Category: Physiotherapy

Swethaa. D¹, Meena², Tejaswee³ 

Corresponding Author:

¹Associate Professor, Venkata Padmavathi Institute of Medical Sciences, Tirupati, Andra Pradesh, E. Mail Id: dswethaa3@gmail.com

Co Authors:

²MPT Graduates, Venkata Padmavathi Institute of Medical Sciences, Tirupati, Andra Pradesh

³MPT Graduates, AVM College of Physiotherapy, Kadapa, Andra Pradesh

Abstract

Background of the Study: Aerobic exercises have shown effect on decrease severity and mortality in tolerant with heart valve illness. Aim of the study was to find the endurance and quality of life in patient with heart valve surgery. Methodology: This was an experimental study conducted in Post Surgical Cardiology Department of Sri Venkateswara Rama Narayana Ruya Government General Hospital, Tirupati. In this study, 60 patients are assigned into two Groups A and B, 30 in each group. Age group of 40-60 was selected for this study. Measurement tools and materials used for this study were Pulse oximeter, Sphygmomanometer, Cycle ergo meter, Stethoscope, Stop watch, Inch tape, Chair with arm rest, Cones, Shoes. Outcome measures used were 6 Minute walk and test, St. George’s respiratory questionnaire. Result:  Endurance training  and quality of life showed significant improvement in  6- minute walk test and St. George’s respiratory questionnaire  between pre and post test. Conclusion: This study shows that endurance training is effective improving the aerobic capacity and quality of life in patient with heart valve surgery patients.

Keywords: Quality of life; Heart valve surgery; Ergo meter; 6- minute walk test; St. George’s respiratory questionnaire

Received on 04^th October  2021, Revised on 20^th November 2021, Accepted on 24^th November 2021            DOI:10.36678/IJMAES.2021.V07I04.002

INTRODUCTION

Heart Valve Disease represent one-third of all coronary illness and are expanding in predominance because of a old age and advances in treatment techniques. As of now, heart valve illnesses are generally degenerative in nature, but profoundly pervasive in non-industrial nations because of rheumatic coronary illness ^1-4.

Heart valve sicknesses is either left sided (aortic and mitral valve illness) or a mixed.  Heart valve sickness is frequently a suggestive with symptoms. At the point when indicative, that clinical show incorporates dyspnea, exhaustion, liquid maintenance and diminished physical capacity. Indicative heart valve infection is related with critical mortality and horribleness and seriously sway wellbeing related personal satisfaction and actual limit^5-7.

Before valve surgery procedure dyspnea and physical in limit is normal. After the surgery procedure, individuals are regularly immobilized because of hospitalization, conceivable post-medical procedure difficulties and limitation intended to help sensation of sternum. Therefore, their physical capacity is in danger of more risk. Also, open heart medical procedure, personal satisfaction might be influenced with mental issues like burdensome manifestations and tension ^8-10.

In rundown, after heart valve medical procedure not exclusively is there a danger of mortality and bleakness, incorporates emergency clinic readmissions and result medical care cost, yet significantly patients additionally experience actual mental or social recuperation issue that may adversely affect on their wellbeing related personal satisfaction¹¹.

Aerobic exercise is related with useful and morphologic heart transformations which remember bradycardia and increments for valve thickness and size of every one of the four chambers. Various investigations have proposed that perseverance practice preparing can work on significant out come in quiet with heart valve medical procedure ¹².

Aerobic exercise may likewise decrease grimness and mortality in tolerant with heart valve illness. Intense exercise activities of the ventilatory muscles in valve one more type of breathing activity utilized dominatingly to work on pneumonic capacity and increment exercise capacity ¹³.

The activity with cycle ergo meter in stage 2 of cardiovascular recovery can further develop fringe muscle strength and practical limit. It can expand oxygen transport and venous return as well as diminishing postoperative difficulties and furthermore modifies muscle work, forestalling greenery misfortune practices with or without obstruction by aloof way, dynamic helped or dynamic activities ¹⁴.

The adequacy of various methods of intense exercise on wellbeing, for example, cycle ergo meter training, walking or running has been shown in a few investigations. Among these mod of activities, cycle ergo meter preparing is especially elective since it is generally simple, safe purposes and causes no connected wounds¹⁵.

Cycle ergo meter preparing is generally a significant part of any perseverance practice program that looks to work on oxygen consuming limit and cardio vascular wellbeing. Cycling is a wellbeing type of perseverance practice and as a non weight bearing movement; less affects joints and is along these lines less unpleasant for the body. At long last, cycle ergo meter is attainable in any event, for fragile more established people ¹⁶.

Physiologically it works on cardiovascular wellbeing, directed glucose, helps in diminishing weight, reinforces resistance, and further develops muscle strength and expanding Range of movement. Chest versatility practices forestall pneumonic inconveniences and torment during in persistent phase. Post operatively respiratory disability and useful impediment found in quiet with heart valve medical procedure, for example, cut torment and seepage, diminished thoracic divider portability ¹⁷.

Aim of the Study: To improve the endurance and quality of life in patients with heart valve surgery.

METHOD:

This was an experimental study with 60 Subjects were taken 30 in each group. The study was conducted in post surgical cardiology department of Sri Venkateswara Rama NarayanaRuya Government General Hospital (SVRRGGH), Tirupati.

Materials and methods:

Material Needed: Pulse oximeter, Sphygmomanometer, Cycle Ergo meter, Stethoscope, Stop watch, Chair with armrest, Inch tape, Cones, Shoes.

Selection Criteria:

Inclusion Criteria: Both Female and male patients heart valve surgery , Age 40 to 60, Aortic Valve stenosis, Mitral Valve stenosis, Right or Left side heart valve surgery, Patients who are willing to participant actively in the study, Annular Valve disease.

Exclusion criteria : Ischemic Heart disease, Musculoskeletal system diseases, Pregnant or breast feeding woman, Non cooperative patients, Psychological patients, Malignancy.

Intervention:

Experimental Group: Experimental group received endurance training; 6Days/week, 2 sessions/day, 4 weeks, Cycle ergo meter- 10 minutes / 2 sessions/day, Chest mobility, exercise ; 8 -10 repetition/set.

Control Group: Control group receives chest mobility exercises; 3 Days/week, 2 sessions/ day, 4 weeks.

Outcome Measures

SIX (6) minutes walk test:

The 6 Minute Walk Test is a sub-maximal exercise test used to survey vigorous limit and perseverance. The distance covered throughout a period of 6 minutes is utilized as the result by which to think about changes in execution limit. The test was at first intended to help in the evaluation of patient with cardiopulmonary issues. Progressively, it was presented in various different conditions.

It assesses the practical limit of the individual and it gives important data in regards to every one of the frameworks during actual work, including respiratory and cardiovascular frameworks, blood course, neuromuscular units, body digestion, and fringe circulation.

Hardware Required: Stopwatch Measuring/trundle wheel to quantify distance covered, 30 meter stretch of unobstructed walkway. Two cones used to check the distance that should be covered. Pulse oximeter for estimating pulse and SpO2 (discretionary). Borg Breathlessness Scale (discretionary).

Set-Up:

Spot cones at one or the flip side of the 30 meter stretch as defining moments. Have seats set up one or the other side and most of the way along the walking 13.

Patient Instructions:

The object of this test is to stroll beyond what many would consider possible for 6 minutes. You will stroll to and fro in this corridor. Six minutes is quite a while to walk, so you will endeavor. You will likely escape breath or become depleted. You are allowed to dial back, to stop, and to rest as fundamental. You might incline toward the divider while resting; however continue strolling when you are capable. You will stroll to and fro around the cones. You should turn energetically around the cones and proceed back the alternate way without a second thought. Presently I will show you. Kindly watch the manner in which I turn decisively.”

Peruse this normalized consolation during the test: After the first moment: “You are progressing nicely. You have 5 minutes to go.” When the clock shows 4 minutes remaining: “Keep doing awesome. You have 4 minutes to go.”

At the point when the clock shows 3 minutes remaining: “You are progressing nicely. You are mostly done. At the point when the clock shows 2 minutes remaining: “Keep doing awesome. You have just 2 minutes left. At the point when the clock shows 1 moment remaining: “You are progressing nicely. You just have 1 moment to go.

With 15 seconds to go: “In a second I will advise you to stop; at the point when I do, stop right, where you are and I will come to you.” At 6 minutes: “Stop” In the event that the member stops whenever earlier, you can say: “You can incline toward the divider assuming you might want; keep strolling at whatever point you feel capable.”

Try not to utilize different inspirational statements (or non-verbal communication) to impact the patient’s strolling speed. Go with the member along the strolling course, however keep simply behind them. Try not to lead them.

In the event that accessible record the distance at which the oxygen immersion drops < 88%.

St. George Respiratory Questionnaire (SGRQ):

St George Respiratory Questionnaire is a sickness – explicit instrument intended to quantify sway on generally speaking wellbeing, day to day existence, and saw prosperity in tolerant with obstructive aviation routes infection.

