Rajiv Gandhi University of Health Sciences, Karnataka
Bangalore
ANNEXURE II
1. / Name of the Candidate and Address (in block letters) / SWATI PODDARDR.M.V.SHETTY COLLEGE OF PHYSIOTHERAPY
VIDYANAGAR
KULOOR,MANGALORE-575013
2. / Name of the Institution / DR.M.V.SHETTY COLLEGE OF PHYSIOTHERAPY
3. / Course of Study and Subject / Master of Physiotherapy (MPT)
4. / Date of Admission to Course / 8th JUNE 2007
5. / Title of the Topic / WORK RELATED LOW BACK PAIN AMONG INDIAN NURSES: A CROSS SECTIONAL STUDY.
6.
7) / Brief Resume of the Intended Work
6.1) Introduction and Need of the Study:
Musculoskeletal disorders represent common occupational problems and also are risk factors among nurses. Work place risk factors including manually handling patients and undertaking physically laborious work has been the case for concern for low back pain in nurses. The complex nature of the musculoskeletal disorder risk factors identified suggested that remediation strategies which focus on the alleviating the risk factors need a greater emphasis; so screening and early diagnosis of the low back pain in the nurses is of uttermost importance.1,2
Previous studies show musculoskeletal disorder in health care personnel’s namely nurses; but there is lack of studies on back pain disorders among women in health care sector. Low back pain is the commonest problem among the musculoskeletal disorders compared to neck, shoulder and upper back pain3.
Nurses have one of the highest rates of musculoskeletal disorders of any occupation as they indulge in bending and lifting activities which causes low back pain commonly. Perceived physical demands are associated with reported musculoskeletal disorders in registered nurses4, 5.
6.1) Need for the study :
Nursing profession involves bending and lifting activities which are associated with low back pain. There are studies which evaluate musculoskeletal disorders in shoulder, neck, knees and upper back in nurses and in other age and sex matched group. However, there is limited data available which evaluates the disability caused due to low back pain among nurses and its relationship with endurance of back extensors. Hence a need arises to evaluate disability among nurses.
Research Question:
How much is the work related disability among nursing professionals due to low back pain in this population?
Does endurance of back extensors have a contributing role in work- related low back pain?
Hypothesis:
Low-back pain is prevalent among nurses and is a cause of disability.
Individuals with lower endurance of extensors of back are prone to low back pain.
6.2) REVIEW OF LITERATURE:
Smith D R et al studied a 12 month period prevalence of MSD at any body site was 85.5% in Japanese nurses. MSD was most commonly reported at the shoulder (71.9%); followed by the lower back (71.3%); neck (54.7%) and upper back (33.9%) 1.
Alison Trikoff et al studied the musculoskeletal disorders among registered nurses and found high prevalence and greater functional consequences2.
Eva l Horneij et al suggested a focus on previous low back disorders and sick leave for the design of early prevention programs aiming at reducing future sick leave to any cause among nursing aides/ assistant nurses3.
Alison Trikoff et al suggested that even though the use of mechanical devices and lifting item a was limited in nursing work places these prevention strategies were related to reduced odds of musculoskeletal disorder4.
Trikoff A. M et al described that moderate and high perceived physical demands were significantly associated with reported neck, shoulder and back musculoskeletal disorder cases and high physical demands are associated with reported musculoskeletal disorders in registered nurses and the associated is stronger in staff nurses5.
Fritz J M et al conducted a study to examine the validity of a global rating of change as a reflection of meaningful change in patient status and to compare the measurement properties of modified Oswestry Low Back Pain Disability questionnaire (OSW) and the Quebec Back Pain Disability Scale (QUE) and found that the modified OSW demonstrated superior measurement properties compared with the QUE6.
Auffrey et al says research demonstrates that nurses are providing care in practice environment that foster high injury rates. Over 60% of back injuries reported in this study occurred in the first 2 hours in 8 hour shift7.
Cheng et al in close calls for low back injuries concluded that great number of near accidents or close calls of low back injuries among home care nurses is high8.
