Low back pain is one of the most common musculoskeletal disorders and represents a significant public health concern worldwide. It contributes substantially to physical disability, reduced functional capacity, impaired quality of life, and increased healthcare utilization. Persistent low back pain can interfere with daily activities, occupational performance, sleep quality, and psychological well-being. The development and persistence of low back pain are influenced by complex interactions among biological, psychological, lifestyle, and environmental factors, often without an identifiable structural cause.[1] Global Burden of Disease estimates have consistently identified low back pain as a leading contributor to years lived with disability, emphasizing the importance of early identification, preventive strategies, and effective management.[2] The prevalence of low back pain varies considerably across geographical regions, age groups, occupational categories, and study populations. Differences in diagnostic criteria, anatomical definitions, symptom duration, assessment methods, and sampling techniques contribute to variations in reported prevalence.[3] Chronic low back pain is generally characterized by pain localized between the lower rib margin and gluteal folds that persists for at least 12 weeks. Unlike acute episodes, chronic low back pain is frequently associated with prolonged functional impairment, recurrent healthcare visits, and reduced work productivity. Meucci et al. reported considerable variation in the prevalence of chronic low back pain across populations, with an increasing burden observed with advancing age.[4] In India, low back pain constitutes a substantial healthcare burden, particularly among working-age and older adults. A systematic review and meta-analysis reported pooled point, annual, and lifetime prevalence estimates of approximately 48%, 51%, and 66%, respectively.[5] These findings highlight the widespread occurrence of low back pain in the Indian population. However, the prevalence of chronic low back pain may differ between community-based populations and patients attending tertiary care hospitals because of variations in healthcare-seeking behaviour, disease severity, occupational demands, and associated medical conditions. Hospital-based studies are therefore important for understanding the clinical and epidemiological characteristics of affected individuals and identifying groups requiring preventive and therapeutic interventions. Several demographic, anthropometric, lifestyle, and occupational factors have been associated with chronic low back pain. Advancing age may contribute to an increased prevalence through age-related musculoskeletal changes, cumulative mechanical exposure, and declining physical capacity. Excess body weight has also been associated with low back pain, potentially through increased mechanical loading and metabolic influences.[6] Physical inactivity may contribute to reduced muscular endurance and functional capacity, although persistent pain itself can also restrict physical activity. Prospective studies have suggested that regular leisure-time physical activity may provide some protection against frequent or chronic low back pain.[7] Occupational factors, including prolonged sitting, repetitive movements, awkward postures, and frequent heavy lifting, have also been investigated as potential contributors to low back pain. Prolonged sedentary behaviour may be associated with sustained postural loading, whereas physically demanding occupations may involve repeated mechanical stress on the lumbar region. Nevertheless, systematic reviews have reported inconsistent evidence regarding independent causal relationships between occupational sitting, heavy lifting, and low back pain.[8,9] Consequently, these exposures should be evaluated alongside demographic and lifestyle characteristics rather than considered isolated determinants. Current evidence-based approaches emphasize patient education, appropriate physical activity, functional rehabilitation, and individualized management strategies to reduce disability and improve quality of life.[10] Therefore, the present hospital-based cross-sectional study was conducted at RVM Institute of Medical Sciences and Research Center, Laxmakkapally, Mulugu, Siddipet, Telangana, India, from April to November 2023, involving 120 adult participants. The primary objective was to estimate the prevalence of chronic low back pain among adult hospital attendees. The secondary objectives were to assess the duration, intensity, and functional impact of chronic low back pain and to evaluate its associations with age, sex, body mass index, prolonged sitting, physical inactivity, and frequent occupational heavy lifting. The study aimed to provide institution-specific information on the burden and associated characteristics of chronic low back pain to support preventive and clinical management strategies.