An all out score of St George Respiratory Questionnaire determined from 0 (no wellbeing debilitation) to 100 (most extreme wellbeing Impairment). Notwithstanding the all out score, there is additionally a score for every space: side effects, movement, and effect which are scored 0 – 100 also.

Data analysis:  Data was analyzed by using the SPSS 18.0 version and also excel package.  Descriptive Statistics was used for both the groups. The relationship within the groups was analyzed by t-test for paired sample observation and between the groups was analyzed by independent two sample t-test.

The pre and post difference of 6 MWT of experimental group of mean and standard deviation was analyzed statistically tested by paired t-test.  The result is presented in table-1

From table-1, it is found that the mean value of 6MWT experimental group before application of Endurance Training mean value is 1553.36 The ‘P’ value is 0.0001 and after application of Endurance Training and is 1730.12The ‘P’ value is 0.0001 Since the P value is less than 0.001 it is concluded that there is a significant improvement in 6MWT experimental group.

The pre and post difference of 6 MWT control group was analyzed statistically by paired t-test.  The result is presented in table -2.

From table-2, it is found that the mean value of 6 MWT before application chest mobility exercise is 1445.42 and after application of chest mobility exerciseis 1622.12 The ‘P’ value is 0.0001.  Since the P value is less than 0.001 it is concluded that there is a significant improvement in 6 MWT in the control group.

The pre and post difference of 6 MWT between groups was analyzed statistically by paired t-test.  The result is presented in table -3.

From table-3, it is found that the mean value of 6 MWT before application chest mobility exercises is 1737.36 and after application chest mobility exercises is 1938.16 The ‘P’ value is 0.0001.  Since the P value is less than 0.001 it is concluded that there is a significant improvement in 6 MWT in the experimental group.

The pre and post difference of control group of mean and standard deviation was analysed statistically tested by paired tested by paired t-test. The result is presented in table 1.

The pre and post difference of SGRQ of control group of mean and standard  deviation was analysed tested by paired t-test.the result is presented in table-5.

The post difference of dyspnoea in SGRQ between experimental and control group was analyzed statistically by using independent two sample t-test. The result is presented in Table-6.

RESULT

Endurance training and quality of life shows significant improvement in 6 minute walk test and ST George respiratory questionnaire in patients with heart valve surgery.

The result showed that there was significant difference between pre and post test training in experimental group.

DISCUSSION

Endurance training is a pattern helpful for patient with heart valve surgery. Endurance training improves muscle strength, venous return, and aerobic capacity and prevents complications.  In experimental group and control group the endurance training was given in phase 2 of surgery.

The endurance training by cycle ergometer is given 10 minutes twice daily for 4 weeks along with chest mobility exercises 2 sessions per day. Chest mobility exercises are given for 3 days/week/ 2 sessions/ 4 weeks. The study found significant improvement in endurance training and quality of life in experimental group compared with the control group.

The parameters of 6 minute walk test and St George respiratory questionnaire showed significant improvement in experimental group compared with the control group.

The exercise component of cardiac rehabilitation is useful for reversing the symptoms associated with deconditioning. Women with mitral valve prostheses improved their peak metabolic equivalent capacity by 19% and their physical working capacity by 25% after undergoing an 8-week program, whereas control subjects did not improve ¹⁹.

Recurrent symptoms and hemodynamic decomposition are leading causes of hospital admission. One study showed that heart failure patients in cardiac rehabilitation reduced readmissions by 19% and mortality by 22% ²⁰.

In stable patients with chronic class II and III heart failure who participated in exercise training for 14 months, survival was prolonged by an additional 1.82 years at a cost of $1,773 per life-year saved in the exercise group compared with non-exercising control subjects ²¹.

Ethical clearance: There was no risk of conducting this study.Ethical clearance was obtained from the ethical committee of Venkata Padmavathi Institute of Medical Sciences, Tirupati, Under the NTR University of Health Sciences, Vijayavada with reference No.198/A4/Diss/MPT/19-20 approval letter dated 25^thFebruary 2021.

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

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

CONCLUSION

In present study there was significant difference found in the post test of control and experimental group. Comparison of pre and post test of experimental and control groups respectively showed significant difference however the post test comparison between control and experimental group had shown high statistical difference.

The experimental group treated with endurance training, showed greater improvement in aerobic capacity and quality of life. The study concludes that endurance training is effective in improving aerobic capacity, cardiovascular health and quality of life in patient with Heart Valve Surgery.

REFERENCES

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4. Newell JP, Kappagoda CT, Stoker JB, Deverall PB, Watson DA, Linden RJ: Physical training after heart valve replacement. Br Heart J. 1980, 44: 638-649. 10.1136/hrt.44.6.638
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6. Lim HY, Lee CW, Park SW, Kim JJ, Song JK, Hong MK, Jin YS, Park SJ: Effects of percutaneous balloon mitral valvuloplasty and exercise training on the kinetics of recovery oxygen consumption after exercise in patients with mitral stenosis. Eur Heart J. 1998, 19: 1865-1871. 10.1053/euhj.1998.1146.
7. Piotrowicz E, Baranowski R, Bilinska M, Stepnowska M, Piotrowska M, Wojcik A, Korewicki J, Chojnowska L, Malek LA, Klopotowski M, Piotrowski W, Piotrowicz R: A new model of home-based telemonitored cardiac rehabilitation in patients with heart failure: effectiveness, quality of life, and adherence. Eur J Heart Fail. 2010, 12: 164-171. 10.1093/eurjhf/hfp181.
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Citation:   Swethaa. D, Meena, Tejaswee (2021).The comparative study of endurance training and quality of life in patient with heart valve surgery, ijmaes; 7(4); 1122-1134.

Weeke Budhyanti

Corresponding Author: 

Physiotherapy Program, Faculty of Vocational Studies, Universitas Kristen Indonesia

Email id: weekeb@uki.ac.id

Abstract

Background of the study: Obesity is a health problem that leads to other problems. Controlling obesity among individuals requires their motivation so they may be engaged in programs created to control their lifestyle. Purposes of this study were to find a relation between body mass index and perceptual fitness level.

Methods: This study is a quantitative descriptive research that used a quantitative approach with cross-sectional analytic design among Jakarta’s young adults. Data collection used primary data of online-based-questionnaire that asks their physical profile, daily activity, sports participation, central fatigue levels, and prevalence of metabolic-related diseases. Data collected was tested by correlation test to find relations between these factors.

Results: There are no significant relation between body mass indexed with daily activity levels (r = 0.05), sports participation (r =-0.16), subjective feeling of fatigue (r = 0.00) and prevalence of metabolic-related-diseases (r =-0.19).

Conclusion: Body mass index did not related with daily activity levels (active or sedentary lifestyle), engagement in sports participation, subjective feeling of fatigue, and prevalence of metabolic-related-diseases (hypertension, diabetes mellitus).

Keywords: Body mass index; Physical activity; Fatigue

Received on 06^th September  2021, Revised on 21^st  October 2021, Accepted on 15^th November 2021            DOI:10.36678/IJMAES.2021.V07I04.001

INTRODUCTION

Increased prevalence of overweight and obesity poses a major threat to public health and WHO has declared obesity as a real but neglected health problem¹. Weight control in overweight and obese individuals has become a concern of several countries, as overweight and obesity has known as risk factors of chronic diseases, including heart disease, cancer, and metabolic diseases. Yet, obesity in lower-to-middle income countries was more difficult as obesity is associated with a large-scale nutritional transition over several decades.

 This nutritional transition leads to the double-burden nutritional situation, where stunting and obesity simultaneously exist in individuals. Thus, body-weight control in lower-to-middle countries should focus on preventing the recurrence of nutritional deficiencies as well as education on the threat of obesity and obesity-related diseases².

Another factor that needs to considerate is individual involvement during their body weight control program. Low awareness of individuals towards obesity often reduces individual involvement in better lifestyle changes and diet². My question is how to motivate overweight people to hold a weight-control program consistently, without crushing their body image. One thing that may concern was their health. Facing their health status may become their motivation.

Thus, my research purpose was to find any actual health problem that exists on overweight and obese people. My previous research³ finds that no significant relations between Body Mass Index (BMI) and blood pressure. Now, we are trying to find other health status indicators that may exist in overweight and obese people. Several previous studies have looked for the relationship between BMI and quality of life and indicated that higher BMI is associated with lower quality of life⁴. One of the factors related to the quality of life is fitness level. Fitness level consists of body mass index, flexibility, stability, and ability to perform daily and recreational tasks.

Ability to perform daily and recreational tasks is usually limited by fatigue. Fatigue is rarely used in daily conversation, as we usually mention it as tired. There is two kinds of fatigue, central fatigue and peripheral fatigue. Central fatigue is an individual’s perception of tiredness level. Central fatigue comes before peripheral fatigue, which is characterized by muscle’s inability to perform any contraction.

Several studies suggest that high BMI is positively related to fatigue, and affects physical activity by causing decreased motility and causing dependence²². Obese individuals tired more easily than leaner-weight people, and are more associated with peripheral factors.

