Associations Among Stress Level, Musculoskeletal Disorders, and Body Mass Index (BMI) Among Final-Year Students at the University of Colombo

Associations Among Stress Level, Musculoskeletal Disorders, and Body Mass Index (BMI) Among Final-Year Students at the University of Colombo | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Associations Among Stress Level, Musculoskeletal Disorders, and Body Mass Index (BMI) Among Final-Year Students at the University of Colombo Menuja Deeghanu, Mahesh Rajasuriya This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7098334/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Musculoskeletal disorders (MSDs) are a leading cause of long-term pain and functional impairment globally, increasingly affecting younger populations due to sedentary lifestyles and academic stress. Despite growing international research, limited data exist on the interrelationship between MSDs and stress among undergraduates in Sri Lanka. Objective: To determine the prevalence and distribution of musculoskeletal disorders among final-year students at the University of Colombo and to assess associations between academic stress, body mass index (BMI), and musculoskeletal pain. Methods: A cross-sectional analytical study was conducted among 420 final-year undergraduates across five faculties of the University of Colombo. Musculoskeletal symptoms were assessed using the Standardized Nordic Musculoskeletal Questionnaire (SNMQ), while academic stress was evaluated using a modified Student Life Stress Inventory (SLSI). BMI was calculated based on self-reported height and weight. Data were analyzed using descriptive statistics and inferential tests including Chi-square and p-value analysis using SPSS v26. Results: The 12-month and 7-day point prevalence of MSDs were 82.1% and 64.5%, respectively. The lower back (48.8%), neck (46.7%), and upper back (42.4%) were the most affected regions, with 49.3% reporting interference with daily activities. Medical students showed the highest MSD prevalence (91.8%). A significant association was observed between academic stress and MSDs in the neck, shoulders, upper and lower back (p < 0.05). BMI was significantly associated with lower back (p = 0.018) and knee pain (p = 0.047). Females reported higher stress levels, especially in response to academic changes and pressures. Conclusion: MSDs are highly prevalent among final-year undergraduates at the University of Colombo, with academic stress emerging as a key contributor, particularly to axial pain. Context-specific interventions combining ergonomic and psychological strategies are essential to address this dual burden. Rheumatology Psychiatry Musculoskeletal disorders academic stress university students body mass index Sri Lanka Introduction Musculoskeletal disorders (MSDs) are among the leading global causes of long-term pain, physical disability, and loss of productivity, affecting millions across all age groups ( 1 , 2 ). They encompass a wide range of inflammatory and degenerative conditions involving muscles, tendons, ligaments, joints, and associated neurovascular structures (3,4). Although traditionally associated with occupational exposure, MSDs are increasingly observed in younger populations, particularly among university students, due to academic demands, sedentary behaviour, and suboptimal ergonomics ( 5 , 6 ). The global prevalence of MSDs pain among university students ranges from 32.9–89.3%, with low back, neck, and shoulder regions most commonly affected ( 6 , 7 ). While physical factors such as prolonged static posture, repetitive tasks, and poor workstation design remain well-documented contributors ( 8 ), a growing body of research has highlighted the significance of psychosocial risk factors, particularly academic stress ( 9 , 10 , 11 ). Academic stress, defined as the physiological and psychological response to academic-related demands that exceed available resources, is a prevalent concern among undergraduates, especially in high-pressure disciplines such as medicine and health sciences ( 12 , 14 ). Sources of stress include time constraints, high workload, examinations, financial concerns, and social pressures ( 15 , 17 ). Chronic academic stress activates the hypothalamic-pituitary-adrenal (HPA) axis, leading to elevated cortisol and catecholamine levels, which disrupt muscle perfusion, increase muscle tone, and impair tissue recovery, thereby contributing to the development or exacerbation of MSDs ( 18 , 19 , 20 ). In addition, stress-induced physiological responses can trigger pro-inflammatory pathways and alter immune function, further increasing vulnerability to musculoskeletal pain ( 21 , 22 ). Body mass index (BMI) is another important factor implicated in MSD development. Excessive body weight exerts additional mechanical stress on weight-bearing joints such as the lumbar spine and knees, predisposing individuals to chronic pain and disability ( 23 ). Studies have shown a positive correlation between increased BMI and MSD symptoms across working and student populations ( 24 , 25 ). Furthermore, chronic stress has been associated with behaviours such as emotional eating and reduced physical activity, both of which contribute to increased BMI, suggesting a potential synergistic interaction between stress and body weight in MSD pathogenesis ( 26 ). Gender differences have also been observed in both stress perception and musculoskeletal symptomatology. Female students often report higher stress levels and are more likely to experience musculoskeletal pain, possibly due to hormonal influences, reduced muscle mass, and greater reporting tendencies ( 27 – 29 ). Despite the evident multifactorial nature of MSDs in student populations, limited studies in Sri Lanka have comprehensively explored the interrelationships among stress and MSDs. This study aims to determine the prevalence and distribution of MSDs among final-year undergraduates of the University of Colombo and to assess the associations between stress level, and musculoskeletal pain. By identifying key risk factors in this unique academic setting, the findings can guide targeted interventions to enhance student well-being and academic performance. Methodology A cross-sectional analytical study was conducted among final year undergraduate students of the University of Colombo, Sri Lanka. The study population included students from the faculties of medicine, science, management and finance, law, arts and assessments were carried out at the beginning of their final academic year. Participants were excluded if they were actively engaged in competitive athletics, diagnosed with diabetes mellitus or other non-communicable diseases, declined to participate, or provided incomplete or inadequate responses on the administered questionnaires. A total sample of 420 students was selected from each of the 5 aforementioned faculties. To recruit participants, student lists were obtained from the respective faculties, and permission was sought to access lecture halls following scheduled lectures. On the designated day, information sheets and consent forms were distributed to randomly selected students. After obtaining informed written consent, participants were invited to a nearby, quiet lecture hall within their faculty to complete two self-administered questionnaires within 20 minutes. The information sheet provided a brief overview of the study’s purpose, procedures, types of data collected, potential risks and benefits of participation, and the expected time commitment. The consent form included details on voluntary participation, confidentiality, right to withdraw, and investigator contact information. All documents were written in clear, accessible language. Demographic data were first collected, including age, sex, faculty, area of residence, and selected lifestyle habits such as smoking, alcohol use, and physical activity. Musculoskeletal symptoms were assessed using the Standardized Nordic Musculoskeletal Questionnaire (SNMQ), which captured the presence or absence of pain or discomfort in nine anatomical regions (neck, shoulders, elbows, wrists, upper back, lower back, hips, knees, and ankles) within the past 12 months and past 7 days. This tool allowed for the identification of both point and period prevalence of musculoskeletal disorders through binary responses (“yes” or “no”). Psychological stress was evaluated using a Modified Student Life Stress Inventory (SLSI), which included 52 binary (yes/no) items. This inventory assessed both academic stressors and responses to stress, organized into subdomains: stressors (frustrations, conflicts, pressures, changes, and self-imposed stress) and reactions (physiological, emotional, behavioral, and cognitive). The maximum possible score was 52, with scores ranging from 0–27 indicating low response to stress, and scores from 28–52 reflecting high response to stress. Scores were also analyzed by subdomain. Both the SNMQ and the modified SLSI were translated into Sinhala and Tamil using a translation and back-translation process to ensure linguistic and conceptual accuracy. These translated versions were pilot tested on five students, and appropriate modifications were made based on their feedback. Further explanations were provided during data collection if any student encountered difficulty understanding a questionnaire item. Data were analyzed using both descriptive and inferential statistics with IBM SPSS version 26 software. Ethical approval for the study was obtained from the Ethics Review Committee of the Faculty of Medicine, University of Colombo. Additional administrative approvals were secured from the Vice Chancellor of the University of Colombo and the Deans of the four participating faculties. All participants were fully informed about the study, and their participation was voluntary. Confidentiality was maintained throughout the study by anonymizing data, assigning identification numbers to participants, and securely storing data in password-protected files. Personal identifiers were destroyed following the completion of data collection, ensuring participants' privacy was upheld throughout the research process. Results Distribution of the socio demographic details The mean age of the participants was 26 ± 1.9 years. A total of 420 students took part in the study, with a higher representation of females (57.1%, n = 240) compared to males (42.9%, n = 180). In terms of academic programme distribution, the majority of participants were from the Faculty of Management and Finance (38.1%, n = 160), followed by the Faculty of Medicine (26.2%, n = 110), Faculty of Science (17.9%, n = 75), Faculty of Law (10.7%, n = 45), and Faculty of Arts (7.1%, n = 30). Table 1 The demographic data of participants (Frequency and percentage%) Category Frequency (n) Percentage Gender Male 180 42.9% Female 240 57.1% Total 420 100% Academic Programme Faculty of Medicine 110 26.2% Faculty of Management and Finance 160 38.1% Faculty of Science 75 17.9% Faculty of Law 45 10.7% Faculty of Arts 30 7.1% Total 420 