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ati
o
n
a
l
Jo
urn
a
l
o
f
P
u
b
lic Hea
l
th Science (IJ
P
HS)
V
o
l.3
,
No
.2
,
Jun
e
2
014
, pp
. 10
1
~
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6
I
S
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: 225
2-8
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0
6
1
01
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urn
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ttp
://iaesjo
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IJPHS
Sleep Habits and Occurrence
of Lowback Pain among
Craftsm
e
n
Ga
briel O.
AYENI
1
,
Ol
adi
re OLANI
Y
I
1
,
Oluwase
g
un
A. AYENI
2
1
Dept of Ph
y
s
iotherap
y
,
Feder
a
l
Me
dical Cen
t
re,
Owerri, Imo St,
Nigeria
2
Dept of M
a
the
m
atics (Sta
tisti
cs), Ek
iti
Sta
t
e
Uni
v
ersit
y
Ado
Ekit
i, Nig
e
ri
a
Article Info
A
B
STRAC
T
Article histo
r
y:
Received
March 25, 2014
Rev
i
sed
Mau
2, 201
4
Accepted
May 26, 2014
Low back pain (
L
BP) is a leadin
g cause of d
i
sab
ilit
y
wi
th high
econom
ic
and public health conse
quences. The stud
y
objectiv
e is to deter
m
ine the
association between sleeping
habits
and
occurrence of low
b
ack p
a
in
among craftsmen in Owerri. From April to Ma
y
,
2012
, a cross-section
a
l
survey
of
rando
mly
selected 50
0 cr
af
t workers
was done. Data
on socio-
dem
ographic ch
arac
teris
t
ics
and
s
e
lec
t
ed l
i
fes
t
yl
e were co
lle
ct
ed
us
ing an
interviewer semi-structur
e
d questionnair
e. Data analy
s
is was d
one using
descript
ive,
infe
renti
a
l sta
tisti
cs of chi squa
re
and m
u
ltipl
e
re
gressions
.
The find
ings of m
u
ltiple r
e
gres
si
on anal
y
s
es showed respondents who
sleep on
soft/sa
g
g
y
surf
ace
wer
e
a
l
m
o
st 5 tim
e
s
m
o
re like
l
y to
deve
lop
LBP independ
e
n
tl
y com
p
ar
ed t
o
those with
rel
a
tiv
el
y f
i
rm
/har
d surfac
e
(OR = 4.56; CI = 2.62 - 7.94; p = 0.001).
Craftsmen with unstead
y
sleeping postur
e
were twic
e l
i
kel
y
to
d
e
velop LB
P (OR=2.10, CI
= 1.04 -
4.25, p<0
.
001)
. Longitudin
a
l stud
y
is
warr
anted to further
ex
plore th
e
relationship b
e
tween sleep h
a
bits and lowback p
a
in.
Keyword:
Sleep s
u
rface
Sl
eep po
st
ure
Sl
eep du
rat
i
o
n
Craftsm
e
n
Lo
wbac
k pai
n
Copyright ©
201
4 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
Gabriel O.
AYENI,
Su
rg
ery / Ortho
p
a
ed
ic Ph
ysioth
er
ap
y un
it, Ph
ysio
th
er
ap
y
Dep
t
,
Fede
ral
M
e
di
c
a
l
C
e
nt
re,
Owe
rri,
PM
B
10
1
0
,
Im
o State, Ni
geria.
E-m
a
il: ayenco_2@yahoo.c
om
1.
INTRODUCTION
Low b
ack
p
a
in
(LBP) is a co
mm
o
n
,
co
m
p
lex
an
d
d
i
fficu
lt to
m
a
n
a
g
e
h
ealth
con
d
ition
[1
]
.
A
p
p
r
ox
im
ate
l
y
,
20
%
o
f
t
h
e adu
lt po
pu
lation expe
riences
an
episode of LBP
at
any
gi
ve
n
t
i
m
e
and est
i
m
a
t
e
s o
f
l
i
f
et
im
e preval
ence a
r
e ar
o
u
n
d
80%
[
2
]
.
Sa
n
y
a
et
al
[3]
f
o
u
n
d
p
o
i
n
t
a
n
d
1
2
-m
ont
h
p
r
eva
l
ence am
ong i
n
dust
r
i
a
l
workers i
n
a s
out
h-west Ni
geria city
t
o
be
59
.7
% an
d
59
.
5
% re
spect
i
v
el
y
.