Central fatigue causes obese individuals to stop their activities quicker, and this situation affects their daily activity, as they will tend to decrease their physical activity and/or increase their sedentary lifestyle^5,6,7,8. Thus, researchers tried to find if body mass indexes related to thefitness level of Jakarta’s young adults.

METHODOLOGY

This study used a quantitative approach with cross-sectional analytic design. The sample of this research is 117 people range from 19-57 years old. Data collection used primary data with online-based-questionnaire consist of height and body weight, daily activities, metabolic-related diseases, and Industrial Fatigue Rating Committee (IFRC) questions.

All of the respondents were adults; classification of nutritional status was using International Obesity Taskforce for Asian race that uses categorical describer as underweight, normal, overweight, obesity I and obesity II as shown on Table 1.

BMI	Category
< 18.5	Underweight
18.5 – 22.9 0	Normal
23 – 24.9	Overweight
25 -29.9	Obesity I
≥ 30	Obesity II

Table 1. Asia Classification of BMI⁹

The subjective feeling of fatigue measured by Subjective Self Rating Test from Industrial Fatigue Rating Committee classification, described as low, moderate, high, and very high level of fatigue. IFRC questions consist of 10 physical experiences, 10 mental experiences, and 10 physiological experiences questions. Respond to the questions were using Likert scale answers to be summarized to categorical describer as low, moderate, high, and very high level of fatigue as shown in Table 2.

Total Score	Category
50-52	Low
53-75	Moderate
67-98	High
99-120	Very High

Table 2. Subjective Feeling of Fatigue by SSRT IFRC Questionnaire

Correlation test used to assess if any correlation between BMI and other factors to identify if there are a correlation between BMI and subjective feeling of fatigue; BMI and involvement to sport; BMI and involvement to active lifestyle; and active lifestyle to subjective feeling of fatigue.

RESULTS

Respondents of this research consist of 46 male and 71 female that live and work in Jakarta. Prevalence of overweight and obese in this research (67%) was higher than shown at Riskesdas 2018¹ (21.8%), as researchers use BMI classification for Asian. Riskesdas 2018¹ use the international BMI classification, where 25-27 are classified as overweight, and ≥ 27 as obese. Asia Pacific BMI classification shows that 23-24.9 were overweight and ≥ 25 were obese.

As seen in Graph 1, overweight and obese respondents claim that they are living an active lifestyle, instead of sedentary.

Correlation test between BMI and daily activity lifestyle has shown r-value were 0.05, thus almost no relation between BMI and lifestyle between respondents.

As comparable between active daily activities claimed by respondents, involvement in sports per week test with BMI, with r-value -0.16, so there is weak negative relationship between participation in sport with respondent’s BMI.

As shown in Graph 3, high and very high levels of fatigue were complained by normal, overweight, and obese level 1 respondents. Correlation test between BMI and subjective feeling of fatigue showing 0.00 r-value, so there is no relation between those indicators. To make sure if fatigue complained were cause by their active lifestyle, correlation test between subjective feeling of fatigue with active daily ativity (r-value 0.01) and involvement in sports (r-value 0.00).

For the main purpose of this study, we find no correlation between subjective levels of fatigue with BMI with r-value 0.00. Surprisingly, the correlation test between BMI and metabolic-related diseases was shown r value -0.19, so there is very weak negative relation between them.

DISCUSSION

First, we need to put our perspective that the incidence of overweight and obese people becomes higher if we use BMI categorization for Asia. 17% of 117 respondents classified as overweight and 50% classified as obese, is dramatic. This data show almost three times incidence of overweight and obesity compared with Riskesdas 2018 for DKI Jakarta that only shows 21.8% incidence of obesity in Jakarta’s adult¹. As we believe that increased BMI leads to the increased risk factor of metabolic-related diseases, functional limitation and decreased well-being, this data that shows us that 67% respondents are facing increased risk factors. Riskesdas 2018¹, as other research in Asia, still using WHO 2005 category of nutritional status, despite this categorical did not suitable for Asian race people. If we neglecting Asia’s standard of nutritional status, we may do not meet overweight and obesity incidences as big as the reality.

Data in this research was higher than several studies, as usually range of overweight and obesity in a population were about 20-31%. This situation may be caused that this research held in Jakarta. Prevalence of overweight and obesity was higher in urban residents compared with rural residents¹¹. Several studies indicating that living in urban areas led to an increased correlation with overweight/ obesity. It may be due to environmental factors that influence their diet, mental activities, and expend less energy in daily life¹¹.

The paradox in this research was faced by other research^12,13,14,15, where only a weak relationship between BMI with the prevalence of metabolic-related diseases and experience of fatigue indicates that obesity within respondents of this research did not yet cause actual problems in their daily living. Based on Edmonton Obesity Staging Scale², their obesity is mainly at stage 0 (no apparent obesity-related risk factor, no physical sign, no psychopathology, no functional limitations or decreases well-being) and stage 1 (presence of subclinical risk factor related to obesity, mild physical symptoms, mild psychopathology, mild functional limitations, or mild impairment of well-being).

It seems like this data shows that not all obese individuals are at increased health risk. In fact, obese individuals with or without metabolic-related diseases are similarly elevated of mortality risk factors. We need to take any action so the respondent will not going to stage 2 and 3 (moderate and severe conditions), or to eliminate comorbidities factors in several situations such as cancer, systematic lupus erythematosus, which put overweight and obesity as their comorbidity.

The situation in this research, which shown no relation (r-value 0.00) between BMI and fatigue may be caused as we are using a subjective state of feeling, so the result is slightly different with other research that using objective measurement of fitness level. With the battery of field tests, overweight and obese women exhibit lower levels of aerobic fitness compared to women with normal BMI¹⁶. Their weight history, weight cycling, history of diet, and physical activity, too, maybe causing different their experience of metabolic aberrations¹².

CONCLUSION

By following the objectives of the study, based on the results and discussion, we may take a conclusion that there is no significant relationship between BMI and fitness level of the respondents, their willingness to hold an active daily lifestyle, and incidence of metabolic-related diseases.

The limitation of this study is that we did not conduct questions to our overweight and obese respondents about their level of urgency to lose weight. Thus, we did not understand if their willingness to control their body weight, if their active lifestyle purposely happened to weight control, or if their active lifestyle helps them to control their body weight.

We conduct a subjective level of fatigue, without comparing their perception with an objective measurement of fatigue and other limitation. Yet, author tend to agree that controlling body weight requires external assistance to help identify contributing factors to individual body weight, motivational encouragement, and handling assistance from professionals. Further research needs to be held, to find out ways to help overweight and obese people to control their body weight.

Conflict of interest:The author has no conflict of interest to declare.

Funding of study:This study has no funding or sponsorship was received. It is self-financed study.

Compliance with Ethics:This study was obtained ethical form University with reference number 458/UKI.F8.D/PPM.1.6/ 2019.

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Citation: Weeke Budhyanti (2021).Body Mass Index and fitness level of Jakarta’s young adults , ijmaes; 7(4); 1113-1121.

James W H Manik¹, Beriman Rahmansyah²

Corresponding Author:

¹Lecturer, Faculty of Vocational Studies, Physiotherapy Program, Universitas Kristen Indonesia, Jakarta, Indonesia, Email: jamesmanik@uki.ac.id

Co-Author:

²Lecturer, Faculty of Vocational Studies, Physiotherapy Program, Universitas Kristen Indonesia, Jakarta, Indonesia

ABSTRACT

Background: Neuromobilization is a technique which is an application of manual therapy focused on nerve fibers with a sliding and stretching mechanism. Currently, it is often used as a form of diagnosis and treatment of musculoskeletal conditions with involvement of the nervous system. Increased nerve flexibility will reduce nerve sensitivity to painful stimuli. The use of transcutaneous electrical stimulation (TENS) electric currents in conditions of nerve disorders can help eliminate/reduce pain symptoms if the area given the TENS current has normal nerve sensitivity. This study aims to determine the effect of median neuromobilization on the perception of pain from electrical stimulation in the body parts innervated by the median sensory nerve.

Method: This study is an experimental research with Single Group Pretest Posttest Design. A research group with a subject of 50 people who will be measured electrical pain perception before and after being given neuromobilization. Pain perception examination was carried out by providing electrical stimulation to the left forearm using an electrical stimulation device brand BTL 4000 with a dynamic current type, constant current intensity 5Hz in 3 minutes. The instrument used to measure pain perception is the visual analog scale (VAS).

Results: Hypothesis testing with the Wilcoxon signed ranks test showed a significant decrease in pain perception after neuromobilization of the median nerve to the sample with a Z value of -2,956 and a p value (Asymp Sign. 2-tailled) of 0.003 (˂ 0.05).

