Relationship between Neck Pain and Quality of Life among Specialist

Residents: A Cross-sectional Study

A. S. Gandra and Murdana Nyoman

Department of Physical Medicine and Rehabilitation, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine,

University of Indonesia, Jakarta, Indonesia

Keywords: Neck Pain, Quality of Life (QoL), Physiatrist.

Abstract: Residents were faced with stress, learning problems, long training hours in hospital wards and clinics; and

also increasing use of computers in teaching and learning, during residency period. This become risk factor

that could increase the prevalence of neck pain (NP) among residents. Since prolonged use of computers

during daily work and leisure activities is often cited as a cause of neck pain, it can also influence resident

work performance and reduce quality of life (QoL). The aim of this study is to examine the relationship

between NP and QoL in Residents. A cross-sectional based daring questionnaire survey using Neck

Disability Index (NDI) and QoL SF-36 to Resident of Physical Medicine and Rehabilitation in Jakarta.

There was 51 subjects, the frequency of NP was 46(90,2%), there were a moderate correlation between NDI

and SF -36 in domain of physical health (PH) (r=-0,436,p<0,01), energy/fatique (EF) (r=-0,409,p<0,01), and

pain (P) (r=-0,689, p<0,01). There was a correlation between NP and QoL in domain of PH, EF, and P.

1 INTRODUCTION

The aim of medical school is to produce competent,

professional doctors and promote public health care.

But during the medical training period, faced with

stress, learning problems, long training hours in

hospital wards and clinics; in addition to the

increasing use of computers in teaching and

learning. thus it is considered a risk factor that can

increase the prevalence of musculoskeletal pain

among medical students (Alshagga et al., 2013).

Musculoskeletal pain has become a major

problem worldwide, and includes a variety of

musculoskeletal tissue injuries, some of which are

work related. Neck pain has a chronic course that

recurs with more than one third of the population

suffering persistent neck pain every year. Findings

from a cross-sectional analysis from the

Saskatchewan Health and Back Pain Survey show

that neck pain has a weak relationship to the low

quality of life from the physical side and is not

related to the quality of life from the mental side.

However, it is still unclear whether neck pain is a

risk factor or a low outcome of quality of life (Nolet

et al., 2015).

Nowadays, laptops are so useful, fast and

powerful that they often replace desktop computers

and bring many benefits to students. Some postures

lie on the floor, use desks that are not designed for

computers, and place laptops on someone's lap.

Prolonged use of computers during daily work and

leisure activities is often cited as a cause of neck

pain. Prolonged use of the computer and sitting with

rounded shoulders and wrong neck posture disturbs

the normal lordotic curve of the neck which causes

muscle imbalance and consequently neck pain.

Potential risk factors for this might increase

computer usage. High reports on computer use are

estimated among post-graduate students because

they carry out further education and require report

writing and research to complete the master's

program (Monika and Rana, 2017; Yakshi Bhardwaj

and Mahajan, 2017).

Computers increase productivity and work

efficiency, but, on the other hand, using it

excessively can cause terminal syndromes of visual

appearance, accompanied by complaints of muscle

aches, vision problems, headaches, and other

symptoms. Among these complaints,

musculoskeletal problems are the most common

(Kang et al., 2012).

Gandra, A. and Nyoman, M.

Relationship between Neck Pain and Quality of Life among Specialist Residents: A Cross-sectional Study.

DOI: 10.5220/0009061400120015

In Proceedings of the 11th National Congress and the 18th Annual Scientiﬁc Meeting of Indonesian Physical Medicine and Rehabilitation Association (KONAS XI and PIT XVIII PERDOSRI

2019), pages 12-15

ISBN: 978-989-758-409-1

Neck disorders associated with musculoskeletal

pain include tension neck syndrome and trapezius

myalgia and often occur in jobs that require

recurrent and repeated submaximal energy by the

neck muscles, for example, computer workers,

sewing machine operators, and dentists. On the other

hand, disorders related to disc degenerative diseases

mainly include disorders of the cervical spine and

related to work involved in physically demanding

work activities, for example, health workers,

construction work, agricultural work, and manual

material handling (Sun et al., 2017).

