Evaluation of work Related Musculoskeletal Disorders in Shoulder and Neck with Ergonomic Intervention among School Teachers

 

Dr. R. S. Senthilkumar¹, B. Parthiban², M. Parghavi³

¹Associate Professor, Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences, Thandalam, Chennai - 602105,

²BPT Intern, Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences, Thandalam, Chennai - 602105,

³BPT Intern, Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences, Thandalm, Chennai - 602105,

 

ABSTRACT:

BACKGROUND: Musculoskeletal Disorder (MSD) have been described as the most disreputable and common causes of severe long term pain and physical disability that affect hundreds of millions of people across the world. From the literature review it is observed that MSD is very common among School teachers and they represent an occupational group among which there appears to be a high prevalence ^[7]. This study explored whether these disorders can be reduced by the provision of ergonomic intervention and exercises. It has been proposed as a conservative, noninvasive and cost effective intervention to treat MSDs as it functions to correct the cause of repetitive micro traumas. Lowering the physical exposure through ergonomic intervention is the traditional strategy to increase the work comfort in teachers. Hence, our goal is to present evidence-based intervention strategies for school teachers that will assist in ultimately reducing these potentially career-threatening injuries. OBJECTIVE: 1) To identify the work related musculoskeletal disorder in shoulder and neck among school teachers 2) To determine the effects of ergonomic intervention among school teachers. METHODOLOGY: 50 subjects with musculoskeletal disorder were selected based on inclusion and exclusion criteria. The subjects were divided into two groups (GROUP A –control group) and (GROUP B –intervention group) by consecutive odd or even method and detailed procedures are explained in patient’s words and informed consent are obtained from all the participants. Subjects were assessed for presence of musculoskeletal disorders affecting neck and shoulder. The subjects are asked to fill the questionnaire form (SPADI and NDI) about musculoskeletal symptoms and intensity. For the two groups pre-test and post-test values will be noted and taken as outcome values. STUDY DESIGN: Quasi Experimental Study Design. OUTCOME MEASURE: 1. SHOULDER PAIN AND DISABILITY INDEX (SPADI) 2. NECK DISABILITY INDEX (NDI). RESULTS: Statistical Analysis was carried out for the collected data using descriptive and interferential statistics. Mean and standard deviation was calculated for sub-scales of SPADI and NDI Questionnaire in pre-test and post-test and the data were computerized and analyzed. The mean value and standard errors were calculated for different variables and the difference in mean value was tested for statistical significance using un paired t test. P value of <0.0001 was considered as statistically significant. CONCLUSION: It has been concluded that, Ergonomic advice, relaxation exercises with isometrics for neck and shoulder of group-B is more effective than conventional exercise of group-A, in reducing pain and disability in subjects with WSMDs in neck and shoulder.

 

 

 

 

INTRODUCTION:

Musculoskeletal disorders represent one of the most common health problems in both developed and developing countries. Work-related musculoskeletal disorders (WMSDs) are becoming a major health problem encountered by professionals^[1]. Factors that predict the risk of musculoskeletal disorders can be divided into individual, ergonomic and psychosocial factors. Health problems range from discomfort, minor aches, and pain to more serious medical conditions requiring time off work and even medical treatment^[2]. The prevalence of WMSDs linearly correlates with age and duration of service. School teachers in general, have been demonstrated relative to other occupational groups, to report a high prevalence of musculoskeletal pain, with prevalence rates of between 40% and 95% ^[3]. The causes of MSD have been described as multi-factorial and prevalence rates vary between body sites and location of study^[3]. WMSDs decrease work productivity due to sick leave, absenteeism and early retirement. The work tasks of school teachers often involves with musculoskeletal complaints especially of the neck, shoulders and the back. During the course of their work, teachers may be subjected to conditions that cause physical health problems. Significant use of ‘head down’ posture, such as frequent reading, prolonged desk work, working on computer, marking of assignments and repetitive overhead writing on the blackboard^[2]. Musculoskeletal disorders can differ in severity from mild, periodic symptoms to severe, chronic and debilitating conditions.  Symptoms like aching, burning, cramping, loss of colour, numbness, swelling, pain, stiffness, tingling and weakness occur in developing stage of this illness. When the musculoskeletal disorder affects a person for a longer period of time it causes different bone problems to person ^[4]. The disorder occurs when the body part is called on to work harder, stretch further, impact more directly or otherwise function at a greater level than it is prepared for. It includes a wide range of inflammatory and degenerative conditions affecting the muscles, ligaments, tendons, nerves, bones and joints. Immediate effect will be minute, but after a repetitive stress/strain, constant micro trauma causes damage^[5].The work of a teacher does not involve only teaching students, but also preparation of lessons, assessing student’s work and may be involved in extracurricular activities The high incidence of MSDs among teachers clearly demonstrates the need for and the importance of current and relevant studies that focus on the prevalence and risk factors of musculoskeletal disorders among school teachers^[6].

