9th ASSP FINAL PRESENTATION OF DR KASTURI MUKHERJEE.pptx

MUSCULOSKELETAL DISORDER AMONG ORTHODONTIST

1. Prevalence of Work Related Musculoskeletal Disorders among Female Orthodontists in West Bengal & applications of interventions in a specific work station for assessment of improvement of Musculoskeletal disorders in terms of perception of pain : Presenter: Kasturi Mukherjee Name of Supervisor Prof. Dr. Somnath Gangopadhyay Ph.D , FABMS Professor Department of Physiology University of Calcutta   Research Laboratory- Occupational Ergonomics Laboratory Department of Physiology University College of science and technology University of Calcutta 92,APC Road, Calcutta 700009,India

2. Introduction....................................................................................................................... Aim and Objectives..................................................................................................................

3. Material and methods: Informed consent................................................................ Ethical Approval ………………………………………… Precise description of methodology of the research…………. Questionnaire.......................................................................... Rapid upper limb assessment work sheet for risk zone determination of the participants ………….. Dental Workstation Observation Check List ……………….. Inclusion and exclusion criteria for entry of subjects into study……… Data Collection to determine the prevalence of musculoskeletal disorder among female orthodontists ......................................

4. Statistical analysis........................................................................... Result and Observation............................................................................................................. Application of interventions............................................................................. Observation of work station after application of intervention……………… Data Collection to determine the improvement of musculoskeletal disorder for a given number of female participants in a specific work station ……...................................... Statistical analysis........................................................................... Result and Observation............................................................................................................. Conclusion……………………………………………………………………………………. References ………………………………………………………………………………..

5. Introduction Occupational health hazards are common in dentistry and are on the rise. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19–22 June 1946; signed on 22 July 1946 by the representatives of 61 States(Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948. The common sites of musculoskeletal complaints among the dental personnel are neck, shoulder and lower back region with diverse prevalence reported in different studies . In the above context, this study is aimed to look deeper into WMSDs among the young female orthodontists and provide a starting point to direct ergonomic intervention .

6. AIM OF THE STUDY: Aim of the study is to determine the prevalence of musculoskeletal disorders among young female orthodontists in West Bengal and execution of few interceptive procedures to increase efficiency and prolong the professional careers of the female practitioners.  

7. OBJECTIVES OF THE STUDY :   To determine the prevalence of musculoskeletal disorders among young female orthodontists. Factors associated with it’s prevalence To know the prevalence of pain in different anatomic locations To investigate association between musculoskeletal disorders and demographic and clinical details. This study will help to take preventive measures in future to control the occurrence of the musculoskeletal disease as well with execution of few interceptive procedures to increase efficiency and prolong the professional careers of the female practitioners.

8. Materials and methods: Informed consent : This study was a cross sectional survey. Written, voluntary informed consent was obtained from the study participants prior to the start of the study. UNIVERSITY OF CALCUTTA, KOLKATA OCCUPATIONAL ERGONOMICS LABORATORY , DEPARTMENT OF PHYSIOLOGY   CONSENT FORM     I , Mr. / Ms ………………… Age /Sex……………………………… resident of ……………………………………………………………………… give my consent to carry out the thesis work performed by Dr. Kasturi Mukherjee, ph.D student; under the guidance of Professor Dr. Somnath Gangopadhyay , Professor, Department of Occupational Ergonomics Laboratory, Department of Physiology, University of Calcutta, Kolkata. I am aware of the purpose of the study. I have no obligation to participate in the study.I am signing the consent form voluntarily out of my free will without any pressure and in my full senses.   Date : Signature Place :      

9. Ethical clearance Ethical clearance for the conduction of the study obtained from the Institutional Human Ethical Committee, Department of Physiology of University of Calcutta.

10. STUDY AREA : – Different dental colleges and private orthodontic clinics of West Bengal.     SAMPLE SIZE: – 150 Female Orthodontists     STUDY POPULATION : – Young female orthodontists (26-36) years who have completed their post-graduation and practicing in hospital set up or private dental clinics doing only speciality job. The list of practicing Orthodontists was obtained from the Indian Orthodontic Society Web Site with their contact details. Of them 150 orthodontists participated in the first part of the prevalence study . In the second part of the study, interventions were applied among 30 female participants (orthodontists) those who were working in a specific work station of Burdwan Government Dental Colleges and Hospital.   STUDY PERIOD : – 2 years  

