THESIS of requirements for the degree of Doctor

THESIS PREVALENCE OF MUSCULOSKELETAL PAIN AMONG UNDERGRADUATE FASHION DESIGN STUDENTS SUBMITTED BYAsia Bashir (M-15621)Muhammad Atif (M-15669)In partial fulfillment of requirements for the degree ofDoctor of Physical Therapy/ Doctor of Nutritional Sciences/ Bachelors of Food and Nutrition (16 font size) SUPERVISOR Dr. Ayesha Jamil Session 2013-2018 Faculty of Health Sciences UNIVERSITY OF SOUTH ASIAJust for student informationCONTENTS OF THESIS FOR WRITE UP1. Letter of supervisor and co supervisor (original)2. Board of study letter (original)3. Table of contents (give accurate page no.

and serial no.)4. List of abbreviations5. Title of the Thesis6. Abstract 7. Introduction 8.

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Operational definitions9. Literature review 10. Objectives11. Hypothesis12.

Methodology13. Ethical declaration14. References 15. Appendix including tool used (Proforma/ questionnaire), consent form inUrdu and English, Gantt chart/ time distribution16. Plagiarism report17. Result18.

Discussion19. Conclusion20. Recommendations & LimitationsNOTE:Use font size of 12 (normal) for the description and 14 for the headings and sub-headings.

The used font will be Times new Roman. Use paper size of A4, portrait and margins; 1.5″, left and 1″ for top, bottom and 0.

75 on the right side. Header short title of 35-40 character and footer withpage no. to the right side.

There should be double spacing within the text. Subheadings within the above mentioned chapters should be as follows;e.g. In Introduction chapter1. (Heading 1)1.

1 (Sub-Heading 1)Ref No. UNIVERSITY OF SOUTH ASIAFaculty of Health SciencesSupervisory LetterDate. _It is to certify that the contents of the thesis used by the student Asia Bashir and M. Atif, Roll no.

M-15621 and M-15669 respectively, session 2013-2018 on the topic Prevalence of Musculoskeletal Pain among Undergraduate Fashion Design Student has been found satisfactory and recommended for the thesis defense, for further correspondence.SupervisorCo-supervisorDean, Faculty of Health SciencesRef No. UNIVERSITY OF SOUTH ASIAFaculty of Health SciencesDate. _Student Name: Reg. No. Board of StudiesName of members SignaturesRef No.

UNIVERSITY OF SOUTH ASIAFaculty of Health SciencesDate. _Student Name: Reg. No. Synopsis approval letterIt is certified that the synopsis by the Asia Bashir and M. Atif , session 2013-2018 has been examined and Approved by board of studies on the topic ” PREVALENCE OF MUSCULOSKELETAL PAIN AMONG UNDERGRADUATE FASHION DESIGN STUDENTSSupervisorDean, FHSRef No. UNIVERSITY OF SOUTH ASIAFaculty of Health SciencesDate.

_Student Name: Reg. No. Plagiarism evaluation reportIt is certified that the report by the student has been examined with the help ofTurnitin software entitled” Prevalence of Musculoskeletal Pain among Undergraduate Fashion Design StudentsThe report contains no text that can be regarded as plagiarism.

The overall similarity index obtained from the Turnitin software is %SupervisorRef No. UNIVERSITY OF SOUTH ASIAFaculty of Health SciencesDate. _Student Name: Reg. No.

Thesis Defence CommitteeStudent name Reg No. Session After getting approvalfrom Supervisor and Board of Studies committee, Faculty of Health Sciences, University of South Asia received satisfactory remarks on the form of thesis, matter of thesis and viva defense. His/ Her topic ” “Was approved and got eligibility for the award of degree of DPT/DNSInternal ExaminerExternal ExaminerDean, FHS “DEDICATION”Dedicated to my ParentsACKNOWLEDGEMENTLIST OF CONTENTSCHAPTER TITLE PAGE NOCHAPTER 1 INTRODUCTIONCHAPTER 2 REVIEW OF THE LITERATURECHAPTER 3 HYPOTHESIS OF STUDYCHAPTER 4 OBJECTIVECHAPTER 5 MATERIALS AND METHODSLIST OF TABLESSerial Table Page No1. Distribution of gender in group 1 and 22.

Frequency of occupation in3. Distribution of side4.LIST OF FIGURESSerial Figure Page No1.

Anatomy of2. Positioning3.4. Simple Bar Chart5. Simple Bar Chart showingLIST OF ABBREVIATIONSSR.

NO. ABBREVIATIONS DESCRIPTIONS1. WRMSD Work-Related Musculoskeletal Disorders 2 NIOSH National Institute for Occupational Safety and Heal 3 SPSS Statistical Package for Social Sciences.

KEY WORDS: Musculoskeletal pain, Fashion design, Undergraduate students, prevalenceABSTRACT (250 words)Introduction:Musculoskeletal disorders are a diverse group of conditions affecting large areas of the body. Musculoskeletal pain refers to the following five overall conditions, non-specific MSK pain in the extremities, RA, OA, OP and BP (i.e. neck pain, mid back pain, and LBP). Most common occupational problem effects not only working population but also effects young population and university students.

Objective:The objective of the study was to determine the prevalence of musculoskeletal pain among the undergraduate fashion design students.Methodology:Study Design: It was a cross sectional study. Data was collected from fashion department of University of Management & Technology (UMT), Hajvery University (HU) Lahore, and Government Collage University Faisalabad (GCUF). The study was completed in 6 months from Jan 2018-June 2018 after the approval of Ethical Committee and Institutional Review Board.

300 participants were included in study .Convenient sampling technique was used. Participants with age ranged from 18-26, both gender, enrolled in fashion design department were included in study. Standardized Nordic Scale was used for determining prevalence of MSK pain.

Results: Mean age of participants was 21.6±2.05, majority of participants i.e.

