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1 VDT Abstract Effect of Therapeutic Excercises on Shoulder Dys funct i on i n VDT-r el at ed Femal e Of f i ce Wor ker s Soon S e ok Choi, Kui Won J e ong, S a ng Hwa Urm, S oo J in J e o ng Jong Tae Lee, Jin Ho Chun, Chae Un Lee, Ki Taek Pae D ep artm ent of P reventive M edicine, Colleg e of M edicine, I nj e Univers ity Visu al display term in al(vdt ) is popular in m ajority of office in m odern countries. Musculoskeletal pain due to repetitive w ork with VDT is a seriou s industrial accident at present. In recent studies, shoulder pain in VDT user s is the m ost common problem in Korea. T he purpose of this study w as to ev alu at e and compar e the effect of ex cercises on shoulder dy sfunction in VDT - related fem ale office worker s. Of th e 119 patient s w ith shoulder dy sfun ction, 32 patient s entered int o the study. 16 patient s (Group ) w ere not prescribed ex cercises, other 16 patients (Group ) performed throughout the specific shoulder ex cercises such as pendular excercises (forw ard, backward and circum duction ) and sidelying - 1 -

2 external rotation ex cercises with w eight s. After 3 m onths of ex cercises, the tw o groups w ere compared in term of the pain rating scale, disability questionnaire score and range of m otion score. T he results were summ arized as follow s 1. T he pain rating scale in Group before and after 3 m onth s w ere not differenced significantly (p value 0.784) and in Group, the scale before and after ex cercises w ere differenced significantly (p value ). 2. T he disability questionnaire scores in Group before and after 3 m onth s w ere not differenced significantly (p v alue 0.437) and in Group, the scores before and after ex cercises were differenced significantly (p v alue ). 3. T he ROM scores of the affected shoulder in Group before and after 3 m onths w ere not differenced significantly (p v alue 0.876) and in Group, the scores before and after ex cercises w ere differenced significantly (p v alue ). In conclu sion, that the specific shoulder ex cercises on shoulder dy sfunction in VDT - related fem ale office worker s are encouraged. Key W ords VDT - related fem ale office w orker s, Shoulder dy sfunction, Shoulder ex cercises, Pain r ating scale, Disability questionnaire, ROM scor es of shoulder

3 ., (visual display terminal, VDT ). VDT WHO,,,,,, (W HO, 1987). VDT, (, 1996). VDT (, 1989b )., % % (Zenz, 1994)., (Alan Patrick, 1996). (1989a)

4 60%. (1996) , VDT... 1),,,, 2), 3),, 4),, 5) (Cailliet, 1991 Su san, 1995). (tendon )., (rotator cuff) (mu scle) (Alan Patrick, 1996 Cailliet, 1991 Su san, 1995 Robert Robert, 1987).,, - 4 -

5 , (Abdulazeem, 1993 T om, 1994 T im othy John, 1998 Kristina, 1995). 1), 2), 3), 4), 5) (Cailliet, 1991 Abdulazeem, 1993 T om, 1994 Kristina, 1995 Bryon, 1993 Karin, 1995). VDT VDT,. VDT Cailliet,

6 I P 1 4 VDT VDT 67 L ,,, X- ray,,,. 3, L VDT 16 (Group ) VDT (Group )

7 2..,, (Fig.1) N (Fig.2) Fig.1. Pendular ex cercises (forward, backw ard and circumduction ) - 7 -

8 Fig.2. Sidelying external rotation ex cercise with weights 1),,,, VDT, VDT. 2 ) Roland Morris (1983) (Pain rating scale) 6 1, 2, 3, 4, 5, 6 (Fig.3)

9 Fig.3. P ain Rating Scale(by Roland & M orris, 1983) 3 ) 22 Croft Pope (1994) (Disability Questionnaire) 1, 0 (T able 1)

10 Tab l e 1. Di sab i l i t y Ques t i onna i r e (by Cr of t & Pope, 1994 ) ????,,?,,,???????????? (, )?????

11 4 ) (1994) 1, , 0, 10, 2 40 (T able 2). Tab l e 2. Scor i ng for Shoul der ROM(by Han, 1994 ) Range of Motion at affected shoulder Forward & Lateral Elevation (degree) Internal Rotation Dorsum of hand to lateral thigh to buttok to lumbosacral junction to 3rd lumbar vertebra to 12th thoracic vertebra to inter scapular region External Rotation Hand behind head with elbow held forward with elbow held back Hand on top of head with elbow held forward with elbow held back Full elevation from on top of head T otal (40)

