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Q.A.S. Akrouf,¹ J.O. Crawford,² A.S. Al-Shatti¹ and M.I. Kamel³

الاضطرابات العضلية الهيكلية بين عاملي البنوك في الكويت

قاسم أكروف، جوان كراوفورد، أحمد خضر الشطي، محمد إبراهيم كامل

الخلاصـة: في الكويت. وقد استخدِم استبيان موثوق يعبأ ذاتياً يحتوي على الاستبيان الهيكلي العضلي لشمال أوروبا، واستبيان صحي عام مكون من 12 بنداً . ومن بين 750 موظفاً، عانى %80 منهم من نوبة على الأقل من الاضطرابات العضلية الهيكلية خلال السنة السابقة، وعانى %42 من نوبة على الأقل من العجز. وكانت أكثر أماكن الجسم المتضررة هي العنق (%53.3)، وأسفل الظهر (%51.1)، والكتفين (%49.2)، وأعلى الظهر (%38.4). وعلى الصعيد الوطني، كانت درجات (أحراز) الاستبيان الصحي العام المكون من 12 بنداً، والتدخين، والجنس منبئات يعول عليها للاضطرابات العضلية الهيكلية خلال العام السابق، وكان شرب الخمر، والحالة الزوجية، ودرجات (أحراز) الاستبيان الصحي العام المكون من 12 بنداً، والجنس، والسنوات في الكويت منبئات يعول عليها للاضطرابات العضلية الهيكلية المسببة للعجز خلال السنة السابقة.

ABSTRACT: This cross-sectional observational study assessed the pattern of musculoskeletal disorders (MSDs) suffered by bank office workers in Kuwait. A self-administered validated questionnaire was used that included the Nordic musculoskeletal questionnaire and 12-item general health questionnaire (GHQ12). Of 750 employees, 80% suffered at least 1 episode of MSD during the previous year and 42% suffered at least 1 disabling episode. The most affected body parts were the neck (53.5%), lower back (51.1%), shoulders (49.2%) and upper back (38.4%). Nationality, GHQ12 score, smoking and sex were significant predictors of MSDs during the previous year, while alcohol drinking, marital status, GHQ12 score, years in Kuwait and sex were significant predictors of disabling MSDs during the previous year.

Troubles musculosquelettiques chez des employés de banque au Koweït
RÉSUMÉ: Cette étude transversale d’observation a évalué les caractéristiques des troubles musculosquelettiques (TMS) chez des employés de banque au Koweït. Nous avons utilisé un autoquestionnaire validé comprenant le questionnaire « nordique » sur les TMS et le questionnaire GHQ12 (questionnaire général de santé en 12 questions). Sur 750 employés, 80 % d'entre eux avaient connu au moins un épisode de TMS au cours de l’année précédente et 42 %, au moins un épisode invalidant. Les parties du corps les plus touchées étaient le cou (53,5 %), le bas du dos (51,1 %), les épaules (49,2 %) et le haut du dos (38,4 %). La nationalité, le score au GHQ12, le tabagisme et le sexe étaient des facteurs prédictifs significatifs de TMS au cours de l’année précédente, alors que la consommation d’alcool, l’état matrimonial, le score au GHQ12, les années passées au Koweït et le sexe étaient des facteurs prédictifs significatifs de TMS invalidants au cours de l’année précédente.

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¹Department of Occupational Health, Ministry of Health, Kuwait.
²Department of Occupational Health, University of Birmingham, Birmingham, United Kingdom.
³Department of Occupational Health, University of Alexandria, Alexandria, Egypt (Correspondence to M.I. Kamel: This e-mail address is being protected from spambots. You need JavaScript enabled to view it ). Received: 20/06/07; accepted: 13/09/07

EMHJ, 2010, 16(1):94-100

 

Introduction

Rapid technological developments, especially in the use of electronic data, have affected both workers and the workplace. Electronic data are mainly displayed on visual display terminals. Improper body posture and long hours in front of these terminals can result in many health hazards, including eye strain and fatigue and musculoskeletal disorders (MSDs) [1]. It has been stated that MSDs are the most common occupational health problem [2]. Around 1.1 million people in the United Kingdom suffered from MSDs caused by or made worse by work in 2001–02 [2] and MSDs accounted for 11.6 million working days lost during 2006 [3]. In the United States, MSDs constituted 41.4% of all adult disabilities (41.2 million) during 1990 [4].

