¹Faculty of Physiotherapy Shree Guru Gobind Singh Tricentenary University, Gurugram, Haryana, India.

²School of Physiotherapy, Delhi Pharmaceutical Sciences and Research University, New Delhi, India

Corresponding author email: dahiya.jyoti25@gmail.com

Article Publishing History

INTRODUCTION

Among all the profession-kindred health issues, dysfunctional shoulder and neck is the most substantial reason of morbidity and absenteeism from work in innumerable countries. Out of all the general musculoskeletal disorders (MSD), neck dysfunction is discrete having a particular pathology among various working communities with its multifaceted bio-psychological origin and socio-economic costs (Lederer et al. 2001; Ingersoll 2001). School teachers play crucial part in overall development of student’s future. Therefore, a school teacher’s comprehensive well being plays an overriding role in success of education system.

Worldwide, it is established and documented that teaching is embellished as one of the most demanding profession lately. Teachers have exorbitant prevalence of anxiety, headache, and psychosomatic disorders which are much inflated as compared to other occupations. These are erupting neck and shoulder dysfunction day by day due to their working posture, leading to headway of profuse musculoskeletal and occupational disorders.

Such symptoms of neck and shoulder dysfunction are very prevalent between the age of 30-35 years (Vernon  1991; Tsutsumi et al. 2002; Johnson et al. 2005; Nejat 2010; Korkmaz et al. 2011). Administrative stipulation at school lay down teachers on extensive amount of coercion. Hence, school teachers are inclined to thrive on psychosocial impairments because of considerable work load at school. There is ample evidence which exhibits that teacher experience hardship from excessive stress, which in turn influence their physical and mental well-being.

School teachers reported to have abysmal quality of life following certain years of working, which in turn executes substantial impact on their health and performance. The major rationale behind evaluation of neck disability and quality of life is to find out consequences of extensive teaching and administrative load over health status among teachers, as poor health not only influence their well-being but also has an immeasurable ramification over student’s performance and future.

Hence, the aim of this study is to analyse neck dysfunction and quality of life among school teachers in Delhi, India. The result and findings of present study may be utilised for development of management strategies for enhancing the quality of life and control of neck dysfunction, by formulation of specific exercise regime with consideration of age, gender and ergonomics (Sadeghian et al. 2013; Han 2014; Hunger et al. 2016).

MATERIAL AND METHODS

A cross-sectional study on school teachers was administered in Delhi, India. Convenience sampling was implemented for data collection. Teachers who were employed on regular basis from primary (1–8 grade) and secondary (9–10 grade) schools were embraced. Private and government schools were designated.

The sample size calculated using a single population proportion formula by considering 69% prevalence of neck pain, 95% confidence interval and 5% margin of error. Sample size of 169 was obtained. Functional disability was assessed using the NDI Neck disability questionnaire. The subjects acknowledged multiple-choice questions, and their scores interpreted on a range of 0-50, 0 being no disability and 50 suggested complete disability. Short-form -36 (SF- 36) questionnaire was used for evaluating quality of life including mental health, emotional limitation, social activity, vitality rate, general health, physical limitation, body pain, and physical functional status (Vernon and Mior 1991; Nejat 2010).

Prior to data collection information letter was sent to government and private schools of Delhi/NCR, with necessary details of research work. Data collection was performed following permission from competent authority of school and was performed from September 2020 to February 2021. School teachers who gave written consent were comprised. Ethical Clearance was obtained from faculty of physiotherapy department, Shree Guru Gobind Singh Tricentenary University (S.G.T University) Gurgaon-Badli Road Chandu, Budhera, Gurugram, Haryana 122505 as per letter no. SGT/FOP/2019/44 dated 4/10/2019.

The data collection process was closely monitored by the principal investigator throughout the data collection period. Filled questionnaires were checked regularly for completeness of information and conflicts if any, and were immediately reported to data collectors. Data was coded and entered into Epi info software version 7.0 and was analysed using IBM Statistical Package for Social Sciences (SPSS) version 23 for windows.

RESULTS AND DISCUSSION

Results statistically shows noteworthy effect on school teacher’s quality of life and functional neck dysfunction. A total of 200 questionnaires were distributed among school teachers, of which 169 were included in the study as they responded well with all questions answered.

Table 1. Frequency distribution of gender

	Frequency	% Distribution
Male	50	29.58
Female	119	70.41

Table 1 displays frequency distribution of gender where 50 (29.58%) males and 119 (70.41%) female school teachers participated in the study. A larger part of study participants were females (70.41%).

Table 2. Frequency distribution of marital status of school teachers

	Frequency	% Distribution
Married	89	52.66
Unmarried	80	47.33

Table 2 represents frequency of marital status of school teachers, where 89 (52.66%) married and 80 (47.33%) unmarried teachers were engaged.

Table 3. Frequency distribution of mode teaching in school.

	Frequency	% Distribution
Black/ white board only	120	71.00
Black board/ white board & Projector	49	28.99

Table 3 constitutes 120 (71%) Government school teachers uses blackboard/ whiteboard and 49(28.99%) uses power point presentation for teaching and learning.

Table 4. Frequency distribution of type of government school teachers and private school teacher included in the study.

	Frequency	% Distribution
Government School teachers	112	66.27
Private School Teachers	57	33.72

Table 4 explains majority of school teachers were from governmental schools 112 (66.27%) as compared to private schools.

Table 5. Frequency distribution of teaching experience, working hours, sitting hours, standing hours and computer utilisation.

