Relationship between musculoskeletal body region pain complaints, depression and physical activity level in major hospitals of Abbottabad, Pakistan

doi:10.21203/rs.3.rs-4138472/v1

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Relationship between musculoskeletal body region pain complaints, depression and physical activity level in major hospitals of Abbottabad, Pakistan

https://doi.org/10.21203/rs.3.rs-4138472/v1

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Introduction/Aim

The growing recognition of musculoskeletal disorders in the northern region of Pakistan, specifically Abbottabad, lacks contextually relevant data for devising effective prevention and intervention strategies in the mitigation of MSDs burden. This study aims to explore the relationship between musculoskeletal body region pain complaints, depression and physical activity of those visiting major hospitals in Abbottabad.

Methodology

The cross-sectional study design aimed to determine the incidence of MSDs (NMQ: Nordic Musculoskeletal complaints rating questionnaire) in 384 female participants in Abbottabad. Informed consent was obtained from all the subjects. Secondly, the relationship between MSD regions, depression (PHQ-9: patient depression questionnaire) and physical activity (IPAQ: International Physical Activity Questionnaire) was sought via phi value, Cramer's V value and logistic regression.

Results

The incidence of MSDs was noticeably higher in females above 40 years of age and who were employees. There was a significant (p < 0.05) negative weak to moderate correlation (Phi − 0.103 to -0.148) between employment and MSDs regions. In contrast, depression and physical activities had a significant (p < 0.05) positive correlation (Cramer's V: 0.129 to 0.225) with the upper back, shoulders and elbow. Individuals who were depressed were more likely to complain about their upper back and shoulders (OR 1.4, p < 0.01).

Conclusion

A significant relationship was observed between depression and MSDs. Higher musculoskeletal pain complaints were noticed in females who were not employees. The study suggested that awareness and multi-dimensional interventions addressing physical, psychological and social barriers are required for prevention and decrease in MSD complaints.

Musculoskeletal

depression

physical activity

Abbottabad

Musculoskeletal disorders are debilitating conditions that cause global morbidity [1]. Almost everyone in their lives have experienced some sort of musculoskeletal pain/disorder, regardless of their socioeconomic status, gender and age [2]. Nevertheless, musculoskeletal disorder (MSD) imposes an enormous burden on patients, families and health care takers, particularly physiotherapists [3]. The wide array of conditions encompassed by MSDs not limited to are arthritis, sarcopenia, tendinopathies, osteoporosis, affecting bones, muscles, joints and associated tissues [4]. The impact of MSDs reverberates leading to substantial financial burden, diminished productivity, disability and overall alleviating societal toll [5].

In recent years, enormous musculoskeletal studies have been conducting, showing MSDs symptoms interplay between array of factors, such as demographic characteristics including gender, BMI, job tenure, education level, age and lifestyle [6]. Notably psychosocial and physical risk factors alongside lifestyle determinants reveal imbued subtlety and complexity relationship with MSDs [7, 8].

There are much evidence that the comorbidity of MSDs associated with working condition and depression have shown similar pattern, particularly in clinical setups [9]. Further, association of psychological issues such as anxiety, insomnia and depression and MSDs have been more prominent in developed countries [10, 11].

Similarly, lifestyle factors, particularly physical activity levels have shown to significant association with MSDs [12]. In work-place, involving in physical activity, specifically after an hour confers a plethora of health benefits [13]. Consequently, the barriers of individuals that are unable to perform proper physical activities like obesity, laziness and sedentary behaviors have been recognized risk factors for the onset of MSDs [14].

To our knowledge, the effect of depression and physical activity on MSDs, particularly to body region level in Pakistan have not been analyzed. So the aim of this study investigate relationship between MSDs body region with depression and physical activity in employed individuals.

This cross-sectional study design research included 384 females participants via convenience sampling technique from major hospitals in Abbottabad including Women institute of rehabilitation sciences, Jinnah international hospital, Ayub teaching hospital and DHQ hospital. Informed consent was obtained from all subjects. Female patients with heath complication such as HIV, congenital neurological disorders, diabetes etc., were excluded for uniformity in samples. Before implementation, the Ethical Research Committee of Women Institute of Learning & Rehabilitation Sciences, Abbottabad, thoroughly reviewed and approved this study (ref: EC0023). Data was collected via Nordic Musculoskeletal complaints rating questionnaire (NMQ), patient depression questionnaire (PHQ-9) and International Physical Activity Questionnaire (IPAQ).

