Rajiv Gandhi University of Health Sciences, KarnatakaCurriculum Development Cell

Registration No. : Name of the Candidate : MR. MIHIR JITENDRAKUMAR THAKER

Address : SDM College of Physiotherapy, Manjushree nagar, sattur, dharwad.

Name of the Institution : SDM College of Physiotherapy, Dharwad

Course of Study and Subject : MPT (Masters In Musculoskeletal Disorders

And Sports)

Date of Admission to Course : 25/05/ 2012.

Title of the Topic : “Correlation of potential risk factors of neck pain with neck pain and neck disability in computer professionals.”

Brief resume of the intended work : Attached

Signature of the Student :

Guide Name : Dr. Salima Mulla (assistant professor)

Signature of the Guide :

Co-Guide Name :

Signature of the Co-Guide :

HOD Name : DR. Ravi Savadatti

Signature of the HOD :

Principal Name : DR. Ravi Savadatti

Principal Mobile No. : 9845051209

Principal E-mail ID : sdmcpt@gmail.com

Principal Signature :

A) BRIEF RESUME OF THE STUDY

1

INTRODUCTION:In the modern era of technology computer use have been amplified to greater extent. Computers are utilized by 56% of people at occupational level and 62% at personal level.1 Even being a crucial tool in every aspect, computer has steered work related diseases. Today as India is becoming the predecessor in the cyber world the health workers are gradually arousing to this group of modern work related diseases, which are slowly sprouting among computer professionals. If such problems are snubbed, it can invite troublesome injuries and even disability; sometimes one might have to change his profession 2, 3

Work related diseases are defined as multifactorial when the work environment and the performance of work contribute significantly, but as one of a number of factors, to the causation of disease.4 Work related Musculoskeletal Disorders (WMSD) are the class of musculoskeletal disorders that include damage of tendons, tendon sheaths, and synovial lubrication of tendon sheaths, and related to bones, muscles, nerves of hands, wrists, elbows, shoulders, neck and back.22

The recent increase in computer-related work as a consequence of rapid industrialization has considerably increased the prevalence of CANS (complaints of arm neck and/or shoulder) among computer office workers not only in western developed countries but also in developing countries. 8,

9 Complaints of the arm, neck and/or shoulder are defined as "musculoskeletal complaints of arm, neck and/ or shoulder not caused by acute trauma or by any systemic disease". 10, 8

Three leading regions of musculoskeletal symptoms among the computer users were the shoulder (73%), neck (71%), and upper back (60%) areas was reported in Taiwan. Similarly, the 3 leading regions of musculoskeletal symptoms among the computer users with high workload were shoulder (77.3%), neck (75.6%), and upper back (63.9%) regions.11

A one year prevalence study from Sri Lanka showed 63.6% incidence of CANS in computer office workers. The highest incidences were for neck (36.1%) and shoulder (34.3%) complaints.9

In a study from Sudan, CANS prevalence rate was 54%,where the highest prevalence rates were found for neck and shoulder symptoms (33% and 31% respectively), followed by hand and upper arm complaints (11% to 12%) and elbow, lower arm and wrist complaints (6% to 7%).16

In a study in India on computer professionals the prevalence of musculoskeletal problems were reported by 77.5% (153/200) and visual problems were 76% (152/200) 18, 19

Neck symptoms, being the most common of all other musculoskeletal problems, are 64% prevalent among computer workers. 8

In United States musculoskeletal problems mainly arm, neck and shoulder are main reason for occupational illness with annual cost related to absenteeism from work and treatment being $45-54 billion. In the Netherlands, with a working population of 7 million, annual costs for these musculoskeletal disorders are estimated to be 2.1 billion Euros.7

2

Work related musculoskeletal disorders (WRMSD) are caused mainly by rigorous use of computer in the workplace, which increases the frequency of sick leaves and in turn financial burden on the employers and family. 5, 6

The identification of risk factors for the development of CANS before they develop into a disabling musculoskeletal complaints is an important step in order to recognize relevant subgroups who have a high risk profile for CANS and also, in the longer run, to develop targeted and effective screening and interventions. Hence, targeting computer workers as the selected case population on which to base and to develop measurement tools specifying the risk factors of CANS would seem the appropriate first step.16

The prevalence of musculoskeletal disorders amongst keyboard users has been reported to be as high as 81%.13 Studies have shown that awkward posture is strongly associated with the development of musculoskeletal problems.14

It has been found that WRMSD associated with numerous risk factors such as age, gender, BMI 22, duration of computer work29, physical work load factors such as force, posture, movement and vibration 11, psychosocial stressors and individual factors 12 which are also known to be important as predictive variables.

