
Total
Self-efficacy beliefs
23
0
23
3
91
94
11
5
16
46
0
46
Psychological stress
8
10
18
59
69
128
16
17
33
0
0
0
Some sports activity
21
24
45
43
63
106
15
9
24
3
0
3
Spouse relations
8
10
18
58
63
121
17
23
40
0
0
0
Stressful life events
10
37
47
57
15
72
16
40
56
0
44
44
Trauma or injury
24
37
61
8
0
8
18
5
23
33
54
87
Types of the chair use at home or work
28
59
87
12
24
36
12
5
17
30
8
38
Table 2c: A perception of participants about the cause of low back pain N=192.
General beliefs about low back pain
Majority of the participants 71.4% have fear of avoidance beliefs about low back pain and belief they should avoid movement when they have LBP. One hundred and fourteen participants (59.4%) recorded that low back pain will not stop them from working, sixtytwo (32.3%) agree that low back pain will stop them from working while three (1.6%) don’t know. One hundred and forty-nine (77.6%) recorded that low back pain gets progressively worse later in life (Table 3).
Variables
Agree
Disagree
Don’t Know
Urban
Rural
Total
Urban
Rural
Total
Urban
Rural
Total
Avoid movement because of LBP
64
73
137
16
19
35
3
4
7
Pain acceptance facilitate recovery
36
43
79
47
53
100
0
0
0
Only health personnel cure LBP
12
10
22
71
86
157
0
0
0
Self-management on LBP has no effect on recovery
12
9
21
71
87
158
0
0
0
LBP eventually stop you from working.
39
33
72
44
63
107
0
0
0
LBP will last you for the rest of your life.
56
2
58
26
94
120
1
0
1
LBP will never stop you from doing what you want To do
52
62
114
30
32
62
1
2
3
Abstain from your duties and avoid physical activity
52
68
120
30
28
58
1
0
1
Having LBP may mean you will end up with disability
44
52
96
39
44
83
0
0
0
You can control the amount of pain you feel by Changing your thoughts.
47
54
101
36
42
78
0
0
0
To know about your pain, best is go to health care Facility
51
61
112
32
35
67
0
0
0
LBP gets progressively worse later in life
69
80
149
14
16
30
0
0
0
Table 3: General beliefs about low back pain N=192.
Knowledge about cause and course of low back pain
Regarding the first question; forty-two participants (21.9%) were able to answer one question correctly and so were termed partially knowledgeable, one hundred and thirty-seven (71.4%) were not able to answer correctly or chose don’t know and so termed not knowledgeable while none of the participants chose the two correct answers.
Regarding the third question; seventy-two (45%) participants were able to answer two or three question correctly and so were termed partially knowledgeable, fifty-eight (30.7%) answered just one correct answer or chose don’t know and so termed not knowledgeable while 49 (24.3%) chose the four correct answers and so termed fully knowledgeable (Table 4).
Variables
Full Knowledgeable
Partial Knowledgeable
Not Knowledgeable
With regards to acute LBP: Mark two most correct statements
0
0
0
24
18
42
59
78
137
These could cause LBP: Mark two most Correct.
40
0
40
43
74
117
0
22
22
These factors could contribute to development of LBP
11
38
49
38
34
72
34
24
58
To protect your spine: Mark the two most correct Statements
29
0
29
10
80
90
44
16
60
In relation to spinal protection: Mark one Statement which is wrong.
35
26
61
0
0
0
48
70
118
The following could be reason for LBP
47
28
75
36
43
97
0
0
0
Table 4: Knowledge about cause and course of low back pain N=192.
Association between perception of causes of low back pain and some sociodemographic variables of respondent
Table 5 shows the association between perception of the causes of low back pain and each of sex, marital status and nature of work .Chi square result showed that there was a significant association between perception of causes of low back pain as regard pile and each of sex χ²=194.793 (p<0.001), marital status (205.973, p<0.001) and nature of work χ²=(230.383 p<0.001) (Table 5).
Variable
MI
NI
SI
VI
X2
P Value
Pile is major cause of Low back pain
Female
19
1
6
67
Male
12
0
6
66
194.793
0
Marital Status
Divorced
1
0
0
4
Married
26
0
10
101
205.973
0
Single
3
1
3
13
Widow
0
0
1
17
Nature of work
Artisan
11
0
4
34
Civil servant
5
0
7
34
230.383
0
Farmer
2
0
0
2
Trader
9
1
3
63
Poor Matrasses
Female
16
3
7
60
195.582
0
Male
25
3
3
62
Marital status
Divorced
0
0
0
4
Married
26
5
7
11
204.3
0
Single
3
1
0
17
Widow
1
0
3
10
Nature of work
Artisan
15
1
4
29
Civil servant
5
2
1
38
Farmer
2
2
0
0
237.83
0
Trader
19
1
5
55
Table 5: Association between perception of causes of low back pain and some sociodemographic variables.