61% were females. 81% participants had complain of MSK pain and most prevalent area of pain was low back which account for 40% and neck pain was 20%. 55% of participants with pain had on campus study hours greater than 6. Sitting posture was majorly assumed i.

e. of 60%. 92% were not doing any kind of job.Conclusion: MSK pain was observed in 81% participants with 40% had complain of LBP. Majority were females and pain was associated with sitting posture, more than 6 in-campus and off-campus study hours.

Prevalence of pain was high among 2nd and 3rd year undergraduate fashion design students. 1. INTRODUCTION Musculoskeletal disorders are a diverse group of conditions affecting large areas of the body. These disorders include strains, sprains, soreness, nerve compression syndromes, hernias, and connective tissue injuries affecting the muscles, bones, cartilages, tendons, ligaments, nerves and spinal discs(1).

Musculoskeletal pain refers to the following five overall conditions, non-specific MSK pain in the extremities, RA, OA, OP (either spine or hip or a combination of both), and BP (i.e. neck pain, mid back pain, and LBP) CITATION Ren12 l 1033 (1). It is one of most common occupational problem in developed countries.

it is not only effect the working population but also effect the young population and university students CITATION der05 l 1033 (2) CITATION drs07 l 1033 (3). According to the National Institute for Occupational Safety and Health (NIOSH), there exists a causal relationship between the physical exertion at the work place and development of musculoskeletal disorders (2).Work-related musculoskeletal disorders (WRMSDs) can be defined as disorders of the musculoskeletal system which assumed to arise due to work-related causes or stress (3).Work related musculoskeletal pain is the major problem which is faced by the adolescents now a days. In European countries 27% to 40% musculoskeletal symptoms are work related (4) (5).Most commonly involved area of musculoskeletal system are the neck, low back, upper extremity.

If these conditions are not treated timely and properly these can lead to permanent or irreversible disabilities (2) (6).Musculoskeletal problems arise due to number of physical factors which includes the repetition of task, use of excessive force, and working in faulty body positions for many hours or prolonged sitting or standing working posture (2). Other workplace or organizational factors like increased work durations, working with no rest or break intervals, psychosocial factors in working environment also take part in developing these types of musculoskeletal problems (7). Among student population, several cross-sectional Studies reported high prevalence (41–81%) of self-reported upper extremity musculoskeletal disorders (MSDs) among senior undergraduate students, engineering graduate students, and female undergraduate students. Severity of these symptoms can be enough to limit university students’ daily and school activities and further result in disabilities CITATION Che07 l 1033 (4)MSK disorders affects the other aspects of person’s life including decreased cognitive ability, sleep disturbance and participation in the activities of the daily living is also compromised (8).

Prevalence of musculoskeletal pain problems is as follows low back pain is extremely common, affecting 30–40% of adults in the general population at any given time. Prevalence is in the range of 15–20% for neck pain and for shoulder pain and 10–15% for knee pain, temporomandibular disorder pain, and chronic widespread pain. High prevalence of musculoskeletal symptoms is seen in the neck and upper extremity among undergraduate technical students ranging from 48-78% (4) In a Swedish cohort of university students 15% developed neck or upper back pain during 1-year follow-up (6).

Neck pain is assumed of multi-factorial origin, indicating that individual, physical, and psychosocial factors can contribute to its onset and persistence. (9). Female sex, older age, high work demands, low social/work support, ex-smoker, sedentary work position, and history of low back disorders were linked to the onset of neck pain. (10).

According to a study range of prevalence of neck pain among Australian general population was between 0.4% to 86.8% (0.23.1%) (11) .

Low back pain is 5th most common disorder, affecting 70-80% of people in developing country; 23% with chronic pain and 11% are being disabled because of low back pain. (12).According to a study in 2010 point Prevalence of low back pain (for 0-100age) was estimated 9.4% globally (13).Risk factors of back pain include heavy physical work; frequent bending, standing or walking for >2hrs per day, frequent moving, lifting or twisting>25 lbs., and prolonged static postures.

Females, obesity and people in their third decade are more prone to low back pain. (14)Fashion designing is a growing field of modern era. Fashion industry is said to produce revenues of about $784 billion globally (15).In this discipline the different task are designed in different semester like draping, pattern making, stitching. These tasks demand long working hours in bending, stooping & sitting posture.The aim of conducting this study is to determine the prevalence of work related musculoskeletal disorder among the undergraduate students of fashion designing.

It will help to prevent students of fashion designing from developing WRMSDs of neck & low back by modifying position educating& identifying the risk factor contributing to pain.OPERATIONAL DEFINITIONSMusculoskeletal pain: Musculoskeletal pain refers to the following five overall conditions, non-specific MSK pain in the extremities, RA, OA, OP (either spine or hip or a combination of both), and BP (i.e. neck pain, mid back pain , and LBP) CITATION Ren12 l 1033 (1)Prevalence: It can be defined as the proportion of the population with a specific problem at a point or period in time. CITATION Epi10 l 1033 (5)Fashion design student: Student can be define as persons registered in a school or official learning program. Fashion design can be define as to make a special among several style of cloths and accessories and word design originate from designare its means to imply some plan that means development of design created in past, and execute some results CITATION Hee00 l 1033 (6)LITERATURE REVIEW:Methodology:The search engines used for searching the literature were Google scholars and PubMed, science direct and DOAJ.

The key words used were low back pain, undergraduate students, fine arts, textile worker, neck pain, nursing students, technical school students, dentists, musculoskeletal problem, painter, weavers, fashion designing. 14, 900 article were extracted by using these keywords. 45 articles were found to be relevant with the study. Articles ranging from 2005 to 2017 were included.

Among these articles only 25 articles were selected in the study based on inclusion criteria. All selected articles were original articles. The mostly study designs were cross sectional, correlational studies others were cohort studies. Systematic review articles and meta-analysis article were excluded from the study the article describing the neck pain or low back pain due to some medical problem are excluded from the studySummary of Evidence:In 2018 a cross sectional study was conducted in Pakistan by husna haroon et,al.

on Musculoskeletal pain and its associated risk factors among medical students of a public sector University in Karachi. From 382 questionnaire 360(94.2%) were Returned. The mean age of the participants was 20.77±1.47 years and mean BMI was 20.