12 SAS packag e W ilcox on signed- rank test

13 VDT , 27.3, 25 8 (50%), (62.5%), 9 (56.3%), 12 (75%), 7 (43.8%), 4 (25%). 3 (18.75%), 4 (25%). VDT 6 (37.5% ), (43.75% ). VDT 7 (43.75%), 8 (50% ). VDT 5 11 (68.75% ), (43.75% ). 14 (87.5% ), 16 (100% ) (T able 3)

14 Tab l e 3. Gener a l char ac t er i s t i cs of s t udy subj ec t s Characteristics Age < < Education level high school college Marital status married single Duration of daily housew ork none < 1 hour 1 3 hours Main type of VDT w ork key - punching word- processing making program Duration of VDT work < 5years 5 10years 10years< Painful side of shoulder right side left side Non Excercise group No(%) 8(50) 4(25) 3(18.75) 1(6.25) 9(56.25) 7(43.75) 3(18.75) 13(81.25) 6(37.5) 5(31.25) 5(31.25) 5(31.25) 7(43.75) 4(25) 11(68.75) 2(12.5) 3(18.75) 14(87.5) 2(12.5) Shoulder Excercise group No(%) 2(12.5) 10(62.5) 2(12.5) 2(12.5) 12(75) 4(25) 4(25) 12(75) 4(25) 5(31.25) 7(43.75) 8(50) 6(37.5) 2(12.5) 6(37.5) 7(43.75) 3(18.75) 16(100) 0(0)

15 (p value=0.784). 3 (p v alue=0.0005) (T able 4). Tabl e 4. Compar i son of pain r at ing sca l e bet ween t wo gr oups Pain rating scale initial (Mean S.D.) 3months later (Mean S.D.) Mean difference * (Mean S.D.) p- value Non- Excercise group Shoulder- Excercise group Statistical significance w ere tested by W ilcox on signed- rank test * Mean difference by 3m onth s later - initial 3. 3 (p value= 0.437). 3 (p value=0.0002) (T able 5)

16 Table 5. Compar ison of di sabi l i ty quest ionnair e bet ween t wo gr oups Disability questionnaire score initial (Mean S.D.) 3months later (Mean S.D.) Mean difference * (Mean S.D.) p- value Non- Excercise group Shoulder- Excercise group Statistical significance w ere tested by W ilcox on signed- rank test * Mean difference by 3month s later - initial 4. 3 (p value=0.876). 3 (p value=0.0017) (T able 6)

17 Table 6. Compar ison of ROMscores at affected shoulder between two groups ROM scores of affected shoulder initial (Mean S.D.) 3months later (Mean S.D.) Mean difference * (Mean S.D.) p- value Non- Excercise group Shoulder- Excercise group Statistical significance w ere tested by W ilcox on signed- rank test * Mean difference by 3month s later - initial

18 .. VDT, 50% (BLS, 1990). VDT (1995) 65.3%, 61.2%, 53.1%, 49%, 24.5%, (1992) 98.9%, 91.2%, 89.9%, 89.9%, 88.9%, 87.8%, 85.6%, (1994) 94.9%, 86.8%, 83.1%, 82.4%, 81.6%, 72.8%, (1989a) 65.2%, 50.0%, 38.6%, 36.2%, 24.8%. VDT. VDT,,. VDT (, 1996),,

19 , VDT. Cailliet (1996) (, ),., (Cailliet, 1991 Su san, 1995).. (head of humerus), (subscapularis tendon), (supraspinatu s tendon ), (infraspinatus tendon ) (teres minor tendon ). (supraspinatus m.) (infraspinatus m.) (suprascapular n.), (teres minor m.) (axillary n.) (subscapularis m.) (upper & lower subscapular n.). (acromion ) (coracoid process )