The ec
on
o
m
i
c
bur
den
o
f
LB
P i
s
si
gni
fi
ca
nt
. M
o
st
o
f
t
h
e c
o
st
s of LB
P a
r
e a
ssoci
at
ed
wi
t
h
persi
s
t
e
nt
or c
h
r
o
ni
c LB
P, i
.
e. LB
P w
h
i
c
h
l
a
st
s for
m
o
re th
an
3
mo
n
t
h
s
[4
]. Th
ere are sev
e
ral im
p
o
r
tan
t
co
n
s
eq
u
e
n
ces of LBP in
clu
d
i
n
g
work
loss [5
],
d
i
sab
ility
and
de
pressi
o
n
[
6
]
.
As a
r
e
sul
t
of t
h
e i
n
creasi
ng
n
u
m
ber of ol
der
peo
p
l
e
t
h
ro
u
g
h
o
u
t
t
h
e w
o
rl
d a
n
d
i
n
d
u
st
ri
al
i
zat
i
on, t
h
e b
u
r
de
n
of
LB
P
on
t
h
e i
n
di
vi
dua
l
and society a
s
a whole is
expecte
d
to increas
e
d
r
am
atical
ly [7]. It is
p
r
ed
icted
th
at t
h
e
g
r
eat
est in
creases in LBP
will b
e
in d
e
v
e
lop
i
ng
n
a
tio
n
s
[8
]
Despi
t
e
i
n
t
e
nsi
v
e researc
h
t
o
enha
nce u
n
d
er
st
andi
ng
,
m
a
nagem
e
nt
i
s
onl
y
m
oderat
e
l
y
effect
i
v
e [
9
]
.
Ev
id
en
ce is
b
e
g
i
nn
ing
to
accu
m
u
late th
at p
a
tien
t
s with
LBP also
repo
rt
sig
n
i
fican
t
p
r
o
b
l
em
s with
their sleep
[1
0]
,[
1
1
]
.
Po
o
r
sl
eep i
s
kno
wn t
o
cau
se a range
of p
h
y
s
i
o
l
o
gi
cal
and
psy
c
hol
ogi
cal
effect
s [1
2]
. From
a
clinical pers
pe
ctive, the
pres
ence
of
sleep
problem
s
has im
plications fo
r the
m
a
nagement of LBP.
A recent
st
udy
fo
u
nd t
h
at
LB
P pat
i
e
nt
s w
h
o
re
po
rt
ed
sl
eep
di
st
ur
ba
nce
were t
w
i
ce as l
i
k
el
y
t
o
be
hos
pi
t
a
l
i
zed c
o
m
p
ared
with
tho
s
e who
d
i
d
no
t [13
]
.
Ano
t
h
e
r
research
su
gg
ests t
h
at i
m
p
r
ov
ed sleep
q
u
a
lity m
i
g
h
t redu
ce th
e pain
and
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJP
H
S
V
o
l
.
3,
No
. 2,
Ju
ne
2
0
1
4
:
10
1 – 1
0
6
10
2
d
a
yti
m
e sy
m
p
t
o
m
s
o
f
p
a
tien
t
s with art
h
ritis [1
4
]
.
It
is cu
rren
tly un
clear
h
o
w co
mm
o
n
sleep
h
a
b
its i
n
flu
e
n
ce
occurre
nce
for
patients
who a
r
e seeki
n
g care
for thei
r LBP.
Gene
ral LBP pre
v
e
n
tive p
r
o
g
ram
s
freq
u
en
tly
focu
s on the recognized bi
om
echani
cal factors
,
wo
rkl
o
a
d
an
d
or
ga
ni
zat
i
onal
i
ssues [
1
5]
wi
t
h
m
i
nim
a
l
effo
rt
at
i
d
ent
i
f
y
i
n
g
an
d c
ont
rol
l
i
ng t
h
e ri
s
k
di
s
posi
n
g
lifestyle. Presen
tly, th
ere is d
earth
of d
a
ta on
th
e
association
betwee
n sleep ha
bits and occurre
n
ce of LBP
am
ong
cra
f
t
s
m
e
n i
n
Ni
geri
a.