78±3.48. 256 participants were Females. Students in their respective years present at the time of data collection were included, Students with any chronic illnesses, known musculoskeletal disease or pregnancy were excluded .modified version of the standardized Nordic questionnaire used for data collection. Results showed that 268 and 140 students reported having musculoskeletal pain in at Least one of the body sites in the past 12 months and in the past seven days, respectively.

Self-reported mental stress and history of trauma in the neck, shoulder or lower back were the most significant predictors of musculoskeletal pain during the past seven days. The use of Computer /laptop for more than three hours per day had an increased occurrence of neck pain there was an alarmingly high occurrence of musculoskeletal pain among medical students.CITATION Mus18 l 1033 (8)In 2011 Karmen et al conducted a cross sectional study on musculoskeletal effects of ergonomics on postgraduate students and faculty of dentistry school in Spain The sample collected between May and June 2007. There were 74 dentists (54 postgraduate students and 20 faculty members) .an anonymous questionnaire was used. Following Results were showed: 79.

8% participants had faced musculoskeletal pain in the previous 6 months. Pain in the neck, cervical ,lumbar, shoulder and wrist were compared and neck was found most affected area (58% ).34% of the participants were taking preventive measures but incorrectly. frequency & intense pain among female’s different body regions was high. A high incidence of wrist pain in professionals was due to oral surgery.

Correlation between the working hours and pain was not found. There were high symptoms rate among the female and younger dentists CITATION Kar11 l 1033 (9).In 2010 A cross sectional study in Italy conducted by Antonio Lorusso et,al musculoskeletal problems in Italian X-ray it was questionnaire survey.109 students (60 males 49 females) currently attending the 3-year X-ray technologist school were recruited for the study. Their mean age was 22.1 years and their mean body mass index was 23 .

Standardized Nordic Questionnaire was used for data was found that prevalence of complaints in anybody site over the previous 12 months was 37%, Low back pain was the Most frequently reported symptom (27%), followed by neck (16%), shoulder (11%), leg (8%) and hand/wrist (5%) pain. Poor physical activity was also associated with problems.

This study was concluded with prevalence rates of musculoskeletal complaints among X-ray technology students to be high, representing about half of those found in Italian technologists. The most common musculoskeletal Problem was low back pain, which had also been found in research conducted among nursing students CITATION Ant10 l 1033 (10). In 2009 A positive relationship between Neck, shoulder, and upper back pain in students entering into working life was found by Hanvold in Norway. The study design was prospective cohort study with 173 participants from 13 technical school.

There were 59 male and 114 female students with median age of 17 years from their last year of school to their first years of working life. Data was collected 3 times, October (2002, 2003) ; December 2005 via Modified questions from Statistics Norway on mechanical exposure, observed stress, extracurricular activities. The prevalence of pain in the neck, shoulder, and upper back among the technical school students was high. Few students were reporting severe pain.

Prevalence of pain was 3 time high in 1st time Pain reporting as compared to other 2 follow-up reporting. Increased physical activity in free time decreases the risk of neck, shoulder, and upper back pain at follow-up. High to moderate levels of mechanical exposure and stress level were not found as risk factors for pain after entering working life and there was ambiguity about risk factors CITATION Han10 l 1033 (11).In 2009 the positive relationship was found between musculoskeletal disorder and dental Hygiene students in the study conducted by Hayes et al. in Australia. The study design was cross sectional with 126 participants, 119 female and 7 male were recruited from currently enrolled students in the three year Bachelor of Oral Health program or 2 years advanced diploma at the University of Newcastle in New South Wales.

Modified Standardized Nordic Questionnaire was used. Response rate of was about 72%. Results showed the prevalence of involvement of area as follows: neck 64.

29%, lower back 57.94% and shoulder 48.41%. The Students without regular exercise every week experienced a higher risk of lower back pain while the Students taking 16 to 20 hr. of study on desk in a week more prone to neck pain.

6 to 10 hours working on a computer per week was a risk factor for shoulder and upper back pain CITATION Mel09 l 1033 (12).In 2008 a study was conducted in Northern Queensland by peter leggat et,al. on the Prevalence and association of Low Back Pain among Occupational Therapy Students there were 150 on-campus students recruited ; Third-year students were excluded on unavailability in campus .

Standardized Nordic Questionnaire for the Analysis of Musculoskeletal Symptoms with questions used for LBP was shown that 12-month prevalence of LBP was 64.6%. Nearly half 46.9% had experienced pain for over 2 days, 38.

8% suffered LBP that affected their daily lives, and 24.5% had sought medical treatment. The prevalence of LBP ranged from 45.5 to 77.1% while the prevalence of LBP symptoms persisting ; 2 days was 34.1 to 62.

5% .year of study and weekly computer usage were Statistically-significant LBP risk was concluded that high prevalence of LBP amongst first-year occupational therapy students may possibility of pre-existing conditions.