6.3) Objectives Of Study :
1. To estimate prevalence of low back pain among nursing professionals.
2. To evaluate disability due to low back pain in nurses.
3. To compare endurance in subjects with low-back pain and asymptomatic control group.
Materials And Methods:
7.1) Study Design
Cross sectional study design.
7.2) Source of data:
Sample will be collected from local hospitals..
7.2(I) Definition of Study Subjects
Registered nurses with age group 21 to 55 years.
7.2(II) Inclusion and Exclusion Criteria:
INCLUSION CRITERIA :
· Group-1 (NURSES)
→ Informed consent
→ Gender: Females.
→ Nurses within age group of 21-55 years.
→ Nurses who are involved in patient care activities.
→ Nurses working for 8 -10 hours.
· Group -2 (Age and sex matched subjects)
→ Informed consent
→ Gender: Females.
→ Subjects within age group of 21-55 years.
EXCLUSION CRITERIA :
→ Non cooperative subjects.
→ Pregnant subjects.
→ Subjects with neurological disorders such as IVDP.
→ Subjects with spine and lower limb fractures.
→ Subjects with structural changes such as increased lumbar lordosis.
7.2(III) Study Sampling Design, Method and Size:
Sample of convenience.
METHOD OF COLLECTION OF DATA:
Subjects will be included in the study after assessed with a structured questionnaire.
SAMPLE – SIZE:
Atleast 200 number of nurses would be screened for low-back pain. Approximately 40 symptomatic subjects from the screened fulfilling the inclusion and exclusion criteria will be included.
7.2(IV) Follow Up:
No follow up is needed.
7.2(V) Parameters used for comparison and statistical analysis used:
Endurance of back extensors would be compared using student‘t’- test among symptomatic and asymptomatic subjects.
7.2(VI) Duration of study:
Data would be collected over a period of 12 months.
7.2(VII) Methodology:
Subjects itself reported low back pain would be identified by survey conducted among nurses. Subjects reporting low back pain will be included into the study after getting their informed consent. A thorough medical history will be taken from all the subjects to screen for inclusion and exclusion criteria. Subjects will be assessed using a structured questionnaire to find out the self attributed causal factors for low back pain, nature and duration of work etc. Modified Oswestry Low Back Pain Disability Questionnaire will be used to evaluate disability due to low-back pain. They will be further evaluated with endurance tests of back extensors; the results obtained will be compared with endurance values of age and sex matched asymptomatic control group.
7.3) Does the study require any investigations to be conducted on patients or other human or animal? If so, please describe briefly.
Yes.
- Modified Oswestry Low Back Pain Disability Questionnaire.
- Endurance tests for back extensors.
Yes
8) List of References :
1) Smith D R, Mihashi M, Adachi Y, Koga H, Ishitake T(2006) A detailed analysis of musculoskeletal disorder risk factors among Japanese nurses.
2) Alison Trinoff,Jane A Lipscomb, Jeanne Geiger- Brown, Barbara Brady(2002). Musculoskeletal problems of the neck, shoulder and back and functional consequences in nurses: Wiley inter science journal.
3) Eva L Horneij, Irene B Holmstrom, Charlotte Ekdahl(2004). Sick leave among home- care personnel; a longitudinal study of risk factors.
4) Alison Trinkoff, Barbara Brady, Karen Nielsen (2003) journal of nursing administration 33(3); 153-158. Work place prevention and musculoskeletal injuries in nurses.
5) Trinkoff A M, Lipscomb J A, Geiger- Brown J, STORR C L, Brady B A (2003) April: 24(3); 270. Am journal of preventive medicine. Perceived physical demands and reported musculoskeletal problems in registered nurses.
6) Fritz JM, Irrgang JJ. A comparison of modified oswestry low back pain disability questionnaire and the Qubec Back Pain Disability scale. Phys Ther. 2001 Feb; 81(2): 776-88.
7) Auffrey, Lucille. Message from the executive director. The Canadian nurse. Oct 2003. vol.99, iss. 9; pg.32.
8) Cheung, kin. Close calls for low-back injuries. The Canadian nurse. Aug 1999. Vol.95, Iss.7; pg.47.