RESEARCH PROPOSOL ON

PREVALANCE OF MASCULOSKELETAL DISORDERS

AMONG UNDERGRADUATE PHYSIOTHERAPY
STUDENTS IN A SELECTIVE INSTITUATE

SUBMITTED BY

MD. SAIFUR RAHMAN

BATCH: 19th

ROLL NO: 34

REG. NO: 5420

SESSION: 2013-2014

SUBMITED TO

DR. DELOWAR HOSSAIN CHOWDHURY

BPT(DU), MPT(NEURO), MRS(CRP,DU)

LECTURER

DEPARTMENT OF PHYSIOTHERAPY

NATIONAL INSTITUATE OF TRAUMATOLOGY AND

ORTHOPEDIC REHABILITATION

SUBMISSION DATE
 INTRODUCTION

1.1 Background

Musculoskeletal disorders are described as injuries to the human supportive system of

muscles, tendons, ligaments, nerves, blood vessels, bones, joints and can occur from
aggregative trauma. Musculoskeletal disorders (MSD) can result pain in the neck,
shoulder, arm, wrist, hands, upper and lower back, hips, knees and feet (Hayes et al.
2009).

Musculoskeletal pain is a huge medical issue in grown-ups as well as in the youthful.

The regular use of computers has resulted in neck pain, shoulder pain and arms pain
ultimately causing loss of productivity, absence from work or even disability
(Obembe et al. 2013).

The cause of musculoskeletal work related disorders remains broadly vague, pain
being the absolute accusation. A musculoskeletal problem was prevalent as a
consequence of 60% work-related injuries among physiotherapists and is a trivial
reason for providing effective physiotherapeutic treatment (Kalyan 2018).

It is usually agreed that musculoskeletal symptoms are of multifactorial origin, and

both occupation related physical factors and individual factors seem to be important
for the development of symptom (Feveile et al. 2002).

The advancement of MSP alters the accustomed aspect of life along with an unusual
drop in capacity in educational in addition to professional life of an individual.
Several types of studies have been conducted by Derek Smith in order to determine
the exact prevalence of MSP in the Asian region, each with their own characteristic
findings. While 36.9% of the female nursing students in central Japan reported
musculoskeletal pain, which occurred most commonly in the shoulders, 70% of the
professional nurses in mainland China reported musculoskeletal pain, with lower back
being the most commonly reported site ( Haroon et al. 2018).
Medical students are more likely to be affected by increased workload in wards of
hospitals, stress and long study hours during the period of their medical training.
According to the research published by World Health Organization (WHO), low back
pain and neck pain were recognized as number 1 and 4 respectively, among the
leading causes of years lived with disability. The United Nations and World Health
Organization (WHO) determined that the burden of musculoskeletal conditions on
individuals and imported this topic into focus (Hasan et al. 2018).

As musculoskeletal problem is unavoidable for health care professional it is beneficial

to evaluate the prevalence of this problem among young workers (Phedy and Gatam
2016).

We tried to identify the various socio-demographic, information related, MSK and

treatment related factors associated with musculoskeletal pain among physiotherapy
students. Previous literature demonstrated that physiotherapists are in risk to develop
musculoskeletal pain as a consequence of high physically demanding work style.
However, there is very limited literature available on the causative factors for the
same among Bangladeshi physiotherapists and there is no study on physiotherapy
student. Therefore, this study was aimed to correlate various factors with
musculoskeletal pain to identify the associated factor with it (Kalyan 2018).
1.2 Justification of study

Now-a-days musculoskeletal pain is becoming a common health hazard.

Musculoskeletal pain is also a commonly reported symptom in adolescents and
undergraduate student’s. Like other undergraduate students, students who are
studying physiotherapy are suffering from different types of musculoskeletal pain.
Physiotherapists are specialist who works on musculoskeletal pain management and
who are much more educated and aware about musculoskeletal pain but are also
suffering from it. These sufferings start from their student life which may be because
of improper ergonomics, prolong study hours, maintaining faulty posture, improper
technique for applying manual therapy and lack of awareness towards healthy
lifestyle. While the determinants of musculoskeletal pain are numerous, no studies
have been conducted on the undergraduate physiotherapy students. So, this study will
be done taking physiotherapist students as participant and factors associated with their
musculoskeletal pain will be analyzed. This may help to identify the associated
factors which are responsible for the musculoskeletal pain and to take interventions
aimed at reducing musculoskeletal pain. We believe that this study will also help
other medical professionals by making them aware about the risk factors and will help
them to take necessary measures.
1.3 Research question:

What are the prevalence of musculoskeletal disorders among undergraduate

physiotherapy students at a selective institute in Dhaka city?
1.4 Objective of the Study

General Objective
To determine the prevalence with musculoskeletal disorder among undergraduate
physiotherapy students at selective institute in Dhaka city.

