RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES.
BANGALORE, KARNATAKA
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1. / NAME OF THE CANDIDATEAND ADDRESS /
JEENAT UPRETY
HOUSE N0:47/12 , SUBARNA MARG , NEW BANESHWOR , KATHMANDU , NEPAL
2. / NAME OF THE INSTITUTION / KRUPANIDHI COLLEGE OF PHYSIOTHERAPY , BANGALORE
3. / COURSE OF STUDY AND SUBJECT / MASTER OF PHYSIOTHERAPY (COMMUNITY REHABILITATION)
4. / DATE OF ADMISSION /
26 JUNE 2010
5. / TITLE OF THE TOPIC
PREVALENCE OF LOW BACK PAIN AND DISABILITY AMONG SCHOOL TEACHERS - A CROSS SECTIONAL STUDY.
BRIEF RESUME OF THE INTENDED WORK
6.0 INTRODUCTION:
Low back pain is ranked first as a cause of disability and inability to work, and expected to affect up to 90% of the world’s population at some point in their lives (1). Lower back pain is a complex condition, influenced by a number of factors and often a challenge when trying to identify any singular cause or even a single major factor .(2)
International surveys of low back pain report a point prevalence of 15–30%, and 1-month prevalence of between 19 and 43% .(3) Worldwide estimates of lifetime prevalence of low back pain vary from 50 to 84% .(3-6)
It is argued that the impact of low back pain includes: loss of physical function, deterioration of general health and reconditioning ; loss of muscle tone and weight gain; constant or episode pain or increase in the level of pain, loss of social functioning manifested as decreased participation in social and leisure activities, family stress, or loss of group and community relatedness (often associated with decreased income and/or job loss); and disruption of psychological functioning manifested through insomnia, irritability, anxiety, depression and somatic complaints.
It is a disorder with many possible etiologies, occurring in many groups of the population, and with many definitions. Consequently, the vast literature available on low back pain is not only heterogeneous but also contradictory. By definition, low back pain is a symptom that cannot be validated by an external standard, the symptom being what a person reports .(6-15)
It had been observed that individuals who suffered from low back pain problems might develop major physical, social and mental disruptions, which could affect their occupations .(16)
In India, occurrence of low back pain is also alarming; nearly 60% of people have significant back pain at some time or other in life. (17)
It accounts for more sick leaves and disability than any other medical condition. It is a major health problem in industrialized countries with significant economic impact.
Risk factors of low back pain are many, but none is convincingly causal. Probable risk factors include genetic factors, age, and smoking. Other possible risk factors include back pain history, job dissatisfaction, heavy physical work, static work postures, lifting, vibration, obesity, and psychosocial factors.(18)
Increasingly common, low back pain is thought to be largely due to our more sedentary lifestyle. Teaching, however is a profession where one is active and on their feet all day long.
Work is essential in the lives of men and women; nonetheless, it can become a health hazard when it is carried out in an inappropriate way. Some groups of workers, due to occupational characteristics, are more exposed to work related musculoskeletal pain. (19) Teachers stand out among these groups. Sometimes, teaching is carried out under unfavorable circumstances, in which teachers mobilize their physical, cognitive, and affective capacity to reach teaching production objectives, over demanding or generating over effort of their psycho-physiologic functions.(20)
If there is not enough time for recovery, pain symptoms that account for the high levels of absenteeism due to health conditions in this group of workers are triggered or prompted. Thus, teaching leads to stress, with consequences to physical and mental health and with an impact on professional performance. (19-21)
In the past, the educational sector went through changes that led to the escalation of teachers’ activities and to increasingly precarious conditions in work relations. Cuts in funding for education reflect the new social organization processes in the globalized age. In face of market demands in the economic globalization process, educational institutions have begun to face new obstacles, especially in relation to meeting their educational commitments appropriately and satisfactorily. The process generates intense conflict for teachers, which are also worsened by the social demands of teachers’ role: on one hand the demands of quality teaching and positive results; on the other hand, in a scenario of mass production, scarcity of material and human resources. These opposite movements push toward a dilemma: the generation of positive results without appropriate and necessary tools.(22)
In the past decade, different studies described the most prevalent health problems among teachers, in which musculoskeletal disorders, voice problems and psychiatric disorders stand out.(19,23-27)