100% The prevalence of musculoskeletal disorders among final year students of University of Colombo. The findings reveal a high burden of musculoskeletal disorders (MSDs) among the participants, with a 12-month prevalence of 82.1% and a 7-day point prevalence of 64.5%, indicating both chronic and acute symptoms. The lower back region is the most affected region in terms of both prevalence (48.8%) and severity, with 19.5% of students reporting interference with activities of daily living (ADL). Neck (46.7%) and upper back (42.4%) regions also showed high prevalence rates, with notable functional impact (14.3% and 13.6% respectively), suggesting that axial musculoskeletal complaints are particularly common. Furthermore, 49.3% of the students experienced symptoms severe enough to disrupt daily functioning, underscoring the clinical significance of these disorders within this population. Table 2 Musculoskeletal Disorder Prevalence by Body Region (n = 420) Body Region 12-Month Prevalence (%, n ) Severity Affecting ADL (%, n ) 7-Day Point Prevalence (%, n ) Total (Any site) 82.1%, n = 345 49.3%, n = 207 64.5%, n = 271 Neck 46.7%, n = 196 14.3%, n = 60 28.1%, n = 118 Shoulders 40.5%, n = 170 13.1%, n = 55 23.6%, n = 99 Elbows 17.4%, n = 73 5.0%, n = 21 9.3%, n = 39 Wrists & Hands 25.7%, n = 108 9.3%, n = 39 15.5%, n = 65 Upper Back 42.4%, n = 178 13.6%, n = 57 29.0%, n = 122 Lower Back 48.8%, n = 205 19.5%, n = 82 33.1%, n = 139 Hips 19.0%, n = 80 6.7%, n = 28 10.7%, n = 45 Knees 30.2%, n = 127 11.0%, n = 46 18.6%, n = 78 Ankles & Feet 22.6%, n = 95 7.9%, n = 33 13.8%, n = 58 12-Month Prevalence refers to the number of students who reported MSD symptoms in the respective region at any point in the past 12 months. Severity Affecting ADL indicates students who reported that symptoms in that region interfered with their ability to perform activities of daily living. 7-Day Point Prevalence represents those who experienced symptoms within the 7 days prior to data collection. The impact of academic programme on developing musculoskeletal disorders among final year students. The academic programme showed a statistically significant impact (P = 0.006) on the development of musculoskeletal disorders among final year students. Notably, students in the Faculty of Medicine demonstrated a significantly higher 12-month prevalence of musculoskeletal disorders (91.8%, p = 0.003 ) compared to other faculties. Furthermore, a significant difference was also observed in the 7-day point prevalence of MSDs among medical students (78.2%, p = 0.004 ), indicating ongoing symptom burden. In contrast, students from the Faculty of Science, Faculty of Law, and Faculty of Management and Finance did not show statistically significant differences in the 12-month prevalence ( p = 0.06 , p = 0.06 , and p = 0.007 respectively), although the value for Management and Finance was borderline. Similarly, the 7-day point prevalence in these faculties did not reach statistical significance ( p > 0.05 ). Students in the Faculty of Arts showed the lowest prevalence and no significant difference in both timeframes. These findings suggest that academic demands and study environments, particularly in medical education, may contribute more heavily to the development of MSDs. Table 3 Association between academic programme and prevalence of musculoskeletal disorders (MSDs) among final year students Academic Programme 12-Month Prevalence of MSDs P value 7-Day Point Prevalence of MSDs P-value Faculty of Medicine 91.8% (n = 101) 0.003* 78.2% (n = 86) 0.004 * Faculty of Management and Finance 81.3% (n = 130) 0.007 60.0% (n = 96) 0.081 Faculty of Science 78.6% (n = 59) 0.060 61.3% (n = 46) 0.078 Faculty of Law 75.6% (n = 34) 0.060 57.8% (n = 26) 0.093 Faculty of Arts 70.0% (n = 21) 0.089 53.3% (n = 16) 0.115 Total 82.1% (n = 345) — 64.5% (n = 271) — * Statistically significant at p < 0.05 BMI Distribution of participants The BMI distribution of participants shows notable gender differences. A significantly higher proportion of females (15.0%) were underweight compared to males (6.7%), while more females (50.0%) fell into the normal BMI range than males (40.0%). In contrast, both overweight and obesity were more prevalent among males, with 26.7% in each category, compared to 17.5% of females. These findings indicate that while females tended to have a healthier BMI distribution with a higher percentage in the normal range, males were more likely to have excess body weight, reflected by the higher rates of overweight and obesity. Table 4 BMI distribution of participants by gender (Based on Asia-Pacific criteria) BMI Category Male (n = 180) % Female (n = 240) % Total (n = 420) % Underweight (< 18.5) 12 6.7% 36 15.0% 48 11.4% Normal (18.5–22.9) 72 40.0% 120 50.0% 192 45.7% Overweight (23.0–24.9) 48 26.7% 42 17.5% 90 21.4% Obese (≥ 25.0) 48 26.7% 42 17.5% 90 21.4% Total 180 100% 240 100% 420 100% Distribution of stressors among final year students in University of Colombo The analysis of mean scores from the Student Life Stress Inventory (SLSI) among final-year students (n = 420) revealed significant differences in both stressors and reactions to stressors across varying levels of perceived stress. Students categorized under the severe stress level reported markedly higher total stressor scores (84.67 ± 10.67) compared to those with moderate (75.61 ± 10.20) and mild (66.66 ± 10.85) stress levels, with this difference being highly significant (p < .0001). Across all specific domains of stressors—frustrations, conflicts, pressures, changes, and self-imposed stressors—there was a consistent and statistically significant increase in mean scores corresponding to the increasing severity of stress (all p < .0001). For instance, self-imposed stressors showed a progressive rise from mild (20.11) to moderate (22.02) and severe (23.97) stress levels. Similarly, reactions to stressors were significantly elevated among students with higher stress levels. The total reaction scores increased from 60.30 (SD = 13.70) in the mild group to 74.38 (SD = 13.48) in the moderate group and further to 88.18 (SD = 16.76) in the severe group (p < .0001). Subdomain analyses revealed that physiological, emotional, and behavioral responses were significantly more intense in students experiencing moderate and severe stress, with all domains showing p-values < .0001. Cognitive appraisal also varied significantly across groups (p < .05), though with a comparatively smaller difference in mean values. The total inventory score, representing overall stress impact, followed a clear ascending trend with increasing stress severity, ranging from 126.96 (SD = 21.63) in the mild group to 172.85 (SD = 24.04) in the severe group (p < .0001). These findings underscore the strong association between stress levels and both the perceived sources of stress and the magnitude of stress-related responses among final-year university students. Table 4 Mean (± SD) scores of stressors among final year students SLSI Domain Mild (n = 154) Moderate (n = 153) Severe (n = 113) p-value I. Stressors (Total) 66.66 ± 10.85 75.61 ± 10.20 84.67 ± 10.67 < .0001 Frustrations 15.89 ± 4.03 18.26 ± 3.88 20.42 ± 4.82 < .0001 Conflicts 9.71 ± 2.86 11.04 ± 2.67 12.23 ± 3.21 < .0001 Pressures 13.96 ± 3.07 15.69 ± 2.66 17.51 ± 1.98 < .0001 Changes 6.98 ± 2.36 8.57 ± 2.46 10.84 ± 2.85 < .0001 Self-imposed 20.11 ± 4.02 22.02 ± 3.86 23.97 ± 3.58 < .0001 II. Reactions to Stressors (Total) 60.30 ± 13.70 74.38 ± 13.48 88.18 ± 16.76 < .0001 Physiological 27.30 ± 7.86 34.72 ± 8.78 41.44 ± 10.60 < .0001 Emotional 9.99 ± 3.60 12.91 ± 3.25 15.97 ± 3.68 < .0001 Behavioral 15.05 ± 4.07 18.18 ± 4.63 22.07 ± 6.00 < .0001 Cognitive Appraisal 7.95 ± 2.65 8.56 ± 2.47 8.69 ± 2.30 < .05 III. Total Inventory Score 126.96 ± 21.63 149.99 ± 20.87 172.85 ± 24.04 < .0001 Distribution of Stressors Among Final Year Students of University of Colombo (By Gender) The analysis of stressor distribution by gender among the 420 final year students revealed notable gender-based differences. A significantly higher proportion of females (60.4%) reported elevated stress due to changes compared to males (52.8%) ( p = 0.009 ). Similarly, pressure-related stress was more prevalent among females (48.8%) than males (36.1%), showing a statistically significant difference ( p = 0.001 ). In contrast, frustration-related stress was significantly higher among males (37.2%) than females (25.8%), also reaching statistical significance ( p = 0.001 ). However, there were no statistically significant gender differences observed in conflict-related stress ( p = 0.819 ) or self-imposed stress ( p = 0.064 ). These findings suggest that while both genders experience multiple stressors, the type and intensity of stress vary, with females more affected by external academic pressures and changes, and males experiencing greater internal frustration. Distribution of reactions to stressors (by gender) among final year students of University of Colombo The analysis of stress reactions among final year students revealed significant differences across stress levels in all domains of reaction to stressors. As stress levels increased from mild to severe, mean scores for emotional, behavioural, and physiological reactions rose significantly (p < 0.0001), indicating a clear escalation in stress responses with severity. Students with severe stress reported the highest emotional reaction scores (15.97 ± 3.68), compared to those with moderate (12.91 ± 3.25) and mild stress levels (9.99 ± 3.60), suggesting that emotional distress intensifies with perceived stress. Similarly, behavioural reactions such as changes in routines or conduct increased from 15.05 ± 4.07 in the mild group to 22.07 ± 6.00 in the severe group. Physiological reactions, including symptoms like fatigue, sleep disturbances, and physical tension, also showed a marked increase with severity, rising from 27.30 ± 7.86 in mildly stressed students to 41.44 ± 10.60 among those with severe stress. Interestingly, cognitive reactions, such as negative thinking and concentration difficulties, showed only a slight but statistically significant increase (p < 0.05), indicating that cognitive responses may be less sensitive to changes in stress level compared to other domains. These findings suggest that as stress levels intensify, students are more likely to experience pronounced emotional, behavioural, and physiological responses, emphasizing the need for early stress intervention strategies in academic environments. Table 5 Distribution of reactions to stressors among final year students of University of Colombo Reaction Type Mild (n = 154) Moderate (n = 153) Severe (n = 113) P-value Total Reactions Score 60.30 ± 13.70 74.38 ± 13.48 88.18 ± 16.76 < .0001* Physiological 27.30 ± 7.86 34.72 ± 8.78 41.44 ± 10.60 < .0001* Emotional 9.99 ± 3.60 12.91 ± 3.25 15.97 ± 3.68 < .0001* Behavioral 15.05 ± 4.07 18.18 ± 4.63 22.07 ± 6.00 < .0001* Cognitive Appraisal 7.95 ± 2.65 8.56 ± 2.47 8.69 ± 2.30 < .05 * *Statistically significant at p < 0.05 The relationship between the level of stress