RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

ANNEXURE-ISYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1 NAME OF THE

CANDIDATE

Ms. SIMI.S

2 NAME OF THE

INSTITUTION

T. JOHN COLLEGE OF

NURSING

3 COURSE OF STUDY

SUBJECT

Ist YEAR M.Sc. NURSING

MEDICAL SURGICAL

NURSING

4 DATE OF ADMISSION 12 June 2013

5 TITLE OF THE TOPIC “A STUDY TO EVALUATE THE

EFFECTIVENESS OF SELF

INSTRUCTIONAL MODULE ON

KNOWLEDGE REGARDING

PREVENTION AND MANAGEMENT

OF REPETITIVE STRAIN INJURY

AMONG BANK EMPLOYEES

WORKING IN SELECTED BANKS,

BANGALORE”

1

6 BRIEF RESUME OF INTENDED WORK6.1 INTRODUCTION

“Good things come to an end. Well I hope through the pain. The heartache and

strain we can still remain friends.”

Amos Lee quotes

Repetitive strain injury is a cumulative trauma disorder resulting from prolonged,

forceful, or awkward movements. Repeated movements strain tendons, ligaments

and muscles causing tiny tares that become inflamed. If the tissues are not given

time to heal properly, scarring can occur. Blood vessels of the arms and hands may

become constricted, depriving tissue of vital nutrients and causing accumulation of

factors such as lactic acid. Without intervention, tendons and muscles can

deteriorate and nerves can become hypersensitive. At this point even slight

movement can cause pain1.

When we are performing tasks, we constantly put stress on our body. Small tares,

strains and disorders develop in our tissues all the time. Usually they heal fairly

quickly; this is the natural way our body functions. However, when the

biomechanical stresses of the task outpace the ability to heal and repair itself

damage can build up until an MSD results. WMSDs are MSDs caused by or made

worse by the work environment2.

WMSDs can cause severe and debilitating symptoms such as pain, numbness and

tingling, reduced work productivity, lost time from work, temporary or permanent

disability, inability to perform job tasks, and an increase in workers’ compensation

costs. Excessive stretching of muscles and tendons can cause injuries. Repeated

stretching causing tissue inflammation can lead to long lasting injury or WMSDs3

NEED FOR THE PRESENT STUDY

Banks have gone through successive innovations in their work processes over the

last three decades, as a means of facing up to the competitiveness of the globalized

2

market. These innovations have been accompanied by the introduction of new types

of physical and psychosocial demands on bank workers, which have been reflected

in increased occurrence of work-related illness among them since the 1990s,

including repetitive strain injury and work-related musculoskeletal disorders

(RSI/WRMSD). 4

These are mainly manifested in the neck, scapular belt and/or upper limbs, as a

consequence from the work. Both the automation process and redefinition of the

bank work profile are responsible for the process in which workers become sick.

This opinion is shared by researchers who describe the situation of bank employees

who are "face to face with the new work organization". Being forced to long work

journeys, struggling to achieve abusive goals, pressure to produce and excessive

control over work time combine to produce stress and mental suffering. 4

Repetitive strain injuries (RSI) Statistics

849,000 new cases of carpal tunnel syndrome occurred in 1994.-National

Center for Health Statistics.

Approximately 260,000 carpal tunnel release operations are performed each

year, with 47% of the cases considered to be work related.-National Center

for Health Statistics.

Up to 36% of all Carpal Tunnel Syndrome patients require unlimited medical treatments in Karnataka.

While women account for about 45% of all workers, they experience nearly 2/3's of all work-related Repetitive Strain Injuries, compared with an increase from 8.2% to 9.9% for men in Karnataka.

Only 23% of all Carpal Tunnel Syndrome patients were able to return to their previous professions following surgery in Bangalore.

