a study to find the occurrence of neck pain among computer professionals with and without forearm support

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					                          Rajiv Gandhi University of Health Sciences, Karnataka

                                             ANNEXURE II

1.   Name of the Candidate and              GAJBHIYE GUNJAN VIJAY
     Address (in block letters)             DR.M.V. SHETTY COLLEGE OF PHYSIOTHERAPY
                                            KULOOR, MANGALORE.

2.   Name of the Institution                DR.M.V.SHETTY COLLEGE OF PHYSIOTHERAPY.

3.   Course of Study and Subject            MASTER OF PHYSIOTHERAPY
                                            MUSCULOSKELETAL DISORDERS                      AND      SPORTS

4.   Date of Admission to Course            22nd JUNE 2011

5.   Title of the Topic                     A STUDY TO FIND THE OCCURRENCE OF NECK
                                            PAIN AMONG COMPUTER PROFESSIONALS WITH
                                            AND WITHOUT FOREARM SUPPORT.



           Occupational disorders are important because they affect a large number of workers.1 There is
           no internationally accepted definition for the term occupational disease or disorders. However,
           occupational disease or disorders are usually defined as disease/disorders arising out of or in the
           course of employment2.

            For people who spend a great deal of time using computers, neck pain is a common problem. By
            computer, we include desktop, laptop, notebook personal computers, video display units and
            terminals, to include the use of keyboards and associated pointing devices like a mouse or
            trackball. Neck pain is pain experienced anywhere from the base of the skull at ear level to the
           upper part of the back or shoulders. There have been great technological advances in computers
           along with an industrial shift to a more service oriented economy. This has led to more sedentary
           jobs as the downsizing of the number of employees is used to minimize losses in corporate
            profits and resulting increased demands in productivity for those who remain with a company
     and an increase in sick leave resulting from neck pain. This means more people use computers
      for work and recreation and we must find better ways of coping with neck pain associated with
      extended use of computers3.

     Musculoskeletal disorders are believed to represent the largest category of work related illness.
     Although musculoskeletal disorders are among the most prevalent and symptomatic
     complaints among workers, occupational medicine lacks measures for certain disorders,
     particularly in early stages4.

     The use of forearm support during computing tasks by adults has generally shown positive
     benefits to the musculoskeletal system, however the issue is complicated by the particular task
     (mousing, keying, and reading) and the type of support (wrist support, forearms on the desk
     surface, or resting on chair arms)5.

     There is strong evidence of an association between musculoskeletal disorders, workplace
     physical factors, and non-work related characteristics. Non-work related characteristics include
     physical fitness, anthropometric measures, lumbar mobility, physical strength, medical history,
     and structural abnormalities of the individuals. Workplace physical factors include heavy
     physical work, lifting and forceful movements, awkward postures, whole-body vibration, and
     static work postures. Static work postures of prolonged standing, sitting, and sedentary work
     are isometric positions where very little movement takes place. These postures are typically
     cramped or inactive and cause static loading on the muscles6.

     Musculoskeletal disorders represent a serious public health problem, being one of the most
     important causes of disability and absenteeism in workers, as well as having various personal,
     social and economic impacts7. Included among these musculoskeletal disorders is low back
     pain, neck, shoulder and knee pain.

Need of the study :
     There are various prevalence studies done to check the occurrence of various musculoskeletal
     disorders related to various professions. Recent studies have shown various musculoskeletal
     disorders pertaining to computer professionals. Related studies have been done on the effects of
     working hours, sittings positions, computer designs and other ergonomic aspects. They showed
     a strong correlation between these findings and the prevalence of musculoskeletal disorders.

      There is limited evidence or studies which have been done on the prevalence of musculoskeletal
     problems like neck pain and its correlation with various sitting positions (modified chairs) in
     computer professionals.

     Hence a need arises to check for the prevalence of neck pain in relation to the chairs with and
     without forearm support.
Research Question:
      Will there be any difference in the occurrence of neck pain with or without forearm support?


Null hypothesis:
      There will be no significant difference in neck pain among computer professionals with or
      without forearm support.

Alternate hypothesis:
      There will be significant difference in neck pain among computer professionals with or
      without forearm support.

