RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF

SUBJECTS FOR DISSERTATION

DEEPA.K

IST YEAR M.SC NURSING

MEDICAL AND SURGICAL NURSING

YEAR 2011 - 2013

CAUVERY COLLEGE OF NURSING

TERESIAN COLLEGE CIRCLE

SIDDARTHA NAGAR

MYSORE

1 / NAME OF THE CANDIDATE
AND ADDRESS / DEEPA.K
IST YEAR M.SC NURSING
CAUVERY COLLEGE OF NURSING, MYSORE
2 / NAME OF THE INSTITUTION / CAUVERY COLLEGE OF NURSING,
MYSORE - 570007
3 / COURSE OF STUDY
AND SUBJECT / MASTER OF NURSING – MEDICAL AND SURGICAL NURSING
4 / DATE OF ADMISSION TO COURSE / 13-10-2011
5.1 / TITLE OF THE STUDY / TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING LIFESTYLE MODIFICATIONS TO PREVENT AND MANAGE ACUTE LOW BACK PAIN AMONG BANK EMPLOYEES IN SELECTED BANKS AT MYSORE
5.2 / STATEMENT OF THE PROBLEM / A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING LIFESTYLE MODIFICATIONS TO PREVENT AND MANAGE ACUTE LOW BACK PAIN AMONG BANK EMPLOYEES IN SELECTED BANKS AT MYSORE

6. BRIEF RESUME OF THE INTENDED STUDY

6.1 INTRODUCTION

“Stabbed in the back: Confronting back pain in an over treated society.”

-H.S.CHHABRA

Back pain is a major ergonomic issue that is becoming increasingly common owing to changing work pattern. Back pain, especially low back pain, is often associated with functional disability as well as economic and social consequences. It is one of the most expensive diseases in the age group of 25-50years as it leads to serious loss of productivity. Most low back pain is caused by one of many musculoskeletal problems, including acute lumbo sacral strain, unstable lumbo sacral ligaments and weak muscles, osteoarthritis of the spine, spinal stenosis, intervertebral disk problems and unequal leg length. Obesity, stress and occasionally depression may contribute to low back pain. Back pain due to musculoskeletal disorders usually is aggravated by activity, whereas pain due to other conditions is not.1

When a person suffers recurrent episodes of pain, but each is separated by a pain-free period of at least 3 months, each episode is acute low back pain. Back pain at work place results either from non-accidental injury, when pain arises as result of poor body mechanics such as slouching in chair, prolonged sitting and fatigue, or it results from accidental injury such as repetitive lifting of heavy objects by workers undertaking physically demanding jobs. 2

Computers have become an important part of modern life from calculating grocery bills, telecommunications, banking operations, and in any sphere one will find computers. The bank employees fall under this category of desk job who use computers and are prone to non-accidental back injury. Breaking a concrete slab with a jack hammer does not produce the same kind of strain that is being felt these days in the less physical environment of computer world. Prolonged periods of sitting or other sedentary activity is not good for health and may cause muscle fatigue since the back and abdominal muscles have to work really hard to maintain the body in a single position for prolonged periods. Since 90% of the general population have a disabling episode of back pain at some point in their lives, most of them take their backs for granted and it is not until they experience pain that they realise what an important role their back plays and how much it is involved in their normal everyday activities. Back pain is the mostly preventable problem, it is important to impart knowledge on simple life style changes such as spinal exercises, good posture at work station, adopting user-friendly work station, maintaining ideal weight, smoking cessation which minimise the risk of developing serious back injury that could ultimately result in a chronic condition which they have to suffer their entire life.3

Low back pain can be occupational in the sense that it is common in adults of working age, frequently affects capacity for work and often presents for occupation health care. It is commonly assumed that low back pain is caused by work, but the relationship between the physical demands of work and low back pain is complex and inconsistent. A clear distinction should be made between the presence of symptoms, the reporting of low back pain, attributing symptoms to work, reporting injury, seeking health care and loss of time from work and long-term damage.4