One out of every 10 Banglorean adults had a repetitive strain injury (RSI)

serious enough to limit their normal activities in 2000/01, according to a

new study published today in Health reports, which shows that RSIs are

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affecting a growing number of adults.5

Certain occupational groups have an increased risk of developing repetitive strain

injury. Among these are bank workers, particularly cashiers, whose activities with

repetitive movements increase their risk of upper limb symptoms and repetitive

strain injury. The study showed a high prevalence of repetitive strain injury. and

related conditions in this population of bank workers, raising serious concerns about

the magnitude of potentially disabling conditions in this occupational group, and

calling for urgent measures to improve work environments and how they are

organized.6

Bank employees continue to have lot of problems including repetitive strain injury,

obesity, poor fitness and stress. One year multi-disciplinary intervention of

corrective measures of Office Ergonomics, Posture correction, planning of right diet

and Preventive exercise program could reduce the symptoms in small number of

professionals. They are intelligent, well qualified, but their attitude towards

preventing work related problems has been very negative. They probably need long

term on-site preventive program, continuous motivation and counseling to enhance

work performance.6

The investigator during her life time come across many of the bank employees with

pain in the neck, Pain in the arm (typically diffuse—i.e. spread over many areas),

tenosynovitis, the pain is worse with activity, Weakness, lack of endurance and so

on.

The preventive measures and treatment can stop or delay further progression and

reduce the complications. By understanding this situation the investigator assumes

that prevention and management may be one of the important aspects to reduce

repetitive strain injuries among bank employees.

Hence the investigator thought that imparting knowledge regarding preventive

measures and methods of management is very essential for repetitive strain injuries

4

among bank employees so an investigator planned to prepare a self instructional

module regarding prevention and management of repetitive strain injuries.

6.2 REVIEW OF LITERATURE

In the present study review of literature was complied and classified as

Literature related to incidence and prevalence of repetitive strain injuries

Literature related to prevention & management of repetitive strain injuries

Literature related to the effectiveness of self instructional module.

Literature related to incidence and prevalence of repetitive strain

injuries

A Pilot study was conducted during 2005 on 30 computer professional workers

working in different information technology industries for two years with more than

4 hours of computer use. The preliminary study revealed an overall morbidity of

70%, among them 56% were computer professionals, out of which 20% had

shoulder pain, 5% had arm pain, 7% had pain in the fingers, 6% had wrist pain 18%

had low back pain, visual problems were detected in 8% of cases and 17% suffered

from headache.7

A cross sectional survey was carried out among bankers by using a 54- item

questionnaire. A 12-month prevalence of neck and upper extremity repetitive stress

injury was observed to be 79%. The prevalence of neck and upper extremity

repetitive strain injury was higher among female bank workers at 52.5% than male

bank workers. The neck was the most affected area (66.8%) while the elbow was

the least affected (22.5%). The highest prevalence was found among Cashiers

(87.5%). The findings of this study suggest that neck and upper extremity repetitive

strain injury is prevalent among bank workers and this may be associated with the

type of job, work station design and job demand.8

A cross-sectional study was conducted with 395 bank workers. We found

prevalence rates of 56% for symptoms of the upper limbs and 30% for 'repetitive

5

strain injury-like condition'. The estimated prevalence of clinically confirmed cases

of repetitive strain injury was 22%. Female sex and occupation (as cashier or clerk)

increased the risk of all conditions, but the associations were stronger for cases of

repetitive strain injury than for less specific diagnoses of 'repetitive strain injury-

like condition' and symptoms of upper limbs.9

A study was conducted to the sample size of 400 was calculated considering a

prevalence of computer related health problems as 20%, which was revealed in a

pilot study. Forty was added to this figure assuming 10% non response. Thus 440

was the final sample size. Mean age of the subjects who participated in this study

was 25.04 years with a range of 18 to 55 years. 183(43.7%) individuals were using

computers for more than 5 years. About 41% of the respondents used to work on

computers for 21 to 40 hours in a week. The results revealed that musculoskeletal

discomfort was 75.2%. i.e., 315 out of 419 subjects reported any of the symptoms.10

Literature related to prevention & management of repetitive strain injuries

A qualitative study investigates the work conditions of bank employees in order to

identify the extent to which changes in work organization interfere with these

workers' health. Data were collected through interviews held with 11 bank

employees. In addition to physical sickening due to occupational diseases directly

related to work intensification, the results also show an increased incidence of

mental suffering and a feeling of loss of professional identity.11

A study was conducted to assess the profile of outpatients seen at an occupational

disease clinic of a general and repetitive strain injury (RSI) patient. 56.9% were

from the economic sector of services. repetitive strain injury was seen in 56% of the

patients diagnosed at their first visit. The analysis confirms the trends seen in the

