6 Brief Resume of the Intended Work: Need for the study



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Brief Resume of the Intended Work:

    1. Need for the study :

The work-related musculoskeletal disorders is injuries or disorders of muscles, nerves, tendons, joints, cartilage, and spinal discs associated with exposure to multiple risk factors in workplace. The multiplicity of factors; physical and psychological factors of individual; and social factors has led to much debate about their source, nature, and severity.1 Work related MSDs include sprains, strains, tears: back pain: soreness, pain, hurt(except the back), carpal tunnel syndrome; hernia; or musculoskeletal system or connective tissues diseases and disorders, when the event or exposure leading to injury or illness is bodily reaction/ bending, climbing, crawling, reaching, twisting, overexertion, or repetitions. Work related MSDs do not include disorders caused by slips, trips, falls, motor vehicle accidents.2

Health research carried out on the employees of transport shows that these people often suffer from respiratory, musculoskeletal, peripheral nervous, cardiovascular, gastrointestinal diseases. Rates of trauma accidents are also high (12–15). More than 50% of all drivers suffer from musculoskeletal disorders, which are manifested through tension, pain and decreased work capacity. Thirty one percent of the auto-transport employees had complaints about their health. Functional complaints about musculoskeletal (46.2%), respiratory (22.7%), gastrointestinal (17.3%), and the central nervous system dysfunction (32.7%) were prevailing.3

The driver’s task is mentally demanding because of having to cope with conflicting requests. The company and the public want the driver to maintain good contact with passengers and to be service-oriented, for instance to traveler (providing information about time tables, routes, stops, fares, etc.). In the operator’s daily life, the demand for service by the individual passenger often conflicts with the need to keep to a tight schedule in dense traffic. The demand on the driver, also conflicting with the other two, is the demand to drive safely according to traffic regulations.4 The environment in which drivers spend the majority of their time is polluted, noisy and dangerous. It is an environment over which they have no control whatsoever and is an environment that wrecks their schedules, disrupts their home life, makes social activities and regular breaks very hard to plan and supplies constant hassle.5

Absenteeism, turnover and disability among the drivers appeared to be high when compared to any other occupation. Almost 90 per cent of bus drivers with high work experience (over 18 years) left the bus company for reasons of poor health. The main conditions leading to disablement among drivers are related to cardiovascular diseases, and psychosomatic disorders. Psychological problems (fatigue, tension, mental overload) cancers, gastro intestinal, Sleeping problems, and Musculo-skeletal problems (lower part of the back, neck, shoulders, upper part of the back, knees).4-5

In terms of research interest, it was not until the middle of the 20th century when occupational health into urban bus drivers began. Studies have shown that there are marked health differences for urban bus driving compared to other occupations. Bus drivers were one of the professions with worst health, based on a range of health indicators (e.g., serum cholesterol levels, systolic blood pressure, body weight). More specifically, the literature indicates three salient categories of morbidity prominent in populations of bus drivers; cardiovascular disease, gastrointestinal disorders, and musculoskeletal problems.6

In conjunction with the bus operator’s seat, the position or placement of the seat in the operator’s workstation was also consideration. The heel reference point was used in placement of the seat within the operator’s cab. Placement of the seat should permit the full range of seat adjustments, unobstructed visibility out of the front windshield, and comfortable reach of the control and foot pedals.7

A working week does not normally exceed 40 hours and normal daily hours of work are eight. In many countries, bus drivers work less hours since they work part time. On the other hand, many drivers work longer. Working weeks and working days, particularly in developing countries. These longer working weeks often lead to insufficient opportunities for recovery and unwinding. In addition to normal working hours, bus drivers may work overtime. This might lead to a long working week exceeding, in practice, the official working week.4

Numerous studies have been conducted on the occupational health of bus drivers.4 Most of them have focused on the musculoskeletal disorders in bus drivers in foreign countries.6 But since the cause of musculoskeletal disorders vary according to bus drivers and there exist a difference in working schedules and working hours,1-2 ergonomics factors,4-7 conditions of road,8-9 safety measures used in transportation,10 between bus drivers of India and other countries, so there is a need for this study to be done on prevalence of musculoskeletal disorders among bus drivers in India. This will help to plan rehabilitation for prevalent musculoskeletal disorders which will ultimately preventing absenteeism among bus drivers.



