Factors Affecting Lower Back Pain (LBP) among Undergraduate

Nursing Students

Rifa Rindayani Syafitri, Ira Suarilah and Makhfudli

Faculty of Nursing Universitas Airlangga, Kampus C Mulyorejo, Surabaya, Indonesia

Keywords: Lower Back Pain, Nursing Students, Biological Factors, Psychological Factors, Social Factors.

Abstract: Introduction: The earlier young people experience lower back pain (LBP), the more potential there is to

acquire chronic back pain in the future. Nursing is a high-risk job regarding LBP. Knowing the factors that

affect the occurrence of LBP in nursing students is important to prevent LBP when working as a nurse later.

Methods: This study analyzed the factors that influence the occurrence of LBP in nursing students at the

Faculty of Nursing, Universitas Airlangga. A stratified random sampling method was used. This study was a

cross-sectional study with questionnaires as the method for data collection, and a logistic regression test for

data analysis. The sample comprised of 120 undergraduate nursing students. The independent variables

were factors influencing the occurrence of LBP: biological, psychological, and social factors. The

dependent variable was the occurrence of LBP during the last 12 months. Results: As many as 60% of

students experienced LBP in the last 12 months and significant factors affecting LBP were: history of spinal

trauma (p = 0.023), stress level (p = 0.000), sports habits (p = 0.044), and motor vehicle usage (p = 0.033).

Conclusions: Biological, psychological, and social factors influence the occurrence of LBP in nursing

students. Avoiding factors affecting LBP may reduce the prevalence and impact of LBP in the nursing

profession.

1 BACKGROUND

Symptoms of lower back pain (LBP) or perceived

pain in the lower back region (Wulandari, 2014) is

major causes of disability, absenteeism, and poor

performance at work (Novitasari et al., 2016). Most

of the research on LBP is performed in adults

engaged in certain types of work, so there is little

understanding of the onset of early LBP among

adolescents and young adults (Heuscher et al.,

2007). The incidence of LBP in the early stages of

life increases the chronic, recurrent risk of LBP,

which potentially reduces the efficiency of the

young population (Study et al., 2017).

Anderson (1999) estimates the prevalence of

LBP in the world at30% (Study et al., 2017).

Research in Perth (Australia), shows that more than

30% of nursing students in clinical education have

experienced LBP in the past 12 months (Mitchell et

al., 2009). In Indonesia, the number of LBP patients

is not known, but it is estimated to be between 7.6%

to 37% (Lailani, 2013). The prevalence of LBP in

nurses in Jakarta is around 61.1% (Kurniawidjaja et

al., 2013). The researchers conducted a preliminary

study in September 2017 with 16 undergraduate

nursing students at Universitas Airlangga (Unair)

who had not undergone professional education, aged

17–35 years. It was determined that 12 students had

suffered with LBP during the last 12 months, but the

factors affecting LBP are still inexplicable.

The risk factor for LBP is a multifactorial

biopsychosocial problem (Mitchell et al., 2009).

Biological factors that can affect the occurrence of

LBP are biomechanics, the central nervous system,

and personal factors. A psychological factor that can

cause LBP is stress. Social factors, such as smoking,

backpack use, driving, sports habits, and

environmental factors, including mattress used, can

also cause LBP (Farrokhi et al., 2017).

According to a preliminary study, all Unair

nursing students complained about the severity of

academic demands. Purwati (2012) states that the

demands of academic work cause students to

experience stress that can have a negative impact

such as starting smoking. time demand lectures and

tasks increase the duration of sitting so there is a

decrease in physical activity. The results of a study

by Idyan (2005) regarding extension students at the

138

Syaﬁtri, R., Suarilah, I. and Makhfudli, .

Factors Affecting Lower Back Pain (LBP) among Undergraduate Nursing Students.

