Jahangirnagar University Journal of Statistical Studies

ISSN 1022-4734

http://www.juniv.edu/department/stat

JUJSS, Vol. 36, 2022, pp. 23-30

The Effectiveness of Health Literacy Intervention (Educational

Booklet) on Chronic Neck Pain Management: Experiment Based on
Repeated Measurements
M. Mazibar Rahman*
Department of Statistics Jahangirnagar University Savar, Dhaka-1342, Bangladesh

Mustafa Amimul Ehsan Siddique

Department of Statistics, Jahangirnagar University, Savar, Dhaka, Bangladesh

Abstract

Health literacy represents a constellation of skills necessary for people to function effectively in the health care
environment and act appropriately on health care information. The study explores the effectiveness of
educational booklet with conventional physiotherapy compare to only conventional physiotherapy for chronic
neck pain. 8 chronic neck pain patients were randomly assigned to conventional physiotherapy group and 8
patients to conventional physiotherapy group. Unrelated “t” test was used to compare the results of ROM and
Pain. Repeated measures analyses of variance (ANOVA) were used. Mean age of the participants of
experimental and control group were consequence 41 &37 years. In Experimental group, Mean difference
in different occasions found more reduction in pain than control group. which were 0.20, 0.50, 0.24
respectively in pretest mid test and posttest. There were significant effects of booklet on pain in the
experimental group. There was also significant effect on time on pain reduction. This experimental study shows
that there was significant difference between educational booklet with conventional physiotherapy and only
conventional physiotherapy for patients with chronic neck pain.
Key words: Health Literacy Intervention, Educational booklet, Chronic Neck Pain management

1. Introduction

Musculoskeletal problems are one of the most common health problems in Bangladesh as well as in
other countries. Taking a broad spectrum there are thousands of different musculoskeletal
problems, including neck pain. Neck pain and other related disorders are very common all over the
world. It is the eighth leading cause of disability in the United States and fourth worldwide
(Sberman et al., 2014). Neck pain is the pain which may be experienced anywhere from the base
ofthe skull at ear level to the upper part of the back or shoulder (Sabeen et al., 2013). Itis estimated
that in every year 30-50% of adults experience a significant form of neck pain (Mantyselka et al., 2010).
On general health showed that 15% of patient reported about grade 2 to 4 neck pain (Manchikanti et
al., 2013). It is also a common symptom among the middle aged population and it has been
shown that 24% of males and 37% of females suffer from neck pain (Mantyselka et al., 2010). It has
also been shown that neck pain is most common between the ages of 40-50 with a reported

*
Corresponding author: [email protected]
© Department of Statistics, Jahangirnagar University, Savar, Dhaka-1342, Bangladesh.
JUJSS Rahman and Siddique

prevalence of 83 people per 100,000 populations (Physiopedia, 2013). In Sweden, females aged
between 35-44 years had a higher risk of having long and medium- term neck pain and ≥ 65 aged
males had a higher risk of having long and medium term neck pain symptoms than males aged
between35-44 (Linder et al., 2012). Work related neck disorders are common problems in office
workers, especially among those who are intensive computer users. (Sabeen et al., 2013).

Consequently, neck pain has been a source of disability which may require substantial health care
resources and treatments (Cheng & Huang, 2014). Physiotherapy has a wide ranging role at all stages of
neck pain to help the patient return early to normal activities (Moffett & Mclean, 2006). Physiotherapy
usually forms part of the treatment offered for patients with neck pain and it includes specific
exercise programs like Mckenzie approach, manual therapy (spinal manipulation and mobilization),
traditional massage, physical modalities and proper patient education (Moffett & Mclean, 2006).

A review of the literature shows that patient education in the form of a brief intervention can be
effective for chronic back pain (Moffett & Mclean, 2006). So this study focuses on the
effectiveness of an educational booklet with a brief intervention for chronic neck pain.

Health literacy interventions that use written and print-based materials designed to be easy to read and
understand have been shown to increase health-related knowledge among children and adults more than
traditional materials. (Darren 2009) Primary care-based group education programs designed to be
sensitive to health literacy limitations also appear to increase knowledge among adults. (Brega et al.
2013)

This research is a quantitative evaluation of the educational booklet used along with conventional
physiotherapy for chronic neck pain. To identify the efficacy and effectiveness of this treatment
approach, two measuring tools were used. First the Numeric Pain Rating scale (NPR) was used as a
measurement tool for measuring the pain intensity in several functioning positions, and second the
Goniometer was used to measure the range of motion. The main objectives of this study are

 To find out the effectiveness of an educational booklet for chronic neck pain.
 To evaluate the intensity of pain at resting position after using the educational booklet.
 To measure the intensity of pain during activity after using the educational booklet.
 To calculate the intensity of pain at different functional position (Sitting,
Standing, Walking, sleeping, neck turning, neck bending).

2. Methodology

An experimental hypothesis predicts a relationship between two variables. So the study adopts a
true repeated measurement experiment between different treatment designs. Conventional
physiotherapy used together with an educational booklet was applied to the experimental group,
and conventional Physiotherapy alone was applied to the control group. After the manipulation of

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 The Effectiveness of Health Literacy …

the independent variables, the outcomes were compared. A pretest (before intervention), mid-test
and posttest (after intervention) were administered with each participant of both groups to compare
the pain effects before, middle of treatment and after the treatment. Study area was Physiotherapy
unit of, CRP Manikganj.

Study sampling 16 patients with neck pain were selected through random sampling. A total of 16
patients were included in this study, among them 8 patients were selected for the experimental group
and the rest were selected for the control group. Patients were selected through some exclusion and
inclusion criteria.

