Demographic characteristics of HP sample
Demographic characteristics of the 1046 participants are shown in Table 1:
Table 1
Demographic characteristics of HP sample (n= 1046)
Age at baseline:
|
N
|
%
|
Range 21-57, Mean: 25.0, Median: 24.0
|
21-25
|
775
|
74.9
|
|
26-30
|
203
|
19.6
|
|
31-35
|
27
|
2.6
|
|
36-40
|
10
|
1.0
|
|
41-45
|
10
|
1.0
|
|
46 -57
|
10
|
1.0
|
|
Gender:
|
|
|
|
Men
|
94
|
9.4
|
|
Women
|
1039
|
90.3
|
|
missing
|
7
|
0.7
|
|
Professions
|
|
|
|
occupational therapy
|
112
|
10.7
|
|
nutritional sciences
|
83
|
7.9
|
|
midwifery
|
107
|
10.2
|
|
nursing
|
481
|
46.0
|
|
physiotherapy
|
263
|
25.1
|
|
Yearly prevalence of MSD
Figure 1 gives an overview of the four MSD under consideration at baseline and follow-up.
[INSERT HERE: Figure 1]
Low back pain (LBP)
At baseline, the adjusted yearly prevalence of LBP [mean (95% CI) was 75.8% (73.2–78.5)] in the total sample of HP students (Figure 1). We found the highest adjusted yearly prevalence of LBP in midwifery students [81.3% (74.3–88.8)], followed by students of occupational therapy [78.4% (70.6–86.1)], nursing students [76.1% (72.3–80.0)], and physiotherapy students [73.3% (67.9–78.6]. Nutritional sciences students had the lowest prevalence [71.6% (61.7–81.5)]. However, at baseline, differences in LBP prevalence among HP students were not statistically significant.
At follow-up, yearly LBP in the total sample was 73.0% (70.7–75.9). Again, we found the highest adjusted yearly prevalence of LBP was in midwifery students [83.2% (76.1–90.2)], and the lowest prevalence of LBP was in nutritional sciences students [60.0% (49.5–70.5)]. LBP prevalence in the remaining HP students was 78.4 (74.8–82.0) in nursing students, followed by students of occupational therapy [67.6% (58.7–76.5)], and physiotherapy students [66.8% (61.0–72.6)]. At follow-up, differences in prevalence were substantial between physiotherapy students compared to midwifery students (p = 0.0005) and nursing students (p = 0.0008). Moreover, differences in LBP at follow-up were significant between nutritional sciences students as compared to midwifery students (p = 0.0002) and nursing students (p = 0.0010) as well as students of occupational therapy as compared to midwifery students (p = 0.0065) and nursing students (p = 0.0308). In summary, LBP prevalence in midwives and nurses compared to the other HP groups was substantially higher at follow-up.
Within HP student groups, differences between baseline and follow-up were not statistically significant at the 5% level. However, LBP prevalence between baseline and follow-up declined in students of occupational therapy [-10.1% (-22.7–1.1)] and reached borderline significance (p = 0.0750). Likewise, detected a decline between baseline and follow-up in physiotherapy students [-6.5% (-14.5–1.5)] and nutritional sciences students [-11.6% (-25.9–2.7)] with near borderline significance (p = 0.1130 and p = 0.1120, respectively).
Neck and shoulder pain (NP)
At baseline, the adjusted yearly prevalence of NP was 75.7% (73.3–78.2) in the total sample of HP students (Figure 1). We found the highest adjusted yearly prevalence of NP in midwifery students [82.2% (75.0–89.5)], followed by students of occupational therapy (81.1% [73.7–88.5)], nutritional sciences students [80.2% (71.5–89.0)], nursing students [74.2% (70.4–78.1)], and physiotherapy students [72.1% (66.7–77.5)]. At baseline, the prevalence of NP was substantially higher in midwifery students compared to physiotherapy students (p = 0.0258) and nursing (p = 0.0565). However, the latter difference was only borderline significant.
At follow-up, yearly NP in the total sample was 72.4% (69.6–75.1). Again, we found the highest adjusted yearly prevalence of NP in midwifery students [84.1% (77.1–91.1)] and the lowest prevalence of NP in physiotherapy students [67.2% (61.5–72.9)]. NP prevalence in the remaining HP students was 75.3 (65.3–85.3) in nutritional sciences students, followed by students of occupational therapy [74.8% (66.3–83.2)], and nursing students [71.5% (67.4–75.5)]. At follow-up, differences in prevalence were substantial between midwifery students as compared to nursing students (p = 0.0027), physiotherapy students (p = 0.0002), and students of occupational therapy (p = 0.0861). However, the latter was only borderline significant. In summary, at follow-up, NP prevalence was substantially higher in midwifery students than all other HP student groups, except nutritional sciences students.
