|Year : 2020 | Volume
| Issue : 3 | Page : 133-140
Prevalence of musculoskeletal symptoms and quality of life in housekeeping workers of a tertiary care hospital in Navi Mumbai, India: A descriptive study
Palak Chheda, Swapna Rajan Sreeraj
MGM College of Physiotherapy, MGM Institute of Health Sciences (Deemed to be University), Navi Mumbai, Maharashtra, India
|Date of Submission||15-May-2020|
|Date of Decision||04-Jun-2020|
|Date of Acceptance||04-Jun-2020|
|Date of Web Publication||18-Aug-2020|
Dr. Swapna Rajan Sreeraj
MGM College of Physiotherapy, MGM Institute of Health Sciences (Deemed to be University), Kamothe, Navi Mumbai, Maharashtra.
Source of Support: None, Conflict of Interest: None
Context: Prevalence of musculoskeletal disorders (MSDs) in India is 90%, leading to loss of working hours, poor quality of life (QoL), and reduction in productivity of the life of the employers. Housekeeping profession, considered a major workforce industry, requires manual labor demanding awkward postures and repetitive movements, leading to MSDs and impacting QoL. Objectives: The objective of this study was to find the prevalence of the symptoms of MSDs and QoL in the housekeeping workers of the hospital. Settings and Design: A descriptive study was carried out among housekeeping workers of MGM Hospital, Kamothe, Navi Mumbai, Maharashtra, India. Materials and Methods: With Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) and WHO-QOL-BREF scale, 82 housekeeping workers were contacted, and an interview-based session was held. Statistical Analysis: Descriptive analysis and graphical representation were carried out using MS Excel. Results: Of the participants, 68.29% were females with a mean age of 42.28 ± 7.4 years, and 31.70% were males with a mean age of 42.04 ± 8.3 years. The prevalence of the symptoms of MSDs was higher in knees followed by lower back and lower leg. Females (80.36%) were affected more than males (61.54%). WHOQOL-BREF for QoL showed a moderate impact without much gender difference. Conclusion: The study concluded that there is a high prevalence of the symptoms of MSDs in housekeeping staff, more likely in the lower back, knee, and lower leg, and WHO QOL-BREF shows comparable mean scores among males and females.
Keywords: Global burden of disease, housekeeping workers, musculoskeletal disorders, quality of life
|How to cite this article:|
Chheda P, Rajan Sreeraj S. Prevalence of musculoskeletal symptoms and quality of life in housekeeping workers of a tertiary care hospital in Navi Mumbai, India: A descriptive study. MGM J Med Sci 2020;7:133-40
|How to cite this URL:|
Chheda P, Rajan Sreeraj S. Prevalence of musculoskeletal symptoms and quality of life in housekeeping workers of a tertiary care hospital in Navi Mumbai, India: A descriptive study. MGM J Med Sci [serial online] 2020 [cited 2020 Sep 28];7:133-40. Available from: http://www.mgmjms.com/text.asp?2020/7/3/133/292373
| Key messages:|| |
Studies addressing the influence of MSDs and QoL on the housekeeping workforce of hospitals are scarce and data addressing the same helps to spread more awareness on areas needing attention and prevention programs needed for this population.
