Effects of Occupational Stress and Frequency of Lifting Heavy Loads on Low Back Pain in Health Workers: A Meta Analysis

Ahmad Syauqi Mubarok, Argyo Demartoto, Bhisma Murti


Background: Health workers have a high risk for experiencing symptoms of disorders of the musculoskeletal system such as pain, injury, trauma, and other disorders. According to the World Health Organization (WHO), work-related musculoskeletal disorders or commonly called work-related musculoskeletal disorders (WRMDs) are injuries that include various inflammatory disorders or degenerative diseases associated with pain or functional disorders in the body.

Subjects and Method: This study is a systematic review and meta-analysis with the following PICO, Population: Health workers. Intervention: High stress and high frequency of heavy lifting. Comparison: Low stress and low frequency of weight lifting. Outcome: Back pain. The articles used in this study were obtained from three databases, namely Google Scholar, Pubmed, and Science Direct. Keywords to search for articles “low back pain” “risk factors” “determinants” “predictors” AND “health workers” The articles included were full-text English with a cohort and cross-sectional study design from 2016 to 2021 and reported the adjusted odds ratio (aOR) in the multivariate analysis. The selection of articles was done by using PRISMA flow diagram. Articles were analyzed using the Review Manager 5.3 application.

Results: A total of 5 cohort and 10 cross-sectional studies, ten articles included nurses as research respondents, four articles included overall medical personnel, and one article included ambulance workers. Research locations are in Denmark, Saudi Arabia, China, Japan, Malaysia, Iran, Brazil Italy, Australia, Yemen, Estonia, and Ethiopia with medical workers who have low levels of job stress (aOR= 2.52; 95% CI= 2.15 to 2.96; p< 0.001) and it can be concluded that medical workers with frequent heavy lifting have a risk of experiencing back pain by 2.01 times compared to medical workers with infrequent weight lifting frequency (aOR= 2.01; 95% CI 1.23 to 3.18; p = 0.003).

Conclusion: Medical workers with high levels of job stress and frequent heavy lifting are at risk for back pain.

Keywords: back pain, stress, weight lifting.

Correspondence: Ahmad Syauqi Mubarok. Masters Program of Public Health Sciences, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: syauqimubarok39@gmail.com. Mobile: 085741144248.

Journal of Epidemiology and Public Health (2022), 07(04): 493-506

Full Text:



Andersen LL, Burdorf A, Fallentin N, Persson R, Jakobsen MD, Mortensen OS, Clausen T, Holtermann A, et al. (2014). Patient transfers and assistive devices: Prospective cohort study on the risk for occupational back injury among healthcare workers. Scand J Work Environ Health. 40(1): 74–81. doi: 10.5271/sjweh.3382.

Andersen LL, Vinstrup J, Villadsen E, Jay K, Jakobsen MD (2019). Physical and psychosocial work environmental risk factors for back injury among health-care workers: Prospective cohort study. IJERPH. 16(22). doi: 10.3390/ijerph16224528.

Bazazan A, Dianat I, Bahrampour S, Talebian A, Zandi H, Sharafkhaneh A, Maleki GA (2019). Association of musculoskeletal disorders and work-load with work schedule and job satisfaction among emergency nurses. Int Emerg Nurs. 44: 8–13. doi: 10.1016/j.ienj.2019.02.004.

Carugno M, Pesatori AC, Ferrario MM, Ferrari AL, Silva FJda, Martins AC, Felli VEA, Coggon D, Bonzini M, et al. (2012). Physical and psychosocial risk factors for musculoskeletal disorders in Brazilian and Italian nurses. Saude Publica. 28(9): 1632–1642. doi: 10.1590/s0102311x2012000-900003.

Elmannan AAA, AlHindi HA, AlBaltan RI, AlSaif MS, Almazyad NS, Alzurayer RK, Al-Rumayh S (2021). Non-specific Low Back Pain Among Nurses in Qassim, Saudi Arabia. Cureus. 13(11).

Feyer AM, Herbison P, Williamson AM, de Silva I, Mandryk J, Hendrie L, Hely MCG (2000). The role of physical and psychological factors in occupational low back pain: A prospective cohort study. Occup Environ Med. 57(2): 116–120. doi: 10.1136/oem.57.2.116.

Freimann T, Coggon D, Merisalu E, Animägi L, Pääsuke M (2013). Risk factors for musculoskeletal pain amongst nurses in Estonia: a cross-sectional study. BMC BMC Musculoskelet. Disord. 14: 334. doi: 10.1186/14712474-14-334.