Conclusion: Mobilization of the median nerve can significantly reduce the perception of electrical pain in the skin area innervated by the C6, C8 and Th1 spinal cord segments and the median nerve (palmar surface of the left forearm 1/3 distal and thenar area)

Keywords: Median nerve mobilization, Pain perception, Physiotherapy, Neuromuscular

Received on 17^th August  2021, Revised on 27^th August 2021, Accepted on 31^ST August  2021, DOI:10.36678/IJMAES.2021.V07I03.009

INTRODUCTION

Pain is an unpleasant sensory and emotional experience resulting from actual or potential tissue damage or described in terms of the damage¹. The mechanism of pain is based on multiple processes, namely nociception, peripheral sensitization, phenotypic changes, central sensitization, ectopic excitability, structural reorganization, and decreased inhibition. The perception of pain felt by individuals without being caused by tissue damage can be controlled, and this does not apply to pain that arises due to tissue damage².Most of the tissue pathological conditions associated with movement and function disorders cause pain complaints, both acute pain and chronic pain³.

Carpal Tunnel Syndrome (CTS)is a condition of the median nerve disorder with symptoms of pain or tingling due to compression of the median nerve around the wrist in the carpal tunnel area⁴. Pressure on the median nerve can result from repetitive wrist movements or holding the wrist still in an improper position. One way to overcome pain due to tissue damage is to use a TENS (transcutaneous electrical nerve stimulation) device by modifying the appropriate current in the form of electrical stimulation to stimulate sensory nerve fibers that receive pain stimuli⁵.

Apart from being an intervention modality to reduce pain, TENS can also be used to measure the level of nerve sensitivity, especially sensory nerves. So that the use of TENS as an intervention modality should begin with measuring the level of nerve sensitivity related to the pain to be overcome. The low nerve excitability brother illustrates that the condition of the nerve sensitivity is high. In other words, the perception of pain is high. This becomes an obstacle in TENS intervention to reduce pain in a condition. For this reason, it is necessary to carry out an intervention that aims to reduce nerve sensitivity so that the perception of stimuli becomes normal, one of which is the electrical stimulation generated from TENS⁶.

High nerve sensitivity can be caused by the structure of the neural network itself (intra-neural) and other tissues around the nerves (extra-neural) which, when experiencing a decrease in flexibility, can increase the sensitivity of the nerve.Neuromobilization is a technique which is a application of manual therapy focused on nerve fibers with a sliding and stretching mechanism⁷.

Neuromobilization techniques are passive or active movements that are focused on restoring the ability of the nervous system to tolerate normal compressive, frictional, and pulling forces associated with daily activities and sports ⁸. Neuromobilization is an intervention aimed at restoring homeostasis in and around the nervous system, by mobilizing the nervous system itself or the structures surrounding the nervous system⁹.

This study aims to determine the effect of median neuromobilization on the perception of pain from electrical stimulation in the body parts innervated by the median sensory nerve. A similar study was conducted by Beneciuk, et al²with the title Effects of Upper Extremity Neural Mobilization on Thermal Pain Sensitivity: A Sham-Controlled Study in Asymptomatic Participants to determine the effect of median neuromobilization on temperature perception in the area innervated by the median nerve by providing hot water (temperature 70 degrees celsius) on the skin innervated by the median nerve as a heat stimulus using a visual analog scale (VAS) instrument and concluded that there was a decrease in the perception of heat sensation in the skin area innervated by the median nerve after median neuromobilization. However, the decrease in heat sensation is temporary. However, in this study, mobilization of the median nerve was carried out to determine its effect on the perception of electrical stimulation of pain by providing an electric current of 5Hz intensity TENS type continuous current type in the area of the skin innervated by the median nerve and measuring the perception of electrical stimulation pain using a visual analog scale (VAS) instrument. Examination of the median nerve tension is the initial stage that will be carried out before providing neuromobilization to determine the level of nerve sensitivity to be given.

METHODS

This study is an experimental research with Single Group Pretest Posttest Design. A research group with a subject of 50 people who will be measured electrical pain perception before and after being given neuromobilization.Pain perception examination was carried out by providing electrical stimulation to the left forearm using an electrical stimulation device brand BTL 4000 with a dynamic current type, constant current intensity 5Hz in 3 minutes. The instrument used to measure pain perception is the visual analog scale (VAS).  

The range of pain is represented as a line 10 cm long, with or without markings per centimeter. The marks at either end of this line can be numbers or descriptive statements. One end represents no pain, while the other end represents the worst possible pain.Median neuromobilization was carried out to the sample in the supine position on the bed with the arm in the scapular depression position, the shoulder abducted at 90, maximal shoulder external rotation, maximum elbow extension, wrist and finger extension. Then the elbow joint is passively extended in accordance with the pain tolerance felt by the sample and the wrist is repeated 10 times. Neuromobilization was performed 3 times a week for 4 weeks.This study was obtained ethical clearance from Universitas Kristen Indonesia with reference number 08/Etik Penelitian/FKUKI/2020.

RESULT

Median Neuromobilization Research for Faculty Vocational studies students has been carried out for 1 month (19 November – 18 December 2020). The number of samples is 47 people.

Table 1 shows the average height of the sample 19.97±3.32, weight 60, 723± 14,400, anxiety level 35,021±10,460 and perception of electrical pain stimulation 3,414±1,667. The average level of anxiety (35,021) is included in the category of severe anxiety and the average perception of electrical pain (3,414) is included in the category of mild pain.

Normality test: To determine the type of comparative statistical test to be used which aims to compare the results of the pre-test and post-test in the paired group, the data normality test was first performed using the Saphiro Wilk Test.

Table 2 shows that the results of the normality test using the Shapiro Wilk Test on the pre-test and post-test variables of the two paired groups were not normally distributed where the pre-test p value = 0.147 (p 0.05) and post-test = 0.001 (p 0.05). 0.05) ,test the mean difference of two groups in pairs.

Table.3 shows the results of the two-group mean difference test in pairs before and after the intervention. The negative ranks value of 31 indicates that there are 31 samples experiencing a decrease in pain perception after neuromobilization with a mean rank of 26.16. While the positive ranks value of 15 shows that as many as 15 samples experienced an increase in pain perception with an average (mean ranks) of 18. Ties 1 indicate that there is 1 sample that did not experience a change in the value of pain perception after neuromobilization.

Pain Perception Hypothesis Test

From the results of hypothesis testing with the Wilcoxon signed ranks test in table 4, it shows a significant decrease in pain perception after mobilizing the median nerve to the sample with a Z value of -2,956 and a p value (Asymp Sign. 2-tailled) of 0.003 (˂ 0.05).

DISCUSSION

In this study, it was concluded that the median nerve neuromobilization in 47 study samples could significantly reduce the perception of electrical pain in the skin area innervated by the C6, C8, and Th1 spinal cord segments and the median nerve (palmar surface of the left forearm 1/3 distal to the spinal cord and thenar area). These results indicate that the mobilization of nerves by using the technique of stretching the median nerve and shearing of nerves with adjacent structures of the nervous system will affect the sensitivity of the nervous tissue. Median neuromobilization intervention was given 3 times a week for a month. Electrical stimulation with a diadynamic current type, constant current intensity of 5Hz for 3 minutes aims to cause electrical pain in the first minute then causes pain until the third minute.

There were 4 samples experienced erythema on the skin surface of the hypothenar area of the hand but a few hours later the erythema disappeared. While the other samples did not cause changes to the skin surface. This result is in line with a similar study entitled Effects of Upper Extremity Neural Mobilization on Thermal Pain Sensitivity: A Sham-Controlled Study in Asymptomatic Participants.The results obtained from the study that compared the effect of the actual neuromobilization technique and the pseudo-neuromobilization was a significant decrease in the perception of hot temperature stimulation in the skin area innervated by the median nerve with temperature stimulation of 49° temporally summation on the actual neuromobilization technique with p value 0.032².

The importance of nerve tissue sensitivity and the slipping effect in adjacent structures of the nervous system, suggests that the neuromobilization test distinguishes normal from abnormal neural tissue, by means of its sensitivity mechanics. neuromobilization can also restore a dynamic balance between the relative motion of the neural network and the surrounding mechanical interface, thereby enabling the intrinsic stress on the neural network to be optimal. Decreased blood supply to nerves due to decreased vasodilation in blood vessels that supply nerves can cause hypersensitivity in these nerve pathways⁷.

Mobilization of the median nerve can also affect the perception of the threshold of vibration stimulation as previous studies in knowing the Effect of neuromobilization on Altered Vibration Perception Threshold (VPT)¹⁰.A total of 6 times the mobilization of the right median nerve which was previously measured by the perception of the vibrational threshold using a bioesthesiometer was given to the thumb of the right hand. The measurement of the vibration threshold with a bioesthesiometer is able to provide vibrations at a constant frequency of 100Hz.

Vibration stimulation is given by increasing the intensity until the thumb feels the vibration, then decreasing the intensity until the thumb does not feel the vibration. Furthermore, the intensity of the vibration is increased again to the first point where the vibration is felt. The experiment was carried out three times, and the mean of the values from the three trials was recorded as the threshold value for vibration perception. The results of this study indicate a significant decrease in the threshold of vibration stimulation at p value 0.001 (p˂0.05).