and the development of musculoskeletal disorders among final year students of University of Colombo Table 2 presents the associations between academic stress levels and Body Mass Index (BMI) with musculoskeletal disorders (MSDs) across different body regions among final year university students (n = 420). A statistically significant association was observed between academic stress and MSDs in the neck (p = 0.003), shoulder (p = 0.012), upper back (p = 0.021), and lower back (p < 0.001), indicating that higher levels of academic stress may contribute to an increased prevalence of MSDs in these regions. Notably, the lower back showed the strongest association with stress. In contrast, the association between BMI and MSDs was significant only in the lower back (p = 0.018) and knee (p = 0.047), suggesting that increased BMI may predispose individuals to MSDs particularly in weight-bearing regions. A borderline association was also noted between BMI and shoulder MSDs (p = 0.053). No significant associations were found between either stress or BMI and MSDs in the elbow, wrist and hand, hip, or ankle and feet. These findings suggest a region-specific pattern of association, where academic stress appears to predominantly impact the upper body, while BMI exerts more influence on the lower back and knees. Table 6 Association of academic stress and BMI with MSDs by body region Body Region Stress level ( p -value) BMI ( p -value) Neck 0.003 0.072 Shoulder 0.012 0.053 Elbow 0.274 0.164 Wrist and Hand 0.087 0.109 Upper Back 0.021 0.064 Lower Back < 0.001 0.018 Hip 0.145 0.231 Knee 0.093 0.047 Ankle and Feet 0.219 0.131 Discussion Our study is the first campuswide analysis of the interaction between academic stress and musculoskeletal disorders (MSDs) among Sri Lankan undergraduates. The principal findings were (i) an exceptionally high 12month MSD prevalence of 8.1 % and 7day prevalence of 4.5 %; (ii) axial regions—particularly the low back—accounted for the bulk of symptoms and disability; (iii) medical students bore the greatest MSD burden; (iv) stress scores on every Student Life Stress Inventory (SLSI) domain rose stepwise from the mild to severestress groups and were paralleled by escalating physiological, emotional and behavioural reactions; and (v) higher stress level was significantly associated with MSDs of the neck, shoulders, upper back and low back, while higher bodymass index (BMI) was linked to lowback and knee pain. These observations are discussed below in light of existing literature, plausible mechanisms, and implications for prevention. Our 12month prevalence (82. %) lies within the global undergraduate range of 32.9–89. % (31) and exceeds the 73. % reported among alliedhealth trainees in another Sri Lankan university (32). Internationally, comparable or slightly lower figures have been noted in Canadian multifaculty cohorts (5967 %) (33) and in a pandemicera scoping review (cervical 9.9 %, lumbar 3.4 %) (34), situating Colombo finalists near the upper extreme of published rates. Lowback pain (LBP) was the dominant site (48. %), followed by neck (46. %) and upperback (424 %) symptoms, reproducing the “axial triad” pattern described among Saudi healthprofession students (neck55 %, LBP48 %) (35) and Canadian undergraduates (LBP 6169 %, neck 77 %) (36). Conversely, Australian dental students reported the neck as the lead site (6.3 %) with lower rates of LBP (37), illustrating how disciplinespecific ergonomics (e.g., static trunk flexion) modulate regional risk. Almost half of our respondents (49.3%) stated that pain limited activities of daily living (ADL). The proportion matches the 43–49% functional impairment seen at two Canadian universities ( 36 ) and confirms that student pain is often clinically consequential rather than trivial. Medical students had the highest 12month (91. %) and 7day (782 %) prevalence. Similar “medicalschool effects” have been recorded in Pakistan (38) and Canada (33), and dental trainees exhibit even higher Figs. 94 %) (39). Clinical curricula impose prolonged standing, awkward postures during ward or laboratory work, and heavier academic pressure, all of which amplify both biomechanical loading and psychophysiological stress. Onequarter of our sample fell into the severestress band, with women significantly overrepresented—a pattern replicated in European (40) and MiddleEastern medical schools (41). Females scored higher on change and pressurerelated stressors, whereas males reported greater frustration. Prior work attributes such gender divergences to differential coping styles and expectations: women internalise and emote, men externalise and display behavioural or physiological reactivity (42–44). Cognitiveappraisal scores, in contrast, showed only small sex differences, echoing findings from American campuses (45). Academic stress was positively associated with MSDs in four axial regions (neck, shoulders, upper and lower back), with the strongest relationship for LBP (p < 0.001). Comparable correlations have been demonstrated in Saudi ( 35 ), Canadian ( 33 ) and Nigerian cohorts ( 46 ), whereas studies in Pakistan ( 38 ) and Japan ( 47 ) failed to find such links, suggesting that contextual factors—study environment, coping resources, cultural norms—modulate the stress–pain pathway. Physiologically, sustained mental stress increases musclespindle discharge and sympathetic vasoconstriction, leading to lowlevel but persistent contraction, particularly in postural muscles of the neck and trunk (48). Repeated over months, this elevates intramuscular pressure, reduces oxygenation and precipitates nociceptor sensitisation, providing a plausible mechanistic bridge between stress and the axial triad of MSDs (49). Elevated body mass index (BMI) was significantly associated with low back pain (LBP) and knee pain, which are both weight-bearing anatomical regions. Similarly, research among Malaysian medical students reported a positive association between higher BMI and the prevalence of LBP ( 50 ). In contrast, no significant association was observed between BMI and neck pain in the present study, consistent with meta-analytic evidence indicating that mechanical loading plays a less prominent role in the aetiology of cervical spine disorders compared to lumbar or knee conditions ( 51 ). This study is included a large, multifaculty sample; simultaneous measurement of psychosocial (SLSI) and physical (Nordic Questionnaire) factors with validated tools; and analysis of both prevalence and functional impact. However, the crosssectional design precludes causal inference; recall bias may inflate 12month and 7-day estimates; pain and stress were selfreported without clinical confirmation; and unmeasured covariates (sleep, physical activity, workstation ergonomics) could confound associations. Recommendations Our data underscore an urgent need for dualpathway interventions. At the biomechanical level, ergonomic education, adjustable seating, and scheduled microbreaks should be prioritised, particularly in clinically intense programmes. Psychologically, universities should integrate stressmanagement workshops, peer support, and counselling services into curricula. Prospective studies are warranted to establish temporal links, evaluate intervention efficacy, and explore moderators such as resilience, sleep hygiene and physical fitness. Conclusion MSDs are highly prevalent among final-year undergraduates at the University of Colombo, with nearly half suffering functionlimiting pain. Academic stress independently predicts axial MSDs, while higher BMI compounds risk in loadbearing regions. Comprehensive, contextsensitive strategies that combine ergonomic modification with stress reduction are therefore essential to safeguard the musculoskeletal health and academic performance of Sri Lankan undergraduates. Author Affiliations 1 Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, Sri Lanka, 2 Department of Psychiatry, Faculty of Medicine, University of Colombo, Sri Lanka Author Declarations Declarations Competing interests: The authors declare that they have no competing interests. Funding: Self-funded Acknowledgments: We thank all the participants of this study. Author contributions: Both authors have contributed to the manuscript through data collection, data analysis, and writing. References Bernard B (ed) (1997) Musculoskeletal disorders and workplace factors: a critical review of epidemiologic evidence for work-related musculoskeletal disorders of the neck, upper extremity, and low back. U.S. Department of Health and Human Services, Washington (DC), pp 97–141 Woolf AD, Akesson K (2001) Understanding the burden of musculoskeletal conditions. 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Ann Saudi Med 25(1):36–40 Sami-Abdo RA, Redhwan AA, Mustafa AA, Krishna GR (2011) Stress and coping strategies of students in a medical faculty in Malaysia. Malays J Med Sci 18(3):57–64 Per-Olof O, Bertil SH, Istvan B et al (2005) Incidence of shoulder and neck pain in a working population: effect modification between mechanical and psychosocial exposure at work? J Epidemiol Community Health 59(9):721–728 Jenifer E, Jenifer C, Jeffrey FP et al (2007) The influence of stress on the menstrual cycle among newly incarcerated women. Women Health 17(4):202–209 Smith DR, Wei N, Ishitake T, Wang RS (2005) Musculoskeletal disorders among Chinese medical students. Kurume Med J 52(1–2):139–146 Lundberg U, Forsman M, Zachau G et al (2002) Effects of experimentally induced mental and physical stress on motor unit recruitment in the trapezius muscle. Work Stress 16(2):166–178 Birch L, Juul-Kristensen B, Jensen C, Finsen L, Christensen H (2002) Acute response to precision, time pressure and mental demand during simulated computer work. Scand J Work Environ Health 28(5):299–305 Abledu JK, Offei EB (2015) Musculoskeletal disorders among Ghanaian nursing students: prevalence and risk factors. Int J Res Health Sci 3(1):37–44 Senarath U, Fernando P, Wickramasinghe V (2021) Prevalence and risk factors of musculoskeletal pain among alliedhealth undergraduates in Sri Lanka. Ceylon Med J 66(2):72–78 NouriParto H, Sharan R, Kim A et al (2023) Musculoskeletal symptoms and mentalhealth correlates among Canadian university students: a multifaculty survey. BMC Musculoskelet Disord 24:1020 Popescu D, Ionescu E (2024) Musculoskeletal complaints during COVID-19 elearning: a global scoping review. J Bodyw Mov Ther 33:217–226 Almuwais AA, Alshammari SA, Alsulaiman SM et al (2023) Perceived stress and multisite musculoskeletal pain in Saudi healthprofession students. Majmaah J Health Sci 11(1):17–23 Campbell A, Côté P, Cancelliere C et al (2023) Oneweek prevalence and burden of neck and lowback pain in Canadian postsecondary students. Chiropr Man Th 31:23 Hayes MJ, Smith DR, Taylor JA (2009) Musculoskeletal disorders and symptom severity among Australian dental students. J Dent Educ 73(7):794–802 Hasan MM, Yaqoob U, Ali SS, Siddiqui AA (2018) Frequency of musculoskeletal pain and associated factors among Karachi undergraduates. Case Rep Clin