|Year : 2017 | Volume
| Issue : 2 | Page : 138-142
Prevalence and risk of musculoskeletal pain in rural homemakers of North India
Mili Mishra, Anup Kumar Srivastava, Vinod Kumar Srivastava
Department of Community Medicine, Hind Institute of Medical Sciences, Barabanki, Uttar Pradesh, India
|Date of Web Publication||14-Mar-2017|
Anup Kumar Srivastava
104, Rohtas Enclave, Ravindra Palli, Faizabad Road, Lucknow - 226 016, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Background: Musculoskeletal pain (MSP) is a well-known burden of disease and disability in all age groups and both sexes. There are very few reports regarding MSP in rural homemakers of North India. Objective: To assess the magnitude of MSP among rural homemakers and to identify its modifiable risk factors. Materials and Methods: A representative sample of 296 homemakers from rural areas of Barabanki district in Uttar Pradesh was studied. Details of MSP and its location; social, demographic information, height, and weight were recorded. A general clinical examination of each subject was also done to rule out any obvious underlying organic pathology and the findings were noted. Results: Prevalence of MSP among homemakers was found to be 40.9%. More than 60% of these could not be diagnosed without specialized investigations. Modifiable risk factors were identified. Conclusions: Parity, body mass index, use of nonsmoking tobacco, and per capita income were identified as modifiable risk factors in this population.
Keywords: Homemakers, modifiable risk factors, musculoskeletal pain, prevalence
|How to cite this article:|
Mishra M, Srivastava AK, Srivastava VK. Prevalence and risk of musculoskeletal pain in rural homemakers of North India. Med J DY Patil Univ 2017;10:138-42
|How to cite this URL:|
Mishra M, Srivastava AK, Srivastava VK. Prevalence and risk of musculoskeletal pain in rural homemakers of North India. Med J DY Patil Univ [serial online] 2017 [cited 2017 Sep 26];10:138-42. Available from: http://www.mjdrdypu.org/text.asp?2017/10/2/138/202092
| Introduction|| |
Musculoskeletal (MS) conditions affect more than 1.7 billion people worldwide and have the fourth greatest impact on the overall health of the world population, considering both death and disability. This burden has increased by 45% during the past 20 years and will continue to escalate unless action is taken. These cause considerable functional limitations in the adult population as compared to any other group of disorders. These are a significant cause of years lived with disability (YLDs) globally. Current estimates of people affected worldwide include back pain 632 million, neck pain 332 million, osteoarthritis of the knee 251 million, and other MS conditions 561 million. As a group, MS disorders cause 21.3% of all YLDs and are second only to mental/behavioral disorders that account for 22.7% of YLDs. Worldwide low back pain is leading cause of disability and contributes 10.7% of all YLDs. Low back pain (83.1 million YLDs), neck pain (33.6 million YLDs), and osteoarthritis (17.1 million YLDs) are chief causes of MS problems.
In general, women have more complex and stressful aging process as compared to men, due to hormonal changes that occur during menopausal transition. Menopause marks the end of female reproductive function and also makes them vulnerable to a new set of health problems such as cardiovascular diseases, and osteoporosis.
Aging is also associated with gait and balance problems. There is an increased risk for falls and subsequent injuries. Body weight, physical activity, and muscle strength are mechanical factors that determine the loads placed on the skeleton.
Personal and behavioral risk factors include increased age, female sex, increased weight, and lifestyle factors, such as tobacco smoking and physical activity, in addition to psychological factors that affect the MS system.,,,
The homemakers play an important role in nurturing the society. They perform a multitude of tasks that cause ergonomic stress and exhaustion of muscle groups that result in MS pain (MSP). The working, living and social architecture in rural areas differ from developed or urban area and the homemakers being the nucleus of the family are exposed to very different stress and their health impact. The present study was undertaken to assess the magnitude and identify modifiable risk factors for MSP among rural homemakers.
| Materials and Methods|| |
A cross-sectional study was conducted in the population living in eight villages of Sathrik block of Barabanki district in Uttar Pradesh from July to December 2015. The study population comprised full-time (not employed in any other job) homemakers in the age group 26–65 years. The sample size was calculated to be 222 considering an expected prevalence rate of 31.1% (MSP among homemakers), with relative precision of 20%. Multistage sampling was done to select the study participants.
