|Year : 2020 | Volume
| Issue : 2 | Page : 93-97
Low back ache, disability, and quality of life in jewelry workers in Bhayandar and Mira road area of Mumbai: An observational study
Vishakha Patil1, Shweta Rathod1, Rajashree Naik1, Avinash de Sousa2
1 Department of Physiotherapy, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
2 Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
|Date of Submission||22-Jun-2019|
|Date of Acceptance||22-Jul-2020|
|Date of Web Publication||31-Dec-2020|
Dr. Avinash de Sousa
Carmel 18, St. Francis Road, Off SV Road, Santacruz West, Mumbai - 400 054, Maharashtra
Source of Support: None, Conflict of Interest: None
BACKGROUND: Low back pain (LBP) is a common condition in clinical practice and may be seen in certain occupations due to awkward sitting postures. Studies have revealed LBP as a common problem affecting the quality of life (QOL) and causing disability in certain occupational settings.
OBJECTIVE: The current study was aimed to study the prevalence of LBP, disability, and QOL in jewelry workers. Disability and QOL would be compared across genders.
METHODOLOGY: One hundred and ninety-five jewelry workers were the participants of the study and were assessed on certain sociodemographic parameters, and the Nordic Musculoskeletal Pain Questionnaire, Modified Oswestry Low Back Pain Disability Questionnaire, and the WHO QOL Questionnaire brief version were administered to those with LBP. The data were statistically analyzed and presented.
RESULTS: One hundred and ninety-five individuals participated in the study. Eighty-two (42.05%) reported the symptom of low back ache. Thirty-one males (n = 68) (45.58%) and 51 females (n = 127) (40.15%) reported the symptom. On the MOLBPQ questionnaire, the disability levels between genders showed no significant difference statistically. A mild negative correlation for the psychological domain of QOL and disability (rho = 0.49, P = 0.001) was obtained.
CONCLUSIONS: LBP is a commonly occurring problem in jewelry workers and must be addressed. Larger studies are needed to validate and corroborate the findings of the current study.
Keywords: Disability, jewelry workers, low back pain, musculoskeletal pain, quality of life, WHO quality of life-BREF
|How to cite this article:|
Patil V, Rathod S, Naik R, de Sousa A. Low back ache, disability, and quality of life in jewelry workers in Bhayandar and Mira road area of Mumbai: An observational study. Physiother - J Indian Assoc Physiother 2020;14:93-7
|How to cite this URL:|
Patil V, Rathod S, Naik R, de Sousa A. Low back ache, disability, and quality of life in jewelry workers in Bhayandar and Mira road area of Mumbai: An observational study. Physiother - J Indian Assoc Physiother [serial online] 2020 [cited 2021 Oct 18];14:93-7. Available from: https://www.pjiap.org/text.asp?2020/14/2/93/305836
| Introduction|| |
Low back pain (LBP) is an important public health problem in industrial countries and remains the leading cause of disability in persons younger than 45 years old. LBP is defined as, “Pain, muscle tension or stiffness localized below the costal margin and above the inferior gluteal fold with or without radicular pain”. It may be classified as acute LBP, if the pain is <6 weeks old and chronic LBP, if it persists for 12 weeks or more. The jewelry industry is one of the widespread small scale industries in Mumbai where the jewelry workers work for a prolonged period in sitting position. Due to this posture, the weight of the head, arm, and trunk is supported on the ischial tuberosities and adjacent soft tissues along with the reduced physical activity that decreases myofascial flexibility., The lack of joint mobility and fatigue of spinal extensor muscles impairs the alignment of the spine, thus compromising the stability of the back. The shortening of hamstring and iliopsoas muscles increases lumbar lordosis which, in turn, increases the spinal and intervertebral disc load. Prolonged sitting alters the normal curvature of the spine, causing more pressure on the discs which, in turn, causes compression of the discs causing static load resulting in LBP and different types of musculoskeletal disorders.