Specific Objective
To find out the social-demographic factor related with musculoskeletal disorder
among the physiotherapy students;
To find out the information related factor with musculoskeletal disorder among the
physiotherapy students;
To find out the site and severity of musculoskeletal disorder among the
physiotherapy students;
To see the treatment related information with musculoskeletal disorder among the
physiotherapy students.
1.5 Conceptual Framework

Independent variable Dependent variable

Socio-Demographic factors

Age,
Sex,
Height,
Weight,
Monthly family income,
Marital status.

Information related to variable

Year of education,
Study hours,
Sitting hours,
Transportation, Musculoskeletal Disorder
Heavy weight carry,
Physical activity (SGPALS)

Musculoskeletal pain related

variables
Site, Onset,
Pattern, Radiation,
Severity (VAS)
Duration of suffering

Treatment related variables

Treatment taken,

Progonosis
1.7 Operational definition

Pain: An unpleasant sensation that can range from mild, localized discomfort to
agony. Pain has both physical and emotional components.

Musculoskeletal disorders (MSD): Musculoskeletal disorders (MSDs) are injuries or

pain in the human musculoskeletal system, including the joints, ligaments, muscles,
nerves, tendons, and structures that support limbs, neck and back. MSDs can result
from a sudden activity of motion like lifting a heavy weight or they can arise from
making repetitive movement, or from repeated exposure to force, vibration, or
awkward posture.

Occupational health: Occupational health deals with all aspects of health and safety
in the workplace and has a strong focus on primary prevention of hazards. The health
of the workers has several determinants, including risk factors at the workplace
leading to cancers, accidents, musculoskeletal diseases, respiratory diseases, hearing
loss, circulatory diseases, stress related disorders and communicable diseases and
others which comes under occupation health.

Prevalence: It is the degree to which something is prevalent or the percentage of a

population that is affected with a particular disease at a given time.

Disability: It is a physical, mental, cognitive, or developmental condition that

impairs, interferes with, or limits a person's ability to engage in certain tasks or
actions or participate in typical daily activities and interactions.

Undergraduate

An undergraduate is a college or university student who's not a graduate student.

After high school, you can become an undergraduate.

Undergraduates are students of universities and colleges: they've graduated from high
school and have been accepted to college, but they haven't graduated yet. If the under
in undergraduate seems confusing, that's because there are also graduate student
students who have a college degree but are no longer undergraduates and are pursuing
an advanced degree, like a Master's or Ph.D. Lots of people say being an
undergraduate was one of the best times of their lives: it's an exciting thing to be.

Physiotherapist: Physiotherapists are highly qualified health professionals who

works in partnership with their patients to help people get better and stay well. They
are the specialist in the promotion of mobility in those handicapped by illness or
accident and treat disease, injury, or deformity by methods such as massage, heat
treatment, and exercise rather than by drugs or surgery.

BMI: means body mass index. It is a value derived from the mass (weight) and height
of an individual. The BMI is defined as the body mass divided by the square of the
body height, and is universally expressed in units of kg/m2, resulting from mass in

kilograms and height in meters.

BMI Value
Less than 18.5 Underweight
18.5-24.9 Normal
25-29.9 Overweight
Above 30 Obese

Pain rating scale: A pain scale measures a patient's pain intensity or other features.
Pain measurements help determine the severity, type, and duration of the pain, and are
used to make an accurate diagnosis, determine a treatment plan, and evaluate the
effectiveness of treatment.

Rating Pain Level

0 No pain

1-3 Mild pain

4-6 Moderate pain

7-10 Severe pain

Physical activity level scale (SGPALS):
SGPALS means Saltin-Grimby Physical Activity Level Scale.

