RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTERATION OF

SUBJECT FOR DISSERTATION

1. / NAME OF THE : CANDIDATE AND ADDRESS / KUSUMA N.S.
Ist YEAR M.sc.NURSING.
GOVERNMENT COLLEGE OF NURSING
HASSAN-573201
2. / NAME OF THE : INSTITUTION / GOVERNMENT COLLEGE OF NURSING HASSAN
3. / COURSE OF STUDY & SUBJECT / Ist YEAR M.sc.NURSING.
MEDICAL SURGICAL NURSING
4. / DATE OF ADMISSION : / 29-07-2011
5. / TITLE OF THE TOPIC : / EFFECTIVENESS OF VIDEO ASSISTED
TEACHING PROGRAMME ON KNOWLEDGE
REGARDING THE PREVENTION AND
MANAGEMENT OF CERVICAL
SPONDYLOSIS AMONG BANK EMPLOYEES
OF SELECTED BANKS AT HASSAN

6. BRIEF RESUME OF THE INTENDED WORK.

INTRODUCTION

Worldwide there are an increased number of people suffering with life style associated disorders in recent times. This is brought about by the wrong kind of food, lack of exercise, and sedentary jobs. In addition to more serious diseases like heart disease, stroke etc, we are also seeing an increase in the number of people with weak bones, excess weight, and various pain problems which are related to bad life style practices. Neck pain along with back pain forms a major group among such pain of patients.

Cervical spondylosis is a very common problem, the earlier age of onset and increasing incidence of cervical spondylosis in recent times is thought to be the effect of changed life style and food habits. The neck movements become more painful and gradually the range of movements is reduced in cervical spondylosis. One of its features is the painful stiffness of neck in the morning. 1

Although Cervical spondylosis is considered an age related degeneration, it is found to occur in younger ages in persons with a sedentary, less active life style, and in persons who operate vibrating tools and machines.1 Repetitive strain injuriescaused due to lifestyle without ergonomic care, e.g., while working in front of computers, driving, traveling etc. also lead to cervical spondylosis.2 Other factors that can make a person more likely to develop cervical spondylosis are being overweight and not exercising, having a job that requires heavy lifting or a lot of bending and twisting, jobs with excesssive neck motion and a forward head position,mental health issues - depression/anxiety can increase tension therefore increasing neck pain,past neck injury (often several years before),past spine surgery, ruptured or slipped disk, severe arthritis, small fractures to the spine from osteoporosis etc.3,4,5

6.1 NEED FOR STUDY

Neck pain may result from abnormalities in the soft tissues like muscles, ligaments, and nerves as well as in bones and joints of the spine. When mechanical factor are prominent, the condition is referred to as “cervical spondylosis”. Most of the studies observed that the symptoms of the cervical spondylosis are related to the neck pain and back pain of the computer user and sedentary workers.Findings of several studies indicated that the sedentary office workers (such as bank employees) face a particularly high risk of developing neck pain, because when they work their neck and shoulders are generally static. 6

A survey was conducted by the World Health Organization (WHO) MONICA (MONItoring of trends and determinants in CArdiovascular disease) project to determine the prevalence of neck pain. Persons randomly selected from the population in a geographically well-defined area completed a self-administered questionnaire. Data analysis showed that 43% of the population reported neck pain, more women (48%) than men (38%). Women of working age had more neck pain than older ones. Chronic neck pain, defined as continuous pain of more than 6 months' duration, was commoner in women (22%) than men (16%).7

Cervical Spondylosisis also referred to degenerativeosteoarthritisof the joints between the centre of thecervical vertebraeand/orneural foraminae. If severe, it may cause radiculopathy. Direct pressure on the spinal cord may result inmyelopathy, characterized by global weakness, gait dysfunction, loss of balance, and loss of bowel and/or bladder control. The patient may experience a phenomenon of shocks (paresthesia) in hands and legs because of nerve compression andlack of blood flow. Vertebrobasilar insufficiency is another major problem related to cervical spondylosis. 2 Cervical spondylotic myelopathy is the most common cause of nontraumatic spastic paraparesis and quadriparesis.4 A study revealed a significantly higher prevalence ofcervical spondylosisamong patients complaining of vertigo. 8

Neck pain is a significant contributor to worldwide disability and poses a significant financial burden to its stakeholders, including expenses related to the diagnostic process, treatment costs, sick leave from work, and premature retirement pensions.8 In USA alone chronic neck pain patients use the health care system twice as often as the rest of the population. The estimated cost associated with work related musculoskeletal problems is projected to be between $45 and $54 billion annually.9