Intraneural movement restriction (Endoneurium, epineurium & perineurium) is a conduit of the meninges (dura mater, arachnoidea, pia mater) and extraneural (tissue that is near the nerve tissue in the form of fascia sheaths, blood vessels, muscles, ligaments, bones) will be detected by a tension testin which high nerve sensitivity is characterized by the onset of stretching pain.

neuromobilization has a direct effect on nerve conduction as measured by electro-physiological examination, thus providing evidence for including neuromobilization as an intervention in altered neuromobilization in peripheral nerves⁸.

One of the goals of neuromobilization is to restore homeostasis around the targeted nerve¹¹. There are also other studies that compare the effect of neuromobilization with neural gliding and neural tension techniques on the threshold for perception of tenderness and temperature¹².

The results found from this study were that there was a significant difference in the reduction in pain and temperature perception thresholds between the neural gliding and neural tension techniques, in which the neural gliding technique was superior.

Neuromobilization is commonly applied to patients with lumbar radiculopathy, carpal tunnel syndrome and other peripheral nerve problems¹³. Application of neuromobilization in Carpal Tunnel Syndrome (CTS) conditions in a study that compared the effects of treatment on median neuromobilization, carpal bone mobilization and untreated CTS conditions. Each group consisted of 7 patients who had CTS¹⁴.

The results obtained from this study are that neuromobilization can reduce pain in CTS in both treatment groups compared to the untreated group (p=0.01). However, in the exploration of the results of the two treatment groups there was no statistically significant difference.

The effect of neuromobilization on significant pain reduction in combination with the provision of a splint in CTS conditions was also proven in a study entitled Effect of neural mobilization and splinting on carpal tunnel syndrome⁴.

The first group in this study was only given splinting for 3 weeks, while the second group, apart from being given splinting, also underwent neuromobilization. There was a significant reduction in pain in the splinting and neuromobilization group with pain measurement instruments using the visual analog scale (VAS) and the Boston Questionnaire Symptom Severity Scale.

Peripheral nerves may be subjected to mechanical or chemical irritation at different anatomic points along their course. Prolonged nerve compression or fixation may result in decreased intraneural blood flow¹⁵. This then triggers the release of pro-inflammatory substances (peptides linked to the calcitonin gene and substance P) from the nerves. This byproduct is referred to as neurogenic inflammation and can interfere with normal nerve function even without marked nerve damage, it can also contribute to the initiation and spread of chronic pain¹⁶.

This study was experimental study, so, in the future need to conduct more comprehensive study to know the best effect of neuromobilization in pain perception.

CONCLUSION

Mobilization of the median nerve can significantly reduce the perception of electrical pain in the skin area innervated by the C6, C8, and Th1 spinal cord segments and the median nerve (palmar surface of the distal 1/3 left forearm and thenar area).

Ethical clearance: Ethical clearance obtained from Faculty of Medicine, Universitas Kristen Indonesia, Jakarta, Indonesia

Conflict of interest: The author has no conflict of interest to declare.

Funding of study: This study was funded by Universitas Kristen Indonesia.

REFERENCE

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2. Beneciuk JM, Bishop MD, George SZ. Effects of upper extremity neural mobilization on thermal pain sensit-ivity: A sham-controlled study in asymptomatic participants. J Orthop Sports Phys Ther. 2009; 39(6); 428-438.

3. Basson A, Olivier B, Ellis R, Coppieters M, Stewart A, Mudzi W. The effectiveness of neural mobiliz tion for neurmusculoskeletal conditions: A systematic review and meta-Analysis. J Orthop Sports Phys Ther.2017; 47(9),593-615.

4. Manchanda V. Effect of neural mobilization and splinting on carpal tunnel syndrome Article Information. J Heal Sci Dev J Heal Sci Dev. 2020; 3:1-10.

5. Al-zamil M, Ng K. TENS and Acupuncture in treatment of Carpal Tunnel Syndrome. Int J Pharmacogn Chinese Med. 2021; 5(1); 1-4. doi:10. 23880/ipcm-16000210

6. Siddiqui A, Dentist P, Practitioner P. Comparative Evaluation of Transcutaneous Electronic Nerve Stimulation and Topical Anesthesia in Reduction of Pain Perception during Administration of Local Anesthesia in Pediatric Dental Patients.2021; 25(6); 1793 -1798.

7. Shacklock M. Clinical Neurodynamics. Elsevier Ltd; 2005.

8. Kumar V, Goyal M, Rajendran N. Effect of neural mobilization on monosynaptic reflex-A pretest post test experimental design. Int J Physiother Res. 2013; 3(3); 58-62.http://www. ijmhr.org/ijpr_articles.

9. Henrique H. Neurodynamic Mobilization and Peripheral Nerve Regeneration: A Narrative Review. Int J Neuror ehabili tation. 2015; 02(02). doi:10.4172/ 2376-0281.1000163.

10. Manisha P, Ganesh B, Ravi S. Effect of Neural Mobilization on Altered Vibration Perception Threshold (VPT). Indian J Physiother Occup Ther. 2011;5(2):85-88.

11. Boyling JD, Jull GA, eds. Grieve’s Modern Manual Therapy. 3rd ed. Churchill Living Stone Elsevier; 2004.

12. Martins C, Pereira R, Fernandes I, et al. Neural gliding and neural tensioning differently impact flexibility, heat and pressure pain thresholds in asymptomatic subjects: A randomized, parallel and double-blind study. Phys Ther Sport. 2019; 36; 101-109.

13. Shacklock M. Clinical Neurodynamics Course Manual. Neurodynamic Solut Adelaide, Aust. Published online 2005.

14. Tal-Akabi A, Rushton A. An investi-gation to compare the effectiveness of carpal bone mobilisation and neuro-dynamic mobilisation as methods of treatment for carpal tunnel syndrome. Man Ther. 2000; 5(4); 214-222.

15. Bove GM, Delany, Sean P, Hobson L, et al. Manual therapy prevents onset of nociceptor activity, sensorimotor dysfunction, and neural fibrosis induced by a volitional repetitive task. Pain. 2019; 160(3); 139-148. doi: 10.1097/j. pain. 00 1443. Manual.

16. Matsuda M, Huh Y, Ji RR. Roles of inflamm ation, neurogenic inflammaion and neuro inflammation in pain. J Anesth. 2019; 33(1); 131-139. doi:10.1007/s00540-018-2579-4.

Citation: James W H Manik, Beriman Rahmansyah(2021). The effect of nerve mobilization on the median nerve in pain perception of electrical stimulation, ijmaes; 7 (3); 1104-1112.

Lucky Anggiat

Corresponding Author:

Lecturer, Faculty of Vocational Studies, Physiotherapy Program, Universitas Kristen Indonesia, Jakarta, Indonesia, Email: lucky.panjaitan@uki.ac.id

Background: Physiotherapists must have precise and accurate clinical decisions when dealing with an injured athlete because they must return to their sport activities as their job. The selection of the right intervention in the sports rehabilitation phase will certainly give good results to the athlete. This study aims to serve as a general guideline for the stages of exercise rehabilitation carried out by physiotherapists with the selection of appropriate physiotherapy interventions.

Methods: This study is a literature review study that took sources from online and offline literature. The literaturein form of books and journal articles that discuss the sport rehabilitation phase.

Results: From the search results, there are not many books and articles that specifically stated that there are phases in sports injury rehabilitation. Some sources are still more specific in a case or only show interventions that can be an option in the application of sports injury management regardless of phase. However, there is also some literature, mostly books, showing the application of progressive programs in sports injury rehabilitation in four phases.

Conclusion: In conclusion, the phase of sport rehabilitation carried out by a physiotherapist must have a clear stage based on the examination and the needs of the athlete. Typical sports rehabilitation phases are phases one to four with a focus on reducing pain in phase 1, increasing flexibility in phase 2, returning and increasing strength, endurance, agility, balance and proprioception in phase 3 and returning to sports in phase 4.

Keywords: Sport; Rehabilitation Phase; Intervention; Physiotherapy

Received on 16^th August  2021, Revised on 26^th August 2021, Accepted on 30^th August  2021, DOI:10.36678/IJMAES.2021.V07I03.008

INTRODUCTION

Musculoskeletal disorders are the most common conditions faced by physiotherapists in their practice¹. Musculoskeletal injuries are similar to sports injuries². In physiotherapy, in general, physiotherapists have several stages to provide intervention³. As in musculoskeletal injuries, the physiotherapist will provide a program that aims to reduce pain, increase range of motion, and then return the patients to their activities⁴.

In contrast to sports injury conditions, in addition to what has been explained for musculoskeletal injuries, the physiotherapist must have the goal of returning the athletes to their sport activities⁵. This is a challenge for the physiotherapist and must really decide clinically and gradually from the onset of the injury to returning to sport activities⁶.

Physiotherapists must have precise and accurate clinical decisions when dealing with an injured athlete because they must return to their sport activities as their job². The selection of the right intervention in the sports rehabilitation phase will certainly give good results to the athlete⁶.

Seeing the amount of literature discussing the handling of physiotherapy in sports conditions, it is necessary to have a guide that can be used by physiotherapists in general in providing interventions for sports injuries. This study aims to serve as a general guideline for the stages of exercise rehabilitation carried out by physiotherapists with the selection of appropriate physiotherapeutic interventions.

