|Year : 2017 | Volume
| Issue : 1 | Page : 50-54
Correlation of physical factors with musculoskeletal pain among physiotherapists
Vidhi Rajen Kalyani1, Surendra Kiran Wani2, Savita Rairikar3, Ashok Shyam4, Parag Sancheti5
1 Department of Musculoskeletal Physiotherapy at Sancheti Institute College of Physiotherapy, Pune, Maharashtra, India
2 Associate Professor, Department of Musculoskeletal Physiotherapy, Sancheti Institute College of Physiotherapy, Pune, Maharashtra, India
3 Principal and HOD, Department of Community Physiotherapy, Sancheti Institute College of Physiotherapy, Pune, Maharashtra, India
4 Chief Research Co-ordinator, Department of Orthopaedics, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India
5 Chairman and HOD, Department of Orthopaedics, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India
|Date of Web Publication||5-May-2017|
Surendra Kiran Wani
Sancheti Institute College of Physiotherapy, Sancheti Healthcare Academy, Thube Park, Shivajinagar,Pune - 411 005, Maharashtra
Source of Support: None, Conflict of Interest: None
Introduction: The etiology of musculoskeletal work related disorders remains largely unclear, pain being the predominant complaint. The prevalence of neck pain, shoulder pain, upper and lower back pain increases drastically during professional practice in Physiotherapy. This study evaluated the prevalence of musculoskeletal pain. Also, the study determined the role of modifiable risk factors for physiotherapists (physical activity, psychological status and quantity and quality of sleep) for pain. Method: The study population includes 60 physiotherapists with atleast work experience of 1 year and work duration of 6 hours per day. Outcome measures used were Nordic Musculoskeletal Questionnaire as a screening tool, Orebro Musculoskeletal Pain Questionnaire, The Short Questionnaire to Assess Health-Enhancing Physical Activity (SQUASH), University of Cambridge sleep questionnaire and Internet Mental Health Quality of Life (IMHQOL) scale. Results: Comparatively, pain was more concentrated at spinal regions than peripheral locations among physiotherapists. Surprisingly, many physiotherapists reported multiple sites of musculoskeletal pains. Conclusion: A weak correlation was established between physical activity and musculoskeletal pain among physiotherapists.
Keywords: Musculoskeletal pain, physical activity, physiotherapists, psychological status, sleep
|How to cite this article:|
Kalyani VR, Wani SK, Rairikar S, Shyam A, Sancheti P. Correlation of physical factors with musculoskeletal pain among physiotherapists. Indian J Pain 2017;31:50-4
|How to cite this URL:|
Kalyani VR, Wani SK, Rairikar S, Shyam A, Sancheti P. Correlation of physical factors with musculoskeletal pain among physiotherapists. Indian J Pain [serial online] 2017 [cited 2019 Aug 20];31:50-4. Available from: http://www.indianjpain.org/text.asp?2017/31/1/50/205712
| Introduction|| |
Physiotherapist promotes the quality health of the community as a whole., While providing physiotherapy services, they adopt challenged abnormal postures which might have an adverse effect on their overall health.,,,, Musculoskeletal problems were prevalent as a consequence of 60% work-related injuries among physiotherapists and is a common reason for providing effective physiotherapeutic treatment.,,,,,
We tried to identify the various physical and mental factors associated with musculoskeletal pain among physiotherapists. Previous literature demonstrated that physiotherapists are prone to develop musculoskeletal pain as a result of high physically demanding work style. However, there is very limited literature available on the causative factors for the same among Indian physiotherapists. Therefore, this study was aimed to correlate various physical and mental factors with musculoskeletal pain to identify the associated factor with it.
| Materials and Methods|| |
In this co-relational study, 60 physiotherapists from Pune city were taken as subjects using purposive sampling technique. The synopsis was sent to the Institutional Review Board (IRB) for approval. After approval from the IRB, written consent was taken from all the subjects and subjects were then screened for the presence of musculoskeletal pain with NMQ before including them into the study. Physiotherapists included in this study were those having musculoskeletal pain, involved in only clinical practice and not any academic work, having minimum 1 year of work experience and having minimum 6 hours work duration per day. Physiotherapists excluded from this study were those having any past history of neurological disorders with neurological deficits, having any past history of recent (within a time span of 6 months -1 year) trauma or surgeries done,, performing regular exercise and indulged in sports. Statistical analysis was done by using Spearmen's co-relational test on SPSS software version 20 (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp). After inclusion of the subjects having musculoskeletal pain, they were given to fill all the questionnaires.
