Author: admin

Kavya Sree.P.P¹, Saji.V.T²

Corresponding Author:

¹MPT Student, Cooperative Institute of Health Sciences,Thalassery, Kerala, India, Email id: kamalakshanppp@gmail.com

Co-Author:

²Principal and Professor, Cooperative Institute of Health Sciences, Thalassery, Kerala, India

ABSTRACT

Background: In the female population, stress urinary incontinence (SUI) is a disorder in which elevated abdominal pressure caused by coughing, laughing, sneezing, or exercising results in accidental urine leakage. Women exercise in more significant numbers and learns about the cardiovascular and musculoskeletal advantages of regular physical activity.

Method: This is a Cross-sectional survey done at Ladies Fitness Centers Kannur and Kozhikode Districts in Kerala. Five hundred young women were selected who fulfils the inclusion and exclusion criteria by simple random sampling. The participant’s height and weight were measured to calculate BMI. The participants were given two questionnaires, ICIQ- SF (International Consultation on Incontinence Questionnaire-Short Form), which contains four primary items that require participants to rate their symptoms over the previous four weeks. The first two items are demographic, while the final one is self-diagnostic. The QUID (the questionnaire for urinary incontinence diagnosis) is the questionnaire in which six questions regarding urinary incontinence in which three items consist of stress urinary incontinenceand the remaining three items consist of urge incontinence symptoms. Both questionnaires were given to each participant and recorded.

Result: This study enrolled 500 young women with an average age of 22.77. 37.2% of the young women attending the gym had SUI while doing high-impact workouts.

Conclusion: The study reported that there is a risk of stress urinary incontinence during high impact exercises in young women. Both married and unmarried young women experienced leakage during high impact exercises. The finding suggests that continuous high-impact exercise may result in chronic mechanical stress of the pelvic floor.

Keywords: High impact exercises; Stress urinary incontinence; ICIQ-SF score; QUID score.

Received on 27^th July 2021, Revised on 12^th August 2021, Accepted on 28^th August  2021, DOI:10.36678/IJMAES.2021.V07I03.006

INTRODUCTION

Urinary incontinence (UI) is defined by the World Health Organization (WHO) and the International Continence Society (ICS) as an unintentional flow of urine via the urethra, and it is regarded as a concern for one’s health, social well-being, and hygiene. Urinary incontinence can be classified into three categories, according to the standardization steering committee (SSC). Stress urinary incontinence(SUI) or effort urinary incont-inence, urge urinary incontinence (UUI), and mixed urinary incontinence are the three types of incontinence (MUI)¹.

The  urgency urinary incontinence (UUI), it is described as the uncontrolled loss of urine that occurs in response to a sense of urgency, there are two other clinical presentations to consider: mixed urinary incontinence (MUI), which is described as a relationship between urgency and leaking during physical exertion and SUI, which is characterized as any symptom of uncontrolled loss of urine that occurs following physical efforts, such as sneezing and coughing, or during any other stressful situation².

Among these types of incontinence, SUIis the most common, with prevalence rates ranging from 10% to 55% in women aged 15 to 64 years.³The significant risk factors can be classified as predisposing factors, such as family history, supporting factors, such as sports participation, and aggravating factors, such as obesity and natural delivery with neuromuscular impairment. In this scenario, women who engage in physical activity, particularly impact sports, have a higher prevalence of urine incontinence. According to a study, 47% of women who regularly exercise may suffer from urine leakage. Numerous individuals link this issue to pregnancy and childbirth. However, 25–28% of non-pregnant high school and collegiate athletes develop stress urine incontinence⁴.

These percentages are even more remarkable in athletics that dramatically increase intra-pelvic pressure, such as gymnastics and trampoline, where between 60% and 80% of players report incontinence.”The proportion of urinary leakage in the different sports was gymnastic 56%, ballet 43%, aerobics 40%, badminton 31%, volleyball 30% athletics 25%, handball 21% and basketball 17%.”⁵Jumping was the most probable action to result in leakage. The majority of the time, SUI is the result of a malfunctioning pelvic floor. Urine leakage is a widespread issue, even among young females, and irrespective of age, between 15% and 30% of women have negative consequences from urinary incont-inence in all sectors of life, and including a decline in life quality. SUI affects one in every three women at some point in their lives and is more prevalent in parous women than in nulliparous women^6,7.

Urinary incontinence is resulted by a complicated synchronization of the bladder, urethra, pelvic floor muscles, and ligaments, which occurs most frequently during activity when abdominal pressure increases.The magnitude and duration of high-impact, frequent exercise may contribute to pelvic floor muscle fatigue and, as a result, incontinence. Raises in intra-abdominal pressure are evenly transferred to the bladder, bladder base, and urethra in an optimally supported urogenital tract. Increased downward direct pressure caused by coughing, laughing, sneezing, and Valsalva manoeuvreis balanced incontinent women by ancillary tissue tone produced by the levator ani muscle and vaginal connective tissue. However, when descending forces are not resisted in those with a compromised supporting “backboard, “funnelling of the ureterovesical junction occurs, resulting in an open urethra and subsequent urine leakage ^8,9,10.

High impact activities are those that need both feet to leave the ground simultaneously, such as sprinting, jumping jacks, plyometrics, some stepping aerobics, and some cardio dancing that requires hopping. These activities should be kept for those who already have a basic level of fitness and are at minimal risk of developing joint problems, as they carry a significant risk of damage, particularly to the ankle, knee, and hip joints, and also the spine.Fit and active women are more prone to experience SUI. Numerous researches have demonstrated that activities requiringmuch physical exertion andhigh impact exercise can significantly increaseintra-abdominal pressure. It may overburden the pelvic organs, resulting in injury to the muscles that brace these organs. Within this setting, exercise becomes a contributor to the progression of urinary incontinence in women, particularly those without a history of childbirth or pregnancy^11,12.

Regular exercise was already recommended to people of any age for its health benefits and as a means of compensating for an ina-ctive lifestyle that can develop obesity, muscle weakness, and postural difficulties. Men and women work out at gyms with this goal in mind, oblivious to the fact that when performing the activities, the peripheral and interior muscles are involved and may be harmed if the activities are performed inappropriately. At some stage of life, all women will have stress urinary incontinence. Unfortunately, many of them “live with” the problem, either because they are too ashamed to ask for help or because they believe it is a “natural” aspect of ageing and having children^13,14.

There has been little research on the influence of high-impact workout on the female lower urinary system. The more effective treatment for SUI is surgery. In women and individuals with minor symptoms, conservative treatment is now suggested as the first line of defence. Conventional non-surgical treatmentsinclude lifestyle changes, bladder strengthening and conditioning, pelvic floor muscle workout, biofeedback, and activating pelvic floor by applying a small voltage.

Kegel workouts are the most common approach toreinforcing the pelvic floor muscles because they are non-invasive and do not require vaginal weights or cones. Arnold Kegel, an American gynaecologist, characterised them for the first time in 1948. They seem to be the most cost-efficient treatment option and are distinguished from other therapies because they may be performed independently by the patient at any time and location while performing other tasks without requiring regular hospital trips. Simply instructing the patient on how to tense their pelvic floor muscles is all that is required. Kegel exercise consistently strengthens the pelvic floor, according to the majority of studies¹⁵.

 By conducting the survey,it tries to find out the prevalence of SUI in young women who participate in high impact exercises at the gym in Kannur and Kozhikode districts in Kerala and also give awareness to the public regarding the significance of pelvic floor strengthening exercises and the relevance of the same in having healthy adultlife.

MATERIALS AND METHODOLOGY

Five hundred young women were selected by the proper screening and fulfilling the inclusive criteria: a) Young women aged 20-25 years, b) Young women who satisfied specific questionnaire criteria about the type of activity in the gym, c) Healthy and sexually active women, d) Willingness to participate, e) Young women who attend gym and exclusion criteria f) Handicapped young women, g) Surgical treatment for gynaecological and urological illness, h) Infection of the urinary tract, i) Diabetics Mellitus, j) Respiratory disease, k) Incomplete questionnaire, l) Refusal to take part in the research, m) BMI above 30, n) Combination of multiplesports.

