Effects of Preventive Physiotherapy Practices on Posture and Work-Related Functions in Office Workers

Study Overview
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Brief Summary
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In this study; aimed to determine an individual-centered, effective physiotherapy method to reduce the negative impacts of the forward head posture on work-related functions and to increase body awareness and functionality among office workers. In addition, aimed to reduce the loss of work with measures to improve the quality and efficiency of work.

Detailed Description
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The purpose of this study is to determine the effects of preventive physiotherapy practices on work related musculoskeletal disorders in office workers. With this purpose, in this study; aimed to achieve improvement on forward head posture, upper extremity functions and cervical pain reduction through three interventions (supervised EMG biofeedback exercise training, home-based exercise program and posture training/ergonomic regulations). Work related changes in muscle activation of Upper Trapezius and posture will be evaluated while working on a computer task in actual work environment. Differences in posture and muscle activation between computer task and resting position, will be determined before and after the intervention.

Official Title
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Effects of Preventive Physiotherapy Practices on Forward Head Posture and Upper Extremity Work-Related Functions in Office Workers

Conditions
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Work-related Musculoskeletal Disorders, Office Workers

Intervention / Treatment
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* Behavioral: Supervised EMG Biofeedback Exercise Training Group
* Behavioral: Home-Based Exercise Training Group
* Behavioral: Posture Training/Ergonomic Regulations Group


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age below 40, Full-time and regular employees in the last 1 year, Office workers using computers at desk for at least 3 hours per day According to RULA, working in a posture that above acceptable level, No trauma history Non-specific neck pain but no chronic conditions of cervical spine and upper extremity Exclusion Criteria: During the study; need of receiving a treatment/ interventions for the upper body due to trauma or any other conditions is concluded with withdraw from the study

Ages Eligible for Study
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Minimum Age: 22 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Group 1: Supervised EMG Biofeedback Exercise Training Group; Posture training will be provided before intervention and ergonomic arrangements will be made in the workplace. Three sessions per week and six weeks of EMG biofeedback training will be carried out with electromyography-controlled video game combined with Proprioceptive Neuromuscular Facilitation (PNF) exercises. Group 2: Home-Based Exercise Training Group; Posture training will be provided before interventions and ergonomic arrangements will be made in the workplace. Posture correction exercises, contains strengthening, stretching, mobility and relaxation exercises, will be given as a home exercises program for 6 weeks. Group 3: Posture Training/Ergonomic Regulations Group Posture training will be provided before interventions and ergonomic arrangements will be made in the workplace.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Supervised EMG Biofeedback Exercise Training Group<br>Frequency: 3/week Duration:6 weeks Dosage: Tolerable intensity-dependent increase in exercises program. | Behavioral: Supervised EMG Biofeedback Exercise Training Group<br>* Posture training and ergonomic arrangements in the workplace. EMG biofeedback training will be carried out with electromyography-controlled video game combined with PNF exercises. Each game sessions comprising the work-rest cycle covers performing the upper trapezius muscle contraction simultaneously the upper extremity PNF patterns.<br>|
| Active Comparator: Home-Based Exercise Training Group<br>Frequency: 3/week Duration:6 weeks Dosage: Tolerable intensity-dependent increase in exercises program. | Behavioral: Home-Based Exercise Training Group<br>* Posture training and ergonomic arrangements in the workplace. Posture correction exercises, contains strengthening, stretching, mobility and relaxation exercises, will be given as a home exercises program. Exercise diary and weekly calls will be use to maintain the exercise adherence<br>|
| Sham Comparator: Posture Training/Ergonomic Regulations Group<br>1 session, no further intervention until second evaluation for 6 weeks. | Behavioral: Posture Training/Ergonomic Regulations Group<br>* Posture training and ergonomic arrangements in the workplace.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Maximal Voluntary Isometric Contraction (MVIC) | It is assessed by Surface Electromyography (sEMG) for upper trapezius muscle. 3 maximum contractions are performed for 6 seconds at the manual muscle testing position. The maximum value among 3 repeats is recorded as Maximal Voluntary Isometric Contraction (MVIC) (mV). | 10 minutes | 
| Muscle Activation of Upper Trapezius | It is the measurement of the Electromyographic activity of trapezius muscles during functional tasks and rest. According to The Surface ElectroMyoGraphy for the Non-Invasive Assessment of Muscles Project (SENIAM) recommendations for sensors and sensor placement procedures, sEMG will be applied for the upper trapezius muscles while resting and also performing the computer task in workplace. The mean values (mV) obtained are normalized according to MVIC. Normalized data (%MVIC) are used in the statistical analysis. | 30 minutes | 
| Cervical Range of Motion (CROM) / Forward Head Posture | The CROM Deluxe is an assessment instrument that lets to measure sagittal, frontal and horizontal plane movements (flexion / extension, lateral flexion, rotation and forward head posture), while resting and also performing a task or work posture. | 10 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Constant-Murley Score (CMS) | The Constant-Murley Score (CMS) is a widely used scale to measure pain, mobility and the ability to carry out the normal daily activities in various shoulder conditions/ pathologies. | 10 minutes | 
| Rapid Upper Limb Assessment (RULA) | The RULA Assessment Tool is used to evaluate the ergonomic risk factors associated with neck, trunk and upper extremity Musculoskeletal Disorders (MSD). The RULA considers biomechanical and postural load requirements of job demands. Scores between 1-7 are classified from acceptable posture (no action required) to very high risk (implement change now). | 10 minutes | 
| The Disabilities of the Arm, Shoulder and Hand Score (DASH) | The DASH is a self reported questionnaire; assesses the parameters of daily life, pain, weakness, social functions, work, sleep and self-confidence associated with the upper extremity of the individual. | 10 minutes | 
| The Disabilities of the Arm, Shoulder and Hand Score Work Module (DASH-W) | Work Module (DASH-W) is the second part of the DASH questionnaire, which consists of 4 questions, determines one's disability in working life. | 2 minutes | 
| Neck Disability Index (NDI) | The NDI is a self-reported scale consists of pain intensity, personal care, lifting, reading, headache, concentration, work, driving, sleeping and leisure time activities sections. The total score varies between 0-50 and the increase in total score indicates the increase in the severity of the neck disability. | 10 minutes | 
| Neck Pain and Disability Scale (NPAD) | The NPAD is a self-reported index which measure the intensity of neck pain during different conditions and activities and related effects of pain on occupational, recreational, social, daily living activities and its relationship with emotional factors. Pain-related data are obtained by marking on visual analogue scales of 20 items. | 10 minutes | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Surface Electromyography, Biofeedback, Forward Head Posture, Posture, Trapezius Muscle, Task- specific Performance, Exercise, Office Worker