Statistical Analysis

The data were statistically analyzed using SPSS (statistical package for the social sciences) version 20. The probability value less than 0.05 was considered statistically significant. Data were descriptive presented with frequency (%) for MSDs, employment, age, depression and physical activities. Associations between variables were via chi square, and strength of association for 2x2 contingency table was determine via phi value and for higher contingency table was Cramer's V value. Predictor variables i.e. depression and physical activity for MSDs was found with logistic regression where odd ratio and significant was observed.

Prevalence of Musculoskeletal Pain Among Employed Individuals: Age-Stratified Analysis

Results (Table 1) showed that the prevalence of neck pain was slightly higher among employed individuals compared to non-employed individuals. Among employees below 40 years old, 16.41% individuals reported neck pain, compared to 29.69% who were above 40 ages. Similar results were observed across upper back, shoulders, lower back, elbow, wrist/hand, hips/thighs, knee and ankles/feet with mainly higher prevalence rates among employees aged above 40 compared to those aged below 40.

Table 1

Prevalence of musculoskeletal pain in various body regions among employees and age group.
	Employee		Age		Total
	No	Yes	< 40	> 40	Total
Neck	62 (16.15)	115 (29.95)	63 (16.41)	114 (29.69)	177 (46.09)
Upper back	85 (22.14)	115 (29.95)	77 (20.05)	123 (32.03)	200 (52.08)
Shoulders	81 (21.09)	85 (22.14)	72 (18.75)	94 (24.48)	166 (43.23)
Lower back	38 (9.90)	85 (22.14)	46 (11.98)	77 (20.05)	123 (32.03)
Elbow	22 (5.73)	38 (9.90)	13 (3.39)	47 (12.24)	60 (15.63)
Wrist/hand	37 (9.64)	45 (11.72)	25 (6.51)	57 (14.84)	82 (21.35)
Hips/thighs	34 (8.85)	56 (14.58)	25 (6.51)	65 (16.93)	90 (23.44)
Knees	62 (16.15)	72 (18.75)	55 (14.32)	79 (20.57)	134 (34.90)
Ankles/feet	30 (7.81)	56 (14.58)	38 (9.90)	48 (12.50)	86 (22.40)

Severity of Depression and Physical Activity Levels Among Participants

Majority of participants report either mild (39.27%) followed by moderate (24.08%) and minimal (22.25%) severity, and least moderately severe (14.92%) depression. As for physical activity, the highest number of participants were inactive (63.87%), followed by minimally active (27.23%) and the least being Vigorous active (9.42%) (Table 2).

Table 2

The depression severity and physical activity levels among the study population.
	Scale	Frequency (%)
Depression Severity	None-minimal	85 (22.25)
	Mild	150 (39.27)
	Moderate	92 (24.08)
	Moderately Severe	57 (14.92)
Physical activities	Inactive	244 (63.87)
	Minimally active	104 (27.23)
	Vigorous active	36 (9.42)

Correlation between MSDs, demographic characteristics, depression and physical activity

The results showed that neck, lower back, hips/thighs and ankles/feet pain had non-significant (P value > 0.05) association with employment status and age. Upper back and knees pain showed highly significant (P value < 0.01) association with employment status. Shoulders showed highly significant (P value < 0.01) association with both employment status and age (Table 3).

The Phi coefficient for upper back pain, wrist/hand and knees suggested a weak negative (φ = -0.148, -0.103, -0.162) association on employment. The Phi coefficients for shoulders against employment status (-0.239) and age (0.135) indicate moderate associations, suggesting that both factors may play a more substantial role in shoulder pain prevalence. Phi coefficients of neck, lower back, hips/thighs and ankles/feet showed negligible association with the study participants employment and age.

Upper back pain, shoulders, wrist/hand and hips/thighs were observed highly significant (p value < 0.01) associated with depression, whereas elbow and ankles/feet were significant (p value < 0.05) associated with depression (Table 4). Other, the upper back, shoulders, and elbow had been significantly (P value < 0.05) associated with physical activities.

The Cramer's V coefficients indicated moderate associations of upper back, shoulder and wrist/hand pain with depression. On the other hand, upper back, shoulder and elbow pain had been observed with weak association with physical activities with the Cramer’s V φ_c 0.129, 0.143 and 0.140 value.

