The Relation between Sitting Duration and Suspected Hernia

Nucleus Pulposus among Cardboard Factory Workers in Tangerang

Christian Shiady, Tjie Haming Setiadi

Department of Anatomy, Faculty of Medicine, University of Tarumanegara

Jakarta, Indonesia

Keywords: Bragard Test, Factory Workers, Hernia Nucleus Pulposus, Laseque Test, Low Back Pain.

Abstract: Low back pain (LBP) has been the leading cause of disability in the world. One of the most frequent is a

disease named hernia nucleus pulposus (HNP) that triggering the low back pain sensation. There are various

factors that lead to the occurrence of the disease. One of those is sitting in prolonged duration

(≥5hours)/day. This study aims to determine whether prolonged sitting duration influences the incidence of

hernia nucleus pulposus among the factory workers. The method of this study is analytical-cross sectional

and used non-random consecutive sampling. The study was in Tangerang city, on March 2019. There were

75 factory workers, each subject underwent the Laseque and Bragard test to assess for suspicion of hernia

nucleus pulposus. 48 respondents were categorized as those who sit in prolonged duration and 27

respondents were categorized as those who sit in normal duration. Nine people were suspected of having the

hernia nucleus pulposus, seven of which admitted having prolonged sitting duration, while the remaining

two sit in a normal period (p= 0.48) by Fischer test. The prevalence ratio was 2.11 (confidence interval

95%). Prolonged sitting duration has no correlation with suspected HNP, but has 2.11 times higher risk to

LBP.

1 INTRODUCTION

A WHO study in “The Global Burden of Disease

2010 Study” stated that it was difficult to estimate

the incidence of low back pain because its first

episode was already high even in young adults. Data

from the study showed that the prevalence of low

back pain ranged between 15% to 45% in general,

even reaching 60% to 70% in industrial countries

(Duthey, 2013). When compared to the previous

study in 1990, the rate of low back pain had

increased by 22%, which means low back pain has

become a serious problem that hasn’t been resolved

totally(Driscoll et al, 2014).

A study in Central Java,

Indonesia conducted by Herry Koesyanto found that

the prevalence of low back pain among Indonesian

factory workers ranged between 7.6% to 37%,

indicating a high rate of low back pain in industrial

sector such as Jabodetabek (Koesyanto, 2013).

Because of Indonesia’s high working hours, as

well as the lack of data about the incidence of hernia

nucleus pulposus in Jabodetabek, thus this study was

conducted to determine the relation between

prolonged sitting on suspected hernia nucleus

pulposus.

2 METHODS

This study is an analytical study with cross-sectional

approach and was done in March – April 2019. The

number of samples were 75 factory workers of PT.

Perdana Mega Jaya, which were collected using

non-random consecutive sampling method. The

inclusion criteria are employees aged between 18 to

65 years old, had been working for at least 6 months,

and were willing to be a respondent. The exclusion

criteria are pregnant women, having a spinal disease

or other diseases related to the spine. The

examination includes short interview and physical

examination using the combination of Laseque and

Bragard test. The independent variable of this study

is the duration of sitting which is categorized as long

(≥5 hours) and not long (<5 hours) and the

Shiady, C. and Setiadi, T.

The Relation between Sitting Duration and Suspected Hernia Nucleus Pulposus among Cardboard Factory Workers in Tangerang.

DOI: 10.5220/0009089402810284

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 281-284

ISBN: 978-989-758-409-1

281

dependent variable is the suspicion of having hernia

nucleus pulposus based on the physical examination.

The result was processed using chi-square/fisher

statistical test in free trial SPSS 25

version.

3 RESULTS

Table 1: Respondents’ characteristics.

Characteristi

Frequency

(%)

Mean

± DS

Media

n(Min;

Max)

Sex

Male 66 (88%)

Female 9 (12%)

Age (years)

≤ 25 20 (26.67%)

33.37

11.26

(18;

60)

26-45 41 (54.67%)

> 45 14 (18.67%)

Weight (kg)

59.11

9.01

(41;

91)

Height (cm)

165.4

6.76

165

(145;

185)

BMI (kg/m

)

< 18.5 10 (13.33%)

21.61

2.97

21.30

(14.69;

29.71)

18.5-22.9 41 (54.67%)

23.0-24.9 13 (17.33%)

≥ 25.0 11 (14.67%)

History of

LBP

Yes 36 (48%)

No 39 (52%)

Total 75 (100%)

From all 75 subjects, the most common

characteristics are male, aged 26 – 45 years old with

59.1 kg average weight and 165.4 cm average

height, BMI of 18.5-22,9 kg/m

, and most of them

didn’t have history of low back pain.

Table 2: Sitting Duration.

Sitting Duration

(hours/day)

Frequency

(n)

Percentage

(%)

1-2 13 17.33

3-4 14 18.67

5-6 21 28.00

7-8 16 21.33

> 8 11 14.67

Table 3: Interpretation of Sitting Duration.

Category

Frequency

(n)

Percentage

(%)

Normal 27 36

Prolonged 48 64

Total 75 100

There were 5 groups of sitting duration with

distribution such as 13 subjects sit for 1-2 hours/day,

14 subjects sit for 3-4 hours/day, 21 subjects sit for

5-6 hours/day, 16 subjects sit for 7-8 hours/day, and

11 subjects sit for more than 8 hours/day. From the

data, we can conclude that 27 subjects sit in normal

duration while 48 others sit in prolonged duration.

