RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCESBANGALORE,KARNATAKA.
SYNOPSIS PROFORMA FOR REGISTRATION O`F SUBJECTS FOR DISSERTATION
1 / NAME AND ADDRESS OF THE CANDIDATE / MR. VISANTH CHITTETH VIJAYAN1ST YEAR M.Sc. NURSING STUDENT
RAJEEV COLLEGE OF NURSING
K.R PURAM, HASSAN, KARNATAKA
2 / NAME OF THE INSTITUTION / RAJEEEV COLLEGE OF NURSING
K.R PURAM, HASSAN
3 / COURSE OF STUDY AND SUBJECT / master of science in nursing, MEDICAL-SURGICAL NURSING
4 / DATE OF ADMISSION TO THE COURSE / 08. 07. 2011
5 / TITLE OF THE TOPIC / “the effectiveness of SIM (self instuctional module) regarding prevention of low back pain among employeeS of selected colleges at hassan”.
5.1 / STATEMENT OF THE PROBLEM / “A STUDY TO ASSESSthe effectiveness of SIM regarding prevention of low back pain among employeeS of selected colleces at hassan”.
6. BRIEF RESUME OF THE INTENDED WORK.
6.1 INTRODUCTION
“Although the world is full of suffering, it is also full of the overcoming of it.
Helen Keller”
Back pain is one of the most common pain complaints, second is headache.Back pain usually occurs as either incervical or lumbosacral region. Back pain result from herniation of the nucleus pulposus in the intervertebral disc.It also occur due to degeneration of the vertebra, or disc injury from hyperreflexia. Herniationor injury results spinal root compression, which leads to subsequent motor and sensory manifestations. Low back pain is often difficult to diagnose. This leads to questioning the pain in clients with low back pain.1
Low back pain is a major public health problem all over the world. Most people suffer incapacitating low back pain at some stages in their lives. It is estimated that, 6.5 million people in the United States are bed-ridden because of low back pain. Approximately 1.5 million new cases of low back pain are seen by physicians in each month. There has been growing concern about the low back disability in western society. In India, occurrence of low back pain is also alarming; nearly 60 per cent of the people in India have significant low back pain at some time or the other in their lifespan. Epidemiological studies provide important information regarding various risk factorssuch as sex, life style, occupation, habit, socio-economic status and smoking associated with the history of low back pain. 2
6.2 NEED FOR THE STUDY
“No One Cares About Your Back Like You Do.”
Musculoskeletal disorders such as impairment of the back and spine; are leading health problems and causes a disability, particularly in people during their employment years. The limitations imposed on the patient are severe, and the economic cost, in terms of loss of productivity, medical expenses, and other costs that are not compensated, is in the billions of dollars.3
A report says that, nearly 1 million people, in each year treat and recovered from musculoskeletal pain or loss of function due to overexertion or repetitive motion either in the low back.Although there is a risk of long-term disability in this disorder, the majority of individuals return to work within 31 days. It is estimated workers' compensation costs associated with these lost workdays range from 13 to 20 billion annually. However, in order to determine the total economic burden, indirect costs related to such factors as lost wages, lost productivity, and lost tax revenues must be added to the cost of compensation claims, leading to estimates as high as 45 to 54 billion annually for musculoskeletal disorders reported as work-related. These figures are conservative and represent only reported cases. Several studies suggest that many disorders that could be attributed to work are not reported and therefore are not counted in any of the existing databases.4
A study was conducted on 11234 patients with history of outdoor activities during June 2001 to June 2002. 2594 patients (23.09%) had low back pain. 4358 roentgenograms were done in these patients, a mean of 1.68 per patient. These patients were interviewed and their psychosocial and demographic details were compared with 1000 controlswho did not have back pain but attended outdoor for other reasons. In the low back pain group, 67% had psychosocial issues, 57% were in blue-collar jobs, 26% had to change/leave their profession, and 38% did not enjoy their present job. All patients had used NSAIDS at some stage of illness and 64% were advised exercises for the back. The comparative figures in control group were 19% with psychosocial issues, 34% in heavy manual workers, 7% had to switch over to new job, 6% did not relish their present job. Hence, it is concluded that along with exercises and NSAIDS, sufficient consideration should be given to short centre-based intensive rehabilitation program followed by a home-based program for chronic low back pain patients.5
A research conducted at G.Sheps Centre for Health Services Research at the University of North Carolina at Chapel Hill found that prevalence of chronic impairing back pain in the state increased from 3.9% t in1992 to 10.2% in 2006.Increase were seen in both men and women. About 80% of the worlds residents suffer from low back pain at one time or another and athletic life style offers no warranty against the problem. Prevalence of back pain is 6 million annually and prevalence rate of back pain as approximately 1 in 45 or2.21% or 6 million people in US .1,993,000 women self reported having back pain or disc disorders.6
