Work 69 (2021) 315–322 315

DOI:10.3233/WOR-213480
IOS Press

Low back pain-associated factors in female

hospital-based personal care attendants
Ku-Chou Changa,b,c , Hsuei-Chen Leed,e , Chu-Ling Yena , Yi-Han Liaof,g ,
Jen-Wen Hungc,h and Ching-Yi Wuf,g,i,∗
a Division of Cerebrovascular Diseases, Department of Neurology, Kaohsiung Chang Gung Memorial Hospital,
Kaohsiung, Taiwan
b Long-term Care Service Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
c School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
d Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University,

Taipei, Taiwan
e Exercise and Health Science Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
f Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine,

Chang Gung University, Taoyuan, Taiwan

g Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
h Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital,

Kaohsiung, Taiwan
i Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou,

Taoyuan, Taiwan

Received 5 January 2018

Accepted 6 February 2019

Abstract.
BACKGROUND: Low back pain (LBP) is common in personal care attendants because this profession requires much
physical work. Information about the prevalence of LBP and LBP-associated risk factors in this group is limited.
OBJECTIVE: This study aimed to investigate the 1-year prevalence of LBP and identify LBP-associated factors in female
hospital-based personal care attendants.
METHODS: Forty-seven female hospital-based personal care attendants were recruited. The Nordic Musculoskeletal Ques-
tionnaire was used to investigate the prevalence of LBP during the recent 12 months. Participants completed a personal traits
and associated factors questionnaire. Physical fitness and the knowledge test of body mechanics were assessed. Multivariable
logistic regression analysis was used to explore LBP-associated factors.
RESULTS: The 1-year prevalence of LBP was 46.8%. The strongest LBP-associated risk factor was poor abdominal muscle
endurance, followed by insufficient knowledge on the test of body mechanics and higher psychological stress.
CONCLUSIONS: The results demonstrate that the prevalence of LBP in female hospital-based personal care attendants
appears to be high. Preventive programs should be initiated to reduce LBP-associated risk factors, such as improving abdominal
muscle endurance, providing education in the proper use of body mechanics, and providing psychological intervention services
pt
for female hospital-based personal care attendants.

Keywords: Physical fitness, knowledge of body mechanics, psychological stress

∗ Address for correspondence: Dr. Ching-Yi Wu, ScD, OTR,
Department of Occupational Therapy and Graduate Institute of
Behavioral Sciences, College of Medicine, Chang Gung Univer-
sity, 259 Wen-hwa 1st Rd, Taoyuan City, 333, Taiwan. Tel.:+886
3 211 8800 #5761; Fax:+886 3 211 8700; E-mail: cywu@mail.
cgu.edu.tw.
1. Introduction
Low back pain (LBP) is a common and critical
issue in personal care attendants. Studies show that
22.4% to 63% of personal care attendants have suf-
fered from LBP during the most recent year of service

ISSN 1051-9815/$35.00 © 2021 – IOS Press. All rights reserved.

