KARNATAKA, BANGALORE
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION1. / Name of the Candidate And Address
(in block letters): / GAURAB SUBEDI
MALIGAUN, NAXAL, HOUSE NO 80
KATHMANDU, NEPAL
2. / Name of the Institute : / LAXMI MEMORIAL COLLEGE OF PHYSIOTHERAPY, MANGALORE.
3. / Course of study and subject : / MASTERS OF PHYSIOTHERAPY (MPT)
2 YEARS DEGREE COURSE
PHYSIOTHERAPY IN MUSCULOSKELETAL AND SPORTS.
4. / Date of Admission to Course : / 29th JUNE 2009
5. / Title of the topic: /
TO STUDY THE OCCURANCE OF WORK RELATED SCOLIOSIS AMONG EXPERIENCED AUTO RICKAHAW DRIVERS.
6. / Brief Resume of the Intended Work:6.1 NEED FOR THE STUDY:
Ergonomics is the science of designing the job, equipment, and workplace to fit the worker. Proper ergonomic design is necessary to prevent repetitive strain injuries, which can develop over time and can lead to long-term disability. The four main contributing causes of these injuries are quick, repetitive actions, awkward position, use of force, and lack of rest. Minimization of repetitive tasks and awkward body positions can help to prevent such injuries from occurring.1
Musculoskeletal disorders have been described as the most notorious and common causes of severe long-term pain and physical disability that affect hundreds of millions of people across the world.2 World-wide estimates of lifetime prevalence of low back pain (LBP) vary from 50 to 84 percent.3-9 Occupational LBP relates to exposure to workplace hazards and incurs high costs to society in terms of health care, loss of productivity, workplace and family stress, as well as individual pain and suffering.10 Thus prevention of occupational LBP is a key research concern.
Factors associated with occupational LBP are commonly cited as physical (workplace) and personal (individual).10-11 Physical factors are proposed as heavy physical work, lifting, bending, twisting and static postures10,13, whilst personal factors are described as non-modifiable (age, gender, anthropometry etc) and potentially modifiable (physical fitness, motor control, strength etc.10
There is a long list of known causes, condition and diseases that are associated with scoliosis. There is several method of classification. A biomechanical classification is provided here and may be appreciated. The spine remains normal because of the maintenance of a delicate and precarious balance. This balance depends on a precise functional status and dynamic symmetry, the key element being the boney structure, the ligament, the intrinsic neuromuscular mechanism. Scoliosis can result from either gross or subtle disruption of the delicate balance.14
Auto rickshaws are the most common means of transportation here in India. Small size drivers cabin, long handle, type of seat, duration of work are few reasons why auto rickshaw drivers sit awkwardly & are prone to develop musculoskeletal disorders like scoliosis. As auto rickshaw drivers are one of the most vulnerable group to develop musculoskeletal disorders due to their working environment there exists a need and background for the genesis of this study.
HYPOTHESES
NULL HYPOTHESIS (HO):
Sitting in abnormal posture for a long period of time may not lead to scoliosis among auto rickshaw drivers
ALTERNATE HYPOTHESIS(H1) :
Sitting in abnormal posture for a long period of time may lead to scoliosis among auto rickshaw drivers.
6.2 REVIEW OF LITERATURE
M. Massaccesi et al: A high incidence of spinal disorders were observed in professional drivers, in particular, back and neck pain results in high morbidity and low retirement.
Grace et al: conducted study on 481 bus drivers in the study that consisted of questionnaire survey as well as physical assessment. They concluded high prevalence rate of work related musculoskeletal disorders.
Magnussion et al: Drivers had greater low back pain than sedentary workers and this was related to greater work absence for drivers.
Dr. V.J Sutherland et al: Almost 90% drivers with high work experience left bus company for reason of ill health, 20% of it back, tendon and joint disorders.
White and Panjabi: Based on a survey of epidemiological literature, concluded that during motor vehicles (especially truck and heavy equipment) being male and working as material handler are well established risk factor for low back pain.
Based on a survey of 57,000 occupational drivers, Heliovaara (1987) found out that they were at high risk of lumber disc herniation.
Kesey and Hardy found that male truck drivers have 5 times the risk of lumber disc herniation that non driving man.
Burtion and Sandove: Reduction in the stiffness in the suspension of grand prix (GP) race significantly decreased the incidence and severity of driver's low back pain.
Barry S Levy et al: Worked performed in awkward or static posture is another important influence on the work related musculoskeletal disorders. The level of mechanical stress produced by the muscle contraction varies with the posture of a joint.
6.3 OBJECTIVES OF STUDY
To find out if experienced auto rickshaw drivers have work related scoliosis due to abnormal posture.
7 /
MATERIALS AND METHODS:
STUDY DESIGN: Cross section study7.1 SOURCE OF DATA: Auto rickshaw drivers from Mangalore will be requested to complete the questioner and auto rickshaw drivers who meet the criteria will be taken for the study. The study will be conducted for the period of one year.