80s regarding the epidemiological changes in occupational diseases.12

A study was conducted to investigate the impact of a multi-component intervention

on health behavior change among office computer workers in bank in preventing

repetitive strain injuries. The intervention took place between time 2 and time 3 and

6

included posters, e-mail tips, mini-workshops, and activities of a Wellness

Ergonomic Team. Study findings revealed positive behavior change for 62% of the

participants. The factors most strongly related to health behavior change appear to

be self-efficacy, the intention to change one's behavior, and perceived health status. 13

A study was conducted to examine Computer professionals and Carpal Tunnel

Syndrome .Carpal Tunnel Syndrome (CTS) is an important problem among

computer professionals. Hence the prevalence of carpel tunnel syndrome among

computer professionals and risk factors were studied. 648 subjects were selected

from 4,276 computer professionals from 21 companies by with simple random

sampling method. carpel tunnel syndrome was diagnosed based on clinical features.

The prevalence of carpel tunnel syndrome was found to be 13.1% (95% CI 10.5-

15.7%). Ergonomic considerations are important in facilitating proper positioning

of hand while working with a computer. 14

Literature related to the effectiveness of self instructional module

An evaluatory study was conducted to determine the effectiveness of structured

teaching programme on prevention and management of accidents to workers in

selected day care centre at Mangalore. The study results showed that the knowledge

gained through structured teaching programme was good as evident with a highly

significant difference between the mean post-test (14.34) knowledge score. This

study recommended that structured teaching programme was found to be an

effective strategy for providing information and for improving the knowledge of

workers15

A experimental study was conducted on prevalence of work related

musculoskeletal disorders the associated risk factors and the coping strategies

among 160 workers. The study shows that 74.4% of workers have

inadequate knowledge regarding work related musculoskeletal disorders in the

protest after administration of structure teaching programme the knowledge of

workers regarding coping stratagems will increase the result shown that 87% of

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workers are having adequate knowledge regarding musculoskeletal disorders .16

A study was conducted to find effectiveness of self instructional module on

knowledge on prevention of computer vision syndrome for computer professionals

working in a selected software enterprise at Bangalore. . A sample of 100 computer

professionals were selected for the study using non probability convenient

sampling..The results shows that post test knowledge score were higher when

compared to pre test knowledge which shows the effectiveness of self instructional

module17.

PROBLEM STATEMENT

“A study to evaluate the effectiveness of self instructional module on knowledge

regarding prevention and management of repetitive strain injury among bank

employees working in selected banks, Bangalore”

6.3 OBJECTIVES

Objectives of study are:

To determine the level of knowledge on prevention and management of

repetitive strain injury among bank employees using structured knowledge

questionnaires.

To develop a self instructional module on prevention and management of

repetitive strain injury among bank employees.

To evaluate the self instructional module on prevention and management

of repetitive strain injury among bank employees in terms of gain in

knowledge scores.

To find the association with pre-test knowledge scores and selected baseline

characteristics (age, gender, educational qualification, marital status, years

of working experience, source of information, etc).

To find the association between the mean differences of gain in knowledge

regarding the prevention and management of repetitive strain injury among

bank employees

6.3.1 HYPOTHESIS

8

HO1: There will be no significant difference between mean pre and post test

knowledge scores of bank employees on prevention and management of repetitive

strain injury.

H02: There will be no significant association between the pre-test knowledge scores

of bank employees and selected baseline characteristics (age, gender, marital status,

educational qualification, years of working experience, source of information, etc).

6.3.2 VARIABLES

1. Independent variable: Self instructional module

2. Dependent variable: Knowledge regarding prevention and management of repetitive strain injury

3. Associated variable: Age, sex, educational background, occupation,

monthly income, marital status and working experience.