 

CLINICAL SIGNIFICANCE:

Musculoskeletal disorders are the disorders of muscles, nerves, tendons, ligaments, joints, cartilage or spinal discs. WMSDs refers to MSDs that are made worse or longer lasting by working conditions. When an individual is exposed to work related ergonomic risk factors (force, repetition, posture), their muscles begin to fatigue. When writing on the board, there is an increased shoulder moment causing higher muscle activation levels in larger shoulder muscles (i.e., deltoid and trapezius). The issue, however, is that if this action is performed for long periods of time, it has the potential to produce adverse effects in the upper extremity related to possible abnormal coupling, scapular mal-positioning, superior and/or anterior migration of the humerus, resulting in possible rotator cuff injury and shoulder pain. As stated by Falla et al., (2007) in the teaching profession, shoulder pain and rotator cuff injury can potentially originate from excess activation of larger shoulder muscles (e.g., trapezius, deltoid, pectorals) when performing prolonged shoulder elevation movements which include writing on the board.

 

OBJECTIVE OF THE STUDY:

1) To identify the work related musculoskeletal disorder in shoulder and neck among school teachers 2) To determine the effects of ergonomic intervention among school teachers

 

METHODOLOGY:

50 subjects with musculoskeletal disorder were selected based on inclusion and exclusion criteria. The subjects were divided into two groups (GROUP A –control group) and (GROUP B –intervention group) by consecutive odd or even method and detailed procedure are explained in patient’s words and informed consent are obtained from all the participants. Subjects were assessed for presence of musculoskeletal disorders affecting neck and shoulder. The subjects are asked to fill the questionnaire form (SPADI and NDI) about musculoskeletal symptoms and intensity. For the two groups pre-test and post-test values will be noted and taken as outcome values.

 

STUDY DESIGN: Quasi Experimental Study Design.

OUTCOME MEASURE:  1. SHOULDER PAIN AND DISABILITY INDEX (SPADI) 2. NECK DISABILITY INDEX (NDI)

 

SELECTION OF CRITERIA:

Inclusion criteria:

Age group - 25 to 45 years.

Only female teachers working for 6-8 hours a day working since a minimum of 2 years.

Pain during neck movements (flexion, extension, lateral rotation and lateral flexion) and shoulder movements (flexion, extension, abduction, adduction, medial and lateral rotation)

Individuals with self-reported pain primarily over the neck and shoulder region for at least 6 months. 

 

Exclusion criteria:

Pregnant women

Malignancy

Fractures or dislocation

Ankylosing spondilitis

Vertebro basilar insufficiency

Recent undergone surgery (3 months)

 

PROCEDURE:

50 subjects with musculoskeletal disorder were selected based on inclusion and exclusion criteria. The subjects were divided into two groups (GROUP A –control group) and (GROUP B –intervention group) by consecutive odd or even method and detailed procedures are explained in patient’s words and informed consent are obtained from all the participants. Subjects were assessed for presence of musculoskeletal disorders affecting neck and shoulder. The subjects are asked to fill the questionnaire form (SPADI and NDI) about musculoskeletal symptoms and intensity.

 

TREATMENT PROCEDURE:

GROUP ‘A’ (Control group)

1    Conventional physiotherapy

2    Isometric exercises for neck and shoulder. The subjects were asked to do the exercise, 3-times, 5-repetition per day for 3 weeks. Follow up was done after 3 weeks

 

GROUP ‘B’ (Intervention group):

1. Ergonomic correction: The subjects were examined, evaluated for their discomfort using SPADI and NDI and prescribed the following ergonomic advice:

·        Maintenance of correct posture while standing and sitting

·        Repeated stooping to be avoided.

·        Head down posture for long is not advised.

·        Overhead activities for long time is not advised.

·        Ergonomically appropriate height of the writing board is very essential.

·        Desk height should be at the ergonomically correct level so that stooping or straining of neck and shoulder muscles are avoided.

·        Desk should be maintained at an angle with respect to the height of the subject so that no stress is there while reading or writing.

·        Avoiding awkward posture is very essential.

 

The subjects were asked to follow the above for 3 weeks- regularly. Follow was done after 3 weeks.

 

2. Relaxation exercises – Alexander relaxation technique as an education or guidance system to improve posture and movement and to use muscle efficiently

·        Neck free

·        Head forward and up

·        Back lengthen

·        Keeping length

·        Back widen

·        Shoulder release and widen

·        changing posture  relaxed breathing.

The subjects were asked to do those exercises 3-times daily for 3 weeks. Follow was done after 3 week

 

3. Conventional physiotherapy.

 

The collected data was tabulated and analyzed using descriptive and inferential statistics. To all parameters mean and standard deviation (SD) was used. Unpaired t-test was used to analyse significant changes between pre and post-test measurements. P value <0.05 was considered as statistically significant.