	Minimum (Hours)	Maximum (Hours)	Mean±SD
Teaching experience	2	10	3.81±2.0
Working hours/Day	8	12	8.09±0.86
Sitting hours/ Day	2	5	4.00±1.15
Standing hours/Day	2	8	3.73±1.35
Computer use/Day	2	7	3.06±1.11

10 years of maximum teaching experience was reported and 2 years of minimum experience with the mean 3.81.

Table 6. Frequency distribution of Age

Age	Frequency	%
25-30	68	40.82
31-35	100	59.17
36-40	1	1.0

A larger part comprised of age group 31-35 years and smallest part comprised of age group 36-40 years.

Table 7. Descriptive statistics of Neck disability index- NDI

	Minimum Score	Maximum Score	Mean±SD
Score NDI	5	35	23.79±4.37

Table 8. Distribution of neck disability among school teachers as per gender distribution

Degree of disability	Female	Male	p- value
0	16	9	0.000
1	18	10	0.00
2	15	20	0.000
3	120	70	0.000

“Neck Disability Index” NDI- 0 – lack of dysfunction, 1 – mild (NDI), 2 – moderate (NDI), 3 – severe (NDI) * p ≤ 0.05 – statistically significant. Results encounter 120 school teachers with severe neck dysfunction, 15 teachers with moderate symptoms of neck dysfunction/disability. Overall result display majority of school teachers were suffering from neck dysfunction (Table- 8).

Table 9. The mean and standard deviation of quality-of-life scores

SF- 36 Major Subscales	Study Sample (n=169) Mean (SD)	P-value
Physical Functioning status	71.32 (21.87)	0.000
Physical Limitations of teachers	61.29 (37.38)	0.000
Bodily Pain	67.65 (20.58)	0.000
General Health of teachers	62.42 (18.10)	0.000
Vitality rate	60.26 (17.32)	0.000
Social Functioning activity	71.32 (21.10)	0.000
Emotional Limitation status	69.29 (38.16)	0.964
Mental Health status	67.05 (15.91)	0.765

Quality of life with respect to psychosocial characteristics like physical functioning 71.32(21.87), and social functioning 61.29 (37.38) were exceptionally contrived. Emotional well-being 69.29 (38.16) and mental health status 67.05 (15.91) display highly affected (Table- 9). In this preliminary research, functional status of Neck (Neck disability), psychological status, health status, and occupational characteristics (quality of life) among school teachers were analysed.

The results were consistent with other previous studies, which may be explained with the demanding work environment of school teachers as compared to general population (Kum-tang 2001; Yang et al. 2009). Moreover, it has been established that most of the time school teachers are assessed by performance of their students test scores and rate of acceptance in entrance exam of higher studies, which puts a lot of pressure on school teachers. They have to deal with increasing demand of quality and quantity of work, along with organisational competitiveness among teachers. This puts a lot of pressure on teachers which greatly affects their overall quality of life (Cooper et al. 1993; Bartlett 2004; Ehsani et al. 2018).

It is established, that school teachers are suffering from excessive workload, which comprise preparation of lesson plans, communication with students and their parents, paper correction, and administrative duties (Ehsani et al. 2018).Recent changes incorporated in education system with application of newest technologies have placed excessive demand on school teachers, which requires absorption of latest knowledge to improve their overall ability and keep up with societal developments. School teachers may sometimes lead to breakdown because of increasing work demand and presence of lower resources, which could reduce the quality of life at personal and professional front (Dussault et al. 2006; Ehsani et al. 2018).

The self-reported questionnaire exhibit 120 teachers agonized severe neck dysfunction (Table 8). The results indicated that neck dysfunction is a common occupational health problem among teachers. Karakaya et al. (2015) found teachers overall health status, work load, and administrative work may increase the prevalence rate of neck pain among school teachers. Though, studies have also reported prevalence rate of SNP is distinctively scant.  The findings of present study are very similar to a study done among Malaysian school teachers which reported 60% prevalence of neck dysfunction due to static work posture (Karakaya et al. 2015; Zamri et al. 2015; Ehsani et al. 2018).

Ehsani et al. (2018), has suggested that school teachers are prone to develop appalling quality of life due to work stipulation and poor physical activity. Therefore, incorporation of regular physical activity has a positive effect in prevention of shoulder and neck dysfunction among school teachers. It also reduces risk of developing neck pain by 82% as compared to those with no exercise. These results were consistent with studies done in Turkey, China and Botswana. The possible reasons of better quality of life may be because, exercise can improve strength, flexibility, pain threshold, and makes muscles and ligaments stronger to support the cervical spine (Erick 2011; Korkmaz et al. 2011; Yue et al. 2012; Ehsani et al. 2018).

CONCLUSION

Present study showcased a significant number of school teachers who experience functional neck dysfunction. School teachers had drastic effects on their physical functioning, physical limitation and general health in the past 12 months. Static head down neck posture, teaching experience, elevated arm over shoulder is mostly associated with neck disability. Therefore, school administration is hereby recommended to provide good facilities to enhance physical activity and ergonomics among school teachers with provision of adjustable board and classroom material. Further research is required to find out the causes of poor health status and contributing factors for altered posture.

ACKNOWLEDGEMENTS

Authors wish to thank the contributing school teachers of Delhi. The procedures followed were in accordance with the ethical standards of the Committee on Human Experimentation of Shree Guru Gobind Singh Tricentenary University, Gurgaon, Haryana, India.

Conflict of Interests: Authors declared no conflict of interests in present research work.

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