6.4 OPERATIONAL DEFINITIONS

a) Evaluate: It refers to the bank employees responses to self instructional module

based on their pre and post test knowledge scores on prevention and management of

repetitive strain injury

b) Effectiveness: In this study it refers to the extent to which the self instructional

module on knowledge regarding prevention and management of repetitive strain

injury achieves its objectives in improving knowledge as evidenced by gain in post

test knowledge score.

c) Self instructional module Prevention and management: It refers to

systematically prepared self explanatory information which are designed to increase

the knowledge regarding prevention and management of repetitive strain injury.

d) Knowledge: In this study it refers to correct responses given by bank employees

for knowledge items in the structured questionnaire regarding prevention and

9

management of repetitive strain injury and is expressed in terms of knowledge

scores.

e) Repetitive strain injuries: It refers to an occupation related injuries caused due to

repeated actions or movements for a long period of time, which includes Carpal Tunnel

Syndrome,: Cervical radiculopathy,cubital tunnel syndrome,etc.

f) Bank employees: In this study it refers to the bank employees who are in the age

group of above 21 years working in selected banks, Bangalore.

g) Banks: It refers to a financial institution which deals with deposits and advances

and other related services.

6.5 ASSUMPTION

Bank employees may have some knowledge regarding prevention

and management of repetitive strain injury

Self instructional module may enhance the knowledge regarding

prevention and management of repetitive strain injury among bank

employees.

6.6 DELIMITATIONS

Study is limited to bank employees working in selected banks, Bangalore.

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MATERIALS AND METHODS

7.1 Sources Of Data : Bank employees working in selected banks

7.1.1 Research Approach: Evaluative.

7.1.2 Research design : Pre experimental one group pre-test post-test design.

7.1.3 Setting : Selected banks in Bangalore.

7.1.4 Sample size : 60 bank employees

Sample size :

Sample Size will be computed from the following formula:

N = Z 2 P (1-P)

10

E2

Where N= sample size

P= Proportion of bank employees which is 50%.

E= Maximum error of the study, which is 0.05.

Z= Standard normal deviation that correspond to 5% level of statistical

significance i.e:1.96

7.1.5 Inclusion criteria Bank employees who are

working in banks.

above the age of 21 years.

willing to participate in the study

able to read & write English & Kannada

7.1.6 Exclusion criteria Bank employees who are

not working under computer application.

sick at the time of data collection

who have been diagnosed and under the treatment for repetitive strain injury

who have attended any type of education program on repetitive strain injury

7.2 Method of collection of data7.2.1 Sampling technique: Simple random sampling.

7.2.2 Tool of research: Structured questionnaire

Structured questionnaire will be constructed in two parts

Part I - Demographic data

Part II- Knowledge based questionnaire regarding prevention and management of

repetitive strain injuries.

7.2.3 Collection of data

The investigator collects data from bank employees.

Investigator introduces herself to subject and notifies about her aims,

objectives, and steps of study and takes written consent.

Selection of subjects (Bank employees)

Pre-test / assess the bank employees for knowledge regarding prevention

and management of repetitive strain injuries using structured knowledge

11

questionnaire.

Administer self instructional module (SIM) on prevention and management

of repetitive strain injuries.

Post-test / assess the gain in knowledge among bank employees for

knowledge regarding prevention and management of repetitive strain

injuries using same structured questionnaire.

7.2.4 Method of data analysis and presentation

The investigator uses descriptive & inferential statistical techniques for data

analysis.

The analyzed data will be presented in the form of tables, diagrams, and

graphs based on finding.

7.3 Does the study require any investigation to be conducted on patients or

other human or animals? If so please describe briefly?

Yes, the investigator needs to assess the knowledge of bank employees on

prevention and management of repetitive strain injuries and also to

administer self instructional module after getting the informed consent from

them.

7.4 Has ethical clearance has been obtained from your institution? Yes, Consent will be obtained from concerned subjects and authority of

institution.

Privacy, confidentiality and anonymity will be guarded.

Scientific objectivity of the study will be maintained with honesty and impartiality.

8 Lists of Reference1. Silverstein B, Viikari-Juntura E, Kalat J: Use of a prevention index to

identify industries at high risk for work-related musculoskeletal disorders of

the neck, back, and upper extremity in Washington state,. Am J Ind Med,

41:149-169, 2002.

