The research, published in the journal Nursing Open, was conducted at four tertiary Grade A hospitals in Shenzhen, a booming metropolis in Guangdong Province. The investigators framed their work around the classic epidemiological triangle: caregiver characteristics as the host, caregiving workload and patient-handling behaviour as the exposure, and perceived social support as the environment. That structure allowed them to move beyond simply counting cases and toward identifying which specific factors set caregivers apart.

The scale of the underlying problem is enormous. China’s disabled population is projected to reach roughly 136 million by 2030, and because the country’s long-term care insurance system remains only partially implemented, about 90 percent of disabled individuals depend on long-term care from family members. These caregivers — often spouses, parents, or adult children guided by deeply rooted traditions of filial responsibility — routinely perform bending, twisting, and heavy lifting without any formal training in safe lifting techniques or back protection.

To capture the phenomenon, the team defined low back pain as pain, muscle tension, or stiffness in the region between the lower ribs and the buttock crease during the previous twelve months, severe enough to limit daily activities for at least one day. Participants had to be at least 18 years old, caring for a patient whose Modified Barthel Index score was 70 or lower, and providing at least eight hours of care per day for a minimum of six months. Caregivers whose pain stemmed from injuries, preexisting lumbar conditions, fever, menstruation, or pregnancy were excluded. From 220 distributed questionnaires, 209 valid responses were analysed — a 95 percent response rate — with a median caregiver age of 52 years.

The headline number was striking: 117 of the 209 caregivers, or 55.98 percent, reported low back pain in the previous year. That figure sits within the wide range reported internationally — from 28.3 percent among Japanese cancer caregivers to 69 percent in another Japanese sample and 64.6 percent among Thai caregivers of patients with spinal cord lesions — but it confirms that musculoskeletal strain is a defining feature of informal caregiving in urban China.

Using binary logistic regression, the researchers isolated four factors independently associated with the condition. Repositioning frequency emerged as the strongest: compared with caregivers who repositioned patients no more than three times a day, those doing so four to seven times daily had nearly three and a half times the odds of low back pain, and those repositioning patients eight or more times a day had almost five times the odds. Each additional year of caregiving raised the odds by about 12 percent, a cumulative effect consistent with the chronic, progressive nature of musculoskeletal injury.

Protective factors were equally revealing. Caregivers who scored high on the Patient Handling Related Safety Behaviour Scale — meaning they assessed patient risk, cleared and adjusted their environment, used sound ergonomics, and sought help — had 74.6 percent lower odds of low back pain than those with low safety scores. Notably, the caregivers’ average safety score of 3.64 on a six-point scale fell well below the 4.94 recorded among intensive care nurses in earlier research, underscoring how unprepared family members are compared with professionals who receive training and have access to mechanical lifts, transfer sheets, and assistive devices.

Social support played a measurable role as well. For every one-point increase on the Perceived Social Support Scale, the odds of low back pain dropped by about 5 percent. The authors suggest several plausible mechanisms: supportive networks may buffer stress and alter pain perception within the biopsychosocial model of chronic pain, and they may also provide practical relief — an extra pair of hands for lifting and transferring, or simply the chance to rest — that reduces cumulative strain on the lumbar spine. In a family-based care system where formal respite services are scarce, caregivers with thin support networks may simply have no one to share the physical burden with.

Interestingly, some conventional suspects did not survive statistical adjustment. Gender, age, and regular exercise showed no significant association with low back pain once the caregiving-related variables were accounted for, suggesting that what caregivers do — and how safely they do it — matters more than who they are. The model performed well statistically, explaining roughly 47 percent of the variance, with good discrimination (an area under the receiver operating characteristic curve of 0.875) and acceptable calibration, and a sensitivity analysis using the continuous safety-behaviour score confirmed the robustness of the findings.

The authors are careful to note the limits of a cross-sectional design: the associations cannot establish causality, self-reported data are vulnerable to recall bias, and convenience sampling from Shenzhen hospitals may not generalize to rural or less-developed regions. Still, the practical implications are clear. The researchers argue that nurses should routinely assess caregiving duration, repositioning frequency, safety behaviour, and social support during discharge planning and community follow-up, and should demonstrate safe repositioning and transfer techniques before patients go home. In a country where the family remains the backbone of long-term care, teaching millions of untrained caregivers how to protect their own backs — and giving them someone to lean on — may be one of the most cost-effective public health interventions available.

Subject of Research: Prevalence and risk factors of low back pain among family caregivers of patients with disabilities in Shenzhen, China

Article Title: Prevalence of Low Back Pain and Associated Factors Among Family Caregivers of Patients With Disabilities in Shenzhen, China: A Cross‐Sectional Study Based on Binary Logistic Regression Modelling

Article References: Sun, Y.-J., Dai, L., Xiong, J., & Liang, S. (2026). Prevalence of Low Back Pain and Associated Factors Among Family Caregivers of Patients With Disabilities in Shenzhen, China: A Cross‐Sectional Study Based on Binary Logistic Regression Modelling. Nursing Open, 13(9), Article e70787. https://doi.org/10.1002/nop2.70787

Image Credits: AI Generated

DOI: 10.1002/nop2.70787

Keywords: low back pain, family caregivers, disability, cross-sectional study, logistic regression, patient handling, social support, Shenzhen, China, musculoskeletal health, nursing, caregiver burden