|Year : 2017 | Volume
| Issue : 2 | Page : 53-57
Musculoskeletal health, quality of life, and related risk factors among physiotherapy students
Dibyendunarayan Dhrubaprasad Bid, Thangamani Ramalingam Alagappan, Hetal P Dhanani, Parita S Goyani, Zenish S Narielwala
Department of Orthopedic Physiotherapy, Sarvajanik College of Physiotherapy, Surat, Gujarat, India
|Date of Submission||13-Aug-2017|
|Date of Acceptance||29-Sep-2017|
|Date of Web Publication||19-Jan-2018|
Dr. Dibyendunarayan Dhrubaprasad Bid
Sarvajanik College of Physiotherapy, Rampura, Surat - 395 003, Gujarat
Source of Support: None, Conflict of Interest: None
BACKGROUND: Musculoskeletal injuries are common among physiotherapy students and these are increasing nowadays. In the recent years, there has been an increase in musculoskeletal complaints, work-related stress, and reduced quality of life among physiotherapy students.
OBJECTIVES: This study was conducted to identify the prevalence and associated risk factors of musculoskeletal health and health-related quality of life of physiotherapy students.
METHODS: 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.
RESULTS: Most of the students had experienced some kind of a musculoskeletal pain in the past 6 months. On comparing 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%).
CONCLUSION: Musculoskeletal pain is prevalent among physiotherapy students, and mostly, back, neck, and lower leg pains are very common among them. Moreover, these pains reduce the physical and mental health of the students and also affect their life satisfaction.
Keywords: Cornell Musculoskeletal Discomfort Questionnaire, musculoskeletal health, quality of life
|How to cite this article:|
Bid DD, Alagappan TR, Dhanani HP, Goyani PS, Narielwala ZS. Musculoskeletal health, quality of life, and related risk factors among physiotherapy students. Physiother - J Indian Assoc Physiother 2017;11:53-7
|How to cite this URL:|
Bid DD, Alagappan TR, Dhanani HP, Goyani PS, Narielwala ZS. Musculoskeletal health, quality of life, and related risk factors among physiotherapy students. Physiother - J Indian Assoc Physiother [serial online] 2017 [cited 2018 Apr 20];11:53-7. Available from: http://www.pjiap.org/text.asp?2017/11/2/53/223701
| Introduction|| |
Musculoskeletal injuries are characterized by the presence of discomfort, disability, or persistent pain in the joint, muscles, tendons, and other soft tissues, caused or aggravated by repeated movement, and prolong awkward or forced body posture. The prevalence of work-related musculoskeletal injuries is significant in many professions, and this has had a marked impact on professionals.
The etiology and risk factors associated with many of these occupational injuries are not well understood. Risk factors that have been previously identified include a history of previous injury, severity of injury, occupations that involve the maintenance of awkward postures and movements over a prolonged time interval, occupations that require repetitive and forceful tasks, and occupations requiring high levels of activity.,,,
Most health-care professionals, including nurses, dentists/dental hygienists, as well as physiotherapists, are engaged in similar labor-intensive and physically demanding work activities. Typical physiotherapy practices involve repeated lifting, bending, twisting, reaching, and performing manual therapy. The manual procedures often involve forward flexion, lateral flexion, and rotation. These awkward postures, over a prolonged period, present increased loads not only on the lumbar spine but also on other body parts.
Work-related physical stresses to the hand, wrist, neck, and shoulder lead to injuries and have been identified through a number of cross-sectional epidemiologic studies. For example, a number of studies have reported the prevalence of low back pain (LBP) among nurses and nurse aides , and the prevalence of low and upper back, neck, hand, wrist, and thumb pains among physiotherapists.,
The purpose of this study was (1) to find the prevalence of musculoskeletal injuries and the work-related risk factors contributing musculoskeletal injuries, (2) to find the relationship between quality of life, physical activity level, and satisfaction, and (3) to find the contribution of work-related musculoskeletal injuries and risk factors to quality of life, physical activity level, and students' satisfaction.
Alshagga et al. stated that musculoskeletal injuries among medical students were relatively high and recommended in-depth study of ergonomics and measures to prevent musculoskeletal injuries due to factors related to medical school.
Thornton et al. found that dental students were no exception. The third-year dental students reported the highest level of musculoskeletal symptoms with the prevalence of pain in the neck, shoulder, and lower back. One study showed prevalence rates of musculoskeletal complaints among X-ray technology students also high.