 

 

Table-1:Pre-test between control group and experimental group

S. NO	STATISTICAL MEASURES	SPADI		NDI
		GROUP A	GROUP  B	GROUP A	GROUP B
1	MEAN	51.32	39.04	19.44	14.68
2	STANDARD DEVIATION	4.75	4.76	2.95	2.75
3	PERCENTAGE	83.29 %	84.73 %	76.96 %	80.04 %

 

 

Table-2:Post-test between control group and experimental group

S. NO	STATISTICAL MEASURES	SPADI		NDI
		GROUP A	GROUP B	GROUP A	GROUP B
1	MEAN	67.96	70.20	29.04	29.60
2	STANDARD DEVIATION	6.04	6.14	3.03	2.94
3	PERCENTAGE	61.90 %	49.02 %	59.25 %	47.52%

Interpretation of SPADI and NDI between Group A and Group B

 

 

S. NO	VARIABLES	STANDARD ERROR	C INTERVAL	t  VALUE	P VALUE SIGNIFICANT LEVEL	DF
1	SPADI	1.344	95%	9.1344	0.0001	48
2	NDI	0.806	95%	5.9071	0.0001	48

 

Graph 1: Pre test for control and experimental group

 

Graph 2: Posttest for control and experimental group

 

Graph 3: Interpretation for SPADI and NDI

 

DISCUSSION:

This study was a questionnaire-based self-reported survey and Relaxation exercises with ergonomic intervention pre and post score analysis, reflecting the attitude and perception of teachers regarding pain and discomfort. School teachers are susceptible to work related musculoskeletal disorders with a significant prevalence for neck, shoulder and back pain too. School teachers, spend a substantial portion of their work-days in tasks involving movements and postures, which stress their bodies (Cheng HYK, Cheng CY, Ju YY, 2013). In this study neck and shoulder pain was the most prevalent musculoskeletal complaint, reported by 78.05% (neck pain) and 84.01% (shoulder pain) of the respondents while chronic neck pain was not reported by the teachers (0%). This was taken prior to the intervention. Hence, The purpose of this study is to describe the work related musculoskeletal disorders in neck and shoulders with ergonomic intervention among school teachers and to analyse the effect of the treatment. The results were compared by pre and post intervention for two variables like pain and disability of school teachers with WMSD in neck and shoulder. In this study, Due to nature of outcome measures of Pain and disability were calculated and compare pre and post intervention, parametric statistical tests, dependent t sample test and un paired t test were used. The two tailed p value is less than 0.0001 by conventional criteria this difference is considered to be extremely statistically significant in the experimental group. In the pre intervention phase the results shows SPADI receiving Group A  of Mean and SD (67.96± 6.04) and Group B (70.20±6.14),  NDI  of Group A (29.04±3.03) and Group B (29.60±2.94). There are no significant changes in the both control and experimental group. In the post intervention phase, results were analysed by Unpaired t test and the results shows SPADI receiving Group A  of Mean and SD (51.32± 4.75) and Group B ( 39.04± 4.76),  NDI  of Group A (19.44±2.95) and Group B ( 14.68±2.75). The results shows that the significant changes in the both groups. The t test calculation shows that the two tailed P value equals 0.0001 by conventional criteria this difference is considered to be very statistically significant in the Group B experimental group. In the SPADI of standard error 1.344 and 95% confidential interval, t value was 9.1344, P value is less than 0.0001there is statistically significant in the Group B. In the NDI were the standard error 0.806 and 95% confidential interval, t value is 5.901. P value is less than 0.0001, there is extremely statistically significant in the experimental Group B.

 

CONCLUSION:

In this study, the teachers were mostly women, married, with children and working as teachers for over 3 yrs. Some health conditions were associated with reduced work ability among teachers. Being a teacher with permanent contract with more time (in years) of profession; the presence of physical pain in the past six months and not sleeping well at night. Such health conditions and also individual factors could have a direct association with the high percentage of WMSDs and “own opinion diseases” related by teachers. The study suggests that studies involving ergonomics will be of importance in identifying prevention strategies. Measures to decrease high prevalence of MSDs among teachers should be implemented. Measures like Health education programs aiming to encourage in maintaining ideal posture and reduce repeated activities with same hand. Measures for schools are proportional reduction of work load for aging teachers, optimizing working hours per day, planning exercise sessions and ergonomic classes to teach how to avoid/decrease WMSDs.

 

LIMITATIONS OF THE STUDY:

1    The study was done in a short time period with a small number of subjects

2    The study is based on only female teachers.

 

RECOMMENDATIONS:

1    To make the study more valid, long term study with large sample size is recommended.

2    Further studies are recommended to analyse the effect of other modified exercise regimen.

3    Inclusion of both genders is recommended.

 

CONFLICT OF INTEREST:

Authors declare no conflict of interest.

 

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Accepted on 06.04.2019          © RJPT All right reserved

Research J. Pharm. and Tech 2019; 12(8):3726-3730.