Volume 12, Issue 1 (Winter 2023)                   J Occup Health Epidemiol 2023, 12(1): 59-66 | Back to browse issues page


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Charu C, Sohrab K A, Harsirjan K, Mazhar M. Prevalence of Work-Related Musculoskeletal Disorders in CISF Staff of Delhi Metro, India (2019). J Occup Health Epidemiol 2023; 12 (1) :59-66
URL: http://johe.rums.ac.ir/article-1-649-en.html

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1- Assistant Prof., K.R Mangalam University, Sohna Road, Gurugram, Haryana, India.
2- Associate Prof., Dept. of Physiotherapy, Jamia Hamdard University, Hamdard Nagar, New Delhi, India.
3- Assistant Prof., Gurugram University, Gurugram, Haryana, India. , sirjan4242@gmail.com
Article history
Received: 2022/10/3
Accepted: 2023/04/18
ePublished: 2023/04/27
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Introduction
Musculoskeletal disorders (MSDs) are connective tissue or musculoskeletal diseases that cause muscle pain or injuries from sudden or sustained contact with repetitive motion, force, vibration, or wrong postural movement. MSDs involve injuries or disorders to the muscles, joints, tendons, cartilage, nerves, and spinal area of the upper limbs (UL) and lower limbs (LL), neck, and lower back [1]. MSDs are self-reported musculoskeletal symptoms that may result in suffering among individuals and have economic effects on society [2].
Delhi Metro is a rapid transit system serving Delhi and its satellite cities in the National Capital Region since the inauguration of its first line in 2002. With the sanctioned strength of 12,528 personnel, the Unit has become the largest single-unit under the security cover of the country's Central Industrial Security Force (CISF). The CISF personnel are responsible for access control of passengers inside the metro stations. Each passenger must go through a door frame metal detector (DFMD) before being frisked by a CISF personnel. Double-layered frisking is carried out when threat perception is high, like national days. The Unit deploys several Quick Reaction Teams (QRTs) to counter any potential man-made threat to the security of the metro system. (DMRC)
A study on police officers in Araçatuba region, Sao Paulo, Brazil, concluded a high prevalence of MSD symptoms, especially over the past 12 months involving the lower back, representing a chronic problem. These findings emphasize the importance of periodic evaluation and the need to implement strategies to promote health and improve working conditions to minimize the prevalence of MSD symptoms [3].
Unlike other work forces, the CISF force does not have a fixed work pattern and must be geared to meet unexpected emergencies for unspecified periods. A culmination of these pressures has resulted in increased stress on a day-to-day basis. This subjective stress caused by daily living or working situations may lead to various health problems such as MSDs leading further to changes in job performance and quality of life [4]
These personnel are highly likely to show musculoskeletal pains due to rough physical activities, including duties, traffic control, driving, security, sports and drills, and handling heavy equipment, and are highly hospitalized or treated [5].
The prevalence of MSDs in CISF metro Personnel has not been documented in literature to date. Thus, the present study aimed to find the prevalence of work-related musculoskeletal disorders (MSDs) in CISF staff of Delhi Metro (DMRC). This will aid in predicting risk factors for developing MSDs and suggest corrective measures for preventing MSDs in the targetted study population.

