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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 51  |  Issue : 4  |  Page : 130-135

Risk of musculoskeletal disorders associated with kitchen platform tasks in young and middle-aged women of a metropolitan city: An observational cross-sectional study


1 Occupational Therapy School and Centre, Seth G. S. Medical College and KEMH, Mumbai, Maharashtra, India
2 Department of Occupational Therapy, Occupational Therapy School and Centre, Seth G. S. Medical College and KEMH, Mumbai, Maharashtra, India

Date of Submission04-Dec-2019
Date of Acceptance12-Dec-2019
Date of Web Publication3-Jan-2020

Correspondence Address:
Dr. Sonal Mahendra Kumar Sharma
Jai Hind Estate, Building No. 3C, 3rd Floor, Flat No. 11, Dr. AM Road, Charni Road, Mumbai - 400 002, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijoth.ijoth_33_19

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  Abstract 


Background: Musculoskeletal disorders (MSDs) are one of the prominent causes of physical impairment. Traditional homemaking tasks require substantial and sustained physical repetitive movements. The presence of awkward work postures and patterns causes musculoskeletal pain. Objectives: The study aims on quantifying the risks associated for MSDs due to kitchen work in young- and middle-aged women and correlate the contribution of each task and kitchen platform type to the risk of MSDs. Study Design: An observational, cross-sectional study was chosen for the research. Methods: Based on the convenient sampling method and the inclusion criteria, 140 women from different areas of large metropolitan were selected. To assess women for pain using Nordic Musculoskeletal Pain Questionnaire (Nordic MPQ) was used, for at least three of five meal preparation tasks (chopping, lifting, stirring, mopping the kitchen platform, and utensils washing) using the Rapid Entire Body Assessment (REBA) was the objective. Measurements of anthropometric characteristics (height of kitchen platform and participant and linear distance between the tip of the shoulder to the kitchen platform and waist to heel) was done using a standard measuring tape at their residence. To correlate the score of Nordic MPQ and REBA with kitchen platform height for finding the risk of MSDs. Results: Women were found to have increased incidence of shoulder pain (mopping task) (P < 0.01) and upper back pain (mopping and stirring task) (P < 0.01). Furthermore, a weak negative association was found between the kitchen platform height with the REBA Score of lifting with r = −0.227 and P = 0.01 (two-tailed). The height of the person was negatively correlated with the REBA Scores of stirring and mopping with r = −o. 228 and − 0.229, respectively and P = 0.01 and 0.03 (two-tailed). Conclusion: Kitchen platform tasks performed in an awkward repetitive posture, over an improper work surface height are associated with increased incidence of MSDs.

Keywords: Kitchen Platform Height, Kitchen Platform Tasks, Musculoskeletal Pain, Posture, Women


How to cite this article:
Sharma SM, Shaikh FV, Bhovad PD, Kale JS, Gupta YP, Bhuta MB. Risk of musculoskeletal disorders associated with kitchen platform tasks in young and middle-aged women of a metropolitan city: An observational cross-sectional study. Indian J Occup Ther 2019;51:130-5

How to cite this URL:
Sharma SM, Shaikh FV, Bhovad PD, Kale JS, Gupta YP, Bhuta MB. Risk of musculoskeletal disorders associated with kitchen platform tasks in young and middle-aged women of a metropolitan city: An observational cross-sectional study. Indian J Occup Ther [serial online] 2019 [cited 2020 Feb 23];51:130-5. Available from: http://www.ijotonweb.org/text.asp?2019/51/4/130/274810




  Introduction Top


Homemaking and kitchen task is a labor conventionally performed by women,[1] spending approximately 3.2 h in India.[2] Chopping, stirring, and lifting utensil were found to be complex activities, requiring multiple changes in posture, whereas mopping kitchen platforms and utensil washing were found to be time-consuming tasks.[2],[3] It requires substantial and sustained physical repetitive movements along with sustained work postures which can lead to various musculoskeletal disorders (MSDs).[4],[5],[6]

MSDs are one of the prominent causes of disability and long-term pain, worldwide it adversely affects the quality of life of people.[7] MSDs as the occupational hazard is the most common reason for orthopedic outpatient visit in Indian women.[8] Ergonomics is the study of relationship between the individual, equipment, and environment for productive activity in daily living.[9]

In a large metropolitan city, less living space adds on to the concerns of the various kitchen tasks to be performed.[10] However, due to the challenging daily routine, not all tasks are being performed by women themselves and are often delegated to domestic helpers or family member(s).[11] The study aims to identify and quantify the risk of MSDs associated with kitchen platform tasks (at least three of five) in young- and middle-aged women of large metropolitan city.

The objectives of this study were to assess women for pain using the Nordic Musculoskeletal Pain Questionnaire (Nordic MPQ).[12],[13] To assess women for various kitchen platform tasks using Rapid Entire Body Assessment (REBA).[14] Measure kitchen platform height, full body height, lower body height (waist to heel), and shoulder to kitchen platform height using standard measuring tape.[15],[16] To correlate the score of Nordic Scale and REBA with kitchen platform height.