A study on the prevalence of musculoskeletal discomfort among the workers engaged in jewelry manufacturing found that the prevalence of musculoskeletal disorders among the workers engaged in jewelry manufacturing was found to be specific to the occupation. A rural housewives study from Kanpur revealed a high prevalence (83%) of LBP among the 301 housewives that participated in the study indicating a need for better health-care measures to enhance education about good posture, ergonomic measure, health scheme, health awareness, and activity pacing that could help rural housewives. Research among handloom weavers in West Bengal found that 68% of the participants reported suffering from LBP, making it the most prevalent disorder in the sample with majority of the sample having moderate disability. A positive association between the intensity of LBP years of work experience was obtained. Similar studies in 100 goldsmith workers in the Pimpri-Chinchwad area of Pune over 6 months found a high prevalence of neck and back pain and poor quality of life (QOL) in the participants. It has been shown that LBP which is occupationally induced can be treated with labor kinesiotherapy that improves lumbar pain, reduces its intensity, and improves the functional capacity of the trunk stabilizing muscles and joint movement amplitude. There have been studies in farmers in rural India that show that nearly 60% of Indian cultivators could be afflicted by LBP, and the issue remains unaddressed.
Keeping these studies in mind and with the lack of studies among jewelry workers in Mumbai, the following study was aimed at estimating the prevalence of LBP in jewelry workers and studying the disability and QOL affected by the same.
| Methodology|| |
The study was an observational cross-sectional study among jewelry workers from the city of Mumbai. The study was carried out over a period of 6 months on jewelry workers from Bhayandar and Mira road areas of Mumbai. The sample size was calculated using standard formulae, and a sample size of 195 was reached for the study. The sampling method used for the study was substage sampling that involved simple random sampling and quota sampling. The inclusion criteria for the study included age between 20 and 50 years, both genders, working in the jewelry field for at least 8 h a day with similar nature of work among all participants. Workers with a previous history of occupational injury, spinal fracture, spinal surgeries, trauma, deformity, neurological involvement, rheumatoid arthritis, and any medical or surgical illness that would affect the outcome of the study were excluded from the study.
All participants were administered the following scales:
Nordic Musculoskeletal Questionnaire (Hindi version)
The Nordic Musculoskeletal Questionnaire (NMQ) was developed from a project funded by the Nordic Council of Ministers with the aim to develop a standardized questionnaire allowing comparison of low back, neck, shoulder, and general complaints for use in epidemiological studies. It has two sections one which is a general questionnaire of 40 forced-choice items identifying areas of the body causing musculoskeletal problems. Completion is aided by a body map to indicate nine symptom sites being the neck, shoulders, upper back, elbows, low back, wrist/hands, hips/thighs, knees, and ankles/feet. Respondents are asked if they have had any musculoskeletal trouble in the last 12 months and the last 7 days, which has prevented normal activity. The second section has additional questions relating to the neck, the shoulders, and the lower back further detail relevant issues. Twenty-five forced-choice questions elicit any accidents affecting each area, functional impact at home and work (change of job or duties), duration of the problem, assessment by a health professional, and musculoskeletal problems in the last 7 days. The reliability of the NMQ, using a test–retest methodology, found the number of different answers ranged from 0% to 23%. Validity tested against clinical history and the NMQ found a range of 0%–20% disagreement, whereas sensitivity ranged between 66% and 92% and specificity between 71% and 88%., The Hindi version of the questionnaire has been developed and has a Cronbach's alpha of 0.88.
Modified Oswestry Low Back Disability Questionnaire (Hindi version)
The scale was originally described in 1980 where individual items were included and selected based on the experience of the scale's developers. The questionnaire consists of ten items addressing different aspects of function. Each item is scored from 0 to 5, with higher values representing greater disability. The total score is multiplied by 2 and expressed as a percentage. The modified scale used in this study replaced the sex life section with a question related to fluctuations in pain intensity. Researchers have reported the levels of test–retest reliability and internal consistency for the modified version similar to those of the original. The Hindi version also has good reliability and validity.
WHO Quality of Life Questionnaire (Hindi version)
The WHOQOL-BREF instrument comprises 26 items, which measure the following broad domains: physical health, psychological health, social relationships, and environment. The WHOQOL-BREF is a shorter version of the original instrument that may be more convenient for use in large research studies or clinical trials. It has been used in a large number of QOL studies worldwide. The Hindi version of the scale had good reliability and validity and has been used in a large number of Indian studies.
