An investigation into the prevalence and risk factors of occupational low back pain amongst commercial pilots registered with the South African Civil Aviation Authority
Stander, Barend Jacobus
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Background Occupational low back pain (LBP) has been described as a significant burden to society. Although there is uncertainty and conflicting studies on the exact causes and combination of causes of LBP, it has been found that occupations which require prolonged sitting periods and have exposure to physical factors such as whole body vibration (WBV) and / or awkward posture, results in increased likelihood for LBP. Pilots are not sheltered from the development of LBP, with the lifetime prevalence of LBP varying from 31.5% to a significant 82%. Additionally, point prevalence varies significantly between 5.1% and 68%, which illustrates that individual pilot and / or occupational factors may contribute to specific pilot subgroups. This could apply to commercial pilots, who use seats that were found to be ineffective in terms of their depth and inclination, therefore limiting the height and impact of the lumbar support. There is a paucity of studies performed on LBP relating to commercial pilots, specifically, on their unique occupational setting. Research is therefore warranted to illustrate the possible risk factors to which they are exposed to, as impeded performance may lead to catastrophic consequences if a pilot’s ability to complete actions critical to flight becomes hindered. Aim To determine the prevalence of low back pain (LBP) in commercial pilots and identify possible risk factors that pilots are exposed to. Study designs The study transpired as a cross sectional questionnaire survey. Participants Study comprised of 100 commercial pilots registered with the South African Civil Aviation Authority (SACAA) and affiliated with the various participating companies utilizing O.R. Tambo International Airport. Methodology All commercial pilots registered with the SACAA and who make use of the O.R.Tambo International Airport (operate through or from) and affiliated with the participating companies during the research study, was approached for participation. Pilots were required to sign and agree to the letter of information and informed consent, as well as the confidentiality agreement. Questionnaires were distributed and all documents were collected, following completion thereof. Pilots were not allocated to more than one group during the data collection (recording) phase of the study. Subgroup analysis was however not excluded in the analysis. IBM SPSS version 21 was used for analysis. A p value <0.05 was considered as statistically significant. Demographics of the pilots were described in the same manner as in the case of categorical variables, and using summary statistics such as mean, standard deviation and range for quantitative variables. Prevalence and characteristics of the low back pain is described using relative frequency and percentages, with 95% confidence intervals. Associations between risk factors and low back pain was identified with log linear regression analysis and tested using Pearson’s chi square test in the case of categorical variables and t-tests in the case of continuous variables. Results The lifetime prevalence of LBP amongst commercial pilots was 80.8%, with the annual prevalence reaching 68.7%. Majority of commercial pilots were white, married males, with nearly the entire population having reached similar educational levels. Considering the male predominance of this population, gender was significantly associated with LBP. Although the female population was much smaller than the male population, it was also found that females were six times more at risk of developing LBP; however the risk was not statistically significant. Awkward posture such as twisting and being stressed at work were found to be significantly related to LBP. Having a history as an ex-smoker or non-smoker was found to be a risk for LBP development. BMI was also significantly related to LBP; however, an inverse relationship is indicated. Having a subjective rating of good health versus excellent health was also an indicator of risk for LBP. Conclusion: Commercial pilots have a significant risk for LBP development. It was found that subjective ratings of own health was a good indicator of LBP whereby good health versus excellent health, was a significant risk factor. Although greater portions of the populace are white males, normally less at risk, a significant lifetime and annual prevalence of LBP was found. Furthermore, the small female population had potentially considerable contribution to the prevalence of LBP through their significant odds ratio. Being a current smoker carried less risk in comparison to a history of an ex-smoker or non-smoker, which further complicates the so often debated contribution of this proposed risk factor. Interesting results were found through the inverse proportional relationship that exists between BMI and LBP, whereby every unit increase in BMI results in a relative decreased risk for LBP development. Majority of the proposed risk factors of LBP was not found to be significant, except stress and twisting, which were found to be common risk factors amongst commercial pilots.