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Work 50 (2015) 379–386 DOI 10.3233/WOR-151994 IOS Press
Musculoskeletal complaints among physiotherapy and occupational therapy rehabilitation professionals in Bangladesh Md. Shofiqul Islama,∗ , Md. Monjurul Habibb , Md. Abdul Hafezc, Nazmun Naharb , Debra Lindstrom-Hazeld and Md. Khalilur Rahmana a
Department of Physiotherapy, Centre for the Rehabilitation of the Paralysed, Savar, Dhaka, Bangladesh Department of Occupational Therapy, Centre for the Rehabilitation of the Paralysed, Savar, Dhaka, Bangladesh c Department of Epidemiology & Biostatistics, Bangladesh Institute of Health Sciences, Mirpur, Dhaka, Bangladesh d Department of Occupational Therapy, Western Michigan University, Kalamazoo, MI, USA b
Received 3 February 2013 Accepted 24 February 2014
Abstract. BACKGROUND: Physiotherapy and occupational therapy professionals are at high risk of developing occupational musculoskeletal injuries globally. Musculoskeletal pain is the most common problem. OBJECTIVE: To determine the extent of discomfort that physiotherapy and occupational therapy health professionals report while working at a physical rehabilitation centre. PARTICIPANTS: Physiotherapy and occupational therapy professionals which include both graduate and diploma physiotherapists and occupational therapists as well as physiotherapy and occupational therapy assistants. METHODS: A self administered questionnaire (survey) was conducted on a convenient sample of 101 physiotherapy and occupational therapy personnel. RESULTS: The mean age of the 101 participants was 27.8 (± 4.5) years and most of the participants (62%) had less than 5 years of work experience. Ninety-five percent of the participants complained of work related pain. Most of the participants reported pain in the lower back (n = 84) followed by upper back (n = 71) and neck (n = 66). Significant associations were found for pain in ankles/feet with age (p = 0.05) and pain in neck with gender (p = 0.01). CONCLUSION: Physiotherapy and occupational therapy professionals suffer from pain in relation to the work they do as therapists which may be due to non-practice of appropriate body mechanics. Mechanism to assess level of practice during dealing with patients may be introduced to enable corrective measures. Incentives should be considered for appropriate practice. Keywords: Musculoskeletal discomfort survey, visual analogue scale, occupational injury, therapist
1. Introduction The occurrence of musculoskeletal complaints in work places is not new. In 1717, Bernardo Ramazz∗ Corresponding author: Md. Shofiqul Islam, Assistant Professor, Department of Physiotherapy, Bangladesh Health Professions Institute, CRP – Chapain, Savar, Dhaka 1343, Bangladesh. Tel.: +88 01725 145973; E-mail: [email protected].
ini, the father of occupational medicine, first introduced the common musculoskeletal disorders to physicians [1]. Musculoskeletal disorders are considered to be among the most common health problems in the contemporary workforces [2]. Musculoskeletal disorders may result in severe long-term pain and physical disability which affect millions of people across the globe including physiotherapists and occupational therapists who move, handle, and transfer their patients
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to restore function and improve independence [3]. The foundational curriculum for both professions includes education in self-protection while providing physical treatment including additional education in ergonomic principles for injury prevention. Evidence shows that therapists are at risk of developing musculoskeletal complaints associated with therapeutic intervention and handling of patients [4,5]. Repetitive tasks, direct pressure, high force and awkward sustained postures are cited as prime risk factors, making healthcare providers particularly vulnerable to musculoskeletal injuries [6]. Since physiotherapists are often involved in physically demanding and intense, repetitive tasks in their practice, they are at risk of suffering musculoskeletal problems [7]. Similarly occupational therapists in their respective job settings have also reported musculoskeletal complains [8]. There is evidence in the literature that musculoskeletal complaints have a significant impact on physiotherapists [4] and occupational therapists [6] and that musculoskeletal injuries are common among health care workers in general [9]. Physiotherapists are at risk of work related musculoskeletal disorders [7]. Occupational therapists are not likely to be exempt from this phenomenon [9]. The highest prevalence of work related musculoskeletal disorders among physiotherapists were in the following anatomical areas: low back (45%), wrist/hand (29.6%), upper back (28.7%), and neck (24.7%) [6]. Work-related injuries amongst occupational therapists are commonly involved in the body regions: lower back (50%), neck (33%) and shoulders (22%) [9]. Cromie et al. (2000) reported that as many as 91% of physiotherapists experience a workrelated musculoskeletal disorders during their career, with more than 80% experiencing symptoms in at least one body area within a 12-month period [7]. Molumphy et al. (1985) reported that 18% of physiotherapists with work-related musculoskeletal disorders of the low back changed their work setting and that 12% of the physiotherapists reduced their patient care hours [10]. Now question arises as to what is the situation in our context? Therefore the aim of the study was to describe our situation in terms of (i) magnitude of musculoskeletal problem by site among physiotherapy and occupational therapy professionals (ii) to identify the factors influencing the problem.
2. Method A Cross sectional study design was used in this study. A total of 101 health professionals working
at different settings (e.g. musculoskeletal, neurology, paediatric, spinal cord injury, hand therapy, special needs school, domiciliary etc.) with more than one year of job experience were selected. Participants who worked fulltime at clinical sites and were involved in the process of rehabilitation were included in the study and interns were excluded. Accordingly 62 physiotherapy and 39 occupational therapy personnel were selected from the two rehabilitation centres (one rural and one urban). The study was conducted between August 2011 and May 2012 in a large rehabilitation centre in South East Asia. A convenient sampling technique was used for collecting data. Self-administered questionnaires were distributed and the procedures explained to all physiotherapy and occupational therapy professionals who met the inclusion criteria. Therapists were assured of confidentiality of their data. The questionnaire consisted of two sections. The first section contained questions about socio-demographic information including age, educational status, employment setting, clinical experiences, designation (physiotherapy/occupational therapy) and about mental and physical exhaustion. The second section, the participants were asked to highlight the musculoskeletal related information based on a discomfort survey that was taken from the Industrial Accident Prevention Association (IAPA) February 2007 [11]. Presently IAPA was changed to Workplace Safety and Prevention Services (WSPS) from where consent was taken to use the survey [12]. The discomfort instrument had thirteen anatomical regions (neck, upper back, lower back, shoulders, elbows, forearms, wrist/hands, hips, thighs, knees, lower legs, ankles/feet and others) of the human body to be surveyed. Data was collected on the basis of three criteria – regions, how often there is discomfort and how much discomfort. The questionnaire included a body diagram with the anatomical regions clearly marked and participants were asked to indicate the areas where they felt musculoskeletal discomfort during their clinical work within their respective field of practice. The original discomfort survey instrument (IAPA) in English was used as participants were literate in English. The researchers were also available to answer any individual’s question about the study. The completed questionnaire was collected by the researchers within one week of delivery. The study procedure was approved by an Ethical Review Board at the rehabilitation centre. Descriptive and inferential statistics were analyzed by using SPSS 16 windows version.
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3. Results 3.1. Participants socio-demographic and psycho-somatic information There were 101 participants from the two centres (one rural and one urban of the same organizaton). Sixty-two participants were physiotherapy health professionals and 39 were occupational therapy health professionals. Of the 62 physiotherapy health professionals, there were 40 physiotherapists, 5 diploma holders and 17 physiotherapy assistants. Of the 39 occupational therapy participants 22 were occupational therapists, 1 was a diploma holder and 16 were occupational therapy assistants. The age of the participants ranged between 21 years and 56 years with mean age of 27.8 (± 4.5) years and modal age of 28 years. Mean height of the participants was 1.6 meters (± 0.1) and mean weight was 59.8 kg (± 9.9). The mean body mass index (BMI) was 22.4 (± 2.8) (Table 1). Of the participants’ almost 53% (n = 54) were male while around 47% (n = 47) were female. In term of marital status, approximately 60% (n = 61) were married and only 40% (n = 40) were single. Majority of the participants that is 95% (n = 96) were born in urban areas compared to only 5% (n = 5) in the rural areas. Walking was the most common way of movement with 48% (n = 49) of the participants followed by 28% (n = 28) and 21% (n = 21) by bus and rickshaws respectively. The majority of the participants, about 93% (n = 94) reported using their right hand as their dominant hand and only 6% (n = 6) of using left hand as their dominant hand. Most of the participants, 62% (n = 63) had less than 5 years of work experience. Among the 101 participants almost 60% (n = 61) felt occasionally mentally exhausted after work. Almost one – third of the participants (n = 32) reported that they were often mentally exhausted after work. Physically exhausted after work was reported occasionally by 49.5% (n = 50) and often by 37.5% (n = 37). Pain during last year was reported by 95% (n = 96) of the participants for both the groups (Table 2). 3.2. Information regarding discomfort survey According to the discomfort questionnaire by the Industrial Accident Prevention Association (IAPA), 13 specific anatomical sites were identified: neck, shoulders, upper back, elbows, lower back, wrist/hands, hips, thighs, knees, lower legs, ankles/feet and others
Fig. 1. Distribution of the participants by reported work related musculoskeletal discomfort (N = 101). From: http://www.health andsafetyontario.ca/HSO/media/WSPS/Resources/Downloads/Disc omfort_Survey_final.pdf?ext=.pdf; retrieved on 18 September 2012.