Before the study, the purpose and procedure were explained to the participants, and their consent wasobtained.  The participant’s height and weight were measured to calculate BMI. The 500 participants who performed high impact exercises were given two questionnaires.The “ICIQ-SF (International Consultation on Incontinence Questionnaire-Short Form)” questionnaire contains four primary items in which respondents are asked to rate their symptoms during the previous four weeks. The first two items are demographic, while the final one is self-diagnostic. The QUID (the questionnaire for urinary incontinence diagnosis) has six questions regarding urinary incontinence, in which three items consist of SUI and the remaining three items consist of urge incontinence symptoms. Both questionnaires were given to each participantand recorded.

RESULT

This study enrolled 500 young women with an average age of 22.77.37.2% of the young women attending the gym had stress urinary incontinence while doing high-impact exercises. The majority of the young women having SUI were in the overweight category. The p-value is less than 0.001. In the QUID score, the relation between age and SUI is positive. The SUI is seen to increase with age. However, since the p-value is greater than 0.05, the coefficient is not statistically significant, and the relation between BMI and SUIis positive.

The SUI is seen increasing with BMI. Since the p-value is less than 0.001, the coefficient is statistically significant. According to the ICIQ SF score, the relationship between age and SUI is positive, and the SUI also increases with age. However, since the p-value is greater than 0.05, the coefficient is not statistically significant, and the relation between BMI and SUIis positive. The SUIis seen increasing with BMI. However, the p-value is greater than 0.05; the coefficient is not statistically significant.

DISCUSSION

The research aimed to determine SUI prevalence in young women who go to the gym and participate in high-impact workouts. “According to the World Health Organization (WHO) and the International Continence Society (ICS), urinary incontinence is defined as the involuntary flow of urine via the urethra and is a cause for concern on health, social, and hygiene reasons”.SUI, UUI, and MUI are the three primary kinds of urine incontinence. In a nutshell, SUI is defined as the loss of urine due tohigh intra-abdominal pressure and rise in intravesical pressure beyond the urethral closure limit. This scenario can arise as a result of coughing, sneezing, or jumping. Urinary incontinence is more frequently diagnosed in women than males, and it was anticipated to impact almost 420 million individuals globally in 2018. According to recent data, women have urinary incontinence twice as frequently as males. This condition affects approximately 20-30% of young women, 30-40% of women in middle age, and up to 50% of old aged women.

High impact activities are those that require both feet to leave the ground simultaneously, such as sprinting, jumping jacks, plyometrics, some step aerobics, and some cardio dancing that incorporates leaping. These types of exercise should be confined to individuals who already have a baseline level of fitness and are not at risk of developing joint problems, as they increase the risk of damage, particularly to the ankle, knee, and hip joints, as well as the spine¹¹. Numerous women incorporate recreational physical activity into their daily routines in order to ensure a healthy lifestyle. Physical activity has long been known to benefit blood pressure, weight loss, diabetes, and hyper cholesterolemia. Men and women work out at gyms with this goal in mind, paying little attention to how they are doing so. The impact of physical activity on normal physiology of bladder, on the other hand, is not well recognized.

According to Celina Fozzati c, this occurs on physical workout when the intra-abdominal pressure varies. Pelvic floor muscle activity can be harmed by injury, and their malfunction is one of the determinants of the evolution of SUI in adult females.¹⁶High impact activities have been known to rupture the endopelvic fascia or the arch tendinous insertion of the pelvic floor muscles. Another possibility is that alterations in the spine’s physiological curvature result in postural changes and modification of the pelvic cavity’s anatomy due to stretch or compression injury to the pelvic floor muscle.

In this study, 500 young women are selected from the various female fitness centres in Kannur and Kozhikode districts in Kerala based on inclusion and exclusion criteria. A validated “ICIQ-SF questionnaire (International Consult-ation on Incontinence Questionnaire-Short Form)” and “QUID (the Questionnaire for Urinary Incontinence Diagnosis)” questionnaire was used for this study. ICIQ SF questionnaire,has four major sections that ask for a rating of symptoms during the previous four weeks. Items 1 and 2 are demographic, and the final item is self-diagnostic.

The QUID is the questionnaire in which six questions regarding urinary incontinence in which three items consist of SUIand the remaining three consist of urge incontinence symptoms. All the subjects were given and explained the questionnaire. From the questionnaire outcome, we obtained the incidence of SUIin young women who perform high impact exercises atthe gym.

SUI develops when a weakened urethral sphincter cannot withstand the discharge of urine from the bladder during instances of increasing intra-abdominal pressure. “The respective elements affect to urethral continence maintenance: passive urethral closure and coaptation, a critical urethral length, maintenance of the bladder muscle and proximal urethra in their normal anatomic positions, and adaptive changes to the urethra during periods of increased intra-abdominal pressure¹⁷.

According to Kari BO, high-impact physical activity increases intra-abdominal pressure. Suppose the muscles of lower pelvic region are unable to co-contract rapidly andsufficiently powerfully to resist this immense pressure or endure the ground compressive force, the levator hiatus may widen, extending and weakening the muscles and increasing the risk of urinary incontinence¹⁸.

Epidemiological research on urine incontinence indicates that the disorder is two to three times more prevalent in women. Thus, urinary incontinence can be considered a specific aspect of ageing when it is not reported in women of all ages, cultures, and races, contrary to popular belief that it is more prevalent in the old population, creating a global problem.

According to Hannestad, the frequency grows steadily with age, reaching a significant high in middle age and continuing to rise continuously after age 65. The kind of incontinence may vary with age; some research indicates that SUI is more prevalent in women under the age of 60. According to the survey, the majority of cases were documented among young women under the age of 25. High BMI is a substantial and unique risk factor for SUI, according to Navneet margon¹⁰.Evidence suggests that both desire and SUI prevalence increase proportionately with BMI. Thus, a rise in intraabdominal pressure associated with higher BMI results in a correspondingly increased intravesical pressure, which overcomes urethral closure pressure and results in incontinence.

In this study, 37.2% of the young women attending the gym had stress urinary incontinence. According to QUID and ICIQ – SF scoring, the relation between age and stress incontinence is positive. The SUI is seen to increase with age. Nevertheless, since the p-valueis greater than 0.05, the coefficient is not statistically significant. The relation between BMI and SUI is positive.

According to ICIQ –SF score SUI seen in increasing with BMI, the p-value is greater than 0.05; the coefficient is not statistically significant. But in the QUID score, SUI increase with BMI. Since the p-value is less than 0.001, the coefficient is statistically significant.

Ethical Approval: Ethical clearance has been obtained from the Ethical Committee of Cooperative Institute of Health Sciences, with reference number: 01/2018/MPT Musculo-skeletal & Sports/CIHS, dated: 12/04/2019, Kozhikode, Kerala.

Conflicts of Interest: No conflict of interest to conduct and publish this article was reported throughout the study.

Fund for the Study: This study is self-funded.

Limitations: The study was conducted in a small sample size. All the data were collected subjectively, which may introduce an error that treats the study’s reliability. No pilot study was conducted.

CONCLUSION

 The study concluded that SUI is a potential danger in young women who engage in high-impact workouts. Both married and unmarried young women reported experiencing leakage throughout high-impact activities.

The study’s findings will assist young women to engage in high-impact activities to strengthen their pelvic floor muscles and prevent stress urine incontinence.

