Occupational Medicine 2009;59:59–61
Published online 10 December 2008 doi:10.1093/occmed/kqn160
SHORT REPORT
...............................................................................................................................................................................................
Low back pain among Irish farmers
Deirdre O’Sullivan, Caitriona Cunningham and Catherine Blake
...................................................................................................................................................................................
Background Despite farming being regarded as a high-risk activity for low back pain (LBP), little LBP research
exists for this work sector.
...................................................................................................................................................................................
Aims
...................................................................................................................................................................................
Methods
A cross-sectional questionnaire survey was distributed to 200 farmers in Ireland via five Irish veterinary practices. Data were entered onto the Statistical package for the Social Sciences (version 12.0.1)
and analysed using descriptive statistics while qualitative data were coded and analysed for common
themes.
...................................................................................................................................................................................
Results
The response rate was 52% (n 5 104). Lifetime, annual and point prevalence of LBP was 74%
(n 5 77), 54% (n 5 56) and 27% (n 5 28), respectively. Of respondents with a history of LBP,
72% (n 5 55) stated that farming had contributed to their problem. Sixty-three per cent (n 5 31)
identified lifting as a contributory factor to their LBP. The majority of respondents (86%, n 5 66)
with LBP sought some form of treatment, with 73% (n 5 56) of these having attended a general practitioner (GP). Few respondents (13%, n 5 14) had ever attended a manual-handling course.
...................................................................................................................................................................................
Conclusions A high prevalence of LBP was found among farmers, with lifting being reported as the major contributing factor. GPs were the most commonly utilized healthcare practitioner for LBP. Farmers do
not commonly attend manual-handling courses with many noting they were not widely accessible or
adequately publicized. There is a need for high-quality studies to examine the effectiveness of different
interventions to prevent LBP among the Irish farming population.
...................................................................................................................................................................................
Key words
Farmers; health promotion; low back pain; manual handling.
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Introduction
Methods
Chronic back pain has accounted for the majority of
reported ill-health among Irish farmers [1]. This
high prevalence of low back pain (LBP) among farmers
is not surprising given the demanding nature of their
work. What is surprising, however, is the lack of published literature regarding LBP among farmers, most especially in Ireland where there are 72 731 farmers,
accounting for 3.5% of the total labour workforce of
the country [2].
This study aims to explore the prevalence of LBP
among Irish farmers, their beliefs regarding LBP prevention and management measures with a view to facilitating
the development of tailored health promotion strategies
for farmers. This study aimed to explore perceived risk
factors for the development of LBP, impact of LBP onfarm activities, choice of health practitioner for LBP,
manual-handling awareness and participation.
A questionnaire devised at University College Dublin
(UCD) (L. Keane, C. Blake and C. Cunningham, unpublished) in consultation with Teagasc (The Irish Agriculture and Food Development Authority) was piloted
among 30 Irish farmers for content and face validity.
The questionnaire sought socio-demographic information on respondents as well as information regarding the
nature of their farm work and their awareness of manualhandling courses. More specific information on LBP
including duration, frequency, contributing factors and
treatment was also sought. A final open-ended question
allowed for further comments relating to LBP and farming.
Five veterinary practices across five widely dispersed
Irish counties were utilized for distribution of the questionnaires. Each practice was given 40 questionnaires
to distribute to farmers by convenience sampling.
Questionnaire data were entered onto the Statistical
package for the Social Sciences (SPSS version 12.0.1)
and analysed using descriptive statistics. Data from the
open-ended question were transcribed and analysed for
common themes using qualitative data analysis methods
[3]. UCD Human Research Ethics Committee granted
ethical exemption.
School of Physiotherapy and Performance Science, Health Science Centre,
University College Dublin, Belfield, Dublin 4, Ireland.
Correspondence to: Deirdre O’Sullivan, Tennis, Valentia Island, Co. Kerry,
Ireland. Tel: 1353 66 9476215; fax: 1353 1 7166501; e-mail:
didimcbride@gmail.com
The Author 2008. Published by Oxford University Press on behalf of the Society of Occupational Medicine.
All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
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To establish LBP prevalence, beliefs regarding LBP, perceived LBP risk factors, related health service
utilization, awareness and participation in manual-handling training among farmers in Ireland.
60 OCCUPATIONAL MEDICINE
Results
Causes of injury
6
Pushing/Pulling
heavy object
12
Slip/Trip/fall
18
Hit by
animal/machinery
5
Prolonged driving
10
Lifting
63
0
10
20
30
40
50
60
70
Figure 1. Self-reported causes of injury on the farm. The sum of all the
practitioner choice percentages is not necessarily 100, as many respondents reported more than one practitioner type.