CITATION Pet08 l 1033 (13)A cross sectional study in 2008 conducted by Karen et,al on college student and computers and assess the usage pattern relation with musculoskeletal discomfort.234 students aged 10–17 recruited by Convenience sampling. Data collected by a web-based questionnaire concerning computer use ; compare student using patterns with professionals that use computers. Students reported their computer use to be at least 18 out of 24 h/day, compared to 12 h for the professionals. Results showed the College students reported a higher frequency of UE and neck discomfort than professional workers. It was concluded that reduced recovery time for the college students may contribute to the higher frequency of discomfort Knowledge and proper equipment are two factors that could help reduce a future workforce’s risk of developing MSDs as a consequence of using computers. CITATION Kar09 l 1033 (14)The physically & psychologically increased working stress causes the low back pain among the nurses. This result was found from the study conducted in 2008 by Tim et al in Australia. A cross-sectional study conducted on 897 undergraduate nursing students from 1, 2 and 3 year and 111 graduate nurses with the age of 18 and 50 years were selected by personal invitation during lectures. Modified version of the Nordic Low Back Questionnaire for LBP, novel questions and questions on daily activities were added in the questionnaire. It was found that there was no significant effect of the age on lifetime prevalence of low back pain. The mean age among over all groups was 26. The prevalence of LBP among nursing student was observed, lifetime, monthly, 7 days .it was found 79%, 71%, 30% respectively and the results were same for 3rd years nursing students. But prevalence of the pain among graduate nursing in life time, monthly, and 7 days pain ratio was found 95.5%, 90%, and 39% respectively. The bending and lifting were found risk factors in low back pain among the nursing student and graduate nursing, although the work related to bending & lifting task for nurses has been decreases CITATION Tim08 l 1033 (15).Another study on computer usage effect on musculoskeletal problem among undergraduates students in 2007 a cohort study conducted by Chang, et, al sample was 27 undergraduate students (13 males and 14 females, with 20-22 years old over three period at the beginning, the middle, and the end of the spring semester. Data collected by PDA was found that Daily computer usage longer than 3 hr. was significantly associated with an odds Ratio 1.50 (1.01–2.25) of reporting symptoms. Odds of reporting symptoms also increased with Quartiles of daily exposure. CITATION Che071 l 1033 (16) In 2007 Smith & Leggat conduct a cross sectional study on prevalence and distribution of MSK pain among medical students 261 students from a medical School in tropical northern Australia were included in the study 61% were female and 39 % were male, with an average age of 19.7 years Data collection done by means of an anonymous self-reporting questionnaire .It was found that 97.3% response rate. The prevalence of MSP at anybody site varied from 75.8 percent in the second-year students to 89.3 %. In the third-year students, neck pain was 52.8 %, lower back 51.6% and shoulders 46.5%. When compared with males, female students were more likely to report MSP (3.4 times for neck pain, 2.5 times for upper back pain, 2.0 times for shoulder pain, and 1.8 times as for lower back pain). Second-year medical students were only 0.4 times as likely to report MSP at either the neck, upper back, or anybody site when compared to students in the other three grades. Study concluded that MSP affects Australian medical students at high rates, although the prevalence, distributions, and correlations for these conditions do not appear to be uniform CITATION DRS07 l 1033 (17).Smith et, al in 2006 conducted another cross sectional study on Upper Body Musculoskeletal Disorders among Australian Occupational Therapy Students with average age of 20 -26 from the first, second and fourth years included and 3rd group was excluded in study. Replies were obtained from 95.7%, 100% and 97.7% (n = 44, 55 and 48) of students in the 1st, 2nd, 3rd years of a large occupational therapy school. Standardized Nordic questionnaire was used for data collection procedure. The result showed 12-month period prevalence of MSDs, neck (67.4%), Shoulder (46.3%) and upper back (39.5%). (75.5%) reported an MSD occurring in at least one of body regions. Over half (56.5%) reported an MSD over 2 days. 40% reported an MSD that had affected their daily life, while one-quarter (25.2%) needed some type of treatment. Logistic regression indicated that students aged over 21 years were almost 4 times more report shoulder-related MSD. Year of study was another important MSD correlate, 3.3 at the upper back to 10.9 at the neck. Computer usage having an increased risk of MSD at the neck (5.0,) and shoulder (4.7) it was concluded that Australian occupational therapy students have a large burden from MSDs in the upper body region, more than other student groups and some working populations CITATION Der06 l 1033 (18)Another study showed a relationship of NSP to young adult it was concluded that incidence of neck and shoulder pain was higher among them. And the psychosomatic symptoms were observed as contributing factor to developing the NSP in 7 years follow up. In the 2004 a longitudinal study conducted by Siivola et al in Finland. There were 826 high school students with the age between 15 -18 years selected by simple random sampling, the second time data was collected in the age of 22 -25years.A modified Nordic musculoskeletal measuring tool used The outcome variables were neck and shoulder pain and the descriptive variables included sociodemographics, extracurricular activities, psychosomatic stress , and fatigue and sleep difficulties. Among them Only 394 participants presents in second survey. Result showed that NSP prevalence increased from 17% to 28% in 7 years & among asymptomatic participants it increased up to 59 %. Among female pain was associated to pain in adulthood and sports loading. The psychosomatic symptoms were found risk factor among models CITATION Sar04 l 1033 (19).Another cross sectional study was conducted in 2005 by Leah & Karen .this study was conducted on undergraduate physiotherapist. This study concluded that the prevalence of low back pain among 2 to 4 year students with age of 20 &21 was high as compared to students in 1st year and aged >21 or <18 these were students who entered in the physiotherapy field directly from high school, now were the final year students . 