Treatment of cervical spondylosis is usually conservative in nature; the most commonly used treatments are nonsteroidal anti-inflammatory drugs (NSAIDs), physical modalities, and lifestyle modifications. Exercises designed for cervical pain include isometric neck strengthening routines, neck and shoulder stretching and flexibility exercises, back strengthening exercises, and aerobic exercises. Patient education on lifestyle modifications and nonsteroidal anti-inflammatory drugs (NSAIDs) has been shown to manage such conditions.2 Alternative therapies such as osteopathic manipulative medicine (OMM), massage, trigger-point therapy, chiropractic, osteopathic care, yoga and acupuncture may be utilized to control pain and maintain musculoskeletal function in some people. Surgery is occasionally performed.4

Physical exercise can reduce the prevalence of musculoskeletal disorders, but adherence to exercise is challenging for many employees. A study was conducted in Copenhagen on 132 office workers with neck/shoulder pain to determine prognostic factors for adherence to workplace exercise. Lower adherence to the 10-week exercise program was predicted by poorer psychosocial work environment and lower exercise self-efficacy. Researchers concluded that concurrent strategies to improve psychosocial work environment and individual exercise beliefs should be considered when implementing exercise at the workplace.10

A currently published data indicate that office workers are not well aware of preventive measures and suggest that the implementation of standard requirements or recommendations allow reducing health risk associated with the use of computers at work. Authors opined that there is an urgent need to promote education in occupational prophylaxis among computer users.11

A randomized controlled study was conducted to evaluate the effects on work-related neck and upper-limb disorders among computer workers stimulated (by a software program) to take regular breaks and perform physical exercises. The data on self-reported recovery suggested a favorable effect that more subjects in the intervention groups than in the control group reported recovery (55% versus 34%) from their complaints and fewer reported deterioration (4% versus 20%). Subjects in the intervention groups showed higher productivity.12

Strength and endurance training of the neck muscles, which has been shown to decrease pain and disability in chronic neck pain may be helpful for computer users with neck pain.Taking minibreaks, or microbreaks of 30 seconds once every 20 to 40 minutes is an effective means to reduce neck pain at work and these short breaks have no adverse effect on worker productivity.Computer workstations should be arranged to maximize correct posture and reduce neck flexion with the use of document stands and screen height adjustments, appropriate chairs and supports.Providing ergonomic counseling has been shown to reduce neck pain in computer users and may be useful as a prevention strategy.9

A randomized controlled trial showed that a comprehensive ergonomic program including education is significantly associated with reduced discomfort scores in the neck/shoulder. Another study demonstrated that providing ergonomic training and altering workstations reduce neck/shoulder pain for individuals working on computers in a call center. Consistent with these and most other studies, patient education is only one component of a comprehensive treatment regime.13

After conducting a thorough review of literature related to cervical spondylosis among sedentary workers and suggestions made by the experts the student investigator realized the need of educating sedentary workers and decided to develop a vedio assisted teaching programme regarding prevention and management of cervical spondylosis and to test its effectiveness on the knowledge of employees of selected banks of Hassan.

6.2 REVIEW OF LITERATURE

Review of literature is the selection of available documents on the topic which contain the information, ideas, data and evidences. It is an examination of the research that has been conducted in a particular field of study.

An extensive search of the literature was performed to review the epidemiologic literature concerning the occurrence of and the risk factors for pain and specific soft-tissue rheumatic conditions that affect the neck and upper limbs. Reviews showed a high prevalence of pain in the neck (10% to 19%), shoulder (18% to 26%), elbow (8% to 12%), and wrist/hand (9% to 17%) at any point in time. Significant risk factors for these disorders include age, female gender, obesity, and association with mechanical exposures (eg, posture, force, repetition, vibration) in the workplace. Also implicated are lack of psychologic well-being and psychosocial workplace factors such as high levels of demand, poor control, and poor support.14

A prospective cohort study with 1-year follow-up was conducted on 250 computer office workers in Khartoum, Sudan to investigate the relationship between work-related physical and psychosocial characteristics and symptoms of the arms, neck, and shoulders.The 1-year follow-up prevalence rate was 0.63 (95% CI: 0.58-0.70) for neck symptoms, 0.56 (95% CI: 0.45-0.66) for shoulder symptoms, and 0.46 (95% CI: 0.42-0.59) for symptoms of the forearms/hands. Three main risk factors were significantly associated with the presence of symptoms: time pressure [P=0.05], task difficulty [P=0.03], and previous history of symptoms [P=0.01].15