Gharib, Nevein and Nashwa stated that mechanical neck pain was common among Taif University female students and more pain was common among students undergoing clinical training.
| Methods|| |
It is a cross-sectional study. All the students of Bachelor of Physiotherapy from three conveniently selected colleges of Surat, Gujarat, India, were taken into the study. Data were collected from 457 physiotherapy students, comprising of 22 male and 435 female physiotherapy students studying in these three colleges. Students who have completed 17 years of age and given consent to participate in the study were included in the study. The following questionnaires were used for data collection:
- Cornell Musculoskeletal Discomfort Questionnaire 
- International Physical Activity Level Questionnaire 
- Health-Related Quality of Life (Short-Form [SF-12])
- Brief Multidimensional Students' Life Satisfaction Scale.
The data were expressed in frequencies for categorical variables and mean and standard deviation for continuous variables. The prevalence of musculoskeletal injuries and the work-related risk factors contributing musculoskeletal injuries which were presented descriptively using percentage relationship between variables was analyzed using Pearson's bivariate correlation test. Moreover, a multivariate regression analysis was done to find the relationship between variables, and the proportion of one variable on another was calculated using a stepwise regression analysis. Data were analyzed using SPSS version 20.0 (IBM, Armonk, NY, USA) for Windows at 95% confidence interval.
| Results|| |
The present study included 22 males (4.8%) and 435 females (95.2%) with the mean age 19.082 ± 1.248, weight 52.89 ± 11.10, height 1.567 ± 0.065, and body mass index 21.706 ± 4.607. [Figure 1] shows the demographical distribution of the participants. [Table 1] shows the prevalence of work-related risk factors of the participants.
[Figure 2] shows the prevalence of musculoskeletal injuries among the participants. [Table 2] shows relationship between physical, mental score of quality of life SF-12, students' life satisfaction, and physical activity score. The physical and mental components of quality of life were negatively related (r = −0.166), and students' satisfaction was positively related to a mental component score of quality of life (r = 0.263).
|Table 2: Correlation among Short-Form-12, Brief Multidimensional Students' Life Satisfaction Scale, and International Physical Activity Level Questionnaire (n=457)|
Click here to view
The significant relationship between the work-related musculoskeletal injuries and risk factors to quality of life, physical activity level, and students' satisfaction of physiotherapy students was done using a multivariate analysis. On the basis of multivariate analysis, the variables showed significant positive or negative relationship which were entered in a stepwise regression analysis to find and predict the variability of the contribution of each work-related musculoskeletal injury and risk factors to quality of life, physical activity level, and students' satisfaction. [Table 3] shows the variance contribution of each significant variable.
| Discussion|| |
The findings of the study revealed a high prevalence (29.1%) of lower back problems followed by the right lower leg (13.8%), neck (13.7%), right shoulder (11.8%), and left lower leg (11.2%) pain problems among the physiotherapy students. These findings are in agreement with Habib et al., who reported a higher prevalence among females than males for all ages for several types of musculoskeletal disorders. Nyland and Grimmer  found that spending more than 20 h in the past month, “sitting looking down” was significantly associated with 1-month LBP prevalence. Schlossberg et al. noted that the high prevalence of upper extremity pain reported by graduate students suggests a public health need to identify interventions that will reduce symptom severity and prevent impairment.
There was a strong positive relationship between the mental component score of health-related quality of life (HRQoL) and students' satisfaction level. However, it had a negative relationship to physical component score. In this study, the musculoskeletal problems of shoulder, upper and lower back, and hip and buttock region along with personal risk factor standing duration at college clinic showed negative relationship to the physical component score of HRQoL, and the problems of neck, upper and lower back, right forearm, and wrist and right lower leg negatively influenced the mental component score of HRQoL as the personal risk factor standing duration at college. However, the eating habits and year of study positively controlled the mental score. Moreover, musculoskeletal problems of the lower back, shoulder region, hip and buttocks, and upper back region contributed 15.7% variance in the physical component scores of HRQoL along with the personal risk factor standing duration at college, and musculoskeletal problems of the right knee, lower back, right wrist, left forearm, and neck region contributed 10.8% variance in the mental component score of HRQoL. Paananen et al. also noticed that the number of involved sites of self-reported musculoskeletal pain was associated with the level of reduction in HRQoL among young adults.
The musculoskeletal health factors such as problems of the right forearm and knee region showed the negative contribution to students' satisfaction and personal risk factors such as sitting at home and eating habits showed a positive contribution to physiotherapy students' life satisfaction. Moreover, we found that the musculoskeletal problems of the right knee region, sitting at home, and eating habit of full lunch showed 7.2% of the variance in students' satisfaction. It is important to emphasize that the great majority of students had mild symptoms and that only a small percentage suffered moderate or severe pain.