| Introduction|| |
Musculoskeletal disorders (MSDs) are one of the major causes of morbidity and the second largest contributor to disability worldwide, with low back pain being the most frequent. World Health Organization (WHO) 2017, estimates between 20%–33% of people across the globe live with painful MSDs and this is a major contributor to the Global Burden of Disease (GBD) to the health-care system directly and to loss of work and productivity indirectly.,,,
In Indian communities, the specific prevalence of MSDs is 20% and occupation-based prevalence is 90%.,,, Occupation-related musculoskeletal injuries are very common in developed as well as developing countries, which lead to the loss of working hours, poor quality of life (QoL), and reduction in productivity, and the risk factors responsible for musculoskeletal morbidity include repetitive work, repetitive strain injuries, repetitive motion injuries, cumulative trauma disorders, aging of the workforce, working with hands above shoulder height or below knee height, carrying heavy loads, and operating vibrating tools.,,, Work-related MSDs are a big contributor to heavy economic burden to companies and organizations due to loss of productivity, training of new workers, and compensation cost, and it can also affect the QoL of the workforce.,,,
Housekeeping profession is considered as a major workforce in any industry, comprising 26% of all employment, which currently makes it the second-largest occupation. According to the Association of National Health Occupational Physicians (ANHOPS), housekeeping workers fall into nonclinical ancillary staff who may have social contact with patients, but not of a prolonged nature. The tasks performed by housekeeping workers are to maintain hygiene in and around the hospital premises by carrying out washing and cleaning work, disposal of waste materials, lifting, carrying, and moving of objects, which are labor intensive, and most of the time must work under time constraints, leading to increased physical stress, which could cause musculoskeletal injuries.,, The Canadian Centre for Occupational Health and Safety relates the occurrence of work-related MSDs to repeated movements in a fixed or constrained body postures without sufficient recovery time, forces concentrated on small body parts such as the hand or wrist and prolonged exposure to heat, cold and vibration. These risk factors can be applicable to housekeeping workers too, as they are doing a variety of demanding physical tasks such as lift, push, pull, and carry weights, stand for long periods, kneel, bend, crawl, squat, and crouch; they work in confined spaces and are exposed to dust and cleaning chemicals. Patient handling is also performed by housekeeping workers along with other healthcare workers in hospitals. Patient handling is one of the most physically demanding tasks for healthcare workers with related musculoskeletal injuries.,
Although it seems apparent from the fact that the housekeeping workers are prone to work-related MSDs considering the tasks performed and risk factors applicable, there is little work done or review of literature available, which are specific to the prevalence of MSDs and QoL among housekeeping workers of hospitals. So, this study explores the prevalence of the symptoms of musculoskeletal problems and QoL among housekeeping workers of a tertiary care hospital.
| Materials and methods|| |
This study has been approved by the Institutional Ethics Committee along with the permission from the authors of the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) and World Health Organization Quality of Life instrument Short Form (WHO QOL-BREF).
This was a descriptive study with convenient sampling method, carried out among the housekeeping workers of MGM Hospital, Navi Mumbai, India, a tertiary care hospital. The participants were selected who had 1 or more years of experience, had no observable deformities, congenital health issues, or neuromuscular or cardiopulmonary conditions, and who were not doing any other jobs apart from housekeeping.
When we conducted a sample size calculation for this prevalence survey, with finite population correction at the precision at 5.00%, prevalence assumption at 50.00%, and the level of the confidence interval at 95%, we got an estimated minimum sample size of n = 68, but we decided to include all the available housekeeping workers of MGM Hospital. Thus, the survey was done on 82 participants fulfilling the inclusion criteria. The consent of the participants willing to participate was taken. An interviewer-assisted session was held in a group of 3–5 participants explaining to them the questionnaires in an understandable language, and their best response was recorded.
CMDQ for standing workers (male and female versions) was used for this study. CMDQ is used for research screening purposes, which combines the frequency and intensity of musculoskeletal pain and work-related impairments for 20 body regions., CMDQ confirms high reliability, validity, and effectiveness in cross-cultural adaptation.,,
WHOQOL-BREF is one of the best-known instruments that measure a broad range of domains of QoL. The WHOQOL-BREF questionnaire contains four domains such as physical health with seven items, psychological health with six items, social relationships with three items, and environmental health with eight items. Each item is rated on a five-point Likert scale and scored from 1 to 5.,, WHOQOL-BREF has a highly significant reliability and validity indices and has a sound, cross-cultural validity.,,
Appropriate consent was taken from the respondents in the consent forms before the data collection. As the respondents were semiliterate or illiterate, an interviewer-assisted session was held explaining the CMDQ and WHOQOL-BREF to the participants in simple and understandable language. CMDQ allowed the participants to mention their current areas of musculoskeletal discomfort, and WHOQOL-BREF allowed them to assess their QoL.
MS Excel was used for data entry, descriptive analysis, and graphical representation.
| Results|| |
The study was conducted on 82 housekeeping staff at MGM Hospital, Navi Mumbai, India. Of the participants, 68.29% (56 of 82) were females, and 31.70% (26 of 82) of the participants were males [Figure 1]. Participants’ mean age for males was 42.04 ± 8.3 years and for females was 42.28 ± 7.4 years. Their work duration was 8h per day.