Firstly the screening tool- Nordic Musculoskeletal Questionnaire (NMQ) (Body Part Discomfort Interview),, which has been applied to a wide range of occupational groups to evaluate musculoskeletal problems in computer and call centre workers, car drivers, nurses etc. The NMQ contains three parameters to measure the quality and quantity of pain according to the parts of the body involved. The parameters are frequency, severity and related work activities. Frequency and severity are both rated on a scale of 1-4. The reliability is 0.77 with a validity of 85% for the given questionnaire. Secondly, for Pain assessment-Orebro Musculoskeletal Pain Questionnaire ,, which was developed as a tool to assist in the early identification of yellow flags and patients risking the development of work disability due to pain.
The OMPSQ has 25 items out of which 21 are scored and it also has satisfactory psychometric properties and predictive ability. This questionnaire was developed by the MacMaster University, Australia and has a reliability of 0.91 with 82% validity. Further, physical activity assessment- The Short Questionnaire to Assess Health-Enhancing Physical Activity (SQUASH),, is a tool to monitor the physical activity behavior of the adult population and compliance to physical activity guidelines. The SQUASH consists of questions to assess commuting activities, leisure time activities, household activities, and activities at work and school. Questions elucidate the frequency, duration, and intensity of physical activities engaged in across a typical week in the previous months. The SQUASH has a reliability of 0.57 with a validity of 67%. Fourthly, Quality and quantity of Sleep assessment- University of Cambridge sleep questionnaire  which was developed for Parkinson's disease patients. The questionnaire contained 45 questions that focused on different sleep-related issues such as duration, quality of sleep, abnormal nocturnal behaviour and quality of life. And lastly, Psychological status assessment- Internet Mental Health Quality of Life (IMHQOL) scale  that measures the individual's quality of life with respect to mental health as it is composed of 78 items (questions) which are divided into 15 categories. It evaluates the social and occupational functioning, mental health, physical health, and progress.
| Results|| |
Descriptive data of prevalence of musculoskeletal pain at various locations, assessment of physical activity, quality and quantity of sleep and psychological status among physiotherapists was documented and presented in tables. Co relational analysis was done using Spearmen's correlational test suggesting a weak co-relation between the amount of physical activity and pain score with p value being non-significant and no co-relation between other physical factors (quality and quantity of sleep, psychological status) and pain score with p value being non-significant. No co-relation was seen between pain score and BMI with p value being non-significant again [Figure 1], [Figure 2], [Figure 3].
|Figure 1: Scatter diagram showing correlation of physical activity with pain|
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|Figure 2: Scatter diagram showing no significant correlation between sleep and pain|
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|Figure 3: Scatter diagram showing no significant correlation between psychological status and pain|
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| Discussion|| |
The prevalence of musculoskeletal pain among physiotherapists was high and often presented at multiple sites. Maximum pain at a single location was found to be at neck (13.33%) and lower back (16.66%), whereas maximum pain at two locations was seen involving upper and lower back region (11.66%). Around 11.6% of physiotherapists had pain more than two sites involving shoulder and upper and lower back region. Very few physiotherapists complained of musculoskeletal pain at more than three sites [Table 1]. However, another study done on Indian physiotherapists in Gujarat in 2013 demonstrated a prevalence of about 68% work-related musculoskeletal disorders.
The present study correlated physical and mental factors with the intensity of pain among physiotherapists. This study found no correlation between musculoskeletal pain intensity and body mass index (BMI) among physiotherapists supported by a research done in 2008 which showed no correlation of pain with BMI even if 50% of the included physiotherapists were overweight. Thus, this proves that body weight does not influence the intensity of musculoskeletal pain and therefore should not affect the working capabilities of a physiotherapist too.