Table 3

Correlation between musculoskeletal disorders (MSDs) with employment status and age.
MSDs	Employment			Age
MSDs	Pearson X²	P value	Phi (φ)	Pearson X²	P value	Phi (φ)
Neck	0.060	0.806	0.013	0.017	0.897	-0.007
Upper back	8.467	0.004	-0.148	1.190	0.275	0.056
Shoulders	21.927	0.000	-0.239	7.023	0.008	0.135
Lower back	1.804	0.179	0.069	0.168	0.682	0.021
Elbow	0.030	0.862	-0.009	6.290	0.012	-0.128
Wrist/hand	4.053	0.044	-0.103	1.345	0.246	-0.059
Hips/thighs	0.226	0.634	-0.024	3.400	0.065	-0.094
Knees	10.061	0.002	-0.162	2.332	0.127	0.078
Ankles/feet	0.030	0.862	0.009	3.275	0.070	0.092

Table 4

Correlation between musculoskeletal disorders (MSDS), depression, and physical activity levels.
MSDS	Depression			Physical Activities
MSDS	Pearson X²	P value	Cramer’s V (φ_c)	Pearson X²	P value	Cramer’s V (φ_c)
Neck	0.512	0.916	0.037	5.744	0.057	0.122
Upperback	15.367	0.002	0.200	6.436	0.040	0.129
Shoulders	19.521	0.000	0.225	7.834	0.02	0.143
Lowerback	3.662	0.300	0.098	2.477	0.290	0.080
Elbow	10.520	0.015	0.166	7.495	0.024	0.140
Wrist/hand	26.653	0.000	0.263	4.784	0.091	0.112
Hips/thighs	11.720	0.008	0.175	0.402	0.818	0.032
Knees	5.405	0.144	0.119	0.027	0.986	0.008
Ankles/feet	9.316	0.025	0.156	1.037	0.595	0.052

Relationship between MSDs, depression and physical activity

For model fit indices, across the MSDS categories, Nagelkerke's R-squared values range from 0.002 to 0.540, suggesting a moderate amount of variability in predicting MSDS based on depression and physical activity levels. The overall predicted correct percentage range from 53.1–84.4%, where higher percentages suggest better model performance in predicting MSDS outcomes (Table 5).

The regression model further indicates that upper back, shoulders, wrist/hand, hips/thighs and knees pain having significant (P value < 0.05) association with corresponding odd ratios suggesting potential moderate effect. Physical activity does not show significant association with any part except for elbow, however, its odds ratio close to 1, (0.606) suggest weak effect on MSDS.

Table 5

Logistic regression models examining the relationships between musculoskeletal disorders (MSDS), depression, and physical activity levels.
MSDS	Model fit	Nagelkerke R square	Overall predicted correct %	Depression		Physical Activity
MSDS	Model fit	Nagelkerke R square	Overall predicted correct %	P value	Odd ratio	P value	Odd ratio
Neck	0.213	0.010	53.1	0.760	0.968	0.097	1.296
Upperback	0.002	0.042	58.3	0.001	1.439	0.308	1.175
Shoulders	0.002	0.042	60.9	0.001	1.451	0.615	1.083
Lowerback	0.349	0.008	68.0	0.181	1.161	0.628	0.922
Elbow	0.103	0.020	84.4	0.811	0.966	0.045	0.606
Wrist/hand	0.000	0.090	78.6	0.000	1.720	0.051	0.654
Hips/thighs	0.086	0.019	76.6	0.033	1.300	0.640	0.916
Knees	0.074	0.019	65.1	0.023	1.285	0.820	1.038
Ankles/feet	0.540	0.005	77.6	0.658	0.946	0.306	0.820

Musculoskeletal disorders (MSDs) are a significant public health concern worldwide, affecting millions of individuals and imposing substantial economic burdens on society [6]. The present study demonstrated MSDs among different demographic groups, such as employees and ages. Across age groups, the prevalence of musculoskeletal pain tends to be higher among employees aged above 40, suggesting that aging may be a significant risk factor for MSDs in Pakistan [15, 16].