DOI: 10.5220/0008321701380145

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 138-145

ISBN: 978-989-758-336-0

Faculty of Nursing Universitas Indonesia, of 35

respondents who sat in every lecture for 1–3 hours,

51.4% experienced severe pain (Saputra, 2009). The

majority of Unair nursing students say the demands

of the tasks cause them to stay up late, so they

consume coffee to relieve drowsiness. Unair nursing

students often carry heavy bags containing a laptop,

medical books, and lecture notes. The majority of

Unair students live in the boarding houses and most

of them complain about their uncomfortable

mattresses. The characteristics of Surabaya as a big

city causes congestion on the road. Congestion

results in an increase in travel time and increased

psychological stress (Tondok, 2009). All Unair

nursing students usually use private vehicle

transportation (cars and motorcycles), because they

feel more safe and comfortable.

In Indonesia, there are still limited studies on risk

factors for LBP. This is important to discuss because

work and lifestyles in Indonesia are not the same as

in places abroad (Kurniawidjaja et al., 2013).

Discussion about risk factors of LBP among nursing

students who have not undergone clinical education

is important based on the high incidence of LBP in

previous research. Therefore, before starting work as

a nurse, attempts to prevent LBP should be carried

out. Based on the description above, the researcher

is interested in analyzing the factors that affect the

occurrence of LPB in students at the Faculty of

Nursing, Universitas Airlangga.

2 METHODS

This research was carried out using a cross-sectional

design, using binary logistic regression statistic test

to measure the influence of the independent variable

on the dependent variable with the degree of

significance p <0.05. The population of this research

were bachelor students from the Faculty of Nursing

at Universitas Airlangga (Unair), who were active

students, aged 1-35 years, with experience of LBP or

not in the last 12 months, and not currently

undergoing clinical education. The total sample was

120 respondents selected by simple stratified

random sampling. This research already has ethical

approval by the Ethical Committee for Health

Research at Universitas Airlangga, No: 582-KEPK.

The independent variables of this study were

factors that influence the occurrence of LBP with

biological factors (age, BMI, history of spinal

trauma, and family disease history associated with

LBP), psychological factors (stress level), social

factors (sitting habits, exercise habits, smoking,

coffee consumption, use of bags, use of mattresses,

and use of motor vehicles). The dependent variable

was the incidence of LBP over the past 12 months.

The research instrument was modified from the

Nordic Low Back Pain questionnaire (Kuorinka et

al., 1987) to measure the incidence of LBP in the

last 12 months and the risk level of disability,

depression anxiety stress scale (DASS) 42

(Psychology Foundation of Australia, 2014) to

measure social factors, and the modified

questionnaire from previous studies by Korovessis

(2010) and Widiasih (2015) to measure biological

and social factors.

3 RESULTS

The population sample represents 16.67% of the

study. Table 1 illustrates the demographic

characteristics of the population. There are 20

respondents per class and most are female (81.7%).

Most respondents had experienced LBP during the

last 12 months (60%).

Table 2 shows the results of the distribution of

data measured regarding the biological,

psychological, and social factors of the respondents.

In relation to biological factors, most respondents, in

the final adolescent age range (90%), had a normal

BMI (65.8%), had never had a spinal trauma

(91.7%), and had no family disease history

associated with LBP (95.8%). In relation to

psychological factors, most respondents experienced

a normal stress level (40%). For social factors, most

respondents sat for 6–9 hours per day (66.7%), took

part in sports <2 hours per week (31.7%), did not

Table 1: Demographic data of respondents

No Characteristics Frequency %

1. Class year

year

year (extension)

Total

16.7

20 16.7

120 100

2. Age

Male

Female

Total

18.3

98 81.7

120 100

3. The LBP incident in

the last 12 months

Never experienced

Ever experienced

Total

40.0

72 60.0

120 100

Factors Affecting Lower Back Pain (LBP) among Undergraduate Nursing Students

139

smoke (96.7%), did not consume coffee (62.5%),

used bags with two shoulders straps (85.8%),

described the bag as having a normal weight (55%),

carried bags for 10–20 minutes (30.8%), described

their mattresses with medium description (60%), and

used motor vehicles for around 20–40 minutes per

day (29.2%).