316 K.-C. Chang et al. / Low back pain-associated factors in female hospital-based personal care attendants
[1–4]. LBP is considered to be the most common
cause of job-related disability and a key reason for
absenteeism in the workplace [5]. Given the increase
of people with disabilities as societies age, the need
for personal care attendants is growing, which high-
lights the need for studies examining LBP in personal
care attendants.
Hospital-based personal care attendants may be at
a higher risk for LBP than personal care attendants
in non-hospital workplaces because they face heavy,
high-pressure workloads caring for patients who have
more extensive injuries and require critical care.
However, little is known about LBP problems among
personal care attendants, especially hospital-based
personal care attendants. In addition, approximately
90% of hospital-based personal care attendants in Tai-
wan are women [6]. They tend to work long hours—
an average of 13.9 hours per day—and work an aver-
age of 5.77 days per week [6]. Furthermore, previous
studies have shown that women are more prone to
LBP than men [7–11]. Therefore, this study aimed
to investigate LBP in female hospital-based personal
care attendants.
Information on LBP-associated factors among
hospital-based personal care attendants is important
for preventive intervention. LBP negatively affects
the health of the personal care attendants and the
patients who need them, which may further increase
social and economic burdens [12]. The economic
burdens of illness involve direct and indirect costs.
While the medical expenses are direct costs, produc-
tivity losses and absenteeism are indirect costs, which
are significant and cannot be ignored. The risk fac-
tors associated with LBP in health care workers and
caregivers include (1) demographic background fac-
tors, such as age or being female [8–11]; (2) lifestyle
habit factors, such as smoking [8]; (3) work-related
factors, such as lifting, patient handling and transfer-
ring, persistent awkward posturing, and insufficient
knowledge of body mechanics during tasks [4, 9–11,
13–15]; and (4) psychosocial factors, such as per-
ceived stress level and mood [8, 16–18]. Physical
fitness has been shown to be related to LBP in police
employees and women [19, 20]. Exercise is currently
recommended to prevent LBP in the general popu-
lation [21]. However, whether physical fitness and
exercise habits are related to the occurrence of LBP
in hospital-based personal care attendants remains
unclear.
For patients with LBP, x-ray imaging is the most
common radiologic procedure used to check bone
structures (bone disease, degeneration, fractures,
dislocations, infections, and tumors) and support
medical diagnoses. Obtaining an accurate diagnosis
of causal mechanisms after LBP is critical because
treatment approaches are specifically based on the
causal mechanisms that sustain the pain. However,
the connection between abnormalities found by x-
ray imaging and the causes of specific cases of LBP
is often unclear. Therefore, this study explored the
relationship between abnormalities identified from x-
rays by physicians and LBP among hospital-based
personal care attendants.
Few studies have focused exclusively on LBP in
hospital-based personal care attendants. Identifying
factors related to LBP in this group is an impor-
tant step in preventing LBP, if needed, and reducing
personal, social, and economic burdens. Thus, the
purpose of this study was to investigate the 1-year
prevalence and risk factors of LBP in hospital-based
personal care attendants. We believe early identifica-
tion of LBP-related factors can help design preventive
strategies to minimize the occurrence of LBP in this
group.
2. Methods
2.1. Study design and subjects
This cross-sectional study was conducted at the
Kaohsiung Chang Gung Memorial Hospital in Tai-
wan by using the convenient sampling method.
The Chang Gung Medical Foundation Institutional
Review Board approved the protocol used in this
study, and all participants signed a written informed
consent form.
Forty-seven female personal care attendants work-
ing in the Department of Neurology were recruited.
The Nordic Musculoskeletal Questionnaire (NMQ),
using a figure depicting the anatomical area of pain,
was administered and used to investigate the 1-year
prevalence of LBP [22–24].
2.2. Procedure
The participants were asked to complete a personal
traits and associated risk factors questionnaire. Next,
a lumbar x-ray examination was performed. Finally,
participants undertook physical fitness tests, includ-
ing hand grasp, hamstring flexibility, and abdominal
and back muscle endurance.
 K.-C. Chang et al. / Low back pain-associated factors in female hospital-based personal care attendants
2.3. Personal traits and associated risk factors
questionnaire
To characterize the participant traits and associated
risk factors, a questionnaire was developed for this
study, with empirical support from previous studies
reviewed on this topic. The questionnaire included
several questions in 4 domains: (1) demographic
background, (2) lifestyle habits, (3) work, and (4)
psychosocial characteristics. The question details in
each domain are listed as follows.
2.3.1. Demographic background
Items related to demographic and clinical back-
ground characteristics included age, height, weight,
body mass index, marital status, and educational
level.
2.3.2. Lifestyle habits
Items related to lifestyle habits included smoking,
alcohol/coffee/tea consumption, and exercise.
2.3.3. Work
Items related to work included working experi-
ence, monthly working days, number of helpers,
on-the-job and license training, knowledge tests, and
work demand. In the current study, a knowledge test
of body mechanics during rolling, transfer, and stand-
ing activities was developed, with 10 yes-and-no
questions consisting of words and pictures. Partici-
pants received 1 point for each correct answer (score
range: 0–10). For work demand items, participants
answered how many times per day they helped clients
with rolling, clapping, shower, feeding, toilet, dress-
ing, transferring, making the bed, changing diapers,
and physical activities.
2.3.4. Psychosocial characteristics
Items related to the psychosocial component
included psychological stress and personal percep-
tions of salary and sleep. Psychological stress was
assessed by Caregiver Strain Index (CSI), a 13-
question self-administered questionnaire [25, 26].
Higher scores indicate a higher the level of psycho-
logical stress. A score of 7 or higher indicated a
greater level of stress. Participants also reported their
personal perceptions of their salary and sleep.
317
2.4. Clinical background
2.4.1. Lumbar x-ray examination
Each participant underwent a lumbar x-ray exam-
ination, and all images were interpreted by radi-
ologists. The findings were viewed as normal or
abnormal findings.
2.4.2. Physical fitness
Physical fitness, including hand grasp strength,
hamstring flexibility, and abdominal and back mus-
cular endurance, was assessed in accordance with
testing methods developed by the Taiwan Institute for
Occupational Safety and Health. Hand grasp strength
was assessed with the JAMAR hydraulic hand
dynamometer (Sammons Preston, Inc, Warrenville,
IL). Hamstring flexibility was assessed by measuring
finger-to-floor distance while the subject stood and
bent her body forward. The best performance of hand
grasp strength and hamstring flexibility during 3 trials
was recorded. Abdominal muscular endurance was
evaluated by the total number of repetitive abdomi-
nal curls in the supine position (curl-up) in a minute.
Back muscular endurance was evaluated by the total
numbers of trunk extension in the prone position per-
formed in a minute. All results of muscle endurance
were classified into poor or fair-good according to the
norms for people of different ages and sexes.
2.5. Statistical analysis
Statistical analyses were performed using SAS 9.4
software (SAS Institute Inc., Cary, NC). Descrip-
tive statistics, including independent t and Chi-square
tests, were used to compare the general characteristics
between participants with LBP (LBP) and without
LBP (No-LBP). Potential factors of LBP were evalu-
ated using univariable logistic regression. All factors
with P ≤ 0.15 in the univariable logistic regression
analyses were entered into the multivariable logis-
tic regression analysis with stepwise selection of the
model. Odds ratios (ORs) of factors were generated
from the logistic regression analyses. Statistical sig-
nificance was set at ␣= 0.05.
3. Results
Of the 47 women recruited, 22 were in the LBP
group and 25 were in the No-LBP group. The 1-year
prevalence of LBP was 46.8% in these hospital-based
personal care attendants. The characteristics in each
group are provided in Table 1.
318 K.-C. Chang et al. / Low back pain-associated factors in female hospital-based personal care attendants

