JMU

Jurnal medika udayana


ISSN: 2597-8012 JURNAL MEDIKA UDAYANA, VOL. 12 NO.11,NOVEMBER, 2023


Diterima: 2023-08-12 Revisi: 2023-10-08 Accepted: 25-10-2023

CORRELATION BETWEEN DURATION AND SITTING POSITION WITH THE INCIDENCE OF LOWER BACK PAIN DURING ONLINE LEARNING

Ahyana, Irfanita Nurhidayah, Riski Amalia, Anda Kamal Faculty of Nursing, Syiah Kuala University, Aceh, Indonesia.

Corresponding author. *Email: [email protected]

ABSTRACT

Low back pain is a musculoskeletal disorder that is very common and has an impact on socioeconomic, individual, family, and community losses. Low back pain is choking between the 12th thoracic rib and the bottom of the gluteal fold, with or without pain radiating down the leg. Since the coronavirus disease 2019 (COVID-19) outbreak hit Indonesia, learning that has been carried out in schools and university has become online learning where learning uses laptops or cell phones with internet facilities and in a prolonged sitting position. The condition of sitting for a long time is the most common posture performed during online learning, so it can cause discomfort and pain in the lower back. This study aimed to determine the correlation between duration and sitting position with the incidence of back pain during online learning. This study used a descriptive correlational method with a cross-sectional design. The sample in this study was 203 students of the Faculty of Nursing at Syiah Kuala University. The data collection technique used a valid and reliable Sitting Position Duration (DPD) questionnaire with a Cronbach's Alpha value of 0.729 and the Nordic Body Map (NBM) questionnaire to see low back pain. This study showed no significant relationship between sitting duration and back pain (p-value = 0.625), sitting duration, and buttock pain (p-value = 0.616). A significant relationship exists between sitting position and back pain (p-value = 0.002) and sitting position and buttock pain (p-value = 0.001). It was concluded that an unergonomic sitting position for a long time could cause low back pain.

Keywords: Sitting Duration; Sitting Position; Lower Back Pain

INTRODUCTION

Low back pain (LBP) is a significant cause of activity limitation and can cause socioeconomic losses for individuals, communities, and countries. Low back pain is choking between the 12th thoracic rib and the bottom of the gluteal folds, with or without pain radiating down the legs1. The condition of sitting for a long time is one of the phenomena that causes low back pain2.The coronavirus disease 2019 (COVID-19), which has hit the whole world, has affected various aspects. Various systems have changed to adapt to the spread of the outbreak as a form of action to stop the spread of COVID-19. Higher education institutions in Indonesia have changed the education system from face-to-face to online.

The Ministry of Education and Culture (Kemendikbud) issued Kemdikbud Dikti circular letter No.1 of 2020 concerning the prohibition for university to carry out face-to-face (conventional) lectures and the obligation to carry out online learning or online.3 This has been well received by all universities in Indonesia, especially Universitas Syiah Kuala in Aceh.The phenomenon in the online learning process is that students do not mobilize during learning and complete assignments given during lectures, individually and in groups. Research conducted by

Daneshmandi, Ghaem, Alhamd, & Fakherpour (2017) found that sitting conditions for long periods, both hours, months, and years, can cause stiffness and hurt student health, the most commonly felt impact is distraction musculoskeletal deficient back pain5.

Students spending more time using laptops, computers, and smartphones during the online learning process during the COVID-19 pandemic can increase the incidence and intensity of LBP6–8. Several systematic reviews found a strong relationship between the duration of smartphone use and LBP9. The research results by Hawamdeh et al. (2023) showed that LBP scores before online learning were lower than LBP scores during and after online learning10. LBP is associated with the student's sitting position11. Disruption of pain in students during online learning is associated with a longer duration of pain, painful areas of the body, and greater pain intensity11. Students were sitting for more than 3 hours every day in front of a laptop often complain of neck, shoulder, or lower back pain during online learning12,13. Caromano et al. (2015) also found that the longer the duration of students sitting in front of the computer (13.5 SD 1.5 hours) can increase LBP14. LBP dramatically impacts physical health conditions that

CORRELATION BETWEEN DURATION AND SITTING POSITION WITH THE INCIDENCE OF LOWER BACK PAIN… Ahyana, Irfanita Nurhidayah, Riski Amalia, Anda Kamal

interfere with the comfort of daily activities. LBP experienced by students can increase monthly consumption of analgesics which results in students not being able to complete assignments from lecturers on time, worsening sleep quality to the point of interfering with daily activities 11 .