  Methods Top


The study was approved by the Institutional Ethics Committee as an observational cross-sectional study. Of 24 administrative wards of a large metropolitan city (Mumbai), 5 wards were selected using the lottery method of randomization. The sample size from each ward was calculated using Probability proportional to size (PPS) sampling method. Five housing societies were considered from each ward, and their secretaries were approached for the same. Collectively, 140 women were chosen from five wards using convenient sampling method.

Reason for dropout: Out of 140 samples (selected according to the fitting inclusion criteria) 5 women were diagnosed with MSDs after starting the evaluations hence were not considered for the study. Additional 5 women were not willing to complete the study. Hence, the final sample size was 130 [Figure 1].
Figure 1: Flowchart of Sample Distribution

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Inclusion Criteria

The study included women residing in large metropolitan between the age group of 25-55 years. Those performing at least three out of five kitchen platform tasks (chopping, lifting, stirring, mopping, and utensil washing) collectively not <4 h/day.[7] Those belonging to the working population, engaged in mild-to-moderate work for not more than 4 h a day.

Exclusion Criteria

Women having a history of diagnosed MSDs in the past 6 months, those diagnosed with psychiatric illness. Women who have attained menopause or involved in heavy work and expectant mothers were excluded from the study.

Study Procedure

The study was conducted in large metropolitan city. The large metropolitan city is administratively divided into 24 wards. Five wards were selected using the lottery method of randomization. Collectively 140 women were chosen from five wards using convenient sampling method. The calculated sample size was achieved through PPS sampling method in each ward. Women based on the inclusion and exclusion criteria were recruited as follows:

The setting of the study was the residences of selected women. This study tries to generalize the findings to the women homemakers in Large metropolitan City. The study participants were drawn from five wards of Large metropolitan city. The data were collected from September 1, 2018 to November 25, 2018. Informed consent was obtained from each woman, filling of the case record form, and assessment was made at the women's residence.

The outcome measures used were Nordic MPQ,[9] REBA,[10] Kitchen platform height, full body height, lower body height (waist to heel), and shoulder to kitchen platform height.

Women were grouped into four major categories - Demographic characteristics, comorbidities, work characteristics, and ergonomic risk factors. They were further recoded for use in bivariate and multivariate analysis. The six categories of educational qualification of women were recorded into five categories: No formal education, Elementary, Highschool, Higher Secondary, Graduate by clubbing graduate, and above graduate into one category during the analysis. The reported time spent for kitchen platform tasks in hours was grouped into six categories 4, 5, 6, 7, 8, and 9 h for bivariate and multivariate analysis. The identification of Ergonomic risk factors during work were assessed using REBA worksheet which evaluated whole-body postural, MSD and risks associated with five kitchen platform tasks: chopping, lifting, stirring, mopping, and utensil washing.

Data were compiled and tabulated using Microsoft Excel version 10. Descriptive statistics such as mean, median, percentages, percentiles, and standard deviation (SD) were used to describe the data. Bivariate analysis for the association was performed using Pearson's correlation and comparison of means was made using ANOVA. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY:IBM Corp. (released on 2013) was used wherever applicable during the analysis.


  Results Top


From the results, it was found that the average age of women participating in the study was found to be 41 years ± 3 months. The sample distribution of the women as per their occupations showed that n = 92 (n% =71%) were homemakers and 38 (29%) were performing other tasks. Around 44 (33.85%) women were engaged in kitchen platform tasks for 20-29 years. Maximum time spent in the kitchen was found to be 9 h and about 58 (45%) women spent on an average 4 h on the kitchen platform tasks. About 82 (84.5%) women reported receiving assistance for utensil washing and mopping of kitchen platform. The minimum kitchen platform height was 60 cm and the maximum was 97 cm with the SD 5.90. As per [Table 1], distribution according to height of kitchen platform, height lower than 80 cm was categorized as low kitchen platform height, 80-84 cm as moderate height and >85 cm as high platform height based on 30th and 70th percentile values. (44 [33.8%]-low platform height users, 54 [41.5%]-moderate platform height users and 32 [24.6%]-high platform height users). As per the association between Nordic pain score and REBA, it shows the maximum association of pain in the upper back, knee and ankle, with REBA scores of all the five Kitchen platform tasks. The pain in the shoulder was also associated with the REBA Scores of all the tasks. As per the REBA score [Table 2], distribution of data according to REBA Scoring of the 5 kitchen platform tasks revealed that: 125 (96.15%) women performed Chopping activity, 127 (97.69%) women performed frequent lifting of utensils to and fro from the stove with weight not more than 5 lbs. One hundred and twenty-eight (96.92%) women performed stirring activity using stirring utensils with weight not more than 3 lbs. and length of the handle on an average of 25 cm. Eighty-eight (67.69%) women performed mopping activity on the kitchen platform using cloth. Eighty-two (63.07%) women performed utensil washing (on an average of 25 utensils) during one washing session. The tasks of utensil washing, stirring, mopping fell into the category of high to very high risk for MSDs. The tasks of chopping and lifting were categorised into the medium-risk for MSDs. As per the association between the kitchen platform height and REBA scores [Table 3]a and[Table 3], significant difference was seen in the mean of REBA scores for utensil washing in between all the three groups of kitchen platform tasks. As per the association of different height parameters with REBA scores during different tasks [Table 4], it was seen that kitchen platform height was negatively correlated with the REBA score of lifting tasks. A weak negative association was found between the Kitchen platform height with the REBA Score of Lifting with correlation coefficient - 0.227 and significance of 0.01 (two-tailed). Furthermore, height of the person was negatively correlated with the REBA Scores of stirring and mopping with correlation coefficient of − o. 228 and − 0.229, respectively, with significance (two-tailed) of 0.01 and 0.03, respectively. As per the association between Nordic pain score and REBA [Table 5], it shows the maximum association of pain in the upper back, knee and ankle, with REBA scores of all the five Kitchen platform tasks. The pain in the shoulder was also associated with the REBA Scores of all the tasks. The pain in the hips and thighs was also associated with the REBA Scores of chopping, stirring, and mopping. Neck pain was associated with mopping and elbow pain was associated with chopping.
Table 1: Distribution According to Height of Kitchen Platform