11. STUDY DESIGN : – Proper close – ended, self- designed questionnaire format was prepared to determine the prevalence of musculoskeletal disorders among young female orthodontists of West Bengasl and factors associated with its prevalence. Few interventions in the forms of aerobic exercises, short breaks , change of posture were used among 30 participants out of 150 to check the improvement of musculoskeletal disorders which would aid in efficiency and prolong the orthodontic professional careers. STUDY TOOLS : – 1.Well designed format of questionnaire modified from the standard Nordic questionnaire.   2. Dental Workstation Observation Check List 3.Assessment of work station with regular records of series photographs for a specific time span. 4. Tracing sheet and pencil were used to trace the photograph of the most sustained posture of the participant during work which was taken out from series of photographs. 5.Rapid Upper Limb Assessment Work Sheet to assess the risk zone of the participant professionals 6. Application of few interventions like short breaks, change of postures and aerobic exercises among given number of population in a specific work station. 7.Observation of improvement of musculoskeletal disorders again with the help of well designed format of questionnaire modified from the standard Nordic questionnaire which was previously used. PREVALENCE STUDY

12. Exclusion criteria: Individuals with some congenital or acquired physical disability involving upper or lower limbs, joints or spine. Pregnant and breastfeeding women. People not agreeing to participate in the research Those who were not present during data collection days were not included in the study.   Inclusion criteria: 26 to 36 year aged female orthodontists who had completed their post-graduation and practicing in hospital set up or private dental clinics doing only speciality job.

13. Study done to determine the prevalence of musculoskeletal disorders of the orthodontists:   The structured, close – ended, self- designed questionnaire containing six questions had been developed by modifying the Standardized Nordic Questionnaire. The questionnaire divided into three sections. The first section included the informed consent and demographic details such as height and weight of the study participant. The second section included the work experience of the orthodontists, duration of the working hours, the patients examined in a day, hand dominance, type of dentistry. . The third section contained the details regarding the location and the frequency of pain in each anatomic location. The locations of pain included neck, low back, shoulder, forearm, hand and wrist, elbow, upper back, thighs , ankle and knees. For frequency, the options given were often, occasionally and never. The reliability of the questionnaire assessed by distributing the questionnaire to 15 practitioners who were not included in the study. The data was collected and subjected to analysis. The reliability of the questionnaire was obtained by Cronbach’s alpha test .   Question Options Frequency Percent Years of practice 0-5 years     6-10 years     >10 years     >20 years     Hours of practice/day <3 hours     3-6 hours     >6 hours     Numbers of patients seen per day <5     5-10     >10     Associated to any dental institution on full time basis Yes     No     Hand dominance Right handed     Left handed     Type of dentistry Two handed dentistry     Four handed dentistry    

14. DENTAL WORK STATION OBSERVATION The photographs of those 150 orthodontists were taken when they were working on their patients with their due permission to get the most prevalent and sustained posture, they were using in their work station. After that the rapid upper limb assessment was done to get an idea in which risk zone that particular orthodontist belonged to. Series of photographs of the postures were taken used by the orthodontist with mentioning the time duration. Tracing for the rapid upper limb assessment was done for the most prevalent and sustained posture for the assessment of the risk zone in which that particular orthodontist belonged to.   MOST PREVALENT AND SUSTAINED POSTURE

15. DENTAL WORK STATION OBSERVATION ON DAILY BASIS RAPID UPPER LIMB ASSESSMENT WORKSHEET

16. The data has been collected from 10.12.2017 to 21.11.2018 . All the participant orthodontists were approached personally and the data was collected. The tools (Dental Workstation Observation Check List- Closed-ended questionnaire), was developed specifically for the study purpose by modifying the Ergonomics Recommendations for Dental Programs from Indian Health Service, and Musculoskeletal Disorders Rating Scale. The check list was validated by statistician and the modifications suggested were implemented.   The following variables were contained in the. Dental Workstation Observation Check List Manual material handling, Physical energy demands , Instruments , Environment , Other musculoskeletal demands  

17. Application of intervention among 30 orthodontists of a specific work station (Burdwan Government Dental College And Hospital) followed by questionnaire analysis to determine the extent of improvement of musculoskeletal disorders:   After assessing the risk zone of the orthodontist the interventions were given like short break, change of posture, hip bridge exercise, neck muscles exercises, wrist strengthening exercises, fingers and thumbs strengthening exercises. These exercises were given for the 30 female orthodontists in a specific work station (Burdwan Government Dental College And Hospital) for the ease of daily monitoring of the participants and for the proper application of the intervention for six months . After that the similar questionnaire which was previously for the prevalence determination were used to assess the extent of improvement of musculoskeletal disorder in terms of perception of pain.