Rating Physical activity and exercise level

01 Physically inactive
(almost completely inactive, reading, watching TV, using computers
or doing other sedentary activities, during leisure time)

02 Some light physical activity

(Physically active for at least 4 hours/week, such as riding a bicycle or
walking to work, walking with the family, gardening, fishing, table
tennis, bowling etc.)

03 Regular physical activity and training

(spending time doing heavy gardening, running, swimming, playing
tennis, badminton, calisthenics and similar activities for at least 2-3
hours/ week)

04 Regular hard physical training for competitive sports

(spending time running, orienteering, skiing, swimming, playing
football, handball etc. several times per week)
CHAPTER 2 LITERATURE REVIEW

Musculoskeletal pain is prevalent among physiotherapy students, and mostly, back,

neck, and lower leg pains are very common among them. In the recent years, there has
been an increase in musculoskeletal complaints, work-related stress, and reduced
quality of life among physiotherapy students. This study was conducted to identify the
prevalence and associated risk factors of musculoskeletal health and health-related
quality of life of physiotherapy students. A cross-sectional study was conducted
among physiotherapy students from three different physiotherapy colleges of Surat,
India, from November 2013 to January 2014. A total of 457 physiotherapy students
(22 males and 435 females) completed the demographic and personal data along with
questionnaires such as Cornell Musculoskeletal Discomfort Questionnaire,
International Physical Activity Level Questionnaire, Quality of Life Short-Form
Questionnaire, and Brief Multidimensional Students' Life Satisfaction Scale. Most of
the students had experienced some kind of a musculoskeletal pain in the past 6
months and different locations of pain (neck, shoulder, upper back, lower back, and
lower legs), the lower back was found to be most commonly affected location
(29.1%) followed by the neck (13.4%) and lower legs (13.8%) (Bid et al. 2017).

The study conducted on factors associated with neck pain among secondary school
children in northern Dhaka city. Main objective of this study was to determine the
factors associated with neck pain for which a cross sectional study was carried out
among 122 school children comprising both boys and girls. A greater percentage
(60.8%) of the respondent complained moderate level of intermittent pain, radiating
neck pain was 44.3% and about 35.2% of the participants complained morning pain.
Neck pain prevalence among school children was found 80% & factors between neck
pain & age, school bag weight, time spend in sitting position showed significant
relationship. So neck pain of secondary school children was found fairly high in
northern Dhaka city & School bag weight; prolong sitting posture were the
responsible factors for neck pain (Kamrujjaman et al. 2017).
Musculoskeletal disorders (MSD) have been identified as a significant occupational
health issue for dental hygienists, few studies have explored this problem among the
dental hygiene student. The aim of this study was to investigate the prevalence and
correlates of MSD among a selection of undergraduate dental hygiene students in
Australia. A self-reporting questionnaire was distributed to dental hygiene students at
an Australian university. Musculoskeletal disorders were most commonly reported by
students at the neck (64.29%), lower back (57.94%) and shoulder (48.41%) regions.
Logistic regression indicated various correlations with MSD. The study suggests that
MSD are a reasonably common problem for dental hygiene students in Australia
(Hayes et al. 2009).

Musculoskeletal disorders are a major health problem resulting in negative effects on

wellbeing and substantial costs to society. Work participation is associated with
positive benefits for both mental and physical health. This study evaluated whether
and how GPTs take participate in the account work and work-related environmental
factors as determining factors in patients with musculoskeletal disorders and how
could be improved. A qualitative study consisted of 7 focus groups involving 30
participants: 21 GPTs and 9 occupational physical therapists (OPTs). Respondents
mentioned that the integration of this item in their GPTP could be improved.
Generally, GPTs place insufficient priority on work participation. Moreover, there is a
lack of cooperation between the generalist physical therapist and (other) occupational
healthcare providers (including OPTs), and the differences between generalist
physcial therapy and occupational health physcial therapy were sometimes unclear.
GPTs showed a lack of knowledge and a need for additional information about
several important work-related factors (e.g. work content, physical and psychosocial
working conditions, terms of employment) (Hutting et al. 2017).

