INTRODUCTION:

One of the principles laid down by the International Council for Nurses (ICN, 2000) is that the fundamental responsibility of the nurse is to alleviate suffering. Failure to comfort the person is therefore a failure to fulfill the professional commitment to nursing. Pain is an abstract concept and it results from harmful stimulus which signals current or impending tissue damage, with a pattern of responses, which operate to protect the organism from harm. Pain is also a personal private sensation of hurt. Head is heavy and balanced on a narrow support made up of seven bones called vertebrae. Each bone has 6 degrees of freedom and 6 movements. The vertebrae are separated from each other by discs, stabilized by joints and ligaments and moved by muscles. Because the neck is so mobile, it is easily damaged.

Neck pain is defined as pain experienced from the base of the skull (occiput) to the upper part of the back and extending laterally to the outer and superior bounds of the shoulder blade (scapula). Work associated neck pain is a common problem for office computer workers, especially since an upward trend for computers use can be seen each year. Today, a large number of people use computers for work and recreation, taking up a great deal of their time each day (Green, 2008). Since the advent of the computer, office workers have become less active. Many people work for hours craning their heads forward to look at the computer screen and become so engrossed in their work that they forget to move or change position (www.physio.com, 2004).

Neck pain can impact on the ability to perform normal daily activities and the resultant treatment costs and work loss contributes to a substantial economic burden for both individual and society (Eurspane, 2009). Neck pain affects approximately 67% of individuals at some point of time in their life. Regarding the 12-month prevalence of neck pain, previous research studies have reported it to range between 30% and 50%. It is not life threatening, but it can cause a sense of being unwell and substantial level of disability due to pain and neck stiffness. This disability can affect the physical functioning of the patients, leading to sickness behavior and activity restrictions. In the general population, the 12-month prevalence of activity-limiting pain has been reported to vary from 1.7% to 11.5%.

A common cause of neck pain is muscle strain or tension. Usually, everyday activities are to blame. Such activities include bending over a desk for hours, having poor posture while watching TV or reading, placing your computer monitor too high or too low, sleeping in an uncomfortable position, or twisting and turning the neck in a jarring manner while exercising (Medline plus. com). Working in a sitting position will lead to a continuous static load on the neck muscles, especially if the design of the workplace is not suitable for the worker. Static loading of the neck muscles will induce biomechanical strain, an increased muscle tone which may in the long term lead to the development of neck pain (Ariens et al., 2001). Work-related neck pain is becoming more common these days with jobs becoming more computer-based. Jobs that may lead to chronic neck pain are those that require repetitive work, typically on computer keyboards. These jobs are primarily in administrative offices, post offices, and banks. In these positions, there is overuse and misuse of the neck and shoulder muscles (Patrick, 2012).

There are lots of therapies available for work related neck pain (WRNP). To quote a few Restriction of movement, application of heat or cold, exercise, medication, surgery and ergonomic teaching (www.ccohs.ca). Neck exercises and ergonomic teaching has proved to be effective in reducing neck pain and improved functional ability. Nurses indeed play a very important role in preventive, promotive and curative health aspects. According to different studies published in the journal Spine, individuals who will have neck pain sometime in their lives range from 22 per cent to 70 per cent. Increasing incidence of neck pain has been reported and one of the most common reasons for this is faulty posture. Prevalence of neck pain increases with age and is most common in women in their fifties. Patients with neck pain frequently visit physical therapy clinics. Mechanical neck pain secondary to faulty postures make up approximately 15 per cent of a physical therapy (The Hindu, 2007). Patient with neck pain represent the second largest population seeking manipulation or manual therapy (Muye et al. 2003).

Silvian (2011) conducted a study on anticedental of work related musculoskeletal disorders in software professionals in Saveetha University Chennai. Adult musculoskeletal disorders (MSD) such as neck and low back pain have been widely reported as being of significant health and economic concern due to increased globalization and industrial advancements. Neck pain is found to be the most prevalent pain. Posture, body fatigue, hours of computer usage and lack of ergonomic knowledge etc. are found to be causal factors determining work related MSD. A total of 355 software Professionals were studied and the research draws conclusion that it is important to have awareness about the changing world and the increased need for ergonomics interventions in today's work places. Lot of therapies and treatments are available for work related neck pain. Previous researchers (Garabet et al., (2012), Bleecker et al., (2011), Zebis et al, (2011) and Hansen et al, (2010)) have proved that neck exercises and ergonomic teaching are effective on reducing neck pain and improving functional ability.

