Association Between Gadget Use and Neck Pain among Bus Conductors in Karnataka

Introduction

Neck pain, a common global problem, is an important source of disability. In 2020, it affected 203 million people.¹ In the general population, the one-year neck pain prevalence has been estimated as 29% and 40% among men and women, respectively.² Neck pain primarily results from diseases of the cervical spine and soft tissues of the neck.³ It can be due to an injury, any mechanical or muscular issue, a trapped nerve caused by a bulge in the discs between the vertebrae, arthritis, and can range from mild discomfort to severe burning pain.⁴ It can be caused by factors such as increased work hours, work pressure, high job demand, poor job content, low job satisfaction, age, poor lifestyle like smoking, lack of exercise, poor nutrition.⁵ Clinical symptoms commonly associated with neck pain include, pain and stiffness in the neck, headache, dizziness, and radiating pain to shoulders and the upper limbs that develop gradually with recurrent episodes.¹ Good posture is a state of muscular and skeletal balance that protects the supporting structures of the body from injury and allows the muscles to function most efficiently. Poor posture is a faulty relationship of the body’s parts that increases strain on the supporting structures and reduces the efficiency of the body’s balance over its base of support.⁶

Occupational factors like muscle load in a prolonged static position and repetitive work may be one source for pain development. Physical activity and gender are few other variables that could be linked to musculoskeletal discomfort.⁷ Musculoskeletal pain (MSP) has become more common in industrialized nations in the recent years. In terms of disability, musculoskeletal problems rank third among those aged 45 years and above and are a major cause for physical and occupational disability in individuals under 45 years.⁸ Poor posture is commonly observed in various professions such as dentistry, teaching, nursing, security services, bus conductors, lab technicians, and salesmen. However, there is a dearth of literature on the presence of neck pain among professionals who stand for prolonged durations.

Bus conductors typically stand for long durations - often around seven hours a day, for several years. They frequently keep their neck in a flexed position while issuing tickets to the passengers and move throughout the bus to perform their duties.⁹ Since the neck remains in a flexed position for extended periods, there is an increased risk of pain and discomfort in the neck region due to the strenuous work load.

The recent increase in the use of electronic gadgets may further contribute to neck pain due to the additional weight of these devices on the neck in bus conductors. Several studies have reported the prevalence of neck pain in various professions, including dentistry (34%), teaching (42.5%), nursing (31-48%), and computer-based office work (36.7%). Therefore, the present study aimed to investigate the neck pain prevalence among bus conductors using electronic gadgets (ticketing machine).

Materials and Methods

The study included conductors working for Karnataka State Road Transport Corporation (KSRTC), and Bang-alore Metropolitan Transport Corporation (BMTC), Bangalore. A convenient sample of 300 bus conductors were recruited for this cross-sectional study. Bus conductors of both the genders, in the age range of 35-45 years were chosen. The bus conductors using electronic gadgets for one year were included in the study. Participants already diagnosed with neck pain, participants with pain due to cervical radiculopathy, participants with pain over the neck region associated with LBP, those with traumatic or surgical records, with any previous history of trauma and non-consenting participants were excluded from the study.

Measuring tools - Neck Disability Index (NDI)

The Neck Disability Index (NDI) is a widely used condition-specific questionnaire designed to assess the impact of neck pain on daily life and functional activities. It is a self-reported measure that helps clinici-ans and researchers evaluate the severity of disability and tracks changes over time. The NDI consists of 10 items, each addressing a different aspect of daily life affected by neck pain: Pain intensity, Personal care, Lifting objects, Reading, Headaches, Concentration, Work performance, Driving, Sleeping and Recreational activities. Each item is scored from 0 to 5, with 0 indicating no disability and 5 indicating complete disability in that category. The total score ranges from 0 to 50 and is often expressed as a percentage: 0 - 4 (0 - 8%): No disability; 5 - 14 (10–28%): Mild disability; 15 - 24 (30 - 48%): Moderate disability; 25 - 34 (50 - 68%): Severe disability; 35 - 50 (70 - 100%): Complete disability. Higher scores indicate greater functional impairment due to neck pain. The NDI is a validated and reliable tool for assessing neck-related disability with moderate to high sensitivity (typically 0.60 - 0.80) and high specificity (typically 0.70 - 0.90), making it useful for monitoring improvement or worsening of symptoms over time.

Procedure

The study included conductors who provided informed consent and satisfied the inclusion and exclusion criteria. Demographic data including the name of the participant, age, gender, occupation related queries such as, number of working hours, years of experience as a bus conductor, duration of usage of electronic gadget, contact address, phone number, mail address, were collected from each participant.

The NDI was introduced to the participants. The questionnaire was then distributed and the study participants were requested to complete the questionnaire. The data collected from the completed forms was used to gather information on the prevalence of neck pain. Based on the responses, the prevalence of neck pain among bus conductors using electronic gadgets was analyzed and interpreted.

