Back Pain, Low Back Pain, Lower Back Pain, Musculoskeletal Pain, Musculoskeletal Pain Disorder, Neck Pain, Nursing Students, Preclinical Education, Spine Health
Conditions
Keywords
lower back pain, low back pain, musculoskeletal pain, neck pain, rehabilitation, university student, nursing students, spine health
Brief summary
The purpose of this study is to identify the prevalence of neck and low back pain in nursing students enrolled at the University of the West Indies, Mona; to assess their knowledge, attitude and practice of good spine health and to determine the outcome of a standardised spine exercise program on nursing students experiencing neck and low back pain, using a prospective randomised control design.
Detailed description
Neck and low back pain are among the most common musculoskeletal conditions worldwide. Although often self-limiting, these conditions can become disabling, negatively affecting productivity, social participation, and activities of daily living. Occupational factors, prolonged sitting, sustained computer use, awkward postures, and repetitive neck movements are recognised contributors to spinal pain. Nursing students are particularly vulnerable to musculoskeletal disorders, with risk beginning during their training years. During the preclinical phase, students spend prolonged periods attending lectures, studying, and completing assignments, often involving sustained sitting and computer use. In the clinical phase, students are exposed to physically demanding tasks such as prolonged standing, ward rounds, assisting with procedures, and manual patient handling, including lifting and repositioning patients. These activities, combined with poor ergonomic practices and reduced core stability, may contribute to the development of neck and low back pain. International studies have reported a high prevalence of musculoskeletal pain among nursing and medical students, particularly during clinical training. Factors such as increased computer use, elevated body mass index, prior trauma, and family history of musculoskeletal disorders have been identified as contributing risk factors. However, no published study has investigated the prevalence of neck and low back pain among nursing students in Jamaica or the wider Caribbean. Exercise therapy is widely recognised as an effective non-pharmacologic intervention for both acute and chronic low back pain, with evidence showing improvements in pain reduction and functional outcomes. Exercise enhances muscular strength, flexibility, and spinal stability, while promoting nutrient exchange within spinal structures, supporting overall spinal health and reducing the risk of injury. This study aims to determine the prevalence of neck and low back pain among nursing students at The University of the West Indies, Mona, and to compare the effectiveness of a standardized spine-specific exercise programme versus non-spine-specific exercises in reducing pain and improving knowledge, attitudes, and practices related to spinal health. It will be conducted in two phases and guided by a descriptive and experimental framework. In the first phase, the descriptive phase, a cross-sectional design will be used to assess the prevalence of neck and low back pain (NLBP) among all year groups of nursing students at The University of the West Indies, Mona. The University of the West Indies, Mona, currently enrolls approximately 400 nursing students across four years of training. Participants will complete questionnaires to determine the presence of musculoskeletal discomfort in the neck and low back pain, as well as their knowledge, attitude, and practice related to spine health. In the second phase, the experimental phase, nursing students who report musculoskeletal discomfort will be randomised into intervention and control groups. The intervention group will participate in an eight-week spine-specific exercise program, while the control group will receive a non-spine specific exercise in parallel during the study period. Pre- and post-intervention data will be collected using the Numeric Rating Scale (NRS), the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ), and custom questionnaires (Questionnaires A & B) to assess changes in assessing knowledge, attitudes and practices toward musculoskeletal health, changes in perceived pain and participants' functional status. Participant confidentiality will be strictly maintained, with each participant assigned a study identification number. Demographic data, presenting complaints, and outcome measures will be collected for study purposes and managed securely using REDCap, a password-protected, web-based platform compliant with national data protection standards. Statistical analysis will be conducted using the International Business Machines Corporation Statistical Product and Service Solutions (IBM SPSS software), and all study records will be securely stored and destroyed three years after study completion.
Interventions
BEHAVIORALClinical Control Group (Group A)
The participants who reported the presence of neck or low back pain and were assigned to the clinical control group (Group A) after randomisation will receive a non-spine specific exercise program provided in a handout. The interventional group (Group B) will be asked to keep the standardised spine-specific exercise program confidential and not share with the control group (Group A). After eight (8) weeks, Group A participants will receive: the Cornell Musculoskeletal Discomfort Questionnaires (CMDQ) to assess for changes in the frequency, discomfort and interference with work due to musculoskeletal pain; a Questionnaire B, to ascertain any changes in their pain level using the Numeric Rating Scale (NRS); as well as their knowledge, attitude and practice towards musculoskeletal problems of the neck and low back pain.
