A cross-sectional study to assess the pattern of work-related musculoskeletal disorder among class-IV workers of tertiary care centres in central India

INTRODUCTION

Musculoskeletal disorders (MSDs) are typically characterised by pain (often persistent) and limitations in mobility and dexterity, which reduces an individual’s ability to work and participate in society. MSDs are prevalent and their impact is pervasive and they are the most common cause of severe long-term pain and physical disability.¹

A recent global burden of disease (GBD) 2019 data analysis showed that approximately 1.71 billion people globally live with musculoskeletal conditions.² Among all MSDs, low back and neck pain is the leading cause of both chronic pain and disability worldwide.³ The prevalence of MSDs among the Indian adult population is 6.92-76.8%.⁴ Musculoskeletal impairments comprise more than 150 different diseases/conditions that affect the system and are characterized by impairments in the muscles, bones, joints and adjacent connective tissues, leading to temporary or lifelong limitations in functioning and participation.^5,6 Work-related musculoskeletal disorders (WMSDs) can be caused by a variety of physical and psychosocial factors, including mental stress.^7-10 Mental stress can contribute to WMSDs in several ways, including increased muscle tension, poor posture, reduced ability to cope, reduced focus etc. To address mental stress in WMSD patients, it is important to identify and address the root causes of the stress. This may involve changing the work environment, providing stress-management training, and encouraging employees to take breaks and practice self-care. Physical therapy and other treatments may also address the physical symptoms of WMSDs.¹¹ MSDs negatively impact employees’ health, leading to decreased productivity, and increased healthcare disability and worker’s compensation costs. Musculoskeletal conditions are also the highest contributor to the global need for rehabilitation.^2,12

Due to the rising pattern of MSDs, WHO launched the Rehabilitation 2030 initiative in 2017 to draw attention to the profound unmet need for rehabilitation worldwide, and to highlight the importance of strengthening rehabilitation in the health systems.¹³ Providing stress-management training, and encouraging employees to take breaks and practice self-care. Physical therapy and other treatments may also address the physical symptoms of WMSDs. In addition to pharmacological strategies, modifications in lifestyle behaviours may play an important role in the prevention of the progression of MSDs and the reduction of important associated comorbidities.^14,15 There should also be a focus on certain lifestyle factors, including tobacco, smoking, alcohol, cannabis, opioids etc. Consumption of these has shown significant importance in the development of MSDs.¹⁴

This study presents an innovative approach focusing on the early detection of MSDs and mental stress (using ERI), identifying the contributing factors and implementing timely preventive measures, consequently leading to improvements in productivity.

Operational definition

Effort-reward imbalance (ERI)

It is defined as “to identify unfavourable psychosocial work characteristics that focus on a mismatch between “costs” and “gains” in costly social transactions”.¹⁶ “Effort” means extrinsic work demands. “Reward” is thought to come from three sources: salary or wage (financial reward), career promotion or job security (status-related reward), and esteem or recognition (socioemotional reward).

Class IV worker

Class IV worker means daftries, jamadars, peons, chowkidars and sweepers appointed under section 8 (2) (d) of the Act. ¹⁷

Objectives

To assess the prevalence and patterns of work-related musculoskeletal disorders (WMSDs) among class-IV workers. To identify the key factors contributing to WMSDs.

METHODS

Study design and period

It was a cross-sectional study that took place for a period of 3 months (January 2023 to March 2023).

Settings and sample

The study was conducted at the Hamidia Hospital and Gandhi Medical College Bhopal. 350 class IV workers were selected using random sampling. Both males and females, aged between 18 and 60 years were considered to be part of the sampling unit. Workers with documented musculoskeletal disease and taking treatment were excluded from the study.

Data collection tool

The interview had three parts: a sociodemographic profile of the workers, questions to assess body location and grading of musculoskeletal pain and questions to assess mental stress (work-related mental stress). The questionnaire was self-derived using previous studies.^9,18

Ethical approval

The study received approval from the Institutional Ethics Committee (IEC-141/2023) at Gandhi Medical College Bhopal.

Data collection method

Data were collected by direct interviews with those who fulfilled the selection criteria. The interviews were conducted without disrupting their regular work routines. The objectives of the study were explained to the respondents before the participants agreed to participate. To avoid any comprehension issues, the questions were read to the subjects, and their answers were recorded individually. The visual analogue pain scale was used to identify their pain grade.¹⁹ The average time of one interview was calculated to be about 20 minutes.

Data analysis

The filled questionnaires were checked for completeness and consistency and findings were coded for analysis. Data were entered using Microsoft Excel 2019 and analysed using Jamovi version 2.3.²⁰ The chi-square test was applied for inferential purposes a p value of ≤0.05 has been considered for declaring the difference statistically significant.

RESULTS

Sociodemographic information of the class IV workers is presented in Table 1. About 55.7% of the workers were male and 44.3% were female. Among them, 58.3% were in the age group 19-35 years. 32.9% were in the 36-49 and 8.8% were in the 50-60 years. The majority of the participants (60.3%) were found to follow the Hindu religion.