An
en
ha
nced
kn
o
w
l
e
d
g
e
of
t
h
e rel
a
t
i
o
ns
hi
p
bet
w
ee
n sl
ee
pi
n
g
habi
t
s
e
f
f
ect
on
t
h
e occ
u
r
r
e
n
ce
of
l
o
wbac
k
pa
i
n
i
n
t
h
i
s
hi
gh
ri
sk
p
o
p
u
l
a
t
i
o
n
w
oul
d hel
p
i
n
app
r
op
ri
at
e p
r
i
m
ary
and s
eco
nda
ry
pre
v
e
n
t
i
v
e a
p
p
r
oac
h
.
T
h
i
s
st
udy
assesse
d t
h
e
rel
a
t
i
ons
hi
p
bet
w
een
sl
ee
pi
n
g
d
u
rat
i
o
n,
p
o
st
u
r
e,
t
i
m
e
, sl
eep
surface a
n
d the
occ
u
rrence
of
LBP am
ongst
craftsm
e
n.
2.
R
E
SEARC
H M
ETHOD
From
Ap
ri
l
t
o
M
a
y
20
12
a
descri
pt
i
v
e cr
o
ss-sec
tional survey
was c
o
nducted am
ong c
r
aftsm
e
n in
Owe
rri
,
S
out
h-
east
,
Ni
ge
ri
a.
Owe
rri
i
s
t
h
e c
a
pi
t
a
l
of
Im
o St
ate an
d
is set i
n
th
e
h
e
art of t
h
e Igb
o
land
.
A m
u
lti
stage sam
p
ling desi
gn was
us
ed to select the study pa
rticip
an
ts. Th
e
p
a
rticip
an
ts were
craftsm
e
n
and
were
random
l
y sele
cted across the three
local
gove
rnm
e
nt areas in Owerri
. They include
welders and
panel
beaters, carpe
nters a
n
d furniture m
e
n
,
m
e
ch
an
ic, lo
cal
so
ap
and
o
il
mil
l
ers, tailo
rs and
weav
ers. After
inform
ed cons
ent was
obtained from
each
worker, i
n
terviews
using stru
cture
d
questionnai
r
e we
re c
o
nducted
with
p
a
rticip
ants with
t
h
e
h
e
lp of
traine
d field researc
h
as
sistants.
The Questi
onnaire
was pre
p
a
r
ed
i
n
En
g
lish an
d it h
a
s three secti
ons
. Se
ct
i
on
A f
o
cu
se
d o
n
s
o
ci
o
-
dem
ogra
phi
c i
n
f
o
rm
at
i
on su
ch as age, m
a
ri
t
a
l
st
at
us, educat
i
onal
l
e
vel
et
c. Sect
i
on B
sou
ght
ans
w
er t
o
que
st
i
on o
n
L
B
P hi
st
ory
suc
h
as prese
n
t
an
d past
l
o
w
b
ac
k
hi
st
ory
an
d sect
i
on C
foc
u
ss
ed o
n
sel
ect
ed sl
eep
habi
t
s
suc
h
as sl
eep du
rat
i
o
n et
c of t
h
e resp
on
de
nt
s. Lo
w
b
ack pai
n
case i
n
t
h
i
s
st
udy
w
a
s defi
ne
d as p
a
i
n
or
di
scom
fort
i
n
t
h
e l
o
w
b
ac
k a
r
ea bet
w
een
t
w
el
ft
h
ri
b a
n
d
gl
ut
eal
f
o
l
d
(l
o
w
er
1/
3
o
f
t
h
e
b
ack)
wi
t
h
or
w
i
t
hout
pai
n
i
n
o
n
e o
r
bot
h l
e
gs l
a
st
i
ng o
n
e day
or l
o
nge
r o
r
st
ro
n
g
eno
u
gh t
o
m
a
ke t
h
e wor
k
e
r
abse
nt
from
wo
rk
, i
n
th
eir life tim
e. Th
e con
t
ro
l
h
a
s no
h
i
story of
lowback pai
n
t
h
at m
e
t the above
defi
nition.
Th
e qu
estion
n
aire was assessed
for v
a
lid
ity. Test-rete
st reliab
ility
was eq
u
a
lly carried
ou
t to
en
sure
th
e qu
estionn
aire reliab
ility. Con
f
id
en
tiality o
f
inform
at
i
o
n was m
a
in
t
a
in
ed th
rou
gho
u
t
t
h
e st
u
d
y
. Th
i
s
researc
h
was conducted
in com
p
lia
nce with the Helsi
n
ki Declarati
on. Data was a
n
alyzed using SPSS
com
puter s
o
ft
ware
ve
rsio
n
17
(
SPS
S,
I
n
c
., C
h
icag
o,
IL
). B
o
th
de
scri
ptive
statistics of m
ean
, stan
d
a
rd
d
e
v
i
ation
,
frequ
e
n
c
y an
d
Inferen
tial statistic
s o
f
ch
i sq
u
a
re an
d
m
u
ltip
le reg
r
ession
s were u
s
ed
for th
e
d
a
ta
analysis with
p-val
u
e set at
0.05.