Lower Back Pain (LBP) is a complaint that is felt caused by a sitting position with a posture that is not ergonomic and for a long duration of time15. This is what students of the Faculty of Nursing at Syiah Kuala University feel who have undergone online learning for 4 semesters. In previous research, many research has been done on the factors and causes of the increase in the incidence of low back pain during online learning. However, there is still little recent research on the extent of the correlation between duration and sitting position and the incidence of low back pain during online learning in college students in Aceh. Researchers focused on this phenomenon, so they were very interested in researching the correlation between duration and sitting position and lower back pain incidence during online learning.

Relationship between sitting duration and low back pain

during online learning Complaints of low back pain in this study focused on criticisms of low back pain

RESEARCH METHODS

The research used is correlational descriptive with a cross-sectional approach. The population of this study wasall students of the Nursing Science Study Program at the Faculty of Nursing. Large sample, namely 203 respondents who met the inclusion criteria, active students of the Faculty of Nursing, Syiah Kuala University, class of 2018, 2019, and 2020. They had no history of kidney disease/kidney stones, stomach disease, rheumatism, or spinal cord injury and did not smoke. The research instrument consisted of a Nordic Body Map questionnaire to find out the scale of a sick body composed of 28 statement items and a sitting position duration (DPD) questionnaire to see ergonomic sitting positions or not ergonomics and sitting duration of more than 4 hours or less than 4 hours in a day. Collection data was held after getting a letter graduated ethics from the Faculty Research Ethics Committee Syiah Kuala University Nursing with research number 111108081221. Analysis data consists from analysis univariate and bivariate.

RESEARCH RESULTS

(point 7) and buttock pain (point 8) on the Nordic body map questionnaire.

Table 1. Relationship between sitting duration and back pain (n = 203)

Sitting Duration

Back Pain Category

Total

p-value

TS

AS

S

SS

< 4 hours

3

6

5

1

15

0.625

≥ 4 hours

28

59

65

36

188

Total

31

65

70

37

203

TS: No pain, AS: Slight pain, S: Pain, SS: Severe pain

Based on the results of data analysis, it is known that of the respondents who had a duration of sitting for more than 4 hours a day, as many as 28 respondents did not feel back pain, 59 respondents felt a slight pain in the lower back, 65 respondents felt low back pain and 36 respondents felt very ill on the waist during sitting for online study. The results of

the statistical test for sitting duration with low back pain obtained a p-value = 0.625 where the value was > α (0.05), so it can be concluded that there is no relationship between sitting duration during online learning and the incidence of lower back pain in the low back pain complaint category.

Table 2. Relationship between sitting duration and buttock pain (n = 203)

Sitting Duration

Buttocks Pain Category             Total        p-value

TS      AS      S      SS

< 4 jam ≥ 4 jam Total

3          6         2         4           15           0,616

39        56       53       40         188

42        62       55       44         203

TS: No pain, AS: Slight pain, S: Pain, SS: Severe pain

The table above shows that as many as 39    > α (0.05), so it can be concluded that there is no significant

respondents did not feel pain, and 56 respondents felt sore    relationship between sitting duration during online learning

in the buttocks while studying for more than 4 hours a day.    and the incidence of lower back pain in the buttocks

The statistical test results for sitting duration with buttock     complaint category.

pain complaints obtained p-value = 0.616 where the value is

The relationship between sitting position and the incidence of low back pain during online learning

Table 3. Relationship between a sitting position and low back pain (n = 203)

Sitting Position

Back Pain Category              Total       p-value

TS _      A S       S       S S

Ergonomics

No Ergonomics

Total

3           9         1 6        1 6         44          0.00 2

2 8          5 6        5 4        2 1         159

31         6 5        70        37        203

TS: No pain, AS: Slight pain, S: Pain, SS: Severe pain

Table 3 shows that 21 respondents who sat in an ergonomic position felt very sick, and 54 respondents felt pain in their waist during online learning. The results of the statistical test of sitting position with low back pain in the category of common back pain complaints in students of the

Faculty of Nursing at Syiah Kuala University obtained a p-value = 0.002 and this value was <α (0.05), so it can be concluded that there is a significant relationship between sitting position during online learning with complaints of low back pain.