Discussion
This study determined the perception, beliefs and knowledge of causes of low back pain among rural and urban dwellers. Literature reported that Nigeria appears to have one of the greatest burdens of LBP in the world, possibly accounted for by people living in rural areas [15]. The results of this study showed that there were more males respondents in the study than females. According to the National population Estimate [16] there were slightly increase in number of males compare to the female population in Nigeria including Ile Ife where the study was carried out. This may be one of the reasons why males were more than females among the study population. Traders were found to be more in the study because one of the study sites is situated close to a well-known trading and commercial center in the city of the study. On the perceived cause of low back pain, close to seventy percent respondents believed that pile was an important cause of low back pain while more than sixty percent demonstrated poor mattresses and close to sixty percent reported bending as being very important factors. There are many contributing physical and psychosocial factors to causes of LBP with an inconclusive evidences form literature on which exactly the most important factors [14,17- 19]. The perception of pile being the most important by some respondents as a cause of low back pain was wrong. Pile is also known as hemorrhoids, which are swellings of large blood vessels inside and around the bottom [20]. However, there was no link between hemorrhoid and low back pain from literature. On the other hand the perception about each of poor mattresses and bending as causes of low back pain were in line with literatures. Different authors reported poor mattresses and bending as factors that can cause and contribute to low back pain [21,22]. It could then be observed that a sizeable number of respondents in this study have relatively good perception on the causes of low back pain. Back injuries that occur in the workplace are majorly from ligaments, tendons, muscles and disc of the spine. They resulted from long duration repeated movement of which cumulated to tear of the muscle. Such repeated movement includes pulling, straining, reaching, twisting and bending which invariably put stress on the spinal structure and cause weakness there by increase the injury risk [Mazanec 2021]. Literature reported that an individual sleeping on a bad mattress may have back pain or back pain become worse, the spine will not be properly supported by the mattress which will lead to poor sleeping posture, muscle strain and poor alignment of the spine [21].
Some of the rural and urban dwellers also ascribe some other factors to causes of low back pain because cultural beliefs manifest in the way people interpret illnesses, especially when they do not have an adequate explanation for the symptoms which may in turn affect treatment outcome as stated by Igwesi-Chidobe et al. [23]. Some other causes according to the report were herbalist, witches, sexual intercourse and many others, these are some of the reasons why some individuals with low back pain will not approach orthodox medicine for intervention. A higher percentage of the participants believed that activities at the work place such as heavy physical work, poor posture and prolonged sitting or standing were responsible for their LBP, which is in agreement with the study of Omokhodion et al. [24]; but on the contrary, most participants, close to sixty percent felt that comorbidity diseases were not important in causing low back pain [25].
Concerning general beliefs of low back pain, more than seventy percent believes they should avoid movement due to their low back pain and that people with LBP should avoid physical activities and abstain from their regular duties for fear of causing more injury to their back. The believe is relatively right in the sense that movement of an injured tissues can result in to further damage of such a tissues and invariable complicate the signs and symptoms of the problems. One of the reasons while there is recurrent and prolonged low back pain is altered spinal motor control [26,27].
Furthermore, close to eighty percent held a belief that their LBP will get progressively worse, this is in agreement with previous study by Tarimo and Diener [14]. The findings from this study serves as evidence while low back pain is one of the major reasons why workers are absent from work [28,29]. Based on the answer supplied by participants about cause and course of low back pain only a small percentage was termed fully knowledgeable, but most were termed partially knowledgeable. These results are in agreement with the results of the previous study by Tarimo and Diener [14]. Also, the urban dwellers were seen to be more knowledgeable compared with the rural dwellers. The reason for this could be because urban dwellers have a higher level of exposure and most residents are learned. They have access to the internet facility, radio and television information and many other sources of information that can enrich their knowledge base. It was observed from the results that a significant association was found between perception of cause of low back pain especially pile, and nature of work. Although this perception was wrong but the informs that there area lot of wrong information and advices that people usually get from the work place. The major reason while many low back pain patients consult herbs and self medication as means of treatment for low back pain. On the other hands, there were significant associations between poor mattresses and bending even with nature of work. The inference from this is that as patient learnt what is wrong, they also learnt what is right from the work places. The work place is station from social interaction where there can be dissemination of information both the right and wrong ones. Various factors (Age, poor mattress, workplace and psychosocial) were shown to be associated with each of gender and marital status.
Conclusion
It can be concluded from the study there are both right and wrong perception about the causes of low back pain, the fear avoidance belief was good there was inadequately knowledge about LBP among the study population.
It can be concluded from the study there are both right and wrong perception about the causes of low back pain, the fear avoidance belief was good there was inadequately knowledge about LBP among the study population.
This study did not differentiate between perception, beliefs and knowledge between participants without low back pain and participants with low back pain and so future studies may address this.
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