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<article article-type="research-article" xmlns:xlink="http://www.w3.org/1999/xlink">
<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Surg.</journal-id>
<journal-title>Frontiers in Surgery</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Surg.</abbrev-journal-title>
<issn pub-type="epub">2296-875X</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fsurg.2022.841339</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Surgery</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Prevalence and Clinical Characteristics of Low Back Pain among Operating Room Personnel: A Cross-Sectional Study in South of Iran</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author"><name><surname>Fayzi</surname><given-names>Reza</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib>
<contrib contrib-type="author"><name><surname>Karimi</surname><given-names>Ashkan</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib>
<contrib contrib-type="author"><name><surname>Fereidouni</surname><given-names>Armin</given-names></name>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref><uri xlink:href="https://loop.frontiersin.org/people/1412648/overview"/></contrib>
<contrib contrib-type="author"><name><surname>Salavatian</surname><given-names>Armin</given-names></name>
<xref ref-type="aff" rid="aff4"><sup>4</sup></xref></contrib>
<contrib contrib-type="author"><name><surname>Imani</surname><given-names>Behzad</given-names></name>
<xref ref-type="aff" rid="aff5"><sup>5</sup></xref></contrib>
<contrib contrib-type="author" corresp="yes"><name><surname>Tavakkol</surname><given-names>Reza</given-names></name>
<xref ref-type="aff" rid="aff6"><sup>6</sup></xref>
<xref ref-type="corresp" rid="cor1">&#x002A;</xref><uri xlink:href="https://loop.frontiersin.org/people/1608847/overview"/></contrib>
</contrib-group>
<aff id="aff1"><label><sup>1</sup></label><addr-line>Department of Operating Room, School of Paramedical</addr-line>, <institution>Kermanshah University of Medical Science</institution>, <addr-line>Kermanshah</addr-line>, <country>Iran</country></aff>
<aff id="aff2"><label><sup>2</sup></label><addr-line>Department of Operating Room, School of Paramedician</addr-line>, <institution>Hamadan University of Medical Science</institution>, <addr-line>Hamadan</addr-line>, <country>Iran</country></aff>
<aff id="aff3"><label><sup>3</sup></label><addr-line>Department of Operating Room Technology, School of Nursing and Midwifery</addr-line>, <institution>Shiraz University of Medical Sciences</institution>, <addr-line>Shiraz</addr-line>, <country>Iran</country></aff>
<aff id="aff4"><label><sup>4</sup></label><addr-line>Students Research Committee, School of Paramedical</addr-line>, <institution>Kermanshah University of Medical Sciences</institution>, <addr-line>Kermanshah</addr-line>, <country>Iran</country></aff>
<aff id="aff5"><label><sup>5</sup></label><addr-line>Department of Operating Room, School of Paramedician, Hamadan University of Medical Science</addr-line>, <addr-line>Hamadan</addr-line>, <country>Iran</country></aff>
<aff id="aff6"><label><sup>6</sup></label><addr-line>Nursing and Midwifery Care Research Center</addr-line>, <institution>Mashhad University of Medical Sciences</institution>, <addr-line>Mashhad</addr-line>, <country>Iran</country></aff>
<author-notes>
<fn fn-type="edited-by"><p><bold>Edited by:</bold> Markus Rupp, University Medical Center Regensburg, Germany</p></fn>
<fn fn-type="edited-by"><p><bold>Reviewed by:</bold> David Paige Gilkey, Montana Technological University, United States Natasa Krsto Rancic, University of Ni&#x0161;, Serbia</p></fn>
<corresp id="cor1"><label>&#x002A;</label><bold>Correspondence:</bold> Reza Tavakkol <email>tavakkolreza.73@gmail.com</email></corresp>
<fn fn-type="other" id="fn001"><p><bold>Specialty section:</bold> This article was submitted to Orthopedic Surgery, a section of the journal Frontiers in Surgery</p></fn>
</author-notes>
<pub-date pub-type="epub"><day>27</day><month>05</month><year>2022</year></pub-date>
<pub-date pub-type="collection"><year>2022</year></pub-date>
<volume>9</volume><elocation-id>841339</elocation-id>
<history>
<date date-type="received"><day>22</day><month>12</month><year>2021</year></date>
