KARNATAKA, BANGALORE
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1. / Name of the Candidate
And
Address
(in block letters): / REENA REWANI
B-43 CHATHURBHAI PARK,
BHD,ESSAR PETROL PUMP,
HARNI-WARASHIYA RING ROAD,
VADODARA
GUJARAT – 390006
2. / Name of the Institute : / LAXMI MEMORIAL COLLEGE OF PHYSIOTHERAPY,
MANGALORE.
3. / Course of study and subject : / MASTERS OF PHYSIOTHERAPY (MPT)
2 YEAR DEGREECOURSE
PHYSIOTHERAPY IN MUSCULOSKELETAL AND SPORTS
4. / Date of Admission / 28th November 2011
5. / Title of the Topic / “ A COMPARATIVE STUDY ON EFFECT OF NECK ISOMETRIC EXERCISES VERSUS ENDURANCE EXERCISES FOR NECK IN OFFICE WORKERS WITH NON-SPECIFIC NECK PAIN”
6. / Brief Resume of the Intended Work:
6.1 NEED FOR THE STUDY
· Neck disorders are a common and costly problem in the modern, industrialized countries, affecting approximately 70% of office workers at some point in their life. Most often neck pain has no specific and identifiable cause and hence is regarded as non specific/mechanical neck pain1-2.
· Non-specific neck pain is common among computer users. More than 50% computer users reported neck musculoskeletal symptoms during the first year after starting a new job.3
· Neck pain causes considerable personal suffering due to pain, disability, and impaired quality of work and life in general which can be a great socio-economic burden on both patients and society.4-7
· Much attention has been paid to the evaluation of the effectiveness of various interventions aiming to prevent or alleviate neck pain.8-9
· Exercise therapy has been found to be beneficial for non-specific neck pain.10-12
· High levels of distress, and physical and psychosocial workplace factors are found to be predictors of onset of neck pain.Thus the origin of neck pain is thought to be multifactorial. So, implementing the same exercise regimen for everyone with neck pain would be irrational.13
· To date, it remains unclear which type of exercise is more beneficial for desk top workers.
· Thus, the aim of the study is to gain insights into which types of exercise from neck isometric exercises and endurance exercises for neck are more effective for the prevention and cure of non-specific neck pain in desktop workers.
6.2 HYPOTHESIS
NULL HYPOTHESIS (H0): There may not be a significant difference between the effect of isometric exercises versus endurance exercises in terms of reducing pain and disability level in office workers with non specific neck pain.
ALTERNATIVE HYPOTHESIS (H1): There may be a significant difference between the effect of isometric exercises versus endurance exercises in terms of reducing pain and disability level in office workers with non specific neck pain.
6.3 REVIEW OF LITERATURE
· Paula. T. Hakala, et al; in their study proved that frequent computer-related activities are an independent risk factor for Neck pain and LBP. Daily use of computers exceeding 2–3 h seems to be a threshold for Neck pain and exceeding 5 h for LBP.14
· B Cagnie, et al; in their cross sectional study regarding individual and work related risk factors for neck pain among office workers concluded that physical and psychosocial work factors as well as individual variables are associated with the frequency of neck pain.2
· T.T.W.Chiu, et al; in their study on the prevalence of and risk factors for neck pain among university academic staff in Hong Kong found a significant association between head posture during computer processing and neck pain.15
· Rattapom Sihawong, et al; in a systematic review to evaluate the effectiveness of various types of exercise for prevention and cure of non specific neck pain in office workers proved that for treatment of neck pain, either muscle strengthening or endurance exercises is recommended, whereas for reduction of pain-related disability, muscle endurance exercise is suggested.16
· Chiu, Thomas T.W.et al; in a RCT to evaluate the efficacy of a neck exercise program in patients with chronic neck pain concluded that patients with neck pain can benefit from the neck exercise program with significant improvement in disability, pain and isometric neck muscle strength in different directions.17
· Jari Ylinen et al; in a RCT to evaluate the efficacy of intensive isometric neck strength training and lighter endurance training of neck muscles on pain concluded that both strength and endurance training for 12 months were effective methods for decreasing pain and disability in women with chronic, non specific neck pain.18
· D Falla et al; in a study to investigate the effectiveness of an endurance-strength training regime in reducing myoelectric manifestations of cervical flexor muscle fatigue in females with chronic neck pain stated that an endurance-strength exercise regime for the cervical flexor muscles is effective in reducing myoelectric manifestations of superficial cervical flexor muscle fatigue as well as increasing cervical flexion strength in a group of patients with chronic non-severe neck pain.19
· Jari Ylinen, et al; in a RCT on effect of long term neck muscle training on pressure pain threshold showed an increase in pressure pain thresholds as a result of long-term muscle training. A decrease inneck painwas associated with reduced pressurepainsensitivity inneckmuscles, showing that the pressurepainthreshold may be a useful outcome measure of the effectiveness ofneck muscle rehabilitation.20
· Deborah Falla,et al; in their study on effect of neck exercise on sitting posture in patients with chronic neck pain achieved that following intervention with an exercise program targeted at training the craniocervical flexor muscles, subjects with neck pain demonstrated an improved ability to maintain a neutral cervical posture during prolonged sitting.21
· Petri K Salo, et al; in their randomised controlled 1-year follow up study on effect of neck strength training on health-related quality of life in females with chronic neck pain found that either strength or endurance training seemed to moderately enhance the health related quality of life of females with neck pain if they are motivated for long term regular exercises.22
· Howard Vernon et al; has stated that Neck disability index is the most widely used and most strongly valid instrument for assessing self-rated disability in patients with neck pain.23
· Bijur P.E et al; has proved that VAS scale is a reliable and valid instrument to be used to assess acute pain.24
7 / 6.4 OBJECTIVE OF STUDY
· To study the effect of isometric neck exercises in reducing pain and reducing disability in office workers with non specific occupation related neck pain.
