Examining the Effectiveness of Occupational Musculoskeletal Disorders Pre vention Education on A Health Center Employees’s Pain and Quality of Life

A musculoskeletal disorder is any disorder or injury affecting various parts of the body, including muscles, nerves, tendons, ligaments, joints, cartilage, and the spinal cord (1). Many health problems result from these risk factors, with one of the most significant being work-related musculoskeletal disorders, which are highly prevalent in both industrialized and developing countries. Statistics indicate that 150 million people are affected by these disorders (2). According to the World Health Organizationreport in 2022, the prevalence of musculoskeletal problems is increasing (3).This disease has imposed a growing burden on both developed and developing countries. There seems to be a direct relationship between musculoskeletal disorders and the resulting pain and inability to perform physical activities, leading to immobility, weakness, and a decreased sense of well-being (4). Physical and psycho-social stressors can cause musculoskeletal disorders. These factors include: working in inappropriate and static positions, handling objects manually, repetitive movements, high forces, and vibration, as well as psycho-social risk factors, such as anxiety, depression, high tensions, inadequate social support, ambiguity, role conflict, and low occupation security (4, 5).Given that a majority of individuals work in environments where both risk factors are likely to coexist, it becomes logical to address both factors concurrently and implement corresponding control measures for each. Consequently, interventions that concentrate on the simultaneous control or reduction of these risk factors are expected to be more effective in curtailing the proliferation of musculoskeletal issues compared to interventions targeting only one of these risk factors (6).These disorders are among industrialized and developing countries' biggest occupational health problems. Health centers are one of the work environments where people are at risk of occupational disease (7).In research conducted on employees of healthcare centers in the cities of Babol, Aqalari et al reported that the highest prevalence of disorders in the past year was observed in the lower back area (9.58%) followed by the neck area (1.54%). In the past 7 days, the highest prevalence was also reported in the lower back area (9.46%) and the neck area (9.44%). Furthermore, 25.7% and 15.5% of employees required medical and physiotherapy services, respectively, due to the presence of disorders in the past year. A significant correlation was observed between sitting at a desk for long hours and experiencing pain in the neck area (p=0.002) and pain in the knee area (p=0.049) (8). According to the information recorded by the United States Statistics Organization in 2014, about 32% of all  diseases were related to musculoskeletal disorders. Musculoskeletal disorders account for 7% of all illnesses in society, 14% of doctor's visits, and 19% of hospitalizations (9).According to the World Health Organization, quality of life is a comprehensive concept that includes physical health, psychological well-being, level of independence, social relationships, personal beliefs, and the individual's relationship with the environmental aspects they are in. Quality of life is the result of the interaction between the individual and the sustainable conditions, as well as situational events, changes, and unexpected occurrences in the person's living environment (10). Occupational health and mental health are promoted by establishing indicators of quality of life, and attention to this issue is essential in all organizations to prevent fatigue and low productivity. Nowadays, organizations consider their human resources valuable and strategically focus more than ever on improving employees' quality of life (11).Considering the high prevalence of musculoskeletal disorders in health workers, whose causes are related to the non-observance of health-oriented behaviors in various physical and psycho-social dimensions; the purpose of this study was to determine how education can affect their perception of pain and quality of life in order to prevent musculoskeletal disorders.

This study constitutes a quasi-experimental intervention conducted to assess the impact of an educational intervention on the prevalence of musculoskeletal disorders among health center employees in Varamin. The study involved both intervention and control groups and was carried out from March to December 2022. The study population was the employees of the Varamin health center, and the study samples were selected from among them. Varamin health center comprises nine comprehensive health centers, 19 health bases, and 24 health houses. Participants in the study were selected from a total of 371 force members of this center. The inclusion criteria for this study were as follows: 1) employment at the Varamin health center, 2) willingness to participate in the study. The exclusion criteria were: 1) unwillingness to engage in subsequent interventions and follow-ups, 2) presence of debilitating conditions such as chronic pain, muscular dystrophy, osteoarthritis, and others, and 3) pregnancy.The study subjects were chosen and enrolled in the research using a simple random sampling technique. This involved creating a list of employees and selecting desired individuals using a table of random numbers. Based on this list of names, individuals were then assigned randomly to either the control or intervention groups.The following formula was used to calculate the sample size of the intervention study, according to the study that Zahra et al. (13) had done in Saudi Arabia. The sample size of the study was 55 people.The data collection tool at this stage was the quality of life questionnaire and the Nordic questionnaire. The quality of life questionnaire had been translated into many countries, such as Iran (13). The questionnaire had eight subscales as follows: 1. Physical performance 2. Role performance limitation due to physical problems 3. Physical pain 4. General health 5. Vitality and cheerfulness 6. Social performance 7. Role performance limitation due to emotional problems and 8. mental health. The Nordic questionnaire had 11 variables that can be completed by self-report method or through an interview, which is the way to answer yes-no questions, which are nine areas of the body (3 areas for the upper limbs, three areas for the spine, three areas of the lower limb) are included.Upon receiving approval for the proposal and obtaining permission from the Research Vice-Chancellor of Shahid Beheshti University of Medical Sciences, as well as introducing the study to the Varamin city health center, the health center employees were systematically divided into two groups: an intervention group and a control group. This division was executed through a random process.In preparation for the study, a standardized questionnaire aimed at assessing the prevention of musculoskeletal disorders and quality of life was distributed to participating employees in person as a pre-test measure. Separate invitations were extended to the participants of each group, prompting them to convene in the health center conference room on distinct days. In the presence of the researcher, the employees completed the questionnaires during these sessions. In the second phase, educational intervention is carried out in accordance with the educational program and is based on the chapters on ergonomic principles, the performance of daily activities, required changes in the working environment, and activities in accordance with ergonomic principles approved by the Iranian Ministry of Health (14).  Also the educational program was prepared with the help of professional health experts from the health center and conducted personally for the intervention group. Six months after the intervention, two intervention and control groups were re-evaluated. Employees eligible to enter the study were randomly assigned to two groups. In the second stage, the intervention was designed according to the educational program and was conducted in person. The educational content was prepared by studying related texts and books approved by the World Health Organization. The educational content of this intervention was taught to the participants face-to-face in 4 sessions, each lasting 45 minutes. The researcher implemented the educational program, and the methods of lectures, questions and answers, and group discussions were used following the behavioral goals of each session. In addition, educational media such as video projectors, educational CDs, and booklets were used to implement the program. At the end of the educational intervention, the control group received the educational content in compliance with ethical principles.Data analysis using SPSS-22 software and descriptive statistical tests (including frequency, percentage of frequency, mean and standard deviation) and inferential in order to compare the difference between baseline values and six months after the intervention in each group from the Independent t-test was used to calculate the mean between two groups, paired sample t-test was used.

Overall, the results of this study showed that education alone does not have much effect on the quality of life of healthcare workers, and it can only have a brief effect on some dimensions of quality of life. Also, the results of this study regarding the existence of pain in different parts of the body of employees showed that ergonomic training could reduce the pain of different parts of the body to some extent. Suppose this training aligns with physical measures, including providing appropriate work tools such as chairs, tables, and footstools. Therefore, the positive effects of these interventions will be more significant. In order to improve the quality of life of employees, in addition to educational interventions, attention should also be paid to other aspects of employees' lives, including their economic, psychological, and social factors.