Med 7(2):131–145 Felemban RA, Sofi RA, Alhebshi SA et al (2021) Predictors of musculoskeletal pain among Saudi dental students. Clin Cosmet Investig Dent 13:419–429 Öhman PO, Stålnacke BM (2005) Gender differences in perceived stress among Swedish university students. Scand J Public Health 33(4):260–264 Sani M, Mahfouz MS, Bani I (2012) Prevalence of stress among medical students in Jizan, Saudi Arabia. Saudi J Med Med Sci 2(1):46–51 Sharma R, Wavare RR (2013) Academic stress and depression among Indian medical students: a gender analysis. Med Innovatica 2(2):15–18 Bayram N, Bilgel N (2008) Depression, anxiety and stress among Turkish university students. Soc Psychiatry Psychiatr Epidemiol 43(8):667–672 ElAnsari W, Stock C (2010) Physical and psychological health of UK undergraduates and its relation to academic performance. Int J Environ Res Public Health 7(2):509–527 Misra R, Castillo LG (2004) Academic stress among American and international students: a comparative study. Int J Stress Manag 11(2):132–148 Ihegihu EYN, Okolo CA, Afolabi TO et al (2024) Academic stress, coping and musculoskeletal disorders in Nigerian healthscience undergraduates. Scholastic Med Sci 1(9):1–6 Sakakibara T, Mizuno T, Kasai Y (2020) Prevalence of chronic pain among Japanese university students. Austin Pain Relief 3(1):1007 Sjøgaard G, Lundberg U, Kadefors R (2000) The role of muscle activity and mental load in the development of musculoskeletal disorders. Eur J Appl Physiol 83(2–3):190–199 Magnavita N, Elovainio M (2011) Workrelated stress and upperlimb musculoskeletal disorders: a review. Occup Med (Lond) 61(6):422–432 Yusoff MSB, Esa AR, Mat Pa MN, Mey SC, Aziz RA, Abdul Rahim AF (2013) Prevalence and associated factors of low back pain among medical students in a Malaysian Medical School. Educ Med J 5(2):e74–e81. 10.5959/eimj.v5i2.124 Hoy D, Protani M, De R, Buchbinder R (2010) The epidemiology of neck pain. Best Pract Res Clin Rheumatol 24(6):783–792. 10.1016/j.berh.2011.01.019 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7098334","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":483856425,"identity":"85ca621e-2e75-40d8-a75a-1b06becee022","order_by":0,"name":"Menuja Deeghanu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA00lEQVRIiWNgGAWjYLACCQZmBn4QI6GAFC2SDSAtBsTbw8xgcABEE6NFt733mIRFjXW+8fnViR8eGDDI84sdwK/F7My5NAmJY+mW22683SwBdJjhzNkJBLTcyDGTkGA7bGB24+wGkJYEg9uEtNx/A9Ty77CB8Yyzm38Qp+UGj5mEZNthAwP+3m1E2nImx9hCsi/dQOIG7zaLBAMJIvxy/IzhbYlv1gb8/Wc33/xRYSPPL01ACwgwS4BICbBKCcLKQYDxA4jkP0Cc6lEwCkbBKBh5AAAxg0GInyzpFgAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0009-0003-0484-8578","institution":"Faculty of Medicine, University of Colombo, Sri Lanka","correspondingAuthor":true,"prefix":"","firstName":"Menuja","middleName":"","lastName":"Deeghanu","suffix":""},{"id":483856812,"identity":"b7a573f4-ee51-48e7-ae83-352ab1ecf182","order_by":1,"name":"Mahesh Rajasuriya","email":"","orcid":"","institution":"Department of Psychiatry, Faculty of Medicine, University of Colombo, Sri Lanka","correspondingAuthor":false,"prefix":"","firstName":"Mahesh","middleName":"","lastName":"Rajasuriya","suffix":""}],"badges":[],"createdAt":"2025-07-11 06:27:02","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7098334/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7098334/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86628666,"identity":"64af1bcf-2aad-45cc-8bd0-933a88c038b0","added_by":"auto","created_at":"2025-07-14 05:48:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1250273,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7098334/v1/b2c4fe3c-6c98-43b1-9847-8a80e4a35d42.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eAssociations Among Stress Level, Musculoskeletal Disorders, and Body Mass Index (BMI) Among Final-Year Students at the University of Colombo\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMusculoskeletal disorders (MSDs) are among the leading global causes of long-term pain, physical disability, and loss of productivity, affecting millions across all age groups (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). They encompass a wide range of inflammatory and degenerative conditions involving muscles, tendons, ligaments, joints, and associated neurovascular structures (3,4). Although traditionally associated with occupational exposure, MSDs are increasingly observed in younger populations, particularly among university students, due to academic demands, sedentary behaviour, and suboptimal ergonomics (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The global prevalence of MSDs pain among university students ranges from 32.9–89.3%, with low back, neck, and shoulder regions most commonly affected (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). While physical factors such as prolonged static posture, repetitive tasks, and poor workstation design remain well-documented contributors (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), a growing body of research has highlighted the significance of psychosocial risk factors, particularly academic stress (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAcademic stress, defined as the physiological and psychological response to academic-related demands that exceed available resources, is a prevalent concern among undergraduates, especially in high-pressure disciplines such as medicine and health sciences (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Sources of stress include time constraints, high workload, examinations, financial concerns, and social pressures (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Chronic academic stress activates the hypothalamic-pituitary-adrenal (HPA) axis, leading to elevated cortisol and catecholamine levels, which disrupt muscle perfusion, increase muscle tone, and impair tissue recovery, thereby contributing to the development or exacerbation of MSDs (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). In addition, stress-induced physiological responses can trigger pro-inflammatory pathways and alter immune function, further increasing vulnerability to musculoskeletal pain (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eBody mass index (BMI) is another important factor implicated in MSD development. Excessive body weight exerts additional mechanical stress on weight-bearing joints such as the lumbar spine and knees, predisposing individuals to chronic pain and disability (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Studies have shown a positive correlation between increased BMI and MSD symptoms across working and student populations (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Furthermore, chronic stress has been associated with behaviours such as emotional eating and reduced physical activity, both of which contribute to increased BMI, suggesting a potential synergistic interaction between stress and body weight in MSD pathogenesis (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Gender differences have also been observed in both stress perception and musculoskeletal symptomatology. Female students often report higher stress levels and are more likely to experience musculoskeletal pain, possibly due to hormonal influences, reduced muscle mass, and greater reporting tendencies (\u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e–\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Despite the evident multifactorial nature of MSDs in student populations, limited studies in Sri Lanka have comprehensively explored the interrelationships among stress and MSDs.\u003c/p\u003e\u003cp\u003eThis study aims to determine the prevalence and distribution of MSDs among final-year undergraduates of the University of Colombo and to assess the associations between stress level, and musculoskeletal pain. By identifying key risk factors in this unique academic setting, the findings can guide targeted interventions to enhance student well-being and academic performance.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eA cross-sectional analytical study was conducted among final year undergraduate students of the University of Colombo, Sri Lanka. The study population included students from the faculties of medicine, science, management and finance, law, arts and assessments were carried out at the beginning of their final academic year. Participants were excluded if they were actively engaged in competitive athletics, diagnosed with diabetes mellitus or other non-communicable diseases, declined to participate, or provided incomplete or inadequate responses on the administered questionnaires.\u003c/p\u003e\u003cp\u003eA total sample of 420 students was selected from each of the 5 aforementioned faculties. To recruit participants, student lists were obtained from the respective faculties, and permission was sought to access lecture halls following scheduled lectures. On the designated day, information sheets and consent forms were distributed to randomly selected students. After obtaining informed written consent, participants were invited to a nearby, quiet lecture hall within their faculty to complete two self-administered questionnaires within 20 minutes. The information sheet provided a brief overview of the study’s purpose, procedures, types of data collected, potential risks and benefits of participation, and the expected time commitment. The consent form included details on voluntary participation, confidentiality, right to withdraw, and investigator contact information. All documents were written in clear, accessible language.\u003c/p\u003e\u003cp\u003eDemographic data were first collected, including age, sex, faculty, area of residence, and selected lifestyle habits such as smoking, alcohol use, and physical activity. Musculoskeletal symptoms were assessed using the Standardized Nordic Musculoskeletal Questionnaire (SNMQ), which captured the presence or absence of pain or discomfort in nine anatomical regions (neck, shoulders, elbows, wrists, upper back, lower back, hips, knees, and ankles) within the past 12 months and past 7 days. This tool allowed for the identification of both point and period prevalence of musculoskeletal disorders through binary responses (“yes” or “no”).\u003c/p\u003e\u003cp\u003ePsychological stress was evaluated using a Modified Student Life Stress Inventory (SLSI), which included 52 binary (yes/no) items. This inventory assessed both academic stressors and responses to stress, organized into subdomains: stressors (frustrations, conflicts, pressures, changes, and self-imposed stress) and reactions (physiological, emotional, behavioral, and cognitive). The maximum possible score was 52, with scores ranging from 0–27 indicating low response to stress, and scores from 28–52 reflecting high response to stress. Scores were also analyzed by subdomain.\u003c/p\u003e\u003cp\u003eBoth the SNMQ and the modified SLSI were translated into Sinhala and Tamil using a translation and back-translation process to ensure linguistic and conceptual accuracy. These translated versions were pilot tested on five students, and appropriate modifications were made based on their feedback. Further explanations were provided during data collection if any student encountered difficulty understanding a questionnaire item.