The prevalence of musculoskeletal discomfort was more among females with 80.36% (45 of 56) reported symptoms compared to 65.54% (16 of 26) among males [Figure 2]. The most prevalent musculoskeletal discomfort among females was on the knee (with left knee 75.6% and right knee 68.9%), followed by low back discomfort among 46.7%, lower leg (with 42.2% for left side and 40% for right side), 17.8% upper back symptoms, and 15.6% for hip/buttock discomfort. Among remaining areas, 11.1% had right shoulder discomfort, 8.9% had left shoulder and left thigh discomfort, 6.7% had right and left forearm and right thigh discomfort, and 4.4% had discomfort over the neck, upper arm, and right and left wrist [Figure 3]. Among males [Figure 4], 50% of respondents reported musculoskeletal discomfort in the lower back and bilateral knee joints, followed by lower leg discomfort with the right side (31.25%) more than the left side (25%), 18.75% had left wrist discomfort, 12.5% had issues over their neck, right shoulder, left upper arm, and right thigh, and 6.25% had discomfort with their left forearm and hip/buttocks.
|Figure 2: Prevalence of musculoskeletal discomfort among females and males using CMDQ (in %)|
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When it comes to the frequency of discomfort among females [Figure 5], the maximum was in knee joint, 66.7% had it several times a day, followed by 62.2% at least once every day, and 15.6% 3–4 times last week. Lower leg and back discomfort was felt several times a day by 48.9% and 37.8%, respectively, and 24.4% of the affected women had lower leg discomfort once every day; 4.4% had low back symptoms present 3–4 times last week; and 15.6% had discomfort over the thigh region several times every day. Among other areas, 8.9% had shoulder discomfort three to four times last week, 6.7% had it several times a day, and 4.4% had once every day. Similarly, 6.7% had hip/buttock, upper arm, or upper back symptoms once every day, and neck, forearm, or wrist discomfort was presented by 4.4% once every day, and forearm and wrist discomfort were reported by 4.4% one to two times last week. Also, 2.2% had upper back and neck discomfort one to two times last week.
|Figure 5: Frequency of ache, pain, discomfort felt during the last work week among Females, in %|
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Among males, the frequency of discomfort [Figure 6] was maximum at the knee; 62.5% had once every day, followed by 25% with discomfort three to four times last week, and 6.25% reported symptoms several times a day. The lower leg was another frequently reported area of discomfort; 43.75% had it once every day and 12.5% had it three to four times a week. Lower back discomfort was felt by 25% once every day, followed by 12.5% for one to two times last week, and 6.25% for three to four times last week. Discomfort over the thigh region was felt by 6.25% once every day, and one to two times last week was reported by 18.75%. Upper arm and wrist discomfort several times a day was reported by 12.5%, and shoulder and neck discomfort was felt by 12.5% three to four times last week. Of male respondents, 6.25% reported discomfort over shoulder and hip/buttock region one to two times last week and 6.25% reported forearm discomfort several times a day.
|Figure 6: Frequency of ache, pain, discomfort felt during the last work week among Males, in %. Upper back is not included as there was no symptoms reported|
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QoL assessment with WHOQOL-BREF shows comparable mean scores among males and females except in the physical domain. For Quality of Life assessment with WHOQOL-BREF shows comparable mean scores in all four domains i.e. Physical, Psychological, Social and Environmental, between males and females with a slight advantage in favor of males except in Psychological domain. When considering domain wise scores, the social domain is slightly better performer among both the genders i.e. 78.22% for males and 75.48% for females. In physical domain males score 60.11% and females score 57.76%, in Psychological domain males were 61.67% and females were 61.13% and males 66.64% and females 62.54% for Environmental domain [Figure 7].