The personal risk factors such as duration of sitting, standing at college and clinic, duration of sleep, exercise frequency per week, and furniture comfort at college showed negative influence on the physical activity levels of physiotherapy students.
| Conclusion|| |
Musculoskeletal pain is prevalent among physiotherapy students, and mostly, back, neck, and lower leg pains are very common among them. Moreover, these pain issues are influencing their physical and mental health of the students and affect their life satisfaction. At this juncture, it is very important to note the personal risk factors and its contribution to the health of physiotherapy students during their study period. This study can be extended to all other allied health sciences students, medical, arts, commerce, science, or any branch of students.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Pollack R. Dental office ergonomics: How to reduce stress factors and increase efficiency. J Can Dent Assoc 1996;62:508-10.
Silverstein B, Viikari-Juntura E, Kalat J. Use of a prevention index to identify industries at high risk for work-related musculoskeletal disorders of the neck, back, and upper extremity in Washington State, 1990-1998. Am J Ind Med 2002;41:149-69.
Anton D, Rosecrance J, Merlino L, Cook T. Prevalence of musculoskeletal symptoms and carpal tunnel syndrome among dental hygienists. Am J Ind Med 2002;42:248-57.
Werner RA, Franzblau A, Gell N, Ulin SS, Armstrong TJ. A longitudinal study of industrial and clerical workers: Predictors of upper extremity tendonitis. J Occup Rehabil 2005;15:37-46.
Tanaka S, Petersen M, Cameron L. Prevalence and risk factors of tendinitis and related disorders of the distal upper extremity among U.S. workers: Comparison to carpal tunnel syndrome. Am J Ind Med 2001;39:328-35.
Holness DL, Beaton D, House RA. Prevalence of upper extremity symptoms and possible risk factors in workers handling paper currency. Occup Med (Lond) 1998;48:231-6.
Chiou WK, Wong MK, Lee YH. Epidemiology of low back pain in Chinese nurses. Int J Nurs Stud 1994;31:361-8.
Hollingdale R, Warin J. Back pain in nursing and associated factors: A study. Nurs Stand 1997;11:35-8.
Bork BE, Cook TM, Rosecrance JC, Engelhardt KA, Thomason ME, Wauford IJ, et al.
Work-related musculoskeletal disorders among physical therapists. Phys Ther 1996;76:827-35.
Cromie JE, Robertson VJ, Best MO. Work-related musculoskeletal disorders in physical therapists: Prevalence, severity, risks, and responses. Phys Ther 2000;80:336-51.
Alshagga MA, Nimer AR, Yan LP, Ibrahim IA, Al-Ghamdi SS, Radman Al-Dubai SA, et al.
Prevalence and factors associated with neck, shoulder and low back pains among medical students in a Malaysian Medical College. BMC Res Notes 2013;6:244.
Thornton LJ, Barr AE, Stuart-Buttle C, Gaughan JP, Wilson ER, Jackson AD, et al.
Perceived musculoskeletal symptoms among dental students in the clinic work environment. Ergonomics 2008;51:573-86.
Lorusso A, Vimercati L, L'abbate N. Musculoskeletal complaints among Italian X-ray technology students: A cross-sectional questionnaire survey. BMC Res Notes 2010;3:114.
Nevein MM, Nashwa SH. Prevalence of mechanical pain in taif university female students: A survey study. J Am Sci 2013;9:347-54.
Erdinc O, Hot K, Ozkaya M. Turkish version of the cornell musculoskeletal discomfort questionnaire: Cross-cultural adaptation and validation. Work 2011;39:251-60.
Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, et al.
International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003;35:1381-95.
Habib RR, Hamdan M, Nuwayhid I, Odaymat F, Campbell OM. Musculoskeletal disorders among full-time homemakers in poor communities. Women Health 2005;42:1-4.
Nyland LJ, Grimmer KA. Is undergraduate physiotherapy study a risk factor for low back pain? A prevalence study of LBP in physiotherapy students. BMC Musculoskelet Disord 2003;4:22.
Schlossberg EB, Morrow S, Llosa AE, Mamary E, Dietrich P, Rempel DM, et al.
Upper extremity pain and computer use among engineering graduate students. Am J Ind Med 2004;46:297-303.
Paananen M, Taimela S, Auvinen J, Tammelin T, Zitting P, Karppinen J, et al.
Impact of self-reported musculoskeletal pain on health-related quality of life among young adults. Pain Med 2011;12:9-17.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]