<date date-type="accepted"><day>04</day><month>05</month><year>2022</year></date>
</history>
<permissions>
<copyright-statement>Copyright &#x00A9; 2022 Fayzi, Karimi, Fereidouni, Salavatian, Imani and Tavakkol.</copyright-statement>
<copyright-year>2022</copyright-year>
<copyright-holder>Tavakkol, Fayzi, Karimi, Fereidouni, salavatian and Abaszadeh</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License (CC BY)</ext-link>. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p></license>
</permissions>
<abstract>
<sec><title>Background</title>
<p>Low back pain is one of the most common musculoskeletal disorders and the most common cause of activity restriction in people younger than 45 years. Nurses have a high incidence and prevalence of low back pain in terms of physical and emotional factors among healthcare workers. This study aimed to evaluate the prevalence and clinical characteristics of low back pain.</p>
</sec>
<sec><title>Methods</title>
<p>This cross-sectional study was performed on 385 operating room personnel of the hospitals affiliated with Shiraz (the largest city in southern Iran) University of Medical Sciences. The data were collected via a research-made developed questionnaire. The questionnaire consisted of two parts, including the demographic information and prevalence and dimensions of low back pain.</p>
</sec>
<sec><title>Results</title>
<p>The results showed that the prevalence of low back pain was 74&#x0025; among operating room personnel. There was a significant relationship among low back pain, education level, and marital status (<italic>p</italic>&#x2009;&#x003C;&#x2009;0.05).</p>
</sec>
<sec><title>Conclusion</title>
<p>Hospital managers should reduce the prevalence of this disorder among operating room staff by teaching preventative patient handling techniques via training courses.</p>
</sec>
</abstract>
<kwd-group>
<kwd>musculoskeletal disorders</kwd>
<kwd>low back pain</kwd>
<kwd>operating room, personnel</kwd>
<kwd>surgery</kwd>
<kwd>perioperative nurse</kwd>
</kwd-group><counts>
<fig-count count="0"/>
<table-count count="4"/><equation-count count="0"/><ref-count count="26"/><page-count count="0"/><word-count count="0"/></counts>
</article-meta>
</front>
<body>
<sec id="s1" sec-type="intro"><title>Introduction</title>
<p>Low back pain (LBP) is one of the most common types of work-related musculoskeletal disorders (MSDs) (<xref ref-type="bibr" rid="B1">1</xref>, <xref ref-type="bibr" rid="B2">2</xref>). LBP is an important public health subject with high prevalence and a considerable negative physical, psychological, social, and economic impact (<xref ref-type="bibr" rid="B3">3</xref>&#x2013;<xref ref-type="bibr" rid="B5">5</xref>). In general, this disorder due to the duration of pain includes three categories: acute (less than 6 weeks), subacute (from 6 to 12 weeks), and chronic (more than 12 weeks) (<xref ref-type="bibr" rid="B6">6</xref>, <xref ref-type="bibr" rid="B7">7</xref>).</p>
<p>The peak of LBP is in the third decade of life, and its incidence increases to 60&#x2013;65 years and then gradually decreases (<xref ref-type="bibr" rid="B8">8</xref>, <xref ref-type="bibr" rid="B9">9</xref>). Nearly more than half of the general population will experience LBP care at some point in their lives (<xref ref-type="bibr" rid="B10">10</xref>). The prevalence of LBP among the general population is estimated to be from 15&#x0025; to 45&#x0025; (<xref ref-type="bibr" rid="B11">11</xref>). Thirty-seven percent of LBP is related to occupations in which professionals are exposed to prolonged periods of standing, such as healthcare workers (<xref ref-type="bibr" rid="B3">3</xref>). LBP can be caused by various components of the spine, abdominal structures, or pelvic organ (<xref ref-type="bibr" rid="B12">12</xref>). Among healthcare workers, nurses have a high incidence of LBP (<xref ref-type="bibr" rid="B13">13</xref>) due to physical and emotional factors (<xref ref-type="bibr" rid="B14">14</xref>). Considering the prolonged standing, unpleasant physical conditions, and movement limitations during surgery (<xref ref-type="bibr" rid="B15">15</xref>), the prevalence of LBP was reported in 70.6&#x0025; of operating room personnel (<xref ref-type="bibr" rid="B16">16</xref>) and most other parts of the hospital (<xref ref-type="bibr" rid="B17">17</xref>).</p>