Table 4. Relationship between a sitting position and buttock pain (n = 203)

Sitting Position            Buttocks Pain Category            Total        p-value

TS      A S      S      S S

Ergonomics

4

12

11

17

44

0.001

No Ergonomics

38

50

44

27

159

Total

42

62

55

44

203

TS: No pain, AS: Slight pain, S: Pain, SS: Severe pain

The results of the data analysis in the table above explain that 27 respondents who sat in an ergonomic sitting position felt very sick, and 44 respondents felt pain in the buttocks during online learning. The statistical test results of the sitting position with lower back pain in the category of buttock pain complaints in students of the DISCUSSION

Relationship between sitting duration and low back pain during online learning

Based on the bivariate analysis, it was found that there was no significant relationship between the duration of the student sitting during online learning and the incidence of low back pain in students of the Faculty of Nursing, Universitas Syiah Kuala.According to Pramana & Adiatmika (2020), lower back pain can occur due to activities carried out in a prolonged sitting position. However, from the results of the study, there was no relationship between a person's sitting state for a long time and low back pain. Research on the relationship between low back pain and prolonged sitting and the results are still controversial 16,17. This is because students are under the age category of 25 years and have an ideal average body weight, so they are not physically at risk for complaints of low back pain 18.

The study's results by Kusumaningrum et al. (2021) found that age has no relationship with the incidence of LBP19. Several studies have found that sitting duration is closely related to or significantly affects the incidence of low back pain20–23. Other studies have also revealed that there is no significant relationship between long-sitting and

Faculty of Nursing at Syiah Kuala University obtained a p-value = 0.001. This value was <α (0.05), so it can be concluded that there is a significant relationship between sitting position during online learning with complaints of buttock pain.

long-standing low back pain in online advertising company workers and the automotive industry 24.Many factors can affect LBP, one of which is age. Musculoskeletal complaints generally begin to be felt at the age of 25 because, at that age, organs and bone conditions experience a decline in function with different percentages. The first complaints will appear at the age of 35 years and will increase with age. Likewise, weight gain that exceeds the ideal will cause pressure on the spine, resulting in easy damage to the spinal structure 19Umboh et al. (2017), who examined complaints of LBP, show that more respondents are 26 years and over (50.9%)25. Arwinno (2018), who also researched complaints about LBP, showed that most respondents entered at the age of > 25 years, as many as 74% 26.

Relationship between Sitting Position and Lower Back Pain During Online Learning

Based on the results of data analysis, it was found that there was a relationship between sitting position and the incidence of low back pain where the p-value = 0.002, there was a significant relationship between sitting position and low back pain. The p-value = 0.001 showed a substantial connection between a sitting position and complaints of pain buttocks in students of the Faculty of Nursing, University of Syiah Kuala.

Ergonomic sitting positions are often not understood by many people. Someone will change their sitting position according to their comfort level without regard to ergonomic positions, which can trigger low back pain. Sitting requires less energy than standing, and this causes a reduction in the static muscle load on the legs. Still, an improper sitting position causes back problems. When sitting, the spinal pressure will increase by 100%, and if the sitting position is not ergonomic or stiff causes the pressure to reach 140%. A sitting place that bends forward causes the pressure to be 190% 27.