While seated, the position of the front head

includes flexion of the lower cervical area, extension

of the upper cervical area, and round shoulders,

which on average reduces the length of muscle

fibers, producing extensor torque around the joints

of the upper cervical region. This abnormal

condition produces musculoskeletal abnormalities

which include decreased upward rotation of the

scapular, greater internal rotation and anterior tilt,

resulting in difficulty in maintaining an upright

sitting posture. This is known as Forward head

posture (Turtle neck posture). This posture is

becoming increasingly common because those who

are exposed to the screen monitor are leaning

forward, especially on smart phones (Kang et al.,

2012; Mubeen, 2016).

A study at a Malaysian medical college found

that 65% of students experienced bone muscle pain

in the past year and reported an association with

clinical years, computer use, and previous trauma

history (Jerry Y et al., 2017). In the Bodwal et al.

Study, it was found that students often suffer from

various musculoskeletal health problems such as

pain or discomfort in the neck (69.3%), shoulders

(22%), wrists, hands and fingers (27.3%) while very

few students experience pain in the forearm (7.3%)

and elbows (6.7)%) after using a laptop (Monika and

Rana, 2017). In the Bhardwaj and Mahajan study,

obtained from 500 students, the Neck Disability

Index score was: there were no disabilities in 171

(34.2%) students and disabilities in 329 (65.8%)

students, where the prevalence of disability due to

neck pain was 65, 8% (Yakshi Bhardwaj and

Mahajan, 2017). In the study of Knudsen et al by

questionnaire on Orthopedic residents, it was found

that the most common symptoms were in the neck

(59%, 19/32), lower back (55%, 17/31), upper back

(35%, 11/31) , and shoulders (34%, 11/32).

The most common complaints are characterized

by pain and stiffness in the neck and lower back,

followed by pain and stiffness in the upper back and

shoulders (Knudsen et al., n.d.). The purpose of this

survey study is to look at the relationship between

the value of disability neck pain with quality of life.

We are hypothesize that there is a relationship

between neck pain disability with quality of life

among specialist residents.

2 METHODS

This study used daring cross-sectional survey

questionnaire. The target population is residents of

Physical Medicine and Rehabilitation at the Faculty

of Medicine, University of Indonesia.

Inclusion criteria: 1)Resident of physical

medicine and rehabilitation at the Faculty of

Medicine, University of Indonesia; 2)Men and

Women; 3)Understand English; 4)Cooperative and

willing to follow research. Exclusion Criterias are:

1)Non Residents of Physical Medicine and

Rehabilitation: 2)In medical treatment;

3)Depression; 4)Have a trauma history; 5)insomnia

history ;6)Official leave.

Screening and recruitment of subjects in the form

of:

 Subjects are given an explanation of the

benefits, objectives and research protocol.

 Data collection is done to get rid of exclusion

criteria.

 If the subject meets the criteria and is willing to

take part in the research or refuse to participate

in the research, fill out the online questionnaire

provided.

Questionnaire data collection are:

 Subject characteristics data: age, sex, education

level.

 Quality of life data by filling in the SF-36

form.

 Data on neck pain by filling in the Neck

Disability Index form.

2.1 Data Analysis

Subject data obtained were processed using SPSS

version 20. For the calculation of the value of the

Neck Disability Index numerical results were

obtained, and the calculation for the SF-36 value

used an application from Orthotoolkit.com/SF36

(Dr. Cathy Sherbourne, n.d.; Lins and Carvalho,

2016; Monica and California, n.d.). If the normal

distribution uses Pearson correlation and if the

distribution is not normal use the Spearman

correlation (Akoglu, 2018; Schober et al., 2018).