Table 3 shows the results of the logistic

regression test; the factors that significantly

influence the occurrence of LBP are the history of

spinal trauma (biological factor), stress level

(psychological factor), sports habits and the use of

motor vehicles (social factors). The magnitude of

influence can be shown by the value of the Odds

Ratio (OR). The result of data analysis indicates that

the greater history of spinal trauma, the higher

chance of LBP, the higher the stress level, the higher

chance of LBP, the longer time exercising time in

one week, the lower chance of LBP, the longer the

driving time, the higher likelihood of LBP. From the

logistic regression analysis, it is clear that the history

of spinal trauma is the most dominant factor

affecting the incidence of LBP.

4 DISCUSSION

4.1 Analysis of the Influence of

Biological Factors on the

Occurrence of LBP

Analysis on the biological effects of age, BMI,

history of spinal trauma, and family history of LBP

is discussed in this section.

Table 2: The Measurements of Variable Data Distribution in the Biological, Psychological, and Social Factors of

Respondents.

Measured Variables Category

LBP the last 12

months

f %

No Yes

Biological Factors

Age

Early adolescents (12–16 years

old)

0 0 0 0

Teenagers (17–25 years old)

45 63 108 90.0

Early Adult (26–35 years old)

3 9 12 10.0

BMI

Very thin (BMI <17)

1 3 4 3.3

Thin (BMI 17–18,4)

7 10 17 14.2

Normal (BMI 18.5–25)

35 44 79 65.8

Fat (BMI 25,1–27)

4 3 7 5.8

Very Fat (BMI> 27)

1 12 13 10.8

History of Spinal Trauma

Never experienced

48 62 110 91.7

Ever experienced

0 10 10 8.3

Medical diagnosis of respondents who

have experienced spinal trauma

Minor injury

- - 3 2.5

Dislocation

- - 2 1.7

Fracture of the sacrum

- - 1 0.8

LBP

- - 1 0.8

Spondylolisthesis

- - 1 0.8

Lumbar muscle spasms

- - 1 0.8

Coccydynia

- - 1 0.8

Family Disease History Associated

with LBP

Chronic LBP

0 1 1 0.8

Osteoarthritis <50 years of age

1 2 3 2.5

Disk hernia

0 0 0 0

Spinal form disorders

1 0 1 0.8

None

46 69 115 95.8

Psychological Factor

Stress Level

Awful

0 8 8 6.7

Severe

0 19 19 15.8

Medium

5 22 27 22.5

Light

8 10 18 15.0

Normal

35 13 48 40.0

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4.1.1 The Influence of Age

Age did not have a significant effect on the

occurrence of LBP, which is not in accordance with

the assertion that the older a person becomes, the

greater the risk of LBP due to bone degeneration. At

the age of 30 years, degeneration occurs in the form

of tissue damage (Andini, 2015). The onset of bone

degeneration cannot be prevented, but LBP can be

prevented by strengthening bone and muscle

structure. Exercise and nutritional balance can

maintain the strength of the musculoskeletal system

(Gabr & Al-eisa, 2017). Differences in previous

research could be caused by the definition of early

adulthood beginning at the age of 26 in this study, so

it can be concluded that respondents aged less than

30 years have not risked the occurrence of bone

degeneration that can cause bias in the early adult

age range. Age factors still need to be considered to

prevent early bone degeneration in college students.

4.1.2 The Influence of BMI

Results showed that BMI did not affect the

occurrence of LBP. This was relevant to a previous

study by Koley et al. (2010) in India and Mangwani

et al. (2010) in the UK showed no significant

difference between BMI and LBP (Lailani, 2013).

The result study by Yasin et al. (2010) in RSDS

Surabaya indicates that BMI influences the

occurrence of LBP. Increased BMI can weaken

abdominal muscles, so that the center of gravity is

pushed to the front of the body causing an increase

in lumbar lordosis and fatigue in the paravertebral

muscle. The mismatch of the research results to the

theory may be influenced by the respondents’

increased time spent sitting; the burden of the

abdomen is sustained by the thigh, so it will not

burden the spine.