Study Design and Setting This hospital-based cross-sectional observational study was conducted at RVM Institute of Medical Sciences and Research Center, Laxmakkapally, Mulugu, Siddipet, Telangana, India, from April to November 2023. The study aimed to determine the prevalence of chronic low back pain and evaluate its association with demographic, anthropometric, lifestyle, and occupational characteristics among adult hospital attendees. Participants and Sample Size The study included 120 adult participants aged 18–75 years, comprising individuals with and without chronic low back pain. Participants were assessed for relevant demographic characteristics, body mass index, physical activity, occupational exposures, and symptoms of low back pain. The sample size was 120 participants, and all included individuals were considered for the prevalence analysis. The study population was evaluated to identify the frequency and associated characteristics of chronic low back pain within the hospital setting. Outcome Definition and Pain Assessment Chronic low back pain was defined as pain localized between the lower rib margin and the gluteal folds persisting for at least 12 weeks.[11] The assessment included anatomical location, symptom duration, pain intensity, and associated functional limitations. The definition was based on symptom duration, while the NIH research standards additionally consider pain frequency.[12] Pain intensity was assessed using an 11-point Numerical Rating Scale (NRS), ranging from 0 (no pain) to 10 (worst imaginable pain). Pain severity was categorized as mild (1–3), moderate (4–6), and severe (7–10).[13] Among participants with chronic low back pain, additional clinical characteristics included symptom duration, radiation of pain to the lower limbs, interference with daily activities, sleep disturbances, and analgesic use during the preceding month. These parameters were evaluated to describe the clinical characteristics and functional impact of chronic low back pain. Exposure Variables Demographic, anthropometric, lifestyle, and occupational characteristics were evaluated for their association with chronic low back pain. Age was categorized into four groups: 18–29, 30–44, 45–59, and ≥60 years. For association analysis, participants were classified into two categories: <45 years and ≥45 years. Sex was recorded as male or female. Body mass index (BMI) was categorized as <25 kg/m² and ≥25 kg/m². Prolonged sitting was defined as sitting for ≥6 hours per day, while physical inactivity was defined as engaging in <150 minutes of moderate-intensity physical activity per week. Frequent occupational heavy lifting was recorded as a categorical exposure (present or absent). These variables were examined to identify potential associations with chronic low back pain. Statistical Analysis Data were summarized using descriptive and inferential statistical methods. Categorical variables were expressed as frequencies and percentages, while continuous variables were presented as mean ± standard deviation or median with interquartile range, as appropriate. The prevalence of chronic low back pain was calculated by dividing the number of affected participants by the total study population (N = 120) and expressed as a percentage with a 95% confidence interval calculated using the Wilson method. [14] Ethical Considerations The study was approved by Institutional Ethics Committee, RVM Institute of Medical Sciences and Research Center, Laxmakkapally, Mulugu, Siddipet, Telangana, India. The study was conducted in accordance with applicable institutional ethical guidelines. Participant privacy and confidentiality were maintained throughout the research, and collected information was used exclusively for academic and research purposes. Personal identifiers were excluded from data analysis and reporting.

Participant characteristics A total of 120 adults were included, with a mean age of 46.8 ± 14.1 years and an age range of 18–75 years. Women accounted for 66 participants (55.0%), and 70 (58.3%) were aged ≥45 years. BMI ≥25 kg/m² was recorded in 46 participants (38.3%). Prolonged sitting and physical inactivity were reported by 62 (51.7%) and 70 (58.3%) participants, respectively (Table 1). Table 1 Demographic and lifestyle characteristics of participants (N = 120) Characteristic n (%) Age group (years) 18–29 20 (16.7) 30–44 30 (25.0) 45–59 43 (35.8) ≥60 27 (22.5) Sex Male 54 (45.0) Female 66 (55.0) BMI category <25 kg/m² 74 (61.7) ≥25 kg/m² 46 (38.3) Sitting for ≥6 hours/day 62 (51.7) Physical inactivity 70 (58.3) Frequent occupational heavy lifting 42 (35.0) Note. BMI = body mass index. Physical inactivity was defined as <150 minutes of moderate-intensity physical activity per week. Lifestyle and occupational categories could overlap. Prevalence of chronic low back pain Chronic low back pain was present in 54 participants, giving a prevalence of 45.0% (95% CI [36.4%, 53.9%]). The remaining 66 participants (55.0%) did not meet the chronic low back pain definition (Table 2). Table 2 Prevalence of chronic low back pain (N = 120) Chronic low back pain status n (%) Present 54 (45.0) Absent 66 (55.0) Total 120 (100.0) Note. The prevalence confidence interval was calculated using the Wilson method. Pain characteristics Among the 54 affected participants, median pain duration was 14 months (IQR [8, 26]), and mean pain intensity was 5.8 ± 1.7. Moderate pain was most common, affecting 31 participants (57.4%); 17 (31.5%) had severe pain. Daily activity interference affected 35 (64.8%), sleep disturbance affected 23 (42.6%), and 38 (70.4%) had used analgesics during the preceding month (Table 3). Table 3 Clinical characteristics of participants with chronic low back pain (n = 54) Characteristic Value Duration of pain, months, median (IQR) 14 (8–26) Pain intensity, mean ± SD 5.8 ± 1.7 Pain severity, n (%) Mild (score 1–3) 6 (11.1) Moderate (score 4–6) 31 (57.4) Severe (score 7–10) 17 (31.5) Radiation of pain to a lower limb, n (%) 19 (35.2) Interference with daily activities, n (%) 35 (64.8) Sleep disturbance attributed to pain, n (%) 23 (42.6) Analgesic use in the preceding month, n (%) 38 (70.4) Note. IQR = interquartile range; SD = standard deviation. The pain scale ranged from 0 to 10. Clinical features could overlap. Factors associated with chronic low back pain Prevalence was higher among participants aged ≥45 years than among younger adults (55.7% vs. 30.0%; crude OR = 2.94, 95% CI [1.36, 6.32], p = .005). Participants with BMI ≥25 kg/m² also had a higher prevalence than those with BMI <25 kg/m² (60.9% vs. 35.1%; crude OR = 2.87, 95% CI [1.34, 6.14], p = .006). Female sex was not significantly associated with chronic low back pain (p = .396). Sitting ≥6 hours/day, physical inactivity, and frequent heavy lifting showed significant unadjusted associations (Table 4). Table 4 Unadjusted associations with chronic low back pain (N = 120) Characteristic Total, n Chronic low back pain, n (%) Crude OR (95% CI) p Age ≥45 years 70 39 (55.7) 2.94 (1.36–6.32) .005 <45 years 50 15 (30.0) Reference — Sex Female 66 32 (48.5) 1.37 (0.66–2.83) .396 Male 54 22 (40.7) Reference — BMI ≥25 kg/m² 46 28 (60.9) 2.87 (1.34–6.14) .006 <25 kg/m² 74 26 (35.1) Reference — Sitting ≥6 hours/day Yes 62 36 (58.1) 3.08 (1.45–6.52) .003 No 58 18 (31.0) Reference — Physical inactivity Yes 70 38 (54.3) 2.52 (1.18–5.38) .016 No 50 16 (32.0) Reference — Frequent occupational heavy lifting Yes 42 25 (59.5) 2.48 (1.15–5.36) .019 No 78 29 (37.2) Reference — Note. Percentages are calculated within each exposure category. OR = odds ratio; CI = confidence interval; BMI = body mass index. p values use Pearson’s chi-square test without continuity correction; odds-ratio confidence intervals use the log-Wald method. All associations are unadjusted and do not establish causation or independent risk factors.

The present study identified chronic low back pain in 45.0% of adult hospital attendees, indicating a considerable burden among the study population. Older age, body mass index (BMI) ≥25 kg/m², prolonged sitting, physical inactivity, and frequent occupational heavy lifting demonstrated statistically significant unadjusted associations with chronic low back pain. Most affected participants experienced moderate to severe pain, while nearly two-thirds reported interference with daily activities. These findings emphasize the clinical and functional impact of chronic low back pain and highlight the importance of evaluating demographic, anthropometric, lifestyle, and occupational characteristics in hospital-based populations. The observed prevalence of 45.0% was comparable to the pooled point prevalence of 48% reported in the systematic review and meta-analysis conducted by Shetty et al. [5] However, their analysis included low back pain irrespective of chronicity, whereas the present study specifically evaluated symptoms persisting for at least 12 weeks. Differences in study populations, diagnostic criteria, sampling procedures, and healthcare-seeking patterns may explain variations in reported prevalence. International systematic reviews have similarly documented substantial differences in low back pain prevalence across populations and geographical regions. [3,4] The relatively high prevalence observed in the present study underscores the importance of identifying chronic low back pain among adults attending tertiary healthcare facilities. Advancing age was significantly associated with chronic low back pain, with participants aged ≥45 years demonstrating nearly threefold higher odds compared with younger individuals (OR = 2.94; p = 0.005). This finding is consistent with the systematic review by Meucci et al., which reported an increasing prevalence of chronic low back pain with advancing age.[4] Age-related musculoskeletal changes, cumulative occupational exposures, reduced muscular strength, and declining physical capacity may contribute to this association. Although the prevalence was higher among women than men, the difference was not statistically significant (p = 0.396). Participants with BMI ≥25 kg/m² demonstrated significantly higher odds of chronic low back pain compared with those with BMI <25 kg/m² (OR = 2.87; p = 0.006). This observation is consistent with the meta-analysis by Shiri et al., which identified an association between obesity and low back pain.