REFERENCES

1. Magdelena Weber-Rajek, Agnieszka strac-zynska. Assessment of the effectiveness of pelvic floor muscle training (PFMT) and extracorporeal magnetic innervation (ExMI) in treatment of stress urinary incontinence in women: A Randomized Controlled Trial. Biomed Res Int. 2020 Jan 16; 2020; 1019872.
2. SoralaTonon Da Luz. Urinary incontinence in physically active young women: preva-lence and related risk factors. Int J Spors Med2017; 38; 937-941.
3. AratiMahishale, Rafat Khalid Hussain Jamadar. Research Article screening of urinary incontinence in female dancers- A cross sectional study. Research Journal of Obstetrics and Gynecology ISSN 1994-7925 DOI: 10.3923/rjog. 2018;31;35.
4. Ellen Casey MD. stress urinary incontinence in the female athletes. July 9; 2015.
5. H. H.Thyssen, L. Clevin,S. Olesen. Urinary incontinence in elite female athletes and dancers. Int Urogynecol J. 2002; 13; 15-17
6. Magdalena Hagovska, Jan Svihra. Prevalence of urinary incontinence in female performing high impact exercises. Int J Sports Med. 2017; 38; 210-216.
7. Aletha Silva Caetano, Maria de Consolacao Gomes Cunha. Urinary incontinence and physical activity practice. Esporte Niteroi July/Aug2007; Vol. 13; No 4; pp 245e-248e.
8. Jodie G. Dakic, Jill Cook, Jean Hay-Smith Pelvic floor disorders stop women exercising: A survey of 4556 symptomatic women. Journal of Science and Medicine in Sport. June 2021; S1440-2440(21)00147-X.
9. Aletha Silva Caetano, Maria de Consolacao Gomes Cunha. Urinary incontinence and physical activity practice.Esporte,Niteroi July/Aug 2007; Vol.13 no 4.
10. Navaneet Margon, Bharati karla. stress urinary incontinence what, when, why and then  what. Journal of mid life health, Jul- Dec 2011; Volume 12.
11. Carls C. The prevalence of stress urinary incontinence in high school and college-age female athletes in the midwest: implications for education and prevention.  Urol Nurs. 2007 Feb; 27 (1); 21-24.
12. Jyoti S Mandge, ArmaityDehmubed. Study of urinary incontinence affecting quality of life and health seeking behavior in women of an urban slum in Mumbai. Int J community Med Public Health. 2019 Jan; 6(1); 290-292.
13. Orly Goldstick, Naam Constantini . Urinary incontinace in physically active women and female athletes. BJSM online First, published on May 18, 2013 as 10.1136/ bjsports-2012-091880.
14. Beta Stach-Lempinen, Clas-HakanNygrad. Is physical activity influenced by urinary incontinence. BJOG: an International Journal of Obstetrics and Gynecology May 2004, Vol.111; pp.475-480.
15. Seong Hi Park, Chang Bum Kang. Effect of kegel exercise on the management of female stress urinary incontinence. A systemic review of Randomized controlled trials.volume 2014/Article ID640262.
16. Celina Fozzatti. Prevalence study of stress urinary incontinence in women  who perform high impact exercises. Int Urogynecol J., 2012; 23(12); 1687-1691.
17. Rovner, E. S., & Wein, A. J. (2004). Treatment options for stress urinary inco-ntinence. Reviews in urology, 6; Suppl 3; S29–S47.
18. Kari. BO .Is physical activity good or bad for the female pelvic floor?. A narrative review. Sports medicine. (2020). 50; 471-484.

Manoj Abraham. M¹, Meenas Mohamed Sageer²

Author:

¹Principal, KG college of Physiotherapy (The Tamil Nadu Dr. M.G.R. Medical University), Thudiyalur Road, Saravanampatti, Coimbatore, Tamilnadu, India,  Email id: manojpt3@gmail.com

Corresponding Author:

²BPT Internee, KG college of Physiotherapy (The Tamil Nadu Dr. M.G.R. Medical University), Thudiyalur Road, Saravanampatti, Coimbatore, Tamilnadu, India,   Email id: skmeenaskm@gmail.com

ABSTRACT

Background: Wearing eyeglasses have a greater influence on adapting to abnormal head and neck posture. As our sensory system is created so efficiently where any obstruction to the visual field will be compensated by body posture. Using an eyeglass provide a  smaller visual field leading to a chronic postural adjustment of the neck causing deep neck flexor weakness and eventually adapting to forward head posture.Aim of the study was to spot the prevalence of forward head posture on people wearing eyeglasses.

Methodology: The study was conducted among 106 eyeglass wearing populations of age groups 19-38. The subjects were assessed subjectively by giving a self-designed questionnaire and objectively the Craniovertebral angle was measured using the photographic method at KG College of physiotherapy outpatient department, Coimbatore.

Result: The study found that 75% of the population was affected by forward head posture and there is a moderate correlation (r value= 0.64) of hours of wearing eyeglasses and craniovertebral angle.

Conclusion:  Supported the result obtained, it is found that there is a high prevalence of forward head posture in people wearing eyeglasses and it depends on the duration of wearing eyeglasses. Thus, the finding of this study revealed that it is important to comprehend that wearing eyeglasses harms head and neck posture and also the importance of assessing visual devices when patient complaints of neck pain and disability.

Keyword: Forward head posture; Eyeglasses; Craniovertebral angle.

Received on 29^th July 2021, Revised on 10^th August 2021, Accepted on 26^th August  2021, DOI:10.36678/IJMAES.2021.V07I03.005

INTRODUCTION

Proper posture is the state of absolute balance with a negligible amount of stress and strain.  Although it is desirable people are unsuccessful in achieving it¹.This is probably due to muscle elongation or shortening which leads to inefficiency of movement, disability and pain².

Forward head posture (FHP) is one of the increasingly prevalent postural deviations. It is the main potential risk factor for various musculoskeletal and neurological problems even when there is no pain or disability at the present. The prolonged placement of the head anterior to the body’s centre of gravity is one of the main etiologies for forward head posture³. Forward head posture is generated due to shortness of the cervical extensors and pectoralis muscles and weakness in the deep cervical flexor muscles and mid-thoracic scapular retractors⁴. One of the common methods to access head posture is by measuring craniovertebral angle (CVA) ⁵.

In most of the low and middle-income countries eyeglasses are still widely used, even after the arrival of latest treatment because it is effective, safe and economically feasible¹. Lately, it had been found that wearing an eyeglass alters viewing distance and gaze angle which influences the body posture resulting in future risk factors⁶. An activity that requires eyeglasses like reading will be done efficiently, only by adapting to small compensatory postures. This is done for making the line of vision perfectly aligned to the focusing object⁷.

Deep neck flexors (DNF) muscles of the neck play a crucial role in maintaining a stable position of head over cervical spine⁸. Most of the time the biomechanical movement of the joint is interrupted by prolonged exposure to load on craniovertebral extensor muscles and the surrounding non-contractile structure and this increased stress can cause postural changes and eventually edge onto musculoskeletal damage or pain⁹.

Previously, there were many studies done to find out the risk factor of forward head posture like long time usage of smart phones or long time desktops working with poor posture. However, in India only few studies have been aimed to find out the relation between the usage of eyeglasses and posture. Hence this study is to find out the proportion at which a very simple and unavoidable material employed in day to day life is affecting one’s body posture which leads to greater expenditure of money and time for the rehabilitation purpose.

Objective of the study: The objective of the study is to identify the prevalence of forward head posture on the person wearing eyeglasses and to find the correlation of craniovertebral angle with hours of wearing eyeglasses.

METHODOLOGY

This is a cross-sectional study design conducted by accessing subjects from the KGISL campus for duration of 3 months. The sampling method for this study is random sampling. The sample size was calculated by using an app named epi info statistical calculator and 106 participants fulfilling inclusion criteria were included.

Inclusion criteria: Voluntary participants of the age group of 19-38 years who use any form of eyeglasses for more than 2 years¹⁰.

Exclusion criteria: Any history of prevailing neck pain or congenital abnormality of neck and participant who do regular exercise are excluded. Participants who are not regular users of eyeglasses or who have language or cognitive deficits were also excluded³.

Outcome measure: The outcome measure used here is a self-designed questionnaire for collecting demographic data and the photographic method for accessing craniovertebral angle.

Procedure: The participants were asked to assemble at the physiotherapy outpatient department at the KGISL campus and the following procedure was done.All the subjects were informed about the procedure and written consent were obtained before taking photographs for accessing CVA.

A self-designed questionnaire was created, the first part of which focused on demographic details and details about the work, the second part included questions of social factors and the third part included details about wearing eyeglasses.

This Questionnaire was validated by 3 senior physiotherapists who are involved in occupational health research. The questionnaire was distributed to every individual participant, the questionnaire was explained and participants were given two days to complete the same.

This method is used to assess forward head posture by finding the craniovertebral angle which is normally 49.9 degrees. Photographic method is used in this study to find CVA, which has a reliability of > 0.972. It is also cost-effective, gives accurate angle measurement and has fewer errors. 