Work-related MSDs can affect shoulders, arms, elbows, wrists, hands, back, legs and feet. They are caused by forceful or repetitive movements or a poor working posture. Symptoms include tenderness, aches and pains, tingling, stiffness and swelling. Lower and upper back pain and muscle spasm could be due to incorrect seating, which also affects the cervical spine and neck muscles leading to pain [5,6]. Crawford et al. concluded that physical and psychosocial risk factors are implicated in the etiology of MSDs especially those affecting the neck and shoulder regions [7]. Jensen et al. showed that neck symptoms were the most common (53%) among female call-centre workers, followed by shoulder (42%) and hand/wrist (30%) symptoms [1].

Although many studies have dealt with MSDs among office workers in other countries, the exact nature and prevalence of this important health problem has not been studied before in Kuwait. This study was formulated to fill the gap of knowledge in this area. The aims of the study were to assess the pattern of MSDs among bank office workers and to identify the impact of demographic, occupational, psychological and social factors on MSDs.

Methods

This study was carried out during 2006 in the 36 branches of one banking company in Kuwait, randomly selected from among the major banks in the country. An observational cross-sectional study design was adopted. All bank workers (n = 800) using visual display units were recruited for the study. A self-administered questionnaire was distributed personally to each employee.

Tools

A specially designed self-administered questionnaire included the following: sociodemographic characteristics (age, sex, nationality, marital status, level of education, years in Kuwait and smoking history) and occupational history (type of job and duration in that job). The modified 12-item Goldberg general health questionnaire (GHQ12) was used [8]. This questionnaire assesses psychiatric morbidity or the “inability to carry out one’s normal ‘healthy’ functions and the appearance of new phenomena of a distressing nature”. Each question is scored from 0 (better than normal) to 3 (much less than normal). The short version of the standardized Nordic musculoskeletal questionnaire was used to evaluate MSDs [6]. This questionnaire deals with the occurrence of MSDs during the previous 7 days and 12 months as well as their severity. It also deals with the distribution of these disorders by body organ. An Arabic translation of the questionnaire was prepared. Back translation was used to ensure correct translation. The questionnaire was assessed by a jury of 6 occupational and psychiatrist consultants to ensure its validity.

A pilot study was carried out on 15 workers to assess the suitability of the questions in Kuwaiti culture and to reveal any defects in the administrative plan for data collection. Reliability of the questionnaire was studied through repeating the same questionnaire on the 15 workers included in the pilot study. The Cronbach reliability coefficient was more than 0.87 for the questionnaire.

Approval to carry out the study was obtained from the headquarters of the bank. Oral consent was also obtained from workers before filling the questionnaire. All collected data were handled confidentially.

Data analysis

The pre-coded questionnaire facilitated data entry. The Microsoft Excel program was used for data entry and Epi-Info for statistical analysis of the data. The quality of data was assured by meeting with the workers and their supervisors to explain the purpose of the studyand  the nature of the questionnaire, and by checking the completeness of data in the field. After data entry, both manual and electronic (frequency analysis and cross-tabulation) revisions were performed to verify data entry.

The prevalence of MSDs during the previous 12 months or attacks occurring during 7 days were calculated if any part of the body was affected. Also the mean GHQ12 score and the number of body parts affected by MSDs were calculated.

Statistical analysis of the results included both descriptive and analytic techniques. Statistical tests used for analysis of the results included the chi-squared and Fisher exact test for qualitative data and Mann–Whitney and Spearman coefficients for non-parametric data. Odds ratio (OR) and multiple logistic techniques were used to determine risk factors. The level of significance adopted for this study was P ≤ 0.05.

Results

The questionnaire was completed and returned by 750 of the 800 bank workers, giving a response rate of 93.8%. Their mean age was 33.2 (SD 9.1) years (Table 1) and over half the respondents were females (52.5%). The predominant nationality was Kuwaiti (53.9%). Almost all the respondents (90.2%) had higher than secondary education. A majority were married (62.9%). Only one-quarter were smokers (25.7%), while alcohol drinkers were only 9.7%. The mean duration in their job was 7.6 (SD 7.5) years. The mean score on the GHQ12 was “upper normal” [11.5 (SD 5.4)] and only a minority (2.0%) were rated as having moderate to severe psycho­logical distress (score 25–36).

