Review Article

The prevalence of low back pain in emergency medical services personnel: A systematic review and meta-analysis


Background & Aim: Among musculoskeletal disorders, low back pain causes the most common complaints among emergency medical services personnel worldwide. This study aimed to investigate the prevalence of low back pain among emergency medical services personnel.
Methods & Materials: We used the PRISMA guideline in the present systematic review and meta-analysis. The search was conducted in PubMed, Scopus, Web of Science, Cochrane, ProQuest, Science Direct, Google Scholar, and Embase using English keywords and SID, Irandoc, and Magiran data resources with equivalent Persian keywords. Studies were selected based on inclusion and exclusion criteria. The data were gathered without a time limit until the end of June 2021. The quality evaluation of the selected studies was performed using the Appraisal tool for Cross-Sectional Studies (AXIS) tool. The random-effects model was used for meta-analysis, applying the I2 index as a measure to estimate heterogeneity among studies.
Results: In the present study, a total of 1038 articles were identified in the primary search, of which ten studies entered the final evaluation phase and meta-analysis after initial screening and removing duplicates. In these studies, 7499 emergency medical services personnel were examined; the prevalence of low back pain was 50.30% (95% CI: 37.98-62.62, I2= 99.1%).
Conclusion: Our results indicated a considerable prevalence of low back pain among emergency medical services personnel. Also, the heterogeneity between studies was very high. It is recommended to teach the correct methods of lifting the stretcher and equipment as well as redefining the duties of the staff with low back pain.

