WORK RELATED MUSCULOSKELETAL DISORDERS OF UPPER LIMB AND NECK IN SCHOOL TEACHERS- A SURVEY

RESEARCH PROPOSAL

MPT (PHYSIOTHERAPY IN MUSCULOSKELETAL & SPORTS)

Mr. BHARAT DEEP

DEPARTMENT OF PHYSIOTHERAPY

FR. MULLER MEDICAL COLLEGE

MANGALORE-575002

RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE

ANNEXURE II

PROFORMA FOR REGESTRATION OF SUBJECTS FOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS
(IN BLOCK LETTERS) /
BHARAT DEEP
DEPARTMENT OF PHYSIOTHERAPY
FR MULLERMEDICALCOLLEGE
MANGALORE
2 /
NAME OF THE INSTITUTION
/ FR MULLERMEDICALCOLLEGE
MANGALORE
3 /
COURSE OF STUDY
/ MASTER OF PHYSIOTHERAPY
(MUSCULOSKELETAL & SPORTS)
4 / DATE OF ADMISSION TO COURSE / 1-06-2007
5
/ TITLE OF THE TOPIC / WORK RELATED MUSCULOSKELETAL DISORDERS OF UPPER LIMB AND NECK IN SCHOOL TEACHERS - A SURVEY
Brief resume of the intended work
6.1 Need for the study
WHO defined “work related musculoskeletal disorders” as “an appropriate nomenclature for constellation of disorders that have been shown to have strong association with one or more work place exposures”1 . . Work related musculoskeletal disorders are the disorders caused or made worse by work environment. Work related musculoskeletal disorders can cause severe and debilitating symptoms such as pain, numbness and tingling reduce productivity, work restriction and transfer to another job. Musculoskeletal disorders include a group of conditions that involve the nerves, muscles, tendons, supporting structures (e.g. intervertebral discs).2-5
The prevalence of occupationally related musculoskeletal disorders has increased dramatically in developing countries. Several work related risk factors such as awkward posture, forceful exertions, high repetition rates, etc have been associated with increased prevalence of musculoskeletal disorders6-8. Teachers who provide knowledge are also prone to musculoskeletal disorders especially the teachers who use board for teaching because of repetitive upper limb movements, over shoulder movements, lack of sufficient rest between tasks and wrong postures. Laboratory based science instructions requires teachers to perform many repetitive tasks, such as writing on the chalk board, using a microscope, keyboarding and pipetting, which can lead to aches and pain.6 Schools are
uncompromising environments. Teachers are on show from the minute they enter the school gates 9 The risk of developing musculoskeletal disorders is low in the education sector, which is reflected in correspondingly low incidence rates. However, even though the rates are low, musculoskeletal disorders prevention in educational sector should not be neglected 10
According to ‘Third European Survey on Working conditions 2000’, the rate of musculoskeletal illness in education sector (expressed as a percentage of total days of absence caused by health problems) is 35%. 10
The aim of the study is to look into the epidemiological picture of work related musculoskeletal disorders in teachers to get a better understanding of extent of severity of work related musculoskeletal disorders, and to access the rate of injury at the time of presentation and to provide basic data to facilitate further research11
We can offer some of the more common ergonomics related hazards of working in the laboratory and suggestions for avoiding them. Finally, we will be able to sort out the cause and different risk factors.6
Research question:
What is the prevalence rate of work related musculoskeletal disorders among school teachers?
Hypothesis:
There will be significant work related musculoskeletal disorders among school teachers.
Null Hypothesis:
There are no significant musculoskeletal disorders among school teachers.
6.2 Review of literature
In a study, it is mentioned thatthelaboratory based science instructions require teachers to perform many repetitive tasks, such as writing on the blackboard, using a microscope, key boarding and pipetting, which can lead to aches and pain.6
Fernando and co-researchers 11 conducted a study on stressors, self-efficacy, coping resources and burnout among secondary school teachers in Spain. Teachers
reported that when their pedagogical practice in the school setting was being interfered or hindered by a set of factors from the multiple contexts involved in students learning, problems of burnout occurred. In addition, teachers with a high level of efficacy and more coping resources reported suffering less stress and burnout than teachers with a low level of self efficacy and fewer coping resources.
Christine and colleagues15, in their study on physical and psychosocial risk factors associated with neck-shoulder discomfort in male and female music teachers, found that the strongest risk factors for women were high psychological demands and teaching at many schools and for men, lifting, playing the guitar and low social support were the strongest risk factors.
The NIOSH review also considered the relationship between psychosocial work
factors and neck and upper limb musculoskeletal disorders. Buckle and Devereux 8 performed a study on the nature of work related neck and upper limb muscoskeletal disorders. It showed that intensified workload, low social support and perceived monotonus work may be involved in the developmental process of pain and aches.