Within HP student groups, differences between baseline as compared to follow-up were not statistically significant. However, in the total sample of HP students, NP prevalence declined slightly between baseline and follow-up [-3.4% (-7.2–0.3)] and reached borderline significance (p = 0.0760).
Pain in arms and hands (AHP)
At baseline, the adjusted yearly prevalence of AHP was 22.5% (20.0–25.1) in the total sample of HP students (Figure 1). We found the highest adjusted yearly prevalence of AHP in students of occupational therapy [34.2% (25.1–43.4)], followed by physiotherapy students [27.1% (21.9–32.3)], nursing students [19.5% (15.9-23.1)], midwifery students [19.2% (12.1–26.4)], and nutritional sciences students [13.9% (6.1–21.7)]. At baseline, the prevalence of AHP was substantially higher in students of occupational therapy as compared to midwifery students (p = 0.0115), nursing students (p = 0.0028), and nutritional sciences students (p = 0.0009). Similarly, the prevalence of AHP was higher in physiotherapy students as compared to nursing students (p = 0.0182), nutritional sciences students (p = 0.0052), and midwifery students (p = 0.0811). However, the latter difference was only borderline significant.
At follow-up, yearly adjusted AHP in the total sample was 27.6% (24.8–30.3). We found the highest adjusted yearly prevalence of AHP in physiotherapists [42.4% (36.3–48.4)] and the lowest prevalence of AHP again in nutritional scientists [11.1% (4.1–18.2)]. AHP prevalence in the remaining HP was 37.8 (28.4–47.3) in occupational therapists, followed by nurses [22.2% (18.4–26.0)] and midwives [16.8% (9.8–23.8)]. At follow-up, differences in AHP prevalence were substantial between physiotherapists as compared to nurses (p < 0.0001), nutritional scientists (p < 0.0001), and midwives (p < 0.0001). Similarly, AHP prevalence was higher in occupational therapists as compared to nurses (p = 0.0038), nutritional scientists (p = 0.0000), and midwives (p = 0.0007). In summary, AHP prevalence in occupational therapists and physiotherapists compared to all other HP groups was substantially higher at follow-up. Within HP student groups, adjusted AHP prevalence increased in physiotherapy students [15.3% (7.3–23.2)] as well as in the total sample of HP students [5.0% (1.3–8.8)] (p = 0.0000 and p = 0.0080 respectively).
Pain in legs and feet (LFP)
At baseline, the adjusted yearly prevalence of LFP was 35.6% (32.9–38.5) in the total sample of HP students (Figure 1). We found the highest adjusted yearly prevalence of LFP in nursing students [42.8% (38.3–47.2)], followed by physiotherapy students [34.8% (29.0–40.7)], midwifery students [33.0% (24.0–42.0)], students of occupational therapy [22.5% (14.8–30.3)], and nutritional sciences students [19.0% (10.1–27.9)]. At baseline, the prevalence of LFP was substantially higher in nursing students as compared to physiotherapy students (p = 0.0413), students of occupational therapy (p < 0.0001), and nutritional sciences students (p < 0.0001), and midwifery students (p = 0.0510). The latter difference reached only borderline significance. Similarly, the prevalence of LFP was higher in physiotherapy students than students of occupational therapy (p = 0.0120) and nutritional sciences students (p = 0.0033). Moreover, midwifery students had a higher prevalence of LFP than nutritional sciences students (p = 0.0349) and students of occupational therapy (p = 0.0824; borderline significant).
At follow-up, yearly adjusted LFP in the total sample was 39.2% (36.2–42.1). Again, we found the highest adjusted yearly prevalence of LFP in nursing students [52.2% (47.7–56.8)] and the lowest prevalence of LFP in nutritional sciences students [18.5% (10.0–27.1)]. LFP prevalence in the remaining groups was 39.3 (30.2–48.4) in midwifery students, followed by physiotherapy students [29.9% (24.5–35.3)], and students of occupational therapy [20.9% (13.1–28.8)]. At follow-up, differences in LFP prevalence were substantial between nursing students as compared to midwifery students (p = 0.0111), physiotherapy students (p < 0.0001), students of occupational therapy (p < 0.0001), and nutritional sciences students (p < 0.0001). Similarly, LFP prevalence was higher in midwifery students as compared to students of occupational therapy (p = 0.0030), nutritional sciences students (p = 0.0009), and physiotherapy students (p = 0.0784, borderline significant). Moreover, LFP prevalence was higher in physiotherapy students than nutritional sciences students (p = 0.0295) and students of occupational therapy (p = 0.0691; borderline significant). In summary, LFP prevalence at baseline and follow-up has been particularly high in nursing students and particularly low in nutritional sciences students. Within HP student groups, adjusted LFP prevalence significantly increased in nursing students [9.5% (3.1–15.8), p = 0.0040].