Low back pain in the occupational setting must be seen against the high background prevalence and recurrent rates of low back symptoms. Jobs with greater physical demands commonly have a higher rates of reported low back injuries, but most of these injuries are related to normal everyday activities such as bending and lifting, there is usually little if any objective evidence of tissue damage and relationship between job demands and symptoms or injury rates is inconsistent. Physical stressors may overload certain structures in individual cases, but, in general, there is little evidence that physical loading in modern work causes permanent damage. Some studies showed that smokers are nearly a third more likely to have low back pain compared to non-smokers.4

When low back symptoms are attributed to work, are reported as injuries, lead to health care seeking and/ or result in time off work depends on complex individual psychosocial and work organizational factors. People with physically or psychologically demanding jobs may have more difficulty working when they have low back pain. There is strong evidence that physical demands of work (manual material handling, lifting, bending, twisting and whole body vibration) can be associated with increased reports of back symptoms, aggravation of symptoms and injuries.4

There is strong evidence that advice to continue ordinary activities of daily living as normal as possible despite the pain can give equivalent or faster symptomatic recovery from the acute symptoms, and leads to shorter periods of work loss, fewer recurrences and less work loss than advice to rest. There is moderate evidence that the above advice can be usefully supplemented by simple educational interventions specifically designed to overcome fear avoidance beliefs and encourage patients to take responsibility for their own self-care. Information and advice designed to overcome fear avoidance beliefs and promote self-responsibility and self-care, can produce positive shifts in beliefs and reduced disability. Health education is viewed as a desirable component of prevention and management to empower the people by providing them with information so that they have the appropriate insight to be able to take a greater responsibility for their own care and thereby to rely on passive medical therapy.4

The four strategies that prevent low back pain for asymptomatic individuals are back exercises, education, mechanical support (corsets) and risk factor modification. The management of low back pain focuses on relief of pain and discomfort, activity modification and patient education. The available data allow that if muscles are strengthened and stretched and if mobility is stored, patient may also obtain relief of pain.2

A variety of preventive strategies have evolved to address the growing number of injuries. These strategies include ergonomic design of the work place, employee selection and placement, aggressive medical management and education/ training of workers. While ergonomic design or redesign of existing equipment may be preferred, it is not always feasible intervention. In some cases the work environment cannot be redesigned to address all ergonomic problems. It is for this reason that numerous authors have advocated education as a preventive method for reducing the incidence and severity of low back pain and other musculoskeletal injuries.2

Workers around the world- despite vast differences in their physical, social, economic and political environments- face virtually the same kinds of work place hazards- chemical, biological, physical and psychosocial which they suffer because of incomplete knowledge of their risks. Whether this high and preventable burden of ill health face by workers in India is the result of ignorance, inattention, or intent, compelling evidence indicates that work-related health conditions could be substantially reduced, often at modest cost. Bank employees are frequently exposed to manual handling tasks which are identified as risk factors for developing low back pain and other musculo-skeletal symptoms.4

6.2 NEED FOR THE STUDY

Musculoskeletal conditions are the most common cause of chronic disability around the world. Of these, back pain is extremely common in both industrial and developing countries, with upto 50% of workers suffering an episode each year. There is little information about global burden of non-traumatic low back pain (LBP) attributable to the effects of occupational stressors (physical and psychosocial). Based on a review of the epidemiological evidence, occupation-specific relative risks were used to compute attributable proportions by age, gender and geographical sub-region for the economically active population aged 15 and older. The referent group was professional/administrative workers and other risk-categories were clerical and sales-low, operators (production workers) and service workers-moderate and farmers-high risk. Back pain causes 0.8 million disability-adjusted life years (DALYs) each year and is a major cause of absence from work of correspondingly high economic losses. Nearly 40% of back pain is due to occupational risk factors, and many of these factors can be prevented with the cooperation of labour, management, industrial engineers, ergonomists and health workers (WHO 2000).5

The high prevalence and social and economic impact of low back pain and related disability are well organised. Low back pain is one of four musculoskeletal conditions specifically targeted by the Bone and Joint Decade (2000-2010) initiative endorsed by the WHO. Related to workplace, many workplace programs and medical services have been designed to prevent back problems or to minimize their negative consequences. Occupational exposures that appear frequently on lists of suspected risk factors are sustained non neutral postures and physical loading such as heavy lifting, bending and twisting.6

