Sitting posture : a predictive factor for upper quadrant musculoskeletal pain in computing high school students

[摘要] ENGLISH ABSTRACT: Introduction: The increased prevalence of adolescent upper quadrant musculoskeletal pain (UQMP) is becoming a great concern to health professionals. The risk factors associated with adolescent UQMP are complex and multifactorial, including, among others sitting as a physical risk factor. However, no evidence exists to support sitting postural angles as a potential predictive factor for adolescent UQMP in computing high school students. Thus, the current project aimed to describe the three-dimensional (3D) sitting postural angles of computing South African high school students in a real-life setting, using a well-tested and documented posture measurement instrument. Methodology: This research project is comprised of seven related studies. Part I of the dissertation presents a systematic review describing the reliability and validity testing of posture measurement instruments. This is followed by three primary correlation and repeated measures observational studies aimed at ascertaining the reliability and validity of a newly developed 3D Posture Analysis Tool (3D-PAT) in the measurement of nine sitting postural angles of computing high school students. Part II of the dissertation presents a systematic review, that evaluates the latest published research evidence of whether sitting is related to UQMP, and, if so, to identify the elements of sitting that significantly contribute to UQMP. This review is followed by a description of a cohort study, with a prospective period of one year. The 3D-PAT was implemented in a clinical research setting in order to measure the 3D sitting posture of a cohort of asymptomatic computing high school students and in order to assess the outcome, seated-related UQMP, prospectively. The prospective study design enabled the research project to contribute to an understanding of any causative relationship between the exposure (sitting postural angles) and the outcome (seated-related UQMP) in a subgroup of adolescents (computer users). Results: After the first phase of psychometric testing of the 3D-PAT using high school students, the findings indicated that the instrument required modifications prior to further psychometric testing. The second phase of testing revealed that the 3D-PAT compared very well with the reference standard for measurement of the X-, Y- and Z-coordinates of the reflective markers on a mannequin. The findings from the phase three study, again using high school students, indicated that the 3D-PAT compared very well with the reference standard and justified its use for the measurement of six sitting postural angles of the upper quadrant in computing high school students. For the cohort study, a 60% response rate for participation was achieved at baseline, with 98% of the students participating at six-month and 80% at one-year follow up. Of the students, 33.5% complained of seated-related UQMP during the follow-up period. Exposure to increased head flexion (>80°) (ρ=0.0001) and the combination of increased head flexion and decreased cranio-cervical angles (ρ=0.007) were significant predictors of seated-related UQMP for those computing high school students complaining of pain greater than the 90th percentile for such. Conclusion: The project described in the current dissertation is the first research project to assess sitting postural angles in asymptomatic high school students, while they worked on desktop computers in a school computer classroom and to assess UQMP prospectively. The research project reports a causal relationship between increased head flexion and seated-related UQMP as increased head flexion was found to be a predictor of seated-related UQMP developing within six to 12 months for computing high school students with a pain score equal or greater than the 90th percentile for pain. The research project emphasises that further research is warranted to investigate the causal pathway between sitting posture and adolescents' UQMP.

[发布机构] Stellenbosch University