<p>The purpose of this research was to determine the frequency of LBP and clinical features among operating room staff at Shiraz University of Medical Sciences. The findings of this research will be presented to hospital administrators and operating room directors, who will be able to design suitable initiatives to prevent, control and reduce the recurrence of low back pain in operating room staff.</p>
</sec>
<sec id="s2"><title>Method</title>
<sec id="s2a"><title>Study Design</title>
<p>This is a cross-sectional study performed in 2019 on operating room personnel working in hospitals affiliated with Shiraz (the largest city in southern Iran) University of Medical Sciences, including Faghihi, Namazi, Khalili, Rajaii, Chamran, and Amiralmomenin hospitals.</p>
</sec>
<sec id="s2b"><title>Population and Sample Size</title>
<p>A total of 385 operating room personnel were sampled, similar to prior research by Choobineh et al. (<xref ref-type="bibr" rid="B18">18</xref>), the sample size was determined with average prevalence of low back pain 50&#x0025;, confidence estimates of 95&#x0025;, and 0.05 accuracy.</p>
</sec>
<sec id="s2c"><title>Data Collection</title>
<p>The total number of operating room personnel in each hospital was first determined, and then, the personnel were recruited and selected for participation based on stratified random sampling. To this end, we referred to investigators who administered surveys in hospitals during different shifts after obtaining permission from the Ethics Committee, and the sampling was carried out based on the inclusion criteria mentioned in different shifts after obtaining informed and written consent from the personnel. The questionnaires were distributed among the personnel and collected at the end of the office time on the same day.</p>
</sec>
<sec id="s2d"><title>Inclusion and Exclusion Criteria</title>
<p>Participants&#x2019; inclusion criteria included a willingness to participate in the study and 2 years of work experience. Exclusion criteria were osteoporosis, acquired spinal diseases, and corticosteroid consumption.</p>
</sec>
<sec id="s2e"><title>Measuring Instruments</title>
<p>Research-made developed questionnaire was used to evaluate and gather data on the prevalence and presence of LBP and its related dimensions. The validity and reliability of the questionnaire had already been examined. During the psychometric phase of instrument development, qualitative and quantitative methods were used to determine the face validity and content and construct validity evaluation. The face validity of qualitative data was checked by interviews with 20 professors and experts in this field, resulting in a modification of three items and the addition of two items. During the quantitative face validity phase, which assessed the importance of each item by using the item impact formula, all tool items received the least impact score. This was done by filling out the initial questionnaire by 20 operating room personnel. The content validity of the qualitative section was determined by the experts&#x2019; correction; three items were corrected, and one item was merged with the other items. Quantitative evaluation of the content validity was done using two indices of the content validity ratio and content validity index, by 14 and 10 professors and experts in this field, respectively. In this phase, two items failed to achieve the required score and were eliminated. The construct validity assessment was completed via the convergent and divergent validity, respectively, using the chronic pain questionnaire and General Health Questionnaire distributed among 30 operating room personnel. The correlation of the mentioned instruments was investigated with the research instrument. The relationship between the research instrument with the chronic pain questionnaire as a convergent tool and the General Health Questionnaire as a divergent instrument was 0.70 and &#x2212;0.37, respectively, which was statistically significant (<italic>p</italic>&#x2009;&#x003C;&#x2009;0.05). The reliability and internal consistency of the instrument, determined by test&#x2013;retest and Cronbach&#x2019;s alpha coefficient, were found to be 0.77 and 0.60, respectively. The questionnaire consisted of two sections: &#x201C;Demographic information and prevalence and dimensions of LBP.&#x201D; This questionnaire assessed the prevalence and dimensions of LBP using 11 multiple-choice questions (18).</p>