3.
R
E
SU
LTS AN
D ANA
LY
SIS
Resp
ond
en
ts’
ag
e w
a
s i
n
th
e r
a
ng
e of
1
9
t
o
58
(35
.
2
±
8.98
)
year
s
w
ith
m
o
r
e
m
a
les
(
8
4
.
1
%
)
th
an
fem
a
les (15.9
%
) ha
vin
g
LB
P. M
a
rrie
d
w
o
rke
r
s 2
1
3
(
6
1
.
7%) e
x
peri
en
c
e
d m
o
re LB
P com
p
ared to
workers
t
h
at
were si
n
g
l
e
. M
ean d
u
rat
i
on
of
pract
i
ce
was (
8
.
3
±
4.
3
5
) y
ears
.
Prese
n
t
e
d i
n
Ta
bl
e 1 i
s
t
h
e rel
a
t
i
o
nshi
p
betwee
n soci
o-dem
ogra
phic c
h
aracteristics of the res
p
ond
e
n
ts and occ
u
rre
n
ce of LBP. Age, ge
nder a
n
d years
of
w
o
r
k
e
x
pe
ri
ence am
on
g
ot
he
r s
o
ci
o
-
dem
ogra
phi
c
charact
e
r
i
s
t
i
c
s ha
d si
gni
fi
c
a
nt
rel
a
t
i
o
ns
hi
p
wi
t
h
i
n
ci
denc
e of L
B
P.
Tabl
e 1. Soci
o-
dem
ogra
phi
c
c
h
aract
eri
s
t
i
c
s o
f
re
sp
o
nde
nt
s
a
n
d
occ
u
rre
nce l
o
w bac
k
pai
n
Variable
Yes LBP
No LBP
P value
Ag
e
(
y
ears
)
≤
29
30 -
3
9
40 -
4
9
≥
50
92 (
26.
7)
113 (
32.
8)
118 (
34.
2)
2
2
(6
.4
)
57 (
36.
8)
65 (
41.
9)
33 (
21.
3)
0
< 0.
001
Gender
Male
Fe
m
a
le
Marital status
Single
Mar
r
ied
290 (
84.
1)
55 (
15.
9)
132 (
38.
3)
213 (
61.
7)
118 (
76.
1)
37 (
23.
9)
70 (
45.
2)
85 (
54.
8)
0.
025
0.
168
Education Level
Nil
Pri
m
a
r
y
Secondar
y
Tertia
ry
2
5
(7
.2
)
47 (
13.
6)
188 (
54.
5)
85 (
24.
6)
1
2
(7
.7
)
22 (
14.
2)
74 (
47.
7)
47 (
30.
3)
0.
512
W
o
rk Experience
(
y
ears
)
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Sl
eep
H
abi
t
s
a
n
d
Occ
u
rre
nce
of
L
o
w
back
P
a
i
n
Am
o
ngst
C
r
af
t
s
me
n (
G
a
b
r
i
e
l
O. Aye
n
i
)
10
3
≤
1
2-
4
≥
5
87 (
25.
2)
95 (
27.
5)
134 (
47.
2)
45 (
29.
0)
71 (
45.
8)
34 (
25.
2)
< 0.
001
The
rel
a
t
i
ons
hi
p
bet
w
ee
n cra
f
t
s
m
e
n sl
eepi
n
g
ha
bi
t
s
an
d oc
c
u
r
r
ence
o
f
LB
P i
s
p
r
ese
n
t
e
d
i
n
Tabl
e
2.
Sig
n
i
fican
tly related
sleep
hab
its with
LB
P o
c
cu
rren
ce
were en
tered
fo
r m
u
ltip
le reg
r
essi
on
an
alyses. The
findings of m
u
ltiple regression anal
yses showed
respondents
who sleep
on soft/saggy surface
were almost
5
t
i
m
e
s
m
o
re l
i
k
el
y
t
o
de
ve
l
op LB
P i
n
d
e
pen
d
e
n
t
l
y
(
O
R
=
4.
56;
C
I
=
2.
62
-
7.
9
4
;
p =
0.