Table 2: The Measurements of Variable Data Distribution in ... (continued)

Measured Variables Category

LBP the last 12

months

f %

No Yes

Biological Factors

Age

Early adolescents (12–16 years

old)

0 0 0 0

Teenagers (17–25 years old)

45 63 108 90.0

Early Adult (26–35 years old)

3 9 12 10.0

BMI

Very thin (BMI <17)

1 3 4 3.3

Thin (BMI 17–18.4)

7 10 17 14.2

Normal (BMI 18.5–25)

35 44 79 65.8

Fat (BMI 25,1–27)

4 3 7 5.8

Very Fat (BMI> 27)

1 12 13 10.8

History of Spinal Trauma

Never experienced

48 62 110 91.7

Ever experienced

0 10 10 8.3

Medical diagnose on

respondents who had

experienced spinal trauma

Minor injury

- - 3 2.5

Dislocation

- - 2 1.7

Fracture of the sacrum

- - 1 0.8

LBP

- - 1 0.8

Spondylolisthesis

- - 1 0.8

Lumbar muscle spasms

- - 1 0.8

Coccydynia

- - 1 0.8

Family Disease History

Associated with LBP

Chronic LBP

0 1 1 0.8

Osteoarthritis <50 years of age

1 2 3 2.5

Disk hernia

0 0 0 0

Spinal form disorders

1 0 1 0.8

None

46 69 115 95.8

Psychological Factor

Stress Level

Awful

0 8 8 6.7

Severe

0 19 19 15.8

Medium

5 22 27 22.5

Light

8 10 18 15.0

Normal

35 13 48 40.0

Factors Affecting Lower Back Pain (LBP) among Undergraduate Nursing Students

141

4.1.3 Influence of History of Spinal Trauma

The results indicated that the history of spinal

trauma influenced the occurrence of LBP; the more

history of spinal trauma, the higher chance of LBP

occurrence. Hendri (2014) also states that a history

of back injury has a risk of LBP 1.95 times greater

than with no history. The spine has an extremely

sturdy and stable structure (Standring, 2016). The

intervertebral discs form a strong joint that allows

the spine to move and support a heavy burden

(Widiasih, 2015). Spinal trauma may alter the

structure of the spine, but the recovery system of the

spinal structure may support its regeneration (Munir,

2012). Most respondents are late adolescents so the

backbone should still be able to regenerate

optimally. The backbone is a solid unit, but in the

results of bone trauma studies can cause LBP. This

may be because the respondents’ history of spinal

trauma is so severe that it causes damage to the

backbone structure, causing LBP to occur.

4.1.4 Influence of Family Disease History

The results showed that family history did not affect

the occurrence of LBP. The results did not match the

assertion that some elements of genetic factors that

can affect the occurrence of LBP, include the

receptor elements of vitamin D, VDR, COL1,

COL9, and Aggrecan. Matsui et al. (1997) suggest

that family history of disc herniation has a

significant relationship to the occurrence of Discus

Degenerative Disease with vitamin D receptors as

one of the disposition genes. VDR plays a role in

normal bone mineralization and remodeling.

Osteoarthritis is associated with the VDR gene.

COL1 and COL9 play a role in facilitating the stress

of the intervertebral discs. Aggrecan acts as a fluid

binder that keeps nucleus pulposus well hydrated

(Hemanta et al., 2016). Genetic factors also

contribute to sensitivity to pain, such as the disorder

of the spine (scoliosis), and degeneration of the

discus (Wong et al., 2017). The differences with the

theory may be caused by only a minority of

respondents who have a family history of disease

associated with LBP. Most respondents never

experienced spinal cord injury, so the spinal

structure should not be disturbed. Also, most

respondents were in the late adolescent age range.

However, it is necessary to be more vigilant if you

have parents who have a family history of illness

that can affect the occurrence of LBP.