Inclusion criteria
 Age between 25 to 50 years.
 Patients who have chronic neck pain.
 Both male and female are included.
 Patients who are literate.
 Patients who have postural and derangement problems
 Those who showed willingness to participants.

Exclusion criteria

 Patients who have pathological problems like tumors

 Neck deformity
 Neck dysfunction
 Severe trauma
 Adhesive capsulitis or other shoulder problems
 Post-operative conditions
 Patients who are not willing.

3. Methods of data collection

Numerical Pain Rating Scale (NPRS)-The NPRS was used for measuring the pain intensity in
several function positions. Patients were asked to indicate the intensity of current, best and worst
levels of pain using an 11-point scale, ranging from 0 (no pain) to 10 (worst pain imaginable)
(Cleland et al.,2008).

Goniometer (Double-Armed) –A goniometer was used for assessing a joint Range of Motion
(ROM).

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JUJSS Rahman and Siddique

Repeated Measures ANOVA

Pain Reduction in Control Group in Different Occasions

Subjects Total pain score Mean pain score

n=8 Pre Test Mid test Post Test Pre test Mid Test Post test
C1 56 30 9 7 3.75 1.125
C2 66 33 8 8.25 4.125 1
C3 63 32 16 7.87 4 2
C4 69 38 10 8.62 4.75 1.25
C5 79 43 25 9.87 5.375 3.12
C6 67 34 10 8.37 4.25 1.25
C7 56 33 13 7 4.125 1.62
C8 64 33 14 8 4.125 1.75
Total 520 276 105 65 34.5 13.12
Mean 65 34.5 13.12 8.12 4.31 1.40

Evaluation Outcome of Pain

Descriptive Statistics of within group mean pain score of control group and experimental group on 3
occasions of measurement are

Dependent Variable- Pain

Experimental group
Test occasion Control groupMean Mean difference N
Mean
Pre test 8.12 7.92 0.2 8
Mid test 4.31 4.26 0.05 8
Post test 1.64 1.4 0.24 8

Figure 1. Mean Difference of Improvement of Pain between in Experimental

and Control Group at Different Occasions.

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 The Effectiveness of Health Literacy …

Repeated Measures ANOVA

SV DF SS MS F P
Treatment group G-1 66454.083 66454.083 912.786 .000
Error (a) 1 1019.250 72.804 .073 .791
Occasions 2 21060.292 10530.146 615.220 .000
Occasions*Treatment 2 5.792 2.896 .169 .845
Error (b) 28 479.250 17.116 17.116
Here, G=Group=2, T=Time=3, N=16

„*‟ denote the significant different at 5% level

Table of repeated measured ANOVA shows that there are significant effects of booklet on pain in
the experimental group. There are also significant effect on occasion on pain reduction. But There
was not significant interaction between the types of treatment and occasion on the effectiveness of
pain, P>0.05.
Multiple Comparisons of Means of Different Pairs of Occasion

(I) occasion (J) occasion Mean Difference (I-J) SD Sig.

Pretest Mid test 29.875* 1.749 .000**
Post test 51.063* 1.427 .000**
Pretest -29.875* 1.749 .000**
Mid test
Post test 21.188* 1.149 .000**
Pretest -51.063* 1.427 .000**
Posttest
Mid test -21.188* 1.149 .000**

Table shows multiple comparison showed that the mean effect of pain in all pairs of occasions (Pretest
and mid-test, pretest and mid-test, mid-test and posttest) are found to be statistically significant P<0.01.

Mean Difference of Improvement of ROM

10.625 10
7.5 8.125

Figure 2. Mean Difference of Improvement of ROM between Pre-Test and Post-Test in

Experimental and Control Group.

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JUJSS Rahman and Siddique

Line diagram showing the effect of health literacy (booklet) intervention on pain on 3different
occasions.

1=Pretest, 2=Mid test and 3=Post test

The line diagram illustrates that the trend of pain in three different times have been projected
downward. The tendency of pain reduction is higher in the experimental group which is substantial
improvement comparing between the groups.
Improvement of ROM
Mean difference of Improvement of Range of motion between pre-test and post-test in
conventional physiotherapy with educational booklet and only conventional Physiotherapy group.

Conventional physiotherapy with Only conventional

Educational booklet Physiotherapy
Name of the variables* (Experimental group) ( Control group)
(Pre test- post test)
(Pre test- post test)

Passive flexion 10.625 6.25

Passive extension 10 7.5

Passive rotation right 10 8.125

Passive rotation left 11.25 8.125
*Rang of Motion, ROM
Table. Mean difference of Improvement of ROM between pre-test and post-test in experimental
and control group

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 The Effectiveness of Health Literacy …

The result of this experimental study have identified that there are statistically significant difference
between educational booklet with conventional physiotherapy group and only conventional
physiotherapy group. That indicated that educational booklet with conventional physiotherapy is
more effective than the conventional physiotherapy alone. This study demonstrated that, there are
gross improvement in mean pain score and ROM in different body posture and movement.

These findings also justify interventional book's efficacy in improving health status in subjects with neck
pain with the study design including internal controls to minimize bias issues and a wider range of
outcomes, including multiple measures of pain, function, disability, patient satisfaction, utilization of
health care services and psychosocial measures. Educational booklet is used along with conventional
physiotherapy that aims to reduce pain, increase functional activity and also increase range of
motion of neck, to facilitate rehabilitation program. It is helpful for better understanding of usual
advice.

Acknowledgement
The authors would like to thank the authority of Jahangirnagar University for funding a research grant
for this study.

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