00
1
)
.
Craftsm
e
n/workers
with
unst
eady sleepi
n
g
post
u
re
, s
o
ft
sleep s
u
rface
we
re all significa
n
tly associated wit
h
t
h
e occ
u
rre
nce
of
LB
P i
nde
pe
nde
nt
l
y
(Ta
b
l
e
3)
Tabl
e
2. R
e
s
p
o
nde
nt
s’
sl
eep
h
a
bi
t
s
an
d
occ
u
r
r
ence
o
f
l
o
w
b
ack
pai
n
Variable
Yes LBP
No LBP
P value
Usual sleep durati
on (
hours)
0 -
8
> 8
Usual sleep surfac
e
Sof
t
Hard
Sleeping post
u
re
Lie with the
chest
L
i
e on the sides
Lie with the
back
Unsteady
Sleep time
(Pm)
<9
9-
11
>11
282 (
81.
7)
63 (
18.
3)
166 (
48.
1)
179 (
51.
9)
88 (
25.
5)
79 (
22.
9)
68 (
19.
7)
110 (
31.
9)
75 (
21.
7)
235 (
68.
1)
35 (
10.
1)
122 (
78.
7)
33 (
21.
3)
113 (
72.
9)
42 (
27.
1)
1
3
(8
.4
)
36 (
23.
2)
43 (
27.
7)
63 (
40.
6)
39 (
25.
2)
107 (
69.
0)
9
(5
.8
)
0.
462
< 0.
001
<0.
001
0.
410
Tab
l
e 3
.
Prev
al
en
ce
an
d
odd
s ratio
s for
low back
p
a
in
i
n
relatio
n
to
sleep
h
a
b
its
Variable
Frequen
c
y
(n
)
Prevalen
ce (%
)
p-
value
adj
.
O
R
*
95%
CI
Usual sleep surfac
e
Hard
Sof
t
Sleeping post
u
re
Lie with the
chest
L
i
e on the sides
Lie with the
back
Unsteady
221
279
101
115
111
173
44.
2
55.
8
20.
2
23.
0
22.
2
34.
6
< .
001
< .
001
1.
00
4.
56
1.
00
0.
29
0.
43
2.
10
2.
62-
7.
94
0.
13-
0.
64
0.
22-
0.
83
1.
04-
4.
25
*
A
dj
u
s
ted
o
dd ratio
(Ad
j
.
OR) ob
tain
ed
fro
m
m
u
lt
ip
le l
o
g
i
stic r
e
gr
ession
(
a
dj
usted
f
o
r ag
e an
d sex)
:
CI
=
Confide
n
ce i
n
terval
Relations
h
ip between
sleep habits and
occ
u
rrence of
LBP
Thi
s
st
udy
de
m
onst
r
at
ed a
si
gni
fi
cant
ass
o
c
i
at
i
on
be
twee
n us
ual slee
p s
u
rface
and t
h
e
occurrence
of
LB
P. Th
ose w
ho sl
ee
p oft
e
n on s
o
ft
su
rfa
ce
were al
m
o
st
five t
i
m
e
s li
kel
y
t
o
devel
o
p LB
P i
nde
pen
d
e
n
t
l
y
t
h
an
sleeping
on rel
a
tively hard/firm
surface.
Likewise, a
n
ass
o
ciation wa
s found bet
w
een us
ual sleep posture a
n
d
t
h
e occu
rre
nce
of LB
P. T
hos
e wh
o ha
ve u
n
s
t
eady
sl
eep p
o
st
u
r
e ha
d i
n
cr
eased ri
s
k
of
d
e
vel
o
pi
n
g
LB
P
by
2.1
t
i
m
e
s. M
a
ny
fact
ors c
oul
d al
so be
resp
o
n
si
bl
e fo
r an i
n
di
vi
dual
t
o
hav
e
u
n
st
eady
sl
eep
p
o
st
u
r
e i
n
cl
u
d
i
n
g LB
P
i
t
s
el
f. B
ack ca
re e
xpe
rt
s i
n
cl
udi
ng
P
h
y
s
i
o
t
h
erapi
s
t
s
oft
e
n
r
ecom
m
e
nd t
h
a
t
pat
i
e
nt
s
(n
ot
al
l
)
or
e
v
en
he
al
t
h
y
indivi
duals e
n
deavour t
o
slee
p face
down
or with side
s
as
sleeping face
up could pr
edis
pos
e them
to have or
p
e
rp
etu
a
te th
ei
r LBP. Th
is st
u
d
y
fi
nd
ing
sho
w
ed
th
ere
was n
o
sign
ifican
t
relatio
n
s
h
i
p
between
th
e
u
s
ual ti
me
of sl
ee
p a
n
d
o
ccur
r
ence
o
f
l
o
w
b
ac
k
pai
n
.