A pretested questionnaire was used to collect personal and social details of each subject. Any history of MSP (pain arising from any part of body due to involvement of muscles, bone, joints, ligaments, or nerves) in last 7 days and its location (neck, shoulders, upper back, upper arms, lower back, forearms, wrists, hip/buttocks, thighs, knees, lower legs, and ankles) was noted. A general clinical examination of each subject was done to rule out any obvious underlying organic pathology. Weight was measured in minimal clothing on weighing machine with an accuracy of 100 g and height was measured using a stadiometer.
Ethical clearance was obtained from Institutional Human Ethical Committee of Hind Institute of Medical Sciences, Safedabad, Barabanki (Letter No. HIMS/IHPC/013/2014) before initiating the study. Informed consent in writing was obtained from each of the participants before enrolling them into the study.
The Statistical Package for the Social Sciences (SPSS) statistical software 17.0 for Windows (SPSS Inc., Chicago, Ill., USA) was used for data analysis. Homemakers who reported MSP were compared to those who did not have MSP.
A manual stepwise multiple logistic regression was used to find the most parsimonious model using the strategy of Habib et al. All variables that showed a significant association with the dependent variable in the bivariate analysis were used for logistic regression. Statistical significance was set at 5%. The adjusted odds ratios (OR) with 95% confidence intervals indicated the strength of the association between MSD and the independent variables.
| Results|| |
The mean age of women studied was 43.11 ± 11.87 years. More than 90% of the women were Hindu and married. More than half the females belonged to lower and lower middle class, illiterate, and lived in joint families. The salient demographic characteristics of the study population are summarized in [Table 1].
The prevalence of MSP was found to be 40.9% (121 homemakers). A definite organic pathology could be identified only in 48 (39.6%) subjects. The most common site for MSP was found to be ankles/feet (29.53%) followed by knees (25.59%) and low back (21.26%). The total sites of MSP reported by study subjects were 254, i.e., each homemaker with MSP had pain in 2.1 locations. [Figure 1] shows the location of MSP among study subjects.
Most of the women had MSP in one location (37.0%), and 34% of subjects had pain in two locations. Details about location of pain are shown in [Figure 2].
The adjusted OR of MSP obtained through multiple logistic regression showed a statistically significant association with age (46–55 years), body mass index (BMI), tobacco chewing, number of children and income [Table 2]. No association could be found with other variables such as education, fuel used, and separate kitchen.
| Discussion|| |
Our research focused on full-time, rural homemakers aged 25–65 years who were not engaged in any formal occupation. Gupta and Nandini reported that 83% nonworking rural homemakers of Kanpur suffered from low back pain. We found a much lower prevalence of MSP, which was similar to that reported by other investigators in rural areas of national capital region.,
This study was undertaken to identify risk factors of MSP among homemakers in rural areas. We found that age, parity, income, and tobacco chewing were associated with MSP. This was in consonance to the findings on the degeneration of physical function with increase in age and weight.,
This study confirms the association shown in previous research between the number of children and MSP. Women with children have been found to develop more neck and shoulder problems than single women with no children due to an increase in home strains. More dependents may lead to a decrease in women's leisure time and an increase in responsibilities and stress level, which could manifest as MSP.
Being overweight or obese puts extra weight on human muscles and thus increases the risk of MSP., A recent follow-up study showed that overweight and obesity increased the risk of widespread chronic MSP over a period of 11-year.
Whether excess body mass has a similar effect on risk of localized chronic pain in the low back or neck/shoulder is unknown as per another study. Several studies have reported higher prevalence of low back pain in menopausal middle aged women.,, Higher BMI was observed among homemakers with MSP as compared to no MSP group. This is similar to a study done in National Capital Region in India. MSP is also one of the most common reasons for seeking medical advice in Western societies.,
Pain in the neck/shoulder and pain in the low back constitute the majority of all MS disorders. Pain in lower back (10.7%) and upper back (7.9%) were commonly encountered among homemakers of National Capital region. Recent prevalence data from the Framingham Study reported that 29% of women reported foot pain on most days of the month, with the prevalence of pain at specific foot locations ranging from 7% to 13%. It is conjectured that the reason for high prevalence pain in ankle/feet observed in our study could be because of use of inappropriate and poorly designed footwear or ergonomic stress. Study of ergonomic and postural factors was not within the terms of reference of this study. It is a lead that deserves to be explored further.