(Fig. 1). Results show that lower back was the main site of pain reported by both the groups with 83% (n = 84) of the participants – physiotherapy personnel 90% (n = 56) and occupational therapy 72% (n = 28). Other frequent sites of pain were upper back 70% (n = 71), neck 65% (n = 66), wrist or hands 62% (n = 63). Elbow was the least reported site of pain by both the groups 18% (n = 18) of the participants – physiotherapy personnel 23% (n = 14) and occupational 11% (n = 4). For this specification of the sites, e.g. right, left and both sides of a specific site say neck is describe in Table 3. Both sites of lower back (right and left) were reported by most of the physiotherapy 71% (n = 44) and 51% (n = 20) of occupational therapy professionals. Nature of pain was assessed by the frequency criteria – never, occasionally, often and always. Out of the thirteen sites four sites viz. neck, upper back, lower back and wrist/hand appear to be quite vulnerable as frequency of ever feeling of pain in these sites overwhelmingly exceeded the frequency of never feeling pain. The physiotherapy professionals reported of ever feeling pain in neck 72% (n = 45), upper back 82%
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M.S. Islam et al. / Musculoskeletal complaints among PT and OT professionals Table 1 Descriptive information of questionnaire respondents (N = 101)
Respondents All Male (53%) Female (47%)
x 27.8 28.4 27
Age (y) SD 4.5 5.3 3.1
Range 21–56 22–56 21–37
x 1.6 1.7 1.6
Height (m) SD Range 0.1 1.5–1.8 0.1 1.5–1.8 0.1 1.5–1.7
x 59.8 64.8 54.2
Weight (kg) SD Range 9.9 35–89 9.2 35–89 7.4 40–75
x 22.4 22.6 22.1
BMI (kg/m2 ) SD Range 2.8 15.1–30 2.9 15.1–30 2.7 17.8–27.8
Table 2 Percentage of participants (n) socio-demographic and psychosomatic information
Age < 30 years 30 years Gender Male Female Marital status Married Unmarried Residential area Urban Rural Mode of transport On Foot Rickshaw Bus Others Work experience 5 Years > 5 Years
PT (N1 = 62) % (n)
OT (N2 = 39) % (n)
Total (N = 101) % (n)
77% (48) 23% (14)
69% (27) 31% (12)
74% (75) 26% (26)
52% (32) 48% (30)
56% (22) 44% (17)
53% (54) 47% (47)
61% (38) 39% (24)
59% (23) 41% (16)
60% (61) 40% (40)
94% (58) 6% (4)
97% (38) 3% (1)
95% (96) 5% (5)
43% (27) 23% (14) 31% (19) 3% (2)
56% (22) 18% (7) 23% (9) 3% (1)
48% (49) 21% (21) 28% (28) 3% (3)
68% (42) 32% (20)
54% (21) 46% (18)
62% (63) 38% (38)
PT (N1 = 62) % (n) Dominant hand Right 97% (60) Left 3% (2) Both hand 0% (0) Mentally exhausted after work Never 8% (5) Occasionally 55% (34) Often 37% (23) Always 0% (0) Physically exhausted after work Never 10% (6) Occasionally 45% (28) Often 32% (20) Always 13% (8) Pain during last year Yes 97% (60) No 3% (2)
OT (N2 = 39) % (n)
Total (N = 101) % (n)
87% (34) 10% (4) 3% (1)
93% (94) 6% (6) 1% (1)
5% (2) 69% (27) 23% (9) 3% (1)
7% (7) 60% (61) 32% (32) 1% (1)
0% (0) 56% (22) 44% (17) 0% (0)
6% (6) 49% (50) 37% (37) 8% (8)
92% (36) 8% (3)
95% (96) 5% (5)
PT: Physiotherapy; OT: Occupational therapy.
(n = 51), lower back 90% (n = 56), and wrist/hand 58% (n = 36). The corresponding figures of occupational therapy professionals were neck 54% (n = 21), upper back 51% (n = 20), lower back 72% (n = 28) and wrist/hand 70% (n = 27). The figure on feeling pain occasionally was reported by majority of the participants of both the groups in the areas of neck 48% (n = 49), upper back 35% (n = 36), lower back 39% (n = 40) and wrist/hand 40% (n = 41). However, the proportion among physiotherapists was higher than occupational therapists in these areas except wrist/hand where the proportion was higher among the occupational therapists. Among the remaining sites pain felt never by both the physiotherapy and occupational therapy professionals was higher than those felt pain ever. The sites mentioned by majority of the participants never felt pain were elbow 77% (n = 48), forearm 76% (n = 47), hips 79% (n = 49), thighs 76% (n = 47), lower legs 62% (n = 38) for physiotherapy. The corresponding figure of occupational therapy are 90% (n = 35), forearm 79% (n = 31), hips 82% (n = 32), thighs 82% (n = 32) and lower legs 46% (n = 18) (Table 4).