346 students were voluntarily selected from all 4 year of physiotherapy level. Data collected by self-administered questionnaire, question were taken from Nordic back pain questionnaire to get information about life time 1 year,1 month,1 week low back pain prevalence. Response rate was 72% and result showed prevalence of pain was 69% for life time, 63% for 1 year, 44% for 1 month, and 28% for 1 week. 1 month LBP was related with previous month sitting, looking down posture >20 hours & treating patient CITATION Lea03 l 1033 (20).In 2000 a study conducted by Jeffrey on prevalence of Upper Extremity Musculoskeletal Disorders among 1,544 College Students sample was based on a stratified, multistage probability cluster sampling this study showed that the 47% reported that they never had symptoms, 41% that they had symptoms after several hours of computer use, 6.9% that they had symptoms after computing for 1 hour or less, 3.2% that they had symptoms after computing for a few minutes, and 2.5% that they had symptoms with virtually all activities. The study was concluded that greater exposure to computer is associated with higher symptom, prevalence was associated with prior work, Female sex, and hours of computer use. CITATION Jef00 l 1033 (21)Conclusion:The results of prior studies show that the work related musculoskeletal disorder particular neck & low back are highly prevalent among general population are closely associated with certain risk factors which include duration of work, prolonged sitting, awkward postures, poorly designed working environment and repetitive movements of hands and wrist , stooping posture ,prolonged standing ,age . Rationale:As there was very little or no work had been done or not yet published in Pakistan on fashion design student. So this study will contribute to the literature and find the gravity of the musculoskeletal problem among the fashion design students.OBJECTIVE:The objective of the study was to determine the prevalence of musculoskeletal pain among the undergraduate fashion design students and to find most prevalent associated factor.METHODOLOGY:Study Design:It was a cross sectional study.Setting:Data was collected from fashion department of University of Management & Technology (UMT), Hajvery University (HU) Lahore, and Government Collage University Faisalabad (GCUF). Duration of Study:The study was completed in 6 months from Jan 2018-June 2018 after the approval of Ethical Committee and Institutional Review Board.Sample Size:300 participants were included in study. p= 0.27d= 0.05alpha= 0.05Sampling Technique: Convenient sampling technique was used. Sample selection: Inclusion criteria: Age ranged from 18-26Both male and female Undergraduate students Student enrolled in fashion designing departmentExclusion criteria: Those who didn’t met the inclusion criteria Data Collection ProcedurePermission for data collection was taken from higher authorities of institutes. Participants was informed about the details of the study. Informed consent was signed by the participant before collecting the data. Clarity, confidentiality and anonymity of the data was maintained. Self-design questionnaire was used for data collection. Questionnaire was based on demographic data, tasks related questions, numeric pain rating scale for the intensity of pain and Nordic musculoskeletal questionnaire used for the prevalence of pain in following areas low back, neck, shoulder and general complaints for use in epidemiological studies CITATION Joa07 l 1033 (22).Variables Demographic Variables:AgeGenderInstitutionPredictive Variables:Year of studyWorking positionOff campus practical work hours On campus practical work hours Perception of pain related to work related tasks Outcome Variable: Presence of musculoskeletal pain in 12 months and 7 days Outcome Measure Tools with Validity and ReliabilityNordic Musculoskeletal Questionnaire was used for screening musculoskeletal pain. The Nordic questionnaires consist of structured, binary and multiple choice variants and can be used as self-administered questionnaires or in interviews. There are two types of questionnaires: a general questionnaire, and specific ones focusing on the low back and neck/shoulders etc. The purpose of the general questionnaire is simple surveying, while the specific ones permit a somewhat more profound analysis.Reliability is 0.80Validity is 0.74Statistical Analysis:Data was analyzed by using the SPSS version 23.Qualitative data (e.g. working posture, gender, area of pain etc.) was presented by frequency table, graph, and charts.Quantitative data (e.g. age) was presented by mean and stander deviation.Cross tabulations and Chi Square was used to find out the association between independent and dependent variables.Ethical Declaration Rights and dignity of all individuals will be the prior consideration The prescribed exercise and other treatment given will be sound and no harmful. Accurate information to patients will be provided, and written consent will be taken from the subjects. Patient’s details and data confidentiality will be maintained at every level. Ethical clearance will be taken from the ethical committee of the university. RESULTSThere were 300 participants recruited in the study. The age was ranged from 18-26 with mean age of the participants was 21.6±2.05.Figure 1: Graphical Representation of Age of Participant with HistogramOut of 300 participants 39.3 % (118) were male whereas 60.7 % (182) were female enrolled in the fashion design department. Figure 2: Graphical Representation of Frequency and Percentage of Gender of ParticipantMost of participants 40.0 %( 66) belongs to 3rd year of the study while participants from 4th, 2nd and 1st year were 34.0 % (102), 22.7 %( 68), 3.3 % (10) respectively Figure 3: Graphical Representation of Frequency of Year of Study Program of ParticipantData was collected from different institute of Punjab. 67.7% (203) participants belong to Government Collage University Faisalabad (GCUF), 17% (51) participants belongs to Hijvery University Lahore (HU), 15 % (46) participants belongs to University of Management and Technology (UMT)Figure 4: Graphical Representation of Institute wise Frequency of ParticipantsMajority of the participants reported that they were not doing in any job. The percentage of those was 92% (277).lesser number of participants mentioned any part time job with the studies which account for 8% (23) of total population of study.Figure 5: Graphical Representation of Frequency of Job Status Participants with Bar ChartsParticipants assumed different body posture for academic tasks assigned to them related to their academic years. 