| Discussion|| |
A study on the housekeeping staff at MGM Hospital showed maximally involved areas to be the knee, lower back, lower leg, and thigh, followed by upper back and upper limb at varying frequencies. This could be due to repeated climbing and descending of stairs, bending, and extending, body twist and turn, at job as well as at household work. It can also be due to poor nutrition and low bone density issues, especially in women, leading to back and lower limb problems. A previous study by Salwe et al. on housekeeping employees of a Texas, US hospital showed that injuries to the lower back were most prevalent followed by the right wrist, ankle, left knee, left wrist, right knee, and right shoulder, and the authors pointed out that awkward working posture is responsible for lower back and knee pain among housekeeping employees of a hospital, and awkward working posture raises the risk of MSDs. They recommended a holistic approach with a change in ergonomics with improvement in postures and reduction of forces. Arun and Vijayalakshmi identified that lower back pain and pain around the knee and early morning stiffness are the major complaints followed by hip, shoulder, ankle and foot, and neck-related problems. Similarly, in a cross-sectional study by Joseph et al., the pattern of pain was found to be high in the lower back, which they associated with long working hours and years of employment, unlike our study, which focused only on the presence of symptoms. The results obtained by Martarello and Benatti indicated the occurrence of musculoskeletal symptoms on shoulders (50%), upper back (43%), and neck and lower back (37.2%) in hospital cleaning and sanitary workers. When considering the possible reasons for the high prevalence of musculoskeletal discomfort among housekeepers of hospitals, the evidence points toward various ergonomic factors such as repetitive upper limb and lower limb movement patterns, non-neutral body postures, repeated bending, and twisting of the back, which may lead to muscle fatigue, tissue density changes, and tissue strain, which over time leads to MSDs., The physiological evidence for the cumulative effects of such work-related forces, whether they are of smaller or larger amplitudes, has been identified as a key risk factor for work-related MSDs.,
In this study the quality of life shows an overall moderate impact and was not showing much gender difference also. The number of working hours was the same for both genders but with different work experience for every individual. Most of the participants reported fatigue toward the end of their working hours, hampering the physical domain. Most of them felt the income was not enough to run their household, affecting the environmental domain, and half of the participants were utilizing the healthcare services provided to them, whereas the remaining half used the reimbursement policy.
Male respondents were displaying a slightly better social balance compared to females, maybe because of more participation in social and recreational activities. Female respondents show a lower value than males in the physical domain, which includes working capacity, fatigue, and sleep pattern, possibly because of other responsibilities such as child grooming and household work. Although in their study conducted among Brazilian cleaning and sanitary workers in a hospital using 36-Item Short Form Survey (SF-36), Martarello and Benatti concluded that the functional capacity domain pointed toward a good result, whereas general health, vitality, and pain showed poor results. Su et al. concluded that working overtime, heavy workload, stiff shift schedules, and less time for social activities can contribute to increased anxiety and/or depression among hospital workers, leading them to perceive their environment more negatively.
Apart from shedding some light on the most prevalent musculoskeletal conditions and QoL among the housekeeping population of one hospital, the strong point to convey from this study is the need for the exploration of various variables on hospital housekeeping population on a wider spectrum, which is rare not only in India but across the world. This can provide new insights into the wellbeing of the housekeeping population of hospitals as their job involves a lot of repetitive activities including bending, lifting, carrying, pushing, and pulling throughout the day. There is also a scarcity of studies addressing the impact of QoL on the housekeeping workforce of hospitals.
| Conclusion|| |
The study concluded that there is a high prevalence of musculoskeletal symptoms in hospital housekeeping staff, most likely in the lower back, knee, and lower leg. There is a prevalence of musculoskeletal discomfort even in other areas of the body, including neck, shoulder, upper back, forearm, wrist, hips/buttocks, and thigh with less intensity. Male participants displayed a better QoL than the female respondents, especially in the social domain.
Declaration of participant consent
The authors certify that they have obtained all appropriate participant consent forms. In the form the participant(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The participants understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
We thank Dr. (Lt Gen). K. R. Salgotra, Medical Superintendent, MGM Hospital, Navi Mumbai, Maharashtra, India, for granting us permission to conduct this survey and to periodically review the progress of the same.
Financial support and sponsorship
This study was funded by MGM Institute of Health Sciences.
Conflicts of interest
There are no conflicts of interest.
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