Among the associated risk factors of work related musculoskeletal disorders awkward working posture plays a major role. A little knowledge of the principles of ergonomics, how people interact safely and efficiently with machines and their work environment, can save a lot of discomfort and maximize both productivity and enjoyment. 15

To find out the association between awkward posture and neck pain, posture assessment is mandatory. There are various techniques, available to evaluate posture in computer workers, such as OSHA ergonomics solutions, MUEQ (Maastricht Upper Extremity Questionnaire), RULA (Rapid Upper Limb Assessment). Most of the questionnaires are lengthy, time consuming and filled by participants themselves. RULA on the contrary is most rapid, easy to administer, less time consuming and is a postural assessment tool administered by the therapist or examiner. It is reliable and valid for evaluating the posture which involves upper limb.20The computer professionals normally sit in table chair arrangement and the work involves upper limb.

The neck pain affects adversely on health related quality of life and in turn leads to various problems which hamper one’s daily activities of life.23So it is important to evaluate neck pain in computer professionals. Visual analogue scale is valid tool to assess the intensity of neck pain. The Neck Disability Index is an valid and reliable instrument to assess neck pain complaints.21

NEED FOR THE STUDY:

Recent studies show that work related musculoskeletal problems are very much prevalent in 3

computer professionals in India. 18, 19, 24 According to several reviews, positive but no conclusive relations have been found between various risk factors and the occurrence of work related musculoskeletal problems.8 The relationships reported in the literature are mostly from studies carried out in Western countries. In most of the studies work related risk factors have been examined by self-administered questionnaire which may lead to false results.

Various epidemiological studies have shown that most affected area in the body is neck, associated with computer work. Neck pain is the leading musculoskeletal problem with the prevalence rate of 64% in computer professionals. 8

Neck pain leads to decreased work performances, absenteeism from work or increased sick leaves which puts financial burden on employee as well as their families. A literature suggests that physical and mental health related quality of life is worse for individuals with neck pain compared to those without neck pain. 23Neck pain leads to disability which affects activities of daily living.

Neck pain has not been correlated with ergonomic risk factors in terms of disability. So the awareness is required about ergonomic risk factors in order to prevent and overcome neck pain and disability in upcoming computer professionals who are at risk of developing neck pain. Hence a strong need arises to examine the correlation of ergonomic risk factors with neck pain and neck disability in computer professionals.

RESEARCH HYPOTHESIS:

NULL HYPOTHESIS (H0): There will not be a correlation of ergonomic risk factors of neck pain with neck disability in computer professionals.

ALTERNATE HYPOTHESIS (H1): There will be a correlation of ergonomic risk factors of neck pain with neck disability in computer professionals.

REVIEW OF LITERATURE:

Shahla Eltayeb et al 2007, conducted a study to find out one year prevalence of complaints of arm, neck and shoulder (CANS). To examine potential workplace risk factors for the presence of CANS, the Maastricht Upper Extremity Questionnaire (MUEQ), a structured questionnaire, was developed and tested among 264 computer office workers of a branch office of the national social security institution in the Netherlands The one-year prevalence rate of indicated that 54% of the respondents reported at least one complaint in the arm, neck and/or shoulder.The highest prevalence rates were found for neck and shoulder symptoms (33% and 31% respectively), followed by hand and upper arm complaints (11% to 12%) and elbow, lower arm and wrist complaints (6% to 7%). MUEQ was valid and reliable in assessing complaints of arm, neck and shoulder among computer user (cronbach’s alpha=0.71).16

A cross sectional study was done by Suparna K et al in 2005, among 200 Information Technology (IT) professionals in the National Capital Region (NCR) to study the computer related health problems and role of ergonomic factors. The computer related morbidity was present in 93% of the study subjects. The visual problems were seen in 76% and musculoskeletal in 77.5% while 35% felt stressful symptoms.28

4

Chris Jensen 1999 conducted a study to identify risk factors for musculoskeletal symptoms in the neck and hand-wrist regions among employees using computers at work. Two questionnaires, containing questions on musculoskeletal symptoms (trouble, ache, or pain) according to a modified version of the Nordic questionnaire were delivered to computer users in 11 Danish companies and institutions. The baseline questionnaire was delivered to 5033 computer users in the early part of 1999. The follow-up questionnaire was mailed in December of 2000 to 3363 respondents. At baseline the prevalence of neck and hand-wrist symptoms for more than 7 days within the last year was 44.7% (N=2533) and 25.8% (N=2539), respectively. At follow-up the prevalence of neck symptoms was 46.4% (N=2558), and the prevalence of hand-wrist symptoms was 31.1% (N=2514).25