Research question:

Is there any prevalence of musculoskeletal disorders among bus drivers in Bangalore or not?












    1. Review of Literatures:

Review on prevalence of musculoskeletal disorders:

Amod Borle, Sandeep Gunjal, et al (2012) To study prevalence and pattern of musculoskeletal morbidities amongst M.S.R.T.C. bus drivers and to study some epidemiological factors related with these morbidities. Commonest morbidity was backache present in 340 (58.5%) study subjects, followed by joint pain among 268 (46.1%) and commonest site being lower back in 318 (85%). Musculoskeletal discomfort was found significantly related with age, duration of service, daily average driving (km) and duration of driving (hrs/wk). It was also significantly higher in study subjects with BMI - 30 kg/m2. Musculoskeletal discomfort increased significantly with increase in age, duration of service, daily average driving.11

Vishwas madaan and Amit chaudhari (2012) the aim of this study was determine the prevalence and associated risk factors for development of musculoskeletal pain among dental students. And they concluded that maximum pain was observed in the hand (92 %) followed by wrist (85 %) and lower back (72 %). 12

Vytautas Obelenis, Daiva Gedgaudienė et all (2003) conducted a study to find the Working conditions and health of the employees of public bus and trolleybus transport in Lithuania and they found that thirty one percent of the auto-transport employees had complaints about their health. Functional complaints about musculoskeletal (46.2%), respiratory (22.7%), gastrointestinal (17.3%), and the central nervous system dysfunction (32.7%) were prevailing.3

Review on work related musculoskeletal disorders:

Barbara A. Silverstein, Diana S. Stetson et al (1997) conducted a study to find work related musculoskeletal disorders and they concluded that symptoms questionnaires and checklist based hazard surveillance are feasible within the context of joint labour management ergonomics programs and are more sensitive indicators of ergonomic problems than pre-existing data sources.13

Review on Symptoms of musculoskeletal disorders:

N J Mansfield,J M Marshall (2001) To investigate by a questionnaire study the prevalence of symptoms of musculoskeletal injuries after rallying in 13 professional and 105 amateur stage rally competitors. They concluded that Almost a fifth (18%) reported “considerable pain” in at least one area, most commonly the lumbar spine (8%), cervical spine (7%), and shoulders (4%). One of the professional participants (FIA World Rally Championship co-driver) reported considerable pain in his neck after participation in rallies.14

Review on work related musculoskeletal disorders among drivers:

Onawumi A. Samuel1 & Lucas E. Babajide2 (2012) conducted a study to find the prevalence of work related musculoskeletal disorder among occupational taxicabs drivers in Nigeria and they found that Significant prevalence of WRMD reported among respondents on the four body segments are located at the neck(67%), right and left wrists(18%, 20%), upper, middle and lower back (29%, 29%, 30%), and buttock (19%) of the operators.15

Nasrin Sadeghi1 and Ehsanollah Habibi2 et al (2012) study investigated the relationship between body dimensions of drivers and the form of this type of disorders. This study showed that drivers' MSDs are related to their height, weight and age. In other words, the high weight and age increases the probability of MSDs; while the height of drivers appeared to be negatively associated. It seems reaching the steering wheel results in back and neck pain; therefore, taller individuals spend lower energy in their body for reaching to steering wheel. Finally, it is better; we select those who are tall, young, fit and healthy for driving jobs.16

Jadhav Abhijeet Vasant (2012) conducted a study to find the prevalence of backache among bus drivers and associated modifiable risk factors in latur and concluded that the profession of driving was found to be associated with LBP. Prevalence of neck pain and most of the suspected risk factors was also higher among drivers. No association was found between most of the newly proposed risk factors and LBP. Drivers did seek health care for LBP but had lesser time at their disposal for recovery.17

Deborah Alperovitch and Yova Santo et al (2010) conducted a study to find a relationship between low back pain among professional bus drivers and they concluded that work related ergonomic and psychological factors showed a significant association with LBP in Israeli professional urban bus drivers.18

Szeto GP and Lam P (2007) conducted a study to find work related musculoskeletal disorders in urban bus drivers of hong kong and they found that generally the male drivers had longer years of work experience but their daily workloads were similar to the females. On the average drivers worked 9-10 h per day, with 5 days on and 1 day off. Neck, back, shoulder and knee/thigh areas had the highest 12-month prevalence rates ranging from 35% to 60%, and about 90% of the discomfort was related to bus-driving. Occupational factors of prolonged sitting and anthropometric mismatch were perceived to be most related to musculoskeletal discomfort.19