3.3. Pain score according to visual analogue scale (VAS) According to the 10-point VAS for pain; 0 indicates no pain and 10 indicates severe pain. Score 5 was indicated by most participants for neck and upper back while score 7 was indicated most for lower back. When the scores were summarized for all sites, a rating of 5 was the most prevalent score followed by score of 4 and score of 3. Scores higher than 5 were indicated by fewer participants. About 21% (n = 80) of physiotherapy and 41% (n = 79) of occupational therapy personnel reported of pain 6. However, severity of lower back pain appears to be the highest among occupational therapy participants as 64% of those reporting any discomfort (n = 28) reported of pain 6 in the scale. Among physiotherapy participants 43% of those participants reporting any discomfort (n = 56) reported 6 in the scale in the lower back. Comparison of physiotherapy and occupational therapy in terms of mean score by site shows significant difference (p
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Table 3 Distribution of participants by major pain sites Area of pain
Neck No pain Pain Right Left Both Upper back No pain Pain Right Left Both Lower back No pain Pain Right Left Both Shoulders No pain Pain Right Left Both Elbows No pain Pain Right Left Both Forearms No pain Pain Right Left Both
PT (N1 = 62) % (n)
OT (N2 = 39) % (n)
Total (N = 101) % (n)
28% (17) 72% (45) 16% (10) 6% (4) 50% (31)
46% (18) 54% (21) 13% (5) 5% (2) 36% (14)
35% (35) 65% (66) 15% (15) 6% (6) 44% (45)
18% (11) 82% (51) 15% (9) 6% (4) 61% (38)
49% (19) 51% (20) 18% (7) 0% (0) 33% (13)
30% (30) 70% (71) 16% (16) 4% (4) 50% (51)
10% (6) 90% (56) 11% (7) 8% (5) 71% (44)
28% (11) 72% (28) 21% (8) 0% (0) 51% (20)
17% (17) 83% (84) 15% (15) 5% (5) 63% (64)
45% (28) 55% (34) 31% (19) 6% (4) 18% (11)
49% (19) 51% (20) 33% (13) 0% (0) 18% (7)
52% (53) 48% (48) 32% (32) 4% (4) 18% (18)
77% (48) 23% (14) 19% (12) 2% (1) 2% (1)
89% (35) 11% (4) 3% (1) 0% (0) 8% (3)
82% (83) 18% (18) 13% (13) 1% (1) 4% (4)
76% (47) 24% (15) 16% (10) 2% (1) 6% (4)
79% (31) 21% (8) 18% (7) 0% (0) 3% (1)
77% (78) 23% (23) 17% (17) 1% (1) 5% (5)
0.05) in six sites out of thirteen. The sites showing significant difference are neck (p = 0.04), shoulder (p = 0.03), wrist/hands (p = 0.02), knee (p = 0.01), lower legs (p = 0.05) and ankles/feet (p = 0.03) (Table 5). Multiple regression analysis was conducted with pain scores separately for each site as dependent variable (DV) with important independent variables (IVs) age, sex, marital status, occupation (physiotherapy & occupational therapy) and BMI. Significant association of pain was observed between (a) marital status with elbow (p = 0.044), forearm (p = 0.009), thighs (p = 0.018), knees (0.004) and others (p = 0.027); (b) occupation with upper back (p = 0.026), wrist/ hand (p = 0.032) and lower legs (p = 0.025); (c) age with thighs (p = 0.053) and (d) BMI (p = 0.037) with lower
Area of pain
PT (N1 = 62) % (n)
OT (N2 = 39) % (n)
Wrist/hands No pain 42% (26) 31% (12) Pain 58% (36) 69% (27) Right 31% (19) 41% (16) Left 5% (3) 10% (4) Both 22% (14) 18% (7) Hips No pain 79% (49) 82% (32) Pain 21% (13) 18% (7) Right 10% (6) 10% (4) Left 3% (2) 0% (0) Both 8% (5) 8% (3) Thighs No pain 76% (47) 81% (32) Pain 24% (15) 19% (7) Right 8% (5) 3% (1) Left 2% (1) 3% (1) Both 14% (9) 13% (5) Knees No pain 47% (29) 65% (25) Pain 53% (33) 35% (14) Right 15% (9) 15% (6) Left 6% (4) 5% (2) Both 32% (20) 15% (6) Lower legs No pain 62% (38) 46% (18) Pain 38% (24) 54% (21) Right 13% (8) 5% (2) Left 3% (2) 5% (2) Both 22% (14) 44% (17) Ankles/feet No pain 55% (34) 65% (25) Pain 45% (28) 35% (14) Right 13% (8) 8% (3) Left 5% (3) 5% (2) Both 27% (17) 22% (9) Others (heel, headache, lower abdomen etc.) No pain 81% (50) 90% (35) Pain 19% (12) 10% (4)
Total (N = 101) % (n) 38% (38) 62% (63) 34% (35) 7% (7) 21% (21) 80% (81) 20% (20) 10% (10) 2% (2) 8% (8) 78% (79) 22% (22) 6% (6) 2% (2) 14% (14) 57% (58) 43% (43) 15% (15) 6% (6) 26% (26) 55% (56) 45% (45) 10% (10) 4% (4) 31% (31) 58% (59) 42% (42) 11% (11) 5% (5) 26% (26) 84% (85) 16% (16)
legs. However, these variables have been able to explain only about 12% of total variation in pain scores for both physiotherapy and occupational therapy together as well as separately.
4. Discussion The purpose of the study was to determine the extent of work-related musculoskeletal discomfort of both physiotherapy and occupational therapy professionals in their respective work setting in a Bangladesh rehabilitation facility. Our study population was comparatively younger (mean age: 27.8 ± 4.5 years for both physiotherapy and occupational therapy) than their
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M.S. Islam et al. / Musculoskeletal complaints among PT and OT professionals Table 4 Percentage of participants frequency of work-related musculoskeletal discomfort of pain
How often pain
Neck Never Occasionally Often Always Upper back Never Occasionally Often Always Lower back Never Occasionally Often Always Shoulders Never Occasionally Often Always Elbows Never Occasionally Often Always Forearms Never Occasionally Often Always Wrist/hands Never Occasionally Often Always
PT (N1 = 62) % (n)
OT (N2 = 39) % (n)
Total (N = 101) % (n)
28% (17) 51% (32) 18% (11) 3% (2)
46% (18) 44% (17) 10% (4) 0% (0)
35% (35) 48% (49) 15% (15) 2% (2)
18% (11) 37% (23) 35% (22) 10% (6)
49% (19) 33% (13) 15% (6) 3% (1)
30% (30) 35% (36) 28% (28) 7% (7)
10% (6) 44% (27) 35% (22) 11% (7)
28% (11) 33% (13) 28% (11) 10% (4)
17% (17) 39% (40) 33% (33) 11% (11)
45% (28) 40% (25) 15% (9) 0% (0)
49% (19) 33% (13) 15% (6) 3% (1)
46% (47) 38% (38) 15% (15) 1% (1)
77% (48) 21% (13) 2% (1) 0% (0)
90% (35) 5% (2) 5% (2) 0% (0)
82% (83) 15% (15) 3% (3) 0% (0)
76% (47) 22% (14) 2% (1) 0% (0)
79% (31) 13% (5) 8% (3) 0% (0)
77% (78) 19% (19) 4% (4) 0% (0)
42% (26) 39% (24) 19% (12) 0% (0)
30% (12) 44% (17) 23% (9) 3% (1)
38% (38) 40% (41) 21% (21) 1% (1)
counterparts in developed countries viz. USA (mean age: 42.8 ± 9.81 years for both physiotherapy and occupational therapy) [13], Canada (mean age: 35.8 ± 9.11 years only for physiotherapy) [14] and Australia (mean age: 38 years only for physiotherapy) [7]. One of the reasons why our study population is younger is that professional academic courses were introduced in our country 14 years ago. Thus about 62% of our study participants had work experience of 5 years or less. The Chartered Society of Physiotherapy (CSP) mentioned that younger physiotherapist especially below the age of 30 was at higher risk of developing musculoskeletal injuries particularly during the first 4–5 years of their practice which is similar to our study results [15]. Musculoskeletal complaints have been described as the common causes of severe long-term pain and physical disability that affects millions of people across the globe [16]. Our study shows that 95% of participants
How often pain
PT (N1 = 62) % (n)
OT (N2 = 39) % (n)