4.2 Analysis of the Influence of

Psychological Factors on the

Occurrence of LBP

Most respondents experienced stress. Stress levels

stress affect the occurrence of LBP; the higher the

level of stress, the higher the chance of LBP

occurrence. Research by Purwati (2012) in FIK UI

shows that nursing students have high stress levels.

Stress is a psychological factor that can cause LBP

(Farrokhi et al., 2017). Stress can cause pain through

increased spinal mechanical load due to increased

muscle tension (Mitchell et al., 2009). This study did

not measure the causes of stress, but based on

preliminary studies, stress was caused by heavy

academic demands. Stress on Unair nursing students

needs to be anticipated. Stress can directly affect the

onset of symptoms of disease, e.g. LBP, but stress

can also cause various behaviors that can trigger the

occurrence of LBP, such as smoking.

4.3 Analysis of the Influence of Social

Factors on the Occurrence of LBP

Analysis on the social influences of length of time

sitting, exercise habits, smoking, coffee

consumption, the use of bags, mattress description,

and the length of time using motor vehicles

compared with the occurrence of LBP are discussed

in this section.

Table 3: Bivariate Test Results Between Independent

and Dependent Variables.

value

Biological Factors

BMI -0.221 0.592 0.801

Age -1.275 0.228 0.280

History of Spinal

Trauma 3.275 0.023 26.4

Family Disease

Histor

-0.441 0.414 0.643

Psychological Factors

Stress Level 1.550 0.000 0.212

Social Factors Sitting

habits -1.051 0.145 0.349

Physical Exercise -0.852 0.044 0.427

Smokin

-2.020 0.188 0.133

Drinkin

coffee -0.120 0.833 0.887

Carrying Bag

Carrying style -1.779 0.087 0.169

Wei

ht -0.800 0.144 0.449

Duration -0.230 0.373 0.794

Matrass 0.271 0.659 1.31

Transportation from

and to cam

us -0.620 0.033 0.538

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4.3.1 The Influence of Time Spent Sitting

The results showed that Unair nursing students

regularly sat for 6–9 hours but the habit of sitting did

not significantly affect LBP occurrence. The results

do not match previous studies. Matthews et al.

(2012) states that sitting for 6–9 hours a day

increases the risk of LBP and sitting more than 9

hours a day is classified as too long sitting (Van der

Ploeg et al., 2012). Sitting for a long time can reduce

lubrication in the joints, causing stiffness (Widiasih,

2015). Continuous seated work causes muscle

contraction to become static and causes repetitive

muscle loading, which blocks blood flow, so that the

oxygen supply is insufficient for aerobic

metabolism. This condition causes accumulation of

lactic acid accumulation and body heat, ultimately

causing skeletal muscle fatigue in a form of muscle

satisfaction.

The mismatch of the study and the theory may be

because respondents who sit for shorter lengths of

time are likely to have other LBP risk factors that

may cause bias on the results. This study also did not

measure how the length of time sitting, posture, and

ergonomic modelled seating commonly used by

students. Anatomically, sitting in a non-upright

position and frequently changing the sitting posture

reduces the load between bone segments, and

provides a discus of time to enter water and nutrients

to keep the disc moist and regenerate in the form of

collagen tissue therein. Students’ sitting habits

require special attention, considering most sit for 6–

9 hours daily. It is advisable not to sit for more than

six hours a day, and if there is no choice, it is

important to stretch and change position as often as

possible during sitting.

4.3.2 The Influence of Exercise Habits

Most respondents only exercise <2 hours per week,

and exercise has a significant effect on the

occurrence of LBP. The results of data analysis

showed that the longer exercise time in one week,

the lower the chance of LBP occurrence. The results

are consistent with the assertion that exercise can

increase the strength and flexibility of the spinal

support muscles, so regular exercise can reduce the

risk of LBP (Kurniawidjaja et al., 2013). Korovessis

et al. (2010) also state that more frequent exercise (>

6 hours per week) showed a lower incidence of LBP

than for those not exercising. Regular exercise can

improve the quality of life, prevent osteoporosis and

various diseases of the skeleton and other diseases

(Andini, 2015). Respondents who exercised for

longer did not experience LBP, i.e. with frequent

sports such as jogging, dancing, and gymnastics.

