prevalence of musculoskeletal disorders in ...

International Journal of Therapies and Rehabilitation Research 2017; 6 (3): 52-57

Original Research Article

doi: 10.5455/ijtrr.000000283

International Journal of Therapies & Rehabilitation Research http://www.onlineijtrr.com

E-ISSN 2278-0343

PREVALENCE OF MUSCULOSKELETAL DISORDERS IN CONSTRUCTION WORKERS IN GUJARAT: A CROSS SECTIONAL SURVEY RUTVIK S. PURANI (M.P.T. REHABILITATION)1*, DR. NEHAL SHAH (PT, PH. D)2 , SRISHTI S SHARMA (M.P.T. REHABILITATION)3 1

2

Lecturer, Khyati Institute Of Physiotherapy- Shahibaug Incharge Principal, S.B.B. College Of Physiotherapy, V. S. General Hospital, Ahmedabad, 3 Lecturer, CM Patel College of Physiotherapy-Gandhinagar

ABSTRACT BACKGROUND: Construction workers are at increased risk of developing musculoskeletal disorders because they are exposed to various physical and psychological factors which are generally attributed to the development of musculoskeletal disorders. Their jobs involve prolonged standing and manual handling tasks such as lifting, carrying, pushing and pulling which have been identified as risk factors for musculoskeletal disorders. METHODOLOGY: A cross-sectional survey was conducted in a sample of 139 full time employed construction workers from various sites across different regions of Gujarat state. All the participants above the age of 18 years having more than 2 years of working experience and standing for average of 5 hours or more were included. Those having BMI more than 25 Kg/ m 2 and those with relevant history of trauma, pre-existing medical conditions like diabetes, hypertension etc. or any obvious musculoskeletal deformities like scoliosis, genu valgum etc. were excluded. Study was explained and written informed consent was obtained. A two part questionnaire concerning the musculoskeletal disorders with information about the study was distributed to each construction worker consisting of Extended Version of the Nordic Musculoskeletal Questionnaire (NMQ- E). Level of significance was set at 5%. Data was analyzed using statistical software Graphpad Prism version 5. RESULTS: Prevalence of low back pain was found to be highest at 83%, followed by neck and shoulder disorders (42%), and knee (38%). CONCLUSION: The part of the body mostly affected by intense labour among construction workers in Gujarat are lower back, followed by shoulder and knee. KEY WORDS Work Related Musculoskeletal Disorders, Nordic Musculoskeletal Questionnaire- Extended, Construction workers, Low back pain

INTRODUCTION Construction is one of the stable growing industry in the world including India. The hazards in construction industry are 8 times riskier than those from any manufacturing industry. 1 It is one of the labor intensive work and construction workers perform high risk work for meager wages. They are exposed to various physical and psychological factors. Their jobs involve

prolonged standing and manual handling tasks such as lifting, carrying, pushing and pulling which have been identified as risk factors for musculoskeletal disorders.2 This leads to increased risk of developing musculoskeletal symptoms and affects the quality of life of these workers, causing lost time or absenteeism, increasing work restriction or disability than any other group of diseases.


Frequent material handling activities found in construction work environments put substantial stress on the neck, shoulder, and lower back resulting in pain and discomfort. A number of studies have evaluated the prevalence of different types of work related musculoskeletal disorders (WMSD) among construction workers. Construction workers are frequently involved in the lifting of heavy objects at the ground, knee, waist, elbow, shoulder, and overhead heights. Due to material and site constraints, construction workers spend ample time lifting, holding, carrying, pulling or pushing loads of material. Manual material handling activities are an inseparable part of any construction project. Epidemiologically, several review studies have clearly established a strong relationship between work activities and the occurrence of WMSDs. Even though these disorders are prevalent among construction workers, very few studies have evaluated the prevalence of these disorders among construction workers in India. The reports have reported that there are more than 20 million construction workers in India at present. The number of construction workers is expanding at fast rate in developing cities, like Jamnagar (Gujarat), Guwahati and Shillong (Northeast). 3 Studies have revealed that the type of work the construction workers undertake under the difficult environment and the physical hazards along with the low economic status aggravate them vulnerable to ill health. Hence, the aim of the present study was to determine the prevalence of musculoskeletal disorders in all body regions among a population of construction workers in Gujarat, using Extended Version of the Nordic Musculoskeletal Questionnaire (NMQ- E). METHODOLOGY

A cross-sectional survey was conducted in a sample of 139 full time employed construction workers from various sites across different regions of Gujarat state. All the participants above the age of 18 years having more than 2 years of working experience and standing for average of 5 hours or more were included. Those having BMI more than 25 Kg/ m2 and those with relevant history of

trauma, pre-existing medical conditions like diabetes, hypertension etc. or any obvious musculoskeletal deformities like scoliosis, genu valgum etc. were excluded. Nature of study was explained and written informed consent was obtained from all subjects. A two part questionnaire concerning the musculoskeletal disorders with information about the study was distributed to each construction worker. Part one collected the participant's personal characteristics and part two assessed occurrence of musculoskeletal disorders using Extended Version of the Nordic Musculoskeletal Questionnaire (NMQ- E). 4 NMQ-E inquires about ‘‘trouble,’’ deﬁned as ‘‘ache, pain or discomfort’’ and 9 body regions (3 each on the upper limbs, spine and lower limbs) are visually depicted on a body chart viewed from behind. In total, the NMQE is comprised of 11 questions asked in reference to 9 body regions, equating to 99 data items generated by the tool. With the exception of age data, all response options are dichotomous (yes/no). Data Analysis was done using Graphpad Prism version 5 and Microsoft Excel 16. Mean age, BMI, work experience, working hours were determined as shown in table 1. RESULTS