KT palmer et al 2001 did a study to find out correlation between use of computer and symptoms in neck and upper extremities. Prevalence of WMSDs among keyboard users has been reported as high as 81%.86% were female & 68% were male. Most of them reported use of computer at least 6 months on computer work stations for at least 4 hours per day for at least 5 days a week (58.72%).29

Jesobanta Sethi et al 2011, conducted a study to find out the effect of BMI on work related musculoskeletal discomforts and occupational stress of computer workers in a developed ergonomic setup. A total of 100 computer workers, aged 25-35 years randomly selected on convenience from software and BPO companies in Bangalore city, India for the participation in this study. Work related musculoskeletal discomfort and occupational stress of the subjects was assessed by Cornell University’s musculoskeletal discomfort questionnaire (CMDQ) and occupational stress index (OSI) respectively as well as a relationship was checked with their BMI. Significant association of BMI with CMDQ score (F = 136.137, P < 0.001) and OSI score (F=422.295, P < 0.001) has been found in this study. This shows that, high BMI group perceives a high level of WMSD and Occupational Stress.22

Stefan IJmker et al conducted a study to examine the association between duration of computer use at work, measured with software and self-reports and the onset of severe arm-wrist-hand and neck-shoulder symptoms. A 2-year follow-up study was conducted between 2004 and 2006 among 1951 office workers in the Netherland. Self-reported duration of computer use was positively associated with the onset of both arm-wrist-hand (RR 1.9, 95% CI 1.1 to 3.1 for more than 4 h/day of total computer use at work) and neck-shoulder symptoms (RR 1.5, 95% CI 1.1 to 2.0 for more than 4 h/day of mouse use at work).27

Gabrielle van der Velde et al conducted a study to elicit neck pain (NP) patients’ preference scores for their current health, and investigate the association between their scores and neck pain disability. Rating scale scores (RSs) and standard gamble scores (SGs) for current health were elicited from chronic NP patients, who were stratified into Von Korff Pain Grades.the study concluded that Health-related quality-of-life is considerably diminished in NP patients.23

Pierre Coˆte et al have done a systemic review study on burden and determinants of neck pain in workers, which states that Neck disorders are a significant source of pain and activity limitations in workers. Most neck pain results from complex relationships between individual and workplace risk factors.1

5

Priyanga ranasinghe et al 2009, conducted a study to find out 1 year prevalence of complaints of arm, neck and shoulder(CANS) among 2500 computer office workers from Sri Lanka using Maastricht Upper Extremity Questionnaire (MUEQ). Individual workstations were evaluated by the validated Occupational Safety and Health Administration (OSHA) VDT workstation checklist. The 1-year prevalence of CANS was 56.9%, commonest region of complaint was forearm/hand (42.6%), followed by neck (36.7%) and shoulder/arm (32.0%). 9

Deepak sharan and Ajeesh P.S. conducted a study to find out the relationship between the musculoskeletal discomfort and the working posture. Data was extracted from 620 IT professionals from Bangalore. Working posture was evaluated using rapid upper limb assessment (RULA), which is known as pen-paper observational method. According to this method a score is calculated for the posture of each body part. A structured questionnaire was administered to evaluate the workstation components such as seating, keyboard/input device, monitor, and working surface. Self reported body part discomforts were also evaluated while working. Results of the postural analysis revealed that 30% of the participant’s posture need to “modify soon” and 15% need to modify “immediately”.26

OBJECTIVES OF THE STUDY:

1. To correlate the risk factors with neck pain and disability in computer professionals.

B) PROCEDURE, MATERIALS AND METHODS:

SOURCE OF DATA COLLECTION:

Various IT companies in Hubli and Dharwad.

METHOD OF COLLECTION OF DATA

The present study is a cross sectional study in which computer professionals will be interviewed and examined for the posture. Computer professionals who fulfill the inclusion and exclusion criteria will be taken for the study. Computer professionals willing to participate in the study will be briefed about the study and written consent will be taken from them.