· To study the effect of neck muscle endurance exercises in reducing pain and reducing disability in office workers with non specific occupation related neck pain.
· To compare the effect of isometric neck exercises and neck muscle endurance exercises in reducing pain and reducing disability in desk top workers with non specific occupation related neck pain.
MATERIALS AND METHODS
STUDY DESIGN: An experimental study design
7.1 SOURCE OF DATA: Nationalised banks in Mangalore
7.2 METHOD OF COLLECTION OF DATA:
SAMPLING TECHNIQUE: Random sampling technique
MATERIALS TO BE USED:
· Consent form
· VAS sheet
· NDI sheet
· Data collection sheet
INCLUSION CRITERIA:
1. Patient age 23-50years (both sex)
2. Office workers
3. Pain on VAS scale < 3
4. Primary complaint of neck pain
EXCLUSION CRITERIA:
1. History of whiplash injury or any recent trauma
2. Diagnosis of spinal stenosis, spondylolisthesis
3. Cervical spondylolysis
4. Upper extremity symptoms, radicular signs and symptoms.
5. Evidence of CNS involvement- nystagmus, vertigos and headache
6. Spinal tumours, fractures, infections, osteoporosis.
7. Pain at rest.
TECHNIQUE:
· As per the selections based on the inclusion and exclusion criteria, a total of 40 subjects with non-specific neck pain will be included in the study.
· All the subjects will be assessed for pain and level of disability of neck.
· The subjects will be randomly assigned into two groups
Group A: 20 subjects will be given neck isometric exercises.
Group B: 20 subjects will be given endurance exercises for neck.
· GROUP A (ISOMETRIC EXERCISE GROUP):
PATIENT POSITION AND PROCEDURE: Sitting
The subjects will be given an elastic rubber band to train the neck flexor muscles in each
session.
They will be asked to perform a single series of 15 repetitions directly forward,
obliquely toward right and left, and directly backward.
The aim is to maintain the level of resistance at 80% of the participant's maximum isometric strength recorded at the baseline and at follow-up visits.
The load will be checked with a handheld isometric strength testing device during the training sessions at the baseline and follow-up visits.18
· GROUP B (ENDURANCE EXERCISE GROUP):
PATIENT POSITION AND PROCEDURE: Supine and prone lying
The subjects will be asked to lift their head up from supine and prone lying position in 3 series of 20 repetitions for each exercise. 1-minute rest intervals will be provided between sets.
· The subjects of both the groups will be given a daily reminder through SMS.
· All the subjects will continue exercise for 6 weeks.
· After 6 weeks, pain and disability levels will be reassessed in all the subjects.
OUTCOME MEASURES AND ITS MEASUREMENTS: The following outcome measures were measured at base line:
1. Visual Analogue Scale to assess level of pain:- It is a line scale anchors at 0 and 10 (0 indicating no pain and 10 indicating worst imaginable pain.
2. Neck disability index to assess level of disability:- It consists of 10 items which include the pain intensity, personal care, lifting, reading, headaches, concentration work, driving, sleeping and recreation.
In ten 6-part questions, the NDI is scored from 0 (no disability) to 5 (total disability) and the total score varies from 0 to 50 (total disability) .
STATISTICAL ANALYSIS: Student ‘t’ test is used to test whether there is a significant difference in pain and disability between two groups.
7.3 Does the study require any investigation or intervention to be conducted on patients or
other humans or animals? If yes, please specify briefly.
YES, isometric and endurance exercises for neck.