Materials and Methods
The study was performed according to the National Ethical Guidelines for Biomedical & Health Research involving human participants guidelines given by the Indian Council of Medical Research (2017) and the Helsinki Declaration (2013). Ethical approval was taken from the local Institutional Review Board, and written informed consent was obtained from CISF Headquarters, Delhi and the participants before the study.
A total of 401 participants were sought for this cross-sectional study. The sample size was determined by the G-Power calculation. CISF metro staff working with Delhi Metro Rail Corporation (DMRC) were recruited from CISF Delhi headquarters and hostels to participate in this study by convenience sampling. The participants were recruited from headquarters and hostels to ensure data collection for our intended sample size, as the staff had shift duties and data collection was done in daytime slots. Those included were male and female CISF staff with at least 1 year of working experience a normal BMI for the Asian population. Those excluded were retired subjects, staff with a history of previous musculoskeletal injuries and/or neurological disorders, and obese subjects. The participants worked 8-10 hours on an average per day. The nature of work for males included sitting and standing for long hours without rest, carrying and loading heavy goods, and walking for long distances with or without additional weighted equipment. The nature of work among female staff was limited to standing and sitting for long hours and walking long distances.
A close-ended structured questionnaire, the standardized Nordic Musculoskeletal Questionnaire [6], for investigating work-related musculoskeletal symptoms in working populations was used in this study. The questionnaire comprised questions on the prevalence, risk factors, and coping strategies of WMSDs. Questions on prevalence portrayed a portrait of a human structure with nine body parts: neck, shoulders, upper back, lower back, elbows, wrists/hands, thighs, knees, and ankles. This structure was meant for a table that demands a “yes” or “no” response for each body part to three questions about 12 months prevalence, 7-day prevalence, and any disability during the last year (annual disability). The investigation of musculoskeletal complaints in an ergonomic or occupational health environment using standardized questionnaires is described. The free-response variations of the questions can be utilized in both self-administered tests and in-person interviews. They focus on the symptoms experienced in occupational settings the most frequently. It has been established that the questionnaires' dependability is satisfactory. The number of questionnaire replies reflects certain job strain characteristics. [7]
After a formal introduction, the staff of CISF, which were prospecting participants, was sought, and the study was explained to them in detail as much as possible. This includes the merits and demerits (if any). Confidentiality and anonymity of all information obtained were as assured. It was also made clear to them that participation was voluntary. After obtaining their informed consent, questionnaires were distributed to the participants by one of the researchers (FDA). This questionnaire took less than 15 minutes to complete.
Data was analyzed by using proportions and chi-square test. The statistical software SPSS 29 was used to analyze the data, and Microsoft Word and Microsoft Excel have been used to generate graphs and tables.

Results
A total of 401 participants, 311 (77.55%) males and 92(22.9%) females volunteered in this study. The mean age of the participants was 32.99 years, and the mean height and weight were 172.77 cm and 59.50 kg, respectively. Most of the participants were unmarried, and the average duration of service in the profession was 13.07 years for males and 3.31 years for females. Duration of service for males ranged from 1 to 43 years, and for females ranged from 1 to 27 years.
The point prevalence of low back pain was reported highest, with 19.09 % in males followed by 10.35% of those who reported pain in the neck. Amongst females, 17.39% reported pain in one/ both shoulders, while 13.4% reported low back pain (Table-1and Fig.1).
Table 1. Point prevalence of MDSs and pain (%) in different regions of the body in both males and females as reported by the Nordic pain questionnaire
Point prevalence
Parameters Males Females
Pain No pain Pain No pain
Neck 277 32 84 8
Shoulder (both) 286 23 76 16
Elbow (both) 301 8 86 6
Wrist (both) 303 6 88 4
UB 293 16 87 5
LB 250 59 80 12
Hips/thighs (both) 302 7 90 2
Knee (both) 281 28 88 4
Ankle (both) 285 24 85 7
 
Females
Fig.1. Point Prevalence of MSDs and % pain in Males and Females
Results for the last 7 days (Period prevalence) indicated that 17.79% of males reported low back pain, followed by 9.70% who reported pain in the neck region. Amongst females, 13.04% reported low back pain, followed by 11.95% who reported pain in one or both shoulders (Table 2 and Fig.2).

Table 2.  Period prevalence of MSDs and pain (%) in different body regions in both males and females as reported by the Nordic pain questionnaire for the last 7 days.
Period prevalence (last 7 days)
Parameters Males Females
Pain No pain Pain No pain
Neck 279 30 85 7
Shoulder (both) 288 21 81 11
Elbow (both) 301 8 88 4
Wrist (both) 301 8 89 3
UB 294 15 86 6
LB 254 55 80 12
Hips/thighs (both) 302 7 91 1
Knee (both) 275 34 88 4
Ankle (both) 277 32 82 10
Fig.2. Period Prevalence of MSDs and % pain in Males and Females (Last 7 days)
The 12-month prevalence of MSDs was found to be highest in both men and women, i.e., 17.47% in the low back region, followed by 11% who complained of pain in one/both knees in men, and 17.39% of females reported pain in the low back and shoulder region. The participants reported that this pain interfered with their occupation as it persisted for a longer period (Table 3 and Fig.3).  The average age of CISF staff(both male and female) with back msd was 34.86 years, and the average duration of service was 12.27 years.

