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 -
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 0.0005). 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 0.0002). 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 0.0017). 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. 1997. - 2 -
., (visual display terminal, VDT ). VDT WHO,,,,,, (W HO, 1987). VDT, (, 1996). VDT (, 1989b )., 1980 18% 1991 61% (Zenz, 1994)., (Alan Patrick, 1996). (1989a) 290-3 -
60%. (1996) 1994 20, 1996 120 112 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 -
, (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,. - 5 -
. 1. 1996 10 1 1997 5 31 8 I P 1 4 VDT VDT 67 L 52. 119,,, X- ray,,,. 3, 4 47. L VDT 16 (Group ) VDT 31 15 16 (Group ). - 6 -
2..,, (Fig.1) N (Fig.2) 5 10 2 3. 7 1 3. 3. Fig.1. Pendular ex cercises (forward, backw ard and circumduction ) - 7 -
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). - 8 -
Fig.3. P ain Rating Scale(by Roland & M orris, 1983) 3 ) 22 Croft Pope (1994) (Disability Questionnaire) 1, 0 (T able 1). - 9 -
Tab l e 1. Di sab i l i t y Ques t i onna i r e (by Cr of t & Pope, 1994 ) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22????,,?,,,???????????? (, )????? - 10 -
4 ) (1994) 1, 0 10 10, 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) 0 30 31 60 61 90 91 120 121 150 151 180 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) 0 2 4 6 8 10 0 2 4 6 8 10 2 2 2 2 2-11 -
3. 16 16 3 SAS packag e W ilcox on signed- rank test. - 12 -
. 1. 32 VDT 4. 26.2, 27.3, 25 8 (50%), 20 10 (62.5%), 9 (56.3%), 12 (75%), 7 (43.8%), 4 (25%). 3 (18.75%), 4 (25%). VDT 6 (37.5% ), 1 3 7 (43.75% ). VDT 7 (43.75%), 8 (50% ). VDT 5 11 (68.75% ), 5 10 7 (43.75% ). 14 (87.5% ), 16 (100% ) (T able 3). - 13 -
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 < 25 25 29 30 35 35< 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) 2. 3-14 -
(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 3.88 0.87 3.86 0.77-0.02 0.62 0.784 Shoulder- Excercise group 3.94 0.85 2.88 0.50-1.06 0.77 0.0005 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). - 15 -
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 7.38 2.70 7.75 2.29 0.37 1.63 0.437 Shoulder- Excercise group 7.31 3.46 4.13 2.03-3.18 2.38 0.0002 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). - 16 -
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 36.00 1.93 35.94 2.21-0.06 1.29 0.876 Shoulder- Excercise group 36.94 1.77 38.50 0.73 1.56 1.67 0.0017 Statistical significance w ere tested by W ilcox on signed- rank test * Mean difference by 3month s later - initial - 17 -
.. 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),, - 18 -
, 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 ). - 19 -
(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)., - 20 -
., (glenohum eral joint )., (synovial layer s ) (Cailliet, 1991)..,.. (Cailliet, 1991). VDT (elbow joint ) (forearm ), VDT - 21 -
(Cailliet, 1991 Carolyn, 1993).,, 70 120 (Robert Rob ert, 1987). (biom echanical stimuli), (T om, 1994).,. 32 23 (71% ) 7), 8), 9) 32 26 (81% ).,. - 22 -
(pain rating scale) 3, 3, (Disability questionnaire) 3, 3, (Scoring for shoulder ROM ) 3 3.,., Cailliet (1991). VDT, - 23 -
. 2 9, (neuromu scular imbalance) (Bryon, 1993) 1.,,,,,,,,,,. VDT, VDT,,,. - 24 -
. VDT 32 16 16 3,. 1. Roland Morris 3 (p v alue 0.784), 3 (p value 0.0005). 2. Croft Pope 3 (p v alue 0.437), 3 (p value 0.0002). 3. 3 (p v alue 0.876), 3 (p v alue 0.0017). VDT. - 25 -
,.. 94.. 1994, 4100-68342- 7 51-78., 1996.,,... 1989a 1(2) 141-150,,... 1989b 1(2) 151-159,,,. VDT. 1995 28(2) 433-449,,. VDT. 1996 8(3) 403-413,,.. 1992 25(4) 429,,.. 1996 8(2) 301-319,,.. 1994 18(3) 607-612 - 26 -
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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 1995 32 57-66 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 1994 53 525-528 Roland M, M orris R. A study of th e n atur al history of back pain. Spine 1983 8(2) 141-145 Robert PB, Robert MB. Shoulder pain guidelines to diagnosis and management. Postgraduate Med 1987 82(1) 185-189 Su san MG. Shoulder pain a diagnostic dilemma. Am erican F amily Phy sician 1995 51(7) 1677-1687 T im othy MS, John VC. T he painful shoulder diagnosis and treatment. Prim ary care 1988 15(4) 709-724 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 1994 20(6) 319-327 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. 48-64 - 28 -