2. Bongers PM, de Vet HC, Blatter BM: Repetitive strain injury (RSI):

occurrence, etiology, therapy and prevention. 146:. 2002.

12

3. Santos Filho SB, Barreto SM: Methodological issues in epidemiological

studies of repetitive strain injuries. Cad Saude Publica, 14:555-563. 1998

4. Szabo RM, King KJ: Repetitive stress injury: diagnosis or self-fulfilling

prophecy? J Bone Joint Surg Am, 82:1314-1322. 2000

5. Nathan PA, Meadows KD: Neuromusculoskeletal conditions of the upper

extremity: are they due to repetitive occupational trauma? Occup Med,

15:677-93, 2000

6. Verhagen AP, Bierma-Zeinstra SMA, Feleus A, Karels C, Dahaghin S,

Burdorf L, de Vet HCW, Koes BW: Ergonomic and physiotherapeutic

interventions for treating upper extremity work related disorders in adults.

The Cochrane Database of Systematic Reviews, :Issue: 3, 2003

7. Alexopoulos EC, Stathi IC, Charizani F: Prevalence of musculoskeletal

disorders in dentists. BMC Musculoskelet Disord, 5:16. 2004

8. Farnsworth EM: Diagnosis and management of repetitive strain injury. Adv

Nurse Pract, 9:32-8; 2001

9. Willems JH: Repetitive strain injury (RSI); a report from the Health Council

of the Netherlands. Ned Tijdschr Geneeskd, 146, 2002

10. Picavet HS, Hazes JM: Prevalence of self reported musculoskeletal diseases

is high. Ann Rheum Dis, 62:644-650, 2003

11. Leclerc A, Chastang JF, Niedhammer I, Landre MF, Roquelaure Y:

Incidence of shoulder pain in repetitive work. Occup Environ Med, 61:39-

44. 2004

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12. Treaster DE, Burr D: Gender differences in prevalence of upper extremity

musculoskeletal disorders. Ergonomics, 47:495-526. 2004

13. Nieradko B, Borzecki A: Computer use and computer related repetitive strain injuries among students of the Medical University of Lublin. Ann Univ Mariae Curie Sklodowska [Med], 58:354-357. 2003

14. Gerr F, Monteilh CP, Marcus M.Department of Occupational and Environmental Health, College of Public Health, University of Iowa, edu J Occup Rehabil.  16(3):265-77. 2006

15. Hall B, Lee HC, Fitzgerald H, Byrne B, Barton A, Lee AH. Investigating the effectiveness of full-time wrist splinting and education in the treatment of carpal tunnel syndrome: a randomized controlled trial. Am J Occup Ther.; 67(4):448-59. 2013

16. Bleecker ML, Celio MA, Barnes SK. A medical-ergonomic program for symptomatic keyboard/mouse users. J Occup Environ Med. 53(5):562-8. 2011

17. Keulers BJ, Welters CF, Spauwen PH, Houpt P. Can face-to-face patient education be replaced by computer-based patient education? A randomised trial. Patient Educ Couns. 67(1-2):176-82. 2007

18. Polit DF, Hungler BP, Nursing research, principles and methods, Philadelphia: Lippincott; 1999.

19. Kader P. Nursing research: Principles, process and issues. 2nd Ed. New York: Palgrave Macmillan; 2006.

20. Saravanavel P, Research methodology, 16th edition, Kitab Mahal agencies, Page 169– 170; 2006.

WEBSITES

14

www.google.comwww.pubmed.comwww.medline.com

9 Signature of Candidate

10 Remarks of the Guide This study is more appropriate in creating

awareness among bank employees

regarding prevention and management of

repetitive strain injury.

11 Name & Designation Of:

11.1 Guide

Mrs. Gladish George

Associate Professor

11.2 Signature

11.3 Co-Guide Mrs. Ambily Thomas

Lecturer

11.4 Signature

11.5 Head of the Department Mrs. Gladish George

11.6 Signature

12 12.1 Remarks of the Principal This study is relevant pertaining with

prevention and management of repetitive

strain injury and it will be very useful for

bank employees.

12.2 Signature

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