Table 3. Period prevalence of musculoskeletal disorders and pain (%) in different body regions in both males and females as reported by the Nordic pain questionnaire for the last 12 months and that interfered with their occupation.
Period prevalence (last 12 months)
Parameters Males Females
Pain No pain Pain No pain
Neck 278 31 84 8
Shoulder (both) 287 22 76 16
Elbow (both) 300 9 87 5
Wrist (both) 301 8 87 5
UB 291 18 85 7
LB 255 54 76 16
Hips/thighs (both) 301 8 90 2
Knee (both) 275 34 87 5
Ankle (both) 277 32 81 11

Fig.3. Period Prevalence of MSDs and % pain in Males and Females (Last 12 days)
The average age of females with musculoskeletal symptoms was 26.20, and the average duration of service was found to be 3.43 years. On the other hand, the average age of males with musculoskeletal symptoms was 38.47 years, and the average duration of service was 16.36 years.
The study showed that the upper back was the most affected during the previous week (Table 4), which was statistically significant(p<0.001). The Association between the Standardized Nordic Questionnaire and Demographic, duration of service, and type of work was calculated. The study reveals that MSDs in the previous 7 days were more common among 21-30 year age groups (17.21%) and were statistically significant. MSDs in the previous 1 year followed the same pattern as MSDs in the previous 7 days. Among study subjects, disabling attacks were more common among the 21-30 year age group 14.46% (Table 5). Our study also reveals that disabling attacks and MSDs in the previous year are more common in 1-5 years of service, which is statistically significant. Also, males were found to be more affected than females but were not statistically significant (Table 5).
Table 4. Distribution of the study subjects according to the Standardized Nordic Questionnaire
MSD Last 12 Months Last 7 Days Interference with occupation in the last 12 months Chi-square value P-value
Neck Yes 40 39 37 0.134 0.935
No 361 362 364
Shoulders Yes 23 22 21 0.098 0.952
No 286 287 288
Elbows Yes 14 14 12 0.207 0.902
No 387 387 389
Wrist Yes 10 13 11 0.424 0.809
No 391 388 390
Upper Back Yes 21 376 21 924.073 <0.001*
No 380 25 380
Lower back Yes 71 70 67 0.151 0.927
No 330 331 334
Hips/thighs Yes 9 10 8 0.227 0.898
No 392 391 393
Knee yes 32 39 38 0.868 0.648
No 369 362 363
Ankles Yes 31 43 42 2.538 0.281
No 370 358 359
(* denotes significant p-value at 0.05 level).

Table 5. Association between Standardized Nordic Questionnaire and Demographic, duration of Service and Type of Work
Variables Last 12 months Last 7 days Interference with occupation in the last 12 months
MSD % No MSD % MSD % No MSD % MSD % No MSD %
Age Wise 21-30 60.00 14.96 176.00 43.89 69.00 17.21 167.00 41.65 58.00 14.46 178.00 44.39
31-40 28.00 6.98 34.00 8.48 27.00 6.73 35.00 8.73 29.00 7.23 33.00 8.23
41-50 35.00 8.73 36.00 8.98 34.00 8.48 37.00 9.23 34.00 8.48 37.00 9.23
51-60 16.00 3.99 18.00 4.49 17.00 4.24 17.00 4.24 16.00 3.99 18.00 4.49
chi-square value value 20.98 13.35 22.54
P-Value <0.001* <0.001* <0.001*
Gender Females 29.00 7.23 63.00 15.71 37.00 9.23 55.00 13.72 28.00 6.98 64.00 15.96
Males 115.00 28.68 194.00 48.38 117.00 29.18 192.00 47.88 112.00 27.93 197.00 49.13
chi-square value 1.00 0.17 1.05
P-Value 0.32 0.68 0.30
Duration of service 1 to 5 54.00 13.47 157.00 39.15 63.00 15.71 148.00 36.91 54.00 13.47 157.00 39.15
6 to 10 24.00 5.99 29.00 7.23 25.00 6.23 28.00 6.98 22.00 5.49 31.00 7.73
11 to 15 11.00 2.74 13.00 3.24 11.00 2.74 13.00 3.24 10.00 2.49 14.00 3.49
16 to 20 7.00 1.75 11.00 2.74 6.00 1.50 12.00 2.99 6.00 1.50 12.00 2.99
21 to 25 11.00 2.74 11.00 2.74 11.00 2.74 11.00 2.74 11.00 2.74 11.00 2.74
26 to 30 22.00 5.49 18.00 4.49 22.00 5.49 18.00 4.49 22.00 5.49 18.00 4.49
31 to 35 11.00 2.74 14.00 3.49 12.00 2.99 13.00 3.24 11.00 2.74 14.00 3.49
36 to 40 4.00 1.00 2.00 0.50 4.00 1.00 2.00 0.50 4.00 1.00 2.00 0.50
41 to 45 0.00 0.00 2.00 0.50 0.00 0.00 2.00 0.50 0.00 0.00 2.00 0.50
46 to 50 0.00 0.00 1.00 0.25 0.00 0.00 1.00 0.25 0.00 0.00 1.00 0.25
chi-square value 26.00 17.79 24.10
P-Value 0.00* 0.02* 0.00*
Type of Work Walking 53.00 13.22 64.00 15.96 55.00 13.72 62.00 15.46 51.00 12.72 66.00 16.46
Sitting 53.00 13.22 62.00 15.46 53.00 13.22 62.00 15.46 52.00 12.97 63.00 15.71
Carrying Heavy goods 44.00 10.97 44.00 10.97 45.00 11.22 43.00 10.72 41.00 10.22 47.00 11.72
Standing for long hours 70.00 17.46 113.00 28.18 71.00 17.71 112.00 27.93 68.00 16.96 115.00 28.68
Loading goods or Transferring 22.00 5.49 14.00 3.49 22.00 5.49 14.00 3.49 21.00 5.24 15.00 3.74
chi-square value 8.09 8.10 6.6913
P-Value 0.09 0.09 0.15
 (* denotes significant p-value at 0.05 level).

