6Brief resume of the intended work:6.1Need for the studyGold ornament making industry are one of the wide spread small scale industries of India, belongs to unorganized sector. Indian strength lies in the two millions highly skilled work forces dedicated to the cause of this sector of which one million are exclusively engaged in production of export oriented jewellery items. The estimated annual demand for gold in country is over 800 tonne. Indian market share in the jewellery sector is $2.5 billions which are 4% of worlds market. (Gold ornament jewellery cluster Thirssur). 1

The proliferation of gold ornament making industry has generated a concern related to the potential health hazards associated with their work. There have been numerous goldsmiths complaining of a wide range of symptoms and work related musculoskeletal disorders are one among them.2

Goldsmiths usually suffer from musculoskeletal disorders of back, arm, shoulder and neck. The neck and low back are involved 80% and 75% respectively1. Work related musculoskeletal disorders are manifested as numbness, reduced joint ROM, Swelling, burning, pain weakness, redness, clumsiness, aching and tingling.3 Pain in the neck and shoulder area with tenderness over the descending part of the trapezius/other adjoining muscles is more commonly seen. The signs and symptoms of musculoskeletal disorders includes ache and pain on loading of the joints, Local tenderness, stiffness, pain on muscle contraction and pain on stretching of the tendons4.The U.S department of labor defined work related musculoskeletal disorders as injuries or disorders of the muscles, nerves, tendons, joints, cartilage and spinal discs associated with exposure to risk factors in the work place.5

The most common cause is because of the awkward posture adopted by the goldsmiths due to poorly designed work station. This poorly designed work station forces the goldsmiths work for a prolonged period in a forward inclined posture which promotes unnecessary physical effort reducing the efficacy and productivity.2

Evidences suggest job redesign and intervention that address the workers work-style when placed with the increased work demands helps to reduce the work related musculoskeletal disorders. 6 7

Literature suggests matching the workstation to the employee provides effective basis for the optimal posture thus reducing the work related musculoskeletal disorders.8 But there is a paucity of the studies exclusively on fitting of a workstation specific for the goldsmiths. Hence the purpose of this study is to know the impact of work station design on work related musculoskeletal disorders among goldsmiths.Hypothesis:-Null hypothesis:-There will not be any significant reduction in work related musculoskeletal disorders in goldsmiths after work station design modification.Alternative hypothesis:-There will be a significant reduction in work related musculoskeletal disorders in goldsmiths after work station design modification.

6.2 Review of Literature:

Tirtankar ghosh, Banibrata das, Somanath gangopdhyay (2010) conducted a study to identify the occupational disorders of goldsmiths in India. A detailed questionnaire study on discomfort feeling was done by the modified Nordic questionnaire; the existing work station was done by measurement of work area, analysis of body posture done by rapid upper limb assessment technique to evaluate the work stress during their job the study showed a prevalence rate of occupational disorders. Workstation assessment revealed goldsmiths work in 180cms/280cms room which are poorly illuminated (19 Lux) for a prolong time with forward neck inclination of 41 degree and forward back inclination of 52 degrees from the vertical sitting posture. An average of 19cms of distance is maintained between eye and work surface. At neck (80%), shoulder (20%), wrist (45%), low back (75%) and also problems like eye irritation (30%), burning sensation (70%). The conclusion of the study includes that the health of the goldsmiths were highly affected due to improper body posture and work load.2

John-f-Kennnedy, Ingenieurbor Schwan Frankfurt (2007) has conducted a study on ergonomic work place design for sewing workers, as The number of work related diseases and lost working hours has increased so the spatial arrangement of the work place under the work bench and the foot pedal were altered to maintain upright posture and to relieve the strain on the spinal column. A work table of adjustable height was introduced that can switch easily between sitting and standing. The result achieved was the workers acceptance of newly designed work station and a clear reduction in stress and strains and increased job satisfaction. The number of working days lost fell by 16%, the needle operating time for the redesigned machines increased by up to 50% and the productivity rose by 15%.6

Jan Persson, Asa Kiborn, B. Jorn. G. Jonsson (2003) conducted a study on disorder of cervico brachial region among female workers in electrical industry for 2 years revealed the prevalence rate of 24%. The study also found the significant relation between awkward posture and neck musculoskeletal disorders.9Maria Beatriz, G. Villanueva, Hiroshi Jonai, Midori Sotoyama, Yasuhiro Takeuchi and Susumu(1997) has conducted a study to examine the effect of the VDT screen height on the working posture and the EMG activities of the neck and shoulder muscles. With sample size of 10, the subjects performed a mouse drive interactive task at screen height setting of 80, 100 and 120cms and noted EMG readings for the neck extensor muscles and trapezius muscle. They concluded that at higher screen height sittings the neck becomes erect. The EMG readings of the neck and shoulder muscles were related to the neck angle and shoulder inclination.10

Al-Haboubi MH, Baia A (1989) Has conducted a study on barbers work station, as their profession demands standing for long time. A prototype work station was designed and constructed in which the barbers sit and performs the work. The discomfort levels obtained while standing and sitting were statistically analyzed from the results and concluded that the mean of the discomfort levels while standing is significantly higher then that of while sitting.7

Anderson, chaffin D B, Herrin G D (1986) Described the study of lumbar and sacrum orientation in various standing posture with patient holding different load in the hand. Vertebral rotation data were gathered from the subjects while performing static lift at 2 load levels and in posture ranging from erect standing to varying level of forward bending and concluded that the amount and quality of forward bending posture on technique of work influence compressive force on the vertebral discs and erector spinae muscle.11

Kumar s and Scaife W.G.S (1979) proved that the Cervical & Lumbar extensors muscle forces are found from moment equations which primarily depend on the size of the angle of neck inclination & back inclination the vertical sitting posture. Thus for even a 30o inclination angle from the vertical, the movement and corresponding muscle force values are at 50% of the values achieved at 90o(Horizantal).12

Synder R G, Cheffin D B (1975) revealed in their study that the subjects are capable of maintaining 20o of forward bend posture because the load movement increases rapidly for each degree of back inclination above 20o. It is also recorded that when the work surface is too low person not only leans forward but also lowers and rotates shoulders causing the fatigue and pain in the levator scapulae muscle.13

6.3 Objectives of the study:-

To study the impact of work station ergonomic intervention on work related musculoskeletal disorders in goldsmiths.