All the questionnaires were administered to the participants in a single setting, and written informed valid consent was obtained from all participants for participation in the study. The participants were offered a session of psychoeducation in a group of thirty for LBP management and posture training as an incentive for participation in the study. The study was approved by the Institutional Ethics Committee of Lokmanya Tilak Municipal Medical College, Mumbai. The data collected were transferred to an Excel sheet, subjected to appropriate statistical analysis, and the results were presented.
| Results|| |
A total of 195 participants participated in the study. Eighty-two (42.05%) reported the symptom of low back ache. Thirty-one males (n = 68) (45.58%) and 51 females (n = 127) (40.15%) reported the symptom. The average age of the sample was 36 ± 0.6 years with no major difference between the mean ages of males and females. On area-wise representation of musculoskeletal pain, the highest preponderance was that of LBP (42%), neck pain (14%), and knee pain (25%) [Figure 1]. The pain was more on the posterior side of the body. On the Modified Oswestry Low Back Disability Questionnaire (MOLBPQ) questionnaire, the mean score for female participants was 8.4 ± 3.04 and that of male participants was 7.2 ± 3.7 with the disability levels between genders showing no significant difference statistically (P = 0.1115). The mean score of all 82 participants on the MOLBPQ was 7.92 ± 3.3 which was in the mild range.
The scores and differences between male and female participants on the WHOQOL-BREF are described in [Table 1]. The differences between genders in all subdomains were not statistically significant except the environment domain where males had better scores than females (P = 0.043).
On applying a correlation between WHOQOL-BREF scores and disability scores for the entire sample, no correlation between scores with any domain was obtained except a mildly negative correlation for the psychological domain of QOL and disability (rho = 0.49, P = 0.001) [Table 2].
|Table 2: Correlation between WHO quality of life-BREF scores and disability scores (full sample) (n=82)|
Click here to view
| Discussion|| |
The cause of LBP in the sample was due to the awkward posture while working. Poorly designed workstations promoted further unnecessary physical effort which reduced their efficiency and productivity. The prevalence of LBP in our study was in keeping with that of other studies done in industrial workers., The disability levels of workers in the study were mild which is in keeping the mild-to-moderate disability noted in other studies. On assessing QOL, it was noted that all domains were affected, and the environmental domain was affected more in men than women. There may be many factors that lead to this, and the exact reasons cannot be elucidated. QOL was generally affected among both genders, and this is a finding in keeping with other studies., The psychological domain of QOL correlated with disability in a negative manner. It is well known that LBP can have psychological connotations, and many psychological factors may present with physical pain as a primary symptom. The greater the disability caused by the pain, the greater is the psychological discomfort. It is important that along with treating the physical disability, the physician and therapist must also pay attention to the psychological factors involved and help for those issues must be sought. Frequent training in proper posture and rest pauses between work with ergonomic considerations may provide relief from LBP and improve QOL in general.
| Conclusions|| |
The findings of our study suggest that LBP is commonly seen in jewelry workers and is associated with a mild grade of disability and affects the psychological domain of QOL. The study was a small circumscribed study restricted to a small part of Mumbai. Pain, range of movements, and strength of the lumbar spine and radiological evaluations were not done. Posture evaluation and correction with studies in larger samples across multiple centers shall yield more data to corroborate the findings of our study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Lee P, Helewa A, Goldsmith CH, Smythe HA, Stitt LW. Low back pain: Prevalence and risk factors in an industrial setting. J Rheumatol 2001;28:346-51.
Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. BMJ 2006;332:1430-4.
Nasser MJ. How to approach the problem of low back pain: An overview. J Family Community Med 2005;12:3-9.
Ghosh T, Das B, Gangopadhyay S. Work-related Musculoskeletal Disorder: An occupational disorder of the goldsmiths in India. Indian J Community Med 2010;35:321-5.
] [Full text]
Cohen SP, Argoff CE, Carragee EJ. Management of low back pain. BMJ 2008;337:a2718.
Deyo RA, Weinstein JN. Low back pain. N Engl J Med 2001;344:363-70.
Nourbakhsh MR, Arab AM. Relationship between mechanical factors and incidence of low back pain. J Orthop Sports Phys Ther 2002;32:447-60.
Sparrey CJ, Bailey JF, Safaee M, Clark AJ, Lafage V, Schwab F, et al
. Etiology of lumbar lordosis and its pathophysiology: A review of the evolution of lumbar lordosis, and the mechanics and biology of lumbar degeneration. Neurosurg Focus 2014;36:E1.
Dankaerts W, O'Sullivan P, Burnett A, Straker L. Differences in sitting postures are associated with nonspecific chronic low back pain disorders when patients are subclassified. Spine (Phila Pa 1976) 2006;31:698-704.