\u003c/p\u003e\u003cp\u003eData were analyzed using both descriptive and inferential statistics with IBM SPSS version 26 software. Ethical approval for the study was obtained from the Ethics Review Committee of the Faculty of Medicine, University of Colombo. Additional administrative approvals were secured from the Vice Chancellor of the University of Colombo and the Deans of the four participating faculties. All participants were fully informed about the study, and their participation was voluntary. Confidentiality was maintained throughout the study by anonymizing data, assigning identification numbers to participants, and securely storing data in password-protected files. Personal identifiers were destroyed following the completion of data collection, ensuring participants' privacy was upheld throughout the research process.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eDistribution of the socio demographic details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean age of the participants was 26\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9 years. A total of 420 students took part in the study, with a higher representation of females (57.1%, n\u0026thinsp;=\u0026thinsp;240) compared to males (42.9%, n\u0026thinsp;=\u0026thinsp;180). In terms of academic programme distribution, the majority of participants were from the Faculty of Management and Finance (38.1%, n\u0026thinsp;=\u0026thinsp;160), followed by the Faculty of Medicine (26.2%, n\u0026thinsp;=\u0026thinsp;110), Faculty of Science (17.9%, n\u0026thinsp;=\u0026thinsp;75), Faculty of Law (10.7%, n\u0026thinsp;=\u0026thinsp;45), and Faculty of Arts (7.1%, n\u0026thinsp;=\u0026thinsp;30).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eThe demographic data of participants (Frequency and percentage%)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency (n)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e240\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e420\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAcademic\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eProgramme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFaculty of Medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFaculty of Management and Finance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFaculty of Science\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFaculty of Law\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFaculty of Arts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e420\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eThe prevalence of musculoskeletal disorders among final year students of University of Colombo.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings reveal a high burden of musculoskeletal disorders (MSDs) among the participants, with a 12-month prevalence of 82.1% and a 7-day point prevalence of 64.5%, indicating both chronic and acute symptoms. The lower back region is the most affected region in terms of both prevalence (48.8%) and severity, with 19.5% of students reporting interference with activities of daily living (ADL). Neck (46.7%) and upper back (42.4%) regions also showed high prevalence rates, with notable functional impact (14.3% and 13.6% respectively), suggesting that axial musculoskeletal complaints are particularly common. Furthermore, 49.3% of the students experienced symptoms severe enough to disrupt daily functioning, underscoring the clinical significance of these disorders within this population.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMusculoskeletal Disorder Prevalence by Body Region (n\u0026thinsp;=\u0026thinsp;420)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBody Region\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e12-Month Prevalence (%, \u003cem\u003en\u003c/em\u003e)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSeverity Affecting ADL\u003c/p\u003e\n \u003cp\u003e(%, \u003cem\u003en\u003c/em\u003e)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e7-Day Point Prevalence (%, \u003cem\u003en\u003c/em\u003e)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (Any site)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82.1%, \u003cem\u003en\u0026thinsp;=\u0026thinsp;345\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49.3%, \u003cem\u003en\u0026thinsp;=\u0026thinsp;207\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.5%, \u003cem\u003en\u0026thinsp;=\u0026thinsp;271\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNeck\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46.7%, \u003cem\u003en\u0026thinsp;=\u0026thinsp;196\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.3%, \u003cem\u003en\u0026thinsp;=\u0026thinsp;60\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.1%, \u003cem\u003en\u0026thinsp;=\u0026thinsp;118\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eShoulders\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.5%, \u003cem\u003en\u0026thinsp;=\u0026thinsp;170\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.1%, \u003cem\u003en\u0026thinsp;=\u0026thinsp;55\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.6%, \u003cem\u003en\u0026thinsp;=\u0026thinsp;99\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eElbows\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.4%, \u003cem\u003en\u0026thinsp;=\u0026thinsp;73\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.0%, \u003cem\u003en\u0026thinsp;=\u0026thinsp;21\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.3%, \u003cem\u003en\u0026thinsp;=\u0026thinsp;39\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eWrists \u0026amp; Hands\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.7%, \u003cem\u003en\u0026thinsp;=\u0026thinsp;108\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.3%, \u003cem\u003en\u0026thinsp;=\u0026thinsp;39\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.5%, \u003cem\u003en\u0026thinsp;=\u0026thinsp;65\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eUpper Back\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.4%, \u003cem\u003en\u0026thinsp;=\u0026thinsp;178\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.6%, \u003cem\u003en\u0026thinsp;=\u0026thinsp;57\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29.0%, \u003cem\u003en\u0026thinsp;=\u0026thinsp;122\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLower Back\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.8%, \u003cem\u003en\u0026thinsp;=\u0026thinsp;205\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.5%, \u003cem\u003en\u0026thinsp;=\u0026thinsp;82\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.1%, \u003cem\u003en\u0026thinsp;=\u0026thinsp;139\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHips\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.0%, \u003cem\u003en\u0026thinsp;=\u0026thinsp;80\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.7%, \u003cem\u003en\u0026thinsp;=\u0026thinsp;28\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.7%, \u003cem\u003en\u0026thinsp;=\u0026thinsp;45\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnees\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.2%, \u003cem\u003en\u0026thinsp;=\u0026thinsp;127\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.0%, \u003cem\u003en\u0026thinsp;=\u0026thinsp;46\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.6%, \u003cem\u003en\u0026thinsp;=\u0026thinsp;78\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnkles \u0026amp; Feet\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.6%, \u003cem\u003en\u0026thinsp;=\u0026thinsp;95\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.9%, \u003cem\u003en\u0026thinsp;=\u0026thinsp;33\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.8%, \u003cem\u003en\u0026thinsp;=\u0026thinsp;58\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003e12-Month Prevalence refers to the number of students who reported MSD symptoms in the respective region at any point in the past 12 months.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eSeverity Affecting ADL indicates students who reported that symptoms in that region interfered with their ability to perform activities of daily living.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e7-Day Point Prevalence represents those who experienced symptoms within the 7 days prior to data collection.\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eThe impact of academic programme on developing musculoskeletal disorders among final year students.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe academic programme showed a statistically significant impact (P\u0026thinsp;=\u0026thinsp;0.006) on the development of musculoskeletal disorders among final year students. Notably, students in the Faculty of Medicine demonstrated a significantly higher 12-month prevalence of musculoskeletal disorders (91.8%, \u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.003\u003c/em\u003e) compared to other faculties. Furthermore, a significant difference was also observed in the 7-day point prevalence of MSDs among medical students (78.2%, \u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.004\u003c/em\u003e), indicating ongoing symptom burden. In contrast, students from the Faculty of Science, Faculty of Law, and Faculty of Management and Finance did not show statistically significant differences in the 12-month prevalence (\u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.06\u003c/em\u003e, \u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.06\u003c/em\u003e, and \u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.007\u003c/em\u003e respectively), although the value for Management and Finance was borderline. Similarly, the 7-day point prevalence in these faculties did not reach statistical significance (\u003cem\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/em\u003e). Students in the Faculty of Arts showed the lowest prevalence and no significant difference in both timeframes. These findings suggest that academic demands and study environments, particularly in medical education, may contribute more heavily to the development of MSDs.