MATERIAL :

1. Data collection sheet2. Rapid Upper Limb Assessment (RULA) sheet3. Self reported questionnaire – Neck Disability Index

6

4. Visual Analogue Scale (VAS) 100mm.

INCLUSION CRITERIA:

Computer professionals of age between 25 -35 years.22

Computer professionals, who are working on computer as the part of their profession for more than at least 4 hours in a day for at least 5 days a week.29

Computer professionals, who are working at current place for more than 6 months.29

EXCLUSION CRITERIA:

Subjects with recent neck injury due to any trauma.

Cervical spine fracture

Ankylosing spondylosis

Pregnant women.

STUDY DESIGN: Cross sectional study.

STUDY DURATION: 1 year.

SAMPLE: A prevalence study done in a Asian country showed neck pain prevalence of 64%

among computer office workers. Based on that sample size was calculated under 10% allowable

error of prevalence. Estimated sample size is 225.

SAMPLE SIZE: 225

FORMULA:

n=4 pqL2

Z= 1.96

p= prevalence= 64%= 0.64

q= 1-p= 1-0.64= 0.36

L=allowable error= 6.4%= 0.064

STATISTICAL TESTS:

1. Chi square test

2. Regression analysis

7

C)

PROCEDURE:

Ethical clearance has been obtained from the Ethical committee of S.D.M. College of Medical Sciences and Hospital, Dharwad. The participants will fill the data collection sheet assessing sociodemographic data including various risk factors age, gender, height and weight (BMI), desktop or laptop use or both, duration of computer use in a day, working years at current place. The participants will be assessed for their working posture with RULA (rapid upper limb assessment) and will be graded accordingly. According to this method a score is calculated for the posture of each body part. Whereas low grand scores of 1 or 2 indicate that the work posture is acceptable, for grand score of 3 or 4 indicate further investigation and changes if required, prompt investigation and changes for grand scores of 5 or 6 and immediate investigations and changes for a grand score of 7. All the participants will be assessed on Visual Analogue Scale (VAS) for neck pain intensity. VAS is a horizontal line, 100 mm in length, with the ends labeled as the extremes of pain i.e. “no pain” to “worst imaginable pain”. Disability will be assessed using NDI (neck disability index). Here the participants will rate their perceived disability on 10 different items: pain intensity, personal care, lifting, reading, headaches, concentration, work, driving, sleeping, and recreation. The items will be scored from 0 to 5, giving a total score of 50. The NDI scores of patients will be divided into categories: having minimal or no disability (0-20%), moderate disability (20-40%), severe disability (40-60%), crippled (60-80%), or bed-bound or exaggerating the symptoms (80-100%).

DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER HUMAN BEINGS OR ANIMALS? IF SO DESCRIBE BRIEFLY- YES

All the participants who fit in to inclusion and exclusion criteria will complete the questionnaire and

will be evaluated for working posture by principle investigator.

LIST OF REFERENCES:

1. Hurwitz EL, Guzman J, Peloso PM. The burden and determinants of neck pain in

workers – Results of the bone and joint decade 2000–2010 task force on neck pain and its

associated disorders. Spine, 2008, 33, 60–74.

2. Choudhary SB, Sapur S, Deb PS. Awkward posture and Development of RSI

(Repetitive Strain Injury) in Computer Professionals. Indian J Occup Environ Med

2002;6:10-2

3. Rao KC, Chandu K, Vedachalam V. Hardships of Soft People- A Clinical Study of

Ocular and Visual Discomfort in Video Display Terminal (VDT) Users. Indian J Occup

Environ Med 1999;3:14-6

4. World Health Organization (WHO). Identification and control of work-related diseases.

8

Geneva: WHO, 1985:7-11. (Technical report; no 174.)

5. Armstrong TJ et al. A conceptual model for work related neck and upper-limb musculoskeletal disorders, Scand J. Work Environ. Health, 1993, 19, 73 – 84.

6. Karlqvist L, Hagberg M, Selin K, Variation in upper limb posture and movement during word processing with and without mouse use, Ergonomics, 1994, 37, 1261 – 1267.

7. Bongers PM, Ijmker S, van den Heuvel S, Blatter BM: Epidemiology of work related neck

and upper limb problems: psychosocial and personal risk factors and effective interventions

from a bio behavioral. Journal of occupation rehabilitation 16.3 (2006): 272-295.

8. Eltayeb SM, Staal JB, Hassan AA, Awad SS, de Bie RA: Complaints of the arm, neck and

shoulder among computer office workers in Sudan: a prevalence study with validation of an

Arabic risk factors questionnaire. Environ Health 2008, 7:33.