Discussion
Musculoskeletal disorders (MSD) rank first in frequency among work-related injuries and diseases. Musculoskeletal injuries result from acute injuries or can be chronic in nature. These disorders are seldom life-threatening, but impair the quality of life of a large proportion of the adult population. MSD causes considerable losses in productivity and high expenses as a result of short- and long-term disability and the use of health care services [8]. This is the first study by far which described the prevalence of MSDs among CISF staff of Delhi Metro.
The study was performed on 401 participants of CISF Metro staff, and it was found that the prevalence of low back pain was reported highest in males, followed by neck pain, and in females, the highest prevalence of MSDs was found in the shoulder followed by low back pain. The low back pain had the highest period prevalence for the last seven days in both males and females, as reported by Nordic Pain Questionnaire. Also, the 12 months prevalence of MSD was highest in the low back region in both genders.
The results of our study are in tandem with the extensive literature concluding low back pain to be the most prevalent MSD in a wide array of occupations. Sayed Tantawy, in the year 2019, conducted a prevalence study on the employees of Ahlia University, Bahrain, and found similar results of the highest prevalence of low back pain in both the last 7 days and 12 months. Further, age groups 32 to 36 were the most prevalent age group for MSDs, with a 30% prevalence which is in line with the average age group of this study. Further, the prevalence of low back pain in the current study was approximately the same for the 7 days and 12 months, which was not the case with the study done on Police Officers. It was reported that period prevalence for the past 12 months was greater than the last 7 days for low back pain. [3]
The probable reason for the above findings of MSD in the Central Industrial Security force can be attributed to a distinctive and adaptable training and work schedule that prepares them to handle various emergencies and disasters. The many factors operating in the family and at work are the reasons for the significant level of musculoskeletal and mental stress that the CISF personnel experience [8]. The majority of the additional stressors are connected to the workplace, including "having no regular work hours," and "having to work overtime when necessary," "having no well-defined roles"—being trained for one thing but forced to work in a different field. Apart from other variables, "being away from their families" is recognized as a significant contributor to musculoskeletal stress since staff members are expected to handle all household duties and professional obligations. [9]
This study had a few limitations which might be considered while conducting similar studies in the future. Firstly, only the data of CISF personnel working in Delhi Metro was recorded, making it difficult to generalize the results to large impending security forces. Secondly, the nature of work for each individual was not consistent but variable, making it difficult to explain the actual mechanism behind the prevalence of MSD. Lastly, the majority of the population recruited for the study were young to middle-aged adults who had been in the profession for less than 10 years, making it hard to conclude the long-term prevalence of MSDs in CISF Metro personnel.
Similar studies could be undertaken on employees working for more than 10-15 years in a more defined role. Furthermore, the menstrual and obstetrical history of female personnel can be considered while making conclusions about the causes behind back pain being the most common long-term MSD.

Conclusion
It was concluded from the study that a wide array of work-related MSDs is prevalent amongst the CISF staff of Delhi Metro, with the highest prevalent area of pain being the lower back region. We must use this knowledge to emphasize the importance of occupational ergonomics and conscious maintenance of correct posture. Furthermore, these security personnel should regularly screen biomechanical imbalances due to consistent occupational stress, which will prevent a high incidence of MSDs amongst this targeted population.

Acknowledgement
We extend my heartfelt gratitude towards all the CISF staff metro staff who willingly participated in this study, despite their professional commitments.

Conflict of interest: None declared.

References
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