Due to Technological advancement there is an increased use of computers which results in work related neck pain. But the people are unaware that the improper working environment is the reason for that pain. So the nurses play a major role in improving health status of people with work related neck pain. Prevention must aim at eliminating the repetitiveness of the work by proper job design. Where this is not possible, preventive strategies such as good workplace layout, tool and equipment design, and proper work practices should be considered. Early recognition of these disorders is very important because medical treatments are unlikely to be effective once these injuries become long standing. In order to provide proper cost-effective public health measure and essential curative services for the appropriate treatment of neck pain, nurses are trained to provide exercises in hospital, community and various setups. Nurses should technically be competent and socially responsible for promoting health and improve the quality of life.

OBJECTIVES:

1. To assess the level of neck pain and functional limitation among sedentary office workers in experimental group before and after implementing selected nursing intervention.

2. To assess the pre and posttest level of neck pain and functional limitation among sedentary office workers in control group.

3. To evaluate the effectiveness of selected nursing interventions on neck pain and functional limitation among sedentary office workers with work related neck pain.

4. To find out the relationship between neck pain and functional limitation among sedentary office workers with work related neck pain

5. To find out the association between the level of neck pain with selected demographic variables , selected clinical variables and selected ergonomic variables .

6. To find out the association between the level of functional limitation of experimental group with selected demographic variables , selected clinical variables , and selected ergonomic variables .

HYPOTHESIS:

All the hypothesis were tested at 0.05 level of significance.

H1:

The mean posttest neck pain score of experimental group who underwent selected nursing interventions will be significantly lower than their mean pretest score.

H2:

The mean post test neck pain score of experimental group who underwent selected nursing interventions will be significantly lower than mean posttest neck pain score of control group.

H3:

The mean post test functional limitation score of experimental group who underwent selected nursing interventions will be significantly lower than mean pretest functional limitation score of control group.

H4:

The mean posttest functional limitation score of experimental group who underwent selected nursing intervention will be significantly lower than mean posttest functional limitation of the control group score.

H5:

There will be a significant relationship between neck pain and functional limitation among sedentary office workers with work related neck pain.

H6:

There will be a significant association between mean posttest neck pain score of the experimental group with the selected demographic variables ,selected clinical variables,and selected ergonomic variables

H7:

There will be a significant association between the mean posttest functional limitation scores the experimental group with selected demographic variables , selected clinical variables and selected ergonomic variables.

CONCEPTUAL FRAME WORK:

This study is based upon Wiedenbach’s helping art of clinical nursing theory. Wiedenbach first published her ideas in 1964 in clinical nursing. Wiedenbach views nursing as an art of goal directed care. Factual and speculative knowledge judgement, and skills are necessary for effective practice. Wiedenbach’s vision of nursing practice closely parallels assessment, implementation, and evaluation steps of nursing process. According to Wiedenbach, nursing practice consists of identifying a patient’s need for help, ministering the needed help and validating that the need for help was met.

MATERIALS AND METHODS:

RESEARCH APPROACH:

Research approach consists of two phases:

Phase I: Survey approach

Phase II: Experimental approach

RESEARCH DESIGN:

Quasi experimental design with non-equivalent pre-test and post-test control group design was adopted for this study.

Quasi experimental design with non- equivalent pretest and posttest control group

design:

It involves two groups of participants, from whom outcome data are collected before and after implementing an intervention.

The design was represented as follows:

GROUP	PRE TEST	INTER VENTION	POST TEST
GROUP	PRE TEST	INTER VENTION	15^th day	30^th day
Experimental group	O₁	x	O₂	O₃
Control group	O₁	-	O₂	O₃

O₁ – Pretest assessment of neck pain and functional limitation

X – Intervention (neck exercise and teaching on ergonomics)

O₂and O₃ – Post test assessment of neckpain and functional limitation

VARIABLES:

Dependent Variable:

Neck pain and functional limitation

Independent variable:

Selected nursing interventions (neck exercises, teaching on ergonomics).