The aim of this study to investigate the status of work-related musculoskeletal

disorders (WMSDs) in nurses working in the hospitals. A cross sectional study, 6674
nurses involved in the nursing profession were selected from 16 hospitals using the
stratified cluster sampling method and a prospective 12 month follow-up study. e
most commonly affected regions by WMSDs were lower back, neck, shoulder, and
back, with an annual prevalence of 62.71%, 59.77%, 49.66%, and 39.50%,
respectively. The analysis indicated that the following risk factors were associated
with the prevalence of WMSDs: working duration of ≥6 years; working in the
Emergency Department, Department of Anesthesia, or Supply Room; night shift of
more than once, working duration of >40 hrs per week; poor health status; and feeling
of fatigue. Rest time of >10 min and no history of WMSDs were the protective factors
of WMSDs (Yan et al. 2017).

This study is done to find out the prevalence of work related pain amongst
physiotherapist according to their specialization and also to provide them appropriate
knowledge about the problem and safety issues. The physiotherapist who participated
had work experience between 1-5 years and were working in different hospitals in
India were the part of the study. Respondents that took part in the study were 500. Out
of which 265(53%) were Females and 235(43%) were Males. Physiotherapist who
had done masters in Musculoskeletal physiotherapy had higher prevalence in shoulder
(50%) and neck (30%), masters in Neuroscience physiotherapy had higher prevalence
in wrist/hand (65%) and neck (20%), masters in Sports physiotherapy had higher
prevalence in lower back (85%), masters in Cardio respiratory physiotherapy had
higher prevalence in elbow (75%) and Physiotherapist who were bachelors had higher
prevalence in knee (45%) and calf (20%) (Gharote et al. 2016).

This study was done to determine the prevalence of musculoskeletal pain among
undergraduate students in a Nigerian University so, a cross sectional study was
conducted and participants were selected using the non-probability sampling
technique. The Boston University Computer and Health Survey questionnaire was
self-administered to 400 undergraduate laptop users. Research findings suggests that
shoulder pain was the most reported musculoskeletal complaint from 268 (75.7%)
participants and elbow pain was the least common complaint from 132 (37.3%)
participants. The prevalence of musculoskeletal pain was slightly higher among
female students 93 (50.3%) of 185 and highest among students aged between 24 and
26 years: 60(37.5%). In addition, the prevalence of musculoskeletal complaints was
highest among those who used single-strap laptop bags 176 (94.1%) (Obembe et al.
2013).

This study sought to determine the lifetime, 12-months period and point prevalence of
work-related musculoskeletal disorders (WMSDs); the associated job risk factors and
the coping strategies toward reducing the risk among nurses from selected hospitals in
Ibadan, Southwest Nigeria. A cross sectional study was done and 118 data was taken.
84.4% of the nurses have had WMSDs once or more in their occupational lives. The
12-months period and point prevalence rate of WMSDs at any body region was 78%
and 66.1% respectively. WMSDs occurred mostly in low back (44.1%), neck
(28.0%), and knees (22.4%). 30.3% treated themselves or had visited other health
practitioners for care. Working in the same positions for long periods (55.1%), lifting
or transferring dependent patients (50.8%) and treating an excessive number of
patients in one day (44.9%) were the most perceived job risk factors for WMSDs
during their clinical practice (Tinubu et al. 2010).

The objective of this study was to determine the prevalence, identify the risk factors
and coping strategies for WRMDs among physiotherapists of Saurashtra region. A
self administered semi structure questionnaire was sent via e-mail to 34
physiotherapists of Saurashtra region. The questionnaire consisted of demographic
information including age and clinical experience; self reports of work related
musculoskeletal injuries, perceived job related risk factors and strategies or responses
that are adopted for prevention were obtained. The data obtained were analyzed using
the Microsoft Excel 2007. The questionnaire was returned by 29 physiotherapists,
giving a response rate of 85%. Low back (35%) followed by neck (25%) and
shoulders (15%) were the most commonly affected region. The risk factors quoted by
most of the respondents were managing large number of patients in a day, adoption of
constant uncomfortable postures and manual therapy techniques.. Further research is
required to build up effective preventive or ergonomic strategies (Neeti and Ilesh
2010).
The study conducted on upper extremity pain and computer use among engineering
graduate students. The objective of this study was to investigate risk factors
associated with persistent or recurrent upper extremity and neck pain among
engineering graduate students. Total 206 graduate students studying Electrical
Engineering and Computer Science at a large public university was included in this
study. Approximately 60% of the respondents reported upper extremity or neck pain
attributed to computer use and reported a mean pain severity score of 4.5 on a scale of
0–10. In a final logistic regression model, female gender, years of computer use, and
hours of computer use per week were found significantly associated with pain
(Schlossberg et al. 2004).