A cross-sectional study was performed in a Danish population of individuals 12-41 years of age to study the lifetime cumulative incidence, the 1-year period prevalence, and point prevalence of low back pain in the general population and to investigate whether there were any differences in the occurrence of low back pain that were related to age and gender, especially in young individuals. The results reveal that, the prevalence of the various definitions of low back pain increased greatly in the early teen years (earlier for girls than for boys), and by the ages of 18 years (girls) and 20 years (boys) more than 50% had experienced at least one low back pain episode. The pattern for the 1-year period prevalence of low back pain was very similar to that for the lifetime prevalence; both started at 7% (95% confidence interval, 5-9%) for the 12-year-old individuals and reached 56% (95% confidence interval, 53-59%) and 67% (95% confidence interval, 62-71%), respectively, for the 41-year-old individuals. The pattern for the point prevalence resembled that of the more than 30 days of low back pain reported in the preceding year; the rate increased steadily from 1% (95% confidence interval, 0-2%) to 17% (95% confidence interval, 14-20%). There was a general tendency for more women to report low back pain than men, but this difference generally was not statistically significant.7
Across-sectional survey was conducted at Turkey, to estimate the prevalence of low back pain (LBP) in an urban population of Turkey and to determine the factors associated with occurrence of LBP. Little information exists in the literature regarding the epidemiology of LBP in developing countries. A total of 100 clusters of households were selected by systematic sampling. Of these, 3,173 study participants agreed to interview. The response rate was 98.7%.The crude lifetime, 12-month, and point prevalence’s of LBP were 46%. In logistic regression analysis, age of 36 years or older, female sex, multiparty, being a housewife, being from East Turkey, and smoking showed independent associations with having current LBP. Being religious, heavy smoking, and age 26 to 45 years were associated with having restricted activity related to LBP.In comparison with other developing countries, point prevalence of LBP is higher in Turkey and approximates to prevalence estimates of LBP in developed countries. Smoking may be associated with both occurrence and severity of LBP. Although piety is not associated with having LBP, religious people are more likely to have restricted activity related to LBP.8
In the present scenario, India as developing country, is stepping forward in to an early industrial society. And urban workers have a major role to play on the emergence of India to achieve the status of a developed country. In the course of emerging India, the middle class has grown to be the work horse of our country. And transforming them adapted to life style of western civilization making them vulnerable to suffer from different diseases. Most of the diseases go undiagnosed, either due to less knowledge regarding the disease or no time for regular medical check up due to increased job strain.
The prevalence of musculo-skeletal diseases and low back pain is rapidly increasing in developing countries. This increases, most marked in the urban population, is likely to be related to Lumbar strain (acute, chronic), Nerve irritation, Lumbar radiculopathy, Bony encroachment, Bone and joint conditions, Degenerative bone and joint conditions Injury to the bones and Arthritis and also other problems like Pregnancy, Tumors, Kidney problems. There are currently no clear indications for surgery in nonspecific low back pain. Low back pain usually goes undiagnosed, leading to increasing the risk of musculo-skeletal disease and complications like decreased flexibility and movement and may cause a range of lifestyle, sleep, work, social, and other issues.
Back pain and back injuries are very common in our society. Studies say that, 60 to 90 percent of all citizens will experience at least one back injury in their lives. Half of these people will experience multiple episodes of back problems. Many will undergo surgical procedures, and roughly 10 percent will see their condition become chronic. The ultimate cost to society in lost productivity and health-care resources totals in the billions of dollars. An even higher price, however, is paid by the people who have lost the ability to participate in the activities they most enjoy. Hence, the researcher felt the need to educate the urban employees about low back pain and it prevention to avoid untoward complications.Despite this, entire people still take their backs for granted, not realizing the incorrect postures they put their backs in every day. Almost everything you do requires the use of your back, and back problems are rarely the result of a single activity or accident. Most injuries occur over a period of years or even decades, as a result of various factors - how you sleep or sit, what you eat, or how you deal with the emotional stresses at home and work place.9
The researcher felt the need of preventive measures for LBP, for employees to reduce the increasing risk of musculo-skeletal problems and complications. The researcher felt that LBP is quite common with employees at the later agedue to prolonged working hours, incorrect posture stress at work. If they know preventive measures at the early age it can be avoided further. So, it is necessary to educate preventive measures for employees so that they practice in their life time to avoid back pain.
6.3 REVIEW OF LITERATURE
Review of literature is the selection of available documents on the topic which contain information, ideas, data, and evidence. It is an examination of the research that has been conducted in a particular field of study.
Review of literature is divided in to four parts. They are literature related to,