18. DIFFERENT INTERVENTION SWHICH WERE USED AMONG THE MENTIONED POPULATIONS Ergonomics, posture and exercises — Painfree , prolong orthodontic career Avesh Sachan , Vinay Kumar Verma , Sujit Panda, Karuna Singh, [Downloaded free from http://www.jorthodr.org on Friday, May 27, 2016, IP: 14.99.68.58] Hip Bridge Exercise Exercises strengthen the neck musculature Fingers and Thumbs Strengthening Exercises Wrist Strengthening Exercises

19. PRE PROCEDURE EXERCISES

20. POST PROCEDURE EXERCISES

21. From the above findings it was evident that maximum female orthodontists felt pain occasionally in the region of upper back (86.7%) followed by neck and low back (53.3% each) then comes the shoulder pain which consists of 46.7% occasionally. Maximum pain felt (often) in the region of shoulder which consists of 30%. Least pain felt by the orthodontists in the region of ankle (No-78 %) and elbow (No-73.3%).

22. The sample consisted of totally 30 participants from a same work station out of 150 participants from different work station who took part in the prevalence determination study. INTERVENTION STUDY

23. The study revealed that the overall frequency of pain had been improved because in the pre intervention study or, prevalence study 100 % of population was suffering from pain in any of the ten anatomical sites in the form intensity often or, occasionally but in the post intervention study 40% of population were pain free i.e 12 participants and 60% of population were suffering from pain in the different anatomical areas i.e 18 participants . So post intervention study showed that there was the improvement of musculoskeletal disorders among orthodontic professionals in terms of pain perception in the different anatomical areas. Table 29 distribution of total pain

24. Percentage of perception of pain in the different anatomical sites by the participant orthodontists in the post intervention study :   S hows in the post intervention study often felt neck pain was (6.7 %) i.e (2 participants)and occasionally felt pain was (40 %) i.e (12 participants)   Pain felt "occasionally" in the case of low back and shoulder 43.3% and 10% respectively. 6.7% often pain felt in the region of low back . None of the participants felt pain in the fore arm region . distribution of neck pain distribution of low back pain distribution of shoulder pain distribution of forearm pain

25. Percentage of perception of pain in the different anatomical sites by the participant orthodontists in the post intervention study :   10% of population felt occasional pain in the region of upper back i.e (3 participants) 3.3% of population felt occasional pain in one or, both the knees (1 participant) in the post intervention study .   Participants did not feel in the hand and wrist, elbow, thighs and ankle . distribution of hand and wrist pain distribution of elbow pain distribution of upper back pain distribution of thigh pain distribution of ankle pain distribution of knee pain

26. COMPARISON OF PAIN PERCEPTION OF PREVALENCE STUDY AND INTERVENTION STUDY

27. To sum up, young female orthodontists report a high prevalence of various types of work-related musculoskeletal symptoms and most are perceived symptoms from the upper back, neck low back and shoulders . After the application of intervention when post intervention study was done and it was revealed that the overall frequency of pain had been improved because in the pre intervention study 100 % of population was suffering from pain in any of the nine anatomical sites in the form intensity often or, occasionally but in the post intervention study 40% of population were pain free i.e 12 participants and 60% of population were suffering from pain in the different anatomical areas i.e 18 participants . So post intervention study showed that there was the improvement of musculoskeletal disorders among orthodontic professionals in terms of pain perception in the different anatomical areas.

28. Within the limitations of the study, musculoskeletal disorder is a significant occupational health problem among the orthodontists. The study revealed that various socio-demographic variables contributed to the musculoskeletal disorders experienced by orthodontists . However, the association between number of patients attended per day by the orthodontists, years of practice, hours of practice in a day pain experienced by the orthodontists in the upper back, lower back, shoulder and neck was significant. Many factors influence the risk of musculoskeletal disorders among Orthodontists. A comprehensive approach for prevention includes education, assessment of risk factors, proper equipment and instruments, posture, and personal habits such as exercises . In the dental office, a team approach including the use of four-handed techniques can help both the dentist and the assistant work more comfortably . It is also important to be aware of the warning signs of MSDs and to seek medical intervention as early as possible . Regular exercises, frequent breaks during the day and assuming correct posture along with change of posture can increase efficiency and prolong the professional careers of the practitioners. CONCLUSION

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