First, adhesive markers were placed on the tragus of the ear, and the 7th cervical spinous process.  A mobile (iPhone of 12 megapixels) was placed at a distance of 100 cm on a tripod stand. Participants were made to stand in such a way their side faces the camera and were asked to focus on an object in front of them. The subjects were asked to do the neck movements a few times before achieving the standing neck resting position and focusing on the target object. The necessity of maintaining a natural position before the photography was explained to the participants. Then, three sagittal plane photos were taken by the camera.  Repeated photographs aimed at reducing bias due to participant’s tension during photography capturing as well as to overcome the difference between measurements because of postural swaying.

The photos are then transferred to an application; angle measure and then the C7 spinous process was marked as the vertex of the angle. Two lines were drawn one joining the C7 spinous process and tragus of the ear, another line passing horizontally through the C7 spinous process. The angle formed by these two lines was marked as CVA.

Appropriate information collected was entered in the data collecting sheet for purpose of statistical analysis. Once the procedure was over a ‘thank you’ note along with postural advice and an awareness pamphlet was given to everyone.

Statistical analysis: MS-excel were used to enter the data and find the result. Descriptive statistics, Pearson coefficient correlation and prevalence calculation was done and result obtained.

RESULT

By careful examination of 106 participants, descriptive statistics of participants were analyzed and expressed in the table given below.

Prevalence calculation of forward head posture is done, which shows that there is a greater prevalence of forward head posture in participants wearing eyeglasses such that 70 people i.e, 75% of participants were affected with forward head posture.

Correlation of hours of wearing eyeglasses with craniovertebral angle was calculated, the result reveals that there is a moderate positive correlation between them with r value is 0.64 which indicate that the longer the duration of eyeglass usage worst the FHP is. This finding reveals that a widely used eye correction device will eventually become the cause of sustained pain in the future.

DISCUSSION

The purpose of this study is to find the prevalence of forward head posture in people wearing eyeglasses. In this study 106 regular eyeglass users were selected, they were accessed to find the development of forward head posture.

Risk factor identification is an important factor while accessing a person with neck pain or any other postural deviation¹¹. Forward head posture has been linked with neck pain and dysfunction, cervicogenic headache, carpal tunnel syndrome and even an increased falling risk in the elderly¹².

Vision problem is a global health concern, especially in children and adolescents ¹³. As depicted by the Vision Council of America, some sort of vision correction is used by 75% of adults. In which 64% prefer eyeglasses, whereas only 11% prefer contact lenses, with or without frequent use of eyeglasses. Sustained activation of muscle causes calcium ion accumulation which leads to impaired blood flow (Cinderella hypothesis) and again there will be reperfusion of these muscles finally adapting permanent faulty posture. Using eyewear for a prolonged duration can

lead to muscle damage due to sustained low-intensity muscle activity for a prolonged time. Studies have shown that postural adaptation has been caused while viewing a visual target as a result of interaction between the visual and musculoskeletal systems ¹⁴.

Larry Sachs et al, found that on an average population there is a significant increase in the degree of forward head posture in the multifocal lens users than non-multifocal lens users and this gives important information for the physiotherapist who treats patient complaining pain over the neck-shoulder region. He also stated in his study that if a patient is having forward head posture and who is a multifocal lens user, then the lens usage is a greater contributing factor to the change in head posture¹⁴

A recent study conducted in India claims that DNF endurance was less in subjects wearing bifocal eyeglasses followed by unifocal and no eye glasses, which leads to a greater risk of getting forward head posture especially in people wearing a bifocal lens^3.

These changes in posture may lead to a greater risk of musculoskeletal disorder and headache¹⁵. Early identification of risk factors leading to permanent postural changes is helpful to take necessary preventive measures.

Even though an eyeglass has risk factors it is unavoidable. Thus, exercise is the only remedy for potential postural deviations. Regular neck exercise is advisable for a person using eyeglass and more studies must be done for the same. Regular postural assessment must be indicated for a regular eyeglass user and rehabilitation to prevent future postural deviation must be started as earlier as possible.

Ethical Concern: This study had no risk factor involved; the study was approved by Institutional ethical committee K G College of physiotherapy, Coimbatore.

Conflicts on Study: The author declares there is no competing interest in publishing this article.

Fund of Study: This is a self-funded study.

Acknowledgement: I thank all the participants for spending their valuable time to answering the questionnaire given and for letting me take the photographs without hesitation.

CONCLUSION

Based on the result obtained, it is found that there is a high prevalence of forward head posture in people wearing eyeglasses. Thus, the finding of this study revealed that it is important to realize wearing eyeglasses has an adverse effect on head and neck posture. This implicates the need for postural correction and regular head and neck exercise in daily life, especially for those people who wear eyeglasses every day.

While assessing any musculoskeletal problems in the neck, checking the details of the optic devices will be helpful to find out the etiologies and assists to derive a proper diagnosis. This small check could be a big move towards reducing the future financial and psychological burden on patient. It can also be a very less invasive public health solution for postural changes on the neck.

This study has put forward the need for further studies searching optometric parameters causing neck disability and to research on the treatment for the same. Further, this study can be done using radiological examination and finding the effect of using each eyeglass like unifocal, multifocal and progressive types on the neck along with the treatment protocol.

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3. Alka Pawalia, Shabnam Joshi, Vikram Singh Yadav(2019); Can your eye glasses lead to future neck pain and disability, international journal of community medicine and public health. 6(6)- 2402
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Manoj Abraham. M¹, Soumya Murali²

Author:

¹Principal, KG college of Physiotherapy (The Tamil Nadu Dr. M.G.R. Medical University), Thudiyalur Road, Saravanampatti, Coimbatore, Tamilnadu, India,  Email id: manojpt3@gmail.com

Corresponding Author:

²BPT Internee, KG college of Physiotherapy (The Tamil Nadu Dr. M.G.R. Medical University), Thudiyalur Road, Saravanampatti, Coimbatore, Tamilnadu, India, Email id: soumyamurali2818@gmail.com

ABSTRACT

Background: Upper crossed syndrome occurs due to muscular imbalance created in opposite muscle groups developing due to postural disturbances. It is presented with the simultaneous tightening of postural muscles and weakening of non-postural muscles in the upper body resulting in limited mobility. The purpose of the study is to determine the prevalence of upper crossed syndrome among software professionals.

Methods: A randomized sampling of 106 software professionals was conducted based on inclusion and exclusion criteria. The research was a cross-sectional study where software professionals of age group 20-40 years having a daily working schedule of minimum of 3 hours and a maximum of 18 hours on computers were included. A self-designed questionnaire and Neck Disability Index were circulated among participants and were assessed by performing special tests.

Results: The prevalence of upper crossed syndrome among the software professionals is 55.6%. There is a positive linear relationship between the development of the upper crossed syndrome and the functional disability among the people and in the Neck Disability Index and the hours of working in front of computer.

Conclusion: This study illustrates that there is a significant prevalence of upper crossed syndrome among software professionals. Neck pain and functional limitation were presented as the main symptom that is in the verge of occurrence.

Keywords: Upper crossed syndrome, musculoskeletal imbalance, neck disability index.

Received on 29^th July 2021, Revised on 10^th August 2021, Accepted on 26^th August  2021, DOI:10.36678/IJMAES.2021.V07I03.004

INTRODUCTION

India has been the vanguard in the cyber world with the development of information techno-logy. Approximately 6 computers per 1000 population and about 18 million personal computers are prevalent in our country. This number is increasing day by day. The booming of the information technology industry in India has led to an increase in the use of computer devices as well as marked the start of a new genre of occupational health problems among software professionals¹. It has led to various musculoskeletal discomforts². The mushroom-ming of the Visual Display Units (VDU) or the Visual Display Terminals (VDT) in the modern office settings has led to the various occupational health problems and musculo-skeletal ailments associated with it³. With the  association of improper posture, excessive muscular tension, and limited mobility results⁴. The excess time on work demands results in a significant increase in pain, functional limita-tion and fatigue⁵.

The physiological response from the work has been termed as “workstyle”. Workstyle has been recognized as a coupling factor for the muscular imbalances creating pain and functional limitation dueto the ergonomic factors inthe computer users⁶. Among the musculoskeletal complaints, the neck was the common site to be affected because of the static posture during work hours in front of the computer⁷.