</sec>
<sec id="s2f"><title>Data Analyses</title>
<p>After collecting the questionnaires, the data were entered into SPSS version 19 and then analyzed. Descriptive statistics calculated demographic data of the population, frequency distribution, mean, and standard deviation.</p>
</sec>
<sec id="s2g"><title>Ethical Considerations</title>
<p>The Institutional Review Board of Shiraz University approved this medical science study (ethical code: IR.SUMS.REC.1398.263) available link:<ext-link ext-link-type="uri" xlink:href="https://ethics.research.ac.ir/EthicsProposalView.php?id&#x2009;&#x003D;&#x2009;57702.">https:&#x002F;&#x002F;ethics.research.ac.ir&#x002F;EthicsProposalView.php?id&#x2009;&#x003D;&#x2009;57702.</ext-link></p>
<p>All participants agreed to participate in the study and signed informed consent. The participants were assured that their information would remain confidential.</p>
</sec>
</sec>
<sec id="s3" sec-type="results"><title>Results</title>
<p>A total of 385 operating room personnel working in six hospitals affiliated with Shiraz University of Medical Sciences were studied. <xref ref-type="table" rid="T1">Table&#x00A0;1</xref> shows the frequency distribution of the demographic characteristics of the population under study. Among 385 participants, 240 (62.3&#x0025;) were women. The mean and standard deviation of the age was 33.25&#x2009;&#x00B1;&#x2009;7 7.96. Besides, the majorities of participants were undergraduates (85.7&#x0025;) and married (57.4&#x0025;).</p>
<table-wrap id="T1" position="float"><label>Table 1</label><caption><p>Demographic characteristics of the operating room personnel.</p></caption>
<table frame="hsides" rules="groups">
<colgroup>
<col align="left"/>
<col align="left"/>
<col align="center"/>
</colgroup>
<thead>
<tr>
<th valign="top" align="left"/>
<th valign="top" align="center">Variable</th>
<th valign="top" align="center">Frequency (&#x0025;)</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left" rowspan="2">Gender</td>
<td valign="top" align="left">Male</td>
<td valign="top" align="center" char="&#x0028;">240 (62.3)</td>
</tr>
<tr>
<td valign="top" align="left">Female</td>
<td valign="top" align="center">145 (37.7)</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="4">Age</td>
<td valign="top" align="left">20&#x2013;29 years</td>
<td valign="top" align="center" char="&#x0028;">155 (40.3)</td>
</tr>
<tr>
<td valign="top" align="left">30&#x2013;39 years</td>
<td valign="top" align="center">150 (39)</td>
</tr>
<tr>
<td valign="top" align="left">40&#x2013;49 years</td>
<td valign="top" align="center">58 (15.1)</td>
</tr>
<tr>
<td valign="top" align="left">Above 50 years</td>
<td valign="top" align="center">22 (5.7)</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="2">Marital status</td>
<td valign="top" align="left">Married</td>
<td valign="top" align="center" char="&#x0028;">221 (57.4)</td>
</tr>
<tr>
<td valign="top" align="left">Single</td>
<td valign="top" align="center">162 (42.6)</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="3">Education level</td>
<td valign="top" align="left">Bachelor degree</td>
<td valign="top" align="center" char="&#x0028;">330 (85.7)</td>
</tr>
<tr>
<td valign="top" align="left">Associate degree</td>
<td valign="top" align="center">45 (11.7)</td>
</tr>
<tr>
<td valign="top" align="left">Master degree</td>
<td valign="top" align="center">10 (2.6)</td>
</tr>
</tbody>
</table>
</table-wrap>
<p>The prevalence of LBP was reported at 75&#x0025;. Therefore, it was found that the prevalence of LBP in hospitals varied, and the highest prevalence (84.2&#x0025;) was in the hospital of burn and plastic (<xref ref-type="table" rid="T2">Table&#x00A0;2</xref>). Also, the highest prevalence of LBP was in married (61.05&#x0025;) people.</p>
<table-wrap id="T2" position="float"><label>Table 2</label><caption><p>Prevalence of LBP in the studied hospitals.</p></caption>
<table frame="hsides" rules="groups">
<colgroup>
<col align="left"/>
<col align="center"/>
<col align="center"/>
</colgroup>
<thead>
<tr>
<th valign="top" align="left">Hospital name</th>
<th valign="top" align="center">Number of personnel</th>