A retrospective population based study was conducted to determine the presence or absence of an inherited predisposition to the development ofcervicalspondylotic myelopathy (CSM). Genealogical Index of Familiality analysis for patients with CSM showed significant excess relatedness for disease (p<0.001). Relative risks were significantly elevated in both first- (p<0.001) and third-degree relatives (p<0.05). Investigators came to a conclusion that excess relatedness of cases and significantly elevated relative risks to both close and distant relatives supports an inherited predisposition to cervical spondylosiswith myelopathy.16

A cross-sectional survey was conducted using a descriptive questionnaire, which was distributed to 2000 office workers in 54 workplaces, in Bangkok to investigate the relationships between the self-reported prevalence of musculoskeletal symptoms in the neck, upper back and low back and certain individual, work-related physical and psychosocial factors. Findings revealed that frequently working in an uncomfortable posture increased the risk of experiencing head/neck symptoms Researchers concluded that some biopsychosocial factors were associated with the prevalence of musculoskeletal symptoms in the spine among office workers. They suggested developing specific strategies to reduce the occurrence of such symptoms in the office environment.17

A study was conducted to investigate the effect ofcervical spondylosison blood flow velocity of vertebral arteries duringcervicalrotation and to identify the possible association of vertigo with the decreased blood flow velocity through vertebral arteries during head rotation in these patients. The incidenceofcervical spondylosiswas estimated in patients with and without vertigo. Results revealed a significantly higher prevalence ofcervical spondylosisamong patients complaining of vertigo than those in non-vertigo group (71.4% vs. 32.9%, respectively). Furthermore, among patients with cervical spondylosis, patients having vertigo showed significantly more evident degenerative changes (P = 0.003).8

A retrospective study was conducted on 107 patients with cervical spondylosis aged 70 years or older surgically treated between 1995 and 2005 to analyze surgical outcome. The patients were divided into Group 1 (n = 60) aged between 70 and 74 years, and Group 2 (n = 47) 75 years or older. Patients with localized compression within 2 levels responsible for the neurological symptoms underwent anterior fusion, and patients with a narrow spinal canal were treated by laminoplasty. The pre- and postoperative neurological status (Neurosurgical Cervical Spine Scale) and postoperative complications were compared. Group 2 had a much higher ratio of anterior fusion at the C3-4 level. Many of the aged patients had multiple risk factors after surgery. 18

An experimental case-control study was conducted on 18 symptomatic female office workers and 21 asymptomatic female office workers to know whether symptomatic female office workers perform computing tasks with higher cervical postural muscle loads (in terms of higher amplitudes and less muscular rest) and experience more discomfort compared with asymptomatic individuals. The study finding revealed that case group had significantly higher discomfort during all conditions compared with the control group. The case group demonstrated higher median amplitudes and lower gap frequencies than the control group during bilateral conditions (typing and type-and-mouse) compared with unilateral conditions (mousing).19

A random controlled trial was conducted on Central registry office employees (n = 192; study group) and 192 peripheral registry office and central tax office employees (controls) in the city of Turin , Italy, to evaluate the effectiveness of a workplace educational and physical programme in reducing headache and neck and shoulder pain. Results revealed significant improvements in headache frequency, frequency of neck pain, responder rates for headache, for neck and shoulder pain, and for days with analgesic drug consumption. The study suggests that an educational and physical programme reduces headache and neck and shoulder pain in a working community.20

STATEMENT OF THE PROBLEM

A STUDY TO ASSESS THE EFFECTIVENESS OF VIDEO ASSISTED TEACHING PROGRAMME ON KNOWLEDGE REGARDING THE PREVENTION & MANAGEMENT OF CERVICAL SPONDYLOSIS AMONG BANK EMPLOYEES OF SELECTED BANKS AT HASSAN

6.3 OBJECTIVES OF THE STUDY

1.  To assess the existing knowledge regarding prevention and management of cervical spondylosis among bank employees.

2. To evaluate the effectiveness of video assisted teaching programme on knowledge regarding the prevention and management of cervical spondylosis among bank employees

3. To find the association between the post test knowledge scores and selected demographic variables of bank employees

6.3.1 HYPOTHESIS

H1- There will be a significant difference between mean pretest and post-test knowledge scores of bank employees

H2- There will be a significant association between post- test knowledge scores and demographic variables of bank employees.

6.3.2. VARIABLES

a) Independent Variables: Video assisted teaching programme regarding prevention and management of cervical spondylosis.