Table 1
Comparison of groups without LPB (No-LBP) and with LBP on characteristics
No-LBP LBP P value
N = 25 N = 22
Demographic background
Age 50 ± 6.43 51.45 ± 5.71 0.42
Height 156.7 ± 5.56 156.05 ± 4.76 0.68
Weight 59.82 ± 7.75 60.09 ± 8.79 0.91
Body mass index 24.46 ± 3.64 24.65 ± 3.25 0.85
Marital status 0.27
Unmarried 1(4) 4(18.18)
Married 16(64) 13(59.09)
Others 8(32) 5(22.73)
Education level 0.56
Elementary school 6(24) 3(13.64)
and below
Junior and senior 17(68) 18(81.82)
high school
College and above 2(8) 2(4.55)
Lifestyle habits
Smoking 0 0 1
Alcohol consumption 0 0 1
Coffee consumption 8(32) 11(50) 0.21
Tea consumption 7(28) 9(40.91) 0.35
Exercise (hour/week) 2.23 ± 3.64 2.11 ± 4.36 0.92
Work-related description
Working experience (year) 10.76 ± 6.37 12.41 ± 6.02 0.37
Monthly working days 22.74 ± 2.66 21.39 ± 2.49 0.08
Number of helpers 0.08 ± 0.27 0.14 ± 0.35 0.54
Receiving on-the- 25(100) 21(95.45) 0.28
job training
Receiving license training 23(92) 20(90.91) 0.89
Knowledge test (points) 8.72 ± 1.06 7.82 ± 1.53 0.02∗
Knowledge total points ≥ 8 22(88) 13(59.09) 0.02∗
Work demand (count/day)
Rolling 5.94 ± 4.18 7 ± 5.59 0.46
Clapping 5.46 ± 5.17 5.89 ± 5 0.78
Shower 1.06 ± 0.46 1.18 ± 0.36 0.33
Feeding 3.48 ± 2.99 3.5 ± 2.66 0.98
Toilet 4.04 ± 4.17 3.89 ± 4.81 0.91
Dressing 1.48 ± 0.68 1.32 ± 0.70 0.43
Transferring 0.88 ± 1.51 1.05 ± 2.19 0.77
Making the bed 0.84 ± 0.79 0.78 ± 0.67 0.77
Changing diapers 2.38 ± 3.03 1.93 ± 2.97 0.61
Physical activities 2.08 ± 2.3 2.68 ± 3.03 0.44
Psychosocial component
Caregiver Strain 3.52 ± 2.62 4.91 ± 2.22 0.06
Index (CSI)
Sufficient salary 22(88) 17(77.27) 0.33
(self-perceived)
Sufficient sleep 12(48) 11(50) 0.89
(self-perceived)
Data are presented as the mean ± standard deviation or number (%).∗ Statistically significant (P < 0.05).

