Low back pain is one of the most common musculoskeletal complaints encountered in clinical practice and remains a major cause of pain, disability, work loss, and health-care utilization worldwide. The Global Burden of Disease analyses identify low back pain as the leading contributor to years lived with disability, with a large and growing burden across both high-income and low- and middle-income settings [1]. Population-level estimates also show wide variation in prevalence because studies differ in anatomical definition, recall period, population structure, and methods of ascertainment [2,3]. Despite these variations, the condition is consistently recognized as a public health problem that extends beyond pain alone and affects mobility, productivity, sleep, psychological well-being, and quality of life.

The clinical importance of low back pain is particularly evident in orthopaedic outpatient departments, where patients seek care for acute painful episodes, recurrent symptoms, chronic mechanical pain, radicular complaints, and functional limitation. Most cases are non-specific, but a careful outpatient assessment is essential to identify red flags, document neurological symptoms, classify pain by duration, and provide appropriate advice regarding activity, ergonomics, analgesic use, and rehabilitation. Chronic low back pain is more difficult to manage than acute pain and is associated with recurrent consultations and sustained functional restriction [4,5]. Therefore, estimating the outpatient burden of low back pain provides useful local evidence for service planning and patient education.

Risk factors for low back pain are multidimensional. Age, sex, body mass index, smoking, prior injury, physical workload, awkward posture, prolonged sitting, and insufficient physical activity have all been examined in epidemiological research [6,7]. Indian data also indicate that low back pain is not limited to elderly individuals and is frequently observed among younger and working-age adults, especially when sedentary study or work patterns, stress, poor posture, and previous spine problems are present [7]. Sedentary behaviour and prolonged sitting are increasingly relevant in modern work settings, although the strength of association varies across study designs and populations [8]. In contrast, heavy workload, repeated lifting, flexed postures, and physically demanding tasks are commonly reported mechanical contributors [9-11].

Body weight and lifestyle factors add another layer to risk assessment. Overweight and obesity increase axial load on the lumbar spine and have been associated with low back pain in meta-analytic evidence [12]. Smoking has also been linked with current, chronic, and disabling low back pain, although the magnitude of association is usually modest and affected by confounding [13]. Because several risk factors are modifiable, identifying their distribution in local outpatient populations helps clinicians deliver focused counselling on posture correction, workplace modification, regular physical activity, weight control, and prevention of recurrent episodes.

The present study was undertaken with the objective of estimating the prevalence of low back pain among adults attending an orthopaedic outpatient department at Konaseema Institute of Medical Sciences & Research Foundation, Amalapuram, Andhra Pradesh, India. The study also aimed to describe the clinical profile of affected patients and to assess the association of low back pain with selected demographic, occupational, anthropometric, and lifestyle-related risk factors.

Study design and setting: This was a hospital-based cross-sectional observational study conducted in the Department of Orthopaedics, Konaseema Institute of Medical Sciences & Research Foundation, Amalapuram, Andhra Pradesh, India. The study was designed to estimate the prevalence of low back pain among adult patients attending the orthopaedic outpatient department and to examine selected associated risk factors. The manuscript was prepared in accordance with the principles of the STROBE recommendations for reporting observational studies [14]. Study period and participants: Data collection was carried out from April 2021 to September 2021. Adults aged 18 years and above attending the orthopaedic outpatient department during the study period were considered eligible. Patients of both sexes were included after obtaining consent and after confirming that the required clinical and risk-factor information could be recorded. Patients with acute major trauma requiring emergency management, previous spine surgery, known spinal malignancy, spinal infection, severe neurological deficit requiring urgent referral, pregnancy-related back pain, or incomplete data were excluded. Sample size: A sample size of 100 was used for the study. For sample size estimation, an expected prevalence of 50% was considered because it gives the maximum sample size for a prevalence study when local prior data are limited. With 95% confidence level and 10% absolute precision, the calculated sample size was approximately 96; this was rounded to 100 to improve completeness and feasibility within the defined study period. Data collection and study variables: Data were collected using a structured proforma. Baseline variables included age, sex, residence, and body mass index category. Low back pain was defined as pain located between the lower costal margin and the gluteal folds, with or without lower-limb radiation. Pain duration was categorized as acute when less than 6 weeks, subacute when 6-12 weeks, and chronic when more than 12 weeks. Pain severity was recorded as mild, moderate, or severe based on patient-reported intensity. Clinical variables included lower-limb radiation, neurological symptoms, previous similar episode, and work limitation due to pain. Risk-factor assessment: Occupational category was classified as sedentary work, manual labour, prolonged standing, or other work. Prolonged sitting was defined as sitting for more than 6 hours per day. Heavy weight lifting, poor posture, insufficient physical activity, previous trauma, and smoking status were recorded as present or absent based on history. Body mass index was categorized as normal, overweight, or obese using standard clinical categories. Statistical analysis: Data were entered into a spreadsheet and analysed using descriptive statistics. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequency and percentage. The prevalence of low back pain was calculated as the proportion of patients reporting low back pain among the total sample. Associations between categorical risk factors and low back pain were examined using the Chi-square test. A p value less than 0.05 was considered statistically significant. Ethical considerations: The study was conducted after institutional permission and in accordance with ethical principles for human participant research. Written informed consent was obtained from the participants before enrolment. Confidentiality of patient data was maintained, and anonymized data were used for analysis. Institutional Ethics Committee approval number: To be added.

A total of 100 adult patients attending the orthopaedic outpatient department were included in the study. The mean age of the participants was 43.8 ± 13.6 years. Males constituted 56.0% of the study population. Low back pain was present in 62 patients, giving an overall prevalence of 62.0%. The baseline demographic profile of the study population is shown in Table 1.