METHOD

This study is a literature review study that took sources from online and offline literature. The literature is in form of books and journal articles that discuss the sport rehabilitation phase. Articles taken are specifically to review articles that describe the phases of sports rehabilitation in general. A case-specific exercise rehabilitation study was not included as a result. The search was conducted using the keywords ‘sport physio phase’ and ‘sport rehab phase’ or ‘sport physiotherapy phase’ and ‘sport rehabilitation phase’. However, the method used is not a systematic review research method because there is not much literature available. The online database used in the search only uses Google Scholar as one of the largest research databases.While the book used is a book about showing the theoretical concepts progressive phase of sport injury rehabilitation.

RESULTS AND DISCUSSION

From the search results, there are not many books and articles that specifically stated that there are phases in sports injury rehabilitation^5,7,8.

Some sources are still more specific in a case or only show interventions that can be an option in the application of sports injury management regardless of phase^9–12. However, there is also some literature, mostly books, showing the application of progressive programs in sports injury rehabilitation in four phases^13–17.

Literature is related to the sports rehabilitation phase summarized in table 1. The results are summarized in the stages of phase 1 to Phase 4. Table 2 can be seen as a summary of the discussion.

Phase 1

In this phase, physiotherapists need to pay attention to complaints that arise in athletes, such as pain or inflammation in muscle. Physiotherapists should focus on providing interventions in the form of pain reduction and if they do occur can also provide interventions to reduce tissue inflammation^3,12.

In addition, in this phase, attention is also paid to the ability to move in the range of motion (ROM) of the injured joint so that it does not decrease or be disturbed. Furthermore, it is also necessary to pay attention to cardiovascular conditions along with the condition of other parts of the body that are not injured in order to maintain their function and ability^13,14,17.

Some research reports related to a case of sports injury also supports this theory. In the research, the initial focus of physiotherapy was on reducing pain and maintaining ROM so that it did not decrease significantly^9,10,12.

Interventions that can be given in this phase include the use of compresses for acute conditions, electrophysiology modalities, manual therapy for pain reduction (joint mobilization grade I-II), massage or relaxation therapy and exercise therapy with the aim of reducing pain such as isometric contraction and stretching exercises^3,13,14.

Phase 2

Continue to the second phase, the physiotherapist must identify the patient’s condition well in order to determine the appropriate intervention. In the second phase, the athlete’s condition must have begun to show changes such as increased ROM, reduced pain and started to be able to move the injured body for daily activities^7,8. The physiotherapist’s focus on intervention should aim to restore ROM to 70-80 of normal^13,14. Pain reduction also needs to be considered, so that the implementation of the intervention can also be carried out. Moreover, the physiotherapist must stimulate the ability of the muscle tissue to contract perfectly^8,10.

Interventions that can be done include manual therapy/joint mobilization aimed at increasing ROM (Grade III-V) as well as exercise therapy such as contract-relax and stretching exercises^14,18.

Then, progress to initial strengthening exercises such as isometric exercises with weights, isotonic exercises with light weights(minimum) or body weights, proprioceptive exercises, and closed kinetic chain exercises⁵. This includes other exercises aimed at the body parts that are not injured, such as aerobics and strengthening exercises. It aims to keep the body parts that are not injured remain in good condition^13,16.

Several previous studies also support this theory, where after pain subsides and ROM begins to improve, it should be started with exercises that lead to early and proprioceptive muscle strengthening^9,10,12.

Phase 3

Then in phase three, where in this phase the patient is expected to no longer or at least feel pain¹⁴. In fact, it must be ensured that the ROM condition of the joint affected by the injury no longer has impaired flexibility or ROM¹⁵. In other words, the physiotherapists must ensure by their examination that the athlete is free or has minimal interference with the movement and function of the injured body¹³.

This phase is the initial phase of strengthening the injured muscle and restoring the ability of muscle contraction to normal. In this phase the physiotherapist is expected to focus on intervention in the form of strengthening exercises with progressive loads from 70-80 Maximum Reps^14,18. However, the load given needs to be adjusted to the condition of the injury and its area. Furthermore, training in the form of advanced proprioceptive exercises, balance, and coordination exercises and open kinetic chain exercises can be started for athletes. Movement patterns in sports that athletes are engaged in can also be patterns of strengthening exercises^13,14.

When strength has begun to improve, the physiotherapist can also consider plyometric exercises that suit the athlete’s needs^14,17. Thus, the agility, speed, and endurance abilities of athletes begin to emerge. The exercise is also expected to coordinate the injured body part with the uninjured.

Phase 4

This phase is the last phase of exercise rehabilitation by a physiotherapist. The physiotherapist will focus more on strengthening the muscles, balance, agility, strength, and endurance of the athlete in order to return to sport activities. Physiotherapy interventions that can be carried out are generally strengthening exercises with a maximum total load of repetitions (RM), advanced plyometric exercises, cardiovascular and musculoskeletal endurance exercises, as well as specific exercises from the athlete’s sport when they train with the coaching team^8,19. Physiotherapists must monitor athletes for other complaints that may arise when training returns to sports so that they can provide advice and tools to support the athlete’s sports skills^5,14,17.

Furthermore, at this stage, return to sport (RTS) testing needs to be carried out^8,11. Physiotherapists with their abilities can examine athletes according to their sport and based on clinical examination. A coach or sports scientist at a sports club can participate with a physiotherapist to determine whether the athlete can return to their sport activities or not^12–14,20.

Table 2. Phase of Sport Rehabilitation

Time Stages and Variations

The time stages of sports rehabilitation by physiotherapists are relatively different in some injured body parts, so they cannot be equated or used as a guide^3,5. However, what the physiotherapist needs to understand is the theory of tissue healing time (both bone and muscle) to be a reference for the physio-therapist to determine the rehabilitation time^3,21,22. Progressive time and training load will be very different for each individual athlete and also different in the injured part so they really have to pay attention to the examination before giving physiotherapy intervention to the next stage^14,19.

There are many variations of rehabilitation phases in the world of physiotherapy practice, but from the author’s point of view, the basic concept still refers to the stages that are adapted to the athlete’s condition. Starting from pain reduction, increased flexibility, increased strength, and then back to sports^5,20,23.

This research is a literature search by the author, so it is important to make more comprehensive research in the future.

CONCLUSIONS

In conclusion, the phase of sport rehabilitation carried out by a physiotherapist must have a clear stage based on the examination and the needs of the athlete. Typical sports rehabilitation phases are phases one to four with a focus on reducing pain in phase 1, increasing flexibility in phase 2, returning and increasing strength, endurance, agility, balance and proprioception in phase 3 and returning to sports in phase 4.

Conflict of interest: The author has no conflict of interest to declare.

Funding of study: This study has no funding or sponsorship wasreceived. It is self-financed study.

Compliance with Ethics: This study based on review of previous literature, so no need to obtain the ethical clearance.

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Citation:   Lucky Anggiat(2021). Sports Rehabilitation Phases: A literature Review, ijmaes; 7 (3); 1096-1103.

Novlinda Susy Anrianawati Manurung¹, Lucky Anggiat²

Corresponding Author:

¹Lecturer, Faculty of Vocational Studies, Physiotherapy Program, Universitas Kristen Indonesia, Jakarta, Indonesia, Email: novlinda.manurung@uki.ac.id

Co-Author:

²Lecturer, Faculty of Vocational Studies, Physiotherapy Program, Universitas Kristen Indonesia, Jakarta, Indonesia

ABSTRACT

Background: The development of entrepreneurial activities in society is the basis of the progress and prosperity of a nation. Currently the development of the age of the community is at a productive age which requires a prime or fit body condition and at an elderly age with a history of decreased movement activity which results in a decrease in quality of life. These existing problems are business opportunities that can be solved by physiotherapists by creating, building or opening a creative and innovative form of physiotherapy service business or physiotherapy entrepreneurship. This study aims to observe entrepreneurial activities carried out by physiotherapists.

Methods: this study uses a type of description taken from observations on 3 forms or models of business entities or physiotherapy entrepreneurship, in the form of: 1. independent clinics, 2. independent fitness training centers and 3. clinics in collaboration with doctors. Results: Based on the results of data searches and observations on the three physiotherapy entrepreneurial models, it can be seen the success of each entrepreneurial model. The independent clinic has a higher and higher level of difficulty, responsibility, creativity and innovation, while the clinical model that collaborates with doctors has a low level of difficulty with the division of responsibilities and has easier access to patients or clients compared to independent clinics.

Conclusion: The model for implementing physiotherapy entrepreneurial activities can be carried out independently in the form of clinics, fitness centers or in collaboration with doctors. Physiotherapy entrepreneurial activities have a contribution in creating job vacancies, solving health problems, and improving the welfare of society and the country’s economy.

Keywords: Physiotherapy; Entrepreneurship; Clinic

Received on 16^th August  2021, Revised on 26^th August 2021, Accepted on 30^th August  2021, DOI:10.36678/IJMAES.2021.V07I03.007

INTRODUCTION

The driving factor for the progress of a country lies in the number of entrepreneurs who stayed¹. Indonesia in improving the welfare and progress of the nation, is currently leading the goals of economic development which is focused on empowering the community to develop the economy through independent business as an entrepreneur in various forms of entrepreneurial activities².