Gourdeau P (1997) conducted a study to find the prevalence of neck and shoulder musculoskeletal disorders in school bus drivers and concluded that school bus drivers had more health problems to the neck and shoulders than are found in the general population.20

Martin J M Robb and Neil J Mansfield conducted a study to find self reported musculoskeletal problems amongst professional drivers. They found that Most of the respondents (81%) reported some musculoskeletal pain during the previous 12 months, and 60% reported low back pain. Contrary to expectations, vibration exposures were significantly lower among those who suffered musculoskeletal symptoms when distance was used as an exposure measure. Manual handling and subjective ratings of seat discomfort were associated with reported musculoskeletal problems.21

Review on risk factors of musculoskeletal disorders:

Shyamal Koley, Lalit Sharma et al (2010) conducted a study to find the effect of occupational exposure to whole body vibration in tractor drivers with low back pain in Punjab and they concluded that the age of the tractor drivers and the duration of exposure to their whole body vibrations have some close associations with the occurrence of low back pain. Tractor drivers of higher age groups (31-40 years and above) and with the duration of at least 11- 15 years of exposure to vibrations have been reported to be more prone for low back pain.22

Bruno R. da Costa and Edgar Ramos Vieira,(2009) This systematic review was designed and conducted in an effort to evaluate the evidence currently available for the many suggested risk factors for work-related musculoskeletal disorders and concluded that risk factors with at least reasonable evidence of a causal relationship for the development of work-related musculoskeletal disorders include: heavy physical work, smoking, high body mass index, high psychosocial work demands, and the presence of co-morbidities. The most commonly reported biomechanical risk factors with at least reasonable evidence for causing WMSD include excessive repetition, awkward postures, and heavy lifting.23

Anker Jensen · Linda Kaerlev · Finn Tüchsen et al (2007) High risks for loco motor diseases have been reported for bus and truck drivers in general; however, little is known about the specific risks of long-haul truck drivers. and they concluded that all groups of professional drivers experience high risk of various disorders of the loco motor system but type of vehicle and specific working conditions are associated with different health effects on the loco motor system.24

A E Dembe, J B Erickson et al (2005) To analyse the impact of overtime and extended working hours on the risk of occupational injuries and illnesses among a nationally representative sample of working adults from the United States. Working in jobs with overtime schedules was associated with a 61% higher injury hazard rate compared to jobs without overtime. Working at least 12 hours per day was associated with a 37% increased hazard rate and working at least 60 hours per week was associated with a 23% increased hazard rate. A strong dose-response effect was observed, with the injury rate (per 100 accumulated worker-years in a particular schedule) increasing in correspondence to the number of hours per day (or per week) in the workers’ customary schedule.25

Review on standardized Nordic questionnaires:

I. Kuorinka , B. Jonsson et al (1987) conducted a study on the standardised Nordic Questionnaires for the analysis of musculoskeletal symptoms; a study of reliability and validity. Test retest reliability conducted on 29 safety engineers , one on 17 medical secretaries and one on 22 railway maintenance workers and showed that the number of non identical answers varied from 0 to 23 %. Validity test was conducted one on 19 medical secretaries and one on 20 railways maintenance workers and showed that numbers of non identical answers varied from 0 to 20 %. 26

6.3 Objectives of the Study:

  1. To find out the prevalence of musculoskeletal disorders among bus drivers and to find out the association of the musculoskeletal disorders with the base line characteristics of Bus drivers.

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Material and methods:

7.1 Source of Data:
  • Karnataka State Road Transport Corporation (KSRTC) , Bus depot, Bangalore.





    1. Methods of Collection of Data:

  • Population : Bus drivers

  • Sample design : Convenience sampling

  • Sample size : 500

  • Study design : Cross-sectional Study design.

  • Duration of study : 6 months.



Inclusion Criteria:

  • Non A-C bus drivers

  • Age group between 35-55 years

  • Actively in the profession for at least 3 years.

  • Male gender.

Exclusion Criteria:

  • History of recent orthopedics injuries.

  • Cardiovascular or respiratory problem.

  • Non co-operative subjects.