Ghilan K, Al-Taiar A, Yousfi NAl, Zubaidi RAl, Awadh I, Al-Obeyed Z (2013). Low back pain among female nurses in Yemen. Int J Occup Med Environ Health. 26(4): 605–614. doi: 10.2478/s13382013-0124-0.

Holtermann A, Clausen T, Jørgensen MB, Burdorf A, Andersen LL (2013). Patient handling and risk for developing persistent low-back pain among female healthcare workers. Scand J Work Environ Health. 39(2): 164–169. doi: 10.5271/sjweh.3329.

Ibrahim MI, Zubair IU, Yaacob NM, Ahmad MI, Shafei MN (2019). Low back pain and its associated factors among nurses in public hospitals of Penang, Malaysia. Int J Environ Res. 16(21). doi: 10.3390/ijerph16214254.

Jradi H, Alanazi H, Mohammad Y (2020). Psychosocial and occupational factors associated with low back pain among nurses in Saudi Arabia. J. Occup. Health. 62(1): 1–7. doi: 10.1002/1348-9585.12126.

McEwen BS (1998). Stress, adaptation, and disease: Allostasis and allostatic load. Ann N Y Acad Sci. 840(1):33–44. doi: 10.1111/j.17496632.1998.tb09546.x.

Milhem M, Kalichman L, Ezra D, Alperovitch ND (2016). Work-related musculoskeletal disorders among physical therapists: A comprehensive narrative review. Int J Occup Med Environ Health. 29(5): 735–747. doi: 10.13075/ijomeh.1896.00620.

Ngan K, Drebit S, Siow S, Yu S, Keen D, Alamgir H (2010). Risks and causes of musculoskeletal injuries among health care workers. Occup Med (Oxford, England). 60(5): 389–394. doi: 10.1093/occmed/kqq052.

Pinheiro MB, Ferreira ML, Refshauge K, Maher CG, Ordoñana JR, Andrade TB, Tsathas A, Ferreira PH. Symptoms of depression as a prognostic factor for low back pain: a systematic review. Spine J. 16(1):105-16. doi: 10.1016/j.spinee.2015.10.037.

Rezaee M, Ghasemi M (2014). Prevalence of low back pain among nurses: Predisposing factors and role of work place violence. Trauma Monthly. 19(4): 9–14. doi: 10.5812/traumamon.17926.

Sanjoy SS, Ahsan GU, Nabi H, Joy ZF, Hossain A (2017). Occupational factors and low back pain: a cross-sectional study of Bangladesh female nurses. BMC Res Notes. 10(1):1-6. doi:10.1186/s13104017-2492-1.

Tefera BZ, Zeleke H, Abate A, Abebe H, Mekonnen Z, Sewale Y (2021). Magnitude and associated factors of low back pain among nurses working at intensive care unit of public hospitals in Amhara region, Ethiopia. PLoS ONE. 16(12): 1–13. doi: 10.1371/journal.pone.0260361.

Tsigos C, Chrousos GP (002). Hypothalamic–pituitary–adrenal axis, neuro-endocrine factors and stress. J Psychosom Res. Z53(4): 865–871.

Tullar JM, Brewer S, Amick BC, Irvin E, Mahood Q, Pompeii LA, Wang A, Van Eerd D, Gimeno D, Evanoff B, et al. (2010). Occupational safety and health interventions to reduce musculoskeletal symptoms in the health care sector. J Occup Rehabil. 20(2): 199–219. doi: 10.1007/s10926010-9231-y.

Vinstrup J, Jakobsen MD, Andersen LL (2020). Perceived stress and low-back pain among healthcare workers: A multi-center prospective cohort study. Front Public Health. 8: 1–7. doi: 10.3389/fpubh.2020.00297.

WHO (1985). Identification and control of work-related diseases. Geneva: World Health Organ. Tech. Rep. Ser.

Yoshimoto T, Oka H, Ishikawa S, Kokaze A, Muranaga S, Matsudaira K (2019). Factors associated with disabling low back pain among nursing personnel at a medical centre in Japan: A comparative cross-sectional survey. BMJ Open. 9(9): 11–13. doi: 10.1136/bmjopen2019032297.

Zhang Q, Dong H, Zhu C, Liu G (2019). Low back pain in emergency ambulance workers in tertiary hospitals in China and its risk factors among ambulance nurses: A cross-sectional study. BMJ Open. 9(9). doi: 10.1136/bmjopen2019029264

Zunszain PA, Anacker C, Cattaneo A, Carvalho LA, Pariante CM (2011). Glucocorticoids, cytokines and brain abnormalities in depression. Prog Neuropsychopharmacol Biol Psychiatry. 35(3): 722–729. doi: 10.1016/j.pnpbp.2010.04.011.


  • There are currently no refbacks.