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eAssociation between academic programme and prevalence of musculoskeletal disorders (MSDs) among final year students\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr style=\"height: 59px;\"\u003e\n \u003cth style=\"height: 59px;\" align=\"left\"\u003e\n \u003cp\u003eAcademic Programme\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"height: 59px;\" align=\"left\"\u003e\n \u003cp\u003e12-Month Prevalence\u003c/p\u003e\n \u003cp\u003eof MSDs\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"height: 59px;\" align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"height: 59px;\" align=\"left\"\u003e\n \u003cp\u003e7-Day Point Prevalence\u003c/p\u003e\n \u003cp\u003eof MSDs\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"height: 59px;\" align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr style=\"height: 35px;\"\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003eFaculty of Medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003e91.8% (n\u0026thinsp;=\u0026thinsp;101)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003e0.003*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003e78.2% (n\u0026thinsp;=\u0026thinsp;86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003e0.004 *\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"height: 35px;\"\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003eFaculty of Management and Finance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003e81.3% (n\u0026thinsp;=\u0026thinsp;130)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003e60.0% (n\u0026thinsp;=\u0026thinsp;96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003e0.081\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"height: 35px;\"\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003eFaculty of Science\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003e78.6% (n\u0026thinsp;=\u0026thinsp;59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003e0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003e61.3% (n\u0026thinsp;=\u0026thinsp;46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003e0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"height: 35px;\"\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003eFaculty of Law\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003e75.6% (n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003e0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003e57.8% (n\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003e0.093\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"height: 35px;\"\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003eFaculty of Arts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003e70.0% (n\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003e0.089\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003e53.3% (n\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003e0.115\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"height: 35px;\"\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003e82.1% (n\u0026thinsp;=\u0026thinsp;345)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003e64.5% (n\u0026thinsp;=\u0026thinsp;271)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr style=\"height: 13px;\"\u003e\n \u003ctd style=\"height: 13px;\" colspan=\"5\"\u003e* Statistically significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eBMI Distribution of participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe BMI distribution of participants shows notable gender differences. A significantly higher proportion of females (15.0%) were underweight compared to males (6.7%), while more females (50.0%) fell into the normal BMI range than males (40.0%). In contrast, both overweight and obesity were more prevalent among males, with 26.7% in each category, compared to 17.5% of females. These findings indicate that while females tended to have a healthier BMI distribution with a higher percentage in the normal range, males were more likely to have excess body weight, reflected by the higher rates of overweight and obesity.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBMI distribution of participants by gender (Based on Asia-Pacific criteria)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBMI Category\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMale (n\u0026thinsp;=\u0026thinsp;180)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFemale (n\u0026thinsp;=\u0026thinsp;240)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;420)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnderweight (\u0026lt;\u0026thinsp;18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNormal (18.5\u0026ndash;22.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOverweight (23.0\u0026ndash;24.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eObese (\u0026ge;\u0026thinsp;25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e180\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e240\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e420\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eDistribution of stressors among final year students in University of Colombo\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe analysis of mean scores from the Student Life Stress Inventory (SLSI) among final-year students (n\u0026thinsp;=\u0026thinsp;420) revealed significant differences in both stressors and reactions to stressors across varying levels of perceived stress. Students categorized under the severe stress level reported markedly higher total stressor scores (84.67\u0026thinsp;\u0026plusmn;\u0026thinsp;10.67) compared to those with moderate (75.61\u0026thinsp;\u0026plusmn;\u0026thinsp;10.20) and mild (66.66\u0026thinsp;\u0026plusmn;\u0026thinsp;10.85) stress levels, with this difference being highly significant (p\u0026thinsp;\u0026lt;\u0026thinsp;.0001). Across all specific domains of stressors\u0026mdash;frustrations, conflicts, pressures, changes, and self-imposed stressors\u0026mdash;there was a consistent and statistically significant increase in mean scores corresponding to the increasing severity of stress (all p\u0026thinsp;\u0026lt;\u0026thinsp;.0001). For instance, self-imposed stressors showed a progressive rise from mild (20.11) to moderate (22.02) and severe (23.97) stress levels.\u003c/p\u003e\n\u003cp\u003eSimilarly, reactions to stressors were significantly elevated among students with higher stress levels. The total reaction scores increased from 60.30 (SD\u0026thinsp;=\u0026thinsp;13.70) in the mild group to 74.38 (SD\u0026thinsp;=\u0026thinsp;13.48) in the moderate group and further to 88.18 (SD\u0026thinsp;=\u0026thinsp;16.76) in the severe group (p\u0026thinsp;\u0026lt;\u0026thinsp;.0001). Subdomain analyses revealed that physiological, emotional, and behavioral responses were significantly more intense in students experiencing moderate and severe stress, with all domains showing p-values\u0026thinsp;\u0026lt;\u0026thinsp;.0001. Cognitive appraisal also varied significantly across groups (p\u0026thinsp;\u0026lt;\u0026thinsp;.05), though with a comparatively smaller difference in mean values. The total inventory score, representing overall stress impact, followed a clear ascending trend with increasing stress severity, ranging from 126.96 (SD\u0026thinsp;=\u0026thinsp;21.63) in the mild group to 172.85 (SD\u0026thinsp;=\u0026thinsp;24.04) in the severe group (p\u0026thinsp;\u0026lt;\u0026thinsp;.0001). These findings underscore the strong association between stress levels and both the perceived sources of stress and the magnitude of stress-related responses among final-year university students.\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMean (\u0026plusmn;\u0026thinsp;SD) scores of stressors among final year students\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eSLSI Domain\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;154)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;153)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;113)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eI. Stressors (Total)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e66.66\u0026thinsp;\u0026plusmn;\u0026thinsp;10.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75.61\u0026thinsp;\u0026plusmn;\u0026thinsp;10.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e84.67\u0026thinsp;\u0026plusmn;\u0026thinsp;10.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFrustrations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e15.89\u0026thinsp;\u0026plusmn;\u0026thinsp;4.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.26\u0026thinsp;\u0026plusmn;\u0026thinsp;3.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e20.42\u0026thinsp;\u0026plusmn;\u0026thinsp;4.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConflicts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e9.71\u0026thinsp;\u0026plusmn;\u0026thinsp;2.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.04\u0026thinsp;\u0026plusmn;\u0026thinsp;2.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e12.23\u0026thinsp;\u0026plusmn;\u0026thinsp;3.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePressures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e13.96\u0026thinsp;\u0026plusmn;\u0026thinsp;3.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.69\u0026thinsp;\u0026plusmn;\u0026thinsp;2.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e17.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChanges\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e6.98\u0026thinsp;\u0026plusmn;\u0026thinsp;2.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.57\u0026thinsp;\u0026plusmn;\u0026thinsp;2.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e10.84\u0026thinsp;\u0026plusmn;\u0026thinsp;2.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf-imposed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e20.11\u0026thinsp;\u0026plusmn;\u0026thinsp;4.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.02\u0026thinsp;\u0026plusmn;\u0026thinsp;3.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e23.97\u0026thinsp;\u0026plusmn;\u0026thinsp;3.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eII. Reactions to Stressors (Total)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e60.30\u0026thinsp;\u0026plusmn;\u0026thinsp;13.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74.38\u0026thinsp;\u0026plusmn;\u0026thinsp;13.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e88.18\u0026thinsp;\u0026plusmn;\u0026thinsp;16.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePhysiological\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e27.30\u0026thinsp;\u0026plusmn;\u0026thinsp;7.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.72\u0026thinsp;\u0026plusmn;\u0026thinsp;8.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e41.44\u0026thinsp;\u0026plusmn;\u0026thinsp;10.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmotional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e9.99\u0026thinsp;\u0026plusmn;\u0026thinsp;3.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.91\u0026thinsp;\u0026plusmn;\u0026thinsp;3.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e15.97\u0026thinsp;\u0026plusmn;\u0026thinsp;3.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBehavioral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e15.05\u0026thinsp;\u0026plusmn;\u0026thinsp;4.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.18\u0026thinsp;\u0026plusmn;\u0026thinsp;4.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e22.07\u0026thinsp;\u0026plusmn;\u0026thinsp;6.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCognitive Appraisal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e7.95\u0026thinsp;\u0026plusmn;\u0026thinsp;2.