This is in line with Anggraika, Apriany, & Pujiana's (2019) research, which found a significant relationship between sitting position and the incidence of low back pain ( p-value = 0.021). A hunched sitting position is often the cause of complaints of back pain, even though sometimes a person uses a chair with a backrest but is not used correctly. If the activity is not carried out ergonomically, it will cause the body to become uncomfortable, and the risk of musculoskeletal disorders or diseases is higher. This is also CONCLUSION

Based on statistical testing of the relationship between sitting position and complaints of low back pain, it was found that there was a relationship between sitting position and the incidence of low back pain in students of the Faculty of Nursing, Syiah Kuala University, with the results of statistical tests in a sitting position with complaints of back pain obtained p-value = 0.002 and the effects of statistical tests in a sitting position with complaints of buttock pain received p-value 0.001.

REFERENCES

  • 1.    Yuwono A, Wahyuni OD. The Relationship Between Sitting Duration and Low Back Pain on Office Workers in DKI Jakarta 2021. Adv Heal Sci Res. 2021;41(Ticmih):17–20.

  • 2.    Azwar Y, Santi E, Tegar Larasati D. Faktor-Faktor yang Berhubungan Dengan Keluhan Nyeri Punggung Bawah Pada Pekerja Welding. Heal Care J Kesehat. 2021;10(1).

  • 3.    Sadikin A, Hamidah A. Pembelajaran Daring di Tengah Wabah Covid-19. Biodik. 2020;6(2):109–19.

  • 4.    DANESHMANDI     et all. Efek masalah

muskuloskeletal pada kelelahan dan produktivitas personel kantor : studi potong lintang. 2017;252-8.

  • 5.    Daneshmandi H, Choobineh AR, Ghaem H, Alhamd M, Fakherpour A. The effect of musculoskeletal problems on fatigue and productivity of office personnel: A cross-sectional study. J Prev Med Hyg. 2017;58(3):E252–8.

  • 6.    Harun Z, Hashim H, Fathul W, Zamri HW. Basic Needs in Online Learning During Covid-19: A Malaysian Students ’ Survey. 2021;(December).

  • 7.    Leirós-Rodríguez R, Rodríguez-Nogueira Ó, Pinto-Carral A, Álvarez-álvarez MJ, Galán-Martín M, Montero-Cuadrado F, et al. Musculoskeletal pain and

proven by several theories that a monotonous sitting position for more than 2 hours a day increases the risk of developing back pain 28.

Sitting more static behavior is generally more physiological and impacts a person's biology. The pressure on the lower back caused by a continuous sitting position and compression on the intervertebral discs can result in reduced disc nutrition and ischemic effects resulting from sitting static for a long time. Ergonomic sitting positions that vary through hip rotation and postural movements are highly recommended to prevent LBP 29.

Research by Kett, Sichting & Milani (2021) found that prolonged periods of sitting caused a significant increase in lower back muscle stiffness. Sitting referred to in this study is sitting slumped. This hung sitting condition is often preferred for sitting posture on a chair with a back. However, it could not be found that time spent sitting slumped increase muscle stiffness, and postural activity changes muscle stiffness. Even so, sitting in an ergonomic position can prevent LBP from occurring.30

non-classroom teaching in times of the covid-19 pandemic: Analysis of the impact on students from two Spanish universities. J Clin Med. 2020;9(12):1– 12.

  • 8.    Yaseen QB, Salah H. The impact of e-learning during COVID-19 pandemic on students’ body aches in Palestine. Sci Rep. 2021;11(1):1–9.

  • 9.    Xie Y, Szeto G, Dai J. Prevalence and risk factors associated with musculoskeletal complaints among users of mobile handheld devices: A systematic review. Appl Ergon. 2017;59:132–42.

  • 10.    Hawamdeh M, Altaim TA, Shallan A, Gaowgzeh RA, Obaidat SM, Alfawaz S, et al. Low Back Pain Prevalence among Distance Learning Students. Int J Environ Res Public Health. 2023;20(1).

  • 11.    Kim HJ, Boo S, Meeker TJ. Pain prevalence, management and interference among university students in south korea: An exploratory crosssectional study. J Pain Res. 2021;14:2423–31.

  • 12.    Haroon H, Mehmood S, Imtiaz F, Ali SA, Sarfraz M. STUDENTS CORNER Musculoskeletal pain and its associated risk factors among medical students of a public sector University in Karachi , Pakistan. 2016;(November):682–8.