This study documented the amount of physical activity in physiotherapists using SQUASH questionnaire which is a valid and reliable tool.,, Physical activity is defined as any body movement produced by a skeletal muscle that leads to increase in energy expenditure above basal level. The amount of physical activity performed by physiotherapists ranged between mild, moderate, and severe physical activity. A maximum number of physiotherapists were identified to have moderate physical activity (46.66%). A few physiotherapists also documented their physical activity as severe (11.66%). Both high and low levels of physical activity may be associated with musculoskeletal problems in physiotherapists.,, This study showed high levels of physical activity was weakly associated with intensity musculoskeletal pain among physiotherapists. On the contrary to this, a dissertation done in Finland in 2010 stated that high physical activity levels having more than 6 h of brisk activity per week are significantly related to pain. Similarly, many other studies identified the common aggravating risk factors of musculoskeletal pain and discomfort to involve physiotherapy practices such as bending, twisting, applying force, management of large number of patients in a day, lifting with sudden maximal effort, prolonged sitting, working in the same position for long, adoption of uncomfortable posture, not having enough rest, carrying heavy equipment, and continuing to work while injured. In a paper presentation done in India, there was a positive correlation between adverse work style score and pain and concluded that 72.72% of the physiotherapists had adverse work style and 87% of physiotherapists revealed that they worked through pain  [Table 2].
Quality and Quantity of sleep was calculated using Cambridge score of physiotherapists with the categories being normal rapid eye movement (REM) sleep, mild and severe affection of sleep. A majority of physiotherapists were found to have normal REM sleep (68.33%). Newer technologies and social networking have restructured today's lifestyle resulting in poor sleep quality. Sleep disturbances overall increase the risk of many health problems and could very well be related to the increased risk of musculoskeletal pain. It is also suggested that fatigue, difficulties in falling asleep, waking up at night, and other sleep problems are risk factors of musculoskeletal pain. Difficulty in falling asleep and symptoms of fatigue were found to be allied with musculoskeletal pain in adolescents according to the Finland research study. It stated that daytime tiredness and waking up at night are associated with recurrence of pain. In spite of the overall total sleeping time being reduced, no association could be proved with musculoskeletal pain, and thus, this study established normal REM sleep in majority of the physiotherapist population  [Table 3].
|Table 3: Assessment of quality and quantity of sleep in physiotherapists|
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Psychological status and depressive behavior may also be related to the incidence of musculoskeletal pain. IMHQoL score determined the psychological status of physiotherapists. Physiotherapists were divided into three groups on the basis of their score. All the physiotherapists were analyzed and categorized into Group 1 as normal psychological status. Thus, it was a total (100%) distribution. Appreciatively, the psychological status of all participating physiotherapists was found to be normal, and thus it can be rightly inferred that psychological status does not have any effect on musculoskeletal pain. Earlier studies have also mentioned insufficient quality and quantity of sleep causing musculoskeletal disorders through a psychological pathway and also that reciprocal relations are suggested between pain and a participant's current psychology. Moreover, although this study does not support any correlation, in all the relations between psychological status and symptoms, quality and quantity of sleep, and musculoskeletal pain are complex. [Table 4]
A weak correlation was found between the amount of physical activity and pain score with P value being nonsignificant. On the other hand, no correlation was found in between other physical factors (quality and quantity of sleep and psychological status) and pain score with P value being nonsignificant, respectively. Then again, no correlation was also found between pain score and BMI with P value being nonsignificant [Table 5].
As a clinical implication of this study, a regular assessment of the above-mentioned physical factors is recommended as it would determine the physical and mental status of a physiotherapist that may affect the working capacities of a physiotherapist during clinical practice. Future scope of this study suggests that correlation of all these physical factors with musculoskeletal pain should be done keeping in mind the specialties of physiotherapists too, i.e., neurosciences, musculoskeletal sciences, cardiorespiratory sciences, and community and social sciences. Furthermore, a comparison can be done in between each of these specialties.
| Conclusion|| |
A weak correlation was observed between musculoskeletal pain and level of physical activity of physiotherapists. However, musculoskeletal pain was not associated with quality and quantity of sleep and psychological status among physiotherapists.
We are thankful to hospital management and other teaching staff for their support during the study. We wish to recognize the statistical experts Dr. Apurv Shimpi (PT) and Dr. Mrs. Rachana Dabadghav (PT) who helped me in statistical analyses. In addition, we would like to extend my sincere appreciation toward all the clinical physiotherapists participating in the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Alshagga MA, Nimer AR, Yan LP, Ibrahim IA, Al-Ghamdi SS, Radman Al-Dubai SA. Prevalence and factors associated with neck, shoulder and low back pains among medical students in a Malaysian Medical College. BMC Res Notes 2013;6:244.
Wang SY, Liu LC, Lu MC, Koo M. Comparisons of musculoskeletal disorders among ten different medical professions in Taiwan: A nationwide, population-based study. PLoS One 2015;10:e0123750.
Sharan D, Ajeesh PS. Injury prevention in physiotherapists – A scientific review. Work 2012;41 Suppl 1:1855-9.