      L.Straker et al 2006 conducted a study to determine the impact of computer display height and
      desk design on young adults. The study results suggest the potential benefits of reduced head
      and neck flexion with a high display may be offset by an increase in upper cervical extension.
      The increased head and neck flexion and asymmetry suggest an increased risk of
      musculoskeletal disorder when working with paper8.

      L Straker el al 2008 conducted a study on the effect of forearm support during computer use.
      This study quantified the postural and muscle activity effects of providing forearm support
      when using computers. Data from this study suggest providing forearm support probably
      reduces neck / shoulder muscle loads. This is broadly consistent with adult results. It appears
      that both adults and children act intuitively to reduce loading, by finding support where they

      Niklas Krause et al 2006 conducted a study. Providing forearm support is an effective
      intervention to prevent musculoskeletal disorders of the upper body and aids in reducing upper
      body pain associated with computer work. The study shows that use of large arm broads
      significantly reduces neck and shoulder pain as well as hand, wrist and forearm pain. Study

      findings also show arm broads and ergonomics trainings provide the most effect, with a
      statistically significant reduction in both neck and shoulder pain and right hand/wrist/forearm
      pain in comparison to the control group, who did not receive forearm support9.

      Keith T Palmer et al conducted a study to determine the prevalence of neck pain and its
      relation to occupation and occupational activities in the general population. The data provide
      evidence against a strong association between neck pain and examined occupational physical
          Rene Fejer et al conducted a study. The objective of the study was to determine the prevalence
          of neck pain in the world population. The study resulted in high prevalence of neck pain in
          world population11.

          Alperovitch-Najenson et al conducted a study. The aim of the study was to evaluate the
          prevalence of upper body quadrant pain among Israeli professional urban bus drivers and to
          evaluate the association between individual, ergonomic, and psychosocial risk factors and
          occurrence of neck pain. Drivers with neck pain reported significantly higher prevalence of pain
          in the upper back, shoulders and wrists compared to drivers without neck pain12.

          Gholam-Hossain Sadri investigated risk factors of musculoskeletal disorders in bus drivers and
          the result of this study shows that bus drivers’ musculoskeletal disorders like back, neck, and
          leg pain were relevant to some occupational risk factors13.

          Borje Rehn et al analyzed whether professional drivers of all terrain vehicles (ATVs) with neck
          pain have a different array of neuro musculoskeletal disorders in the neck and upper extremities
          than a reference group with neck pain from the general population and found out a high
          prevalence of asymmetrical and focal neuropathies among drivers with pain in the neck,
          operating various all terrain vehicles14.

          M. J. H. McCarthy et al conducted a study on the reliability of the Vernon and Mior Neck
          Disability Index, and its validity compared with the short form-36 Health Survey Questionnaire.
          This study showed that the Neck Disability Index has good reliability and validity compared
          with the SF3615.

          Vernon H, Mior S conducted a study for the reliability and validity of Neck Disability Index by
          targeting those whose activities of daily living are most affected due to neck pain. Neck
          Disability Index was compared with other questionnaire for statistical significance. Neck
          Disability Index score was compared to various questionnaires and Neck Disability Index
          achieved a high degree of reliability and internal consistency16.

          1) To determine the occurrence of neck pain among computer professionals with and without
             forearm support.

          2) To find out the relationship between time period of using computer and neck pain.


     7.1) Study Design:
          Descriptive Cross-sectional Study.
7.2) Source of data :
        Both Male and Female computer professionals in Mangalore.

7.2(I) Definition of Study Subjects:
        200 computer professionals in the age group of 22-30years will be recruited for the study from
        in Mangalore.

7.2(II) Inclusion and Exclusion Criteria:

Inclusion Criteria:
   1)   Informed consent.
   2)   Patients with neck pain.
   3)   Both male and female.
   4)   Subjects in the age group of 22-30 years.
   5)   Co-operative subjects.
   6)   Minimum work period of 20hrs per week for at least one year.

Exclusion Criteria:
   1)   Any joint problem.
   2)   History of any upper limb surgery.
   3)   Upper limb deformity.
   4)   Recent injuries.
   5)   Neurological condition.
   6)   Any deformities.
   7)   Taking any analgesics.
   8)   Non co-operative subjects.