Work-related information about the workers is shown in Table 2. Among all housekeeping staff, 82% showed the symptoms of MSD. All participants have working hours of 6-9 hours/day. Almost 2/3^rd (60%) had 8 hours of work in a day while a small proportion (12.9%) had ≥9 hours of work every day, 32.6% of the workers take a break during work and the remaining 67.4% did not take a break during work. The duration of each break was 10-60 minutes. Out of which most of the workers took a break of 30 minutes.

Figure 1 demonstrates the location and grading of musculoskeletal pain of the 211 workers. The participants mostly suffered from pain in the lower back (49.3%) followed by the lower leg (32.9%), and shoulders (28%).

Among 211 participants having pain, 157 (74.5%) had aching followed by cramping 50 (23.7%) and 4 (1.8%) had a burning sensation.

Table 3 demonstrates the level of mental stress. Among 350 participants, 72 had mental stress in the form of difficulty falling asleep, restlessness, anxiety and work-related stress. 34.7% present with severe difficulty in sleeping. 41.7% have low work-related stress and 9.8% have high work-related stress.

Table 5 demonstrates a different type of substance abused by class IV workers, gutkha was the most common substance abused by class IV workers, which shows musculoskeletal pain.

Modifiable factors associated with the musculoskeletal pain of the workers are presented in Table 6. Showing, Workers who did not exercise or only exercise 1-2 times a month experience higher levels of pain, with 34.6% and 38.9% respectively reporting pain. In contrast, workers who exercise more frequently have a lower incidence of pain.

DISCUSSION

Musculoskeletal pain is a pervasive health problem among class IV workers. The number of incident cases and disability-adjusted life years (DALYs) of MSDs increased by 59.86% to 77.39%, respectively, from 1990 to 2019. Similarly, an increasing trend has been demonstrated in previous reports analysing the GBD 2017.^2,21-24 Analysis study showed that 48.3% of males and 51.7% of females participated, and a slightly high prevalence was noticed in females (70.32%) compared to all males (52.30) which were statistically significant p<0.001, similar results were shown in a previous study as well.²⁵

Among all participants, most participants showing musculoskeletal pain belong to the middle age group 36-49, and it was found statistically significant. In contrast, a previous study by Thamrin et al did not show any significant correlation between age group and MSD pain.²⁶

Most participants belonging to primary education and High school groups showed more presence of MSD pain in comparison to higher secondary and college groups which shows a significant correlation (p<0.001) between literacy and MSD pain, similar results were observed in a previous study by Hansen et al which showed that a high educational level was associated with reduced odds of pain compared with low educational level.²⁷

Among all participants, the majority were married and reported musculoskeletal pain, while all widowed or divorced participants experienced musculoskeletal pain. No previous studies have shown a significant correlation between marital status and musculoskeletal pain. The study showed that most of the participants with BMI <18.5 and 25-29.99 had MSD pain concerning normal BMI (18.5-24.9), similar results were seen in a study by Rosa et al.^28,29 Observation showed the positive effect of exercise on MSD pain, participants performing ≥6 times a month showed less MSD pain compared to participants who are not performing the exercise/1-2 times in a month/ 3-5 times in a month. Similar results were observed in a previous study by Bullo et al.³⁰

Housekeeping staff showed the maximum musculoskeletal symptoms among all participants (p<0.001), similar results were seen in a previous study as well.³¹ Analysis showed that the longer the working hours, the more the musculoskeletal pain, similar results were observed in a prior study by Amiri et al.³² Participants who were not taking any breaks showed more musculoskeletal symptoms in comparison to those who were taking breaks, and similar results were seen in previous studies by Park et al.³³

Participants were found mostly suffering from pain in the lower back (49.3%) followed by the lower leg (32.9%), Similar results were shown in previous studies where lower back pain was more prevalent in females along with pain in other sites and most likely due to muscular strain in a similar research Yang et al 36, found the prevalence of shoulder disorder was 72% and 53% in females and males respectively.^34,35 There was a slightly higher prevalence of lower back problems (30%) in females as compared to males.

Many studies have focused on the risk factors and the prevalence of WRMDs using a cross-sectional study, but cross-sectional studies cannot determine the association among different variables.³⁷ As demonstrated in a previous study, the proportion of prolonged standing hours increases the presence of lower extremity muscle pain.³⁵ There is extensive literature explaining that musculoskeletal pain is multifactorial.³⁸ In the present study, physical factors, directly and indirectly, affected WRMDs through the risk perception by class IV, similar results were demonstrated in previous studies as well.³⁹ In the present study, 110 participants were found as substance users, 32 (among 44 gutkha consumers), and 15 (among 31 alcoholics) showed MSD. Similarly, as per previous studies, addiction decreases bone mineral density ultimately leading to the development of MSD.^14,40

CONCLUSION

From this study, we can conclude that class IV workers are often working in very physically demanding situations, they have to work for a longer period in their duty hours and this leads to fatigue, pain etc, hence a break should be advised at regular interval. Current scientific evidence suggests that individuals with MSDs should be encouraged to quit addiction habits and informed about the impact on several disease-specific outcomes such as symptoms and physical function. Literacy should be promoted to prevent and early detection of MSD. Chronic pain leads to the development of MSDs. Thus, basic intervention and counselling need to be given which can help in the prevention of the development of mental stress and MSDs.

ACKNOWLEDGEMENTS

The authors would like to acknowledge all the participants.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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