Economic Burden of Low Back Pain among Quarry Workers Attending Outpatient Physiotherapy Clinic at a Tertiary Health Institution in Ondo State, Nigeria

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DOI: 10.21522/TIJPH.2013.04.04.Art050

Authors : Ebenezer Obi Daniel


Problem: The economic burden of health care in developing countries (like Nigeria) especially among the low social class and those involved in risky environment and occupations is worrisome and increase the out-of-pocket expenses of such individuals and expose them to poverty. A limited amount of data exists on the burden of low back pain (LBP) especially in developing countries.

Objective: This study was carried out to determine the economic burden of LBP of quarry workers who attend out-patient physiotherapy clinic of a tertiary health institution in Owo, Ondo State.

Methods: This study was carried out at Federal Medical Centre Owo in Ondo State, Nigeria. A descriptive cross sectional survey of forty quarry workers with LBP (28 males, 12 females) receiving physiotherapy at Federal Medical Centre, Owo, was carried out with purposive sampling method (non-probability sampling). Data on the economic burden of LBP and socio-demographic information of participants were collected using a self-developed questionnaire, reviewed by research experts. Data was analyzed using descriptive statistics of proportions, mean and standard deviations.

Outcome: It was discovered in this study that, the cost of Physiotherapy represents the highest cost (63%) among the direct costs, followed by the cost expended on Physician visit (23.56%) while the cost of diagnostic tests represents the least (3%). Among the indirect costs, the expenditure on paid help, 34000 naira (45.7%) is the highest, while that of meals outside home, 9738.46 naira (13.0%) is the lowest. On the overall, this study reveals that the direct cost of low back pain among quarry workers (60.6%) forms the bulk of expenses of the management of low back pain by quarry workers. It is recommended that, policy formulation on alleviating the economic burden of ailments associated with risky jobs should be considered in developing countries, the research work should be carried out using larger population, inclusion of other risky occupations in future researches and that other possible factors that can be responsible for the low back pain of such workers should be taken into consideration in future studies.


[1]. Ajeet Jaiswal (2013): Low Back Pain and Work-Related Risk Factors among Drivers of Pondicherry. International Journal of Scientific Footprints ; 1(2): 7–16

[2]. Aliu and Saidu;(2006): Occupational hazards and safety measures among stone quarry workers in northern Nigeria shows Nigeria Medical Practitioner vol 50(2);pp42-47

[3]. American college of occupational and environmental medicine. Sessions 2301 (2003): Current research in occupational and environmental medicine.771-77

[4]. Andersson GB (1999): Epidemiological features of chronic low-back pain. Lancet 1999;354:581-5

[5]. Andrade SC, Araújo AG, Vilar MJ (2005): Escola de Coluna: revisãohistórica e suaaplicaçãonalombalgiacrônica. Rev Bras Reumatol,45(4):224-248.

[6]. Araoye M O (2003): Subject selection and sample size determination: Research methodology with statistics for health and social sciences.1st ed. Nathadexpublishers. ilorin, Nigeria. pp;115-129

[7]. Borenstein D (2000): Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain. Current opinion in orthopedics, 11(3): 225-231

[8]. Cunningham C., Doody C. and Blake C. (2008): Managing low back pain: knowledge and attitude of hospital manager. Journal of Occupational Medicine 258:282-288

[9]. Dagenais S (2008): A systematic review of low back pain cost of illness studies in the United States and internationally Spine; 8:8-20.

[10]. Daniele TatianeLizier, Marcelo Vaz Perez, RiokoKimikoSakat (2012) Exercises for Treatment of Nonspecific Low Back Pain RevistaBrasileira de Anestesiologia Vol. 62, No 6, November-December

[11]. Danneels LA, Vanderstraeten GG, Cambier DC, Witvrouw EE, Cuyper HJD (2000) Computed tomography of trunk muscles in chronic low back patients and healthy control subjects. Eur Spine J;9:266-72.

[12]. Devereaux M W. (2004) Low back pain. Primary care, Clinics in office practice. 31(1) 65-70

[13]. Deyo RA (1996) Low back pain. A primary care challenge. Spine; 21(24): 2826-2832.

[14]. Deyo RA, Battie M, Beurskens AJ, Bombardier C, Croft P, Koes B, Malmivaara A, Roland M, VonKorff M, Waddell G. (1998): Outcome measures for low back pain research. A proposal for standardized use. Spine ;23:2003–13.

[15]. Deyo RA, Rainville J, Kent DL (1992) What can the history and physical examination tell us about low back pain? Jama ;268(6):760-765.

