Low Back and Neck Pain in Nursing Students at The University of The West Indies

Neck and low back pain are among the most common musculoskeletal conditions worldwide. Although often self-limiting, these conditions can become disabling, negatively affecting productivity, social participation, and activities of daily living. Occupational factors, prolonged sitting, sustained computer use, awkward postures, and repetitive neck movements are recognised contributors to spinal pain. Nursing students are particularly vulnerable to musculoskeletal disorders, with risk beginning during their training years. During the preclinical phase, students spend prolonged periods attending lectures, studying, and completing assignments, often involving sustained sitting and computer use. In the clinical phase, students are exposed to physically demanding tasks such as prolonged standing, ward rounds, assisting with procedures, and manual patient handling, including lifting and repositioning patients. These activities, combined with poor ergonomic practices and reduced core stability, may contribute to the development of neck and low back pain. International studies have reported a high prevalence of musculoskeletal pain among nursing and medical students, particularly during clinical training. Factors such as increased computer use, elevated body mass index, prior trauma, and family history of musculoskeletal disorders have been identified as contributing risk factors. However, no published study has investigated the prevalence of neck and low back pain among nursing students in Jamaica or the wider Caribbean. Exercise therapy is widely recognised as an effective non-pharmacologic intervention for both acute and chronic low back pain, with evidence showing improvements in pain reduction and functional outcomes. Exercise enhances muscular strength, flexibility, and spinal stability, while promoting nutrient exchange within spinal structures, supporting overall spinal health and reducing the risk of injury. This study aims to determine the prevalence of neck and low back pain among nursing students at The University of the West Indies, Mona, and to compare the effectiveness of a standardized spine-specific exercise programme versus non-spine-specific exercises in reducing pain and improving knowledge, attitudes, and practices related to spinal health. It will be conducted in two phases and guided by a descriptive and experimental framework. In the first phase, the descriptive phase, a cross-sectional design will be used to assess the prevalence of neck and low back pain (NLBP) among all year groups of nursing students at The University of the West Indies, Mona. The University of the West Indies, Mona, currently enrolls approximately 400 nursing students across four years of training. Participants will complete questionnaires to determine the presence of musculoskeletal discomfort in the neck and low back pain, as well as their knowledge, attitude, and practice related to spine health. In the second phase, the experimental phase, nursing students who report musculoskeletal discomfort will be randomised into intervention and control groups. The intervention group will participate in an eight-week spine-specific exercise program, while the control group will receive a non-spine specific exercise in parallel during the study period. Pre- and post-intervention data will be collected using the Numeric Rating Scale (NRS), the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ), and custom questionnaires (Questionnaires A \& B) to assess changes in assessing knowledge, attitudes and practices toward musculoskeletal health, changes in perceived pain and participants' functional status.

Participant confidentiality will be strictly maintained, with each participant assigned a study identification number. Demographic data, presenting complaints, and outcome measures will be collected for study purposes and managed securely using REDCap, a password-protected, web-based platform compliant with national data protection standards. Statistical analysis will be conducted using the International Business Machines Corporation Statistical Product and Service Solutions (IBM SPSS software), and all study records will be securely stored and destroyed three years after study completion.

• Knowledge, Attitude and Practice towards Musculoskeletal Problems of Neck and Low back Pain (Questionnaire A) [Time frame: Done at the time of enrollment (Baseline)]
• Change from Baseline in Knowledge, Attitude and Practice Towards Musculoskeletal Problems of Neck and Low Back Pain (Questionnaire B) [Time frame: From Enrollment to the end of treatment at 8 weeks]
• Change from Baseline in the Numeric Rating Scale (NRS) [Time frame: From Enrollment to the end of treatment at 8 weeks]