The school well being report (London), in Teachers support network reported that the management wanted to enable employers both to identify and tackle the causes of work-related ill health before an individual needs to take time off, and to provide support for those returning to work following a period of sickness absence.9
Buckle and Devereux 8 in their study on the nature of work related neck and upper limb musculoskeletal disorders, reported that work related musculoskeletal disorders described a wide range of inflammatory and degenerative diseases and disorders. These conditions resulted in aches and pain and functional impairment and may affect, besides others, the neck, soulders, elbows, forearms, wrists and hands. Blatter et al and Borg and Burr showed that self reported symptoms of the neck and shoulders were more prevalent than symptoms experienced in the upper limbs. In recent years, the majority of the illness has been due to repetitive trauma of the upper extremities. Scandinavian studies have often combined neck and shoulder musculoskeletal disorders into one health outcome variable.
Rosecrance and Cook7 conducted a study on upper extremity musculoskeletal disorders. The author concluded that a substantial prevalence of neck and upper limb disorders were associated with repetitive work perform with a flexed neck and elevated and abducted arms.
Pope and colleagues14 performed a study on occupational risk factors for shoulder pain. It was found that shoulder pain was the result of many factors, including physical load and the psychosocial work environment.
6.3 Objectives of the study
Identify the work related musculoskeletal problems among government and private school teachers on the basis of:
  1. Age
  2. Gender
  3. Working hours per day
  4. Work experience
7. Materials and methods
7.1 Source of data
School teachers working in and around Mangalore.
7.2 Method of collection of data
Study design: Descriptive studySampling procedure:
A questionnaire will be prepared to find out various work related musculoskeletal disorders in school teachers, which will be validated by experienced physiotherapy faculties and statisticians. This questionnaire in printed form will be given to school teachers directly by the researcher. A request or introductory letter will be added with the questionnaire.
Sample size:
500 school teachers
Inclusion criteria:
-Teachers using board.
- Teachers with atleast two years of experience.
Exclusion criteria:
-Teachers with the history of neurological problems
-Pregnancy
-Injury due to trauma
-Teachers who are not using board
Measurement tools:
Survey questionnaire.
Statistical analysis:
Collected data will be analyzed by frequencies, percentages and by chi-square test.
7.3Does the study require any investigations to be conducted on patients or
animals?
NO
7.4Has ethical clearance been obtained?
YES
8. List of references:
1. Kamath S. U., Kamath K.R.. Work related musculoskeletal disorders in Computer
1 professionals. Journal of Orthopaedic Association of South Indian States.September2007; 4: 45–47
2 BarrA. E., Barbe M. F. Pathophysiological tissue changes associated with repetitive movement, a review of the evidence. Physical therapy. Feburary 2002; 82(2): 173 - 187.
3 Novak C. B., Mackinon Susan E. Nerve injury in repetitive motion disorders.
Clinical orthopaedics and related research. 1998; 351: 10 – 20.
4 Siogaard . Muscle injury in repetitive motion disorders.
Clinical orthopaedics and related research. June 1998; 351: 21 – 31. 5 Allan D. A. Structure and physiology of joints and their relationship to repetitive . strain injuries. Clinical orthopaedics and related research.1998; 351 : 32 –38.
3 6 Roy, Ken. More Ergo, Less Aargh!
Science scope. July 2005; 28 (8): 50 -51.
7 Rosecrance J. C., Cook Thomas M.. Upper extremity musculoskeletal disorders.
Occupational association and a model of prevention. Central European Journal of Occupational and Environmental Medicine. 1998; 4(3) : 214-231
8 Buckle P.W, Jason Devereux J. . The nature of work related neck and upper limb
musculoskeletal disorders. Applied Ergonomics. May 2002; 33(3): 207 – 217.
9 Teachers support network. The school well being report, London.
10 Work-related musculoskeletal disorders in education. E – FACTS.
11 BetoretF. D. . Stressors, Self-efficacy, Coping resources and Burnout
among Secondary school teachers in Spain. Educational Psychology. 4 august 2006;
26: 519 – 39.
12 Engels J A, Gulden Jw Van Der. Work related risk factors for musculoskeletal
complaints in the nursing profession: results of a questionnaire survey.
Occupational and Environmental Medicine.1996; 53: 636 – 641.
13 Melhorn J. M. . Repetitive strain injuries: fact or fiction. Current opinion in
. Orthopaedics. August 2004; 15 (4): 226 – 233.
14 Daniel P. P., Elaine Thomas. Occupational risk factors for shoulder pain.
Occupation Environmental Medicine. July 2000; 57: 433 – 442.
15 Brulin C., Sundeline G. . Physical and Psychosocial risk factors associated with
neck-shoulder discomfort in male and female music teachers. Medical problems of
performing artists. March 2003; 18 (1): 33.
9 / SIGNATURE OF CANDIDATE
10 / REMARKS OF THE GUIDE
11 / NAME AND DESIGNATION OF
(In Block Letters)
11.1. GUIDE: / Mr. Kanagaraj R.
Associate Professor
Dept. of Physiotherapy
11.2. SIGNATURE:
11.3. CO-GUIDE: / Dr. Edward Nazareth
Professor
Dept. of Orthopaedics
11.4. SIGNATURE
11.5. HEAD OF THE DEPT. / Mr. Kanagaraj R.
Associate Professor
Dept. of Physiotherapy
11.6. SIGNATURE
12 / 12.1. REMARKS OF THE DEAN
12.2. SIGNATURE