Hips Never 79% (49) 82% (32) Occasionally 15% (9) 15% (6) Often 6% (4) 3% (1) Always 0% (0) 0% (0) Thighs Never 76% (47) 82% (32) Occasionally 24% (15) 18% (7) Often 0% (0) 0% (0) Always 0% (0) 0% (0) Knees Never 47% (29) 64% (25) Occasionally 40% (25) 18% (7) Often 13% (8) 15% (6) Always 0% (0) 3% (1) Lower legs Never 62% (38) 46% (18) Occasionally 35% (22) 51% (20) Often 3% (2) 3% (1) Always 0% (0) 0% (0) Ankles/Feet Never 54% (34) 64% (25) Occasionally 34% (21) 23% (9) Often 10% (6) 13% (5) Always 2% (1) 0% (0) Others (heel, headache, lower abdomen etc.) Never 80% (50) 89% (35) Occasionally 18% (11) 8% (3) Often 2% (1) 3% (1) Always 0% (0) 0% (0)
Total (N = 101) % (n) 80% (81) 15% (15) 5% (5) 0% (0) 78% (79) 22% (22) 0% (0) 0% (0) 53% (54) 32% (32) 14% (14) 1% (1) 55% (56) 42% (42) 3% (3) 0% (0) 58% (59) 30% (30) 11% (11) 1% (1) 84% (85) 14% (14) 2% (2) 0% (0)
complained of musculoskeletal pain during last year which is a very high rate. Campo (2010) stated that physiotherapists and occupational therapists experience high rates of work-related pain [17]. Similarly the scientific committee for musculoskeletal disorders of the International Commission on Occupational Health (ICOH) recognizes work-related musculoskeletal disorders have high incidences and prevalences among workers who are exposed to manual handing, repetitive and static work, vibrations, and poor psychological and social conditions [18]. Passier (2011) reported that work postures and movements, lifting or carrying, patient related factors and repetitive tasks were perceived by health professional as high risk of work-related musculoskeletal disorders [19]. Back pain in this study was the most commonly expressed symptom for both physiotherapy and occupational therapy and more specifically low back
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Table 5 Work related musculoskeletal discomfort according to VAS Site 1 1 0
2 2 0
3 5 0
4 13 4
Pain score 5 13 8
6 6 4
7 2 4
8 2 1
9 1 0
10 0 0
Total 45 21
Mean (SD) 4.7 (1.6) 5.5 (1.2)
Median (Rangea ) 5 5
t-test
Neck
PT OT
0 0 0
Upper Back
PT OT
0 0
0 0
3 0
6 3
12 2
14 7
5 3
5 3
4 1
2 0
0 1
51 20
5 (1.8) 5.5 (1.8)
5 5
p = 0.38
Lower Back
PT OT
0 0
1 0
4 0
5 1
7 4
15 5
11 8
9 9
3 1
1 0
0 0
56 28
5.2 (1.8) 5.8 (1.3)
5 6
p = 0.78
Shoulders
PT OT
0 0
2 0
5 1
8 2
8 3
6 6
4 4
1 3
0 1
0 0
0 0
34 20
3.8 (1.5) 5.2 (1.5)
4 5
p = 0.03∗
Elbows
PT OT
0 0
0 0
4 1
4 0
2 1
4 0
0 1
0 1
0 0
0 0
0 0
14 4
3.4 (1.2) 4.8 (2.2)
3 5
p = 0.13
Forearms
PT OT
0 0
2 0
3 2
5 1
3 1
2 2
1 2
0 0
0 0
0 0
0 0
16 8
3.2 (1.4) 4.1 (1.6)
3 4.5
p = 0.16
Wrist/Hands
PT OT
0 0
0 0
5 1
6 1
10 6
8 6
1 7
4 4
2 1
0 1
0 0
36 27
4.4 (1.7) 5.4 (1.6)
4 5
p = 0.02∗
Hips
PT OT
0 0
1 0
3 0
4 3
2 2
2 1
1 1
0 0
0 0
0 0
0 0
13 7
3.3 (1.4) 4 (1.2)
3 4
p = 0.29
Thighs
PT OT
0 0
1 0
2 1
5 2
3 0
3 4
1 0
0 0
0 0
0 0
0 0
15 7
3.5 (1.4) 4 (1.3)
3 5
p = 0.45
Knees
PT OT
0 0
1 0
6 0
9 3
4 1
8 4
3 2
2 2
0 2
0 0
0 0
33 14
3.9 (1.6) 5.4 (1.7)
4 5
p = 0.01∗∗
Lower Legs
PT OT
0 0
1 0
4 1
10 6
2 6
5 1
2 7
0 0
0 0
0 0
0 0
24 21
3.5 (1.4) 4.3 (1.4)
3 4
p = 0.05∗
Ankles/Feet
PT OT
0 0
1 0
4 1
7 3
8 0
5 5
2 3
1 2
0 0
0 0
0 0
28 14
3.8 (1.4) 4.9 (1.6)
4 5
p = 0.03∗
Others
PT OT
0 0
2 0
2 0
1 2
0 0
3 2
1 0
2 0
1 0
0 0
0 0
12 4
4.3 (2.5) 4 (1.2)
5 4
p = 0.80
p = 0.04∗
(a )Range is evident; ∗ Significant; ∗∗ Highly Significant.
pain which was reported by 83% of the participants. Similar findings were reported in the USA [17], Saudi Arabia [20] for both physiotherapy and occupational therapy. Studies conducted among the physiotherapy professionals found similar results in Canada [14], United Kingdom [3], Australia [5], Kuwait [21], Nigeria [16]. A study conducted by the University of Iowa, USA showed that low back pain was the most common causes of work related musculoskeletal disorders among physiotherapists and it was 45% [6]. The University of Iowa study and the current study ranks lower back pain as the most common site. However, our study shows very high rate of 83% participants reporting lower back pain compared to 45% in the University of Iowa study. The difference in the rate is highly significant. This study was about musculoskeletal complaints among physiotherapy and occupational therapy professionals which showed back pain, especially in the upper back region, was the most common area for
discomfort. Age and gender of the participants were associated with pain in their different body regions. Age was significantly associated with ankles/feet (p = 0.05) and gender was significantly associated with neck pain (p = 0.01). Multiple regression analysis conducted on five IVs showed marital status as an important factor. But those five factors (age, sex, marital status, occupation and BMI) could explain only 12% variations. So we need to look for other variables such as practice of good body mechanics during treatment sessions. Also further details of the marital factor such as duration of marriage, living/not living with spouse etc. should possibly be looked into.
5. Limitations Cross-sectional type of study can only identify risk indicators. The variables that we looked into could not explain relations and variability quite well. Patients
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are advised by therapists about how to maintain good health. So they themselves need to practice what they teach and avoid injury by using better body mechanics. We did not consider this aspect in our study. Maybe a prospective cohort study is conducted to look for explanations in-depth.
6. Conclusion and recommendation Physiotherapy and occupational therapy professions are perceived as physically demanding and these are also the two categories which are at high risk of developing work related musculoskeletal complaints. This study shows quite high percentage of both physiotherapy and occupational therapy professionals reporting musculoskeletal pain particularly back (both lower and upper) and neck pain which is undesirable. As this study could not identify factors responsible for the pain, more in-depth studies are needed. Particularly a prospective cohort study is recommended. In view of the above we hypothesize that one reason for the pain could be due to non-practice of better body mechanics. Mechanism to assess level of practice during dealing with patients may be introduced to enable corrective measures. If it is observed that they really do not practice then a yearly in-service training for all of the physiotherapy and occupational therapy professionals should be arranged. Introduction of incentive in some form or other may be considered for those who practice good body mechanics.
Acknowledgement We are grateful to the authorities of Workplace Safety and Prevention Services (WSPS) (formerly known as Industrial Accident Prevention Services) for their kind permission to use the instrument on discomfort survey. The participants are also acknowledged for their sincere contribution in this study.
References [1] [2] [3]
Sanders MJ. Ergonomics and the management of musculoskeletal disorder. Elsevier: USA, 2004. Reilly T. Musculoskeletal disorders in health-related occupations. IOS Press: Amsterdam (ed.), 2002. Glover W, McGregor A, Sullivan C, Hague J. Work – related musculoskeletal disorders affecting members of the chartered society of physiotherapy. Physiotherapy. 2005; 91(3): 138147.