Individual dynamics of pain experience
Depending on the type of pain, HP students experienced different patterns of change in pain over time (Figure 2). Most students who reported LBP at baseline (n = 785) also reported LBP at follow-up (n = 646). Overall, the LBP condition did not change for 75.5% of HP students, 62.1% consistently reported LBP at both times, and 13.4% reported no LBP at both times. LBP was no longer present at follow-up in 13.4% of the students, and 11.2% experienced new LBP. While more students experienced an improvement in their LBP condition, the overall change over time was not sufficient to achieve statistical significance (McNemar’s χ2(1) = 2.07; p = 0.1498).
Similarly, the overall NP condition did not change for 74.7% of HP students, 61.4% consistently reported NP at both times, and 13.3% reported no NP at both times. NP was no longer present at follow-up in 14.5% of the students, and 10.8% experienced new NP. Overall, the NP experience for HP students did change over time (McNemar’s χ2(1) = 5.78; p = 0.0162), i.e., more students improved their NP condition over time.
Most HP students experienced no AHP (59.5%), and 9.8% reported AHP at both times. Moreover, 12.8% who reported AHP at baseline did not report AHP at follow-up. Finally, 17.9% of HP students experienced a change for the worse and reported AHP at follow-up. Overall, the AHP experience for HP students changed slightly over time (McNemar’s χ2(1) = 8.56; p = 0.0034), i.e., more students experienced a change for the worse over time compared to students that no longer had AHP at follow-up.
LFP or no LFP at both times was reported by 45.6% and 20.6% of HP students, respectively. LFP was no longer present at follow-up in 15.1% of the students, and 18.6% with no LFP at baseline reported LFP at follow-up. Overall, the LFP experience students slightly changed over time (McNemar’s χ2(1) = 3.72; p = 0.0536; borderline significant), i.e., the overall burden of LFP increased over time.
[INSERTE HERE: Figure 2]
Attribution of pain
Only a minority of HP students reported that LBP was not related to either their studies at baseline or to work at follow-up (26.8% (23.8–29.7) and 19.0% (16.6–21.4) respectively). Moreover, those who attributed LBP to studies/work increased significantly and substantially at follow-up by 10.3% (6.6–14.0), while the percentage of HP students who did not attribute LBP to work or attributed LBP partly to work declined by 7.8% (4.9–10.6) and 2.5% (1.4–3.7) respectively (Figure 3).
A minority of HP students did not attribute NP to studies at baseline [19.7% (17.2–22.3)] or to work at follow-up [20.5% (17.9-23.1)], 35.7% (33.1-38.3) and 36.1% (33.5-38.7) partly attributed NP to work at baseline or follow-up, and a majority attributed NP to studies/ work at both times [44.6% (41.1-48.0) and 43.4% (40.0–46.7)]. Attribution of NP did not significantly change over time.
At baseline, roughly one-third of HP students reported AHP to be unrelated to their studies, partly related to studies, or related to studies [34.3% (28.0–40.5), 31.5% (27.2–35.8), and 34.3% (28.2–40.4) respectively]. At follow-up, the percentage of HP students attributing AHP to work substantially and significantly increased by 17.9% (10.6–25.3), while those partly attributing or not attributing AHP to work declined by 3.6% (1.6–5.6) and 14.3% (8.0–20.6) respectively.
At baseline, most HP students did not attribute LFP to their studies [46.4% (41.4–51.3)], 27.7% (24.3–31.2) partly attributed LFP to their studies, and a minority of 25.9% (21.8–30.0) reported LFP to be related to their studies. At follow-up, however, a substantial majority attributed LFP to work [45.9% (41.2–50.6)], 27.8% (24.4–31.2) partly attributed LFP to work, and 26.2% (22.2–30.3) did not attribute LFP to work. Thus, to summarize, the percentage of students who perceived LFP to be unrelated to work declined substantially and significantly while those who attributed LFP to work increased.
Overall, we found that – except for NP – the percentage of HP students attributing pain to work had substantially increased at follow-up.
[INSERT HERE: Figure 3]