This article describes the protocol of the baseline assessment of the PTC study. A
cross-sectional study will be conducted and will include a representative random
sample of approximately 300 physical therapists employed in Germany. Besides the
wide spectrum of the work-related exposures and complaints as well as diseases,
potential confounders which could bias the association between exposure and
outcome, will be assessed. Consequently, to diminish the influence of confounding,
socio-demographic factors (age, sex), body mass index and lifestyle choices
(smoking, sport activities) will be observed (Girbig et al. 2013).

Many students attending the coaching institutes report to outpatient clinics of multiple
specialties with musculoskeletal disorders (MSD). We carried out a cross-sectional
study of 500 coaching students. Males and females accounted for 63.9% and 36.1%,
respectively. The respondents’ mean age was 18.6 ± 1.06 years; mean body mass
index was 21.4; mean duration of attending classes was 15.6 ± 7.66 months; mean
hours of daily study were 4.78 ± 1.71 hours; mean duration of sitting continuously at
a stretch was 2.2 hours. The overall prevalence of MSD was 87.1%. The mean
frequency of MSD per participant was 2.6. Most participants reported pain in the neck
region and lower back (43%), followed by ankle/foot (36%), followed by upper back
(32%), followed by shoulder (28%); knee, elbow, and wrist/hand were lesser than
20%, while hip/thigh pain was the least common symptom (8%) (Philippa and
Stephen et al 2004).
This study explored the prevalence and academic performance interference (API) of
musculoskeletal symptoms (MS) and investigated the associations of individual and
computer-use-related risk factors with MS among a group of university undergraduate
students. The study involved first application of Student-Specific Cornell
Musculoskeletal Questionnaire (SSCMDQ) as a new tool to collect symptom data
among student population. MS was found to prevail and interfere with ability to
perform academic activities mostly in the neck, upper back and lower back with
prevalence rates of 69.8%, 61.8% and 55.1%, respectively. Among the investigated
factors, being female, non-engineering academic concentration, years of computer
use, daily computer use more than 4 h and experiencing visual discomfort during
computer use were the significant risk factors (Mahmut Eksioglu et at 2017).

This study was done to determine the prevalence of musculoskeletal pain among
madrassa teachers in Karachi. so, a cross sectional study was conducted and
participants were selected using the non-probability sampling technique. A total of
109 madrassa teachers taken part in this research study almost all participants were
male. There were two types of madrassa teachers; one is full time teachers (73.4%)
and part time (26.6%). (58.7%) madrassa teachers were suffering from discomfort
during teaching and 41.3 didn’t feel any discomfort, coming to pain regions 37 said
they had back pain (33.9%), 35 said they had shoulder pain (35%), 37 said they had
knee pain (24.8%) and four said they had heel pain (3.7%) (Fazli Azim et al 2016).

The study aimed to assess work-related musculoskeletal disorders among nursing

students during clinical training. A cross- sectional study design used to achieve this
aim. Convenience sampling technique was used to include all consenting nursing
students from fifth level to eighth level (3rd and 4th year) (n=253) student who were
having clinical training. The study took place at the Faculty of Nursing, Princess
Nourah Bint Abdulrahman University. The first part include demographic data
questions. The second part is a self-reported pain using standardized Nordic
questionnaire for the analysis of musculoskeletal symptoms that will assess different
body parts namely upper limb, lower limb, and trunk sections of the body. The study
illustrated that more than half of students reported pain (71.1%) and ankle or feet
(43.9%) during the last 12 months. Consistent also with students who reported MSD
in the last seven days, 48.2% of them reported lower back problem. There is
significant relationship between number of clinical days (p = 0.05) and MSD, and no
significant relationship between the MSDs and the number of the clinical hours per
day (p =0.973), weight (p = 0.806). The main conclusion drawn from the current
study is that the majority of nursing students are high risk for MSDs due to improper
body mechanics or wrong posture (Amel Ahmed Elsayed et al 2019).
CHAPTER 3 METHODOLOGY

3.1 Study Design

Self-administered questionnaire formed by cross-sectional survey under a quantitative

study design aiming to gather data on prevalence with musculoskeletal pain among
undergraduate physiotherapy students at a selective institution (NITOR).