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Campo M, Weiser S, Koenig KL, Nordin M. Work-related musculoskeletal disorders in physical therapists: A prospective cohort study with 1-year follow-up. Phys Ther. 2008; 88(5): 608-619. [5] West DJ, Gardner D. Occupational injuries of physiotherapists in North and Central Queensland. Aust J Physiother. 2001; 47(3): 179-186. [6] Bork BE, Cook TM, Rosecrance JC, Engelhardt KA, Thomason MEJ, Wauford IJ, Worley RK. Work related musculoskeletal disorders among physical therapists. Phys Ther. 1996; 76(8): 827-835. [7] Cromie JE, Robertson VJ, Best MO. Work related musculoskeletal disorders in physical therapist: Prevalence, severity, risk and responses. Phys Ther. 2000; 80(4): 336-351. [8] Darragh AR, Huddleston W, King P. Work – related musculoskeletal injuries and disorders among occupational and physical therapists. Am J Occup Ther. 2009; 63(3): 351-362. [9] Passier L, McPhail S. Work related injuries amongst occupational therapists: A preliminary investigation. Br J Occup Ther. 2011; 74(3): 143-147. [10] Molumphy M, Unger B, Jensen GM, Lopopolo RB. Incidence of work – related low back pain in physical therapist. Phys Ther. 1985; 65(4): 482-486. [11] IAPA, Discomfort Survey. (http://gvsafety.com/Documents/ SAFETY%20HANDOUTS/Lifting%20Procedures%20&% 20Back%20Safety/Back%20Pain%20Survey%20Forms/ Discomfort%20&%20Pain%20Survey%20Form.pdf). 2007. Industrial Accident Prevention Association. [12] WSPS, Discomfort Survey. (http://www.healthandsafetyonta rio.ca/WSPS/Home.aspx). 2011. Workplace Safety & Prevention Services. [13] Darragh AR, Campo M, King P. Work – related activities with injury in occupational and physical therapists. Work. 2012; 42(3): 373-384. [14] Mierzejewski MAC, Kumar S. Prevalence of low back pain among physical therapists in Edmonton, Canada. Disabil Rehabil. 1997; 19(8): 309-317. [15] The Chartered Society of Physiotherapy (CSP). Employment relations & union services: health & safety – work-related strain injuries (musculoskeletal disorders). London, 2001. [16] Adegoke BOA, Akodu AK, Oyeyemi AL. Work – related musculoskeletal disorders among Nigerian Physiotherapists. BMC Musculoskelet Disord. 2008; 9: 112. [17] Campo M, Darragh AR. Impact of work – related pain on physical therapist and occupational therapists. Phys Ther. 2010; 90(6): 905-920. [18] Kilbom A, Armstrong T, Buckle P, Fine L, Hagberg M, Haring-Sweeney M, Martin B, Punnett L, Silverstein B, Sjogaard G, Theorell T, Viikari-Juntura E. Musculoskeletal disorders: Work-related risk factors and prevention. Int J Occup Environ Health. 1996; 2(3): 239-246. [19] Passier L, MaPhail S. Work related musculoskeletal disorders amongst therapists in physical demanding roles: qualitative analysis of risk factors and strategies for prevention. BMC Musculoskelet Disord. 2011; 12: 24. [20] Devreux ICN, Al-Awa B, Mamdouh K, Elsayed E. Relation of work – related musculoskeletal disorders and over – commitment of rehabilitation staff in Saudi Arabia. Life Sci J. 2012; 9(3): 781-785. [21] Alrowayeh HN, Alshatti TA, Aljadi SH, Fares M, Alshamire MM, Alwazan SS. Prevalence, characteristics, and impacts of work – related musculoskeletal disorders: A survey among physical therapists in the State of Kuwait. BMC Musculoskelet Disord. 2010; 11: 116.
Work 50 (2015) 379–386 DOI 10.3233/WOR-151994 IOS Press
Musculoskeletal complaints among physiotherapy and occupational therapy rehabilitation professionals in Bangladesh Md. Shofiqul Islama,∗ , Md. Monjurul Habibb , Md. Abdul Hafezc, Nazmun Naharb , Debra Lindstrom-Hazeld and Md. Khalilur Rahmana a
Department of Physiotherapy, Centre for the Rehabilitation of the Paralysed, Savar, Dhaka, Bangladesh Department of Occupational Therapy, Centre for the Rehabilitation of the Paralysed, Savar, Dhaka, Bangladesh c Department of Epidemiology & Biostatistics, Bangladesh Institute of Health Sciences, Mirpur, Dhaka, Bangladesh d Department of Occupational Therapy, Western Michigan University, Kalamazoo, MI, USA b
Received 3 February 2013 Accepted 24 February 2014
Abstract. BACKGROUND: Physiotherapy and occupational therapy professionals are at high risk of developing occupational musculoskeletal injuries globally. Musculoskeletal pain is the most common problem. OBJECTIVE: To determine the extent of discomfort that physiotherapy and occupational therapy health professionals report while working at a physical rehabilitation centre. PARTICIPANTS: Physiotherapy and occupational therapy professionals which include both graduate and diploma physiotherapists and occupational therapists as well as physiotherapy and occupational therapy assistants. METHODS: A self administered questionnaire (survey) was conducted on a convenient sample of 101 physiotherapy and occupational therapy personnel. RESULTS: The mean age of the 101 participants was 27.8 (± 4.5) years and most of the participants (62%) had less than 5 years of work experience. Ninety-five percent of the participants complained of work related pain. Most of the participants reported pain in the lower back (n = 84) followed by upper back (n = 71) and neck (n = 66). Significant associations were found for pain in ankles/feet with age (p = 0.05) and pain in neck with gender (p = 0.01). CONCLUSION: Physiotherapy and occupational therapy professionals suffer from pain in relation to the work they do as therapists which may be due to non-practice of appropriate body mechanics. Mechanism to assess level of practice during dealing with patients may be introduced to enable corrective measures. Incentives should be considered for appropriate practice. Keywords: Musculoskeletal discomfort survey, visual analogue scale, occupational injury, therapist
1. Introduction The occurrence of musculoskeletal complaints in work places is not new. In 1717, Bernardo Ramazz∗ Corresponding author: Md. Shofiqul Islam, Assistant Professor, Department of Physiotherapy, Bangladesh Health Professions Institute, CRP – Chapain, Savar, Dhaka 1343, Bangladesh. Tel.: +88 01725 145973; E-mail: [email protected].
ini, the father of occupational medicine, first introduced the common musculoskeletal disorders to physicians [1]. Musculoskeletal disorders are considered to be among the most common health problems in the contemporary workforces [2]. Musculoskeletal disorders may result in severe long-term pain and physical disability which affect millions of people across the globe including physiotherapists and occupational therapists who move, handle, and transfer their patients
c 2015 – IOS Press and the authors. All rights reserved 1051-9815/15/$35.00
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to restore function and improve independence [3]. The foundational curriculum for both professions includes education in self-protection while providing physical treatment including additional education in ergonomic principles for injury prevention. Evidence shows that therapists are at risk of developing musculoskeletal complaints associated with therapeutic intervention and handling of patients [4,5]. Repetitive tasks, direct pressure, high force and awkward sustained postures are cited as prime risk factors, making healthcare providers particularly vulnerable to musculoskeletal injuries [6]. Since physiotherapists are often involved in physically demanding and intense, repetitive tasks in their practice, they are at risk of suffering musculoskeletal problems [7]. Similarly occupational therapists in their respective job settings have also reported musculoskeletal complains [8]. There is evidence in the literature that musculoskeletal complaints have a significant impact on physiotherapists [4] and occupational therapists [6] and that musculoskeletal injuries are common among health care workers in general [9]. Physiotherapists are at risk of work related musculoskeletal disorders [7]. Occupational therapists are not likely to be exempt from this phenomenon [9]. The highest prevalence of work related musculoskeletal disorders among physiotherapists were in the following anatomical areas: low back (45%), wrist/hand (29.6%), upper back (28.7%), and neck (24.7%) [6]. Work-related injuries amongst occupational therapists are commonly involved in the body regions: lower back (50%), neck (33%) and shoulders (22%) [9]. Cromie et al. (2000) reported that as many as 91% of physiotherapists experience a workrelated musculoskeletal disorders during their career, with more than 80% experiencing symptoms in at least one body area within a 12-month period [7]. Molumphy et al. (1985) reported that 18% of physiotherapists with work-related musculoskeletal disorders of the low back changed their work setting and that 12% of the physiotherapists reduced their patient care hours [10]. Now question arises as to what is the situation in our context? Therefore the aim of the study was to describe our situation in terms of (i) magnitude of musculoskeletal problem by site among physiotherapy and occupational therapy professionals (ii) to identify the factors influencing the problem.
2. Method A Cross sectional study design was used in this study. A total of 101 health professionals working
at different settings (e.g. musculoskeletal, neurology, paediatric, spinal cord injury, hand therapy, special needs school, domiciliary etc.) with more than one year of job experience were selected. Participants who worked fulltime at clinical sites and were involved in the process of rehabilitation were included in the study and interns were excluded. Accordingly 62 physiotherapy and 39 occupational therapy personnel were selected from the two rehabilitation centres (one rural and one urban). The study was conducted between August 2011 and May 2012 in a large rehabilitation centre in South East Asia. A convenient sampling technique was used for collecting data. Self-administered questionnaires were distributed and the procedures explained to all physiotherapy and occupational therapy professionals who met the inclusion criteria. Therapists were assured of confidentiality of their data. The questionnaire consisted of two sections. The first section contained questions about socio-demographic information including age, educational status, employment setting, clinical experiences, designation (physiotherapy/occupational therapy) and about mental and physical exhaustion. The second section, the participants were asked to highlight the musculoskeletal related information based on a discomfort survey that was taken from the Industrial Accident Prevention Association (IAPA) February 2007 [11]. Presently IAPA was changed to Workplace Safety and Prevention Services (WSPS) from where consent was taken to use the survey [12]. The discomfort instrument had thirteen anatomical regions (neck, upper back, lower back, shoulders, elbows, forearms, wrist/hands, hips, thighs, knees, lower legs, ankles/feet and others) of the human body to be surveyed. Data was collected on the basis of three criteria – regions, how often there is discomfort and how much discomfort. The questionnaire included a body diagram with the anatomical regions clearly marked and participants were asked to indicate the areas where they felt musculoskeletal discomfort during their clinical work within their respective field of practice. The original discomfort survey instrument (IAPA) in English was used as participants were literate in English. The researchers were also available to answer any individual’s question about the study. The completed questionnaire was collected by the researchers within one week of delivery. The study procedure was approved by an Ethical Review Board at the rehabilitation centre. Descriptive and inferential statistics were analyzed by using SPSS 16 windows version.