  • 13.    Roggio F, Trovato B, Ravalli S, Di Rosa M, Maugeri G, Bianco A, et al. One year of COVID-19 pandemic in Italy: Effect of sedentary behavior on physical activity levels and musculoskeletal pain among university students. Int J Environ Res Public Health. 2021;18(16).

  • 14.    Caromano FA, Amorim CAP de, Rebelo C de F, Contesini AM, Fávero FM, Frutuoso JRC, et al. Prolonged sitting and physical discomfort in university students. Acta Fisiátrica. 2015;22(4):176– 80.

    • 15.    Hutasuhut RO, Lintong F, Rumampuk JF. Hubungan Lama Duduk Terhadap Keluhan Nyeri Punggung Bawah. J e-Biomedik. 2021;9(2):160–5.                   24.

    • 16.    Gupta N, Christiansen CS, Hallman DM, Korshøj M, Carneiro IG, Holtermann A. Is objectively measured sitting time associated with low back pain? A crosssectional investigation in the NOMAD study. PLoS One. 2015;10(3):e0121159.

    • 17.    Nordin NAM, Singh DKA, Kanglun L. Low back pain and associated risk factors among health science      25.

    undergraduates. Sains Malaysiana. 2014;43(3):423–8.

    • 18.    Pramana1 IGBT, I Putu Gede Adiatmika2. Hubungan Posisi dan Lama Duduk dalam Menggunakan Laptop Terhadap Keluhan Low back pain pada Mahasiswa Fakultas Kedokteran Universitas Udayana. 2020;9(8):3–7.                                             26.

    Punggung Bawah (LBP). J Ilm Kesehat Sandi Husada. 2021;10(1):74–81.

    A systematic, critical literature review. Scand J Public Health. 2000 Sep;28(3):230–9.

    S. Causal assessment of occupational sitting and low back pain: results of a systematic review. Spine J.

    2010 Mar;10(3):252–61.

    Dec;61(8):541–8.

    • 23.    Lis AM, Black KM, Korn H, Nordin M. Association between sitting and occupational LBP. Eur spine J


Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. 2007 Feb;16(2):283–98.

Dwi Pangestu A, Kurniawati N, Studi IV Fisioterapi PD, Studi Profesi Fisioterapi Jurusan Fisioterapi P, Kemenkes Jakarta III P. Hubungan Lama Duduk dan Lama Berdiri Dengan Nyeri Punggung Bawah Miogenik Pada Pekerja Perusahaan Periklanan Online dan Perusahaan Industri Otomotif. J Fisioter dan Kesehat Indones. 2022;2(1):2807–8020.

Umboh B, Rattu JAM, Adam H, Kesehatan F, Universitas M, Ratulangi S. Hubungan Antara Karakteristik Individu Dengan Keluhan Nyeri Punggung Bawah Pada Perawat Di Ruangan Rawat Inap Rsu Gmim Pancaran Kasih Manado. Kesmas. 2017;6(3):1–9.

Arwinno LD. Keluhan Nyeri Punggung Bawah pada Penjahit Garmen. Higeia J Public Heal Res Dev. 2018;2(3):406–16.

Widjayanti Y, Ragil R, Pratiwi D, Katolik S, Vincentius S, Surabaya AP. PUNGGUNG BAWAH PADA MAHASISWA STIKES KATOLIK ST VINCENTIUS A PAULO SURABAYA.

Anggraika P. Hubungan Posisi Duduk Dengan Kejadian Low Back Pain (Lbp) Pada Pegawai Stikes. J ’Aisyiyah Med. 2019;4:1–10.

Bontrup C, Taylor WR, Fliesser M, Visscher R, Green T, Wippert PM, et al. Low back pain and its relationship with sitting behaviour among sedentary office workers. Appl Ergon [Internet]. 2019;81(January 2020):102894. Available from: https://doi.org/10.1016/j.apergo.2019.102894

Kett AR, Sichting F, Milani TL. The Effect of Sitting Posture and Postural Activity on Low Back Muscle Stiffness. Biomechanics. 2021;1(2):214–24.

http://ojs.unud.ac.id/index.php/eum

doi:10.24843.MU.2023.V12.i11.P03

15