<th valign="top" align="center">Prevalence of low back pain,<break/>frequency (&#x0025;)</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">Faghihi</td>
<td valign="top" align="center">83</td>
<td valign="top" align="center" char="&#x0028;">62 (74.6)</td>
</tr>
<tr>
<td valign="top" align="left">Namazee</td>
<td valign="top" align="center">94</td>
<td valign="top" align="center" char="&#x0028;">62 (65.9)</td>
</tr>
<tr>
<td valign="top" align="left">Khalili</td>
<td valign="top" align="center">49</td>
<td valign="top" align="center" char="&#x0028;">37 (75.5)</td>
</tr>
<tr>
<td valign="top" align="left">Rajaey</td>
<td valign="top" align="center">85</td>
<td valign="top" align="center" char="&#x0028;">68 (80)</td>
</tr>
<tr>
<td valign="top" align="left">Chamran</td>
<td valign="top" align="center">55</td>
<td valign="top" align="center" char="&#x0028;">40 (72.7)</td>
</tr>
<tr>
<td valign="top" align="left">Amiralmomenin</td>
<td valign="top" align="center">19</td>
<td valign="top" align="center" char="&#x0028;">16 (84.2)</td>
</tr>
<tr>
<td valign="top" align="left">Total</td>
<td valign="top" align="center">385</td>
<td valign="top" align="center" char="&#x0028;">285 (74)</td>
</tr>
</tbody>
</table>
</table-wrap>
<p><xref ref-type="table" rid="T3">Table&#x00A0;3</xref> shows the clinical characteristics of low back pain in the participants of this study. Most participants had a normal body mass index (BMI) (73.2&#x0025;), work experience of less than 10 years (60.3&#x0025;), rotating shifts (71.7&#x0025;), and standing physical condition (54&#x0025;). In addition, in 67.71&#x0025; of participants, low back pain occurred less than 10 years after the start of work, and 81.40&#x0025; of total low back pain was acute low back pain in nature. Sixty-seven percent of the patients reported pain only in the lumbar region, and according to the type of pain, intermittent pain was the most frequent, with 32.28&#x0025;. Another criterion evaluated in this study was the severity of pain in the patients. Furthermore, transient mild pain that resolves spontaneously without using analgesics or rest was the highest, with 60.35&#x0025;. The relationship between participant demographic information and clinical characteristics of low back pain showed that only sex (<italic>p</italic>-value&#x2009;&#x003D;&#x2009;0.023) and marital status (<italic>p</italic>-value&#x2009;&#x003D;&#x2009;0.017) had a significant relationship with pain area (<xref ref-type="table" rid="T4">Table&#x00A0;4</xref>).</p>
<table-wrap id="T3" position="float"><label>Table 3</label><caption><p>Clinical characterization of low back pain among operating room personnel.</p></caption>
<table frame="hsides" rules="groups">
<colgroup>
<col align="left"/>
<col align="center"/>
<col align="center"/>
</colgroup>
<thead>
<tr>
<th valign="top" align="left"/>
<th valign="top" align="center">Variable</th>
<th valign="top" align="center">Frequency (&#x0025;)</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left" rowspan="4">BMI</td>
<td valign="top" align="left">BMI is less than 18.5 (underweight)</td>
<td valign="top" align="center">20 (5.2&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left">BMI is 18.5 to 24.9 (normal weight)</td>
<td valign="top" align="center">282 (73.2&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left">BMI is 25 to 29.9 (overweight)</td>
<td valign="top" align="center">77 (20&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left">BMI is 30 or more (obese)</td>
<td valign="top" align="center">6 (1.6&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="3">Work experience</td>
<td valign="top" align="left">Less than 10 years</td>
<td valign="top" align="left" char="&#x0028;">232 (60.3&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left">10&#x2013;20 years</td>
<td valign="top" align="center">109 (28.3&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left">More than 20 years</td>
<td valign="top" align="center">44 (11.4&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="4">Shifts</td>
<td valign="top" align="left">Morning</td>
<td valign="top" align="left" char="&#x0028;">60 (15.6&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left">Evening</td>
<td valign="top" align="center">33 (8.6&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left">Night</td>