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3. Results 3.1. Participants socio-demographic and psycho-somatic information There were 101 participants from the two centres (one rural and one urban of the same organizaton). Sixty-two participants were physiotherapy health professionals and 39 were occupational therapy health professionals. Of the 62 physiotherapy health professionals, there were 40 physiotherapists, 5 diploma holders and 17 physiotherapy assistants. Of the 39 occupational therapy participants 22 were occupational therapists, 1 was a diploma holder and 16 were occupational therapy assistants. The age of the participants ranged between 21 years and 56 years with mean age of 27.8 (± 4.5) years and modal age of 28 years. Mean height of the participants was 1.6 meters (± 0.1) and mean weight was 59.8 kg (± 9.9). The mean body mass index (BMI) was 22.4 (± 2.8) (Table 1). Of the participants’ almost 53% (n = 54) were male while around 47% (n = 47) were female. In term of marital status, approximately 60% (n = 61) were married and only 40% (n = 40) were single. Majority of the participants that is 95% (n = 96) were born in urban areas compared to only 5% (n = 5) in the rural areas. Walking was the most common way of movement with 48% (n = 49) of the participants followed by 28% (n = 28) and 21% (n = 21) by bus and rickshaws respectively. The majority of the participants, about 93% (n = 94) reported using their right hand as their dominant hand and only 6% (n = 6) of using left hand as their dominant hand. Most of the participants, 62% (n = 63) had less than 5 years of work experience. Among the 101 participants almost 60% (n = 61) felt occasionally mentally exhausted after work. Almost one – third of the participants (n = 32) reported that they were often mentally exhausted after work. Physically exhausted after work was reported occasionally by 49.5% (n = 50) and often by 37.5% (n = 37). Pain during last year was reported by 95% (n = 96) of the participants for both the groups (Table 2). 3.2. Information regarding discomfort survey According to the discomfort questionnaire by the Industrial Accident Prevention Association (IAPA), 13 specific anatomical sites were identified: neck, shoulders, upper back, elbows, lower back, wrist/hands, hips, thighs, knees, lower legs, ankles/feet and others
Fig. 1. Distribution of the participants by reported work related musculoskeletal discomfort (N = 101). From: http://www.health andsafetyontario.ca/HSO/media/WSPS/Resources/Downloads/Disc omfort_Survey_final.pdf?ext=.pdf; retrieved on 18 September 2012.
(Fig. 1). Results show that lower back was the main site of pain reported by both the groups with 83% (n = 84) of the participants – physiotherapy personnel 90% (n = 56) and occupational therapy 72% (n = 28). Other frequent sites of pain were upper back 70% (n = 71), neck 65% (n = 66), wrist or hands 62% (n = 63). Elbow was the least reported site of pain by both the groups 18% (n = 18) of the participants – physiotherapy personnel 23% (n = 14) and occupational 11% (n = 4). For this specification of the sites, e.g. right, left and both sides of a specific site say neck is describe in Table 3. Both sites of lower back (right and left) were reported by most of the physiotherapy 71% (n = 44) and 51% (n = 20) of occupational therapy professionals. Nature of pain was assessed by the frequency criteria – never, occasionally, often and always. Out of the thirteen sites four sites viz. neck, upper back, lower back and wrist/hand appear to be quite vulnerable as frequency of ever feeling of pain in these sites overwhelmingly exceeded the frequency of never feeling pain. The physiotherapy professionals reported of ever feeling pain in neck 72% (n = 45), upper back 82%
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M.S. Islam et al. / Musculoskeletal complaints among PT and OT professionals Table 1 Descriptive information of questionnaire respondents (N = 101)
Respondents All Male (53%) Female (47%)
x 27.8 28.4 27
Age (y) SD 4.5 5.3 3.1
Range 21–56 22–56 21–37
x 1.6 1.7 1.6
Height (m) SD Range 0.1 1.5–1.8 0.1 1.5–1.8 0.1 1.5–1.7
x 59.8 64.8 54.2
Weight (kg) SD Range 9.9 35–89 9.2 35–89 7.4 40–75
x 22.4 22.6 22.1
BMI (kg/m2 ) SD Range 2.8 15.1–30 2.9 15.1–30 2.7 17.8–27.8
Table 2 Percentage of participants (n) socio-demographic and psychosomatic information
Age < 30 years 30 years Gender Male Female Marital status Married Unmarried Residential area Urban Rural Mode of transport On Foot Rickshaw Bus Others Work experience 5 Years > 5 Years
PT (N1 = 62) % (n)
OT (N2 = 39) % (n)
Total (N = 101) % (n)
77% (48) 23% (14)
69% (27) 31% (12)
74% (75) 26% (26)
52% (32) 48% (30)
56% (22) 44% (17)
53% (54) 47% (47)
61% (38) 39% (24)
59% (23) 41% (16)
60% (61) 40% (40)
94% (58) 6% (4)
97% (38) 3% (1)
95% (96) 5% (5)
43% (27) 23% (14) 31% (19) 3% (2)
56% (22) 18% (7) 23% (9) 3% (1)
48% (49) 21% (21) 28% (28) 3% (3)
68% (42) 32% (20)
54% (21) 46% (18)
62% (63) 38% (38)
PT (N1 = 62) % (n) Dominant hand Right 97% (60) Left 3% (2) Both hand 0% (0) Mentally exhausted after work Never 8% (5) Occasionally 55% (34) Often 37% (23) Always 0% (0) Physically exhausted after work Never 10% (6) Occasionally 45% (28) Often 32% (20) Always 13% (8) Pain during last year Yes 97% (60) No 3% (2)
OT (N2 = 39) % (n)
Total (N = 101) % (n)
87% (34) 10% (4) 3% (1)
93% (94) 6% (6) 1% (1)
5% (2) 69% (27) 23% (9) 3% (1)
7% (7) 60% (61) 32% (32) 1% (1)
0% (0) 56% (22) 44% (17) 0% (0)
6% (6) 49% (50) 37% (37) 8% (8)
92% (36) 8% (3)
95% (96) 5% (5)
PT: Physiotherapy; OT: Occupational therapy.
(n = 51), lower back 90% (n = 56), and wrist/hand 58% (n = 36). The corresponding figures of occupational therapy professionals were neck 54% (n = 21), upper back 51% (n = 20), lower back 72% (n = 28) and wrist/hand 70% (n = 27). The figure on feeling pain occasionally was reported by majority of the participants of both the groups in the areas of neck 48% (n = 49), upper back 35% (n = 36), lower back 39% (n = 40) and wrist/hand 40% (n = 41). However, the proportion among physiotherapists was higher than occupational therapists in these areas except wrist/hand where the proportion was higher among the occupational therapists. Among the remaining sites pain felt never by both the physiotherapy and occupational therapy professionals was higher than those felt pain ever. The sites mentioned by majority of the participants never felt pain were elbow 77% (n = 48), forearm 76% (n = 47), hips 79% (n = 49), thighs 76% (n = 47), lower legs 62% (n = 38) for physiotherapy. The corresponding figure of occupational therapy are 90% (n = 35), forearm 79% (n = 31), hips 82% (n = 32), thighs 82% (n = 32) and lower legs 46% (n = 18) (Table 4).