Musculoskeletal pain or painful feeling has been mentioned in several studies among teachers as a relevant health problem, and conditions due to musculoskeletal system disorders are the main causes of absenteeism and of professional diseases in this category. (28) Everyone, excluding individuals with congenital insensitivity, has already felt pain sometime in their lives. However, when symptoms continue, they become a problem, a reason for reducing work activity, work leaves, and absence, in addition to the possibility of developing depression. (29) Several socio-demographic, psychosocial, physical, and organizational factors are related to triggering, developing, and maintaining musculoskeletal pain .(30)
In a study it has been proved that low back pain is the most common musculoskeletal problem in teachers along with upper limb .(22)
6.1 NEED FOR THE STUDY
It had been observed that individuals who suffered from low back pain problems might develop major physical , social , and mental disruptions which could affect their occupation.(Tavafian et al 2007)
The job nature of school teachers includes frequent reading, marking of assignments as well as writing on blackboard. Poor posture and improper techniques of lifting or carrying are the two very common causes of low back pain. Twisting such as turning from the board to the class and back again , prolonged sitting when marking and preparing notes , prolong standing in the class while teaching et cetera make teachers more prone to back pain .Working with computer also make them prone to one or other musculoskeletal problems, such as neck pain and upper limb pain. Besides, the teachers have to crane their necks while typing; making the shoulders and backs more tense thus resulting in pain.
Low back pain is the most common complains in patients that come for physiotherapy.
Medical and social costs due to these problems have grown incessantly in past years in several countries, representing a significant impact on health and quality of life of workers.
Some studies report that female gender or higher age increases the risk of low back pain, whereas other studies report no association between these factors. Recent studies have reported that psychological factors such as job satisfaction and job strain also may be risk factors for low back pain.
Therefore, the analysis and appropriate determination of the problem, and the investigation of its associated factors, are relevant to design measures that may intervene on the problem.
There are several studies about the prevalence of low back pain among other professions such as nurses, medical staffs, and drivers along with its associated risk factors. Teaching profession despite being prone in developing low back pain, there is a dearth of the data regarding its prevalence and associated risk factors .The teachers are not aware about the fact that the main cause of their low back pain could be their profession.
This study aims to describe the prevalence of low back pain and the risk factors associated with it and to create awareness among the school teachers about low back pain, its consequences and to suggest them the ways to decrease the occurrence of low back pain .
6.2 OBJECTIVE OF THE STUDY
(A) OBJECTIVE
· To determine the prevalence of back pain in teachers.
· To find out the disability level due to back pain.
· To find out the association between years of teaching and back pain.
· To find out the association between gender and low back pain
· To find out the association between the body weight and back pain.
(B) HYPOTHESIS
NULL HYPOTHESIS :
· There is no significant association in level of disability due to back pain.
· There is no significant association between years of teaching and back pain.
· There is no significant association between gender and low back pain.
· There is no significant association between the body weight and back pain.
ALTERNATIVE HYPOTHESIS:
· There is significant association in level of disability due to back pain.
· There is significant association between years of teaching and back pain.
· There is significant association between gender and low back pain.
· There is significant association between the body weight and back pain.
6.3 REVIEW OF LITERATURE
1) Chong EY,Chan AH (2010) (31) did a study on subjective health complaints of teachers from primary and secondary schools in Hong Kong and got the result that, the 10 most frequently reported health complaints among the teachers were tiredness, eyestrain, anxiety, sleep problems, voice disorder, shoulder pain, neck pain, headache, cold/flu, and lower-back pain.
2) Nurul Izzah Abdul Samad et al (2010) (32) conducted a study to determine the prevalence of low back pain and the associated risk factors among primary school teachers in the Klang Valley, Malaysia. Through this study he concluded that the prevalence of low back pain was 40.4%. Teachers with poor mental health status had higher risk of developing low back pain.