It
al
so s
h
owe
d
no
rel
a
t
i
o
nshi
p b
e
t
w
ee
n t
h
e
du
rat
i
o
n o
f
sl
e
e
p a
n
d
occurre
nce of
l
o
wbac
k pai
n
.
(
p
>0
.0
5
)
Tom
i
t
a
et
al [16]
i
n
t
h
ei
r st
ud
y
fou
n
d
n
o
rel
a
t
i
ons
hi
p bet
w
een sl
eep d
u
r
at
i
on an
d LB
P
.
Naga
su et
al
[17
]
repo
rted sh
ort sleep to
be a risk
facto
r
for LBP.
Nittera et al [18
]
in
a pro
s
p
ectiv
e
su
rv
ey fro
m
Norway,
in
vo
lv
ing
on
ly wo
m
e
n
an
d ov
er a
1
7
-
y
ear
per
i
od
,
f
oun
d that d
i
sru
p
t
ed
sleep
w
a
s a r
i
sk
facto
r
f
o
r
t
h
e
on
set
of
chr
o
ni
c
pai
n
a
n
d
p
r
e
d
i
c
t
i
v
e
f
o
r
pai
n
persi
s
t
e
nce (b
ut
not
w
o
rse
n
i
n
g o
f
pai
n
)
.
Certain
sleep surfaces have resulted
i
n
com
p
la
ints
of low bac
k
discom
fort, pain,
or stiffnes
s a
nd
sho
u
l
d
er
pai
n
[
19]
One
st
u
d
y
fo
u
nd t
h
at
s
u
b
j
ect
s dev
e
l
o
ped
bac
k
pai
n
a
f
t
e
r sl
eepi
n
g
o
n
f
o
am
m
a
t
t
r
esses [
20]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJP
H
S
V
o
l
.
3,
No
. 2,
Ju
ne
2
0
1
4
:
10
1 – 1
0
6
10
4
In
a c
o
m
p
ari
s
o
n
of
be
ds
de
scr
i
bed
as “
h
ar
d,”
“so
f
t
e
r,”
wat
e
r, a
n
d
wat
e
r/
f
o
am
, su
bject
s
w
i
t
h
cu
rre
nt
bac
k
pai
n
rep
o
rt
e
d
re
duc
ed pai
n
aft
e
r sl
eepi
n
g o
n
“ha
r
d” be
ds [
2
1]
. Ove
r
al
l
com
f
ort
whi
l
e
sl
eepi
ng
on t
h
e m
a
ttress i
s
equal
l
y
im
port
a
nt
as suf
f
i
c
i
e
nt
back s
u
pp
or
t
i
n
hel
p
f
u
l
du
ri
n
g
sl
eep. Sl
e
e
pi
n
g
o
n
a
m
a
t
t
r
ess t
h
at
i
s
t
oo fi
rm
can ca
use ac
he
s an
d
pai
n
s
o
n
pre
ssu
re
p
o
i
n
t
s
. A
m
e
di
u
m
-fi
rm
m
a
t
t
r
ess
m
a
y
be m
o
re co
m
f
ort
a
bl
e beca
use i
t
allo
ws t
h
e sh
ou
ld
er an
d h
i
p
s
to
sink
i
n
sligh
tly [22
]
. Berg
ho
ld
t et al
[23
]
fo
und
th
at t
h
e
waterb
ed an
d th
e
foam
m
a
ttress seem
ed supe
rior to t
h
e
hard
mattress, espe
cially w
h
en u
s
i
n
g th
e pr
ob
ab
ly
m
o
st r
e
lev
a
nt "w
or
st
case" data. T
h
ere we
re no re
levant di
ffe
rence betwee
n th
e
effects of the
water be
d a
nd
the foam
bed.