BEHAVIORALSpine Exercise Program (Group B)
The standardised spine-specific exercise program will be provided in a handout and given only to the intervention group (Group B), and will include specific spine basic neck or low back exercises to be done three (3) times per week, as well as brief stretching exercises, to be done during periods of sitting for greater than sixty (60) minutes. The selected participants will be asked to comply with instructions on the handout. Participants who experience worsening of their symptoms, or who develop new symptoms will be assessed as having an adverse outcome and will be withdrawn from the study and referred for evaluation and treatment if necessary.
Sponsors
The University of The West Indies
The University of The West Indies, Mona
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
1. All students enrolled in the student nursing program at the University of the West Indies, Mona Campus, Jamaica during the period October 4, 2025 to October 3, 2026. 2. Individuals who express a willingness to consent to the study. 3. Individuals who express a willingness to adhere to the standardised exercise program for the stipulated period.
Exclusion criteria
1. Individuals with a history of having spine surgery. 2. Individuals who were previously diagnosed with spine pathology and currently receiving rehabilitation therapy. 3. Individuals who express an unwillingness to participate in the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change from Baseline in the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) | From enrollment to the end of treatment at eight (8) weeks | The Cornell Musculoskeletal Discomfort Questionnaire measures the frequency, discomfort and interference with work due to musculoskeletal pain, as reported by participants. The individually reported frequency score is then multiplied by the discomfort score and by the interference score to determine overall severity of pain experienced. This tallied score is then classified by severity into: no discomfort (0), mild (1 to 4.5), moderate (5 to 14), severe (15 - 45) and very severe (45 or higher). All participants will complete this assessment upon enrollment, as well as after an eight (8) week period of treatment, to evaluate any changes in their reported scores. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Knowledge, Attitude and Practice towards Musculoskeletal Problems of Neck and Low back Pain (Questionnaire A) | Done at the time of enrollment (Baseline) | Questionnaire A is a self-administered general questionnaire used to evaluate participants' knowledge, attitudes, and practices regarding musculoskeletal problems of the neck and low back. Knowledge is scored on a scale of 0-5, with 0-1 indicating poor or inadequate knowledge, 2-3 indicating moderate knowledge, and 4-5 indicating good or adequate knowledge. Attitude is scored 0-4, with 0-1 representing poor attitude, 2-3 moderate attitude, and 4 good attitude. Practice is scored 0-56, based on 12 questions, with 0-12 indicating poor or inadequate practices, 13-24 below average or fair, 25-32 average or moderate, 33-43 above average or good, and 44-56 excellent practices. Higher scores indicate better knowledge, more positive attitudes, and healthier practices related to neck and low back musculoskeletal problems. The questionnaire is administered at baseline (time of enrolment), and each domain will be analysed separately. |
| Change from Baseline in Knowledge, Attitude and Practice Towards Musculoskeletal Problems of Neck and Low Back Pain (Questionnaire B) | From Enrollment to the end of treatment at 8 weeks | Questionnaire B is a self-administered general questionnaire used to evaluate participants' knowledge, attitudes, and practices regarding musculoskeletal problems of the neck and low back. Knowledge is scored on a scale of 0-5, with 0-1 indicating poor or inadequate knowledge, 2-3 indicating moderate knowledge, and 4-5 indicating good or adequate knowledge. Attitude is scored 0-4, with 0-1 representing poor attitude, 2-3 moderate attitude, and 4 good attitude. Practice is scored 0-56, based on 12 questions, with 0-12 indicating poor or inadequate practices, 13-24 below average or fair, 25-32 average or moderate, 33-43 above average or good, and 44-56 excellent practices. Higher scores indicate better knowledge, more positive attitudes, and healthier practices related to neck and low back musculoskeletal problems. The questionnaire is administered at the end of treatment at 8 weeks, and each domain will be analysed separately. |
| Change from Baseline in the Numeric Rating Scale (NRS) | From Enrollment to the end of treatment at 8 weeks | The Numeric Rating Scale is a reliable and valid, unidimensional 11-point scale used for patient self-reporting of perceived pain. Its scale uses integers which range from zero (0) to ten (10), where 0 represents no pain, and 10 represents the worst imaginable pain. This is then categorised into mild (1-3), moderate (4-6), and severe (7-10). All participants will complete this assessment upon enrollment, as well as after an eight (8) week period of treatment, to evaluate any changes in their perceived pain. This scale is from public domains and as such, permission for its use is not required. |
Countries
Jamaica
Contacts
CONTACTPaula U. A. Dawson, MBBS, Diplomate ABPMR
CONTACTShantelle B Peddlar, MBBS
PRINCIPAL_INVESTIGATORPaula U.A Dawson, MBBS, Diplomate ABPMR
Division of Physical Medicine and Rehabilitation, Faculty of Medical Sciences, The University of the West Indies, Mona, Jamaica.
Outcome results
None listed