60 % (180) participants had to work in sitting position, while 34% (103) students had a standing position while working on particular activities, 4% (12) and 2% (5) student reported stooping and kneeling respectively on their projects.Figure 6: Graphical Representation of Frequency of Posture assumed by Participants On campus working hours of 45 % (134) students were less than 6 hours and 55 % (166) participants had on campus working hours of more than 6 hours.Figure 7: Graphical Representation of Frequency of On-Campus Work Hours of Participants Off campus working hours of 77 % (231) students were ? 6 hours and 23 % (69) participants were working for < 6 hours.Figure 8: Graphical Representation of Frequency of Off-Campus Work Hours of Participants Out of total 300 participants, majority of the participants i.e. 81% (242) had complain of pain in any musculoskeletal region of body during last one year whereas 19% (58) didn’t report any complain regarding pain. Figure 9: Graphical Representation of Frequency of Complain of Pain of Participants On response of a question that those participants who complain of any regional pain perceives that their pain is due to tasks assigned to them in their academic session, 73% respond yes in answer whereas 27% respond no relation of pain to their assigned tasks. Figure 10: Pie Chart representing of Frequency of self-perceived pain relation with activities of Participants Table 1: Summary of Demographic and Predictive Variables of Participants of Study Characteristics of Participants Categories Frequency(F=N) Percentage(%)Mean ± SDAge – 21.7 ± 2.05Gender Male 118 39 -Female 182 61 Year of the Study 1ST Year 10 3 -2ND Year 68 23 3RD Year 120 40 4TH Year 102 34 Institution Name GCUF 203 68 -HU 51 17 UMT 46 15 On Campus Working Hours ; 6 Hours 134 45 -? 6 Hours 166 55 Off Campus Working Hours ; 6 Hours 69 23 -? 6 Hours 231 77 Job Status Yes 23 8 -No 277 92 Body Posture while Working Sitting 180 60 -Standing 103 34 Stooping 12 4 Kneeling 5 2 Complain of Pain in any Body Region Yes 242 81 -No 58 19 Perception of Pain in Association with Task Yes 220 73 -No 80 27 As there were 81% of those participants who reported pain in any of the region of the body, among them 40% (120) complain of pain in lower back, 20% (61) reported pain in neck region. Shoulder pain was found in 6% (18) participants, pain in wrist and hand was observed by 4% (13) participants, 4% (11) had a history of pain in upper back, 3% (9) were those participants who had pain in hip, 2% (7) are those who reported pain in knee area, elbow pain was found in 1% (3) participants, whereas only 0.3% (1) are those who had pain in ankle and foot.Figure 10: Graphical Representation of Frequency of painful body area of Participants Complain of Pain in Any Body Region Total Chi SquareYes No Year of the Study 1.00 Count 6 4 10 ?2 (1)= 5.459 p=0.141% within Year of the Study 60.0% 40.0% 100.0% 2.00 Count 56 12 68 % within Year of the Study 82.4% 17.6% 100.0% 3.00 Count 102 18 120 % within Year of the Study 85.0% 15.0% 100.0% 4.00 Count 78 24 102 % within Year of the Study 76.5% 23.5% 100.0% Table 2: Cross Tabulation and Chi Square between Year of Study Program and Complain of Pain in BodyTable 2 shows Cross tabulation was applied between Year of the Study and Pain in Any Body Region to find out the relation between these variables. High prevalence of pain i.e. 85% was seen within 3rd academic year of study in fashion design students, within 2nd year 82% reported pain. Pain was reported by 77% participants in 4th year and 60% participants in 1st year of study.The chi square test was applied to find out the association between year of the study and pain in any of the body region. The results show no association between the two variables with value of ?2 (1) = 5.459, p=0.141Table 3: Cross Tabulation and Chi Square between Job Status of Participants and Complain of Pain in BodyComplain of Pain in Any Body Region Total Chi SquareYes No Job Status Yes Count 23 0 23 ?2 (1)= 5.97 p=0.015% within Job Status 100.0% 0.0% 100.0% No Count 219 58 277 % within Job Status 79.1% 20.9% 100.0% Table 3 shows cross tabulation was applied between job status of the participants and pain in any of body region to find out the relation between these variables. 100% participants who were doing job complained of pain whereas among those who were not doing any job 79% reported pain. Chi square results showed association between job status of the participants and pain in any of body region with ?2 (1) = 5.97, p=0.015Table 3: Cross Tabulation and Chi Square between Body Posture of Participants and Complain of Pain in BodyComplain of Pain in Any Body Region Total Chi SquareYes No Body Position While Working Sitting Count 134 46 180 ?2 (3)= 12.44 p=0.006% within Body Position While Working 74.4% 25.6% 100.0% Standing Count 91 12 103 % within Body Position While Working 88.3% 11.7% 100.0% Stooping Count 12 0 12 % within Body Position While Working 100.0% 0.0% 100.0% Kneeling Count 5 0 5 % within Body Position While Working 100.0% 0.0% 100.0% Table 3 shows the cross tabulation was applied between body position of the participants while working and pain in any of body region to find out the relation between these variables. Among those who had sitting posture while working, 74% participants complained of pain whereas among those who worked in standing posture 88% reported pain. Among those with stooping posture, all the participants i.e. 100% had pain, likewise 100% of kneeling posture assumed participants reported pain. Chi square results showed association between job status of the participants and pain in any of body region with ?2 (3) = 12.44, p=0.006Table 5: Prevalence of Pain according to Standardized Nordic Questionnaire Pain in Body Region Trouble during Last 12 Months Trouble Preventing Activities Trouble during Last 7 DaysFrequency(N) Percentage(%) Frequency(N) Percentage(%) Frequency(N) Percentage(%)Yes 239 80 179 60 172 57No 61 20 121 40 128 43Table 2 shows the prevalence of pain according to Standardized Nordic Questionnaire. It provides information regarding period prevalence of 12 months and last 7 days. Accordingly 80 % had trouble in terms of pain, ache, numbness etc. from last 12 months, whereas among 60% participants the trouble found to be affecting daily activities. 