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.56\u0026thinsp;\u0026plusmn;\u0026thinsp;2.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e8.69\u0026thinsp;\u0026plusmn;\u0026thinsp;2.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;.05\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eIII. Total Inventory Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e126.96\u0026thinsp;\u0026plusmn;\u0026thinsp;21.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e149.99\u0026thinsp;\u0026plusmn;\u0026thinsp;20.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e172.85\u0026thinsp;\u0026plusmn;\u0026thinsp;24.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eDistribution of Stressors Among Final Year Students of University of Colombo (By Gender)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe analysis of stressor distribution by gender among the 420 final year students revealed notable gender-based differences. A significantly higher proportion of females (60.4%) reported elevated stress due to \u003cstrong\u003echanges\u003c/strong\u003e compared to males (52.8%) (\u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.009\u003c/em\u003e). Similarly, \u003cstrong\u003epressure-related stress\u003c/strong\u003e was more prevalent among females (48.8%) than males (36.1%), showing a statistically significant difference (\u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.001\u003c/em\u003e). In contrast, \u003cstrong\u003efrustration-related stress\u003c/strong\u003e was significantly higher among males (37.2%) than females (25.8%), also reaching statistical significance (\u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.001\u003c/em\u003e). However, there were no statistically significant gender differences observed in \u003cstrong\u003econflict-related stress\u003c/strong\u003e (\u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.819\u003c/em\u003e) or \u003cstrong\u003eself-imposed stress\u003c/strong\u003e (\u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.064\u003c/em\u003e). These findings suggest that while both genders experience multiple stressors, the type and intensity of stress vary, with females more affected by external academic pressures and changes, and males experiencing greater internal frustration.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDistribution of reactions to stressors (by gender) among final year students of University of Colombo\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe analysis of stress reactions among final year students revealed significant differences across stress levels in all domains of reaction to stressors. As stress levels increased from mild to severe, mean scores for emotional, behavioural, and physiological reactions rose significantly (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), indicating a clear escalation in stress responses with severity. Students with severe stress reported the highest emotional reaction scores (15.97\u0026thinsp;\u0026plusmn;\u0026thinsp;3.68), compared to those with moderate (12.91\u0026thinsp;\u0026plusmn;\u0026thinsp;3.25) and mild stress levels (9.99\u0026thinsp;\u0026plusmn;\u0026thinsp;3.60), suggesting that emotional distress intensifies with perceived stress. Similarly, behavioural reactions such as changes in routines or conduct increased from 15.05\u0026thinsp;\u0026plusmn;\u0026thinsp;4.07 in the mild group to 22.07\u0026thinsp;\u0026plusmn;\u0026thinsp;6.00 in the severe group. Physiological reactions, including symptoms like fatigue, sleep disturbances, and physical tension, also showed a marked increase with severity, rising from 27.30\u0026thinsp;\u0026plusmn;\u0026thinsp;7.86 in mildly stressed students to 41.44\u0026thinsp;\u0026plusmn;\u0026thinsp;10.60 among those with severe stress. Interestingly, cognitive reactions, such as negative thinking and concentration difficulties, showed only a slight but statistically significant increase (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), indicating that cognitive responses may be less sensitive to changes in stress level compared to other domains. These findings suggest that as stress levels intensify, students are more likely to experience pronounced emotional, behavioural, and physiological responses, emphasizing the need for early stress intervention strategies in academic environments.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDistribution of reactions to stressors among final year students of University of Colombo\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eReaction Type\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMild (n\u0026thinsp;=\u0026thinsp;154)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eModerate (n\u0026thinsp;=\u0026thinsp;153)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSevere (n\u0026thinsp;=\u0026thinsp;113)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Reactions Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.30\u0026thinsp;\u0026plusmn;\u0026thinsp;13.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74.38\u0026thinsp;\u0026plusmn;\u0026thinsp;13.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88.18\u0026thinsp;\u0026plusmn;\u0026thinsp;16.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.0001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysiological\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.30\u0026thinsp;\u0026plusmn;\u0026thinsp;7.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.72\u0026thinsp;\u0026plusmn;\u0026thinsp;8.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.44\u0026thinsp;\u0026plusmn;\u0026thinsp;10.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.0001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmotional\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.99\u0026thinsp;\u0026plusmn;\u0026thinsp;3.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.91\u0026thinsp;\u0026plusmn;\u0026thinsp;3.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.97\u0026thinsp;\u0026plusmn;\u0026thinsp;3.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.0001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBehavioral\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.05\u0026thinsp;\u0026plusmn;\u0026thinsp;4.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.18\u0026thinsp;\u0026plusmn;\u0026thinsp;4.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.07\u0026thinsp;\u0026plusmn;\u0026thinsp;6.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.0001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCognitive Appraisal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.95\u0026thinsp;\u0026plusmn;\u0026thinsp;2.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.56\u0026thinsp;\u0026plusmn;\u0026thinsp;2.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.69\u0026thinsp;\u0026plusmn;\u0026thinsp;2.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.05 *\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e*Statistically significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eThe relationship between the level of stress and the development of musculoskeletal disorders among final year students of University of Colombo\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e presents the associations between academic stress levels and Body Mass Index (BMI) with musculoskeletal disorders (MSDs) across different body regions among final year university students (n\u0026thinsp;=\u0026thinsp;420). A statistically significant association was observed between academic stress and MSDs in the neck (p\u0026thinsp;=\u0026thinsp;0.003), shoulder (p\u0026thinsp;=\u0026thinsp;0.012), upper back (p\u0026thinsp;=\u0026thinsp;0.021), and lower back (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating that higher levels of academic stress may contribute to an increased prevalence of MSDs in these regions. Notably, the lower back showed the strongest association with stress. In contrast, the association between BMI and MSDs was significant only in the lower back (p\u0026thinsp;=\u0026thinsp;0.018) and knee (p\u0026thinsp;=\u0026thinsp;0.047), suggesting that increased BMI may predispose individuals to MSDs particularly in weight-bearing regions. A borderline association was also noted between BMI and shoulder MSDs (p\u0026thinsp;=\u0026thinsp;0.053). No significant associations were found between either stress or BMI and MSDs in the elbow, wrist and hand, hip, or ankle and feet. These findings suggest a region-specific pattern of association, where academic stress appears to predominantly impact the upper body, while BMI exerts more influence on the lower back and knees.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab7\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eAssociation of academic stress and BMI with MSDs by body region\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBody Region\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStress level (\u003cem\u003ep\u003c/em\u003e-value)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBMI (\u003cem\u003ep\u003c/em\u003e-value)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNeck\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.072\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eShoulder\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.012\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eElbow\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.274\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.164\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eWrist and Hand\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.109\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eUpper Back\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.021\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.064\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLower Back\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.018\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHip\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.231\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnee\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.093\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnkle and Feet\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.131\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study is the first campuswide analysis of the interaction between academic stress and musculoskeletal disorders (MSDs) among Sri Lankan undergraduates. The principal findings were (i) an exceptionally high 12month MSD prevalence of 8.1 % and 7day prevalence of 4.5 %; (ii) axial regions\u0026mdash;particularly the low back\u0026mdash;accounted for the bulk of symptoms and disability; (iii) medical students bore the greatest MSD burden; (iv) stress scores on every Student Life Stress Inventory (SLSI) domain rose stepwise from the mild to severestress groups and were paralleled by escalating physiological, emotional and behavioural reactions; and (v) higher stress level was significantly associated with MSDs of the neck, shoulders, upper back and low back, while higher bodymass index (BMI) was linked to lowback and knee pain. These observations are discussed below in light of existing literature, plausible mechanisms, and implications for prevention.