Narendrasinh JU, Mulla A. Prevalence and risk factors of work related injuries among physical therapists in Indian population. Int J Sci Res 2015;4:2575-8.
Ajeesh PS, Sharan D. Musculoskeletal Symptoms among Physiotherapists in India. In the Proceeding of the 30th
International Congress on Occupational Health; 2008.
Buddhadev N, Kotecha I. Work-related musculoskeletal disorders: A survey of physiotherapists in the Saurashtra region. Natl J Med Res 2012;2:179-81.
Sharan D, Mohandoss M, Ranganathan R, Rajkumar J, Jose J. Musculoskeletal Disorder among Physiotherapists – A Survey Report. In the Proceedings of the Nordic Ergonomics Society Annual Conference – 46; 2014.
Yasobant S, Chandran M, Reddy EM. Are bus drivers at an increased risk for developing musculoskeletal disorders? An ergonomic risk assessment study. J Ergon 2015;S3:011:2-5.
Auvinen J. Neck, Shoulder and Low Back Pain in Adolescence [Dissertation]. Finland: University of Oulu; 2010.
Hanvold TN, Wærsted M, Mengshoel AM, Bjertness E, Twisk J, Veiersted KB. A longitudinal study on risk factors for neck and shoulder pain among young adults in the transition from technical school to working life. Scand J Work Environ Health 2014;40:597-609.
Bharadva N, Verma M, Kantharia S. Are physiotherapy students at risk of musculoskeletal pain? A study on physiotherapy students of Government Physiotherapy College, New Civil Hospital, Surat. International Journal of Interdisciplinary and Multidisciplinary Studies (IJIMS) 2014;1:157-63.
Mohan H. Textbook of Pathology. 5th
ed. New Delhi: Jaypee Brothers; 2005. p. 174-9.
Maheshwari J. Essential Orthopaedics. 3rd
Revised Edition. New Delhi: Mehta Publishers; 2005. p. 8-10.
Arsalani N, Fallahi-Khoshknab M, Ghaffari M, Josephson M, Lagerstrom M. Adaptation of questionnaire measuring working conditions and health problems among Iranian nursing personnel. Asian Nurs Res (Korean Soc Nurs Sci) 2011;5:177-82.
Bergstena E, Mathiassena S, Vingardb E. Psychosocial Work Factors and Musculoskeletal Pain among Swedish Flight Baggage Handlers. In the Proceedings of the 19th
Triennial Congress of the IEA; 2015.
Crawford J. The Nordic Musculoskeletal Questionnaire. Occup Med 2007;57:300-1.
Linton SJ, Nicholas M, MacDonald S. Development of a short form of the Örebro Musculoskeletal Pain Screening Questionnaire. Spine (Phila Pa 1976) 2011;36:1891-5.
Leeuw M, Goossens ME, Linton SJ, Crombez G, Boersma K, Vlaeyen JW. The fear-avoidance model of musculoskeletal pain: Current state of scientific evidence. J Behav Med 2007;30:77-94.
Kirkwood R, MacDermid J, Hayden J, Woodhouse L. External Validation of the Orebro Musculoskeletal Pain Screening Questionnaire within an Injured Worker Population: A Retrospective Cohort Study [Dissertation]. McMaster University; 2011.
Wagenmakers R, van den Akker-Scheek I, Groothoff JW, Zijlstra W, Bulstra SK, Kootstra JW, et al.
Reliability and validity of the short questionnaire to assess health-enhancing physical activity (SQUASH) in patients after total hip arthroplasty. BMC Musculoskelet Disord 2008;9:141.
Campbell N, Gaston A, Gray C, Rush E, Maddison R, Prapavessis H. The short questionnaire to assess health-enhancing (SQUASH) physical activity in adolescents: A validation using doubly labeled water. J Phys Act Health 2016;13:154-8.
Mack DE, Wilson PM, Gunnell KE, Gilchrist JD, Kowalski KC, Crocker PR. Health-enhancing physical activity: Associations with markers of well-being. Appl Psychol Health Well Being 2012;4:127-50.
Goodman AO, Morton AJ, Barker RA. Identifying sleep disturbances in Huntington's disease using a simple disease-focused questionnaire. PLoS Curr 2010;2:RRN1189.
Mamidi P, Gupta K, Thakkar A. Ashwagandha in psychogenic erectile dysfunction: Ancillary findings. Int J Res Ayurveda Pharm 2014;5:36-40.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]