9. Ranasinghe et al.: Work-related complaints of arm, neck and shoulder among computer

office workers in an Asian country: prevalence and validation of a risk-factor questionnaire.

BMC Musculoskeletal Disorders 2011 12:68.

10. Huisstede BM, Miedema HS, Verhagen AP, Koes BW, Verhaar JA: Multidisciplinary

consensus on the terminology and classification of complaints of the arm, neck and/or

shoulder. Occup Environ Med 2007, 64:313-319.

11. Chiung-Yu Cho, PT, PhD,a Yea-Shwu Hwang, PhD,b and Rong-Ju Cherng, PhDc.

musculoskeletal symptoms and associated risk factors among office workers with high

workload computer use. J Manipulative Physiol Ther 2012;35:534-540

12. SA Zakerian1, ID Subramaniam. Examining the Relationship between Psychosocial Work

Factors and Musculoskeletal Discomfort among Computer Users in Malaysia. Iranian J

Publ Health, Vol. 40, No.1, 2011, pp.72-79

13. Harvey R., Peper E., Surface electromyography and mouse use position, Ergonomics 1997,

9

4, 781 – 789.

14. J J Devereux, I G Vlachonikolis, P W Buckle. Epidemiological study to investigate potential

interaction between physical and psychosocial factors at work that may increase the risk of

symptoms of musculoskeletal disorder of the neck and upper limb. Occup Environ Med

2002;59:269–277

15. Lamba M., Ergonomics as applied to working on computers. Indian J Occup Environ Med.,

5, 171-6 (2001).

16. S. Eltayeb, J Bart Staal, J. Kennes, Petra HG, Rob A. Prevalence of complaints of arm, neck

and shoulder among computer office workers and psychometric evaluation of a risk factor

questionnaire. BMC Musculoskeletal Disorders 2007, 8:68

17. Andersen JH, Fallentin N, Thomsen JF, Mikkelsen S. Risk Factors for Neck and Upper

Extremity Disorders among Computers Users and the Effect of Interventions: An Overview

of Systematic Reviews. PLoS ONE 6(5): e19691.

18. R. Talwar, R. Kapoor, K. Puri, K. Bansal, and S. Singh. Study of Visual and

Musculoskeletal Health Disorders among Computer Professionals in NCR Delhi. Indian J

Community Med. 2009 October; 34(4): 326–328.

19. Sharma AK, Khera S, Khandekar J. Occupational health problems and role of ergonomics in

information technology professionals in national capital region. Indian J Community

Med. 2006;31:36–8.

20. McAtamney L, Corlett E N. RULA: a survey method for the investigation of work-related

musculoskeletal disorders. Appl Ergon 1993; 24: 91-99.

21. Jan Lucas Hovinga,b, Elizabeth F. O’Learyc, Ken R. Nierec, Sally Greend, Rachelle

Buchbindera,b. Validity of the neck disability index, Northwick Park neck pain

questionnaire, and problem elicitation technique for measuring disability associated with

whiplash-associated disorders. Pain 102 (2003) 273–281.

22. Sethi et al.: Effect of Body Mass Index on work related musculoskeletal discomfort and

occupational stress of computer workers in a developed ergonomic setup. Sports Medicine,

10

Arthroscopy, Rehabilitation, Therapy & Technology 2011 3:22.

23. G.V. Velde et al.: Neck pain patients’ preference scores for their current health. Qual Life

Res (2010) 19:687–700

24. R. Kauasalya,P. Amuthalakshmi.: relationship between ergonomic factors and health

hazards in soft ware industries (a study condected at chennai, india). Journal of

Environmental Research And Development. Vol. 2 No. 2, October-December 2007

25. Jensen C. Development of neck and hand-wrist symptoms in relation to duration of

computer use at work. Scand J Work Environ Health 2003; 29(3):197–205.

26. Deepak Sharan 1and Ajeesh P S. Correlation of ergonomic risk factors with RULA in IT

professionals from India. IOS Press (2012) :1051-9815/12

27. SI Jmker et al.: Software-recorded and self-reported duration of computer use in relation to

the onset of severe arm-wrist-hand pain and neck-shoulder pain. Occup Environ Med

2011;68:502-509.

28. Suparna K, Sharma AK, Khandekar J. Occupational health problems and role of

ergonomics in information technology professionals in national capital region. Indian J

Occup Environ Med 2005;9:111-4

29. Palmer KT, Cooper C, Walker-Bone K, Syddall H, Coggon D. Use of keyboards and

symptoms in the neck and arm: evidence from a national survey.  Occup Med

(Lond).2001;51:392-395.