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Table 2: Frequencies (Number of People) According to Rapid Entire Body Assessment Scoring for Five Different Activities

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Table 4: Correlation between Different Kitchen Parameters with Rapid Entire Body Assessment Scores of Different Activities

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Table 5: Association between Nordic Pain Score and Rapid Entire Body Assessment Scores

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  Discussion Top


Homemakers play an important role in nurturing society. They perform a multitude of tasks that cause ergonomic stress and exhaustion of muscle groups that result in musculoskeletal pain.[17],[18] Accidents in domestic happen generally due to poor ergonomics. The number of hazards are significantly higher in the kitchen than in other high-risk rooms.[19]

In our study, as seen in the Nordic questionnaire, about 60.77% complained of lower back pain especially during and immediately after the Kitchen platform tasks, 44.62% of them complained about pain around shoulder and 39.5% has knee pain.

As per the REBA score [Table 2], the tasks of utensil washing, stirring, mopping fell into the category of high to very high risk for MSDs. The tasks of chopping and lifting fell into the medium-risk category. This can be attributed to the fact that these tasks are often repetitive and require sustained postures. Repetitiveness has been frequently cited as risk factors associated with the development of upper and lower-extremity disorders and arise due to overuse of a particular part of the body.[20]{Table 2}

As per the association between Nordic pain score and REBA [Table 5], it shows the maximum association of pain in the upper back, knee and ankle, with REBA scores of all the five Kitchen platform tasks. The pain in the shoulder was also associated with the REBA Scores of all the tasks.

Highly repetitive works directly damage tendons, through repetitive stretching and elongation as well as increased likelihood of fatigue and decrease in the opportunity for tissue to recover.[21],[22]

As per the association of different height parameters with REBA scores, during different tasks [Table 4] it was seen that kitchen platform height was negatively correlated with the REBA score of lifting and utensil washing. As the kitchen platform height decreases, the risk of MSDs increases. Furthermore, the height of a person was negatively correlated with the REBA scores of stirring and mopping tasks, thus contributing to MSDs.{Table 4}

The problems are caused or aggravated by repetitive motions including vibration or sustained or constrained postures, improper work surface height, and forceful movements.[21],[22]

In a study done among rural housewives, it was found that awkward posture, such as bending, lifting, and working in squatting position, movements of repetition were associated with MSDs in different body areas. Most affected regions were upper and lower back, wrist, knees, and elbow.[23],[24]

As per a study done by Nag et al.,[25] on the hand anthropometry in Indian Women, forceful, repetitive usage of kitchen tools, that are not designed as per their hand dimensions and strength ranges, have a higher prevalence of MSDs of the hand. It is necessary to take into consideration the ergonomic criteria of both planning and correcting the existing kitchen situations.[2],[9],[10],[17],[18]

This is essential as knowledge of the incidence of MSDs and their burden is fundamental to any country's health planning.[5],[23]

Limitation

The study did not consider the effect of Psychosocial Factors as a cause of MSDs. The sample size was small and ground-level kitchen platforms were not included and the association of age with type of MSDs. A significant correlation was found in all the five tasks (P< 0.01) associated with knee pain, which could probably be due to undiagnosed osteoarthritis of the knee.


  Conclusion Top


Kitchen platform tasks performed in awkward, repetitive postures, over an improper work surface height is associated with an increased incidence of MSDs among young- and middle-aged women.

Acknowledgment

We would like to express our special thanks of gratitude to our institution Dean, Head of Department, Guide, Authors, Statistician and the Participants of the study.



Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.



 
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    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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