Keywords
chronic neck pain - kinesiophobia - anxiety - computer programmers - fear-avoidance
model
Introduction
A musculoskeletal condition in neck pain is commonly compromising a person's physical,
psychological, and social well-being.[1] The most prevalent occupational health issue, described as a feeling of suffering
in the neck region, impacts up to 67% of the general public at some point in their
lives.[2] The Bone and Joint Decade 2000 to 2010 stated that neck pain begins in the anatomical
area of the neck and may or may not radiate to the arms with trunk and head.[3] Organizational, demographic, physical (computer usage duration, bad posture, repetitive
motions, computing skills, exercise performance, and breaks), and psychological variables
such as mental stress, anxiety, lack of social support are known influential risk
factors for neck discomfort.[4]
[5]
The rapid adoption of smart electronics in the workplace has sparked worries regarding
computer employees' health and well-being.[6] Prolonged static working positions, which result in uninterrupted activity in motor
units which have less threshold, Ca2+ buildup, lower local blood flow, and various homeostatic changes in active muscle
fibers, are likely to contribute to musculoskeletal problems related to the neck as
well as shoulder in office workers. As a result, pain sensations grow with extended
static muscular activity and repetitive job tasks.[7] Computer employment has been connected to a number of detrimental consequences on
health, including high mental demand and workload.[8]
According to Marloes et al, pain in neck, among other areas, can be a risk factor
for the onset of anxiety disorders leading to depression.[9] Anxiety disorders are widespread, with estimates of its peak incidence from 3.8
to 25% worldwide, and prevalence as high as 70% in those with longstanding health
issues.[10] Elbinoune et al discovered that 68.4% of patients had a high degree of anxiety.[7] It is similar to fright, reacting to a real or perceived immediate warning; anxiety,
conversely, is a retaliation to the forecast of a future threat plus apprehension.
People experiencing it might retreat from situations that have formerly bring about
worry.[11]
Kinesiophobia (fear of movement) is defined as an excessive, illogical, and incapacitating
dread of performing a bodily movement as a result of a worry of suffering a painful
injury or reinjury.[12] Fear-avoidance model (FAM), a high fear of mobility, is related to the growth of
avoidance behavior, which leads to increased impairment and physical deconditioning
(inactivity or disuse).[13] The FAM has explained how psychological factors such as kinesiophobia affect chronicity
and disability in musculoskeletal patients.[14]
[15] Fear-avoidance belief has been linked to chronic musculoskeletal pain, notably neck
discomfort, in terms of prevalence and prognosis.[16]
[17]
People who had painful experience of cognitive-behavioral models like the fear-avoidance
theory may develop a fear of moving, resulting in behavioral agitation and increasing
levels of functional impairment. The main causes of complaints about chronic pain
are kinesiophobia and fear-avoidance behaviors.[14] It has been found that pain is often misinterpreted leading to fear and avoidance
and therefore has a negative impact on function (Lenz et al).[18]
[19] The proposed study aimed to answer the question of the association between neck
pain, kinesiophobia, and anxiety, which may help to frame a better rehabilitation
protocol for the patients. Also, kinesiophobia and anxiety among computer programmers
are the least researched parameters. The lack of evidence with reference to the prevalence
of kinesiophobia and psychological distress, such as anxiety among computer programmers,
warrants this study.
Materials and Methods
Ethical clearance was obtained from the institutional ethical committee of Krupanidhi
College of Physiotherapy, Bangalore (Ref: EC-MPT/2/PHY/009) for conduct of the study.
It was an observational case–control study and a convenient sampling technique was
performed. The study included both male and female aged 35 to 50 years having primary
complaint of neck pain for more than 3 months with a daily working schedule of minimum
6 hours in the computer programming field for a minimum 6 months. Individuals with
any physical trauma, tumor, nonmechanical cause of neck pain, history of cervical
surgery or infectious neurological disorders (e.g., meningitis) and presence of any
inflammatory rheumatic disease (e.g., ankylosing spondylitis and rheumatoid arthritis)
were excluded. Each participant signed informed consent was acquired. Three-hundred
eighty-eight subjects were registered for the study and segregated into two groups
(case group: 194 subjects with chronic neck pain, control group: 194 subjects without
chronic neck pain) based on inclusion criteria that included subjects with primary
complaint of neck pain, age group 35 to 50 years, computer programming work experience
of a minimum of six months, daily working schedule of at least 6 hours, and neck pain
persisting for more than 3 months. Subjects were excluded from the study if they had
physical injury, tumor, or other nonmechanical causes of neck pain, history of cervical
surgery, history of infectious neurological disorders like meningitis, and presence
of any inflammatory rheumatic diseases such as ankylosing spondylitis or rheumatoid
arthritis.