While working in a sitting posture for a prolo- nged time, they tend to adopt a forward head posture shifting the head forward to the spinal central line. This is because they find it difficult to maintain the normal posture of the spine during the prolonged work hours of sitting⁸. For every one inch of forward head posture, there is an increase of additional 10 pounds of weight of head on the spine. Where the poor sitting may result in forward head posture and rounded shoulders due to altered body kinematics⁹. This forward head posture results in mechanical stress on the neck and cause smuscular imbalances¹⁰ where onegroup of muscles gets tightened and the other group gets weakened and inhibited¹¹.

This leads to the weakening of middle, lower trapezius, rhomboid scrossing ventrally with the weakness of significant cervical flexors. Simultaneously, the tightening and over active upper trapezius, levator scapulae crossing dorsally with the tightness of pectoralis major and minor also occur¹². This may also cause rounded shoulder, and abnormal postures of shoulder blades. Janda defined this phenom- enon as Upper Crossed Syndrome (UCS)¹³. Dr. Vladimir Janda coinedthis syndromeas Upper Crossed because when the weakened and tightened muscles form a cross when they are connected in the upper body¹⁴.

These muscular imbalances created in upper crossed syndrome in opposite muscle groups develop postural disturbances. This would res- ult in a reduction of the quality of the glenohu- meral joint. This is because the glenoid cavity will become more vertical because of the serratus anterior weakness creating the scapulae for winging and turning¹⁵. Sitting with the posture of forward head position creates upper cervical region extension and lower cervical region flexion which will in turn, reduce the muscle fiber length. This will eventually develop extensor torque around the upper cervical joints which will later lead to musculoskeletal imbalances and abnormalities like reduced scapular upward rotation, incre- ased internal rotation, anterior tilt which will eventually make them more difficult to maintain their erect posture of sitting¹⁶. This winging, elevated, and abducted scapula creates scapular dyskinesia there by which creates inrounding of shoulders.

Nearly three-fourths of the software profess- ionals were identified with computer- related health problems and musculoskeletal ailments. This is almost a significant proportion of the population of software professionals. This den- otes a need to emphasize a field of concern among the software professionals, their well being, and occupational health. Hence regular health check-ups and ergonomic advice being sensitized regarding the importance of their wellbeing and proper working conditions¹⁷.

METHODOLOGY

This was a cross-sectional study that was conducted in the Physiotherapy Outpatient Department, KGiSL Campus, Saravanampatti, Coimbatore. This study included 106 particip- ants who were selected by a simple random- ized sampling method. The study duration was three months. Epistat info was used for sample size calculation.

The objectives of the study were; to identify the occurrence of upper crossed syndrome among software professionals; to correlate the upper crossed syndrome with the functional disability of the individuals and also to correlate the upper crossed syndrome with the working hours infront of computer among software professionals.

Procedure: A written consent is obtained from every individual who signed up for the study. Before the study, a brief instruction was given regarding the research. Individuals selected for the study were instructed and asked to assemble in the K.G Outpatient Department in Coimbatore. Aself-designed questionnaire was distributed, the first section of which question- naire was focused on demographic details (name, age, gender, years of working) and the second section included social factors (personal and past history of any illness or treatment), the third section included the occ-urrence of neck pain(onset, duration and past treatment ), the fourth section consisted of other factors (history of working details and confirmatory tests) after the filling up of ques-tionnaire the subjects were also given the Neck Disability Index (NDI).

Neck disability index (NDI): It is a self-reported condition-specific questionnaire that includes 10 items- pain intensity, personal care, lifting, reading, headache, concentration, work, driving, sleeping, recreation). This questio- nnaire emphasizes how neck pain affects the ability to manage the activities of daily life (ADL).

The questionnaire was validated by 3 senior physiotherapists who are involved in occupational health research. After completion of filling the data, Trapezius and pectoralis tests are performed. The collected data were noted and taken for analysis. After the compl- etion of the procedure, thank you note accom- panied with ergonomic advice and a postural awareness pamphlet was given to subjects.

Inclusion criteria: Age between 20-40 years¹⁸, Software professionals with a computer-related work experience of minimum of 6 months¹⁸, with duration of working hours taken into consideration whichis fixed as at least 3 hours a day or 15 hours per week¹.

Exclusion criteria: previous history of any surgery/underlying pathology/inflammatory di- seases to cervical spine, known history of fractures of cervical spine or tumors^18,19.

RESULTS

This study showed that a significant proportion of software professionals in the present study reported that they experience muscular disco-mforts. This may be due to various factors such as the impact of the prolonged working hours in poor posture, involvement of multiple joints in computing tasks, adopting biomechanical and anatomical alignment of body motions of high physiologic cost leading to muscular imbalances gradually.

Most of the subjects spent a prolonged time in the office as their working hours showed that 31% of the population worked in front of the computer for 4-8hours and 69% of them had more than 8 hours of working on the computer with a static posture. Due to this static posture, they develop symptoms of neck pain. Out of 54% males and 46% females selected rando- mly, 94% of the population reported neck pain and 6% had no neck pain. 30(28%) of them experienced pain for less than one year, 40 (38%) mentioned that they are experiencing pain for one to two years and 36(34%) population had pain for more than 2 years. It was also discovered that only 82% of the population had proper back-supported well-cushioned chairs and the remaining 18% had no properly back supported chair in the office which can be a potential ergonomic risk for the yielding of symptoms as they work for prolonged hours.

Neck Disability Index values revealed that 11% of them had 0-8% of scoring stating no disability, 37% of them had mild disability scoring 10-28%, 52% of them scored 30-48% had moderate disability. None of the popula- tion had severe or complete disability. Further from the study, it was found that the symptoms and muscular discomforts were most debilitating causing a reduction in Activ- ities of Daily Living(ADL).

The mean value of the software professionals who are on the verge of developing upper crossed syndrome is 1.44±0.49 subjects and the mean value of their working hours is 3.68±0.46 hours. The value of ‘’r’’ value correlating them is 0.60. This is a moderate uphill (positive) linear relationship between the development of the upper crossed syndrome and the hours of working among software professionals in front of the computer.

The mean value of the software professionals who are on the verge of developing upper crossed syndrome is 1.44±0.49 subjects and the mean value of their functional disability in Neck Disability Index scale is 27.35±12.8.The value of “r” correlating them is 0.54. This is a moderate uphill (positive) linear relationship between the development of the upper crossed syndrome and the functional disability among the people on the neck disability index.

DISCUSSION

The study has focused on the prevalence of upper crossed syndrome among software professionals. Christensen Ketal, in 2015 evide- ntly proposed upper crosss yndrome appears to be a simple muscular imbalance but it may impart huge stress on the economy of the country via resulting in functional disability due to neckpain²⁰.

 As derived from this study, work organization plays an important role, especially when ergonomic measures are largely implemented. A study also has reported that the individuals developing upper cross syndrome were some how associated with bad postureor indulge in any activity that makes them adopt a posture of high physiologic cost thereby leading to a muscular imbalance that will yield upper cross syndrome²¹. Morrisetal, Stated that the correlation between upper cross syndrome and poor posture is relevant and found the subjects suffering from the upper cross syndrome were mostly because of poor posture or due to any those activity that makes them adopt bad posture developing a muscular imbalance that will yield upper cross syndrome²².

As Kwonetal, in a study in 2015 suggested that If proper steps are not taken at the initial moment when identified with neck pain with functional disability this may become an endemic not only in the working population but also in the people who tend to adopt a poor posture and least bothered regarding their posture, it is suggested that there should be a pace in the blow to generate postural awareness in people of all ages and most predominantly the risk groups who are in the verge of the occurrence of upper crossed syndrome gradually²³.

After review and knowing that neck pain is the main symptom initiated, Neck Disability Index was used as the outcome measure used to assess the impact of neck pain on activities of daily living (ADLs). Most of them had neck disability associated with muscular imbalances. On studying musculoskeletal symptoms of the upper extremities and the neck with symptom-predicting factors at visual display terminal (VDT) workstations, preventive measures should be focused on neck and shoulder disorders. So, for preventive aspect this study also states that ergonomic  interventions sho-uld  be implemented.