This type of exercise not only increases muscle and

bone strength, but can also train and maximize

flexibility between joints, so that the structure of the

spine is stronger and the spine's ability to hold the

load can increase.

4.3.3 The Influence of Smoking

According to the results, smoking does not affect the

occurrence of LBP, which is not supported by some

previous studies. Hemanta et al. (2016) suggest that

smoking can lead to reduced blood flow to the

vertebral body, and lower bone mineral content,

which promotes intervertebral disc degeneration.

Nicotine also induces irreversible disc degeneration.

The mismatch with previous studies could be

because almost all respondents were not smokers.

There is an absence of measurements as to how long

the respondent had smoked, nor is there any

literature that states whether the length of time

smoking can affect LBP; the rare frequency of

smoking could also cause bias on the results.

4.3.4 The Influence of Coffee Consumption

Results showed that coffee consumption had no

significant effect on the occurrence of LBP, which

differ from the opinion of Hallstrom (2010) who

states that coffee consumption can accelerate bone

degeneration. Coffee consumption more than three

times per week had a higher risk (88%) of LBP

(Huang et al., 2014). Caffeine helps in overcoming

fatigue and drowsiness and reduces pain, but Currie

(1995) states the importance of reducing coffee

intake, because caffeine contributes to the

modulation of pain perception in various acute pain

states. Caffeine also increases urinary calcium and

may have long-term adverse effects on bones

(Alshagga et al., 2013). Until now there is still no

literature that states how much coffee should be

consumed to cause the risk of LBP. The Dietary

Guidelines Advisory Committee recommends no

more than 400 mg/day of coffee (equivalent to 3–5

cups). The maximum coffee drinking limit has

different effects on individuals, such as heart

palpitations, nausea, and vomiting (Sass, 2015).

Coffee has beneficial effects but also has long-

term effects that are very harmful, so the coffee-

drinking habits of nursing students should be

anticipated. This must be individualised as everyone

has different toleration of coffee. The mismatch with

previous research could be because this study does

not measure the concentration level of coffee

consumed per cup and how long the students

Factors Affecting Lower Back Pain (LBP) among Undergraduate Nursing Students

143

consume coffee for, so further research on the level

of coffee concentration and duration of coffee

consumption should be conducted to determine how

that may affect LBP occurrence.

4.3.5 Effect of Bag Usage

The results of carrying a bag, the bag’s weight and

the length of time carrying the bag have no

significant effect on LBP occurrence. This was a

different opinion to that of Korovessis et al. (2010)

who state in their study that backpacks with one or

both shoulders cause LBP. Aggarwal (2017) states

that an increase in bag load can explain the increase

in LBP. Korovessis et al. (2010) state that high

school students in Greece show that the use of bags

with heavy descriptions has the highest significance

value compared with the description of normal or

very heavy bags. The use of backpacks for 40–60

minutes has a higher significance value compared to

<40 minutes.

The mismatch with previous studies could be

because most respondents only carry their bags for

10–20 minutes. Respondents often use vehicles to

travel to the campus and usually put their bags on

chairs or on the floor when they arrive at the

campus, reducing the duration of time carrying bags.

The data also determines that Unair nursing students

who carry bags >1 hour per day do not experience

LBP, which is different to the theory. This could be

because students carrying bags for longer may only

be carrying lighter loads.

4.3.6 Effect of Mattress Description

The results showed that the types of mattress used

did not have a significant effect on the occurrence of

LBP. This is different to the opinion of Korovessis

et al. (2010) who states that a hard mattress has a

significant effect on the incidence of LBP in school

students. A hard bed will cause static and recurrent

muscle loading causing blocked blood flow,

resulting in insufficient oxygen supply for aerobic

metabolism. This condition causes the accumulation

of lactic acid accumulation and body heat, ultimately

causing skeletal muscle fatigue (Widiasih, 2015).