57% participants reported trouble since last 7 days.Table 6: Period Prevalence of Musculoskeletal Pain according to Standardize Nordic Scale with respect to Characteristics of ParticipantsCharacteristics of Participants Categories Trouble during Last 12 Months Trouble Preventing Activities Trouble during Last 7 Days(%) (%) (%)Gender Male 70 53 51Female 86 64 61Chi Square; P value ?2 (1)= 12.42p=0.00 ?2 (1)= 4.60p=0.10 ?2 (1)= 3.34p=0.67Year of Study 1ST Year 30 20 602ND Year 81 35 653RD Year 86 75 384TH Year 77 61 76Chi Square; P value ?2 (3)= 18.75p=0.000 ?2 (6)= 37.4p=0.000 ?2 (3)= 34.58p=0.000Body Position While Working Sitting 72 52 59Standing 89 66 52Stooping 100 92 67Kneeling 80 100 80Chi Square; P value ?2 (3)= 16.42p=0.001 ?2 (6)= 16.63p=0.011 ?2 (3)= 2.66p=0.446On Campus Working Hours ; 6 Hours 60 42 45? 6 Hours 96 74 68Chi Square; P value ?2 (1)= 59.55p=0.000 ?2 (2)= 32.55p=0.000 ?2 (1)= 15.61p=0.000Off Campus Working Hours ; 6 Hours 52 42 36? 6 Hours 88 65 64Chi Square; P value ?2 (1)= 41.81p=0.000 ?2 (2)= 13.69p=0.000 ?2 (1)= 16.31p=0.000Table 7: Body Area Wise Prevalence of MSK Pain with Respect to Gender of ParticipantsCharacteristics Area of Body Male Female Pain No – 29 13 ?2 (9) = 25.29, p=0.003Yes Neck 12 29 Lower Back 42 39 Upper Back 4 3 Wrist ; Hand 3 5 Shoulder 3 8 Hip 1 4 Knee 3 2 Ankle ; Foot 1 0 Table 4 describes the prevalence of pain in area of body with respect to gender. Among males, high prevalence of pain was seen in low back and neck i.e. 42% and 12% respectively. Other prevalent area of pain were upper back and shoulder where 4.2% and 3.4% prevalence was observed. Among females, the prevalent areas were lower back and neck with 39% and 29% prevalence was seen. Shoulder was the third most prevalent area with 8% prevalence was seen in females.Chi square test was applied to find out the association between gender and painful area of body. Results showed association between the two variables with ?2 (9) = 25.29, p=0.003Discussion:Musculoskeletal disorders are among the most common disorders seen in every individual affecting at any point of their life. The pain is the primarily symptom seen in every musculoskeletal condition.The results of this cross sectional study showed the prevalence of musculoskeletal pain was high i.e. 81% among undergraduate fashion design students over the last 12 months involving different areas of body predominately involving the one in which the overuse was seen. The results were consistent with many studies conducted on undergraduate students that reported high prevalence of musculoskeletal pain symptoms.The mean of the participants in this study was 21.7 years with the age ranged from 18-26 years was included, the same age was observed in research studies on undergraduate students determining the prevalence of any musculoskeletal symptom in body area.The female participants was high in this cross sectional study with subsequent high pain was observed among females, this goes parallel to the findings of other studies which reported high pain prevalence among female students.The high prevalence of pain was observed in low back, neck and shoulder region, the same sequence of involvement was observed in the study of Hayes et al. in 2009 in Australia on undergraduates of bachelors of oral health and the study of Karmen et al. in 2011 on dentistry students. But the study findings had a contrary findings with other researchers, some reported high painful area were neck, shoulder and upper back by study of Hanvold in 2009 in Norway on technical school students with mean age of 17 years. The current study find out the prevalence of musculoskeletal pain prevalence over a period of past 12 months with related disability and pain over last 7 days. High prevalence of pain i.e. 80% was observed over the last 12 months and 51% pain prevalence was seen during last 7 days from the point of data collection. These results were parallel to the study conducted in 2003 by Leah ; Karen on undergraduate physiotherapist.According to the results of this study, the higher rate of pain was seen in 2nd and 3rd year of academic programme of fashion design students, like pattern was observed in a study carried out in 2008 by Tim et al in Australia on bachelors in nursing where advanced courses and in higher semesters or years mainly 3rd and final year was more crucial in developing musculoskeletal pain in any area of body specially lower back. The study represented other exposures like working hours and self-perception of work related pain was also associated with MSK pain and discomforts. Study reported association of pain with working hours of more than 6 hours either off campus or on campus. Posture is associated with period prevalence. The study results showed that prolonged posture is associated with related regional pain.Conclusion:The study concluded that females had higher prevalence of pain and disability than the males with most prevalent painful area among undergraduate fashion design students is low back region. The pain was mostly reported in 2nd and 3rd academic year of study with more than 6 hours of in and off-campus working hours, sitting posture and job parallel to academic tasks were the most prevalent factors associated with pain. LIMITATIONS AND SUGGESSTIONS:LIMITATIONS:One of the possible limitations of the study is the use of self-reported measures of all the variables. A self-administered retrospective questionnaire has the limitation of participants failing to remember previous symptoms, which means that recall bias can affect the findings.RECOMMENDATIONS:It is recommended to future researchers to conduct the study longitudinally study both before and after graduation. References BIBLIOGRAPHY 1. What is the prevalence of musculoskeletal problems in the elderly population in developed countries? A systematic critical literature review. Ruhe2, René Fejer1* and Alexander. s.l. : Fejer and Ruhe Chiropractic ; Manual Therapies , 2012. 20:31.2. musculoskeletal disorder among chinese medical students. derek.r smith et, al. china : kurume medical journal, 2005, Vol. 52. 139-146.3. Prevalence and Distribution of Musculoskeletal Pain Among Australian Medical Students. al, d.r.smith et. 4, australia : Journal of Musculoskeletal Pain,, 2007, Vol. 15.4. Daily Computer Usage Correlated With Undergraduate Students’ Musculoskeletal Symptoms. Che-hsu (Joe) Chang, PT, MSet,al. 50, s.l. : AMERICAN JOURNAL OF INDUSTRIAL MEDICINE , 2007. 481–488.5. Epidemiology of Musculoskeletal Pain . s.l. : © 2009 International Association for the Study of Pain®, 2010.6. Application of interactive genetic algorithm to fashion design. Hee-Su Kim, Sung-Bae Cho. (2000), South Korea : Elsevier Science Ltd, 2000, Vol. 13. 