According to Zimmerer, entrepreneurship is a process of applying creativity and innovation in solving problems and finding opportunities to improve lives³. Broadly speaking, it can be concluded that entrepreneurship is an effort to make an improvement by combining resources through new and different ways to win the competition⁴. This improvement can be made by developing new technologies, discovering new knowledge, finding new ways to produce brand-new goods and services that are more efficient, improving existing products and services, and finding new ways to provide satisfaction to consumers⁵.

Entrepreneurship in the health sector is a common phenomenon⁶. Since before the second world war nurses (health workers) have become entrepreneurs. Health entrepreneurship has increased in many countries in recent decades and there is evidence that entrepreneurs also play a role in public health⁷. Therefore, health professionals need to be educated to have entrepreneurial skills. Education in the health sector is still based on traditional forms of teaching and pays little attention to entrepreneurial issues⁸. In the health sector, there are several forms or models of entrepreneurship that are often implemented, such as the business activities of doctors, nurses, and physiotherapists who treat patients independently by coming to their homes, and this is a form or model of entrepreneurship called home care or home visit⁷. Furthermore, practice specialist doctors independently or jointly in the form of a health consulting service center clinic. Then, a physiotherapy service for fitness in the form of a fitness center working independently⁹. The physiotherapistworking with fitness training center in sports clubs for the improvement of achievement and hobbies. Moreover, a physiotherapy training service center in the form of a health sports club for movement recovery in specific conditions, such as stroke, heart disease, diabetes mellitus, asthma, and for pediatric patients with movement disorders during growth and development, as well as for patients with geriatric conditions¹⁰.

 Physiotherapy according to the Indonesian Regulation of the Minister of Health No. 65 of 2015 is a form of health service aimed at individuals and/or groups to develop, maintain, and restore body movement and function throughout the life span by using manual handling, movement improvement, equipment (physics, electrotherapeutic, and mechanical), functional exercise, and communication¹¹.

Currently, physiotherapy services in Indonesia are not only accessible at the referral level health care facilities, but also can already be found in several primary level health care facilities including independent practice⁹. Thus, arrangements and adjustments are needed so that the accessibility and quality of physiotherapy services can be accountable, meet the needs of the community while meeting the demands of the development of health services, including the development of accreditation of health care facilities¹². In addition, according to Regulation of Indonesian Ministry of Health Number 80 year 2013 that physiotherapists can practice independently or work in Health care Facilities¹³.

The entrepreneurial practice model in physiotherapy includes home visit, which is an independent physiotherapy service business activity by coming to the patient’s house¹⁰. Moreover, physiotherapy with fitness center is a physiotherapy service business activity in the form of specific physiotherapy training or exercises¹⁴.

Training centers or health sports clubs, achievement sports and hobbies, which are physiotherapy service businesses in the form of consultation, training or sports instructors both in the case of recovery and care of health conditions, improving sports performance and hobby sports activities carried out in a sports club. Independent Practice, is a physiotherapy service business activity that is carried out in a clinic independently. Furthermore, collaborative practice with doctors, is a physiotherapy service business activity carried out in a clinic in collaboration with a doctor and is a type of joint clinical business¹⁵. This study aims to observe what strategies and challenges are faced by entrepreneurs with a physiotherapy background in implementing their business in the field of physiotherapy services.

METHODS

This research is descriptive of the observation results on three entrepreneurial models in physiotherapy. The researcher interviewed three entrepreneurs in physiotherapy practice. The three resource person is physiotherapists who work and own the business. The spectrum of physiotherapy entrepreneurial services obtained is independent physiotherapy clinics for sports injury specific services, physiotherapy services at Pilate’s studios/centers and physiotherapy services at clinics in collaboration with general practitioners and specialists. The three resource persons were interviewed and the results of the interviews were collected and described in detail related to the strategy for implementing entrepreneurial activities. Then, conclusions are drawn which are the results of the research.

RESULTS AND DISCUSSION

Researchers obtained three types of entrepreneurial activities in physiotherapy services. The details of these types of activities can be seen in table 1. Through the results of the analysis and observation of three entrepreneurial models in physiotherapy, the following is a description of the form of entrepreneurship and its implementation.

Entrepreneur with Independent Clinic Model

Independent Sport Physiotherapy Clinic: The first resource person was the entrepreneurial activity of an independent clinic at a clinic called Physiopreuner Sport Physiotherapy, which has a specialty in sports and was founded in 2012, Jakarta. This clinic was built with a vision to become a physiotherapy clinic that can free Indonesia from injuries, specifically those caused by sports and injuries in general. Based on this vision, Physiopreuner Sport Physiotherapy clinic carried out a self-development mission by opening clinics in Surabaya and Makassar, then in 2017 a physiotherapy clinic named Quick Rehab & Performance was also opened in Jakarta and then in 2019 it was redeveloped by opening a clinic called Functional Prehab in Jakarta, Tangerang, Bogor, Bandung, Bali, and Makassar.

The initial strategy taken in opening an independent clinical business, which is carried out by the founder or entrepreneur, is to look at the various opportunities that exist in the sports field in the form of a high level of need for injury handlers. In addition, with capital preparation in the form of abilities and expertise in the field of physiotherapy in general and specifically in the field of sports, especially football. Second, the founder has the ability to observe and learn about the situation in the community as well as the need for physiotherapy services that are able to adapt to all situations and conditions. Third, the founder has the ability to respond to existing situations with creative ideas according to the field of physiotherapy.

Fourth, the founder has a relationship or network that supports and provides various assistance in the form of input, as well as leads and support regarding strategies in building a business. Fifth, founders have communication skills that become a marketing tool in business development and sustainability. The founder in carrying out business activities with independent clinical models has a significant vision, namely; “Indonesia BebasCidera” (Indonesia Incident & Injury Free), and has a specialty in the field of sports. During the establishment, they face enormous challenges and also bearing responsibilities and risks.

All of the management activities starting from preparation, selection, and determination as well as recruitment of human resources in the form of more experts and must have the same capabilities and qualities since they have very rapid business development, the provision of the same infrastructure in all branches, a very accurate financial system from each branch, quality of service, then supervision and quality control from all branches that must be the same and promotion and marketing for business development and sustainability are carried out independently. Entrepreneurs must have a scientific background in the field of sports physiotherapy, managerial skills, and courage as well as mental struggle and integrity.

Physiotherapy and Pilates Center: The second type of entrepreneurial activity is the model of combining physiotherapy service activities (clinical) with Pilates exercise training (gymnasium) in a business entity known as Cardea Physiotherapy and Pilates, and was established in 2016 as a physiotherapy clinic which continues to develop as a form of creative efforts and innovations in improving services by building specific physiotherapy training centers, pilates gymnastics in the form of a gymnasium. This business activity is an example of a physiotherapy business model which in its implementation provides comprehensive physiotherapy handling services in the form of a collaborative effort between clinical business activities with specific therapy services and business activities in the gymnasium and pilates exercise training. The type of physiotherapy services provided at the physiotherapy clinic is in the form of specific and up-to-date physiotherapy treatments or interventions that have great potential in providing various forms of quality services in overcoming physical problems and improving service quality. The type of service provided at the gym in the form of pilates training has great potential which creates the characteristics and advantages as well as triggers selling points in the community in this company.

The initial strategy taken in opening an independent clinic business with gymnasium collaboration by the founder or entrepreneur is as follows. First, seeing the existence of business opportunities through various types of specific and up-to-date interventions in the field of physiotherapy as superior products that are competitive and not owned by other companies that run similar businesses (Physiotherapy clinics). Moreover, conduct scientific learning and training on specific therapeutic techniques and up-to-date for human resources (physiotherapists) to improve the quality of services. Furthermore, carry out creative and innovative business development activities through the establishment of a physiotherapy training center using the Pilates method in the form of a gymnasium. Second, entrepreneurs have the ability to observe and learn about the situation that exists in the community for the need for physiotherapy services that are able to adapt to all situations and conditions. Third, entrepreneurs have the ability to respond to existing situations with creative ideas according to their field of physiotherapy and decide as well as implement these ideas.

Entrepreneurs in carrying out business activities with the model of merging two types of services in the form of clinics and gymnasiums face enormous challenges, responsibilities and risks seen from the management activities or management of companies that have two forms or models of business activities. In carrying out business management activities by combining the two forms of business models, entrepreneurs require the recruitment of human resources in the form of experts with different specifications according to the type of client-specific handling required in the two business models. Then, the provision of infrastructure for two business models, finance, service quality with two business models. In addition, promotion and marketing in maintaining business continuity are carried out for two business models. Entrepreneurs who carry out business activities with diversified products or services must have expertise in producing services or products of the same quality in maintaining business continuity, therefore more ability is needed in managing time and energy, devotion to work and integrity in carrying out business activities (professionalism at work).