They
concl
ude
d
t
h
a
t
W
a
t
e
r
b
ed
a
n
d
f
o
am
m
a
t
t
ress'
di
d
i
n
fl
u
e
nce
bac
k
sy
m
p
t
o
m
s
, fun
c
t
i
on a
n
d sl
ee
p
m
o
re
p
o
s
itiv
ely as
op
po
sed
to
t
h
e
h
a
rd
m
a
ttress, b
u
t
t
h
e d
i
fferen
ces
were sm
all. Bert et al [24
]
con
c
lud
e
d th
at n
e
w
b
e
dd
ing
system
s
in
creased
sleep
qu
ality an
d
redu
ced
b
a
ck
d
i
sco
m
fo
rt.
Th
e co
m
f
o
r
t an
d
sup
port o
f
t
h
e sleep
surface a
r
e
related to
problems of sleep quality and e
fficien
cy [25]. Jac
obson et al,
[26] in
2 se
parate st
udie
s
,
fo
u
nd t
h
at
m
e
di
um
-fi
r
m
m
a
tt
resses re
d
u
ced
cl
i
n
i
cal
l
y
di
agnos
ed
bac
k
pai
n
, s
h
oul
der
pai
n
, s
p
i
n
e
st
i
f
f
n
e
ss, a
n
d
p
o
s
itiv
ely affected
sleep qu
al
ity an
d
th
at
even
sub
j
ects
with
m
i
n
o
r
sleep
d
i
stu
r
b
a
n
ces
ben
e
fited sign
ifi
can
tly
in
sleep qu
ality an
d efficiency with
m
e
d
i
um
-fir
m
b
e
d
d
i
ng
system
s [2
7
]
. Had
l
er and
Ev
ans
[
28]
c
o
nc
l
ude
d
that m
e
diu
m
-firm
m
a
ttresses serve
d
t
o
red
u
c
e
lo
w
bac
k
pai
n
m
o
re s
o
tha
n
firm
m
a
ttresses.
Prese
n
t
l
y
, no
f
o
rm
ul
a exi
s
t
s
f
o
r
recom
m
endi
ng
be
ddi
ng sys
t
e
m
s to
m
e
e
t
s
p
ecific sleep
needs or for
redu
cing
sleep d
i
sturb
a
n
ces [2
9
]
. Health care professi
on
als h
a
v
e
little in
fo
rm
atio
n
to
sup
port reco
mm
e
n
d
i
n
g
sleep s
u
rfaces. Howe
ver, Jac
obs
on et
al [26] suggested tha
t
body
weight
may
be
one de
termining factor for
cho
o
si
ng a
be
d
.
Des
p
i
t
e
t
h
e l
a
ck o
f
gui
del
i
n
e
s
, an
d ca
ut
i
o
ns
t
h
at
p
h
y
s
i
c
i
a
n
s
sh
oul
d a
voi
d
recom
m
endi
ng
fi
r
m
m
a
t
t
r
esses, 7
5
%
o
f
ort
h
o
p
edi
c
su
rge
o
ns'
rec
o
m
m
e
nd
fi
rm
or
ha
rd
m
a
tt
resses f
o
r
t
h
e
rel
i
ef o
f
back
pai
n
[
3
0]
.
Thi
s
prese
n
t
st
udy
has
co
nt
ri
but
e
d
t
o
fi
ndi
n
g
s i
n
LB
P
,
ho
weve
r
fu
rt
he
r
researc
h
o
n
pa
t
i
e
nt
s wi
t
h
l
o
w
bac
k
p
a
in
and
sleep
h
a
b
its is
requ
ired
to
d
e
lin
eate
th
ese co
m
p
lex
relatio
n
s
h
i
p
s
so
th
at effectiv
e m
a
n
a
g
e
m
e
n
t
can
b
e
achi
e
ve
d.
4.
CO
NCL
USI
O
N
Sleep post
ure
and s
u
rface
showe
d
signifi
cant relations
hip to th
e occ
u
rrence of
lowbac
k pain.
At
t
e
nt
i
on s
h
o
u
l
d
be
gi
ve
n t
o
sl
eep ha
bi
t
s
i
n
t
h
e pre
v
e
n
t
i
on a
nd m
a
nagem
e
nt
of l
o
w
b
ac
k pai
n
. Furt
he
r
lo
ng
itu
d
i
n
a
l st
u
d
y
fo
cu
si
n
g
on
sleep
h
a
b
its
will b
e
v
a
lu
ab
l
e
.
ACKNOWLE
DGE
M
ENTS
Th
e au
t
h
ors than
k
th
e
v
a
ri
o
u
s craftsm
e
n
g
r
o
u
p
s
who
allo
wed
th
ei
r m
e
m
b
ers to
p
a
rticip
ate in
th
e
stu
d
y
. W
e
th
ank
Elizab
et
h
A. Ayen
i (Mrs.) fo
r
h
e
r
assistance
in
p
r
oo
f read
ing
th
is
m
a
n
u
s
crip
t.