<td valign="top" align="center">16 (4.2&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left">Rotating Shift</td>
<td valign="top" align="center">276 (71. 7&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="4">Physical condition</td>
<td valign="top" align="left">Standing</td>
<td valign="top" align="left" char="&#x0028;">208 (54&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left">Sitting</td>
<td valign="top" align="center">37 (9.6&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left">Moving</td>
<td valign="top" align="center">21 (5.5&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left">Combination of different physical conditions</td>
<td valign="top" align="center">119 (30.&#x0025;9)</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="4">Duration of pain</td>
<td valign="top" align="left">Acute (less than 6 weeks)</td>
<td valign="top" align="left" char="&#x0028;">232 (81.40&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left">Subacute (between 6 and 12 weeks)</td>
<td valign="top" align="center">34 (11.92&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left">Chronic (more than 12 weeks)</td>
<td valign="top" align="center">1 (0.35&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left">No improvement</td>
<td valign="top" align="center">18 (6.31&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="4">Beginning of low back pain</td>
<td valign="top" align="left">Less than 5 years</td>
<td valign="top" align="left" char="&#x0028;">193 (67.71&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left">5&#x2013;9 years</td>
<td valign="top" align="center">69 (24.21&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left">10&#x2013;15 years</td>
<td valign="top" align="center">21 (7.36&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left">More than 15 years</td>
<td valign="top" align="center">2 (0.70&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="2">Pain area</td>
<td valign="top" align="left">Regional low back pain (only in the waist area)</td>
<td valign="top" align="left" char="&#x0028;">191 (67.01&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left">Low back pain with spread to the legs</td>
<td valign="top" align="center">94 (32.98)</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="8">Type of pain</td>
<td valign="top" align="left">Sharp pain</td>
<td valign="top" align="left" char="&#x0028;">23 (8.07&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left">Burning pain</td>
<td valign="top" align="center">36 (12.63&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left">Stingray and mormor</td>
<td valign="top" align="center">76 (26.66&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left">Numbness</td>
<td valign="top" align="center">13 (4.56&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left">Intermittent pain</td>
<td valign="top" align="center">92 (32.28&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left">Constant pain</td>
<td valign="top" align="center">26 (9.12&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left">Constant exacerbating pain</td>
<td valign="top" align="center">7 (2.45&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left">Other cases</td>
<td valign="top" align="center">12 (4.21&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="4">Severity of pain</td>
<td valign="top" align="left">Transient mild pain that resolves spontaneously without the use of analgesics or rest</td>
<td valign="top" align="left" char="&#x0028;">172 (60.35&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left">Permanent mild pain in such a way that it does not stop you from doing the hard work</td>
<td valign="top" align="center">62 (21.75&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left">Moderate pain in such a way as to prevent heavy physical activity or heavy work</td>
<td valign="top" align="center">44 (15.43&#x0025;)</td>
</tr>
<tr>
<td valign="top" align="left">Severe pain that prevents daily activities</td>
<td valign="top" align="center">7 (2.45&#x0025;)</td>
</tr>
</tbody>
</table>
</table-wrap>
<table-wrap id="T4" position="float"><label>Table 4</label><caption><p>The relationship between clinical characteristics of low back pain and demographic characteristics of the operating room personnel.</p></caption>