The use of appropriate mattresses in most

respondents caused the mismatch with previous

research, which states that a hard mattress

significantly affects the occurrence of LBP. Based

on raw data of respondents who perceived a hard

mattress experienced LBPThis is in sharp contrast to

previous theories that suggest that a soft mattress

will reduce muscle tension. Based on this, it can be

attributed as a cause of LBP; multifactorial and

biopsychosocial approaches can also explain the

occurrence of LBP, i.e. biological, psychological,

and social factors are interrelated.

4.3.7 Influence of the Use of Motor Vehicles

The results showed that the duration of using motor

vehicles in a day can affect the occurrence of LBP:

the longer the driving time, the higher the chance of

LBP occurrence. This is consistent with claims that

driving with a vibrating vehicle (car or motorcycle)

has the potential to generate LBP. Vibration may

cause increased muscle contractions resulting in

poor blood circulation, accumulation of lactic acid,

and pain (Andini, 2015). Complaints of LBP will be

felt after six months, if motorcyclists routinely drive

every day for at least 2.5 hours (Saputra, 2009).

Based on preliminary studies, most respondents

travel on motorcycles and carry heavy bags, which

will further increase the burden and pressure on the

lower back and increase the risk of LBP. This

research does not link motorcyclists and motorists to

LBP, but almost all students travel to work on

motorcycles, so it can be generalized that the

duration of driving on motorbikes might influence

the occurrence of LBP. This study did not measure

how long the students had been driving a motor

vehicle: it could be that nursing students had used

motor vehicle since high school, or since becoming a

student, junior high school or even elementary

school, so this needs further consideration to achieve

more accurate results.

5 CONCLUSIONS

The results reinforce the previous theory that LBP is

a biopsychosocial problem. Factors influencing the

occurrence of LBP in nursing students of Universitas

Airlangga can be based on biological factors, such as

the history of spinal trauma, psychological factors

such as stress levels, on social factors, such as sport

habits and motor vehicle usage. The most dominant

factor of LBP is the history of spinal trauma. It is

suggested that nursing students prevent factors

affecting LBP, and further research related to LBP is

also recommended.

ACKNOWLEDGEMENTS

The author is very grateful to the participants, the

undergraduate nursing students of the Faculty of

Nursing, Universitas Airlangga.

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REFERENCES

Alshagga, M. A., Nimer, A. R., Yan, L. P., Abdel, I.,

Ibrahim, A., & Al-ghamdi, S. S. (2013). Prevalence

and factors associated with neck , shoulder and low

back pains among medical students in a Malaysian

Medical College.

Andini, F. (2015). Risk factors of low back pain in

workers, 4, 12–19.

Farrokhi, S., Mazzone, B., Schneider, M., Gombatto, S.,

Highsmith, M. J., & Hendershot, B. D. (2017).

Biopsychosocial Risk Factors Associated with Chronic

Low Back Pain after Lower Limb Amputation.

Medical Hypotheses.

https://doi.org/10.1016/j.mehy.2017.07.030

Gabr, S. A., & Al-eisa, E. S. (2017). Mechanical factors

and vitamin D deficiency in schoolchildren with low

back pain : biochemical and cross-sectional survey

analysis, 855–865.

Hemanta, D., Jiang, X., & Feng, Z. (2016). Etiology for

Degenerative Disc Disease. Chinese Medical Sciences

Journal, 31(3), 185–191.

https://doi.org/10.1016/S1001-9294(16)30049-9

Heuscher, Z., Gilkey, D. P., Peel, J. L., & Kennedy, C. A.

(2007). The Association of Self-Reported Backpack

Use and Backpack Weight With Low Back Pain

Among College Students. Journal of Manipulative and

Physiological Therapeutics, 33(6), 432–437.

https://doi.org/10.1016/j.jmpt.2010.06.003

Huang, H., Chang, H., Lin, K., & Chiu, H. (2014). A

Closer Examination of the Interaction Among Risk

Factors for Low Back Pain, 28(6), 372–379.

https://doi.org/10.4278/ajhp.120329-QUAN-171

Kuorinka, I., Jonsson, B., Kilbom, A., & Vinterberg, H.