Data Sources and Measurement
Demographic characteristics of subjects participating in the study were recorded.
Fear of movement was determined utilizing Tampa Scale of Kinesiophobia (TSK) consisting
of 17 questions rated on a 4-point Likert scoring wherein 4 = strongly agree, 1 = strongly
disagree. A total score was calculated between 17 and 68. TSK score lesser than 37
represents “low kinesiophobia,” whereas score higher than 37 represents “high kinesiophobia”
degrees.[12]
Anxiety was estimated using Penn State Worry Questionnaire (PSWQ) that is a 16-item,
self-administered Likert-type scale for measuring worry which is considered as the
benchmark for evaluating anxiety.[20]
Statistical Analysis
Data was analyzed using SPSS (version 29.0) for windows. Descriptive statistics was
performed for the demographic data and outcome variables. Chi-squared test was performed
to check the association between TSK and the PSWQ for Anxiety. Microsoft excel was
used to generate graphs and tables. Significance value desired level is as 0.05.
Hypothesis
Null Hypothesis (H0)
There is no significant association between kinesiophobia, anxiety, and chronic neck
pain among computer programmers.
Alternate Hypothesis (H1)
There is significant association between kinesiophobia, anxiety, and chronic neck
pain among computer programmers.
Results
Based on inclusion criteria, the age group was taken between 35-50 years ([Table 1]). The mean value for the case group (group A) of age in years was (mean ± SD: 41.72 ± 4.963),
and for control group (group B), the value was 42.25 ± 4.452. The average age in years
of computer professionals was almost similar in both groups.
Table 1
Descriptive statistics of age of computer programmers
|
Variable
|
Case group
|
Control group
|
|
Mean
|
SD
|
Mean
|
SD
|
|
Age in years
|
41.72
|
4.963
|
42.25
|
4.452
|
Abbreviation: SD, standard deviation.
Out of 388 participants of computer professionals, 68.80% had work-related musculoskeletal
disorder (WRMSDs) due to neck pain, whereas 31.20% were unaffected by it. There is
a prevalence of severe neck pain in computer programmers.
[Table 2] depicts the outcome of TSK score for kinesiophobia among the case and control group.
In case group, the outcome of the mean and standard deviation (SD) of kinesiophobia
score was 43.47 ± 16.132, where an average of 43.47 participants responded with kinesiophobia
score of more than or equal to 37. In control group, it was found to be less with
mean and standard deviation of 22.40 ± 6.470 with the average 22.40 having value less
than 37.
Table 2
Descriptive statistics of kinesiophobia and anxiety
|
Group
|
Kinesiophobia (score)
|
Anxiety (score)
|
|
Group A (case)
|
Mean
|
43.47
|
47.15
|
|
Standard deviation
|
16.132
|
22.799
|
|
Group B (control)
|
Mean
|
22.40
|
21.92
|
|
Standard deviation
|
6.470
|
9.656
|
Similarly, the outcomes of PSWQ scores for anxiety in both the groups were presented.
In case group, the outcome of the mean and SD was 47.15 ± 22.799, whereas in control
group, the anxiety score was with the mean and SD of 21.92 ± 9.656. The average PSWQ
score for case group was 47.15 with value considered from 30 to 76 suggesting the
participants suffering from some anxiety and the control group the average was 21.92
with value less than 29 with no anxiety.
The results showed a strong association among the case and control group of kinesiophobia
score with chronic neck pain, in which the variables were statistically significant
(p < 0.05). This indicated the statistical association between TSK score, suggesting
computer programmers enduring chronic neck pain were affected by kinesiophobia.
The results showed significant association between case and control group of anxiety
score with chronic neck pain, in which the variables were statistically significant
(p < 0.05) indicating that there was statistical association between PSWQ score suggesting
that the computer programmers having chronic neck pain were affected by anxiety.
The results showed significant association between the control and case group of kinesiophobia
score with anxiety score, in which the variables were statistically significant (p < 0.05). This suggested statistical association between TSK and PSWQ score signifying
computer professionals having persistent neck pain were affected by kinesiophobia
and anxiety.
Discussion
Considering the development of information and communication technology, computer
employment has increased from sales to administrative in industrialized countries.