<table frame="hsides" rules="groups">
<colgroup>
<col align="left"/>
<col align="center"/>
<col align="center"/>
<col align="center"/>
</colgroup>
<thead>
<tr>
<th valign="top" align="left" colspan="2">Variable<hr/></th>
<th valign="top" align="center">Frequency (&#x0025;)</th>
<th valign="top" align="center">The significance level</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left" rowspan="2">Gender</td>
<td valign="top" align="left">Male</td>
<td valign="top" align="center" char="&#x0028;">240 (62.3)</td>
<td valign="top" align="center" char="." rowspan="2">0.023</td>
</tr>
<tr>
<td valign="top" align="left">Female</td>
<td valign="top" align="center">145 (37.7)</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="2">Marital status</td>
<td valign="top" align="left">Married</td>
<td valign="top" align="center" char="&#x0028;">221 (57.4)</td>
<td valign="top" align="center" char="." rowspan="2">0.017</td>
</tr>
<tr>
<td valign="top" align="left">Single</td>
<td valign="top" align="center">162 (42.6)</td>
</tr>
</tbody>
</table>
</table-wrap>
</sec>
<sec id="s4" sec-type="discussion"><title>Discussion</title>
<p>The present study was performed to evaluate the prevalence of LBP and its clinical characterization in operating room personnel of six hospitals affiliated with Shiraz University of Medical Sciences. This study&#x2019;s results showed a high prevalence of low back pain (75&#x0025;) in operating room personnel. LBP is one of the most common work-related MSDs (<xref ref-type="bibr" rid="B19">19</xref>), which has many detrimental consequences for the healthcare system and its personnel (<xref ref-type="bibr" rid="B20">20</xref>).</p>
<p>LBP had a high prevalence among participants. In a study conducted by Choobineh et al. to investigate the prevalence of MSDs in the Shiraz operating room nurses, it was found that more than half of the participants had LBP during the past year, which was the most prevalent among other MSDs (<xref ref-type="bibr" rid="B18">18</xref>). High prevalence can be attributed to working in a stressful operating room environment and specific activities. In another study, Trinkoff et al. reported LBP as the most common musculoskeletal disorder in nurses at the University of Maryland, USA (<xref ref-type="bibr" rid="B21">21</xref>). The prevalence of LBP was higher in women, indicating the impact of the female sex on the development of low back pain (<xref ref-type="bibr" rid="B8">8</xref>).</p>
<p>The other additional results of this study revealed differentiated pain duration. Consistent with this finding, 167 patients had acute LBP and a few suffered from chronic LBP. In the study by La Torre et al., LBP was identified as the most important musculoskeletal disorder among operating room nurses in Rome, and acute LBP was the most prevalent (<xref ref-type="bibr" rid="B17">23</xref>). The high prevalence of acute LBP in these studies may be in terms of the heavy and risky transient activity during surgical operations, such as stretching and specific physical postures in operating room personnel. Besides, in a study conducted by Barkhordari et al. to evaluate the prevalence of LBP in nurses of hospitals in Yazd, the duration of pain in LBP patients was in two-thirds cases less than two weeks and in others at least two weeks during the past 12 months (<xref ref-type="bibr" rid="B24">24</xref>).</p>
<p>Other results of this study indicated the absence of work in one-third of the affected people. Moreover, about two-thirds of patients did not see a doctor. Among those who were referred to a physician, most people underwent diagnostic or therapeutic measures. Drug therapy and X-rays were the most prevalent diagnostic modality among these measures. In a similar study, Bejia et al. reported the prevalence of LBP in more than half of Monastir Tunisian hospital staff. About one-quarter of patients in this study suffered from chronic low back pain. Thus, it was found that most patients needed medical care, and about half of them needed radiologic diagnoses. Hence, in a significant number of participants, LBP led to absence from work (<xref ref-type="bibr" rid="B25">25</xref>). Regarding the high rate of chronic LBP in the study of Bejia compared to the present study, there may be an increased need for patients with medical care and radiological diagnoses, as well as an increased absence of work related to this type of LBP.</p>