Fu
ndi
ng:
N
o
n
e
Co
m
p
etin
g
in
t
e
rest:
W
e
declare
we
h
a
v
e
no con
f
lict of i
n
terest.
Eth
i
cal app
r
oval: Eth
i
cal ap
pro
v
a
l
w
a
s sough
t and
ob
tain
ed
for
th
is
stud
y.
W
e
co
m
p
ly with
th
e prin
ci
p
l
es laid
d
o
wn
in th
e
Declaratio
n
of Helsin
k
i
.
Ori
g
in
ality: We certify th
at t
h
is work
h
a
s
no
t b
e
en
p
u
b
lish
e
d
an
ywh
e
re or
su
b
m
itted
for
pu
b
lication
in o
t
h
e
r
j
our
n
a
l.
REFERE
NC
ES
[1]
Manchikan
ti L.,
Singh V., Datta
S., C
ohen S. P.,
Hirsch J. A., “Comprehensi
ve review of epidemiolog
y
, scope, and
im
pact of
spina
l
pain”
,
Pain Phys
ician
, vol. 12
, pp
. E35-
E70, 2009.
[2]
Walker B. F., “The prev
alen
ce of
low back
pain
:
a s
y
stematic rev
i
ew of th
e literature from 1966 to 1998”,
J Spina
l
Disord,
vol. 13,
pp. 205–217
, 20
00.
[3]
San
y
a A. O., Omokhodion F.
O., Ogwumike O. O., “R
isk factors for low back pain among hospital workers in
Ibadan,
O
y
o S
t
a
t
e, Nig
e
ri
a”
,
J. Nig. Soc.
Physio
th
, vol/issue: 15(2)
, pp. 31-34, 2005
.
[4]
Walker B. F., Muller R., Gran
t W. D., “Low
b
ack pain in Australian a
dults: the economic burden”,
Asia Pa
c
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BIOGRAP
HI
ES OF
AUTH
ORS
Gabriel O AYE
NI is an orthop
aedi
c
ph
y
s
iothe
r
apist and
a c
lin
ica
l
rese
arche
r
working
with the
feder
a
l
hospital
in Owerri Nige
ria
.
He
has Bach
elor o
f
Medica
l Reh
a
bilit
atio
n
(Ph
y
siother
a
p
y
)
and Master of
Public Health
degree
. His
ar
e
a
s
of s
p
ecia
l
in
teres
t
are
Orthopaedi
c
and
traum
a
P
h
y
s
io
th
erap
y,
Exer
cise Therap
y and
Co
m
p
liance
,
Ep
ide
m
iolog
y
of chronic diseases and injuries, Health prom
otio
n, Electroth
e
rap
y
. He has publications in
thes
e are
a
s
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJP
H
S
V
o
l
.
3,
No
. 2,
Ju
ne
2
0
1
4
:
10
1 – 1
0
6
10
6
Oladire OLANI
YI is
a ph
y
s
ioth
erapis
t
,
adm
i
nis
t
rator and
cl
inic
al
res
ear
cher work
ing with
the Federa
l hospital
in Owerri
Nigeria
.
He
has Bachelo
r
of Medical R
e
ha
bilit
atio
n
(Ph
y
siother
a
p
y
)
and Master of
Science (Ph
y
s
i
otherap
y
) d
e
gree. His ar
eas of
special
inter
e
s
t
ar
e Neu
r
o-P
h
y
s
iother
ap
y,
Exer
cis
e
The
r
ap
y and Com
p
l
i
anc
e
,
Epidem
io
log
y
of
chronic
dis
e
as
es
,
Heal
th
promotion. He has pub
licat
ions
in thes
e
areas
.
Oluwasegun A AYENI is Ma
thematician
/
Sta
tistician
.
He has
Diploma in Computer
S
c
ienc
e and
a
Bache
l
or of S
c
i
e
nce d
e
gre
e
in
M
a
them
ati
c
s
/
S
t
a
tis
tics
.
He is
c
u
rren
t
l
y
undergoing his
Master degree p
r
ogramme. He has special intere
st in statistical analy
s
is,
software d
e
velo
pment and
data
mana
gement with some published works.
Evaluation Warning : The document was created with Spire.PDF for Python.