20 (greater tuberosity ) (scapula) (coracoacromial arch ) (subacromial elem ents ) (Alan Patrick, 1996 Cailliet, 1991 Su san, 1995 Barbara, 1994)., VDT (supraspinatus tendinitis ), (impingement syndrome) (Cailliet, 1991 Robert Robert, 1987 Carolyn, 1993). (supraspinatus tendon ) (subdeltoid bursa), (subacromial bursa), (Cailliet, 1991 Su san, 1995)., (Cailliet, 1991 Su san, 1995 Barbara, 1994).,

21 ., (glenohum eral joint )., (synovial layer s ) (Cailliet, 1991)..,.. (Cailliet, 1991). VDT (elbow joint ) (forearm ), VDT

22 (Cailliet, 1991 Carolyn, 1993).,, (Robert Rob ert, 1987). (biom echanical stimuli), (T om, 1994)., (71% ) 7), 8), 9) (81% ).,

23 (pain rating scale) 3, 3, (Disability questionnaire) 3, 3, (Scoring for shoulder ROM ) 3 3.,., Cailliet (1991). VDT,

24 . 2 9, (neuromu scular imbalance) (Bryon, 1993) 1.,,,,,,,,,,. VDT, VDT,,,

25 . VDT ,. 1. Roland Morris 3 (p v alue 0.784), 3 (p value ). 2. Croft Pope 3 (p v alue 0.437), 3 (p value ) (p v alue 0.876), 3 (p v alue ). VDT

26 , , , 1996.,, a 1(2) ,, b 1(2) ,,,. VDT (2) ,,. VDT (3) ,, (4) 429,, (2) ,, (3)

27 Abdulazeem K, Jam es JI, Susan CW. Nonoperative m anagem ent of secon dary sh oulder impin gem ent syndr om e. J ourn al of Orthopaedic & Sport s Phy sical T herapy (5) Alan SC, P atrick W. Sh oulder pain in the w ork place. Orthopedic Clinics of North America (4) Barbara GF, T odd JA, John MF. Rotator cuff disease a review of diagnosis, pathophy siology an d curr ent trends in tr eatm ent. Archiv es of Phy sical Medicine & Rehabilitation (5) Beureau of Labor Statistics Report s on Surv ey of Occupational Injuries an d Illnes ses in W ashington, DC, Beureau of Labor Statistics, US Dept of Labor, 1990 Bry on T B, S ally JO, J odie LP, et al. Electrom y ogr aphic activity of selected shoulder mu scles in comm only u sed therapeutic ex cercises. Phy sical T herapy (10) Calliet R. Shoulder pain, 3rd ed. philadelphia, FA Davis Comp., 1991, pp Carolyn MS, Jam es DM, William SM. Occupational risk factor s associated with soft tissue disorders of the shoulder a review of recent inv estigation s in the literature. Ergonomics (6) Karin HR, Kristina S, Jan E. Principles of prevention of neck - and shoulder pain. Scand J Rehab Med

28 Kristin a S, Karin HR, Jan E. Principles for m edical r ehabilit ation of patient s with chronic neck and shoulder pain. Scand J Rehab Med P. Cr oft, D. Pope, M. Zonca, et al. M ea sur em ent of sh oulder r elated disability result s of a validation study. Annals of the Rheum atic Diseases Roland M, M orris R. A study of th e n atur al history of back pain. Spine (2) Robert PB, Robert MB. Shoulder pain guidelines to diagnosis and management. Postgraduate Med (1) Su san MG. Shoulder pain a diagnostic dilemma. Am erican F amily Phy sician (7) T im othy MS, John VC. T he painful shoulder diagnosis and treatment. Prim ary care (4) T om AT, Helge DM, Morten S. T he effect of medical excercise therapy on a patient with chronic supraspinatus tendinitis. diagnostic ultr asoundtissue regeneration a case stady. Journal of Orthopaedic & Sports phy sical T herapy (6) WHO. Visual display terminals and w orker ' s health, Geneva, WHO, 1987, pp. 85 Zenz C. Occupational m edicine, 3rd ed. St. Louis, Mosby, 1994, pp

012임수진

012임수진 Received : 2012. 11. 27 Reviewed : 2012. 12. 10 Accepted : 2012. 12. 12 A Clinical Study on Effect of Electro-acupuncture Treatment for Low Back Pain and Radicular Pain in Patients Diagnosed with Lumbar