[16]. Deyo, R. and Phillips W. (1996): Low back pain: A primary care challenge. Spine 21:2826-32.

[17]. Egwuonwu V.A, Abidemi T B, Aiyejunsunle C B, Ezeukwu O A, Auwal A, C Okoye C E.(2013) A Cross-Sectional Survey Of Work Related Musculoskeletal Disorders Prevalence And Associated Risk Factors Among Quarry Workers In A South Eastern Nigerian Community. The Internet Journal of Epidemiology, Volume 11 Number 2.

[18]. Ehrlich GE. (2003): Low back pain. Bulletin of the World Health Organization, 81 (9): 671-676.

[19]. Ferreiro F, Moore T, Fredericson M. (2008): Core stability exercise principles. Curr. Sports Med. Rep., Vol. 7, No. 1, pp. 39Y44.

[20]. Frank JW, Kerr MS, Brooker AS (1996) Disability resulting from occupational low back pain. Spine ; 21:2909–17.

[21]. Fransen M, Woodward M, Norton R, Coggan C, Dawe M, Sheridan N. (2002) Risk factors associated with the transition from acute to chronic occupational back pain. Spine, 27(1): 92-98

[22]. Gatchel RJ, Plantin PB, Mayer TG. (1995): The dominant role of psychosocial risk factors in the development of chronic low back pain disability. Spine; 20: 2702-2709.

[23]. Hartvigsen J, Leboeuf YC, Lings S, Corder EH. (2000) Is sitting-while-at-work associated with low back pain? A systematic critical literature review. Scand J Public Health; 28(3):230–239.

[24]. Hartvigsen, J, Bakketeig, L, Leboeuf-Yde, C, Engberg, Lauritzen, T. (2001) The association between physical workload and low back pain clouded by “Healthy

[25]. Hazard, R.G. (1996): Chronic low back pain and disability. The efficacy of functional restoration. Bulletin of Hospital Joint Disease, 55, 213-6.

[26]. Hoogendoorn, W, Bongers, P, De Vet, H, Douwes, M, Koes, B, Miedema M. (2000): Flexion and rotation of the trunk and lifting at work are risk factors for low back pain: results of a prospective cohort study. Spine, 25(23): 3087-3092

[27]. Huppe A, Muller K, Raspe H (2007): Is the occurrence of back pain in Germany decreasing? European Journal of the Public Health; 17(3): 318-322.

[28]. Ihleback C, Eriksen. (2003): Are the myths of low back pain alive in general Norwegian Population? Scand J Public Health; 31: 395-398.

[29]. Jette, A.M., Smith K., Haley S. and Davis K.D. (1994) Physical therapy episode of care for patients with low back pain. Physical Therapy 74; 101- 115.

[30]. Johnson M I. (1997) The Physiology of sensory dimensions of clinical pain. hysiotherapy83 (10): 526-536

[31]. Katz JN. (2006): Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. Journal of Rheumatic Diseases; 88(2): 21-40. 11.

[32]. Kovac F.M., Muriel A., Medina J.M., Abraira V., Sanchez M.D.C., Jauregi J.O. and the Spanish Back Pain Research Network. (2006). Psychometric characteristics of the Spanish version of the FAB questionnaire. Spine 31: 104-110.

[33]. Kovacs FM, Abria V, Povo F, Heinbaun DG (1997). Local and Remote Sustained Trigger Therapy for exacerbation of Chronic Back Pain. Spine; 22(7) 788-797.

[34]. Krismer M, van Tulder M. (2007) Strategies for prevention and management of musculoskeletal conditions. Low back pain (non-specific). Best Pract Res ClinRheumatol, 2007;21:77-91.

[35]. Lafuma A, Fagnani F, Vautravers P. (1998): Management and cost of care for low back pain in primary care settings in France. Pharmaco Economic;14(3): 313-22.

[36]. Lawrence RC, Helmick CG, Arnett FC. (1998) Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis & Rheumatism 41:778-799.

[37]. Lee P, Helewa A, Goldsmith CH, Smythe HA, Stitt LW. (2001): Low back pain: prevalence and risk factors in an industrial setting. J Rheumatol ; 28(2):346–351

[38]. Lively MW (2002): Sports medicine approach to low back pain. Spine; 95(6): 642-648.

[39]. Loney P, Stratford P, (1999): The prevalence of low back pain in adults: A methodological review of the literature. Physical Therapy 79(4):384-396.

