WORKING ENVIRONMENT AND QUALITY OF LIFE AMONG HEALTH CARE PROFESSIONALS SUFFERING FROM MUSCULOSKELETAL DISORDERS IN KHULNA REGION, BANGLADESH (PhD Thesis- Running)

1. Background Information

Musculoskeletal health refers to the performance of the locomotor system, comprising intact muscles, bones, joints and adjacent connective tissues. Musculoskeletal impairments comprise more than 150 different diseases/conditions that affect the system and are characterized by impairments in the muscles, bones, joints and adjacent connective tissues leading to temporary or lifelong limitations in functioning and participation (World Health Organization, 2022). Musculoskeletal disorder is group of conditions affecting bones, joints, muscles, and connective tissues. These disorders may result in pain and loss of function (United States Bone and Joint Initiative, 2014). Musculoskeletal disorders are further classified as specific or non-specific disorders. Specific musculoskeletal disorders have clear clinical features, whereas non-specific musculoskeletal disorders present with pain without evidence of a clear specific disorders (Azma et al., 2016). Work-related musculoskeletal disorders are known by many terms and are used interchangeably, such as repetitive motion injuries, cumulative trauma disorders, repetitive strain injuries, overuse syndrome, regional musculoskeletal disorders and soft tissue disorders (Azma et al., 2016). Work-related musculoskeletal disorders, referred to as work-related repetitive stress (overuse) injuries, have accounted for a significant proportion of work injuries and workers’ compensation claims in western industrialized nations since the late 1980s (David et al, 2015). Work-related musculoskeletal disorders are described as wide range of degenerative and inflammatory conditions that affect the supporting blood vessels, peripheral nerves, joints, ligaments, tendons, and muscles. Such conditions could result in functional impairment and pain which are widely experienced at the upper extremities and the neck (Korhan et al., 2010). Approximately 1.71 billion people have musculoskeletal conditions worldwide. Musculoskeletal conditions are the leading contributor to disability worldwide, with low back pain being the single leading cause of disability in 160 countries (WHO, 2022). Musculoskeletal disorders continue to be the most prevalent occupational health problem among workers, representing 60% of all self-reported problems across the 28 European Union Member States. Among these 2 conditions, backache accounted for 43%, followed by muscular pains in the neck or upper limbs (42%), and muscular pains in the hipneck or upper limbs (42%), and muscular pains in the hip or lower limbs (29%) (Kok et al., 2019). Workers in all sectors and occupations can be affected by MSD, Health professionals are no exception; with the reported prevalence ranging from 28% to 96% during a period of one year (Anderson et al., 2016). Nurses constitute one of the groups with the highest prevalence of MSDs. A systematic review estimated an average of musculoskeletal symptoms in nurses at 71.85% (Ellapen et al, 2014). Nurses play an important role in the provision of healthcare services to patients. Factors that affect the nurses' health, as well as their quality of life and worklife balance, are expected to affect the quality of health-care services provided by them and their patients' level of satisfaction (Aiken et al., 2012). One study conduct with 300 nurses and reported that, the nurses presented with occasional mental exhaustion (44.3%) and often physical exhaustion (44.0%). Almost all (97.3%) the nurses complained of having work-related pain during the last 12 months. Body parts with the most pain were the lower back (86.7%), ankles (86.7%), neck (86.0%), shoulders (85.0%), lower legs (84.7%) and upper back (84.3%). The pain frequency was rated as occasional pain for the neck and upper back, pain was often felt for the rest of the parts. Nurses complained of severe pain in the lower back (19.7%), right shoulder (29.7%) and left shoulder (30.3%). The frequency of having musculoskeletal symptoms in anybody region was increased with age, lower education level, female gender, high BMI, job tenure and lifestyle (Krishnan et al., 2021). Environment can be defined as a sum total of all the living and non-living elements and their effects that influence human life. While all living or biotic elements are animals, plants, forests, fisheries, and birds, non-living or abiotic elements include water, land, sunlight, rocks, and air (Byju’s, 2023). The term work environment is used to describe the surrounding conditions in which an employee operates. The work environment can be composed of physical conditions, such as office temperature, or equipment, such as personal computers. It can also be related to factors such as work processes or procedures. In some cases, companies try to improve employees' productivity and well-being by allowing them to use their own devices (Moneyzine, 2022). 3 A positive working environment is a workplace that promotes employee safety, growth and goal attainment. These environments are most conducive to a successful workforce as they encourage employees to perform to their highest ability (Indeed, 2023). Employees are very important assets in an organization. A good organization is one which takes care of its employees. This is often done by paying attention to their workplace environment. This is because the employees spend substantial part of the time of their lives at the workplace while carrying out their work. Hence, workplace environment influences their cognitive and emotional states, concentration, behavior, actions, and abilities. It plays an important role in the employees’ engagement as well as in their performance. In fact, workplace environment has a big contribution for the organization in maintaining a high level of employees’ productivity and hence the organizational productivity (Ispat Guru, 2015). 

General objectives
 To explore the working environmental status and quality of life among health care professionals suffering from musculoskeletal disorders.
Specific objectives
 To explore the socio demographic characteristics among health care professionals.
 To assess the association between work environment and quality of life among health care professionals suffering from musculoskeletal disorders.
 To assess the association between work environment and quality of work among health care professionals suffering from musculoskeletal disorders.
 To assess the association between musculoskeletal disorders and quality of life among health care professionals suffering from musculoskeletal disorders.
 To assess the association between musculoskeletal disorders and quality of work outcome among health care professionals suffering from musculoskeletal disorders.
 To assess the association between work environment and musculoskeletal disorder among health care professionals.
 To find out the common complications treatment for musculoskeletal disorder among health professionals.
 To find out the effect of environmental and physical rehabilitation on health care professionals suffering from musculoskeletal disorder. 

• Supervision