7.2 METHOD OF COLLECTION OF DATA
SAMPLING TECHNIQUE: Systematic Random Sampling
INCLUSION CRITERIA
a) Professional drivers.
b) Professionally driving auto rickshaw at least for 4-5 year.
c) Should be driving auto rickshaw at least for 5-6 hrs a day.
d) Auto rickshaw drivers with low back pain.
e) Age 30-50 yrs
f) Patient able to follow instructions.
EXCLUSION CRITERIA
a) Previous spinal fractures.
b) Previous spinal T.B.
c) Limb length discrepancy.
d) Previous spinal surgery.
e) Any thoracic and abdominal surgery.
f) Disc herniation.
g) Congenital spinal disorders.
MATERIALS
a) Measuring tape.
b) Scale
c) Scoliometer.
d) Goniometer
e) Weighing Machine
TECHNIQUE OF APPLICATION
Method
Detail questionnaire for low back pain related to occupation will be distributed among auto rickshaw drivers in Mangalore. Once the questionnaire is collected back 100 auto rickshaw drivers satisfying the criteria of questionnaire and who falls under the inclusion criteria will be taken for the study.
Once the 100 subjects are collected a detail physical assessment will be taken regarding the Range of motion of the spine using Schobers method, muscle power of the abdominal and back muscle using manual muscle testing (MMT) method, height of the subject using measuring tape, weight of the patient using weighing machine and muscle tightness of lateral trunk flexors, hamstrings and Illio Tibial band.
The subjects will be instructed to bend forward, exposing visible trunk asymmetries. During each forward bend, the upper measurement is taken over the apex of the curve by scoliometer in the thoracic region. The patient is then instructed to continue to bend forward, exposing the apex of the curve in the lumbar region, and here the lower measurement is taken by scoliometer. These measurements are repeated two more times with the patient coming to an erect standing position between trials.
OUTCOME MEASURES: Scoliosis will be measured using Scoliometer.
STATISTICAL ANALYSIS: Frequency distribution percentage.
Chi squire analysis.
Multiple regression analysis.
7.3 Does the study require any investigations or interventions to be conducted on
Patients or other humans or animals? If so, please describe briefly.
YES; Measurement of strength, range of motion and limbs, weight and height.
7.4 Has ethical clearance been obtained from your institutions
In case of 7.3.
YES.
8 / List of References:
1. Berkeley Lab. Integrated safety Management: Ergonomics. Earnest Orlando Lawrence Berkeley national laboratory. Sept 2007.
2. Work-related musculoskeletal disorders among Nigerian Physiotherapists Babatunde OA Adegoke. Aug 2008.
3 Biering-Sorensen F:A prospective study of low back pain in a general population.Scandinavian Journal of Rehabilitation Medicine1983, Vol 15, pp: 71-79.
4 Cassidy JD, Carroll LJ, Cote P:The Saskatchewan health and back pain survey: the prevalence of low back pain and related disability in Saskatchewan adults.
Spine1998, Vol,23, pp:1860-1867
5 Leboeuf-Yde C, Klougart N, Lauritsen T:How common is low back pain in the Nordic population? Spine1996, Vol21, pp: 1518-1526.
6 Matsui H, Maeda A, Tsuji H, Naruse Y:Risk indicators of low back pain among workers in Japan: association of familial and physical factors with low back pain.
Spine1997,Vol22, pp:1242-1248
7 Papageorgiou AC, Croft PR, Ferry S, Jayson MIV, Silman AJ:Estimating the prevalence of low back pain in the general population: evidence from the South Manchester pain survey.
Spine1995, Vol20, pp: 1889-1894.
8 Suadicani P, Hansen K, Gyntelberg F:Low back pain in steel plant workers.
Occupational Medicine1994, Viol44, pp: 217-221.
9 Walsh K, Varnes N, Osmond C, Styles R, Coggon D:Occupational causes of low-back
pain. Scandinavian Journal of Work and Environmental Health1989, Vol15, pp: 54-59.
10. Kelsey JL, Golden AL, Mundt DJ:Low back pain/prolapsed lumbar intervertebral disc.
Rheumatic Disease Clinics of North America1990, Vol16, pp: 699-715.
11. Gluck JV, Oleinick A:Claim rates of compensible back injuries by age, gender, occupation and industry: do they relate to return-to-work experience? Spine1998, Vol23, pp: 1572-1587.
12 Ingemarsson AH, Sivik T, Nordholm L:Sick leave among Patient’s withlumbar and cervical pain: relationship to previous sick leave, education, nationality, sleeps disturbance and experience of pain. Physiotherapy Theory and Practice1996, Vol12, pp: 143-149.
13 Andersson GBJ:Epidemiologic aspects on low-back pain in industry.
Spine1981, Vol6, pp: 53-60
14. White & Panjabi: Clinical Biomechanics of the spine,1990; 2nd edt
15. David J. Magee: Orthopedic Physical Assessment.2002; 4th edt, pp: 425-559.
16. Pamela K. Levangie, Cynthia C. Norkins. Joint structure and function.2001; 3rd edt, pp: 403-432.