3.3. Pain score according to visual analogue scale (VAS) According to the 10-point VAS for pain; 0 indicates no pain and 10 indicates severe pain. Score 5 was indicated by most participants for neck and upper back while score 7 was indicated most for lower back. When the scores were summarized for all sites, a rating of 5 was the most prevalent score followed by score of 4 and score of 3. Scores higher than 5 were indicated by fewer participants. About 21% (n = 80) of physiotherapy and 41% (n = 79) of occupational therapy personnel reported of pain 6. However, severity of lower back pain appears to be the highest among occupational therapy participants as 64% of those reporting any discomfort (n = 28) reported of pain 6 in the scale. Among physiotherapy participants 43% of those participants reporting any discomfort (n = 56) reported 6 in the scale in the lower back. Comparison of physiotherapy and occupational therapy in terms of mean score by site shows significant difference (p
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Table 3 Distribution of participants by major pain sites Area of pain
Neck No pain Pain Right Left Both Upper back No pain Pain Right Left Both Lower back No pain Pain Right Left Both Shoulders No pain Pain Right Left Both Elbows No pain Pain Right Left Both Forearms No pain Pain Right Left Both
PT (N1 = 62) % (n)
OT (N2 = 39) % (n)
Total (N = 101) % (n)
28% (17) 72% (45) 16% (10) 6% (4) 50% (31)
46% (18) 54% (21) 13% (5) 5% (2) 36% (14)
35% (35) 65% (66) 15% (15) 6% (6) 44% (45)
18% (11) 82% (51) 15% (9) 6% (4) 61% (38)
49% (19) 51% (20) 18% (7) 0% (0) 33% (13)
30% (30) 70% (71) 16% (16) 4% (4) 50% (51)
10% (6) 90% (56) 11% (7) 8% (5) 71% (44)
28% (11) 72% (28) 21% (8) 0% (0) 51% (20)
17% (17) 83% (84) 15% (15) 5% (5) 63% (64)
45% (28) 55% (34) 31% (19) 6% (4) 18% (11)
49% (19) 51% (20) 33% (13) 0% (0) 18% (7)
52% (53) 48% (48) 32% (32) 4% (4) 18% (18)
77% (48) 23% (14) 19% (12) 2% (1) 2% (1)
89% (35) 11% (4) 3% (1) 0% (0) 8% (3)
82% (83) 18% (18) 13% (13) 1% (1) 4% (4)
76% (47) 24% (15) 16% (10) 2% (1) 6% (4)
79% (31) 21% (8) 18% (7) 0% (0) 3% (1)
77% (78) 23% (23) 17% (17) 1% (1) 5% (5)
0.05) in six sites out of thirteen. The sites showing significant difference are neck (p = 0.04), shoulder (p = 0.03), wrist/hands (p = 0.02), knee (p = 0.01), lower legs (p = 0.05) and ankles/feet (p = 0.03) (Table 5). Multiple regression analysis was conducted with pain scores separately for each site as dependent variable (DV) with important independent variables (IVs) age, sex, marital status, occupation (physiotherapy & occupational therapy) and BMI. Significant association of pain was observed between (a) marital status with elbow (p = 0.044), forearm (p = 0.009), thighs (p = 0.018), knees (0.004) and others (p = 0.027); (b) occupation with upper back (p = 0.026), wrist/ hand (p = 0.032) and lower legs (p = 0.025); (c) age with thighs (p = 0.053) and (d) BMI (p = 0.037) with lower
Area of pain
PT (N1 = 62) % (n)
OT (N2 = 39) % (n)
Wrist/hands No pain 42% (26) 31% (12) Pain 58% (36) 69% (27) Right 31% (19) 41% (16) Left 5% (3) 10% (4) Both 22% (14) 18% (7) Hips No pain 79% (49) 82% (32) Pain 21% (13) 18% (7) Right 10% (6) 10% (4) Left 3% (2) 0% (0) Both 8% (5) 8% (3) Thighs No pain 76% (47) 81% (32) Pain 24% (15) 19% (7) Right 8% (5) 3% (1) Left 2% (1) 3% (1) Both 14% (9) 13% (5) Knees No pain 47% (29) 65% (25) Pain 53% (33) 35% (14) Right 15% (9) 15% (6) Left 6% (4) 5% (2) Both 32% (20) 15% (6) Lower legs No pain 62% (38) 46% (18) Pain 38% (24) 54% (21) Right 13% (8) 5% (2) Left 3% (2) 5% (2) Both 22% (14) 44% (17) Ankles/feet No pain 55% (34) 65% (25) Pain 45% (28) 35% (14) Right 13% (8) 8% (3) Left 5% (3) 5% (2) Both 27% (17) 22% (9) Others (heel, headache, lower abdomen etc.) No pain 81% (50) 90% (35) Pain 19% (12) 10% (4)
Total (N = 101) % (n) 38% (38) 62% (63) 34% (35) 7% (7) 21% (21) 80% (81) 20% (20) 10% (10) 2% (2) 8% (8) 78% (79) 22% (22) 6% (6) 2% (2) 14% (14) 57% (58) 43% (43) 15% (15) 6% (6) 26% (26) 55% (56) 45% (45) 10% (10) 4% (4) 31% (31) 58% (59) 42% (42) 11% (11) 5% (5) 26% (26) 84% (85) 16% (16)
legs. However, these variables have been able to explain only about 12% of total variation in pain scores for both physiotherapy and occupational therapy together as well as separately.
4. Discussion The purpose of the study was to determine the extent of work-related musculoskeletal discomfort of both physiotherapy and occupational therapy professionals in their respective work setting in a Bangladesh rehabilitation facility. Our study population was comparatively younger (mean age: 27.8 ± 4.5 years for both physiotherapy and occupational therapy) than their
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M.S. Islam et al. / Musculoskeletal complaints among PT and OT professionals Table 4 Percentage of participants frequency of work-related musculoskeletal discomfort of pain
How often pain
Neck Never Occasionally Often Always Upper back Never Occasionally Often Always Lower back Never Occasionally Often Always Shoulders Never Occasionally Often Always Elbows Never Occasionally Often Always Forearms Never Occasionally Often Always Wrist/hands Never Occasionally Often Always
PT (N1 = 62) % (n)
OT (N2 = 39) % (n)
Total (N = 101) % (n)
28% (17) 51% (32) 18% (11) 3% (2)
46% (18) 44% (17) 10% (4) 0% (0)
35% (35) 48% (49) 15% (15) 2% (2)
18% (11) 37% (23) 35% (22) 10% (6)
49% (19) 33% (13) 15% (6) 3% (1)
30% (30) 35% (36) 28% (28) 7% (7)
10% (6) 44% (27) 35% (22) 11% (7)
28% (11) 33% (13) 28% (11) 10% (4)
17% (17) 39% (40) 33% (33) 11% (11)
45% (28) 40% (25) 15% (9) 0% (0)
49% (19) 33% (13) 15% (6) 3% (1)
46% (47) 38% (38) 15% (15) 1% (1)
77% (48) 21% (13) 2% (1) 0% (0)
90% (35) 5% (2) 5% (2) 0% (0)
82% (83) 15% (15) 3% (3) 0% (0)
76% (47) 22% (14) 2% (1) 0% (0)
79% (31) 13% (5) 8% (3) 0% (0)
77% (78) 19% (19) 4% (4) 0% (0)
42% (26) 39% (24) 19% (12) 0% (0)
30% (12) 44% (17) 23% (9) 3% (1)
38% (38) 40% (41) 21% (21) 1% (1)
counterparts in developed countries viz. USA (mean age: 42.8 ± 9.81 years for both physiotherapy and occupational therapy) [13], Canada (mean age: 35.8 ± 9.11 years only for physiotherapy) [14] and Australia (mean age: 38 years only for physiotherapy) [7]. One of the reasons why our study population is younger is that professional academic courses were introduced in our country 14 years ago. Thus about 62% of our study participants had work experience of 5 years or less. The Chartered Society of Physiotherapy (CSP) mentioned that younger physiotherapist especially below the age of 30 was at higher risk of developing musculoskeletal injuries particularly during the first 4–5 years of their practice which is similar to our study results [15]. Musculoskeletal complaints have been described as the common causes of severe long-term pain and physical disability that affects millions of people across the globe [16]. Our study shows that 95% of participants
How often pain
PT (N1 = 62) % (n)
OT (N2 = 39) % (n)