Table 1. Baseline demographic profile of the study population [n=100]

Low back pain was identified in 62.0% of the participants. The prevalence increased progressively with age, from 38.9% among adults aged 18-30 years to 83.3% among those aged above 60 years. Low back pain was slightly more frequent among females than males, although the difference was not marked. A higher prevalence was also observed among overweight and obese participants compared with those having normal body mass index. The distribution of low back pain according to selected demographic variables is presented in Table 2.

Among the 62 patients with low back pain, chronic pain of more than 12 weeks duration was present in 30 patients [48.4%]. Moderate pain was the commonest severity grade, reported by 35 patients [56.5%]. Radiation of pain to the lower limb was present in 18 patients [29.0%], while neurological symptoms such as numbness or tingling were reported by 10 patients [16.1%]. Work limitation due to low back pain was observed in 24 patients [38.7%]. The clinical profile of patients with low back pain is summarized in Table 3.

Risk-factor analysis showed that low back pain was significantly associated with occupation, prolonged sitting, heavy weight lifting, poor posture, insufficient physical activity, and previous trauma. Smoking showed a higher proportion of low back pain cases, but the association was not statistically significant. The association between selected risk factors and low back pain is shown in Table 4.

Overall, low back pain was common among adults attending the orthopaedic outpatient department. The main associated factors were occupation-related mechanical strain, prolonged sitting, poor posture, heavy weight lifting, and inadequate physical activity. These findings suggest that occupational and lifestyle-related factors contributed substantially to the burden of low back pain in the study population.

Table 2. Prevalence of low back pain according to selected demographic variables

Table 3. Clinical profile of patients with low back pain [n=62]

Risk-factor analysis showed that low back pain was significantly associated with occupation, prolonged sitting, heavy weight lifting, poor posture, insufficient physical activity, and previous trauma. Smoking showed a higher proportion of low back pain cases, but the association was not statistically significant. The association between selected risk factors and low back pain is shown in Table 4.

Table 4. Association of risk factors with low back pain

The present cross-sectional observational study found that 62.0% of adults attending the orthopaedic outpatient department had low back pain. This indicates a high outpatient burden and supports the clinical observation that low back pain is one of the commonest reasons for orthopaedic consultation. The prevalence observed in this study is comparable to reports from primary care and outpatient-based populations, where low back pain has often shown higher rates than community-based point prevalence estimates because symptomatic patients actively seek care [6]. Global reviews have also documented wide variation in prevalence estimates, largely due to differences in study setting, case definition, recall period, and population age structure [2,3].

The age-wise distribution showed a progressive increase in low back pain from younger adults to those above 60 years. This pattern is biologically plausible because advancing age is associated with degenerative disc changes, facet joint arthropathy, reduced paraspinal muscle strength, and cumulative mechanical exposure. The study also showed a slightly higher proportion among females, although the difference was small. Previous systematic evidence has shown that low back pain is common across both sexes, with some studies reporting higher rates among females, particularly for chronic pain [2,4]. In the present study, the OPD-based sample and modest sample size probably contributed to the narrow sex-wise difference.

Nearly half of the affected patients had chronic pain lasting more than 12 weeks, and moderate pain was the dominant severity category. This finding is clinically important because chronic low back pain contributes more strongly to functional limitation, repeated health-care visits, and reduced productivity than isolated acute episodes [4,5]. Work limitation was present in 38.7% of affected patients, indicating that low back pain had practical consequences beyond symptom reporting. Radiation to the lower limb and neurological symptoms were less frequent, suggesting that a considerable proportion of cases were likely mechanical or non-specific in nature, which is consistent with common outpatient patterns.

The strongest associations in this study were seen with occupation, prolonged sitting, heavy weight lifting, poor posture, and insufficient physical activity. These findings agree with existing literature showing that both sedentary and mechanically demanding occupational exposures are relevant to low back pain [8-11]. Prolonged sitting can increase static loading, reduce lumbar movement variability, and encourage slouched postures, while heavy lifting and awkward posture can increase spinal load and paraspinal muscle strain. The significant association with insufficient physical activity also supports the role of physical conditioning in spinal health. Evidence suggests that balanced physical activity is protective, whereas very low activity and excessive occupational loading both contribute to symptoms [9].

Overweight and obesity showed a higher prevalence of low back pain in descriptive analysis, which aligns with meta-analytic evidence linking excess body weight with low back pain [12]. Smoking was more common among patients with low back pain but did not show statistical significance in this sample. This contrasts with meta-analytic findings showing a modest association between smoking and low back pain [13]. The absence of statistical significance in the present study is likely related to sample size and the smaller number of smokers. Overall, the findings support a preventive strategy focused on posture correction, reduction of prolonged sitting, safe lifting practices, regular physical activity, and weight control in adults attending orthopaedic outpatient care.

Limitations

The study has limitations. It was conducted in a single tertiary care outpatient department with a sample of 100 participants, restricting generalizability to the wider community. The cross-sectional design prevents temporal interpretation of risk factors. Pain, posture, physical activity, and occupational exposure were self-reported, introducing recall and reporting bias. Imaging and detailed functional disability scores were not included.

Low back pain was highly prevalent among adults attending the orthopaedic outpatient department, affecting 62.0% of the study population. Chronic pain and moderate pain severity were common among affected patients, and more than one-third reported limitation of work activities. The major associated factors were occupation, prolonged sitting, heavy weight lifting, poor posture, insufficient physical activity, and previous trauma. These findings emphasize the need for routine risk-factor assessment in orthopaedic outpatient care. Patient counselling should focus on ergonomic correction, periodic breaks during prolonged sitting, safe lifting methods, regular physical activity, and weight control. Local preventive strategies can reduce recurrent pain and improve functional outcomes.

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