Low Back Pain, Pain Beliefs, Fear-Avoidance, and Self-Activation in Nursing Students

Nursing students are at increased risk for low back pain due to physical and psychological stressors encountered during nursing education. Low back pain can interfere with academic performance, clinical readiness, and long-term career sustainability.

This study examined the prevalence of low back pain among nursing students and explored how pain-related beliefs, fear-avoidance beliefs, self-activation, and pain intensity are associated with health-related quality of life.

A cross-sectional survey was conducted among 200 nursing students enrolled in traditional and accelerated programs at a one central Israeli nursing school. Validated self-report instruments assessed low back pain prevalence, beliefs, activation, coping strategies, and health-related quality of life. Regression analyses were used to identify predictors of health-related quality of life.

A total of 63.5% of participants reported low back pain during the past 12 months, with 90.6% indicating symptom onset during nursing education. While most episodes were short in duration, students with low back pain reported significantly lower health-related quality of life. Notably, fear-avoidance beliefs-but not pain intensity-emerged as the strongest predictor of diminished health-related quality of life.

This study underscores the need to address psychological contributors to pain-related disability among nursing students. Fear-avoidance beliefs emerged as key modifiable factors associated with diminished quality of life, independent of pain intensity. Incorporating evidence-based pain management approaches that target maladaptive beliefs and promote active coping may reduce the burden of low back pain in this vulnerable population and support workforce sustainability in clinical settings.