11

CONSENT FORM

Participant name:

Address:

Title of the project: “Correlation of potential risk factors with neck pain and disability in

computer professionals”

The details of the study have been provided to me in writing and explained to me in my own

language. I confirm that I have understood the above study and had the opportunity to ask

questions. I understand that my participation in the study is voluntary and that I am free to withdraw

at any time, without giving any reasons, without my medical care or legal rights being affected. I

agree not to restrict the use of any data or results that arise from this study provided such a use is

only for scientific purpose(s). I fully consent to participate in the above study.

Signature of the participant: Date:

The Neck Disability Index12

Overview: The Neck Disability Index is an instrument to assess neck pain complaints. It was developed from the Oswestry index for back pain and the Pain Disability Index. The authors are from the Canadian Memorial Chiropractic College in Toronto Canada.

Patient Instructions:

This questionnaire has been designed to give the doctor information as to how your neck

pain has affected your ability to manage in everyday life. Please answer every section and

mark in each section only the ONE box which applies to you. We realize you may consider

that two of the statements in any one section relate to you but please just mark the box

which most closely describes your problem.

Section Statement Points

pain intensity I have no pain at the moment. 0

The pain is very mild at the moment. 1

The pain is moderate at the moment. 2

The pain is fairly severe at the moment. 3

The pain is very severe at the moment. 4

The pain is the worst imaginable at the moment.

5

personal care (washing dressing etc.)

I can look after myself normally without causing extra pain.

0

I can look after myself normally but it causes extra pain.

1

It is painful to look after myself and I am slow and careful.

2

I need some help but manage most of my personal care.

3

I need help every day in most aspects of self care.

4

I do not get dressed I wash with difficulty and stay in bed.

5

lifting I can lift heavy weights without extra pain. 0

I can lift heavy weights but it gives extra pain. 1

Pain prevents me from lifting heavy weights off the floor but I can manage if they are conventiently positioned (on a table etc.).

2

13

Pain prevents me from lifting heavy weights but I can I can lift very light weights. 4

I cannot lift or cary anything at all. 5

reading I can read as much as I want to with no pain in my neck.

0

I can read as much as I want to with slight pain in my neck.

1

I can read as much as I want to with moderate pain in my neck.

2

I can't read as much as I want because of moderate pain in my neck.

3

I can hardly read at all because of severe pain in my neck.

4

I cannot read at all. 5

headaches I have no headache at all. 0

I have slight headaches which come infrequently.

1

I have moderate headaches which come infrequently.

2

I have moderate headaches which come frequently.

3

I have severe headaches which come frequently.

4

I have headaches almost all the time. 5

concentration I can concentrate fully when I want to with no difficulty.

0

I can concentrate fully when I want to with slight difficulty.

1

I have a fair degree of difficulty in concentrating when I want to.

2

I have a lot of difficulty in concentrating when I want to.

3

I have a great deal of difficulty in concentrating when I want to.

4

I cannot concentrate at all. 5

work I can do as much work as I want to. 0

I can only do my usual work but no more. 1

I can do most of my usual work but no more. 2

I cannot do my usual work.

14

I can hardly do any work at all. 4

I can't do any work at all. 5

driving I can drive my care without any neck pain. 0

I can drive my car as long as I want with slight pain in my neck.

1

I can drive my care as long as I want with moderate pain in my neck.

2

I can't drive my care as long as I want because of moderate pain in my neck.

3

I can hardly drive at all because of severe pain in my neck.

4

I can't drive my car at all. 5

sleeping I have no trouble sleeping. 0

My sleep is slightly disturbed (less than 1 hour sleepless).

1

My sleep is mildly disturbed (1-2 hours sleepless).

2

My sleep is moderately disturbed (2-3 hours sleepless).

3

My sleep is greatly disturbed (3-5 hours sleepless).

4

My sleep is completely disturbed (5-7 hours sleepless).

5

recreation I am able to engage in all my recreation activities with no neck pain at all.

0

I am able to engage in all my recreation activities with some pain in my neck.

1

I am able to engage in most but not all of my usual recreation activities because of pain in my neck.

2

I am able to engage in a few of my usual recreation activities because of pain in my neck.

3

I can hardly do any recreation activities because of pain in my neck.

4

I can't do any recreation activities at all. 5

Total score=SUM (points for all 10 findings)

Disability in percent=(total score) /50*100

15