SETTINGS:

The study was conducted in selected Banks, computer centres, post office and IT centre at Madurai. The researcher has selected 20 samples from the bank and 10 samples from computer centre for experimental group and for control group 11 samples from bank,3 from post office and 16 from computer Centre.

STUDY POPULATION:

The target population for the study were sedentary office workers with work related neck pain at selected settings of Madurai.

SAMPLES:

Sedentary office workers with work related neck pain who fulfilled the inclusion criteria.

SAMPLE SIZE:

The total sample size was 60, out of which 30 samples were assigned in the experimental group and 30 samples were assigned into the control group.

SAMPLING TECHNIQUE:

Convenience sampling technique was used to select the settings and the samples.

CRITERIA FOR SAMPLE SELECTION:

The samples were selected based on the following criteria.

INCLUSION CRITERIA:

1. Nonspecific neck pain which last for >15 days and not associated with any pathological condition

2. Neck pain more prominent than other pain in the spine

3. Intellectual and physical ability to participate in the study.

4. Who were willing to participate in the study.

EXCLUSION CRITERIA:

1 Cervical pain related to malignancy

2 Cervical pain due to an accident

3 Inflammatory joint disorders (Disc prolapse, Arthritis, Ankylosing spondylitis)

4 Pervious spine surgery

5 Protrusion/ prolapse of a spinal disk

6 Those were performing neck exercises continuously

7 Pregnancy

8 Severe chronic or acute disease interfering with therapy attendance.

RESEARCH TOOL AND TECHNIQUE:

The tools were divided into 6 sections.

Section A : Survey questionnaire

Section B : Socio demographic variables

Section C : Clinical variables

Section D : Ergonomic variables

Section E : Numerical Pain Rating Scale .

Section F : Modified Neck Disability Index

TESTING OF THE TOOL:

Section A:

This first section was a semi structured questionnaire which consisted of 5 questions. This questionnaire was used to identify samples with WRNP.

Section B:

This section consisted of socio demographic variables such as age, sex, marital status, education level, occupation, religion, income, travel distance and mode of travel.

Section C:

This section consisted of clinical variables such as type of pain, nature of pain, onset of pain, intensity of pain increases and remedies.

Section D:

This section consisted of ergonomic variables such as ventilation in the office, type of chair, posture, computer put on a special desk, keyboard position, computer screen position, number of hours of computer uses, taking rest period within work time, practices some exercises to relax body muscles.

Section E:

This section consisted of Numerical Pain Rating Scale. The 0 to 10 pain scale is commonly and successful used with hospitalized and nursing home patients. This scale asks the person in pain to assign a number from zero to ten according to the severity of their pain. In this scale, 0 means no pain and 10 means excruciating pain. The patient score obtained was interpreted as follows:

0 – No pain

1-3 - Mild pain

4-5 - Moderate pain

6-9 - Severe pain

10 - Excruciating pain

Section F:

This section consisted of Modified Neck Disability Index (MNDI), first developed in 1991 by Howard Vernon and Mior. The MNDI has become a standard instrument for measuring self-reported disability due to neck pain and is used by clinician and researchers alike. This tool consisted of 9 items, each 9 items are scored from 0-5.The maximum score is therefore 45.The 9 items are as follows:

1 Personal care ( dressing and washing)

2 Lifting

3 Reading

4 Concentration

5 Headache

6 Work

7 Travelling

8 Sleeping

9 Recreation

Interpretation:

0 – 4 - No disability

5 – 14 - Mild disability

15 – 24 - Moderate disability

25 – 34 - Severe disability

35 – 45 - Completely disabled

VALIDITY:

Validity of the tool and procedure was established by giving the content and tool to 5 experts in the field of nursing, orthopedics and physiotherapy. Modifications were done according to their recommendations.

RELIABILITY:

The reliability of the tool (Modified Neck Disability Index) was determined by split half method. According to Karl Pearson correlation coefficient the reliability of the tool was 0.83 which was highly reliable. Numerical Pain Rating Scale demonstrated a good reliability of 0.9 on the inter- rater method.