Data analysis

The statistical software namely SAS 9.2, SPSS 15.0, Stata 10.1, MedCalc 9.0.1, Systat 12.0 and R environ-ment ver.2.11.1 were used to analyze the data, while Microsoft word and Excel were used to generate graphs and tables. Descriptive statistics like range, mean and standard deviation were used to analyze the data from NDI. Frequency and percentage were used to assess the prevalence of neck pain. Chi square was used to determine the association of NDI with the baseline characteristics of bus conductors using electronic gadgets (Ticketing machine).

Results

A cross-sectional study with 300 bus conductors was undertaken to investigate the neck pain prevalence using NDI. Table 1 presents the data on gender distribution, age (in years), experience in the field (in years), working hours (in days), distribution of years of gadget usage by the conductors.

In terms of distribution of scores of NDI, % of conductors with minimal disability were 189 (63%) and with moderate disability were 111 (37%).

Table 2 depicts the distribution of NDI scores according to age in years. The NDI score of 171 conductors in age group of 35-40 and 129 conductors in 41-45 years of age group demonstrated minimal to moderate disability.

Discussion

Neck related problems are common among professionals required to stand for prolonged durations. Among 300 conductors studied, 227 were male conductors (75.7%) and 73 were female conductors (24.3%). About 171 conductors (57%) were aged between 35-40 years. Based on the mean age of 37.40 years, which is the most productive age, the study findings indicate that neck pain is more common among men (54%) compared to women (46%). The cervical and lumbar regions of the spine are the most movable and experience most loading stress.3 Among the participants, 152 conductors (50.7%) reported working eight hours per day, while 159 (53%) had been using electronic gadgets for 2-3 years. Additionally, 142 conductors (47.3%) had 11-15 years of work experience. Prolonged static neck positions and repetitive movements associated with their work are recognized as risk factors for neck pain.¹⁰

Wearing a Head Mounted Display (HMD) modifies the neck posture, placing the musculoskeletal system of the head and neck under increased levels of stress.¹¹ Thus, longer working hours in a standing posture, combined with the use of an electronic gadget around the neck over several years, can cause greater discomfort and neck pain. In this study, among the 300 bus conductors included, 89 (63%) presented with minimal disability while 111 (37%) presented with moderate disability.

Neck pain is highly prevalent and is a common source of disability in the working age population.¹² According to this study, 171 conductors in the age range of 35-40 years were more prone to disability, as indicated by their NDI scores. Thus, musculoskeletal disorders have become the leading cause of physical and occupational disability among individuals under 45 years of age, largely due to the increasing incidence of musculoskeletal pain, particularly neck pain, which has reached a prevalence of 42.5% in recent years (mean age 38).8 Based on the NDI scores, 227 male conductors (59%) who worked eight hours per day (57.2%), with an experience of more than 10 years (55.2%) and using the electronic gadget for 2-3 years (75.5%) were found to be prone to minimal disability. As previously mentioned, neck pain is more prevalent among men. Factors such as repetitive, frequent, or awkward posture-related work activities, extended work hours, insufficient rest periods, lack of social support, and limited ergonomic awareness are all associated with the development of severe musculoskeletal issues and disorders.¹³

The NDI is widely used to measure neck pain. Among its 10 components, some do not directly measure neck pain but rather provide information about the activities and functions of daily living. Also, the scoring system denotes the disability rather than pain. However, there is evidence supporting the association between neck pain and related functional disability.12,14 This study found that conductors aged between 36-40 years, working eight hours per day, with over a decade of work experience and using electronic gadgets for 2-3 years, reported a higher prevalence of neck pain and associated disability.

Limitations

There may be differences in neck pain prevalence between conductors working in air-conditioned Volvo buses and those in non-air-conditioned buses. The time of the day could also impact the presence and severity of neck pain. Additionally, conductors who take frequent rest breaks during their shifts may influence the study outcomes. The utilization of electronic gadgets may be minimized with the availability of bus passes. Furthermore, the load on the neck is not constant throughout the day, as the ticketing machine is often held in the hand while issuing tickets.

Further Recommendations

Future studies focusing on the identification of risk factors and implementing preventive strategies in managing neck pain in bus conductors can be under-taken. Further studies can be conducted on different populations with working hours exceeding eight hours, and can also explore the prevalence of other musculoskeletal disorders (MSDs) among bus conductors.

Conclusion

This study aimed to investigate the prevalence of neck pain among bus conductors using the ticketing machine. It can be concluded that conductors in the age group of 36-40 years, with over a decade of work experience, working for almost eight hours in a day and using the ticketing machine around the neck for 2-3 years showed high neck pain prevalence and its related disability.

Conflict of Interest

Nil