Neck/shoulder and back pain in new graduate nurses: A growth mixture modeling analysis

Int J Nurs Stud. 2014 Apr;51(4):625-39. doi: 10.1016/j.ijnurstu.2013.08.009. Epub 2013 Aug 31.


Background: Although it is well known that musculoskeletal disorders are common among registered nurses, little longitudinal research has been conducted to examine this problem from nursing education to working life.

Objectives: The aim was to investigate the prevalence and incidence of neck/shoulder and back pain in nursing students in their final semester, and one and two years after graduation. Furthermore, to identify common trajectories of neck/shoulder and back pain, and explore sociodemographic and lifestyle-related factors, contextual factors and health outcome that might be characteristic of individuals in the various trajectories.

Design: Longitudinal study following nursing students from their final year of studies, with follow-ups one and two years after graduation.

Settings and participants: Nursing students who graduated from the 26 universities providing undergraduate nursing education in Sweden 2002 were invited to participate (N=1700). Of those asked, 1153 gave their informed consent.

Methods: The participants answered postal surveys at yearly intervals. Descriptive statistics were used to analyze prevalence and incidence of pain, and growth mixture modeling was applied to identify different homogeneous clusters of individuals following similar trajectories in pain development across time.

Results: The prevalence of neck/shoulder and back pain remained constant over time (around 50% for neck/shoulder pain and just over 40% for back pain). Six different development trajectories for each symptom were found, reflecting patterns of stable pain levels or variation in levels over time: one symptom-free group, two decreasing pain groups, two increasing pain groups, and one chronic pain group. With few exceptions, the same factors (sex, children, chronic disease, working overtime, work absence, sickness presence, physical load, depression, self-rated health, sleep quality and muscular tension) were associated with neck/shoulder and back pain trajectories. Different types of physical load characterized new nurses with neck/shoulder pain and back pain respectively.

Conclusions: The high prevalence of pain among nursing students and among new graduate nurses, suggests that it would be effective to implement preventive strategies already during nursing education, but they should also preferably continue after graduation. Many factors associated with pain in the neck/shoulder and back seem to be modifiable, and thereby constitute targets for preventive strategies.

Keywords: Back pain; Longitudinal studies; Neck pain; Nursing; Shoulder pain; Students.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Back Pain*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Models, Theoretical*
  • Neck Pain*
  • Nursing Staff*
  • Shoulder Pain*
  • Sweden
  • Young Adult