3.1. Personal traits and associated risk factors
questionnaire
3.1.1. Demographic and clinical background
characteristics
The characteristics of demographic and clinical
background did not differ between No-LBP and LBP
groups (P > 0.27 for all) (Table 1). Both groups were
middle aged (No-LBP group: 50 ± 6.43 years; LBP
group: 51.45 ± 5.71 years). Height, weight, body
mass index, marital status, and education level were
similar in the 2 groups.
3.1.2. Lifestyle habits
The No-LBP and LBP groups did not differ in per-
sonal habits (P > 0.21 for all) (Table 1). None of the
 K.-C. Chang et al. / Low back pain-associated factors in female hospital-based personal care attendants 319

participants were smokers or alcohol drinkers. About Table 2

30% of the participants in the No-LBP and about 40% Comparison of clinical background, including lumbar x-ray
examination and physical fitness, between groups without
to 50% participants in the LBP were coffee and/or tea (No-LBP) and with LBP (LBP)
drinkers. The No-LBP and LBP groups spent 2.23 and
No-LBP LBP P value
2.11 hours/week exercising, respectively. The weekly N = 25 N = 22
exercise duration did not significantly differ between Lumbar X-ray examination 0.56
the two groups. Abnormal 20(80) 19(86.36)
Normal 2(20) 3(13.64)
Hand grasp 0.33
Poor 3(12) 5(22.73)
3.1.3. Work-related description Fair-Good 22(88) 17(77.27)
The No-LBP and LBP groups demonstrated sim- Hamstring flexibility 0.56
ilar work characteristics, except for the monthly Poor 5(20) 6(27.27)
working days and the performance in the knowl- Fair-Good 20(80) 16(72.73)
Abdominal muscle endurance 0.06
edge test. The No-LBP participants tended to have Poor 8(32) 13(59.09)
more monthly working days (P = 0.08), but the dif- Fair-Good 17(68) 9(40.91)
ference in the average working days between the two Back muscle endurance 0.78
Poor 7(28) 7(31.82)
groups was less than 2 days (Table 1). The mean
Fair-Good 18(72) 15(68.18)
score on the knowledge test (maximum score: 10) was
LBP indicates low back pain Data are presented as the number
higher in the No-LBP group (8.72) than in the LBP (%).
group (7.82) (P = 0.02) (Table 1). A greater propor-
tion of participants demonstrated a score greater than
8 points in the No-LBP group (88%) than in the LBP 3.2.2. Physical fitness
group (59.09%)(P = 0.02) (Table 1). In addition, the Hand grasp, hamstring flexibility, and back mus-
No-LBP and LBP groups had similar required work cle endurance were similar between the two groups
tasks (P > 0.33 for all). (P > 0.33 for all) (Table 2). However, a greater per-
centage of No-LBP participants (68%) demonstrated
fair to good abdominal muscle endurance than LBP
3.1.4. Psychosocial component participants (40.91%) (P = 0.06) (Table 2).
The No-LBP group tended to have higher psycho-
logical stress than the LBP group (P = 0.06) (Table 1). 3.3. Determinants of LBP
The groups had similar perceptions of salary and
sleep (P = 0.33 for both). Determinants of LBP are presented in Table 3. In
model 1, the univariable logistic regression analy-
ses revealed that a low score on the knowledge test
3.2. Clinical background of body mechanics was negatively related to LBP
(OR, 0.58; 95% confidence interval [CI], 0.35–0.59).
3.2.1. Lumbar X-ray examination Further, potential factors of LBP included monthly
The rate of abnormalities on the lumbar X-ray working days, abdominal muscle endurance, and
examinations did not significantly differ between the psychological stress (CSI score) (P = 0.06–0.08)
No-LBP (80%) and LBP (86.36%) groups. (Table 3, model 1).