Most epidemiologic data concerning low back pain are related to developed and industrialised countries and there is little information about low back pain in the general or working population in developing and low income countries. This lack of research leaves a profound gap in what is known about low back pain in a large part of the world, where the bulk of the world’s working population resides. International surveys of low back pain report a poor prevalence of 15-30%, and a 1-month prevalence of between 19% and 43%. Worldwide estimates of lifetime prevalence of low back pain vary from 50%-84%. The consequences of low back pain are far-reaching, associated with increased absence from work, loss of productivity and corresponding increase in economic costs. Individual factors such as age, sex, physical fitness, body mass index (BMI), strength and smoking habits have been discussed in association with low back pain. Work-related factors associated with low back pain are physical and psychosocial in origin.7

In north India, according to survey (2001-2002), 23.09% had low back pain, out of which 67% had psychosocial issues, 57% were in blue collar jobs, 26% had to change or leave their profession and 38% did not enjoy their present job.8 The incidence of low back pain has increased rapidly due to ignorance and failure to take precautionary measures at the earliest. Changes in the lifestyle with ignorance towards the sitting posture and strenuous activities have led to the problem. “Due to the sedentary lifestyle, the problem of low back pain has spread like an epidemic. Since most of us suffer from backache at some stage of life, the tendency to ignore can lead to critical condition. Since it is a harmless problem, nearly 90% of the cases can be tackled by taking appropriate preventive measures. The remaining 10% need to go for proper treatment.8

A questionnaire based survey showed that symptoms such as low back pain (73%), shoulder pain (75.5%), neck pain (76%) and eye problems (59.5%) were common among computer users. The computer users need to be provided with an ergonomically conducive environment as well as to be educated to prevent occupational overuse syndrome. The importance of work place intervention has increasingly been recognised in the literature on back pain rehabilitation. The nurse should become familiar with the work and work environment of the target group before providing education. Education programme with booklets serve as a useful adjunct to a physician’s care by standardising and reinforcing messages about self-rehabilitation. They may achieve increased employees satisfaction, reduced use of health care and reduced absenteeism.9

To prioritize prevention efforts appropriately world-wide information on the burden caused by occupational exposure to physical and psychosocial stressors would be useful. Non-organic or psychosocial issues are frequently present in patients with back pain and often dwarf the organic aspects of patient’s problem. The presence of these issues clearly can impact adversely on the outcome of treatment. Prediction of chronicity in patients with an episode of acute low back pain was most successful by assessing the presence of “fear avoidance variables”.10

Employers have a statutory and moral responsibility to safeguard the health, safety and welfare of workers, and to take reasonably practicable steps to prevent avoidable injuries. Over the last 50 yrs, there have been considerable reductions in the physical demands of most work and much effort has gone into ergonomic improvements; this has reduced many serious occupational health risks, but there is inconsistent evidence on whether or to what extent it has reduced occupational low back pain. There is limited evidence but general consensus that joint employer-worker initiatives can reduce the number of reported back injuries and sickness absences, but there is no clear evidence on the optimum strategies and inconsistent evidence on the effect size.4

General disaffection with the work situation, attribution of blame, beliefs and attitudes about the relationship between work and symptoms, job satisfaction and poor employer-employee relationships may also constitute ‘obstacles of recovery’. Therefore communication, cooperation and common agreed goals between the worker with low back pain, the occupational health team, supervisors, management and primary health care professionals is fundamental for improvement in clinical and occupational health management and outcomes. There is preliminary evidence that educational interventions which specifically address beliefs and attitudes may reduce future work loss due to low back pain.2

The incidence of musculoskeletal injuries especially low back pain associated with computer use is increasing. Bank employees spend the majority of their working days using the computer. Education has been advocated as a prevention method for reducing the incidence and severity of these injuries. Although the inclusion of education in prevention programmes has become a popular practice, its efficacy is poorly defined. Many corporations, unions and businesses are recognizing the potential value of programmes aimed at preventing musculoskeletal injuries. Health and safety literature stressed the importance of including education as a part of any prevention programme. Further, the need for practice as a means of reinforcing educational information is emphasized.2