INTERVENTION:

The intervention for the present study was framed after wide literature review and expert opinion. Selected nursing intervention for the present study consisted of Structured teaching on Ergonomics, Demonstration of neck exercises which includes neck muscle stretching and strengthening exercises.

DATA ANALYSIS:

Data analysis was done according to the objectives of the study. Both descriptive and inferential statistics were used.

1. Analysis of demographic variables, clinical variables, ergonomic variables was done by frequency percentage.

2. Comparison of pretest and posttest results of selected variables was done by using paired ‘t’ test, comparison between the two groups was done by independent ‘t’ test.

MAJOR FINDINGS OF THE STUDY:

In the experimental group 66.6% of the samples had moderate level of neck pain and 6.6% of the samples had mild neck pain. After intervention on the 15^th day posttest showed that 18(60%) of the samples had moderate neck pain and 10(33.3%) had mild neck pain On 30th day 73.3% of the samples had mild neck pain and 13.3% samples reported no neck pain.

· Majority of samples 21 (70%) in the experimental group had moderate level of functional limitation and 6(20%) had mild level of functional limitation and 3(10%) had severe level of functional limitation. On15th day posttest 16(53.3%) had moderate level of functional limitation whereas on 30th day posttest majority of the samples 86.6% had mild functional limitation and none had severe functional limitations.

· Neck exercises and teaching on ergonomics proved effective in reducing neck pain and improving functional limitation.

· Comparison of 15th day posttest neck pain scores – ‘t’ value (3.3), P(0.01)

· Comparison of 30th day posttest neck pain scores – ‘t’ value (8), P(0.001)

· Comparison of 15th day posttest level of functional limitation – ‘t’ value (6), P(0.001)

· Comparison of 30th day posttest level of functional limitation – ‘t’ value (11.7), P(0.001)

· Neck pain was positively related to functional limitation among sedentary office workers with work related neck pain (r =0.7,p (0.001))

· Among the clinical variables there was an association between the onset of pain with posttest level of functional limitation. [χ2(9.1),P (0.05)].

· There was an association between posttest level of neck pain and selected ergonomic variables like type of chair [χ2(12.52); P (0.01)] ,Posture [χ2 (6.54); P (0.05)], computer put on special desk [χ2 (7.02) ; P (0.05)], computer screen position [χ2(14.85) ; P (0.001)], number of hours of computer use [χ2 (8.2); P (0.05)], practices some exercises to relax body muscles in between work [χ2 (11.17),P (0.05) ].

· There was an association between the posttest level functional limitation of experimental group with selected ergonomic variables like ventilation in the office [χ2(6.72);P (0.05) ], posture [χ2 (12.17); P(0.01)], number of hours of computer use [χ2(8.12); P (0.05.)].

DISCUSSION:

Neck pain is a common problem for computer workers. It has been reported that the prevalence of neck pain among office workers is much higher than the general population (Korhonen, 2003). Today, a large number of people own computers for work and recreation, taking up a great deal of their time each day. While part of the increased image is cultural adaptation to the convenience of new technology, over the past decades an industrial shift to a service oriented economy has occurred, bringing with it more sedentary jobs. Compounding this shift, the downsizing of the number of employees on a means to minimize nurses in corporate profits often results in an increase in productivity for those who remain with a company. Concomitant with downsizing, an increase in sick leave used for musculoskeletal disorders has been noted (J Can Chiropt Assoc, 2008).Extended work with computers can lead to muscular fatigue and discomfort usually in the back, arms, shoulders and neck, As well ,if the computer is used for prolonged periods in inconvenient postures also lead to musculo skeletal disorders. This risk increases as the intensity of computer work increases (www.orosha. com). Neck exercises and ergonomic teaching has proved effective in reducing the neck pain and improving functional limitation of the sedentary office workers with work related neck pain which is evident in the following findings.

· Comparison of 15th day post test neck pain scores – ‘t’ value (3.3), P (0.01)

· Comparison of 30th day post test neck pain scores – ‘t’ value (8), P (0.001)

· Comparison of 15th day post test level of functional limitation – ‘t’ value (6), P (0.001)

· Comparison of 30th day post test level of functional limitation – ‘t’ value (11.7),P (0.001)

These findings configured with the following studies.