Table 3
Determinants of low back pain (LBP) by logistic regression
Model 1† Model 2‡
LBP/No-LBP LBP /No-LBP
OR (95% CI) P value OR (95% CI) P value
Work-related description
Monthly working day 0.8 (0.64–1.03) 0.08
Knowledge test per unit increase 0.58 (0.35–0.95) 0.03∗ 0.51(0.30–0.88) 0.015∗
Psychosocial component
CSI per unit change 1.27 (0.99–1.63) 0.06 1.34 (1.001–1.8) 0.0489∗
Poor abdominal muscle endurance 3.07 (0.93–10.14) 0.07 4.57 (1.1–18.99) 0.04∗
LBP, low back pain; OR, odds ratio; and CI, confidence interval. † Univariable logistic regression. ‡ Multivariable logistic regression.
∗ Statistically significant (P < 0.05).
320 K.-C. Chang et al. / Low back pain-associated factors in female hospital-based personal care attendants
In model 2, the multivariable logistic regres-
sion analysis revealed that poor abdominal muscle
endurance, high psychological stress, and low scores
on the knowledge test of body mechanics were fac-
tors related to LBP. Participants with poor abdominal
muscle endurance were 4.57 times more likely to
have LBP than those with fair-to-good abdominal
muscle endurance (OR, 4.57; 95% CI, 1.1–18.99). A
1-point increase on the knowledge test decreased LBP
by 51% (OR, 0.51; 95% CI, 0.33–0.88). A 1-point
increase in the CSI score increased LBP by 134%
(OR, 1.34; 95% CI, 1.001–1.8) (Table 3, model 2).
4. Discussion
This study showed a high prevalence of LBP in
female hospital-based personal care attendants, with
almost half reporting LBP in the previous year. This
is not surprising, given that this profession requires
much physical effort. In addition, poor abdominal
muscle endurance, insufficient knowledge of body
mechanics, and high psychological stress were the
three most common factors in the occurrence of LBP.
Specifically, participants with poor abdominal mus-
cle endurance appeared to have a 457% higher risk
of developing LBP compared with their counterparts
(fair-to-good). A 1-point increase on the knowledge
test decreased LBP by 51%. A 1-point increase in
the CSI score increased LBP by 134%. Abnormali-
ties identified from x-ray images were not related to
LBP, thus highlighting the importance of abdominal
muscle endurance, knowledge test of body mechan-
ics, and psychological stress in female hospital-based
personal care attendants.
The most dominant risk factor in the current study
was poor abdominal muscle endurance. Participants
with poor abdominal muscle endurance appeared
to have a non-negligible risk of developing LBP
(457%). Although patients with LBP demonstrate
muscle weakness in both the abdominal and back
muscles [19], the participants in this study with LBP
reported poor muscle endurance in their abdominal
muscles but not in their back muscles. We speculate
that the reason for the apparent lack of back mus-
cle endurance problems may be that the participants’
work as personal care attendants generally requires
them to maintain a standing posture, which relies on
the persistent activation of back muscles; therefore,
the deterioration of back muscle endurance may not
be significant. Sufficient muscle endurance is critical
for preventing injuries. Repetitive curl-up exercises
have been shown to improve abdominal muscle
endurance, increasing electromyography activity in
the rectus abdominis and in the cross-sectional area of
the abdominal muscles [27]. We suggest that abdomi-
nal muscle strengthening exercises, such as repetitive
curl-up exercises, should be emphasized in female
hospital-based personal care attendants.
The second dominant risk factor found in this study
was the performance on the knowledge test. Despite
the similar work tasks required of each group, the two
groups may perform the tasks in different ways. The
No-LBP group participants had higher scores on the
knowledge test, implying that participants in the LBP
group have poorer knowledge of body mechanics and
are more likely to perform work tasks in an inefficient
way.
We suggest that information on correct body
mechanics while caring for patients should be empha-
sized in on-the-job training and/or license training.
Studies have confirmed that education intervention
programs in LBP prevention are effective in improv-
ing nurses’ knowledge of body mechanics [28, 29].
However, another study found on-the-job training
(30-minute lecture and 6 minutes of stretch exercises)
had little effect on pain reduction in female caregivers
with LBP in nursing homes [30]. The difference in the
findings between these two studies may result from
the application of the knowledge delivered. Although
lectures were offered to the female caregivers with
LBP, this knowledge may not have been applied to
their routine care work because they did not have the
educational background of medicine like the nurses.