Physiotherapy Clinic with Medical Doctor: The next type of entrepreneurial activity is a physiotherapy clinic business model that collaborates with doctors and was founded in 2018 and has a business entity named “Apotik Jaya Bekasi Clinic”. The form of business that is created as an example at this time has a form of cooperation service between physiotherapy and a doctor’s clinic as the owner who is also the executor of clinical governance in terms of financial administration management as well as a provider of facilities in the form of a place of practice needed in the implementation of physiotherapy service business activities.

The initial strategy in opening a clinical business with collaboration was to see the potential and opportunities for additional types or diversification of health service businesses at the KlinikApotik Jaya Bekasi, as well as the need for physiotherapy services in the community around Bekasi which was then followed up by submitting a collaboration proposal. The contents of the proposal are various forms of agreements between parties that work together regarding the profit sharing system and business governance activities in the form of administration, service implementation, and financial governance issues as well as business results sharing agreements in terms of payroll, payment of electricity costs, provision, maintenance, and addition of equipment. Furthermore, in this collaboration, entrepreneurs have capital in the form of expertise in the field of physiotherapy, therapeutic equipment and physiotherapy service personnel, who will work in physiotherapy clinics and are recruited by physiotherapy entrepreneurs. Patients or clients come with promotional management that has been carried out by the manager, while the owner of the physiotherapist clinic is responsible for providing services according to what has been promoted by the manager. Doctors who work closely with physiotherapists can also directly send patients so that physiotherapists do not have difficulty getting patients or clients. Physiotherapists do not have to face significant challenges in promoting their business so that business activities can last for a long time in the sense that the business is running stably, as long as the practice of doctors and pharmacies is still ongoing with the meaning that the sustainable value is high, however, this still prioritizes the quality of services provided for business continuity and success.

Entrepreneurs in carrying out business activities with a model of cooperation with several types of businesses such as doctors’ practices, pharmacies and physiotherapy, have challenges in terms of providing tools that require capital in the form of large amounts of funds. However, currently in terms of providing tools, entrepreneurs have a way to provide these facilities through cooperation with tool providers or equipment manufacturers in the form of a payment system that is given a payment settlement period and the tools have been provided to entrepreneurs in advance. In this case, the maintenance of the condition of the equipment is an important part in order to provide business results as expected and fulfill payments in accordance with the equipment purchase agreement. Business activities in the form of cooperation, Entrepreneurs face challenges in terms of preparing business capital, such as: providing tools, care, and providing physiotherapists, and having responsibilities for cooperation agreements both to owners of large facilities and equipment providers. However, the risk in the implementation of the service is not significant because it will be shared together, and for management activities or company management with a cooperative system, it will be divided between the owners and the members who cooperate. (Entrepreneurs must have expertise, capital in terms of funding tools through cooperation with tool providers, love for the field of work and integrity).

CONCLUSION

Based on the three models of physiotherapy entrepreneurship, it can be seen that the opportunities and business potential in the field of physiotherapy in Indonesia are widely opened. The crucial community need for health services related to human body movement activities has potential and is an opportunity to build a physiotherapy business or entrepren-eurship. The model for implementing physiotherapy entrepreneurial activities can be carried out independently in the form of clinics, fitness centers or in collaboration with doctors. Physiotherapy entrepreneurial activities have a contribution in creating job vacancies, solving health problems, and improving the welfare of society and the country’s economy.

Ethical clearance: Ethical clearance obtained from Faculty of Vocational Studies, Physiotherapy Program, Universitas Kristen Indonesia, Jakarta, Indonesia

Fund of Study: This study is self-funded study

Conflict of Interest: Author has no conflict of interest to declare.

Acknowledgement: We would to thanks Clinic Physiopreneur Sports Physiotherapy, Cardea Physiotherapy and Pilates, and Apotik Jaya Bekasi Clinic as resource persons in this research.

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Citation: Novlinda Susy Anrianawati Manurung, Lucky Anggiat (2021). Entrepreneurship models in physiotherapy practice: An observational study, ijmaes; 7 (3); 1088-1095.

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.
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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.

Citation: Kavya Sree.P.P, Saji.V.T(2021). A survey on the effect of high impact exercises on stress urinary incontinence in young women, ijmaes; 7 (3); 1080-1087.

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.

REFERENCES

1. llesh Patel, Sheila K West (2007). Presbyopia: prevalence, impact, and interventions, Community Eye Health.  20(63): 40-41.
2. Melody tabatabaei, Behrouz Barjasteh Mohebbi, Alireza Rahimi(2017); The impact of 8 weeks selected corrective exercises on neck pain, range of motion in the shoulder and neck of lifesaver women who suffering from forward head posture and myofascial pain syndrome, journal of biomedical research and therapy.  4(6): 1420-1431.
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
4. Susan Armijo-Olivo Jaime Bravo, David J Magee, et al.,(2006) The association between head and cervical posture and temporo-mandibular disorders: A systematic review, Journal of orofacial pain 20(1):9-23.
5. Ghi-Hwei Kao, T. K. Philip Hwang (2018) Head and Neck Supporting for Seating International Conference on Human-Computer Interaction HCI ; HCI International 2018; Posters’ Extended Abstracts; pp 375-380.
6. Karen Grimmer (1998) The association between cervical excursion angles and cervical short flexor muscle endurance; Australian Journal of Physiotherapy 1998; Volume 44; Issue 3; Pages 201-207.
7. Edmondston S J, Sharp M, nawaf Alhabib N, et al.,(2011) Changes in mechanical load and extensor muscle activity in the cervico-thoracic spine induced by sitting posture modification; Ergonomics. 54(2);179-86.
8. Haejung Lee, Leslei L Nicholson (2005) Neck muscle endurance, self report, and range of motion data from subjects with treated and untreated neck pain. Joint Manipulative Physiological Therapy; 28(1):25-32.
9. Bae YH, Lee GC (2011) Effect of Motor Control Training with Strengthening Exercises on Pain and Muscle Strength of Patients with Shoulder Impingement Syndrome. J Korean Soc Physiotherapy; 23(6):1–73
10. Andreas Hartwig et al.,(2007) analysis of head position used by myopes and emmetropes while performing a near-vision reading task. Vision research. 51(14)1712-1717. 
11. Aliaa Rehan Youssef (2016) photogram-metric quantification of forward head posture is side dependent in healthy participants and patients with mechanical neck pain, international journal of physiotherapy; Vol 3; Issue 3. Pages 326-331.
12. Jaap H.van Dieën (2006) Pathophysiology of upper extremity muscle disorders; Journal of Electromyography and Kinesiology Volume 16, Issue 1, Pages 1-16.
13. J smith, J Lewis D Pricard (2005) Physiotherapy exercise programs: Are instructional exercise sheets effective; physiotherapy theory and practice; 21(2) 93-102.
14. Lary sachs et al.,(1996) the interaction of wearing multifocal lens with head posture and pain; journal of orthopedics and sports physiotherapy; 23(3) 194-9.
15. Cureton Jr TK (2013) Bodily Posture as an Indicator of Fitness. Res Quarterly Am Assoc Heal Phys Educ Recreat; 348-357.

Citation: Manoj Abraham. M1,  Meenas Mohamed Sageer (2021). Study on prevalence of forward head posture among young individuals wearing eye glasses, ijmaes; 7 (3); 1072-1079

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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Citation: Manoj Abraham. M1, Soumya Murali(2021).Prevalence of upper crossed syndrome among software professionals , ijmaes; 7 (3); 1061-1071

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.

Received on 11th July 2021, Revised on 16th August 2021, Accepted on 25th August  2021, DOI:10.36678/IJMAES.2021.V07I03.002

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.

REFERENCES

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4. Safitri E, Selviana , Amelia D S, Anggraini E, Hanjarvelianti S. Pendampingan Pembuatan Filtrasi Air dari Limbah Kulit Pisang Kepok dan Penerapan PHBS di Pesantren Hidayatul Muhsinin. Community Empowerment. 2021; 6(1): p. 54-63.
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9. Wijayanti AR, Maghfirah S, Mas’udah AF. Perbedaan Sikap Perangkat Desa Tentang Perilaku Hidup Bersih dan Sehat (PHBS) Sebelum dan Saat Pandemi Covid-19. : Jurnal Ilmiah Ilmu Kesehatan. 2021; 9(1); p. 26-37.
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15. Budhyanti W, Anggiat L, Juwita CP. Pencegahan Dan Penanganan Nyeri Leher Dan Punggung Bawah Dengan Peregangan Mandiri Pada Pegawai Sekolah Menengah Kejuruan Negeri 10 Cawang. Jurnal Fisioterapi dan Rehabilitasi. 2020; 4(1); p. 78-89.
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Citation: Citra Puspa Juwita, Rosintan Milana Napitupulu (2021).Hygiene  and healthy living behavior and stress during the Covid-19 pandemic, ijmaes; 7 (3); 1041-1048.

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.

REFERENCES

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Citation: Nazrin Ahmad,Ting Shau Chen,Mazlinda Musa, et al(2021). The association between knowledge and practice of body mechanic technique among nurses in emergency department from hospital in North Borneo, ijmaes; 7 (3); 1034-1040.