CONCLUSION

It is concluded that most of the software professionals were having muscular imbalances yielding upper crossed syndrome and experie- nced the muscular ailment symptoms of neck pain leading to functional disability. The prevalence of neck pain to be 94.3% and the verge of developing upper crossed syndrome to be found as 55.6% among the software professionals. They were exposed to the risk of adopting poor postures due to extended periods of working hours in a   static posture. This study provides knowledge that ergonomic advice to be educated and postural awareness should be introduced and proper biomechanics to be utilized during work hours to enable the work efficiently and comfortably thus improving productivity.

Limitations And Recommendation: This study does not focus on any treatment to the participants as the present study only consisted of ergonomic advice and was done within a limited geographical location there by decrea-sing generalizability. No diagnostic tests other than trapezius and pectoralis tests are included. Future studies could evaluate the association between the occurrence of Work-Related Musculoskeletal disorders and various psychosocial factors such as high stress, low control among the Software professionals. Radiographic diagnostic procedures can be done for the findings. A similar study can be conducted on a wider age group to find out theage impact on the development of the upper crossed  syndrome. Treatment protocols can be given for the selected population as the present study consisted of ergonomic advice only.

Ethical Approval: Ethical clearance has been obtained from the K.G College of Physiotherapy Ethical Committee.

Conflicts Of Interest: No conflict of interest to conduct and publish this article was reported throughout the study.

Fund For The Study: This study is self-funded.

Acknowledgement: The authors would like to express sincere gratitude and special thanks to all the participants who took part in the research.

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18. Kumar, S., Sambyal, S., &Vij, J. (2013). Analysis of disability and pain in Computer Professionals with Neck Pain. IOSR JNHS, 3; 6-9.
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Citra Puspa Juwita¹, Rosintan Milana Napitupulu²

Author:

¹Physiotherapy Program, Faculty of Vocational Studies, Universitas Kristen Indonesia

Corresponding Author:

²Physiotherapy Program, Faculty of Vocational Studies, Universitas Kristen Indonesia Mail id: rosintan.napitupulu@uki.ac.id

ABSTRACT

Background: Our awareness of coexistence with the covid-19 virus, forces us to carry out hygiene and healthy living behaviors which we have been ignoring. Objective of thestudy is to find out the description of hygiene and healthy living behavior before and during the pandemic as well as the psychological during the pandemic.

Methods: Descriptive with a quantitative approach, data collection using a questionnaire of nine hygiene and healthy living behaviors indicators and stress indicators.

Results: Hygiene and healthy living behavior of 245 respondents before the pandemic was still low, especially in sports behavior 0.06%, behavior wearing masks when leaving the house 15% and washing hands before entering the house 16%. Changes in behavior during the pandemic occurred in the behavior of respondents using masks when leaving the house as much as 75%, washing hands before entering the house 50%, and washing hands with soap as much as 37%. The Psychological condition of respondents during the pandemic 67% felt stressed about personal and family health, 77% of respondents took more vitamins than before the pandemic.

Conclusion: There was a change in respondents’ hygiene and healthy living behavior during the pandemic.

Keywords: PHBS; Hygiene and healthy living behaviors; Behavior change; Covid-19.

INTRODUCTION

Entering 2020, Indonesia is overshadowed by the news of the Covid-19 pandemic which first appeared in the city of Wuhan, China with a very fast spread. The stipulation of the Health Protocol was immediately taken by the world and Indonesia when the Covid-19 virus attack was announced as a pandemic. At the beginning of the determination, there were 3 health protocolsset by the Indonesian government, namely: washing hands, wearing masks, and maintaining distance. In 2017 a policy was issued through the Presidential Instruction of the Republic of Indonesia Number 1 of 2017 concerning the Healthy Living Community Movement where the purpose of this program is to accelerate and synergize actions from promotive and preventive efforts to healthy living to increase population productivity and reduce the burden of financing health services due to disease (1). One of these movements is the promotion of hygiene and healthy living behavior.

Hygiene and healthy living behaviors in Indonesia we call it PerilakuHidupBersihSehat (PHBS) has not become a culture in society (2) (3) (4) so ​​that Indonesia faced a triple burden of health problems, namely the presence of infectious diseases, non-communicable diseases, and new diseases that befall the community. When the Covid-19 virus attack Indonesia, people stuttered and took many victims. Individual behavior is the key to adapting to new habits that we must live so that we can coexist with the existence of the Covid-19 virus. We don’t know how long this covid-19 will pass, so we have to adapt by adopting new habits, which in practice are healthy living behaviors.

Behavioral changes that occur in individuals can occur naturally and planned. Natural change is a change in behavior that occurs automatically due to changes in a person’s social or economic environment. Planned change is a change in the behavior of a person or group of people due to a very strong impulse, for example, the current Covid-19 pandemic has pushed all the joints of human life almost all over the world to change. Based on the above background, the purpose of this study is to find out a description of the hygiene and healthy living behavior of the community and a description of stress during the pandemic COVID-19.

METHODOLOGY

This study uses a quantitative approach with a descriptive design regarding hygiene and healthy living behavior. This study uses a quantitative approach that is intended to reveal the symptoms in a holistic-contextual way through collecting data from a natural setting by utilizing the researcher as a key instrument ⁵. The population of this research is employees of one of the oldest private universities in Indonesia who are active and registered at Human Resources Development as many as 625 at the time the research were carried out in October 2020. With a sample error rate of 5%, a sample of 245 was obtained. Data collection used primary data with an online questionnaire. Which was contains a statement of nine indicators of hygiene and healthy living behavior program during a pandemic as well as stress indicators during the COVID-19 pandemic according to WHO⁶. The frequency of hygiene and healthy living behavior indicators used are always, never but not always, and never. Frequency of stress was meassured using yes and no during a pandemic.

RESULTS

From the data, it can be seen that the majority of respondents are lecturers, namely 59% and 41% are education personnel. As many as 67% of respondents are married and the rest are not married. The age of the most respondents is in the age range of 25-45 as much as 56%, which means that the respondents who contribute to the study are of productive age. The education of the most respondents is in Masters 53% this is because most respondents are lecturers whose minimum education is masters.

Before analyzing the description and relationship of clean and healthy living behaviors indicators before and during the covid-19 pandemic, the instrument was tested for reliability through validity and reliability tests. Test the validity with Pearson’s product moment where the value of r count is greater than r table. By using SPSS statistic 21, it is found that r table with degree of freedom (df=28, Sig 5%) is 0.3610. R calculated for the 38 questions obtained is greater than r table so that the instrument is valid. To test the reliability of the croanbach’s alpha value, which is 0.887, it is greater than the r table, so the instrument is reliable.An overview of clean and healthy living behaviorsbefore and during the COVID-19 pandemic seen from nine indicators can be seen in table 1 below.

From table 2 it can be seen that there is a change in behavior from the number of respondents who always carry out clean and healthy living behaviors, during a pandemic, employees apply more clean and healthy living behaviors than before the pandemic.

The behavior that changed the most was in the behavior of washing hands and using masks. An overview of the stress experienced by employees with the new normal can be seen in table 2 below.

The highest stress during the pandemic was shown by employees consuming more vitamins than before the pandemic, followed by anxiety about personal and family health. Meanwhile, the stress indicator that was felt by the employees was the use of drugs that were not prescribed by the doctor and it was difficult to concentrate.

DISCUSSION

The pandemic, which has been running for almost a year, is a challenge in itself to be able to carry out its responsibilities in the midst of increasing Covid-19 cases, even the area where the university is located is designated as a red zone. The new normal or adaptation to a new life is a behavior that must be done by society today to be able to break the chain of transmission of covid-19, which is a new habit that includes wearing masks, frequently washing hands with soap, maintaining a minimum distance of 2 meters and avoiding crowds of people.

Data collection was carried out in October 2020, when the community underwent the semi lockdownperiod. The public has been exposed to a lot of health promotions carried out by the government both at the residential level, workplace, public places, online media and television stations which are constantly providing information about the development of COVID-19. Many behavioral changes occur in the clean and healthy lifestyle of the community, both individually, in families and in society.

The increasing number of COVID-19 cases requires an illustration from the community whether they already know clean and healthy living behavior to break the chain of transmission, such as survey research conducted on parents of early childhood children in Kendari, it was found that 98% of parents already know about the clean and healthy lifestyle program⁷.