The significant associations observed for upper back and shoulder pain with employment status and age suggest that these factors may mainly contribute to the prevalence of MSDs in these regions [17]. The present study finds negligible associations for neck pain and some other body regions indicate that factors other than employment status and age may be more influential in determining pain prevalence such as quality of life [18], low socio economic status [19], poor posture and diet [20]. These results were supported by study conducted by Saat et al. [21]. Employers regard to their age may need to tailor their health and safety policies to address their specific needs, like ergonomic accommodations for older workers or implementing age-appropriate practice setting and specialty area [22]. More, education on proper lifting techniques [23], and the promotion of physical activity and stress reduction strategies can help mitigate the risk of MSDs among individuals of all ages [24].

The high prevalence of depression symptoms of the study population underscores the importance of addressing mental health concerns within the population. Depression is a significant public health issue associated with adverse outcomes, including elevated risk of chronic diseases [25], increased healthcare utilization and impaired quality of life [26].

The high prevalence of inactivity emphasizes the need for targeted interventions to promote physical activity and reduce sedentary behavior within the study population. Strategies include policies supporting active transportation, workplace wellness programs, community-wide initiatives, and recreational opportunities. Encouraging individuals to engage in adopt active lifestyles and regular physical activities can have profound benefits for both mental and physical health outcomes, particularly in older aged population [27]. Past studies have shown bidirectional relationship between depression and physical activity [28]. In the present study the significant associations observed between depression with upper back pain and shoulder pain suggest a potential link between mental health and specific musculoskeletal conditions. Depression contribute to the development of musculoskeletal disorders or exacerbate pain perception through shared behavioral factors or neurobiological pathways [3, 29]. The significant associations between physical activities and upper back pain, shoulder pain, elbow pain, wrist/hand pain, and ankle/feet pain suggest that engagement in physical activities may play a role in the prevention or management of certain musculoskeletal disorders. Regular exercise can improve muscular strength, flexibility, and posture, thereby reducing the risk of musculoskeletal pain and improving overall musculoskeletal health [30, 31].

While some MSDS categories show significant associations with depression or physical activity, others do not, suggesting that the etiology of musculoskeletal pain may be multifactorial and context-dependent [32]. The cross-sectional nature of the data limits the ability to establish causality or infer temporal relationships between MSDS, depression and physical activity. Longitudinal studies could provide valuable insights into the causal pathways underlying these associations. The study's sample characteristics and settings may limit the generalizability of the findings. Replication studies in diverse populations and settings are needed to validate the observed associations and generalize the findings to broader contexts. So, wholly, depression contribute to decrease motivation and energy levels, leading to physical inactivity, regular exercise has result in better outcome in positive effects on mood, mental well-being and overall quality of life. Screening and public health interventions for depression and physical activity promotion can have broader implications for reducing the burden of musculoskeletal disorders in Pakistani and alike population.

The study propose valuable insights into the associations between depression, physical activity levels, and musculoskeletal disorders. While the associations vary across different MSDS categories, the findings underscore the importance of considering mental health and physical activity in the prevention and management of musculoskeletal pain. Understanding the associations between MSDs, employment status, and age is crucial for developing targeted interventions and workplace health promotion strategies to mitigate the risk of musculoskeletal disorders. Thus, integrating comprehensive approaches that address modifiable risk factors and promote holistic well-being may hold promise for improving musculoskeletal health outcomes at both individual and population levels.

Authors Declaration

All authors reviewed and authorized the final manuscript and agreed to publish it

Competing interests

The authors declared no competing interests.

Availability of data and materials

The manuscript includes all the necessary data; related data may be provided on request from the corresponding author.

Funding

There is no funding received to conduct the study

Authors' Contributions

You may edit it accordingly

Data collection and descriptive statistic were prepared by MT, ZW and KBK. RUS and NUK aid in conceptual framework and critical review the final manuscript.

Acknowledgments

We gratefully acknowledge the Women Institute of Rehabilitation Sciences, Abbottabad, for providing us with the invaluable opportunity to conduct this research.

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No competing interests reported.

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Version 1

posted

You are reading this latest preprint version

Relationship between musculoskeletal body region pain complaints, depression and physical activity level in major hospitals of Abbottabad, Pakistan

Status:

Version 1

Abstract

Introduction/Aim

Methodology

Results

Conclusion

Introduction

Methodology

Statistical Analysis

Results

Prevalence of Musculoskeletal Pain Among Employed Individuals: Age-Stratified Analysis

Severity of Depression and Physical Activity Levels Among Participants

Correlation between MSDs, demographic characteristics, depression and physical activity

Relationship between MSDs, depression and physical activity

Discussion

Conclusion

Declarations

References

Additional Declarations

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Version 1