Relationship between Neck Pain and Quality of Life among Specialist Residents: A Cross-sectional Study

3 RESULTS

From the characteristics of the respondents in Table

1, it was found that filling in the questionnaire was

12 male respondents and 39 female respondents. The

average age of respondents who took the survey was

31 years old with a body mass index of 23.88 kg /

m2. Respondents who were married as many as 33

people and not married as many as 18 people. The

respondents who took part in the survey consisted of

a debriefing residency phase of 15 people, an

internship of 16 people and an independent of 20

people. The respondents also had a long time span of

using a laptop during education between under 3

hours by 5 people to more than 5 hours by 33

people, who had a neck pain experience of 46

people.

Table 1: Corespondent Characteristics.

Respondents 51

Male, n(%) 12(23,5)

Female, n(%) 39(76,5)

Age (years), median(min-max) 31(26-40)

BMI (kg/m2), median(min-max) 23,88(17,22-30,46)

Marital status, n(%)

Married 33(64,7)

Unmarried 18(35,3)

Residency Level, n(%)

Preparation 15(29,4)

Intership 16(31,4)

Independent 20(39,2)

Smoking, n(%)

Yes 1(2)

No 50(98)

Laptop user, n(%)

Yes 51(100)

No 0(0)

Laptopn screen time, n(%)

< 3 hours 5(9,8)

< 5 hours 13(25,5)

> 5 hours 33(64,7)

History of neck pain, n(%)

Yes 46(90,2)

No 5(9,8)

There were a weak correlation between the value

of NDI with the domain of physical functioning (r =

-0.277, p <0.05), emotional problem domain (r = -

0.342, p <0.05), emotional well-being domain (r = -

0.350, p < 0.05), social functioning domain (r = -

0.181, p> 0.05), general health domain (r = -0.156,

p> 0.05). While there were a moderate correlation

between the value of the neck disability index with

the physical health domain (r = -0,436, p <0.01),

energy / fatique domain (r = -0,409, p <0.01), pain

domain (r = -0,689, p <0.01) (table 2).

Table 2: Correlation between Neck Disability Index and

SF-36 Questionairre.

Domain SF-36

Neck Disability Index Score

Correlation

Coefficent

Sig (2-

tailed)

Physical Functioning -.277* .049

Role limitations due to

physical health

-.436** .001

Role limitations due to

emotional problems

-.342* .014

Energy/fatigue -.409** .003

Emotional well-being -.350* .012

Social functioning -. 181 .202

Pain -.689** .000

General health -.156 .276

*.Correlation is significant at the 0.05 level (2-tailed)

**.Correlation is significant at the 0.01 level (2-tailed)

4 DISCUSSIONS

From the characteristic results it was found that the

prevalence of women was 76.5%, according to the

study of Alshagga et al the majority were women

(72.9%) (Alshagga et al., 2013).

The results suggested a relationship between the

value of disability neck pain with quality of life and

the relationship was followed by a negative

correlation of weak-moderate. This is consistent

with the study of nolet, et al who also found an

association between neck pain and quality of life in

the future (Nolet et al., 2015). The prevalence of

neck pain experienced by residents due to laptop use

by 90.2% according to research Bodwal et al. Some

students reported neck pain due to incorrect sitting

position for hours, sleeping in the wrong position,

length of study, while traveling, constantly seeing at

whiteboard, use a high pillow and increased mental

pressure after using a laptop (Monika and Rana,

2017).

5 CONCLUSIONS

Our study has limitations which may be possible due

to the selection bias and the small amount of sample.

Therefore, the instrument may not fully capture the

impact of neck pain on some quality of life. Future

research needs to examine the course of neck pain

on quality of life while controlling for confounding

effects.

KONAS XI and PIT XVIII PERDOSRI 2019 - The 11th National Congress and The 18th Annual Scientiﬁc Meeting of Indonesian Physical

Medicine and Rehabilitation Association

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Relationship between Neck Pain and Quality of Life among Specialist Residents: A Cross-sectional Study