Table 1 Characteristics of the sample of bank workers in Kuwait (n = 750)

Of all bank workers, 57% reported suffering from MSDs during the previous week, while 80% suffered such disorders during the previous year. A total of 42% of the bank workers had suffered disabling attacks of MSDs in the previous year. Table 2 shows that lower back (30.3%), shoulders (29.5%) and neck (28.0%) were the most affected body parts during the previous week. Elbow (5.1%), hips (7.5%) and ankles/feet (9.5%) were the least affected. For MSDs occurring during the previous year, the affected body parts showed a slightly different priority, as neck (53.5%), lower back (51.1%) and shoulders (49.2%) topped the list, and elbows (11.5%), hips (13.3%) and ankles/feet (16.8%) respectively had the lowest prevalence. The most disabling MSDs affecting bank workers were in the wrists/hands (28.3%) and lower back (24.5%).

Table 2 Prevalence of musculoskeletal disorders (MSDs) by affected body part among bank workers in Kuwait during the previous week or year and prevalence of disabling disorders (n = 750)

Table 3 portrays the univariate analysis of factors associated with MSDs among bank workers. Factors positively associated with the occurrence of MSDs during the previous week were: being female, having Kuwaiti nationality and scoring high on the GHQ12; while factors positively associated with the occurrence of MSDs during the previous year were: being female, having Kuwaiti nationality, being younger, holding more than a secondary education certificate and having a high GHQ12 score. Factors associated with disabling MSDs were: being female, drinking alcohol, being married, longer job duration and a higher GHQ12.

Table 3 Relationship between characteristics of bank workers and prevalence of musculoskeletal disorders (MSDs) during the previous week or year and prevalence of disabling disorders

Table 4 shows the significant predictors of MSDs using multiple logistic regression models. Female sex and high GHQ12 score were significantly associated with all forms of MSDs, while Kuwaiti nationality was significantly associated with attacks, whether occurring during the previous week or year. Older age, longer job duration, drinking alcohol and being married were additional risk predictors for disabling MSDs among these bank workers.

Table 4 Significant risk predictors of musculoskeletal disorders (MSDs) among bank workers using multiple logistic regression

Discussion 

The questionnaire was completed and returned by 750 of the 800 bank workers, giving a response rate of 93.8%. Their mean age was 33.2 (SD 9.1) years (Table 1) and over half the respondents were females (52.5%). The predominant nationality was Kuwaiti (53.9%). Almost all the respondents (90.2%) had higher than secondary education. A majority were married (62.9%). Only one-quarter were smokers (25.7%), while alcohol drinkers were only 9.7%. The mean duration in their job was 7.6 (SD 7.5) years. The mean score on the GHQ12 was “upper normal” [11.5 (SD 5.4)] and only a minority (2.0%) were rated as having moderate to severe psycho­logical distress (score 25–36).

Of all bank workers, 57% reported suffering from MSDs during the previous week, while 80% suffered such disorders during the previous year. A total of 42% of the bank workers had suffered disabling attacks of MSDs in the previous year. Table 2 shows that lower back (30.3%), shoulders (29.5%) and neck (28.0%) were the most affected body parts during the previous week. Elbow (5.1%), hips (7.5%) and ankles/feet (9.5%) were the least affected. For MSDs occurring during the previous year, the affected body parts showed a slightly different priority, as neck (53.5%), lower back (51.1%) and shoulders (49.2%) topped the list, and elbows (11.5%), hips (13.3%) and ankles/feet (16.8%) respectively had the lowest prevalence. The most disabling MSDs affecting bank workers were in the wrists/hands (28.3%) and lower back (24.5%).

Table 3 portrays the univariate analysis of factors associated with MSDs among bank workers. Factors positively associated with the occurrence of MSDs during the previous week were: being female, having Kuwaiti nationality and scoring high on the GHQ12; while factors positively associated with the occurrence of MSDs during the previous year were: being female, having Kuwaiti nationality, being younger, holding more than a secondary education certificate and having a high GHQ12 score. Factors associated with disabling MSDs were: being female, drinking alcohol, being married, longer job duration and a higher GHQ12.

Table 4 shows the significant predictors of MSDs using multiple logistic regression models. Female sex and high GHQ12 score were significantly associated with all forms of MSDs, while Kuwaiti nationality was significantly associated with attacks, whether occurring during the previous week or year. Older age, longer job duration, drinking alcohol and being married were additional risk predictors for disabling MSDs among these bank workers.

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