<p>Another notable result of this study was determining the severity of LBP and its impact on participants&#x2019; daily life activities. The results showed that more than half of the patients had transient and permanent mild pain, about two-fifths of them had moderate pain that prevented heavy physical activity or heavy work, and only a few suffered severe pain that prevented them from doing their daily activities. In a study conducted by Awosan et al. to investigate the prevalence of LBP among healthcare workers in Sokoto, Nigeria, most participants experienced LBP after work. Among the patients, about half had mild pain, a significant number had moderate pain, and a small number had severe pain (<xref ref-type="bibr" rid="B26">26</xref>). By comparing the results of the Awosan study and the present study, it was found that most patients had mild pain. High-risk activities are probably the reason for increased pain over time, while rest leads to decreased pain intensity and less progression towards chronic forms.</p>
<sec id="s4a"><title>Limitations</title>
<p>The limitations of this study include no evaluation of students and operating room personnel of private hospitals. Therefore, evaluating other risk factors such as mental status and occupational stress can provide better results among operating room personnel. Besides, it is recommended that other studies should evaluate students and private hospitals. The self-reported surveys were completed by the study subjects and are subject to recall and response bias. Subjects may not have recalled events or characteristics accurately or may have been reluctant to report the truth. This is because of the fact that some people believe that one with LBP lacks a normal life, leading to their decreased self-confidence. This can be due to factors such as old age, high BMI, low education level, and so on, which are related to LBP.</p>
</sec>
</sec>
<sec id="s5" sec-type="conclusions"><title>Conclusions</title>
<p>The present study showed a high prevalence of low back pain among the operating room personnel. By examining the different factors and characteristics of participants, there was a significant relationship among LBP, education level, and marital status. Therefore, more attention is needed to these cases, and the increase in awareness among operating room staff via taking classes and courses has partly reduced the prevalence of the disorder.</p>
</sec>
</body>
<back>
<sec id="s6" sec-type="data-availability"><title>Data Availability Statement</title>
<p>The raw data supporting the conclusions of this article will be made available by the authors without undue reservation.</p>
</sec>
<sec id="s7"><title>Ethics Statement</title>
<p>The studies involving human participants were reviewed and approved by The Institutional Review Board of Shiraz University of Medical Science (ethical code: IR.SUMS.REC.1398.263) available at <ext-link ext-link-type="uri" xlink:href="https://ethics.research.ac.ir/EthicsProposalView.php?id&#x003D;57702">https:&#x002F;&#x002F;ethics.research.ac.ir&#x002F;EthicsProposalView.php?id&#x003D;57702</ext-link>. The patients&#x002F;participants provided their written informed consent to participate in this study.</p>
</sec>
<sec id="s8"><title>Author Contributions</title>
<p>Study conception and design: RT, RF, AK, AF and BI. Data collection: RT. Statistical analysis: RT. Interpretation of results: RT, RF. Drafting of the manuscript: All authors. Revision of the final manuscript: RT. All authors approved the final version of the manuscript, including the authorship list.</p>
</sec>
<sec id="s9" sec-type="funding-information"><title>Funding</title>
<p>This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.</p>
</sec>
<ack><title>Acknowledgments</title>
<p>The authors thank Dr. Abdollahpour-Alitappeh for editing the manuscript.</p>
</ack>
<sec id="s10" sec-type="COI-statement"><title>Conflict of Interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec id="s11" sec-type="disclaimer"><title>Publisher&#x0027;s Note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
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