1. Mehrani F, Fadaee M, Manshadi SS, Ahmadi K, Orandi A, Zebardast J, Nejatisafa AA, Khorramnia S, Eftekhar N, Majedi H. The Evaluation of Low Back Pain Prevalence in First Year of Anesthesiologists’ Career; A cross sectional study. Archives of Anesthesiology and Critical Care. 2018 Apr 29;4(2):448-54.
2. Mehrdad R, Shams-Hosseini NS, Aghdaei S, Yousefian M. Prevalence of low back pain in health care workers and comparison with other occupational categories in Iran: A systematic review. Iranian Journal of Medical Sciences. 2016 Nov;41(6):467-78.
3. Rahimi A, Vazini H, Alhani F, Anoosheh M. Relationship between low back pain with quality of life, depression, anxiety and stress among emergency medical technicians. Trauma Monthly. 2015 May;20(2):e18686.
4. Rahimpour M, Shahbazi S, Ghafourifard M, Gilani N, Breen C. Electrocardiogram interpretation competency among emergency nurses and emergency medical service (EMS) personnel: A cross‐sectional and comparative descriptive study. Nursing Open. 2021 Jul;8(4):1712-9.
5. Sheikhbardsiri H, Afshar PJ, Baniasadi H, Farokhzadian J. Workplace violence against prehospital paramedic personnel (city and road) and factors related to this type of violence in Iran. Journal of Interpersonal Violence. 2020 Oct 27:0886260520967127.
6. Aljerian N, Alshehri S, Masudi E, Albawardi AM, Alzahrani F, Alanazi R. The prevalence of musculoskeletal disorders among EMS personnel in Saudi Arabia, Riyadh. The Egyptian Journal of Hospital Medicine. 2018 Oct 1;73(1):5777-82.
7. Studnek JR, Crawford JM. Factors associated with back problems among emergency medical technicians. American Journal of Industrial Medicine. 2007 Jun;50(6):464-9.
8. Deros BM, Daruis DD, Thiruchelvam S, Othman R, Ismail D, Rabani NF, Hatta MF, Hassan A, Zakaria NI. Evaluation on ambulance design and musculoskeletal disorders risk factors among ambulance emergency medical service personnel. Iranian Journal of Public Health. 2016 Mar 2;45(Supple 1):52-60.
9. Sahebi A, Golitaleb M, Jahangiri K. Occupational burnout in pre-hospital emergency personnel in Iran: A systematic review and meta-analysis. Iranian Journal of Nursing and Midwifery Research. 2021 Jan 18;26(1):11-7.
10. Sahebi A, Jahangiri K, Sohrabizadeh S, Golitaleb M. Prevalence of workplace violence types against personnel of emergency medical services in Iran: a systematic review and meta-analysis. Iranian Journal of Psychiatry. 2019 Oct;14(4):325-34.
11. Hong SW, Uhm DC, Jun MH. Job stress and work-related musculoskeletal symptoms of 119 emergency medical technicians. Korean Journal of Occupational Health Nursing. 2010;19(2):223-35.
12. Ham YL, Ahn YH. A study on low back pain prevalence rate and related factors among emergency medical technicians working at fire stations. Journal of Muscle and Joint Health. 2008;15(2):175-82.
13. Studnek JR, Crawford JM, Wilkins III JR, Pennell ML. Back problems among emergency medical services professionals: The LEADS health and wellness follow‐up study. American journal of industrial medicine. 2010 Jan;53(1):12-22.
14. Clari M, Godono A, Garzaro G, Voglino G, Gualano MR, Migliaretti G, Gullino A, Ciocan C, Dimonte V. Prevalence of musculoskeletal disorders among perioperative nurses: a systematic review and META-analysis. BMC Musculoskeletal Disorders. 2021 Dec;22(1):1-2.
15. Yasobant S, Rajkumar P. Work-related musculoskeletal disorders among health care professionals: A cross-sectional assessment of risk factors in a tertiary hospital, India. Indian journal of occupational and environmental medicine. 2014 May;18(2):75-81.
16. Mukhtad AA, Mohamed HA. Lower Back Pain among Health Care Workers in Operating Room at Al-Fateh Children’s Hospital: Prevalence and Risk Factors. Asian Journal of Research in Nursing and Health. 2018;1(1):1-11.
17. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group*. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of internal medicine. 2009 Aug 18;151(4):264-9.
18. Downes MJ, Brennan ML, Williams HC, Dean RS. Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS). BMJ open. 2016 Dec 1;6(12):e011458.
19. Sahebi A, Abdi K, Moayedi S, Torres M, Golitaleb M. The prevalence of insomnia among health care workers amid the COVID-19 pandemic: An umbrella review of meta-analyses. Journal of Psychosomatic Research. 2021 Oct 1;149:110597.
20. Zhang Q, Dong H, Zhu C, Liu G. Low back pain in emergency ambulance workers in tertiary hospitals in China and its risk factors among ambulance nurses: a cross-sectional study. BMJ open. 2019 Sep 1;9(9):e029264.
21. Lonik EA, Kamauzaman TH, Abdullah AA, Nor J, Ab Hamid SA. Prevalence of low-back pain among public ambulance workers in Kelantan, Malaysia. Malaysia. Malaysian Journal of Public Health Medicine. 2017 Jan 1;17(1):126-35.
22. Osae Y. Prevalence and Factors Associated with Low Back Pain among Emergency Medical Technicians of the Ghana National Ambulance Service in the Greater Accra Region: MPH thesis University of Ghana; 2019. Available from:
23. Imani A, Borna J, Alami A, Khosravan S, Hasankhani H, Bafandeh Zende M. Prevalence of low back pain and its related factors among pre-hospital emergency personnel in Iran. Journal of Emergency Practice and Trauma. 2019 Jan 1;5(1):8-13.
24. Kılınç A, Çalışkan Pala S, Arslantaş D, Ünsal A. The evaluation of low back pain and perceived stress among prehospital emergency care workers. European Journal of Public Health. 2020 Sep;30(Supplement_5):ckaa166-1383.
25. Okada N, Ishii N, Nakata M, Nakayama S. Occupational Stress among Japanese Emergency Medical Technicians: Hyogo Prefecture. Prehospital and Disaster Medicine. 2012;20(2):115-21.
26. Kim MG, Seo JI, Kim K, Ahn YS. Nationwide firefighter survey: the prevalence of lower back pain and its related psychological factors among Korean firefighters. International Journal of Occupational Safety and Ergonomics. 2017 Oct 2;23(4):447-56.
27. Alnaami I, Awadalla NJ, Alkhairy M, Alburidy S, Alqarni A, Algarni A, Alshehri R, Amrah B, Alasmari M, Mahfouz AA. Prevalence and factors associated with low back pain among health care workers in southwestern Saudi Arabia. BMC Musculoskeletal Disorders. 2019 Dec;20(1):1-7.
28. Al Amer HS. Low back pain prevalence and risk factors among health workers in Saudi Arabia: A systematic review and meta-analysis. Journal of Occupational Health. 2020;62(1):e12155.
29. Azizpour Y, Delpisheh A, Montazeri Z, Sayehmiri K. Prevalence of low back pain in Iranian nurses: a systematic review and meta-analysis. BMC Nursing. 2017 Dec;16(1):1-0.
30. Wong AY, Chan LL, Lo CW, Chan WW, Lam KC, Bao JC, Ferreira ML, Armijo‐Olivo S. Prevalence/Incidence of Low Back Pain and Associated Risk Factors Among Nursing and Medical Students: A Systematic Review and Meta‐Analysis. PM&R. 2021 Nov;13(11):1266-80.
31. Awosan KJ, Yikawe SS, Oche OM, Oboirien M. Prevalence, perception and correlates of low back pain among healthcare workers in tertiary health institutions in Sokoto, Nigeria. Ghana Medical Journal. 2017;51(4):164-74.
32. Friedenberg R, Kalichman L, Ezra D, Wacht O, Alperovitch-Najenson D. Work-related musculoskeletal disorders and injuries among emergency medical technicians and paramedics: A comprehensive narrative review. Archives of Environmental & Occupational Health. 2022 Jan 27;77(1):9-17.
33. Aasa U, Barnekow‐Bergkvist M, Ängquist KA, Brulin C. Relationships between work‐related factors and disorders in the neck‐shoulder and low‐back region among female and male ambulance personnel. Journal of occupational health. 2005 Nov;47(6):481-9.
34. Davison C, Cotrim TP, Gonçalves S. Perception of Musculoskeletal Symptoms and Psychosocial Risk Factors among a Sample of Portuguese Emergency Medical Technicians. International Conference on Healthcare Ergonomics and Patient Safety 2019 Jul 3. Springer, Cham.
IssueVol 9 No 3 (2022): Summer QRcode
SectionReview Article(s)
low back pain; emergency medical technicians; musculoskeletal disorders; paramedic; emergency medical services; meta-analysis

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Sahebi A, Nateghinia S, Golitaleb M, Alizadeh S, Jahangiri K. The prevalence of low back pain in emergency medical services personnel: A systematic review and meta-analysis. NPT. 2022;9(3):193-201.