7Materials and methods:-

7.1 source of data :

Gold merchants association, Andhra Pradesh.

7.2 Method of collection of data:-

Population - Goldsmiths with musculoskeletal disorders of back neck and upper

extremity Sample size - 30

Sample design - stratified sampling

Type of study - experimental-pre- post design

Duration of study - 3 months

Inclusion criteria:-

Goldsmiths with age group of 24-37years.

Experience 9-23yrs.

Duration Work per day 9-14hrs/day.

Exclusion criteria:-

Persons who are having pre existing neuro-musculoskeletal disorders. Under any treatment for the existing work related musculoskeletal disorders.

Measuring tools:-

Vas scale

Pressure Algometer

7.3 Methodology:-

Subjects having the work related musculoskeletal disorders in the neck, back and upper extremities are identified by using Nordic questionnaire.

The subjects who fulfill inclusion and exclusion criteria will be randomly assigned into control & Intervention group.

By using VAS & Pressure algometer outcome measures are recorded prior and after 12 weeks of intervention.

1) Pain:

The pain caused by work related musculoskeletal is measured by VAS scale. The scale consists of a 10cm line with 0 on one end, representing no pain, and 10 on the other, representing the worst pain ever experience, which a subject marks to indicate the severity of his pain.2) Tenderness:

The pressure pain algometer is placed perpendicular to the tissue surface and the pressure is applied steadily at a constant rate. The compression should be performed slow enough to allow the subject time to react when pain is felt. When the subject reports feeling pain the action of pressure is stopped by pressing a switch on an electronic pressure algometer.

Procedure:-

Subjects in the study will be participating in 12wk training program.

Intervention group:-

The training program will require the subjects in the intervention group to work in the modified work station for about 3-4hrs per day with three training sessions in a week.

Modified work station will consists of 4037cms adjustable working desk with adjustable forearm support, so the angle of inclination of back and neck will be maintained at 20o.

Control group:-

The subjects in the control group will be given with conventional physiotherapy. Conventional physiotherapy treatment will include ergonomic advices on postural correction in order to maintain 20o of angle of inclination of back.

Out come measures:

Pain

Tenderness

Statistics :-

Descriptive Statistics

Independent-T test7.4 Ethical Clearance:-

As this study involve human subjects, the ethical clearance has been obtained from the ethical committee of Padmashree institute of physiotherapy, Nagarbhavi, Bangalore, as per ethical guidelines research from biomedical research on human subjects, 2000, ICMR, New Delhi.

8List of references:

1 Diagnostic study of gold ornament jewellary cluster thrissur. 2005 feb 28;1-3.

2 Tirtankar ghosh, Banibrata Das, Somanath gangopadhyay. Work related musculoskeletal disorders: an occupational disorders of the goldsmiths in India, pokhra, Nepal. Official publication of Indian association of preventive and social medicine Indian journal of community medicine 2010; 35:321-325.

3 James E. Mc Greevey. Cumulative trauma disorders in office workers, public employee occupational safety and health program, Public employee occupational safety and health progromme New Jersey; 2003

4 Allan Toomingas. method of evaluating work related musculoskeletal neck and upper extremity disorders in epidemiological studies. Goteborg university. 1998;18-20.

5 Marry F barbeab department of physical therapy, Ann E Barra department of anatomy, work related musculoskeletal disorders- definitions and risk fsctors. Philadelphia (USA) Pubmed central 2006;2-3.

6 John-F-Knnedy Ingenieurbo schwan Frankfort. Systemic ergonomic workplace design in sewing work. Safety and health at work European Good practice awards. 2007;9-10.

7 Al-haboubi M H, Baia A, ergonomic design of a barbers work station, Saudi Arabia: Pubmed Index for MEDLINE 1989;13.

8 Kulahutte Gmbh, The Ergonomic Design of Work Places and Work Organization in Small to Medium Size Enterprises,Safety and health at work European Good practice awards. 2007;9-10.

9 Bjorn G. Jonsson, Jan Persson and Asakilbom, Disorders of the cervico-brachial region among female workers in the electric industry, A two years follow up. Sweden: International Journal of Industrial Ergonomics 2003;3:1-12.

10 Maria Beatriz, G.VILLANUEVA, Hiroshi JONAI, Midori SOTOYAMA, Naomi HISANAGA, Yasihuro TAKEURCHI and Susumi SAITO. Sitting posture and neck and shoulder, muscular activities at different screen height sittings of the visual display terminals, Japan : Industrial health. 1997;1-3.

11 Anderson, chaffin D B, Herrin G D, A study of lumbo sacral orientation under varied static loads, USA: Pubmed index for MIDLINE 1986;1.

12 Kumar S and Scaife W.G.S. precision task and strain, journal of safety research.1979; 11: 28-36.

13 Synder R G, Cheffin D B. Bioengineering study of basic physical measurements related to susceptibility to cervical hyper extension hyperflexion. Highway safety research institute. 1975;75-76.

14 David J. Magee, orthopedic physical assessment, 5th ed. Canada: Elsevier 2008;9.

15 Jari ylinen. Pressure Algometry. Australian physiotherapy association 2007;53;207.