[40]. Lotters F, Burdorf A. (2006): Prognostic factors for duration of sickness absence due to musculoskeletal disorders. Clinical Journal of Pain, February 22 (2): 212-221

[41]. Lu JLP. (2003): Risk factors for low back pain among Filipino manufacturing workers and their anthropometric measurements. ApplOccup Environ Hyg, 18(3):170–176.

[42]. Maitland G D. (1986) Vertebral Manipulation, fifth edition, Butterworths& Co publishers, 119-128

[43]. Maniadakis, N. and A. Gray. (2000): The economic burden of back pain in the UK. Pain 84:95–103.

[44]. May, S.J. (2001): Patient satisfaction with management of back pain (Part 1). Physiotherapy, Hochanadel C D, Conrad D E. 1993. Evolution of an on-site industrial physical therapy program, JOM 35(10), October: 1011-1016

[45]. Murphy, P, Volinn, E. (1999): Is occupational low back pain on the rise? Spine, 24(7): 691-697

[46]. Omokhodion FO, Sanya AO (2003) Risk factors for low back pain in office workers. Journal of Occupational Medicine; 53:287-289.

[47]. Omokhodion FO, Umar US, Ogunnowo BE (2000): Low Back Pain in a Nigerian University Journal of Occupational Medicine; 53: 287-289.

[48]. Omokhodion, F.O. and Sanya A.O. (2003): Risk factors for low back pain in the office workers. Journal of Occupational Medicine 53: 287-289.

[49]. Palmer K T, Griffin M J, Syddall H E, Pannett B, Cooper C and Coggon D. (2000): The relative importance of whole body vibration and occupational lifting as risk factors for low-back pain. Occupational and Environmental Medicine, 60: 715-721

[50]. Riihimäki H. (1991): Low-back pain, its origin and risk indicators. Scand J Work Environ Health ; 17:81–90.

[51]. Scharf T, Vaught C, Kidd P, Steiner L, Kowalski K, Wiehagen W, Rethi L, Cole H: (2001): Toward a typology of dynamic and hazardous work environments. Human and Ecological Risk Assessment;7(7): 1827-1841.

[52]. Shekelle PG, Coulter I, Hurwitz EL, Genovese B, Adams AH, Mior SA, Brook RH. (1998): Congruence between decisions to initiate chiropractic spinal manipulation for low back pain and appropriateness criteria in North America. Ann Intern Med.; 129: 9-17.

[53]. Van Middelkoop M, Rubinstein SM, Verhagen AP et al. (2010) Exercise therapy for chronic nonspecific low-back pain. Best Pract Res ClinRheumatol; 24(2):193-204

[54]. Van Tulder, Becker A (2006). European guidelines for the management of acute nonspecific low back pain in primary care. European Spine Journal ; 15(2): S169-S191.

[55]. van Tulder, M.W.; Becker, A.; Bekkering, T.; Breen, A.; Teresa, M.; del Real, G.; Hutchinson, A.; Koes B.; Laerum, E.; Malmivaara, A. (2009): European guidelines for the management of acute nonspecific low back pain in primary care on behalf of the cost B13 Working Group on Guidelines for the Management of Acute Low BackPain in Primary Care.

[56]. Van Vuuren B J, Becker P J, van Heerden H J, Zinzen E, Meeusen R. (2005): Lower back problems and occupational risk factors in a South African steel industry. American Journal of Internal Medicine, May 47 (5): 451-457

[57]. Van Vuuren B, van Heerden J, Bekker P, Zinzin E, Meeusen R. (2003): Lower back problems among workers at two industrial sites in South Africa. Medicine & Science in Sports and Exercise 35(5) Supplement 1, May, S334

[58]. Waddell G. (1998) The Back Pain Revolution. Edinburgh: Churchill Livingstone.

[59]. Walker BF, Muller R, Grant WD (2004): Low back pain in Australian adults. Prevalence and associated disability. Journal of Manipulative & Physiological Therapeutics 27(4):238-244.

[60]. William JH, Money JK, Kristina SB. (2009): Implications for physical activity in the population with low back pain. American Journal of Lifestyle and Medicine 2009; 3(1): 63-70.

[61]. Williams M, Solomonow M, Zhou B, Baratta R V, Harris M. (2000): Multifidis spasm elicited by prolonged lumbar flexion. Spine, 25(22), 15 November, 2916-2924

[62]. Worker” effect: Population-base cross-sectional and 5-year prospective questionnaire study. Spine, 26 (16): 1788-1792

[63]. Zedka M, Prochazka A, Knight B, Gillard D, Gauthier M. (1999): Voluntary and reflex control of human back muscles induced pain. The Journal of Physiology, 20(2), 591-604