3)Aderonke O, Akinpelu et al (2010) (33) studied the prevalence and pattern of musculoskeletal pain in a rural community in Southwestern Nigeria and revealed that 8 out of every 10 adult residents of this Nigerian rural community experience musculoskeletal problem (MSP) in 12 months and low back pain is the most common MSP. Gender, age, and occupation are associated with MSP in this community.
4) Jefferson Paixão Cardoso et al (2009) (22) studied the prevalence of musculoskeletal pain among teachers and found out that there was a high prevalence of pain in lower limb (41.1%) and low back pain (41.1%) than upper limb (23.7%).The prevalence of musculoskeletal pain was associated with the following occupational variables: working over five years at the school, high level of physical exertion, not having a paid activity other than teaching, and reporting heat in the classroom.
5)Levent Altinel et al (2008) (34) conducted a study on the prevalence of low back pain and risk factors among adult population in Afyon region , Turkey and concluded that the prevalence of chronic low back pain was 13.1%.with regard to occupation , the highest incidence of low back pain was seen in housewives. Depression and increased body mass index (BMI) was found to be the risk for low back pain, whereas smoking, hypertension, or diabetes was not correlated with the prevalence of low back pain.
6) Erika Nelson-Wong et al (2007) (35) studied postural control strategies during prolonged standing: is there a relationship with low back discomfort? And revealed that the findings suggest an apparent increase in co-activation at the hip in individuals with increased low back discomfort when exposed to a prolonged standing task. This factor appears to be a useful predictive variable in identifying which individuals will develop low back discomfort with standing.
7) Mostafa Ghaffari et al (2006) (36) conducted a study on low back pain among Iranian industrial workers and came to a conclusion that low back pain is a common problem in the working population even in a developing country. Age and gender as well as certain work-related physical and psychosocial factors influenced the prevalence of low back pain but the differences between different categories of workers were small.
8) Pande Ketan et al (2005) (37) did a study on low back pain in obstetricians and gynecologists. Because the obstetrician and gynecologist is frequently required to adopt awkward postures during clinical examination as well as surgery , this may involve prolonged standing (static posture), and bending and twisting of the trunk like teachers do .and concluded that a large number of obstetricians and gynecologists suffer from low back pain and it can be a cause of significant disability. To reduce this incidence particular attention should be given to good ergonomic practices and to maintaining proper body weight.
9)Punnett L et al (2005) (38) estimated the global burden of low back pain attributable to combined occupational exposures and gave a result that worldwide, 37% of low back pain was attributed to occupation, with two-fold variation across regions. The proportion attributable was higher for men than women, because of higher participation in the labor force and in occupations with heavy lifting or whole-body vibration. Work-related low back pain was estimated to cause 818,000 disability-adjusted life years lost annually. Occupational exposures to ergonomic stressors represent a substantial source of preventable back pain.
10) Jin et al. (2004) (32) did a study in Chinese school teachers .In this study, female teachers showed a significantly higher prevalence of low back pain (48.1%) than men (39.6%).
11) Stergioulas A,et al (2004) (39) conducted a study titled low back pain in physical education teachers. Through this study they concluded that physical education teachers who spent more than 35 hours per week in teaching physical education were correlated with low back pain.
12)Kezhi Jinet al (2003) (40) did a study on prevalence of low back pain in three occupational groups in Shanghai, People's Republic of China and revealed that the prevalence of low back pain among teachers were 40%.
13) Hirohito Tsuboi et al (2002) (41) investigated on the related factors of low back pain (LBP) among school personnel in which prevalence of low back pain in each work category was compared to that in general teachers of each gender after adjusting for age. Male teachers at schools for the handicapped and in classrooms for the handicapped showed significantly higher low back pain prevalence. Among female participants, teachers at schools for the handicapped, physical education teachers, kindergarten personnel, and school nurses displayed higher low back pain prevalence. In work categories which demonstrated high low back pain prevalence, low social support and low job satisfaction were related to low back pain of school nurses despite low physical loads. High job demand and physical loads correlated to low back pain in kindergarten personnel.