FatherMullerMedicalCollege

Department of Physiotherpy

Mangalore

I ,Bharat Deep, first year, postgraduate physiotherapy student, Department of Physiotherapy, FatherMullerMedicalCollege, Mangalore, am conducting a survey to find out various work related musculoskeletal disorders of upper limb and neck among school teachers. I request you to kindly accept my invitation and participate in this study by filling the questionnaire.

Thank you.

[ A work related musculoskeletal injury is defined as an injury that results from a work related event ]

Questionnaire for the survey

[You are requested to answer all the questions]

Demographic data

Name:

Age:Sex:

Qualification:Height (cm):

Weight (kg):Number of years of experience:

Name of the School:

Type of school: a. Government b. Private

Kindly go through the alternatives given below the questions and tick (√) whichever is applicable to you. You can tick more than one option if it is applicable.

1. The level of school

a. Lower primaryb. Upper primary

c. Secondaryd. Higher Secondary

2. Average number of work hours per day.

a. 1 to 3b. 4 to 5

c. 6 to 8d. More than 8

3. Average number of students in a class.

a. 11 to 20b. 21 to 30

c. 31 to 40d. More than 41

4. You are performing any body work-outs

a. Morning walkb. Exercises

c. Yogad. No

5. While working, I experience work related discomfort (pain)? [excluding non

work related causes such as pregnancy, accidents, previous injuries, diseases etc]

a. Alwaysb. Most times

c. At timesd. Never

[If ‘no’ please go to question number 19]

6. How was the initiation of the pain / discomfort?

a. Suddenb. Gradual

c. Insidiousd. Not aware

7. Which part / joint is giving discomfort or pain in . neck, arm, forearm and hand? [Shade the area . in the picture]

8. After the shift , I do have pain (discomfort)

a. Alwaysb. Most times

c. At timesd. Never

9. Had you taken time off from work due to pain?

a. Many timesb. Some times

c. Rarelyd. Never

10. What was the cause of the injury?

a. Working for prolonged period b. Inadequate infrastructure.

b. Working without adequate rest periods. d. Non cooperative atmosphere.

11. When did you develop the musculoskeletal pain / discomfort?

a. 1 to 4 weeks backb. 1 to 3 months back

c. 4 to 6 months backd. More than 6 months

12. Do you feel that the pain / discomfort have affected your profession?

a. Alwaysb. Most times

c. At timesd. Never

13. If affected, what is your next step? [If not affected go to question number 14]

a. Decrease working hoursb. Avoid students

c. Take off timed. Look for alternatives

14. How long were you unable to work due to the pain / discomfort?

a. Never affectedb. Up to 2 hours

c. One dayd. More than a day

15. Has the pain / discomfort affected your personal life?

a. Alwaysb. Most times

c. At timesd. Never

16. How much does it interfere with your sleep?

a. Neverb. At times

c. Most timesd. It affects every night

17. Have you ever thought of changing your profession because of the pain?

a. Alwaysb. Most times

c. At timesd. Never

18. Have you worked with the sustained pain?

a. Alwaysb. Most times

c. At timesd. Never

19. Are you taking precautions to prevent work related pain or discomfort?

a. Taking adequate rest periods b. Maintaining good posture

c. Sitting with back well supported d. Not taking any precautions.

20. Do you experience any other health problems related to your work?

  1. Throat painb. Allergy

c. Stress d. others

Address

[Your address and identity will be kept confidential]

Thanks for your patience, time and cooperation