\u003c/p\u003e\u003cp\u003eOur 12month prevalence (82. %) lies within the global undergraduate range of 32.9\u0026ndash;89. % (31) and exceeds the 73. % reported among alliedhealth trainees in another Sri Lankan university (32). Internationally, comparable or slightly lower figures have been noted in Canadian multifaculty cohorts (5967 %) (33) and in a pandemicera scoping review (cervical 9.9 %, lumbar 3.4 %) (34), situating Colombo finalists near the upper extreme of published rates.\u003c/p\u003e\u003cp\u003eLowback pain (LBP) was the dominant site (48. %), followed by neck (46. %) and upperback (424 %) symptoms, reproducing the \u0026ldquo;axial triad\u0026rdquo; pattern described among Saudi healthprofession students (neck55 %, LBP48 %) (35) and Canadian undergraduates (LBP 6169 %, neck 77 %) (36). Conversely, Australian dental students reported the neck as the lead site (6.3 %) with lower rates of LBP (37), illustrating how disciplinespecific ergonomics (e.g., static trunk flexion) modulate regional risk.\u003c/p\u003e\u003cp\u003eAlmost half of our respondents (49.3%) stated that pain limited activities of daily living (ADL). The proportion matches the 43\u0026ndash;49% functional impairment seen at two Canadian universities (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e) and confirms that student pain is often clinically consequential rather than trivial. Medical students had the highest 12month (91. %) and 7day (782 %) prevalence. Similar \u0026ldquo;medicalschool effects\u0026rdquo; have been recorded in Pakistan (38) and Canada (33), and dental trainees exhibit even higher Figs.\u0026nbsp;94 %) (39). Clinical curricula impose prolonged standing, awkward postures during ward or laboratory work, and heavier academic pressure, all of which amplify both biomechanical loading and psychophysiological stress.\u003c/p\u003e\u003cp\u003eOnequarter of our sample fell into the severestress band, with women significantly overrepresented\u0026mdash;a pattern replicated in European (40) and MiddleEastern medical schools (41). Females scored higher on change and pressurerelated stressors, whereas males reported greater frustration. Prior work attributes such gender divergences to differential coping styles and expectations: women internalise and emote, men externalise and display behavioural or physiological reactivity (42\u0026ndash;44). Cognitiveappraisal scores, in contrast, showed only small sex differences, echoing findings from American campuses (45).\u003c/p\u003e\u003cp\u003eAcademic stress was positively associated with MSDs in four axial regions (neck, shoulders, upper and lower back), with the strongest relationship for LBP (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Comparable correlations have been demonstrated in Saudi (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), Canadian (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) and Nigerian cohorts (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e), whereas studies in Pakistan (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e) and Japan (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e) failed to find such links, suggesting that contextual factors\u0026mdash;study environment, coping resources, cultural norms\u0026mdash;modulate the stress\u0026ndash;pain pathway. Physiologically, sustained mental stress increases musclespindle discharge and sympathetic vasoconstriction, leading to lowlevel but persistent contraction, particularly in postural muscles of the neck and trunk (48). Repeated over months, this elevates intramuscular pressure, reduces oxygenation and precipitates nociceptor sensitisation, providing a plausible mechanistic bridge between stress and the axial triad of MSDs (49).\u003c/p\u003e\u003cp\u003eElevated body mass index (BMI) was significantly associated with low back pain (LBP) and knee pain, which are both weight-bearing anatomical regions. Similarly, research among Malaysian medical students reported a positive association between higher BMI and the prevalence of LBP (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e). In contrast, no significant association was observed between BMI and neck pain in the present study, consistent with meta-analytic evidence indicating that mechanical loading plays a less prominent role in the aetiology of cervical spine disorders compared to lumbar or knee conditions (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis study is included a large, multifaculty sample; simultaneous measurement of psychosocial (SLSI) and physical (Nordic Questionnaire) factors with validated tools; and analysis of both prevalence and functional impact. However, the crosssectional design precludes causal inference; recall bias may inflate 12month and 7-day estimates; pain and stress were selfreported without clinical confirmation; and unmeasured covariates (sleep, physical activity, workstation ergonomics) could confound associations.\u003c/p\u003e\u003cp\u003eRecommendations\u003c/p\u003e\u003cp\u003eOur data underscore an urgent need for dualpathway interventions. At the biomechanical level, ergonomic education, adjustable seating, and scheduled microbreaks should be prioritised, particularly in clinically intense programmes. Psychologically, universities should integrate stressmanagement workshops, peer support, and counselling services into curricula. Prospective studies are warranted to establish temporal links, evaluate intervention efficacy, and explore moderators such as resilience, sleep hygiene and physical fitness.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eMSDs are highly prevalent among final-year undergraduates at the University of Colombo, with nearly half suffering functionlimiting pain. Academic stress independently predicts axial MSDs, while higher BMI compounds risk in loadbearing regions. Comprehensive, contextsensitive strategies that combine ergonomic modification with stress reduction are therefore essential to safeguard the musculoskeletal health and academic performance of Sri Lankan undergraduates.\u003c/p\u003e\u003cp\u003eAuthor Affiliations\u003c/p\u003e\u003cp\u003e1 Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, Sri Lanka, 2 Department of Psychiatry, Faculty of Medicine, University of Colombo, Sri Lanka\u003c/p\u003e\u003cp\u003eAuthor Declarations\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eCompeting interests:\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eSelf-funded\u003c/p\u003e\u003cp\u003eAcknowledgments: We thank all the participants of this study.\u003c/p\u003e\u003ch2\u003eAuthor contributions:\u003c/h2\u003e\u003cp\u003eBoth authors have contributed to the manuscript through data collection, data analysis, and writing.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBernard B (ed) (1997) Musculoskeletal disorders and workplace factors: a critical review of epidemiologic evidence for work-related musculoskeletal disorders of the neck, upper extremity, and low back. 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Best Pract Res Clin Rheumatol 24(6):783\u0026ndash;792. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.berh.2011.01.019\u003c/span\u003e\u003cspan address=\"10.1016/j.berh.2011.01.019\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Faculty of Medicine, University of colombo, Sri Lanka","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Musculoskeletal disorders, academic stress, university students, body mass index, Sri Lanka","lastPublishedDoi":"10.21203/rs.3.rs-7098334/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7098334/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eIntroduction:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMusculoskeletal disorders (MSDs) are a leading cause of long-term pain and functional impairment globally, increasingly affecting younger populations due to sedentary lifestyles and academic stress. Despite growing international research, limited data exist on the interrelationship between MSDs and stress among undergraduates in Sri Lanka.\u003c/p\u003e\u003cp\u003e\u003cb\u003eObjective:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTo determine the prevalence and distribution of musculoskeletal disorders among final-year students at the University of Colombo and to assess associations between academic stress, body mass index (BMI), and musculoskeletal pain.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA cross-sectional analytical study was conducted among 420 final-year undergraduates across five faculties of the University of Colombo. Musculoskeletal symptoms were assessed using the Standardized Nordic Musculoskeletal Questionnaire (SNMQ), while academic stress was evaluated using a modified Student Life Stress Inventory (SLSI). BMI was calculated based on self-reported height and weight. Data were analyzed using descriptive statistics and inferential tests including Chi-square and p-value analysis using SPSS v26.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe 12-month and 7-day point prevalence of MSDs were 82.1% and 64.5%, respectively. The lower back (48.8%), neck (46.7%), and upper back (42.4%) were the most affected regions, with 49.3% reporting interference with daily activities. Medical students showed the highest MSD prevalence (91.8%). A significant association was observed between academic stress and MSDs in the neck, shoulders, upper and lower back (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). BMI was significantly associated with lower back (p\u0026thinsp;=\u0026thinsp;0.018) and knee pain (p\u0026thinsp;=\u0026thinsp;0.047). Females reported higher stress levels, especially in response to academic changes and pressures.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMSDs are highly prevalent among final-year undergraduates at the University of Colombo, with academic stress emerging as a key contributor, particularly to axial pain. Context-specific interventions combining ergonomic and psychological strategies are essential to address this dual burden.\u003c/p\u003e","manuscriptTitle":"Associations Among Stress Level, Musculoskeletal Disorders, and Body Mass Index (BMI) Among Final-Year Students at the University of Colombo","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-14 05:32:46","doi":"10.21203/rs.3.rs-7098334/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ed0b839c-39ed-4b90-8e86-2ad90f7abac5","owner":[],"postedDate":"July 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":51376524,"name":"Rheumatology"},{"id":51376525,"name":"Psychiatry"}],"tags":[],"updatedAt":"2025-07-14T05:32:46+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-14 05:32:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7098334","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7098334","identity":"rs-7098334","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}