Hips Never 79% (49) 82% (32) Occasionally 15% (9) 15% (6) Often 6% (4) 3% (1) Always 0% (0) 0% (0) Thighs Never 76% (47) 82% (32) Occasionally 24% (15) 18% (7) Often 0% (0) 0% (0) Always 0% (0) 0% (0) Knees Never 47% (29) 64% (25) Occasionally 40% (25) 18% (7) Often 13% (8) 15% (6) Always 0% (0) 3% (1) Lower legs Never 62% (38) 46% (18) Occasionally 35% (22) 51% (20) Often 3% (2) 3% (1) Always 0% (0) 0% (0) Ankles/Feet Never 54% (34) 64% (25) Occasionally 34% (21) 23% (9) Often 10% (6) 13% (5) Always 2% (1) 0% (0) Others (heel, headache, lower abdomen etc.) Never 80% (50) 89% (35) Occasionally 18% (11) 8% (3) Often 2% (1) 3% (1) Always 0% (0) 0% (0)
Total (N = 101) % (n) 80% (81) 15% (15) 5% (5) 0% (0) 78% (79) 22% (22) 0% (0) 0% (0) 53% (54) 32% (32) 14% (14) 1% (1) 55% (56) 42% (42) 3% (3) 0% (0) 58% (59) 30% (30) 11% (11) 1% (1) 84% (85) 14% (14) 2% (2) 0% (0)
complained of musculoskeletal pain during last year which is a very high rate. Campo (2010) stated that physiotherapists and occupational therapists experience high rates of work-related pain [17]. Similarly the scientific committee for musculoskeletal disorders of the International Commission on Occupational Health (ICOH) recognizes work-related musculoskeletal disorders have high incidences and prevalences among workers who are exposed to manual handing, repetitive and static work, vibrations, and poor psychological and social conditions [18]. Passier (2011) reported that work postures and movements, lifting or carrying, patient related factors and repetitive tasks were perceived by health professional as high risk of work-related musculoskeletal disorders [19]. Back pain in this study was the most commonly expressed symptom for both physiotherapy and occupational therapy and more specifically low back
M.S. Islam et al. / Musculoskeletal complaints among PT and OT professionals
385
Table 5 Work related musculoskeletal discomfort according to VAS Site 1 1 0
2 2 0
3 5 0
4 13 4
Pain score 5 13 8
6 6 4
7 2 4
8 2 1
9 1 0
10 0 0
Total 45 21
Mean (SD) 4.7 (1.6) 5.5 (1.2)
Median (Rangea ) 5 5
t-test
Neck
PT OT
0 0 0
Upper Back
PT OT
0 0
0 0
3 0
6 3
12 2
14 7
5 3
5 3
4 1
2 0
0 1
51 20
5 (1.8) 5.5 (1.8)
5 5
p = 0.38
Lower Back
PT OT
0 0
1 0
4 0
5 1
7 4
15 5
11 8
9 9
3 1
1 0
0 0
56 28
5.2 (1.8) 5.8 (1.3)
5 6
p = 0.78
Shoulders
PT OT
0 0
2 0
5 1
8 2
8 3
6 6
4 4
1 3
0 1
0 0
0 0
34 20
3.8 (1.5) 5.2 (1.5)
4 5
p = 0.03∗
Elbows
PT OT
0 0
0 0
4 1
4 0
2 1
4 0
0 1
0 1
0 0
0 0
0 0
14 4
3.4 (1.2) 4.8 (2.2)
3 5
p = 0.13
Forearms
PT OT
0 0
2 0
3 2
5 1
3 1
2 2
1 2
0 0
0 0
0 0
0 0
16 8
3.2 (1.4) 4.1 (1.6)
3 4.5
p = 0.16
Wrist/Hands
PT OT
0 0
0 0
5 1
6 1
10 6
8 6
1 7
4 4
2 1
0 1
0 0
36 27
4.4 (1.7) 5.4 (1.6)
4 5
p = 0.02∗
Hips
PT OT
0 0
1 0
3 0
4 3
2 2
2 1
1 1
0 0
0 0
0 0
0 0
13 7
3.3 (1.4) 4 (1.2)
3 4
p = 0.29
Thighs
PT OT
0 0
1 0
2 1
5 2
3 0
3 4
1 0
0 0
0 0
0 0
0 0
15 7
3.5 (1.4) 4 (1.3)
3 5
p = 0.45
Knees
PT OT
0 0
1 0
6 0
9 3
4 1
8 4
3 2
2 2
0 2
0 0
0 0
33 14
3.9 (1.6) 5.4 (1.7)
4 5
p = 0.01∗∗
Lower Legs
PT OT
0 0
1 0
4 1
10 6
2 6
5 1
2 7
0 0
0 0
0 0
0 0
24 21
3.5 (1.4) 4.3 (1.4)
3 4
p = 0.05∗
Ankles/Feet
PT OT
0 0
1 0
4 1
7 3
8 0
5 5
2 3
1 2
0 0
0 0
0 0
28 14
3.8 (1.4) 4.9 (1.6)
4 5
p = 0.03∗
Others
PT OT
0 0
2 0
2 0
1 2
0 0
3 2
1 0
2 0
1 0
0 0
0 0
12 4
4.3 (2.5) 4 (1.2)
5 4
p = 0.80
p = 0.04∗
(a )Range is evident; ∗ Significant; ∗∗ Highly Significant.
pain which was reported by 83% of the participants. Similar findings were reported in the USA [17], Saudi Arabia [20] for both physiotherapy and occupational therapy. Studies conducted among the physiotherapy professionals found similar results in Canada [14], United Kingdom [3], Australia [5], Kuwait [21], Nigeria [16]. A study conducted by the University of Iowa, USA showed that low back pain was the most common causes of work related musculoskeletal disorders among physiotherapists and it was 45% [6]. The University of Iowa study and the current study ranks lower back pain as the most common site. However, our study shows very high rate of 83% participants reporting lower back pain compared to 45% in the University of Iowa study. The difference in the rate is highly significant. This study was about musculoskeletal complaints among physiotherapy and occupational therapy professionals which showed back pain, especially in the upper back region, was the most common area for
discomfort. Age and gender of the participants were associated with pain in their different body regions. Age was significantly associated with ankles/feet (p = 0.05) and gender was significantly associated with neck pain (p = 0.01). Multiple regression analysis conducted on five IVs showed marital status as an important factor. But those five factors (age, sex, marital status, occupation and BMI) could explain only 12% variations. So we need to look for other variables such as practice of good body mechanics during treatment sessions. Also further details of the marital factor such as duration of marriage, living/not living with spouse etc. should possibly be looked into.
5. Limitations Cross-sectional type of study can only identify risk indicators. The variables that we looked into could not explain relations and variability quite well. Patients
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are advised by therapists about how to maintain good health. So they themselves need to practice what they teach and avoid injury by using better body mechanics. We did not consider this aspect in our study. Maybe a prospective cohort study is conducted to look for explanations in-depth.
6. Conclusion and recommendation Physiotherapy and occupational therapy professions are perceived as physically demanding and these are also the two categories which are at high risk of developing work related musculoskeletal complaints. This study shows quite high percentage of both physiotherapy and occupational therapy professionals reporting musculoskeletal pain particularly back (both lower and upper) and neck pain which is undesirable. As this study could not identify factors responsible for the pain, more in-depth studies are needed. Particularly a prospective cohort study is recommended. In view of the above we hypothesize that one reason for the pain could be due to non-practice of better body mechanics. Mechanism to assess level of practice during dealing with patients may be introduced to enable corrective measures. If it is observed that they really do not practice then a yearly in-service training for all of the physiotherapy and occupational therapy professionals should be arranged. Introduction of incentive in some form or other may be considered for those who practice good body mechanics.
Acknowledgement We are grateful to the authorities of Workplace Safety and Prevention Services (WSPS) (formerly known as Industrial Accident Prevention Services) for their kind permission to use the instrument on discomfort survey. The participants are also acknowledged for their sincere contribution in this study.
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