Not all people are afraid or worried about the transmission of Covid-19 so they don’t always carry out clean and healthy behavior, such as the results of an online survey conducted on sports education students at State University, there is clean and healthy behavior with a very high category of only 7.76% and a high category. 18.59%, and most respondents in the moderate category 29.65%, followed by the very low category 23.06% and the low category 20.94%, (8). Apart from the behavior of the community, the role of the government is needed to be an example so that it familiarizes the community to undergo the new normal, research conducted by the central and regional governments including village officials in Balong Village, Balong District, Ponorogo Regency with a quantitative approach obtained differences in attitudes about clean and healthy living behaviors before and during The covid-19 pandemic, where during the pandemic most government employees implemented clean and healthy living behaviors in their daily lives ⁹.

Research conducted on 19 informants with interviews found that getting used to a healthy and clean lifestyle in children during the COVID-19 pandemic can be done by reminding children to eat nutritious foods such as vegetables and fruit, exercising regularly and getting enough rest and doing regular exercise. sunbathe every morning for about 10-15 minutes, wash hands with soap, and maintain personal hygiene¹⁰. Other education was also carried out to the general public, such as an outreach program on the importance of a clean and healthy lifestyle during the COVID-19 pandemic, which was integrated with the student Thematic Community Service Program as a form of appreciation for the role of students in the surrounding environment by implementing solutions to partner problems, including conducting counseling/ socialization, renovating garbage dumps, conducting training on clean and healthy living behavior, then carrying out maintenance on tourism places in the village and behavioral changes were successfully carried out ^{11, 12 , 13, 14}.

With the implementation of work from home and learning from home, it is likely to lead to a sedentary lifestyle, for that promotion of physical activity so that the body is healthy and fit is important. such as the implementation of self-stretching counseling conducted on teachers and staff of SMKN 10 Cawang, by doing self-stretching there is a decrease in the prevalence of neck pain and low back pain (15). Doing aerobic exercise in post partum women reduces low back pain disorders (16). It is no exception for athletes to maintain motor skills and deal with stress while still doing sports exercises (17). A sedentary lifestyle will cause many other diseases such as cardiovascular disease, motion and body function disease, and psychological.

The highest stress during the pandemic was shown by employees consuming more vitamins than before the pandemic, followed by anxiety about personal and family health. Meanwhile, the stress indicator that was felt by the employees was the use of drugs that were not prescribed by the doctor and it was difficult to concentrate. Research on 42 students from small classes (Grades 1-3 elementary school) and 48 students from large classes (Grades 4-5 elementary school) with the method of collecting data using a psychological scale, namely the Child Reaction Scale, proves that the average stress level of elementary school students is higher than the average stress level of small grade elementary school students ¹⁸. Other research, using qualitative methods through observation and interviews, shows that firstly online learning during the covid 19 pandemic causes students to experience stress, secondly, online learning habits cause students to become bored and lazy due to some disturbances that may occur in learning habits ^{19, 20}.

This stress needs to be addressed immediately so that it does not become another health problem. Some things that can be done are such as research involving 421 employees who work WFH in the private, public and government sectors in Indonesia by testing the moderating effect in this study using moderated regression analysis (MRA), where the results show that coping strategies moderate the relationship positively, so that the relationship between work flexibility and work productivity is enhanced when employees apply problem-focused coping mechanisms to control stressors and maintain their work productivity during the COVID-19 pandemic ²¹. Another alternative is Emotional Freedom Therapy as an alternative therapy to reduce stress levels during the COVID-19 pandemic.

The efficient use of EFT as an alternative during the COVID-19 pandemic can reduce stress levels and eliminate negative energies that can cause anxiety, fear, and stress (22). By overcoming stress, it is hoped that people can live in peace and coexist with the covid-19 virus so that people are able to adapt and manage well the existing conditions and will avoid stress, even being able to make stress into eustress (positive stress) because they become creative and productive²³.

CONCLUSION

The employees’ healthy and clean living behavior before the pandemic period was still low, especially in terms of routinely exercising, using masks when going out of the house, washing hands before entering the house and consuming a balanced diet. There has been a change in behavior during the pandemic, especially in terms of using masks when leaving the house, washing hands before entering the house, washing hands with soap and consuming a balanced diet. There is anxiety about personal and family health during the pandemic, causing behavioral changes by consuming more vitamins than before the pandemic.

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Nazrin Ahmad¹, Ting Shau Chen²,Mazlinda Musa³ , Hamidah Hassan⁴, Syed Sharizman Syed Abdul Rahim⁵, Soong Shui Fun⁶, Siti Fatimah Saad⁷, Rohani Mamat⁸

Authors:

^4,6,7,8 Department of Nursing, Faculty of Medicine& Health Science, University Malaysia Sabah.

^1,2Department of Nursing Sciences, Faculty of Nursing & Allied Science, Open University Malaysia, Kuala Lumpur.

⁵Department of Community and Family Medicine, Faculty of Medicine& Health Science, University Malaysia Sabah

Corresponding Author:

³Department of Nursing, Faculty of Medicine& Health Science, University Malaysia Sabah. Mail id: mazlinda@ums.edu.my

ABSTRACT

Introduction: Body Mechanic Technique (BMT) is a method of moving throughout daily activities, and good body mechanics can help you avoid injury and lower back pain.The aim of this study is to identify the level of knowledge and level of practice among nurses in Emergency Department, Hospital in North Borneo, Sabah regarding Body Mechanic Technique and their relationship.

Method: A descriptive cross-sectional study was conducted on 40 staff nurses from Emergency Department, Hospital in North Borneo. Data was collected using validated questionnaire with 15 minutes to timeframe to answer all questions. Data then was analysed using descriptive statistics and Pearson Correlation Coefficient, aided with IBM’s Statistical Package for the Social Science (SPSS) Version 25 statistic software.

Result: From this study, it is revealed that majority of the respondents had fair level of knowledge (77.5%) and majority of respondents had good level of practice (55%) regarding BMT. The study also revealed that there is weak correlation between level of knowledge and level of practice regarding BWT, as the Pearson Correlation Test indicates that p value is 0.128.

Conclusion: Overall, the level of knowledge and practice regarding BMT among in nurses in ED Hospital in North Borneoare generally fair and there still opportunity for improvement to prevent occurrence low back pain and its complication in the future.

Keywords: Knowledge; Practices; Low Back Pain; Nurses; Body mechanic technique

Received on 7^th July 2021, Revised on 13^th August 2021, Accepted on 24^th August  2021, DOI:10.36678/IJMAES.2021.V07I03.001

INTRODUCTION

Nursing is regarded as a job that is both caring and difficult. Nurses nowadays must deal with a wide range of situations, from simple to complex. This increased competitiveness and job demand put physical and psychological strain on nurses, as well as a significant risk of occupational health problems such as musculoskeletal disorders. According to Cheila et al. (2012)⁶, nurses develop their activities in a variety of settings, including hospitals, and on a continuous basis, requiring continual concen-tration, physical exertion, insufficient positions, repetitive movements, and weight lifting, all of which predispose them to work-related disease. As a result, they are exposed to a number of occupational risk factors on a daily basis. Nurses’ jobs are stressful every day because of the tremendous psycho-emotional weight imposed by the nurse-patient relationship, physical demands, labour shortages, extended shifts, poor working environment, and limited decision-making capacity.

According to Al-Eisa, E., & Al-Abbad, H. (2013)⁴ nurses, for example, are among the health-care workers who are susceptible to lower back pain. The prevalence of lower back pain among nurses ranged from 50 percent to 90 percent. Because of the frequent need to lift or transport patients, who may move quickly and perform repetitive procedures with inappropriate body position, lower back discomfort develops. Musculoskeletal issues such as acute lumbosacral strain, unstable lumbosacral ligaments and weak muscles, incorrect postures, unneeded strain and tiredness of back muscles are the most common causes of low backache. Back pain is a diverse health concern that poses exciting difficulties for health care providers such as nurses.Back discomfort has an impact on a person’s physical, psychological, emotional, economical, and social well-being. The coordinated effort of the musculoskeletal and neurological systems to maintain balance, posture, and body alignment while lifting, bending, moving, and executing activities of daily living is known as body mechanics.The use of good body mechanics can lessen the chance of musculoskeletal system injury while simultaneously facilitating body movement, allowing for physical mobility without causing muscular strain or excessive use of muscle energy. (Aditi et.al., 2017)².