Table 1. Low back pain treatment and treatment options
n (%)a
Previous treatment for LBP
Yes
No
Practitioners farmers would attend
GP
Hospital physiotherapist
Private physiotherapist
Consultant/specialist
Chiropractor
Osteopath
Bone setter
Acupuncturist
Physical therapist
Massage therapist
Other
66 (86)
11 (14)
69
5
38
21
11
2
2
4
3
4
3
(66)
(5)
(36)
(20)
(11)
(2)
(2)
(4)
(3)
(4)
(3)
a
The sum of all the practitioner choice percentages is not necessarily 100, as many
respondents reported more than one practitioner type.
Discussion
The lifetime, annual and point prevalence of LBP among
farmers surveyed was 74, 54 and 27%, respectively. Almost three quarters of respondents with LBP felt farming
had contributed to it and two-thirds of these noted lifting
as a major causative factor. Health service utilization by
farmers for LBP was high (86%) with treatment most
commonly from general practitioners (GPs). Only 13%
of respondents had attended manual-handling courses.
A positive feature of this study is that the veterinary
practices were mixed, serving different farm sectors
and sizes, in geographically different regions allowing
for diverse subject selection.
A response rate of 52% is better than that of previous
farmer studies [4] but potential selection bias must be ac-
knowledged as a limitation of this study. Also this study
failed to account for non-respondents, as all subjects remained anonymous to the researcher.
The prevalence (40%) for daily LBP lasting 1 week is
higher than other groups of farmers previously studied in
America [5,6], which reported prevalences of 31, 36.4
and 28.6%, respectively. Thus, an explanation for this
must be sought.
Seventy-two per cent of respondents reported that
farming had contributed to their LBP. When asked to
specify the principal mechanism of injury (Figure 1),
the causes reported were consistent with those in current
literature [7], many of which are potentially avoidable.
Eighty-six per cent of farmers with LBP surveyed had
sought treatment, unlike previous research on health
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One hundred and four questionnaires (52%) were
returned. Most respondents were part-time, male farmers
and aged between 35–54 years. The majority had been
farming since childhood, farmed between 20 and 50 hectares of land and were engaged in cattle rearing.
The lifetime, annual and point prevalence of LBP was
74% (n 5 77), 54% (n 5 56) and 27% (n 5 28), respectively. Forty-two farmers (40%) had experienced LBP every day for a week or more in the previous year. Fifty-five
(72%) of those who reported having experienced LBP believed farming contributed to their problem. The commonly repeated on-farm, self-reported causes of back
pain are summarized in Figure 1.
Sixty-six per cent (n 5 51) of those who had LBP felt it
had interfered with their ability to farm, causing them to
modify their work. Thirty-one (40%) individuals stated
that there were particular farm tasks that they could
not perform due to their LBP. Lifting was the most problematic task with 37% (n 5 28) noting it as a difficulty.
Driving machinery, moving livestock and dosing animals
were the three next most arduous tasks reported.
Most respondents who had experienced LBP (86%)
had sought some form of treatment as shown in Table 1.
Many respondents (59%, n 5 62) had not heard about
manual-handling courses for farmers held by Teagasc,
fewer again (13%, n 5 14) had attended one.
Lifting was a recurring theme throughout the qualitative study, especially the need to be taught proper lifting
technique with many citing poor lifting skills or repetitive
lifting as a cause of LBP. Respondents also raised the subject of manual-handling courses, which they felt are not
well publicized ‘I have never heard of manual-handling
courses’ and ‘they are not widely available’. Several farmers expressed an interest in attending such courses, some
feeling they should be compulsory: ‘All farmers should
have to attend a course in lifting and safety’.
Causes of injury on the farm
Activity involving
livestock
D. O’SULLIVAN ET AL.: LBP AMONG IRISH FARMERS 61
Key points
• A high prevalence of LBP was found among Irish
farmers, with lifting being reported as the major
contributing factor.
• Eighty-six per cent of farmers with LBP had sought
treatment, unlike previous research on health service utilization by farmers, GPs were the most commonly utilized healthcare practitioner for LBP by
these farmers.
• Higher quality studies must be carried out to examine the effectiveness of different interventions to
prevent LBP among the Irish farming population.
Conflicts of interest
None declared.
References
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service utilization by farmers [8]. In this current study,
the majority who sought treatments attended GPs
(73%), who currently are the most commonly utilized
practitioners for LBP in Ireland [9].
Many respondents (87%) had never attended manualhandling courses, with most even unaware that Teagasc
provide manual-handling courses specifically targeted
at farmers. This is an area that requires further study
as the role manual handling has to play in LBP prevention
among farmers has not been explored. If found to be beneficial, it should be better publicized.
This study, despite the small sample size, provides
a good base line for future research of a larger scale in this
area. As this is a relatively uncharted area, further research is recommended. This study relies solely on selfreport, thus future studies need to explore actual farming
practice. In addition, this study reported only on perceived risk factors for LBP. Any future research should
be designed to explore independent predictors of LBP
among farmers.