Methodology:

Informed consent will be taken from the subjects followed by screening for inclusion and exclusion criteria. Demographic data consisting of name of the subject, age, gender, occupation- how many hours does he work , the nature of the work and his experience as a bus driver, contact address, phone number, mail address, will be collected from the subject. The standardized Nordic questionnaire (enclosed) will be implicated to the subjects. The questionnaire will be distributed to the selected population and will be filled by the selected subjects themselves. Subjects have to fill the questionnaire and from the completed questionnaire the data will be collected to retrieve information about the prevalence of musculoskeletal disorders. On the basis of data retrieved from the above questionnaire, the prevalence rates of musculoskeletal disorders in bus drivers will be interpreted.



Outcome measure :

  • Standardized Nordic Questionnaire.

Statistical Analysis:

  • Descriptive Statistics: Range, Mean and Standard Deviation (SD) will be used to assess the musculoskeletal disorders.

  • Frequency and percentage will be used to assess the prevalence of musculoskeletal disorders.

  • Inferential Statistics:

  • Chi square test will be used to find out the association of the musculoskeletal disorders with the base line characteristics of Bus drivers.




    1. Does the study require any investigation or interventions to be conducted on patients or other humans or animals? If so, please describe briefly.

Yes, the study will be carried out on human subjects. To find out the prevalence of musculoskeletal disorders among bus drivers and to find out the association of the musculoskeletal disorders with the base line characteristics of Bus drivers of age group 35 -55 years.


    1. Has the ethical clearance been obtained from your institution in case of 7.3?

Yes, ethical clearance has been obtained from the institution. As this study includes human subjects, ethical clearance for the study has been obtained from the institutional ethical committee, Padmashree Institute Of Physiotherapy & concerned hospitals in Bangalore, as per the ethical guidelines for biomedical research on human subjects, 2000.ICMR, New Delhi.


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List of References:

  1. National academy of sciences Work related musculoskeletal disorders: A Review of the Evidence.1998 .

  2. David J. Magee, James E. Zachazewski and Williams S. Quilen. Pathology and intervention in musculoskeletal rehabilitation.2009.

  3. Vytautas Obelenis, DaivaGedgaudiene. Working condition and health of the employees of public bus and trolleybus transporter in Lithuania. Medicina. 2003; 39(11): 1103-1109.

  4. Professor M.A.J. Kompier.. Bus drivers: Occupational stress and stress prevention. Working paper. 1996; 2: 4-6.

  5. John Whitelegg. Health of professional drivers. A report for transport & General workers Union. 1995.

  6. John L.M., Rhona Flin, Kathryn mearns. Bus driver well- being review : 50 years of research. Transportation research part. 2006: 89–114.

  7. Harry saporta. Durable ergonomic Seating For Urban Bus operators. OSHA. 2000.

  8. Sanjay K. Singh. Review of Urban Transportation in India. Journal of Public Transportation. 2005; 8(1): 79-98.

  9. Shamsul Bahri Mohd Tamrin, Kazuhito Yokoyama, Juliana Jalaludin, Nasaruddin Abdul Aziz, Nizam Jemoin, Rusli Nordin, Ayub Li Naing,Yunus Abdullah and Mazlan Abdullah. The Association between Risk Factors and Low Back Pain among Commercial Vehicle Drivers in Peninsular Malaysia: A Preliminary Result. Industrial health 2007; 45: 268–278.

  10. T .C Fai1,2, F. Delbressine and M. Rauterberg. Vehicle seat design: state of the art and recent development. Federation of engineering institutions of islamic countries . 2007; 978-983.

  11. Amod Borle, Sandeep Gunjal, Ashok Jadhao, Suresh Ughade, Arun Humne. Musculoskeletal morbidities among bus drivers in city of Central India. nternational Journal of Recent Trends in Science And Technology. 2012; 3(1): 29-32.

  12. Vishwas madaan and Amit Chaudhari. Prevalence and risk factors associated with musculoakeletal pain among students of MGM dental college: A cross sectional survey. Journal of contemporary dentisty. May-august 2012; 2(2): 22-27.

  13. Barbara A. Silverstein, Diana S. Stetson, W. Monroe Keyserling, , and Lawrence J. Fine. Work-Related Musculoskeletal Disorders: Comparison of Data Sources for Surveillance. American journal of industrial medicine. 1997; 31: 600–608.