Thus, incorporating incentives to use the knowledge
gained from education in body mechanics in their
daily routine may help reduce LBP among female
hospital-based personal care attendants. In addition,
strengthening exercises instead of stretching exer-
cises before the occurrence of LBP may significantly
lower or even prevent LBP in these attendants.
The third dominant factor identified in this study
was the CSI score. Although participants with and
without LBP showed similar psychological stress
as assessed by CSI (P = 0.06; Table 1), high psy-
chological stress was related to the occurrence of
LBP. This finding is supported by the relationship
between the mood of caregivers and LBP [16]. LBP
in health care workers is correlated to perceived
stress level and job satisfaction [8, 17]. Our cross-
sectional study does not provide evidence of the
casual relationship between LBP and high psycho-
logical stress; however, this study showed that LBP
in female hospital-based personal care attendants was
 K.-C. Chang et al. / Low back pain-associated factors in female hospital-based personal care attendants
multifactorial and included physical and psycholog-
ical factors. Preventive programs and interventions
should be multidimensional for this specific group.
Because the proportion of abnormalities on x-
ray images did not differ between the two groups,
abnormalities identified via x-ray images were not
an LBP-related factor in hospital-based personal care
attendants. This indicates that the significant differ-
ence between the two groups may be soft tissue
related. This speculation was supported by the find-
ing that poor abdominal muscle endurance was the
most important risk factor for LBP. This study thus
supports provision of strengthening exercises for
abdominal muscles in hospital-based personal care
attendants.
Neither monthly working days nor regular exer-
cise were related to LBP in this study. The number
of monthly working days tended to higher in the
No-LBP group (Table 1) but was not significantly
associated with LBP, implying that the number of
monthly working days does not contribute to LBP
in this group and that the current workload may be
appropriate. In addition, although regular exercise is
related to the reduction of LBP in the general popula-
tion [7], low and high levels of total physical activity
are both associated with an increase in LBP in the
working population [20]. The current study does not
support the contention that physical inactivity is a
risk factor for LBP. On the contrary, we suggest that
the level of activity of hospital-based personal care
attendants during work may already be adequate and
that their increasing physical activity level may have
no significant effect on the occurrence of LBP.
A few limitations to the current study should be
mentioned. First, our sample was relatively small and
homogeneous. The participants in this study were
recruited from only one hospital. This study used a
convenient sampling method, and thus, the sample
recruited may not be representative of the whole pop-
ulation. A large number of personal care attendants at
various hospitals representing different areas of Tai-
wan should be included in future studies. Second,
LBP was self-reported, and a diagnosis by orthope-
dists to specify a cause was not performed. Further
studies are necessary to identify the risk factors for
LBP with different diagnoses of causal mechanisms.
Third, a limited number of LBP-related factors were
investigated in this study. Other risk factors, such as
the physical fitness of other muscle groups, should be
investigated in further studies.
Last, this cross-sectional study does not support
a cause-effect relationship between factors and LBP.
321
The study did, however, identify several LBP-related
factors, and future studies should evaluate these rela-
tionships. Long-term intervention studies are needed
to verify the effect of abdominal strengthening
exercises, knowledge education, and psychological
intervention services in female hospital-based per-
sonal care attendants.
5. Conclusion
This study confirms a high prevalence of LBP in
female hospital-based personal care attendants. The
three most important risk factors for female hospital-
based personal care attendants were poor abdominal
muscle endurance, insufficient knowledge of body
mechanics, and high psychological stress.
Acknowledgements
This study was funded by the Chang Gung Memo-
rial Hospital (CMRPG890391, BMRP553), Healthy
Aging Research Center at the Chang Gung University
(EMRPD1G0241), and the Ministry of Science and
Technology (NSC101-2314-B-010-067, MOST105-
2314-B-010-056) in Taiwan.
Conflict of interest
None to report.
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