Musculoskeletal symptoms and biopsychosocial factors among nursing students: implications for protecting the future health workforce.

62% of nursing students reported musculoskeletal symptoms in the previous 12 months.

• Cross-sectional online survey of 213 nursing students in Türkiye (77% female).
• Data were collected between February and April 2022.
• Symptoms were assessed with validated instruments.

The upper back was the most frequently reported symptom site, followed by the low back and neck.

• Upper back symptoms were reported by 41% of students.
• Low back and neck symptoms were each reported by 33%.

High physical activity was significantly associated with lower odds of upper back symptoms.

• Odds ratio (OR) = 0.19, p = 0.047.
• Estimated using Firth's penalized-likelihood logistic regression with six predictors (age, BMI, gender, physical activity, total perceived stress, total biopsychosocial response score).

High physical activity showed a borderline association with lower odds of any 12-month musculoskeletal symptom.

• OR = 0.25, p = 0.060, which did not reach conventional statistical significance.

Female students had higher odds of neck, shoulder, and upper back symptoms than male students.

• The OR for male vs. female students ranged from 0.05 to 0.19 across these regions.
• The sample was 77% female, so the male group was small.

No stress or biopsychosocial measure was significantly associated with any 12-month musculoskeletal outcome.

• Perceived stress and total biopsychosocial response score were included in the regression models.
• Coping behaviors and biopsychosocial wellbeing were assessed with validated instruments.

Findings for the hip/thigh region are exploratory because of a low events-per-variable ratio.

• Firth's penalized-likelihood method was used to address the limited number of events.
• The models used a simplified set of six predictors.

The authors conclude that physical factors may be more relevant than stress or biopsychosocial wellbeing to symptom occurrence in this sample, and call for longitudinal research.

• The biopsychosocial framework is described as a useful perspective, but its stress and wellbeing components were not associated with symptoms here.
• The cross-sectional design limits causal inference.
• The authors emphasize addressing musculoskeletal health before entry into the nursing workforce.