Tobacco has been linked with several pain conditions that include MSP, rheumatoid arthritis, and fibromyalgia. To the best of our knowledge, tobacco chewing as modifiable risk factor for MSP in rural homemakers of India has been identified for the first time in this study.
Higher OR for MSP was found in subjects having an income of Rs. 1671–2785. However, the odds were quite small. This finding is similar to that reported by Reddy and Yasobant.
Nearly 60% of the people in India have significant back pain at some time or the other during their lives. Knowledge of the incidence of MS disorders and their burden is fundamental to any country's health-planning. As age advances, women tend to gain weight and an additional burden is placed on the lower back causing various types of disabilities including low back pain. The highest odds were observed in 46–55 years age group (OR 2.05), homemakers with >2 children (OR 76.62) as they have to work the maximum for their families.
| Conclusions|| |
More than 40% of homemakers from rural areas in this study suffer from MSP at an average of 2.1 locations in the body, and more than 60% of these had pain for which a simple clinical examination is not sufficient to diagnose the underlying pathology.
High parity, high BMI and use of nonsmoking tobacco were found to be modifiable risk factors. Restricting number of children to one or two, avoidance of tobacco, maintaining a BMI <24.9, and may yield substantial benefits in controlling MSP in this population.
Limitations of the study
The cross-sectional nature of our study did not permit inferences regarding causality between MSP and tobacco chewing. The postural and ergonomic stress on different muscle groups involved in housework has not been assessed for this study as these require skills and resources that were not available to us and was not within the terms of reference of the grant provided for this study.
Authors would like to thank Indian Association of Preventive and Social Medicine for providing Ford Foundation Epidemiological Research Grant. The authors acknowledge the help of Dr. Dhruv Agarwal and Dr. Nirpal Kaur in the field studies of this study.
Financial support and sponsorship
Financial support by Ford Foundation - IAPSM Epidemiological Research Grant.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Woolf AD, Akesson K. Understanding the burden of musculoskeletal conditions. The burden is huge and not reflected in national health priorities. BMJ 2001;322:1079-80.
Morrison JH, Brinton RD, Schmidt PJ, Gore AC. Estrogen, menopause, and the aging brain: How basic neuroscience can inform hormone therapy in women. J Neurosci 2006;26:10332-48.
Shakhatreh FM, Mas'ad D. Menopausal symptoms and health problems of women aged 50-65 years in southern Jordan. Climacteric 2006;9:305-11.
Bemben DA, Fetters NL, Bemben MG, Nabavi N, Koh ET. Musculoskeletal responses to high- and low-intensity resistance training in early postmenopausal women. Med Sci Sports Exerc 2000;32:1949-57.
Palmer KT, Syddall H, Cooper C, Coggon D. Smoking and musculoskeletal disorders: Findings from a British National Survey. Ann Rheum Dis 2003;62:33-6.
Cassou B, Derriennic F, Monfort C, Norton J, Touranchet A. Chronic neck and shoulder pain, age, and working conditions: Longitudinal results from a large random sample in France. Occup Environ Med 2002;59:537-44.
Malchaire JB, Roquelaure Y, Cock N, Piette A, Vergracht S, Chiron H. Musculoskeletal complaints, functional capacity, personality and psychosocial factors. Int Arch Occup Environ Health 2001;74:549-57.
Barnekow-Bergkvist M, Hedberg GE, Janlert U, Jansson E. Determinants of self-reported neck-shoulder and low back symptoms in a general population. Spine (Phila Pa 1976) 1998;23:235-43.
Bihari V, Kesavachandran CN, Mathur N, Pangtey BS, Kamal R, Pathak MK, et al.
Mathematically derived body volume and risk of musculoskeletal pain among housewives in North India. PLoS One 2013;8:e80133.
Gupta G, Nandini N. Prevalence of low back pain in non working rural housewives of Kanpur, India. Int J Occup Med Environ Health 2015;28:313-20.
Kuorinka I, Jonsson B, Kilbom A, Vinterberg H, Biering-Sørensen F, Andersson G, et al.
Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon 1987;18:233-7.
Habib RR, Hamdan M, Nuwayhid I, Odaymat F, Campbell OM. Musculoskeletal disorders among full-time homemakers in poor communities. Women Health 2005;42:1-14.