· Garabet et al, (2012) – Ergonomic trained participants in the experimental group had minimal musculoskletal discomfort.

· Bleecker et al, (2011) – Improvement occurred in neck pain after the following ergonomic intervention.

· Zebis et al, (2011) – High intensity strength training followed by 85% of participants resulted in significant reduction of neck pain (-0.6,9.5% ,CI- 1.0 to - 0.1).

· Muhmud et al, (2011) – Ergonomic training resulted in the largest reduction in the percentage of musculo skeletal disorder was in the neck region (-42.2%, 95% CI- 60.0 – 24.4).

· Hansen et al, (2010) – Physical exercise for office workers caused better effects in relieving musculoskeletal pain (P < 0.01,-0.05).

· Anderson et al, (2008) – Specific strength training had high clinical relevance and led to marked prolonged relief in neck muscle pain as evidenced by (79%, P<0.001) in the worst, VAS pain seen.

The major strengths of the present study is that the samples included were sedentary workers from different sites like banks, computer centers and post offices. The study did not stop with ergonomic assessment but included a teaching ergonomics as part of the intervention. Yet another major strength is that the direct supervision of the performance of exercise by the researcher. Limitations of the study are that it was a quasi-experimental design since the samples were not randomly allotted and long term follow up was not feasible, but a few samples whom the researcher met after 3 months of the study verbalized that they are still continuing the study and are having a pain free life.

CONCLUSION:

Work-related musculoskeletal disorders are widespread among computer users and costly to the health care system. Poor workstation setup and worker postures contribute to upper extremity and neck symptoms among computer users. Ergonomic interventions such as work risk analysis and workstation modifications along with physical therapy can improve workers symptoms. However, ergonomic interventions do not appear to be a common component of traditional physical therapy treatment (Fabrizio (2009).

The Following Conclusions are drawn from the study:

1. Work related neck pain is on the rise among sedentary office workers especially computer users.

2. Regular neck exercises and teaching on ergonomics was found to be effective in reducing neck pain.

3. There was an association between the onset of pain with posttest level of functional limitation.

4. Neck pain was positively related with functional limitation among sedentary office workers with work related neck pain.

IMPLICATIONS:

The findings of the study have several implications in the following fields.

Implications for Nursing Practice:

1. One of the scopes of nursing in occupational nursing. Since work related neck pain is on the rise, assessment of work related neck pain along with ergonomic assessment becomes part of nursing care for occupational nurses.

2. Nurses are trained to assume different roles in preventive, promotive and curative aspects of nursing care and to work in different health care settings like schools, industries etc. Thus ergonomic assessment and ergonomic teaching becomes mandatory and nurses need to be trained in both assessment as well as teaching.

Implications for Nursing Education:

The undergraduate and postgraduate nursing students are taught about occupational diseases. Because of the technological advancements, people have become more sedentary there is an increase in work related neck pain. This holds true for the nursing community also. Work related neck pain, if unattended, can be severely debilitating .Thus ergonomic assessment along with ergonomic teaching should be given due weight age in nursing curriculum which will be benefiting the nursing community themselves along with the general population.

Implications for Nursing Research:

The findings of the present study have added knowledge to the already existing literature and the implications for the nursing research are given in the form of recommendation. This study can prove to be a baseline for future studies to build upon and motivate other researchers to conduct further studies.

Implications for Nursing Administration:

Nurse administrators can organize continuing nursing education on work related neck pain, ergonomic assessment, ergonomic teaching and exercises to prevent work related musculoskeletal problems inclusive of neck pain which will benefit the nurses personally and the patients. Nurse administrator can prepare procedure manual and protocol regarding neck exercises and teaching on ergonomics. The administrators can encourage the nurses to use different safe, cost-effective, interventions to reduce work related neck pain and functional limitation.

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Received on 05.08.2015 Modified on 24.08.2015

Int. J. Adv. Nur. Management 3(4): Oct. - Dec. 2015; Page 335-340

DOI: 10.5958/2454-2652.2015.00028.1