7.4 Has ethical clearance been obtained from your institutions?
YES
LIST OF REFERENCES
1. Cote P, Cassidy Jd, Carroll L. The saskatchewan health and Back Pain Survey.The prevalance of neck pain and related disability in saskatchewan adults. Spine.1998; 23:1689-1698
2. B. Cagnie, L.Danneels, D.Van Tiggelen,V. De Loose, D. Cambier. Individual and work related risk factors for neck pain among office workers: a cross sectional study. Eur Spine J(2007) 16:679-686
3. Fredric Gerr, Michele Marcus, Cindy Ensor, David Kleinbaum, et al; A prospective study of computer users:I. Study design and incidence of musculoskeletal symptoms and disorders. American Journal of Industrial Medicine, April 2002; 41(4) :221–235
4. Ariens GA, Bongers PM, Hoogendoorn WE, van der Wal G,van Mechelen W.High physical and psychosocial load at work and sickness absence due to neck pain. Scand J Work Environ Health 2002;28:222-31.
5. Cote P, Cassidy JD, Carroll L, van der Velde G, Hogg-Jonhson S, Holm LW, et al.
The burden and determinants of neck pain in workers; results of the bone and joint decade 2000-2010 task force on neck pain and its associated disorders.
J Manipulative Physiol Ther 2009;32(2 Suppl):S70-86.
6. Borghouts JA, Koes BW, Vondeling H, Bouter LM. Cost-of illness of neck pain in the Netherlands in 1996. Pain 1999;80:629-36.
7. Green BN. A literature review of neck pain associated with computer use: public
health implications. J Can Chiropr Assoc 2008;52:161-7.
8. Kietrys DM, Galper JS, Verno V. Effects of at-work exercises on computer operators. Work 2007;28:67-75.
9. Blangsted AK, Sogaard K, Hansen EA, Hannerz H, Sjogaard G. One-year randomized controlled trial with different physical-activity programs to reduce musculoskeletal symptoms in the neck and shoulders among office workers. Scand J Work Environ Health 2008;34:55-65.
10. Linton SJ, van Tulder MW. Preventive interventions for back and neck pain problems: what is the evidence? Spine 2001;26:778-87.
11. Verhagen AP, Karels C, Bierma-Zeinstra SM, Feleus A,Dahaghin S, Burdorf A, et al. Exercise proves effective in a systematic review of work-related complaints of the arm,
neck, or shoulder. J Clin Epidemiol 2007;60:110-7.
12. Sarig-Bahat H. Evidence for exercise therapy in mechanical neck disorders. Man Ther 2003;8:10-20.
13. J H Andersen, A Kaergaard S Mikkelsen U F Jensen et el; Risk factors in the onset of neck/shoulder pain in a prospective study of workers in industrial and service companies Occup Environ Med 2003;60:649-654
14. Paula T. Hakala, Arja H. Rimpelä, Lea A. Saarni, Jouko J. Salminen et al;Frequent computer-related activities increase the risk of neck–shoulder and low back pain in adolescents,Eur J Public Health (October 2006) vol 16 (5): 536-541
15. T.T.Chiu, W.Y.Ku, M.H.Lee, et al; A study on the prevalance of and risk factors for neck pain among university academic staff in Hong Kong,Journal of Occupational Rehabilitation 2002,12(2):77-91
16. Rattapom Sihawong, Prawit Janwantanakul, Ekalak Sitthipornvorakul, et al; Exercise therapy for office workers with nonspecific neck pain: A systemic review J Manipulative Physiol Ther 2011;34:62-71
17. Chiu, Thomas.T.W, Lam, et al; A randomized controlled trial on the efficacy of exercise for patients with chronic neck pain; Spine: 1 Jan 2005;30(1):E1-E7
18. Jari Ylinen et al; Active Neck Muscle Training in the Treatment of Chronic Neck Pain in Women, JAMA, May 21, 2003;289 (19) 2509
19. D.Falla,G.Jull, et al; An endurance-strength training regime is effective in reducing myoelectric manifestations of cervical flexor muscle fatigue in females with chronic neck pain;Clinical neurophysiology,April 2006;Volume 117(4):828-837
20. Jari Ylinen, Esa-Pekka Takala,Hannu Kautiaine,Matti Nykanen, Arja Hakkinen, et al, Effect of long-term neck muscle training on pressure pain threshold: A randomized controlled trial;European Journal of Pain, Dec 2005;Volume 9,(6):673-681
21. Deborah Falla,Gwendolen Jull, Trevor Russell, Bill Vicenzino et al;Effect of Neck Exercise on Sitting Posture in Patients With Chronic Neck Pain,Physical Therapy April 2007; vol. 87( 4) 408-417
22. Petri K Salo, Arja H Hakkinen, Hannu Kautiainen, Jari J Ylinen et al; Effect of neck strength training on health-related quality of life in females with chronic neck pain:a
randomized controlled 1-year follow-up study; Health and Quality of Life Outcomes
2010,8:48
23. Howard Vernon, The Neck Disability Index: State-of-the-Art, 1991-2008, Journal of Manipulative and Physiological Therapeutics, September 2008, Volume 31(7):491-502.
24. Bijur, P. E., Silver, W. and Gallagher, E. J. (2001), Reliability of the Visual Analog Scale for Measurement of Acute Pain. Academic Emergency Medicine, 8:1153–1157.