[6] Increased mechanical loading on the lumbar spine, altered biomechanics, reduced physical fitness, and metabolic or inflammatory mechanisms may contribute to the relationship between excess body weight and persistent low back pain. Physical inactivity was significantly associated with chronic low back pain (OR = 2.52; p = 0.016). This finding is consistent with the systematic review and meta-analysis by Shiri and Falah-Hassani, which suggested that leisure-time physical activity may offer protection against frequent or chronic low back pain.[7] Regular physical activity may support muscular endurance, mobility, spinal function, and overall physical capacity. Nevertheless, the relationship between physical inactivity and chronic low back pain may be bidirectional, as persistent pain can itself restrict movement and discourage participation in physical activities. Therefore, the observed association should not be interpreted as evidence of a direct causal relationship. Among the evaluated characteristics, prolonged sitting for ≥6 hours per day demonstrated the highest crude odds ratio (OR = 3.08; p = 0.003). This association may reflect sustained postural loading, reduced movement variability, and other occupational or lifestyle characteristics. However, the systematic review by Roffey et al. did not establish a consistent independent causal relationship between occupational sitting and low back pain.[8] Differences in sitting duration, posture, work conditions, psychosocial factors, and physical activity levels may influence the observed associations. Consequently, prolonged sitting should be considered within a broader assessment of lifestyle and occupational exposures rather than as an independently established cause of chronic low back pain. Frequent occupational heavy lifting was also significantly associated with chronic low back pain (OR = 2.48; p = 0.019). Repetitive physical loading, awkward lifting postures, and demanding occupational activities may contribute to lumbar discomfort and functional limitations. Nevertheless, the systematic review by Wai et al. highlighted inconsistencies in the evidence regarding a direct causal relationship between occupational lifting and low back pain.[9] Variation in lifting frequency, load magnitude, work duration, and individual physical capacity may influence the relationship. The absence of a standardized quantitative lifting threshold in the present study limits further interpretation. These findings highlight the relevance of occupational assessment and appropriate workplace health education. The functional impact of chronic low back pain was also considerable. Among affected participants, 64.8% reported interference with daily activities, 42.6% experienced sleep disturbances, and 70.4% had used analgesics during the preceding month. The predominance of moderate and severe pain indicates that chronic low back pain may be associated with substantial symptom burden and functional limitations. These findings reinforce the importance of comprehensive clinical assessment extending beyond pain intensity to include functional capacity, sleep quality, and treatment requirements. The biopsychosocial approach described by Hartvigsen et al. and Foster et al. emphasizes patient education, physical activity, rehabilitation, and individualized management strategies for improving outcomes in patients with persistent low back pain. [1,10] Standardized pain assessment and validated functional measures may further improve clinical evaluation and monitoring. [12,13] Limitations The present study had certain limitations. First, the single-centre, hospital-based cross-sectional design limits the generalizability of the findings to the broader community population and prevents the establishment of temporal or causal relationships between the evaluated exposures and chronic low back pain. Second, the relatively small sample size of 120 participants may have limited the precision of prevalence estimates and subgroup comparisons. Third, information regarding physical activity, prolonged sitting, occupational heavy lifting, and pain-related characteristics was based on reported exposure categories, which may be susceptible to recall bias and misclassification.

The present study identified chronic low back pain in 45.0% of adult hospital attendees, indicating a substantial burden within the study population. Moderate to severe pain predominated among affected individuals, with considerable interference in daily activities and sleep. Advancing age, BMI ≥25 kg/m², prolonged sitting, physical inactivity, and frequent occupational heavy lifting were significantly associated with chronic low back pain in unadjusted analyses, whereas sex was not significantly associated. These findings highlight the importance of early identification, comprehensive clinical assessment, lifestyle counselling, and occupational health awareness among adults experiencing persistent low back pain. However, the observed associations do not establish causality or independent risk factors.

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