7.2(III) Study Sampling Design, Method and Size:

Sample design:
        Convenient Sampling

Method of collection of data
        A group of 200 computer professionals will be screened, out of which those computer
        professionals fulfilling the inclusion criteria will be taken for the study.
Sample size:
      200 subjects fulfilling the inclusion and exclusion criteria.

7.2(IV) Follow Up:
       One time study.

7.2(V) Parameters used for comparison and statistical analysis used:
       Collected data will be analyzed by ‘chi square’ test.

7.2(VI) Duration of study:
        The study will be conducted over duration of 12 months.

7.2(VII) Methodology:
       200 computer professionals will be screened, out of which those computer professionals
       fulfilling the inclusion criteria will be taken in the study. Suitable time will be set up with the
       computer professionals, to get the informed consent and to distribute the questionnaire. Each
       computer professional will be allowed to answer the questionnaire separately.

       All the questions will be explained to each computer professional in simple words. The
       completed questionnaires will be collected at the end of the session from each computer

       All the computer professional will be screened using Neck Disability Index and it comprises
       of the following:

       A general questionnaire of 10 sections will be given to each computer professional having
       neck pain. Each section has 6 items describing various levels of activities and pain intensities.
       Respondents will be asked if they have neck pain pertaining to any activities. The sum of all
       activities will be converted into scores. Detailed description of all the contents in the Neck
       Disability Index scale will be explained to each computer professional before handling it to

       Neck Disability Index will be used in the study.
     7.3) Does the study require any investigations to be conducted on patients or other
     human or animal? If so, please describe briefly.
               Neck Disability Index

     7.4) Has ethical clearance been obtained from your institution in case of 7.3.

        1. Bildt C, Alfredsson L, Punnett L, et al. Effects of drop out in a longitudinal study of
           musculoskeletal disorders. Occp Environ Med. 2001; 58: 194 – 9.

        2. K.Park. Preventive and Social Medicine.

        3. Cagnie B et al. Individual and work related risk factors for neck pain among office workers: a
           cross sectional study. Eur Spine J 2007; 16(5): 679-86.

        4. D F Salerno; C Copley-Merriman; T N Taylor; J Shinogle; R M Schulz .A review of
           functional status measures for workers with upper extremity disorder Occupational
           and Environmental Medicine; Oct 2002; 59, 10; ProQuest Health and Medical Complete pg.

        5. Leon Straker et. The effect of forearm support on children’s head, neck and upper limb posture
           and muscle activity during computer use. Journal of Electromyography and Kinesiology. 2008.

        6. Harry Saporta. Durable Ergonomic Seating for Urban Bus Operators, 2000.

        7. E.N.C de Barros RN &        N.M.C. Alexandre RN .Cross-cultural adaptation of the Nordic
           musculoskeletal questionnaire, 2003 International Council of Nurses page 101.

        8. L. Straker et al. The impact of computer display height and desk design on 3D posture during
           information technology work by young adults. Journal of Electromyography and Kinesiology,

        9. Niklas et al. Forearm support reduces upper body pain linked to computer use. Journal of
           occupational and Environmental medicine. 2006.
10. Keith T Palmer et al. Prevalence and occupational association of neck pain in British
    population, Scand J Work Environ Health.2001; 27(1): 49-56.

11. Rene Fejer et al. The Prevalence of neck pain in the world population: A systematic critical
    review of the literature. Eur.Spine Journal. 15(6):834-848.

12. Alperovitch-Najenson et al. Upper body quadrant pain in bus drivers. Arch Environ Occupat
    ional Health. 2010; 65(4):218-23.

13. Gholam-Hossain Sadri.Risk factors of musculoskeletal disorders in bus drivers. Arch Iranian
    Med 2003; 6 (3): 214 – 215.

14. Börje Rehn, Tohr Nilsson, Bengt Järvholm. Neuro-musculoskeletal disorders in the neck and
    upper extremities among drivers of all-terrain vehicles – a case series. BMC Musculoskeletal
    Disorders. 2004; 5: 1.

15. M. J. H. McCarthy et al. The reliability of Vernon and Mior neck disability index, and its
    validity compared with the short form -36 health survey questionnaires. Eur Spine J v.16(12);
    Dec 2007.

16. Vernon H, Mior S. The neck disability index a study of reliability and validity. Manipulative
    Physiol Therapy. 1991 Sep; 14(7):409-15.

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