Effects of Telerehabilitation-Based Clinical Pilates Exercises on Health Care Workers

Musculoskeletal disorders can cause a decrease in employees' work continuity and job performance. During their working hours, healthcare workers stand for long periods of time, sit in wrong positions, actively use their upper extremities and work in incorrect postures. For this reason, they experience musculoskeletal system problems. This study was designed to determine the effectiveness of pilates exercises to be applied via tele-rehabilitation method for musculoskeletal system problems that may be seen in healthcare workers.

Work-related disorders that can cause pain, limitation of movement and disability in working people and affect muscles, tendons and ligaments are called work-related musculoskeletal disorders (WMD). Work-related musculoskeletal disorders (WMSD) may occur acutely or chronically depending on age, occupation, activity level and lifestyle.

Health workers are people whose primary purpose is to take actions to improve health. They examine physical and mental problems, diagnose, treat and prevent problems based on the needs of the people they serve. It also conducts research and develops methods to improve evidence-based health services. Healthcare professionals include doctors, nurses, assistants, technicians, and assistants and provide care services to patients.

According to the European Union report, the number of work accidents in healthcare workers is 34% higher than in other professions.. In the 2012-2017 data of the Social Security Institution (SGK), 154 of 3040 occupational disease diagnoses (5.06%) consist of a musculoskeletal system disease. In a study, it was stated that the secondary diagnosis in healthcare workers was musculoskeletal system diseases, accounting for 15.2% (n = 17).In another systematic review examining the prevalence of musculoskeletal diseases in healthcare workers, the 1-year prevalence was found to be 28-96%. A study conducted by the American Nurses Association in 2011 showed that 56% of nurses experienced work-related musculoskeletal disorders.In a cross-sectional study conducted in Turkey in 2010, the 12-month prevalence was found to be 79.5%, and the highest prevalence was waist disorder (49.7%), followed by shoulder (38%) and neck (35%) disorders. A study investigating work-related BDSD in hospital employees found upper extremity pain during work in 58.1% of the employees. Other findings included stiffness, numbness, and swelling in the upper extremity. In another study, it was observed that IBD caused limitations in home and work activities, and an increase in the use of painkillers and the use of rest days in intensive care and operating room workers. In a study involving 78 midwives, at least one musculoskeletal system disorder was found in 67.6% of the participants. The highest prevalence was observed in the shoulder region with 44%, and the lowest prevalence was observed in the elbow (8%). A study investigating the relationship between physiotherapists' quality of life and physical activity level found physiotherapists to be one of the professional groups most prone to musculoskeletal problems.. In a study evaluating injury rates among physiotherapists, it was shown that 74% of physiotherapists working in the general physiotherapy department, 71% of physiotherapists working in the field of neurology, and 48% of physiotherapists working in the field of orthopedics had occupation-related musculoskeletal system problems. BDSRs in medical personnel and healthcare workers can cause difficulty in daily activities and leave work for nurses, nurse assistants, and hospital employees.Neck pain is the most common condition among nurses, and its 12-month prevalence was found to be 61.1%. Other risk areas for nurses were the lower back (47.2%), shoulders (46.7%), wrists and hands (27.3%) and elbow (13.9%). The most important reasons for the increase in upper extremity BDSR include being a woman, poor sleep quality, high physical activity level, poor ergonomics, increased workload and mental stress. In a study, the main reason for receiving a medical report among female hospital employees was found to be musculoskeletal disorders, and they determined that 28% of them required medical treatment.It is stated that low back pain is more common in women than men . They determined that the risk of pain is higher in women than in men and that body mass index is a risk factor that increases pain. Pain complaints increase in women with high body mass index. The risk of increased lower extremity pain is increased in obesity. According to World Health Organization estimates, 70-80% of deaths in developed countries and 40-50% of deaths in underdeveloped countries are caused by lifestyle-related diseases. Therefore, the health services to be provided should be aimed at protecting, maintaining and improving health. Healthcare professionals have important responsibilities in developing and maintaining these behaviors. That's why healthcare professionals must first correct their own lifestyle. When looking at the literature; In a study conducted to determine the healthy lifestyle behaviors of healthcare professionals, the lowest score was obtained from the exercise sub-dimension. In the study conducted to measure the health behaviors of healthcare personnel working in primary healthcare services, the lowest average score belongs to the exercise subfield (26). In a study conducted with nurses, it was stated that the rate of those who did not do physical activity was higher. In the study on health promotion behaviors of nursing school students, the lowest score was in the exercise sub-dimension. When the healthy lifestyle behaviors of healthcare professionals are examined according to their involvement in sports, the difference is significant and people interested in sports form healthy lifestyle behaviors better. Regular exercise has positive effects on health, such as weight control and cancer prevention. A suitable environment and time must be created for people to exercise regularly. It has been observed that healthcare workers who exercise 3-4 days a week or more get high scores on the Healthy Lifestyle Behaviors Scale (HLBD). However, since healthcare workers work on a shift system, they have difficulty in creating a suitable time and environment for exercise. Exercising via telerehabilitation may be an option that comes to mind in order to help healthcare professionals gain regular exercise habits and protect their health.

Telerehabilitation; It is a method that reduces service barriers such as time, cost and distance, and brings healthcare professionals and patients together in a virtual environment. Telerehabilitation enables the implementation of remote rehabilitation using technologies. Physiotherapists use telerehabilitation for evaluation, diagnosis, prognosis and treatment.

Pilates exercises were transferred to the clinic by Australian physiotherapists in the early 2000s and were called "clinical Pilates". The Clinical Pilates method is a mind-body exercise based on 6 principles: centering, concentration, control, precision, breathing and flow. Pilates exercises focus on spinal stabilization and are designed to build muscle strength, flexibility, balance, proprioception and body awareness. Breathing and muscle control during these exercises reduce pain and improve posture. The Clinical Pilates method can be applied as an exercise method for healthy people and sick people (10).Online Pilates exercises are an exercise that increases physical activity and provides positive effects in risky situations such as pandemics or when exercise centers cannot be reached.

When applying clinical pilates exercises, there are 5 elements that should be applied during the exercise. These; Breathing: Lateral breathing is used to maintain stabilization of the core muscles.

Centering: Central stabilization is achieved in the neutral spine position by activation of the Transversus abdominus, Pelvic floor muscles, and Multifidius.

Rib cage placement: The rib cage should be in a neutral position for correct muscle synergy and the neutral position should be maintained during extremity movements.

Shoulder Girdle Placement: Scapula-thoracic stabilization is achieved by activation of the rhomboid muscles, Serratus Anterior, and lower trapezius and is maintained throughout extremity movements.

Head-Neck Positioning: Without allowing the activation of the superficial neck flexors, the head-neck is placed in a neutral position and neck stabilization is achieved by activating the deep neck flexors.

A study has shown that online pilates exercises are almost as practical and easy to implement as face-to-face pilates exercises.

Healthcare workers may encounter risks and dangers due to their work areas and the normal order of work. In order to serve patients, they must first protect their own health.The aim of this study is to investigate the effectiveness of pilates exercises applied with two different tele-rehabilitation methods for the musculoskeletal system problems of healthcare professionals.

Eligibility Criteria:
Inclusion Criteria:

* No health problems that prevent him from exercising
* Being between the ages of 25-50
* Lack of regular exercise habits
* Being a healthcare worker
* female gender
* Individuals with technological opportunities

Exclusion Criteria:

* Individuals who cannot participate in the exercise program regularly Individuals diagnosed with any orthopedic, neurological, rheumatological disease
* Individuals with pregnancy
* Individuals who follow a different exercise program