Additional health issues and injuries are being recorded as a result of the expanding
use and popularity of computers, keyboards, along with corresponding peripheral devices
(mouse, touch pads, etc.). Unknowingly increasing job complexity and producing stressful
and unhealthy work settings, computer-based technology has led to an increase in work-related
musculoskeletal disorders. Concerns regarding the state of being healthy in computer
personnel have been expressed by the workplace's increasing use of smart technology.
This study intended to look over kinesiophobia and anxiety among computer programmers
with chronic neck pain. Analyzing the presence of kinesiophobia and anxiety can reduce
the risk of psychological distress affecting individuals suffering from neck pain.[7]
[17] This study portrayed significant results that kinesiophobia and anxiety were affected
in computer professionals with severe neck pain.
Computer is an essential part of our daily life, and more usage of computer leads
to musculoskeletal complaints. Participants in the study reported neck pain as their
most common musculoskeletal ailment (68.8%). The results obtained during the course
of our study are consistent with earlier researches that have been published in this
regard. In a study transmitted by Ardahan and Simsek, computer-using office workers
reported musculoskeletal neck complaints are 67.85% of cases,[12] where it was discovered that lack of ergonomic understanding, physical pain, gender,
periods of computer use, daily computer usage duration, and uninterrupted computer
use aggravated the risk of musculoskeletal system issues.
Asiri et al indicated a substantial positive connection between kinesiophobia and
severe neck pain. The age of the participants in this study was greater, and elderly
people with persevering neck problems may be less tolerant of pain and kinesiophobia.[21] Luque-Suarez et al[22] found moderate evidence linking superior levels of kinesiophobia to increased level
of pain severity and poor quality of life. Additionally, they discovered substantial
evidence that links kinesiophobia to pain severity and impairment. The development
of impairment over time is predicted by a higher level of kinesiophobia. This avoidance
behavior may turn out to be harmful over the long run. Kinesiophobia is assumed to
occur in such patients. They frequently avoid against participating in activities
that are thought to be likely to result in an actual or probable injury or reinjury,
which leads to increased inactivity. People with musculoskeletal pain over a long
duration may exhibit higher degrees of discomfort, impairment, and emotional distress
resulting into fear of performing particular motions, leading to a continuous cycle
that lowers their quality of life.[23] In a study by Secer et al it was found that there is a low to moderately strong
co-relation between pain intensity and anxiety levels in people suffering with chronic
neck pain.[24]
Parikh et al[25] demonstrated a correlation between anxiety and neck pain that was positive in computer
workers. Patient's quality of life is significantly impacted by long-standing chronic
pain, having major effect on their mental health that makes them more susceptible
to unpleasant feelings like anxiety and worry.[26] Likewise, in a review of psychometrically established pain catastrophizing, pain
anxiety, and intolerance of pain variables among young people with chronic pain was
carried out by Fisher et al. Significant positive correlations between factors for
pain severity, disability, generalized anxiety disorder, and depression were discovered.[27]
According to our study, it was evident that there is significant difference between
TSK and PSWQ score (p < 0.05) which proves significant association between kinesiophobia and anxiety in
computer programmers with chronic neck pain. The possible significant result could
be due to work stress being strongly linked to long working demands, a lack of social
support, and computer-related difficulties, particularly in the pandemic condition.
Additionally, with regard to WRMSDs, ergonomic and psychological workplace factors
interact to increase the musculoskeletal injury risk.
Conclusion
The findings of this study state that there is a fundamental difference in kinesiophobia
and anxiety in computer programmers with chronic neck pain and those without it. There
is positive association seen in kinesiophobia and anxiety among computer programmers
with chronic neck pain. To lower the prevalence of cervical symptoms, it is essential
that prevention efforts consider all work-related risk factors, including ergonomic
and psychosocial ones. The structure of the job should get special consideration to
provide the probability of suitable work breaks. Additionally, the workplace should
be suitably designed taking into account each employee's distinct job prospects.
Limitations
The study involved single population. It has no standardized workstation design. Because
the study was a web survey, ergonomics testing was not possible. Numerous psychological
component such as stress and insomnia that affect cervical pain are discarded.
Future Scope of Studies
A large sample size and a diverse population can be applied for additional research.
Future research can be done on the assessment and treatment of neck impairments and
range of motion issues for computer professionals. To inform the workforce about risk
factors for neck pain that can impair their abilities and offer ergonomic recommendations,
occupational-related education camps can be held. Future studies could incorporate
diverse psychological factors.