(1987). Standardised Nordic questionnaires for the

analysis of musculoskeletal symptoms, 233–237.

Kurniawidjaja, L. M., Purnomo, E., Maretti, N., Pujiriani,

I., Kajian, P., Kerja, K., … Keselamatan, M. (2013).

Pengendalian Risiko Ergonomi Kasus Low Back Pain

pada Perawat di Rumah Sakit Ergonomic Risk Control

on Low Back Pain among Hospitals â€

Nurses,

46(4), 225–233.

Lailani, T. M. (2013). Hubungan antara Peningkatan

Indeks Massa Tubuh dengan Kejadian Nyeri

Punggung pada Pasien Rawat Jalan di Poliklinik Saraf

RSUD Dokter Soedarso Pontianak. Retrieved from

http://uad.portalgaruda.org/index.php?page=19&ipp=1

0&ref=browse&mod=viewjournal&journal=2307

Mitchell, T., Sullivan, P. B. O., Smith, A., Burnett, A. F.,

Straker, L., Thornton, J., & Rudd, C. J. (2009).

International Journal of Nursing Studies

Biopsychosocial factors are associated with low back

pain in female nursing students : A cross-sectional

study, 46, 678–688.

https://doi.org/10.1016/j.ijnurstu.2008.11.004

Munir, S. (2012). Analisis Nyeri Punggung Bawah pada

Pekerja Bagian Final Packing dan Part Supply di PT.

X Tahun 2012. Universitas Indonesia.

Novitasari, D. D., Sadeli, H. A., Soenggono, A., Sofiatin,

Y., Sukandar, H., & Roesli, R. M. A. (2016).

Prevalence and Characteristics of Low Back Pain

among Productive Age Population in Jatinangor, 469–

476.

Psychology Foundation of Australia. (2014). Depression

Anxiety Stress Scale (DASS). Retrieved September

11, 2017, from http://www2.psy.unsw.edu.au/dass/

Purwati, S. (2012). Tingkat Stres Akademik pada

Mahasiswa Reguler Angkatan 2010 Fakultas Ilmu

Keperawatan Universitas Indonesia Tingkat Stres

Akademik Pada Mahasiswa Reguler Angkatan 2010.

Universitas Indonesia.

Saputra, R. H. (2009). Hubungan Lama Berkendara

dengan pada Pengendara Sepeda Motor. Universitas

Muhammadiyah Surakarta.

Sass, C. (2015). How Much Coffee Should You Really Be

Drinking? Retrieved December 5, 2017, from

http://www.health.com/nutrition/how-much-coffee-is-

healthy

Standring, S. (2016). Grey’s Anatomy: The Anatomy Bases

of Clinical Practice (41st ed.). London: Elsevier.

Study, Y. A. A. C., Ganesan, S., Acharya, A. S., Chauhan,

R., & Acharya, S. (2017). Prevalence and Risk Factors

for Low Back Pain in 1,355 Young Adults: A Cross-

Sectional Study. Asian Spine Journal, 610–617.

https://doi.org/10.4184/asj.2017.11.4.610

Tondok, M. S. (2009). Stress Kemacetan Lalu-Lintas :

Bagaimana Mengatasinya ?, 2–5.

Widiasih, G. (2015). Hubungan Posisi Belajar dan Lama

Duduk. UIN Syarif Hidayatullah Jakarta.

Wong, A. Y. L., Karppinen, J., & Samartzis, D. (2017).

Low back pain in older adults : risk factors ,

management options and future directions, 1–23.

https://doi.org/10.1186/s13013-017-0121-3

Wulandari, R. A. (2014). Gambaran Faktor yang

Mempengaruhi Nyeri Punggung Bawah pada Buruh

Kapal, 1–8.

Factors Affecting Lower Back Pain (LBP) among Undergraduate Nursing Students

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