Table 4: Physical Examination Result.

Physical

Examination

Frequency (n)

Percentage

(%)

Lasegue test

Positive 18 24

Negative 57 76

Bragard test

Positive 9 12

Negative 66 88

Table 5: Interpretation of Physical Examination.

Frequency (n)

Percentage

(%)

Normal 66 88

Suspected HNP 9 12

Total 75 100

According to the physical examination which

consisted of laseque and bragard tests, there were 66

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

Medicine and Rehabilitation Association

282

(88%) subjects that were classified as normal and 9 (12%) subjects were suspected to have HNP.

Table 6: Relation between Sitting Duration and Suspicion of HNP.

Interpretation of

Sitting Duration

Suspected

HNP (%)

Normal (%) Total p PR

CI 95%

Lower Upper

Prolonged 7 (9.33%) 41 (54.67%) 48

0.48 2.11 0.74 4.50

Normal 2 (2.67%) 25 (33.33%) 27

Total

9 66 75

From the table above, the p value which is

computed by using fisher statistic test in SPSS is

0.48 with prevalence risk >1 and 95% confidence

interval.

From 75 respondents who are employees of the

cardboard factory PT. Perdana Mega Jaya in

Tangerang city, there were 48 (64%) respondents

with prolonged sitting duration and 27 (36%)

respondents with normal sitting duration. The results

showed that of nine people suspected of hernia

nucleus pulposus, seven (9.33%) were respondents

who belonged to prolonged sitting duration group,

while two (2.67%) respondents belonged to normal

sitting duration group. Although the prevalence was

higher in the group of respondents whose duration of

sitting was long, but through Fisher's calculation, the

p value showed a value of 0.48 so that the difference

could be considered insignificant because it

exceeded the 0.05 limit.

4 DISCUSSION

Based on data from the results on 75 respondents at

PT. Perdana Mega Jaya, Tangerang, on March 23

and 30, 2019, we found 9 out of 75 (12%)

respondents had a physical examination showing a

suspicion of nucleus pulposus hernia. All

respondents were divided into 3 age groups which

are younger than or equal to 25 years old, 26-45

years old, and older than 45 years. Of the 9

respondents suspected of nucleus pulposus hernia, 2

respondents belonged to the age group of younger

than 25 years old, 6 respondents belonged to the age

group 26-45 years old, and 1 respondent belonged to

the age group of older than 45 years old. If each of

the respondents whose results showed a suspicion of

hernias nucleus pulposus being held against their

respective age groups, the results of the age group of

26-45 years were the peak of this suspected nucleus

pulposus hernia with a prevalence of 14.63%. The

results of this study are in accordance with Gopal et

Mahaldevan's research in 2015 which stated that the

peak incidence of nucleus pulposus hernia is in the

age range of 26-45 years old (Gopal and

Mahadevan, 2015).

From the data from the study of 75 respondents,

9 subjects were suspected of having a nucleus

pulposus hernia. The nine subjects if grouped by

body mass index were spread into 1 person out of 10

respondents classified as underweight (10%), 6

people from 41 respondents who were classified as

normal (14.63%), 1 person from 13 respondents

classified as overweight (7.69%), and 1 person from

11 respondents classified as obese (9.09%). This is

consistent with the research conducted by Kanayama

et al., Who said that body mass index did not

significantly influence the incidence of herniation in

the nucleus pulposus (Kanayama et al, 2009).

Based on research data based on a short

questionnaire and the results of physical

examinations conducted at PT. Perdana Mega Jaya,

Tangerang, found that 66 respondents consisting of

41 respondents with a long duration of sitting and 25

respondents with a short duration of sitting did not

show any abnormality or suspected nucleus pulposus

hernia, or in other words normal. However, there

were also nine respondents consisting of seven

respondents with a long duration of sitting and two

respondents with a short duration of sitting who

showed suspicion of nucleus pulposus hernia based

on a series of physical examinations that had been

carried out. Based on fisher's test, p value is 0.48

which means that the relationship between duration

of sitting and the incidence of nucleus pulposus

hernia is not significant. Obtained prevalence ratio

2.11 with 95% confidence interval.

The Relation between Sitting Duration and Suspected Hernia Nucleus Pulposus among Cardboard Factory Workers in Tangerang

283

The final results of this study are in accordance

with Billy et al.'s research which examined the

effects of prolonged sitting on the structure of the

spinal joints that might cause lower back pain. Billy

et al.'s research states that sitting for more than four

hours is not significant in changing the anatomical

structure of the spinal joints so that it does not cause

a sensation of lower back pain but may affect the

progression of lower back pain that has occurred or

will occur in the future (Billy et al, 2014).

5 CONCLUSSION

There were no association between sitting duration

and suspected HNP among cupboard factory in

Tangerang..

SUGGESTION

Many factors have not examined such as smoking,

exercise, and sitting position that is good or not

appropriate In addition, ergonomics and work safety

must always be upheld both in research institutions

and in other workplaces, even applied in all aspects

of life to maintain the body's condition to avoid the

risk of lower back pain due to the nucleus pulposus

hernia. As for if the reader wants to do a similar

study, the writer suggests paying attention to what

confounders have been described by the author in

the previous chapter. Finally, the most important

thing that readers and writers can do is provide

education about the subject matter of this research to

the public so that the principle of work safety is

more concerned for the creation of a safe and secure

work environment for the welfare of workers in

Indonesia.

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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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