3.2 Study Area

The study will be conducted National Institute of Traumatology and Orthopedic

Rehabilitation (NITOR) and data also conducted in National Institute of
Traumatology and Orthopedic Rehabilitation (NITOR).

3.3 Time of Study

The duration of study was ten months from march 2020 to january 2021

3.4 Study Population

The study population included undergraduate physiotherapy students who were

studying at National Institute of Traumatology and Orthopedic Rehabilitation
(NITOR).
3.5 Sample Size

Formula of one-sample population was used calculating sample size

Z²pq
n = --------------------
d²
Here,

n =Desired sample size

z =Standard normal deviate usually set at 1.96 which correspondents to 95%

confidence level.

P =Proportion of the target population estimated to have a particular characteristic.

q =1-p

d =Degree of accuracy desire, usually set at 0.05%

Now, required sample size was:

n= z2pq/d2

(1.96)2 x (.749) x (0.115)

=----------------------------------------
(0.05)2

= 132+13 (10% for accuracy of result)

=145

So, n=Desired sample size was =145

Where,

z=Confidence level =95% for this study

p= Prevalence and associated factors of Musculoskeletal pain in undergraduate

medical student is 74.9% (Bruna Xavier Morais et al. 2019)

q= 1-p=0.115%

d =Degree of accuracy desire, usually set at 0.05%

3.6 Inclusion & Exclusion Criteria

Inclusion Criteria includes

Age; 18-24years. (Bruna Xavier Morais et al.2019)

Sex: Both males and females will be included. (Istiak; et al; 2017)

Those who were willing to participate for interview.

Exclusion Criteria includes

Age: less than 18 years and greater than 24 years.

Pregnant female students.

Those who were not interested to participate for interview.

3.7 Sampling Technique

Sample was selected purposively to interview the study population considering the
inclusion and exclusion criteria.

3.8 Data collection instrument/tool

A pretested structured questionnaire.

Visual analog scale (VAS).

Saltin-Grimby physical activity level scale (SGPAL)

3.9 Data collection technique

The study will be conducted at the National Institute of Traumatology and Orthopedic
Rehabilitation (NITOR), Dhaka, Bangladesh. The data collection procedure will be
included by face to face questionnaire interview. Before data collection, the data
collector will be explained the aims and benefits of this study is smooth. Researchers
will be administered the survey predesigned structural questionnaires because
participants may be illiterate. Informed written consent has to take from all
participants.

The questionnaire having variables including Socio-demographics variables,

information related variables , Musculoskeletal pain related variables, and treatment
related variables.

3.10 Data analysis

The collected data was checked thoroughly and strictly for any error or information
missing and then analyzed by using the software named “Statistical Package for
Social Sciences” (SPSS, version-21). Frequency and percentages were calculated for
all variables, while mean and standard deviation for age, BMI, study hours, duration
of computer/laptop/mobile phone usage, duration of sitting time and suffering time.
Variables like Gender, Academic Year, weight category according To BMI, duration
of Study, duration of Computer/Laptop Usage, duration of Sitting, duration of
suffering and transportation, distance between home to institute physical activity
were cross-tabulated against the presence of musculoskeletal pain. A p-value of 0.05
was considered as statistically significant.

3.11 Data Presentation

Data was presented in table and graph (bar and pie chart) so that the variables could
be visualized at a glance.

3.12 Ethical Considerations

The protocol initially approved by the ethical review committee of National Institute
of Traumatology and Orthopedic Rehabilitation (NITOR). International ethical
guidelines for biomedical research involving human subjects followed throughout the
study. Written informed consent was taken at the time of enrolment of the
participants. In consent form, the title, aim of the study, data collection procedures,
required time for date collection, confidentiality and anticipated use of the result of
the study was written in plain and English language and it was brief to each
participant before date collection. All participants were informed that they were free
to leave or to refuse to take part in this study at any time. The personal information of
the participants was kept totally confidential. The information given by the
participants were analyzed using code number so that nobody can identify them.