635–644.7. Webster’s New World College Dictionary, 4th Edition. Copyright © 2010 by Houghton Mifflin Harcourt. All rights reserved. Online Cited: 07 22, 2018.8. Musculoskeletal pain and its associated risk factors among medical students of a public sector University in Karachi, Pakistan. Husna Haroon, 1 Safia Mehmood,2 Fauzia Imtiaz,3 Syed Arif Ali,4Mohammad Sarfraz5. 4, krachi : J Pak Med Assoc, 2018, Vols. Vol. 68,.9. Ergonomics and musculoskeletal pain among postgraduate students and faculty members of the School of Dentistry of the University of Barcelona (Spain). A cross-sectional study. Karmen Harutunian 1, Jordi Gargallo-Albiol 2, Rui Figueiredo 3, Cosme Gay-Escoda. 3, barcelona  : Community and Preventive Dentistry, 2011, Vol. 1. 425-9..10. RMeseuarschc aurtilcoleskeletal complaints among Italian X-ray technology students: a cross-sectional questionnaire survey. 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Predictive Factors for Neck and Shoulder Pain: A Longitudinal Study in Young Adults. 15, s.l. : Lippincott Williams & Wilkins, Inc., 2004, Vol. 29. 1662–1669.20. Is undergraduate physiotherapy study a risk factor for low back pain? A prevalence study of LBP in physiotherapy students. Leah Jane Nyland, Karen Anne Grimmer. australia : BMC Musculoskeletal Disorders, 2003.21. Prevalence of Upper Extremity Musculoskeletal disorder in college student. Jeffrey N. Katz, MD, MS, Benjamin C. Amick III, PhD,. s.l. : THE AMERICAN JOURNAL OF MEDICINEt, 2000, Vol. 109.22. The Nordic Musculoskeletal Questionnaire. Crawford, Joanne O. 57, s.l. : Oxford University Press:, 2007, Vol. 2007. 300–301.23. Correlation among scapular asymmetry, neck pain, and neck disability index (NDI) in young women with slight neck pain. Su-Rim Kim1), Mi-Hee Kang1), Sun-Young Bahng1), Jin-Kyoung An1), Ji-Young Lee1), Sang-Young Park , PT, PhD1)*, Seong-Gil Kim, PT, PhD1). 28, Korea : IPEC Inc., 2016, Vol. 2016. 1508–1510.24. Association between postures and work-related musculoskeletal discomforts (WRMD) among beverage bottling workers. U.O. Abaraogub, ?, D.O. Odebiyia and O.A. Olawalea. 54, nigeria  : IOS Press, 2016, Vol. (2016). 113–119.25. Prevalence of Musculoskeletal Disorders among the Bangladeshi Garments Workers. the Bangladeshi Garments Workers, Palash Chandra Banik,Rajib Mondal. 1, bangladesh : SMU Medical Journal,, 2015, Vol. 2. 2349-1604.APPENDIXPROFORMA/QUESTIONNAIRESr. No. ________Demographic Variables:Name: ________ Age: ________ Gender: ________ Year of Study: ___________ Institute Name: ________________Job Status: Yes _______ No______Predictive Variables:Which Posture you usually assume during your study tasks/activities? 1. Sitting 2. Standing 3. Stooping 4. KneelingHow many hours you spent in your institute for academic activities/tasks? (On Campus Working Hours) 1. < 6hr 2. > 6hrHow many hours you spent on your academic activities/tasks outside the institute? (Off Campus Working Hours) 1. < 6hr 2. > 6hrDo you perceive that your pain is/was related to work related tasks/activities assigned during study?Yes 2. No Outcome Variable: Do you have any pain at present or during last 12 months?Yes2. NoStandardized Nordic Questionnaire:How to answer the questionnaire: Picture: In this picture you can see the approximate position of the parts of the body referred to in the table. Limits are not sharply defined, and certain parts overlap. You should decide for yourself in which part you have or have had your trouble (if any). Table: Please answer by putting an “X” in the appropriate box – one “X” for each question. You may be in doubt as to how to answer, but please do your best anyway. Note that column 1 of the questionnaire is to be answered even if you have never had trouble in any part of your body; columns 2 and 3 are to be answered if you answered yes in column To be answered by everyoneTo be answered by those who have had trouble Have you at any time during the last 12 months had trouble (ache, pain, discomfort, numbness) in: Have you at any time during the last 12 months been prevented from doing your normal work (at home or away from home) because of the trouble? Have you had trouble at any time during the last 7 days? Neck 3790952540000-685802857500 No Yes 7810503556000-6354572000 No Yes 8026404127500260354191000 No Yes 42227516446500Shoulders -68580-508000 No Yes, right shoulder 422275571500 Yes, left shoulder 4222755778500 Yes, both shoulders 7810503429000-6353429000 No Yes 7981953937000215904889500 No Yes Elbows 0-508000490855-508000 No Yes, right elbow 490855571500 Yes, left elbow 4908555778500 Yes, both elbows 7143753429000-6353429000 No Yes 726440571500215903492500 No Yes Wrist/hands0-508000490855-508000 No Yes, right wrist/hand490855571500 Yes, left wrist/hand4908555778500 Yes, both wrists/hands 704850127000-6353873500 No Yes 7264401905000215903873500 No Yes Upper back 422275285750002857500 No Yes 7048504762500-6352857500 No Yes 8026402857500215902857500 No Yes Lower back(small of back)422275285750002857500 No Yes 7048502857500-6352857500 No Yes 726440952500215902857500 No Yes One or both hips/thighs422275285750002857500 No Yes 7048501905000-6353429000 No Yes 726440952500215903429000 No Yes One or both knees422275285750002857500 No Yes 7810505334000-6352857500 No Yes 8026405334000215905334000 No Yes One or both ankles/feet422275285750002857500 No Yes 7810502857500-6352857500 No Yes 8026402857500215902857500 No Yes CONSENT FORM You are invited to participate in a research study conducted by ASIA BASHIR & MUHAMMAD ATIF and contact information (both student and university)The study has no potential harm and known risks associated to participants with this research. The data collected will not be disclosed to anyone and coded in order to protect your identification. You may choose not to participate or withdraw yourself from the study any time. Refusal or with-drawl from the study will not affect the quality of treatment.Your agreement to participate, indicate that you have read and understood the nature of the study, and that all your inquiries concerning the activities have been answered to your satisfaction. If you have any questions or concerns about your rights as a research participant, please contact the Faculty Review Board or the researcher. Any additional information about the study results will be provided to you at its conclusion, upon your request.I have read this consent form and have been given the opportunity to ask questions.Name: Date:Signature: CONSENT FORM URDUGANTTT CHART


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