Jukariya T, Singh S. Musculoskeletal disorders risk assessment among goldsmiths using the (RULA) Rapid Upper Limb Assessment method. Int J Adv Agrcult Sci Technol 2018;5:33-9.
Gupta G, Nandini N. Prevalence of low back pain in nonworking rural housewives of Kanpur, India. Int J Occup Med Environ Health 2015;28:313-20.
Durlov S, Chakrabarty S, Chatterjee A, Das T, Dev S, Gangopadhyay S, et al
. Prevalence of low back pain among handloom weavers in West Bengal, India. Int J Occup Environ Health 2014;20:333-9.
Dhanuka H, Gaigole R. Prevalence of neck pain in goldsmith workers. Int J Ther Rehabil Res 2016;5:53-62.
Nascimento FK, de Silva BS, de Oliveira AR, Lira UB. Occupational low back pain and postural in the sitting position: Labor kinesiotherapy. Revista Dor 2011;12:308-13.
Gupta G, Tarique S. Prevalence of musculoskeletal disorders in farmers of Kanpur. J Commun Med Health Educ 2013;3:2161-71.
Dickinson CE, Campion K, Foster AF, Newman SJ, O'Rourke AM, Thomas PG. Questionnaire development: An examination of the Nordic Musculoskeletal questionnaire. Appl Ergon 1992;23:197-201.
Crawford JO. The Nordic musculoskeletal questionnaire. Occup Med. 2007;57:300-1.
Dawson AP, Steele EJ, Hodges PW, Stewart S. Development and test-retest reliability of an extended version of the Nordic Musculoskeletal Questionnaire (NMQ-E): A screening instrument for musculoskeletal pain. J Pain 2009;10:517-26.
de Barros EN, Alexandre NM. Cross-cultural adaptation of the Nordic musculoskeletal questionnaire. Int Nurs Rev 2003;50:101-8.
Gupta G, Bhavana S, Rishikesh R. Reliability and validity of the Hindi version of Nordic Musculoskeletal Questionnaire. EC Orthop 2018;9:533-8.
Fairbank JC, Couper J, Davies JB, O'Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy 1980;66:271-3.
Mousavi SJ, Parnianpour M, Mehdian H, Montazeri A, Mobini B. The Oswestry Disability Index, the Roland-Morris Disability Questionnaire, and the Quebec Back Pain Disability Scale: Translation and validation studies of the Iranian versions. Spine (Phila Pa 1976) 2006;31:E454-9.
Bansal D, Gudala K, Lavudiya S, Ghai B, Arora P. Translation, Adaptation, and Validation of Hindi Version of the Pain Catastrophizing Scale in Patients with Chronic Low Back Pain for Use in India. Pain Med 2016;17:1848-58.
WHOQOL Group. Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL Group. Psychol Med 1998;28:551-8.
Gholami A, Jahromi LM, Zarei E, Dehghan A. Application of WHOQOL-BREF in Measuring Quality of Life in Health-Care Staff. Int J Prev Med 2013;4:809-17.
Saxena S, Chandiramani K, Bhargava R. WHOQOL-Hindi: A questionnaire for assessing quality of life in health care settings in India. World Health Organization Quality of Life. Natl Med J India 1998;11:160-5.
Pincus T, Burton AK, Vogel S, Field AP. A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine (Phila Pa 1976) 2002;27:E109-20.
Kovacs FM, Abraira V, Zamora J, Teresa Gil del Real M, Llobera J, Fernández C, et al.
Correlation between pain, disability, and quality of life in patients with common low back pain. Spine (Phila Pa 1976) 2004;29:206-10.
Tavafian SS, Jamshidi A, Mohammad K, Montazeri A. Low back pain education and short term quality of life: A randomized trial. BMC Musculoskelet Disord 2007;8:21.
Linton SJ. A review of psychological risk factors in back and neck pain. Spine (Phila Pa 1976) 2000;25:1148-56.
Kerr MS, Frank JW, Shannon HS, Norman RW, Wells RP, Neumann WP, et al
. Biomechanical and psychosocial risk factors for low back pain at work. Am J Public Health 2001;91:1069-75.
Driessen MT, Proper KI, van Tulder MW, Anema JR, Bongers PM, van der Beek AJ. The effectiveness of physical and organisational ergonomic interventions on low back pain and neck pain: A systematic review. Occup Environ Med 2010;67:277-85.
[Table 1], [Table 2]