  14. N J Mansfield and J M Marshall. Symptoms of musculoskeletal disorders in stage rally drivers and co-drivers. British journal of sports medicine. 2001; 35: 314-320.

  15. Onawumi A. Samuel1 & Lucas E. Babajide. The prevalence of work related musculoskeletal disorders among occupational taxicabs drivers in Nigeria. IJRRAS. June 2012; 11(3); 561-567.

  16. Nasrin sadeghi, Eshanollah Habibi and Seyed Ali Sajjadi. The relationship between musculoskeletal disorders and anthropometric indices in public vehicle drivers. International Journal of Collaborative Research on Internal Medicine & public health. 2012; 4 (6): 1173-1184 .

  17. Jadhav Abhijeet vasant. Prevalence of backache among bus drivers and associated modifiable risk factors in Latur , Maharashtra. Working paper. May 2012; 14. .

  18. Deborah Alperovitch , Youssef Masharwi and Michal Katz. Low Back Pain among Professional Bus Drivers:Ergonomic and Occupational-Psychosocial Risk Factors. IMAJ. January 2010; 12: 26-31.

  19. Szeto GP and Lam P. Work-related musculoskeletal disorders in urban bus drivers of Hong Kong. Journal of occupational rehabilitation. June 2007 ;17(2): 181-98.

  20. Gourdeau P. Study of the prevalence of neck and shoulder musculoskeletal disorders in school bus drivers. Can J Public health. Jul-Aug 1997; 88(4): 271-274.

  21. Martin J M Robb and Neil J Mansfield. Self reported musculoskeletal problems amongst professional truck drivers. Submitted to loughborough’s Institutional repository.

  22. Shyamal Koley, Lalit Sharma and Sukhpal Kaur. Effects of Occupational Exposure to Whole-Body Vibration in Tractor Drivers with Low Back Pain in Punjab. Anthropologist. 2010; 12(3): 183-187

  23. Bruno R. da Costa, and Edgar Ramos Vieira. Risk Factors for Work-Related Musculoskeletal Disorders: A Systematic Review of Recent Longitudinal Studies. American journal of industrial medicine, 2009.

  24. .Anker Jensen · Linda Kaerlev · Finn Tüchsen · Harald Hannerz · Søren Dahl · Per Sabro Nielsen and Jørn Olsen. Locomotor diseases among male long-haul truck drivers and other professional drivers. Interntional arch occupational environmental health. 2007; 270-274.

  25. A E Dembe, J B Erickson, R G Delbos, S M Banks. The impact of overtime and long work hours on occupational injuries and illnesses: new evidence from the United States. Occupational Environmental and Medicine. 2005; 62: 588–597.

  26. I.kuorinka, B. Jonsson, A. Kilbom and H.Vinterberg. stadarised Nordic questionnaires for the analysis of musculoskeletal symptoms. Applied ergonomics. 1987; 18(3): 233- 237.



































Standardized Nordic Questionnaire for Analysis of musculoskeletal Symptoms.26
Trouble with the locomotive organs


To be answered only by those who have had trouble




Have you at anytime during last 12 months Have you at anytime during last 12

had trouble ( ache, pain, discomforts) months been prevented from doing Have you had

your normal work (at home or away trouble at anytime

from home) because of the trouble? during last 7 days?

Neck
1 No 2 Yes 1 No 2 Yes 1 No 2 Yes

Shoulders
1 No 2 in the right shoulder

3 yes , in the left shoulder

4 yes, in both shoulders 1 No 2 Yes 1 No 2 Yes

Elbow
1 No 2 yes, in the right elbow



3 yes , in the left elbow

4 yes, in both elbow 1 No 2 Yes 1 No 2 Yes

Wrists/hands


1 No 2 yes, in right wrist/hand

3 yes, in left wrist/hand

4 yes, in both wrists/hands 1 No 2 Yes 1 No 2 Yes

Upper back


1 No 2 Yes 1 No 2 Yes 1 No 2 Yes

Low back (small of the back)


1 No 2 Yes 1 No 2 Yes 1 No 2 Yes
One or both hips/ thighs
1 No 2 Yes 1 No 2 Yes 1 No 2 Yes

One or both knees


1 No 2 Yes 1 No 2 Yes 1 No 2 Yes

One or both ankles/feet


1 No 2 Yes 1 No 2 Yes 1 No 2 Yes





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