According Jaafar and Ghazali (2014)⁷the phrase “body mechanics” is used to describe how people move in their daily lives. It covers how to sit, stand, lift, carry, bend, and sleep, among other things. Back problems, on the other hand, are frequently caused by poor body mechanics.When people do not move effectively and safely, excessive forces are placed on the spine, which can lead to degeneration of spinal components such as discs and joints, injury, and unnecessary wear and strain over time. That is why it is critical to understand the fundamentals of proper body mechanics. Proper body mechanics are critical for maintaining the health of our spine. It’s also simple to apply these principles in our daily lives. It may seem strange at first, but if we stick with it, they will become second nature, and our backs will reward us.

Problem statement: Nursing is a demanding career that needs frequent back bends, arm and leg flexing, as well as pushing, puling, carrying, and lifting during patient care duties.Long-term performance of these motions, as well as the usage of improper muscles to complete a task, can result in severe musculoskeletal strains and tiredness, as well as an increased risk of injury to the patients.Proper body mechanics should be employed consciously when undertaking physical activities to avoid these issues (Sharifah. 2017)¹¹. Wanless (2016)¹³ in a compreh-ensive evaluation of twelve studies on patient moving and handling, researchers discovered that a technique-driven training programme had no effect on moving and handling culture or injury statistics. Moving and managing patients necessitates the movement of large loads, which has been linked to the development of lower back discomfort in studies. Low back pain and lower back injuries are the most common musculoskeletal issues caused by moving and handling among nurses, which is unsurprising.

Nurses are typically required to work in an upright position for extended periods of time, handle medical devices, and transfer patients based on their level of consciousness. All of these jobs demand the application of the body mechanics concept in order to avoid physical injury and actively employ the body while delivering nursing care(Jung and Suh, 2013)⁸. According to Unison (2013)¹² prior estimates, roughly 3,600 healthcare workers, including nurses, will have to retire every year owing to crippling back injuries caused by poor posture and movement, according to one of the UK’s largest trade unions that represents public sector workers. Poor posture can cause lower back problems in approximately 80% of the population at some point in their lives. Over a quarter of reported health-care worker injuries are connected to movement and handling of patients and inanimate items. Back and over 80% of all back and shoulder injuries are caused by handling and transporting patients, according to the Bureau of Labor Statistics. Overexertion from lifting, tugging, pushing, carrying, and turning motions accounts for over 80% of all injuries. Over 6,6500 injuries have been documented among nurses, resulting in days absent from work. This revealed that nurses who worked in a clinical setting had more low back pain than other types of health workers. As a result, nurses must understand and practice good body mechanics when transferring a patient to limit the chance of damage (Chan, 2017)⁵.

Objective: To determine the association between level of knowledge and level of practice in body mechanic technique among nurses in Emergency Department Hospital in Northern Borneo.

METHODOLOGY

This is a quantitative, convenience sampling, descriptive cross-sectional study design, the study was conducted at Emergency and Trauma Department Hospital in Northern Borneo. The sample was nurses who work in ED as total number of nurses in ED is 45, hence the sample size or number of respondents required for this study is 40 (N=40) respondents. The inclusion criteria for this study is registered nurses work in hospital’s Emergency Department and have work experience of one year and above. Exclusion criteria werenurses on leave such as annual leave, study leave, confinement leave and also the nurses who not willing to participate in this study.IBM Statistical Package for Social Science Version 25 (SPSS) was used to analyzed the data.

The data was collected using questionnaire “Knowledge and Practice of Nurses about Body Mechanic Technique” adapted from Shamin, A., et.al.(2017)¹⁰. The questionnaire consists 3 sections. Section A is demographics data which includes age, gender, marital status, working experience and education level. Section B consists of 15 questions on knowledge among nurses regarding BMT. Section C involves 8 questions on nurse’s practices with regards to BMT. All Section B questions are scored using Likert Scale. Of which 1 mark = strongly disagree, 2 marks = disagree, 3 marks = neutral, 4 marks = agree and 5 marks = strongly agree. All Section C questions also score using Likert Scale, of which 1 mark = never, 2 marks = seldom, 3 marks = Sometimes, 4 marks = often and 5 marks = Always.

Level of knowledge will categorize into three categories i.e. good fair and poor. According to Aboalizm et al (2016)¹ stated that total score less than 50% signifies poor knowledge, 50%-75% is fair knowledge and total score 76% and

above signifies good knowledge. For the level of practice, according to Aboalizm et al (2016)¹ stated that score 60% and above signifies that respondents have good practice regarding BMT whereas score less than 60% signifies that respondents have a poor practice on BMT.

Pilot Study:

Pilot study has been conducted to assess the reliability of the questionnaire. The sample size of this pilot study need 10% from real study (10 respondents). From the pilot study that has been done, the Cronbach’s alpha calculated is 0.772. A Cronbach α > 0.7 indicates that pilot study conducted is reliable. With this, we can conclude that the pilot study shows the questionnaire is reliable and study can be proceeded.

RESULT

A total of 40 questionnaires were returned which gave a response rate of 100%. Out of the 40 participants in the study, 17.5% (7 respondents) are male and 82.5% (33 respondents) are female participants. Most of respondents married (55%) and belong to age group below 30 years old (55%). The majority of them, 30 out of 40 respondents, have 1 to 10 years’ working experience. The highest education level among the respondents is degree level (17.5%), while most of the respondents are diploma holders (82.5%).

Table 2 shows result of statistical hypotheses test from two sets of variables i.e. level of knowledge and level of practice. The end result of statistical test is a “p-value”, where “p”

indicates probability of observing differences between the variables. Meanwhile, significance limit is set at 0.05. In other words, the correlation between the level of knowledge and level of practice was considered true / significant if the “p-value” is less than 0.05.This study found that the Pearson correlation coefficient (r) which measure the -0.245. In other words, the correlation coefficient r= -.245 show a very weak and negative correlation between level of knowledge and level of practice. Moreover, the p value calculated is 0.128 which is more than 0.05. From these finding, it can be concluded that there is no significant correlation between respondents’ level of knowledge and level of practice.

Ethical clearance: Ethical clearance was obtained from the National Medical Research Register. National Medical Research Register (NMRR) was a web-based service initiated by National Institutes of Health (NIH) of the Ministry of Health (MOH) National Institutes of Health (NIH) of the Ministry of Health (MOH), also from OUM ethic committee and written

approval dated 17^th Sept 2019 from Head of Emergency Department.

Conflicts of Interest: There is no conflict of interest in this study.

Fund for the study: This is self-funded study.

DISCUSSION

This study discovered that the Pearson Link Coefficient (r) =-0.245 indicates a very poor correlation between knowledge and practice, with a p-value of 0.128. This is in contrast to Sharifah, K., (2017)¹¹, who reported a p value of 0.000 and concluded that there is a substantial relationship between these two factors. Sebastian and Ramya (2013)⁹, conducted a study in Spain to determine the usefulness of the body mechanic checklist tool.

Their findings demonstrated that adding body mechanics technique information to nurses’ knowledge led to a decrease in musculoskeletal injuries and an increase in body mechanics technique practices. It contradicts with the finding in this study which can be concluded that correlation is negative and not significant. Abolfotouh, S. M.et al (2015)² suggested preventive actions to be implemented, as participating in educational programs that teach good body mechanics, in order to lessen the likelihood of lower back discomfort, yet most studies found nurses do have high knowledge about body mechanic.

Body mechanic technique is acknowledged as one of the effective way to reduce amount of incident low back pain. Low back pain can also be avoided by maintaining a well-balanced emotional and physical life by not acquiring excessive weight, quitting smoking, eating a good diet, and exercising regularly. Every hospital should adopt a multi-pronged approach to deal with low back pain among nurses, according to the report.In addition to health promotion, every large hospital should have an effective monitoring system in place, as well as capabilities for quick reaction and treatment of low back pain.

COCLUSION

Body mechanic technique is acknowledged as one of the effective way to reduce amount of incident low back pain. Maintaining a well-balanced emotional and physical life by not gaining excessive weight, not smoking, following healthy diet and exercise habits are also effective in protection of low back pain. Besides health promotion, an adequate surveillance mechanism should be set up in every large hospital and also, facilities for prompt response and treatment of low back pain should be provided.

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