Mangal A, Kumar V, Panesar S, Talwar R, Raut D, Singh S. Updated BG Prasad socioeconomic classification, 2014: A commentary. Indian J Public Health 2015;59:42-4.
] [Full text]
Bihari V, Kesavachandran C, Pangtey BS, Srivastava AK, Mathur N. Musculoskeletal pain and its associated risk factors in residents of National Capital Region. Indian J Occup Environ Med 2011;15:59-63.
] [Full text]
Gunnarsdottir HK, Rafnsdottir BH, Helgadottir B, Tomasson K. Psychosocial risk factors for musculoskeletal symptoms among women working in geriatric care. Am J Ind Med 2003;44:679-84.
Guo HR, Chang YC, Yeh WY, Chen CW, Guo YL. Prevalence of musculoskeletal disorder among workers in Taiwan: A nationwide study. J Occup Health 2004;46:26-36.
Björkstén MG, Boquist B, Talbäck M, Edling C. Reported neck and shoulder problems in female industrial workers: The importance of factors at work and at home. Int J Ind Ergon 2001;27:159-70.
Fredriksson K, Alfredsson L, Köster M, Thorbjörnsson CB, Toomingas A, Torgén M, et al.
Risk factors for neck and upper limb disorders: Results from 24 years of follow up. Occup Environ Med 1999;56:59-66.
Peltonen M, Lindroos AK, Torgerson JS. Musculoskeletal pain in the obese: A comparison with a general population and long-term changes after conventional and surgical obesity treatment. Pain 2003;104:549-57.
Mork PJ, Vasseljen O, Nilsen TI. Association between physical exercise, body mass index, and risk of fibromyalgia: Longitudinal data from the Norwegian Nord-Trøndelag Health Study. Arthritis Care Res (Hoboken) 2010;62:611-7.
Nilsen TI, Holtermann A, Mork PJ. Physical exercise, body mass index, and risk of chronic pain in the low back and neck/shoulders: Longitudinal data from the Nord-Trondelag Health Study. Am J Epidemiol 2011;174:267-73.
Adera T, Deyo RA, Donatelle RJ. Premature menopause and low back pain. A population-based study. Ann Epidemiol 1994;4:416-22.
Lau EM, Egger P, Coggon D, Cooper C, Valenti L, O'Connell D. Low back pain in Hong Kong: Prevalence and characteristics compared with Britain. J Epidemiol Community Health 1995;49:492-4.
Yip YB, Ho SC, Chan SG. Tall stature, overweight and the prevalence of low back pain in Chinese middle-aged women. Int J Obes Relat Metab Disord 2001;25:887-92.
Moore R, Brodsgaard I. Cross-cultural investigations of pain. In: Crombie IK, Croft PR, Linton SJ. Epidemiology of Pain. Seattle, WA: IASP Press; 1999. p. 53-80.
Weevers HJ, van der Beek AJ, Anema JR, van der Wal G, van Mechelen W. Work-related disease in general practice: A systematic review. Fam Pract 2005;22:197-204.
Picavet HS, Schouten JS. Musculoskeletal pain in the Netherlands: Prevalences, consequences and risk groups, the DMC(3)-study. Pain 2003;102:167-78.
Dufour AB, Broe KE, Nguyen US, Gagnon DR, Hillstrom HJ, Walker AH, et al.
Foot pain: Is current or past shoewear a factor? Arthritis Rheum 2009;61:1352-8.
Riley JL 3rd
, Tomar SL, Gilbert GH. Smoking and smokeless tobacco: Increased risk for oral pain. J Pain 2004;5:218-25.
Reddy EM, Yasobant S. Musculoskeletal disorders among municipal solid waste workers in India: A cross-sectional risk assessment. J Family Med Prim Care 2015;4:519-24.
] [Full text]
Suryapani R. Backache Borne of Modern Lifestyle. Chandigarh: The Tribune; 1996. p. 16.
WHO Scientific Group. The Burden of Musculo-Skeletal Conditions at the Start of the New Millennium. WHO Technical Report Series 919. 2003.
Koley S, Sandhu NK. An association of body composition components with the menopausal status of patients with low back pain in Tarn Taran, Punjab, India. Life Sci 2009;1:129-32.
[Figure 1], [Figure 2]
[Table 1], [Table 2]