83 females and 56 males participated in the study. 65% of the workers were illiterate and 35% had primary education. 67% had a child whereas 33% did not have children. Figure 1 shows the distribution of workers with majority being cement masons (26.6%). Table 2 depicts the prevalence of WMSDS according to different body regions among construction workers. Table 3 shows detailed analysis of consequences of WMSDs on their daily life, hospitalization, sick leaves, consultation with health care professionals. Analysis of joint wise distribution revealed that 20% workers experienced single joint pain, 23% had dual joint pain, 25% had triple joint pain and 32% had multiple joint pain.

TABLE 1. DEMOGRAPHICS OF SUBJECTS Variable 1. 2. 3. 4. 5. 6.

Age Males (%) Females (%) BMI (Kg/m2) Work experience (in years) Working hours per day

Mean + SD 23.53 + 2.65 56 (40.28) 83 (59.71) 22.13 + 1.25 2.25 + 1.75 10.30 + 2.35


TABLE 2. AGE OF ONSET AND PREVALENCE QUESTIONS (%) Body regions

Age at onset of trouble 20 23

Lifetime prevalence

Annual prevalence

Month prevalence

Point prevalence

42 51

36 42

28 26

15 28

Elbow

34

12

10

18

11

Wrist/hand

23

21

13

10

13

Upper back Low back

27

18

19

24

31

24

64

83

59

78

Hip

36

23

28

19

21

Knee

25

47

38

27

39

Ankle/ foot

31

31

22

30

37

Neck Shoulder

TABLE 3. ANALYSIS OF QUESTIONS REGARDING CONSEQUENCES OF PAIN (%) Body regions

Lifetime hospitalization

Neck Shoulder Elbow Wrist/hand Upper back Low back Hip Knee Ankle/ foot

Lifetime changed jobs

41 59 16 23 42 87 34 58 31

13 26 08 10 20 36 11 29 16

Annual prevention of normal work 26 43 10 03 37 73 15 39 22

Annual medication

Annual visit to health consultant

15 38 01 03 31 68 10 57 37

39 48 14 20 33 76 24 42 25

FIGURE 1. DISTRIBUTION OF WORKERS 30 25 20 15 10 5 0

26.6

10.7

7.9

16.5

9.3

15.1

13.6

Annual sick leave 12 29 05 09 22 33 20 27 11


DISCUSSION The present study revealed a high prevalence of low back pain among construction workers, followed by shoulder, neck and knee disorders. Naseh Haydarnzhad et al conducted a similar study on construction workers and concluded the prevalence of WMSDs to be highest in knee (50%) followed by low-back (37.7%) and wrist (37.7%), upper back (34%) and neck and shoulder disorders (24.8%).5 Findings of this study are similar to the findings of our study where knee (38%), lower back (83%) and neck disorders (42%) are highly affected. Harold et al determined the prevalence of musculoskeletal disorders in bricklayers and concluded lower-back to be highly affected (52.17%), followed by shoulder (39.13%), wrist (26%), elbows (21.74%). 6 Affection of low-back disorders was higher in females as compared to males in the present study. Nor Azlin M Nordin et al 7 and Bork et al 8 stated that changes in spinal posture and weakening of joint structure related to a history of pregnancy increases the risk of musculoskeletal symptoms. These reasons may explain why the female workers reported a higher incidence of injuries than their male counterparts in the present study. Pensri P et al reported a positive relationship between prolonged standing and lower extremities symptoms with prevalence rates similar to the present study. 9A research also found out that the construction workers have a high risk of 50% for musculoskeletal injuries, higher than other industrial workers. 10 The repeated postural changes like bending forward or standing and weight bearing may cause backache, low back pain and neck pain and so on. Limitations of the present study are that the memory and ability to recall musculoskeletal disorders over the past 12 months was not taken into consideration. Lower prevalence in certain body areas may be accounted to Healthy worker effect, which happens when workers with musculoskeletal problems leave the job earlier. No follow-up data was taken. Future study can be conducted with a larger sample size and analysis of risk factors with WMSDs can be done. Association of these risk factors with WMSDs can be determined.

CONCLUSION The part of the body mostly affected by intense labor among the population of construction workers in Gujarat are lower back (83%) followed by shoulder (42%) and knee (38%). Such high prevalence rate of musculoskeletal disorders is

suggestive of implementing control measures like training and education, redesigning the work station and providing the mechanical aids or Personal Protective Equipment (PPE).

ACKNOWLEDGEMENTS Authors are extremely grateful to all the subjects for their valuable time and active participation.

CONFLICT OF INTEREST: None

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