- Prevalence of Low back pain
- Knowledge about Low back pain
- prevention of Low back pain
6.3.1 LITERATURE RELATED TO PREVALANCE OF LOW BACK PAIN.
A cross sectional survey of 2405 nurses employed by a group of teaching hospitals was carried out. Self-administered questionnaires were used to collect information about occupational activities, non-occupational risk factors for back symptoms, and history of low back pain. The overall response rate was 69%. Among 1616 women, the lifetime prevalence of low back pain was 60% and the one-year period prevalence 45%. 10% had been absent from work because of low back pain for a cumulative period exceeding four weeks. The study concluded that prolonged working periods leads to LBP.10
A cross-sectional survey was conducted among 222 females in Central Japan with an aim to investigate the prevalence of musculoskeletal disorders. Self-reported questionnaire was used to obtain information from the subjects. The results showed that more than one–third of all women (36.9%) reported a current musculoskeletal disorder at some body site. By location, 13.5% of them reported disorders of lower back in comparison with the disorders of other parts like neck (9.5%), knee (5%), forearm (2.7%), legs (2.3%), and feet (1.8%). Thus it was concluded that low back injuries are the commonest musculoskeletal injuries among the women.11
A questionnaire was mailed to 542 women from a community-based research database. Detailed demographic data were collected, including participants' menopause, relationship, and employment status. Point and period prevalence estimates for low back pain were derived. Participants were classified based on pain intensity and disability scores calculated from the Chronic Pain Grade Questionnaire, and factors associated with high levels of pain and disability were examined.A total of 506 (93.4%) women completed the questionnaire. More than 90% of participants had experienced low back pain, with 75.1% and 22.5% reporting pain in the past 12 months and currently, respectively. Seven percent of women reported a high level of disability and 16% reported high-intensity pain. Women with higher levels of disability were more likely to have a higher body mass index and to have pain currently, whereas those with greater pain intensity were more likely to be younger, have a higher body mass index, not be employed outside the home, drink alcohol, and have current pain.Low back pain is a common problem for community-based women. A high body mass index and current pain were factors independently associated with both high pain intensity and disability. Longitudinal investigation is required to determine the predictive nature of these factors and their potential role in preventing pain and disability.12
6.3.2LITERATURE RELATED TO PREVENTION OF LOW BACK PAIN
A cohort study was conducted at University of Sydney to provide the first reliable estimate of the 1-year incidence of recurrence in subjects recently recovered from acute nonspecific low back pain (LBP) and to determine factors predictive of recurrence in 1 year. Out of 1334 consecutive patients 353 subjects recovered before 6 weeks and entered the current study. Results says that recurrence of LBP was found to be much less common than previous estimates suggest, ranging from 24% using "12-month recall" definition of recurrence, to 33% using "pain at follow-up" definition of recurrence. However, only 1 factor, previous episode(s) of LBP, was consistently predictive of recurrence within the next 12 this study challenges the assumption that the majority of subjects will have a recurrence of LBP in a 1-year period. After the resolution of an episode of acute LBP, about 25% of subjects will have a recurrence in the next year. It is difficult to predict who will have a recurrence within the next yea.13
A cohort study conducted in 30 states from April 1996 through April 1998, the researchers identified material-handling employees in 160 new retail merchandise stores 89 required back belt use; 71 had voluntary back belt use. A referred sample of 13873 material handling employees provided 9377 baseline interviews and 6311 (67%) follow-up interviews; 206 (1.4%) refused baseline interview. The results suggested that, neither frequent back belt use nor a belt-requirement store policy was significantly associated with back injury claim rates or self-reported back pain. In the largest prospective cohort study of back-belt use, adjusted for multiple individual risk factors, neither frequent back belt use nor a store policy that required belt use was associated with reduced incidence of back injury claims or low back pain.14
A study was conducted at North Carolina to practice patterns and evidence in chronic low back pain. The objectives of these studies were to describe health care use for LBP. 57357 households were contacted in 2006 to identify 732 no institutionalized adults 21 years and older with chronic LBP. Five hundred ninety individuals sought care. Individuals with chronic low back pain were middle-aged (mean age 53 years), and the majority were women (62%). 60% used narcotics in the previous month. The mean number of provider visits was 21, and over one-third had an advanced imaging procedure in the past year. Only 3% had engaged in a formal spine rehabilitation program. Half of patients not taking antidepressants were positive on a 2-item depression screen. Although this study was population-based, it was conducted in only one state. Provider and treatment use for chronic LBP are both very common and varied. The study concluded that current treatment patterns are consistent with overutilization of some medications and treatments, and underutilization of exercise and depression treatment.15
A study was conducted as a randomized controlled parallel-group trial at the University of Munich in Germany to examine whether a multimodal, secondary prevention program is superior to a general physical exercise program (EP) in influencing the process leading to chronic low back pain (LBP) in nurses with a history of back pain.A total of 235 nurses from 14 nearby hospitals who experienced at least one episode of back pain during the previous 2 years were invited into the study. Of these, 169 (83 in the MP and 86 in the EP) qualified for the intent-to-treat analysis. Main outcome measurements were the primary study end-point variable was pain interference, and the secondary study end-point variables were pain intensity and functioning as measured with the West Haven-Yale Multidimensional Pain Inventory and the Short Form-36, respectively. There was no statistically significant difference between the 2 groups. Small-to-moderate effects were observed in both intervention programs across all study end-point variables. For pain interference, the effect size at 12 months after intervention was 0.58 in the MP and 0.47 in the EP.Study found that a multimodal program is not superior to a general exercise program in influencing the process leading to chronic LBP in a population of nurses with a history of pain. The most likely explanation is a common psychological mechanism leading to improved pain interference that is irrespective of the program used. Considering the lower resources of the general exercise program, the expense for a multimodal program is not justified for the secondary prevention of LBP and disability.16