Iran Occupational Health

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Background  and Aims: Musculoskeletal risk factors are multi factorial with physical and psychosocial factors. Physical and Psychosocial risk factors include repetitive tasks, awkward postures, the use of force and job satisfaction, workplace stress, respectively. Work-related musculoskeletal disorders (WMSDs) refer to those in which muscles, blood vessels and nerves around such joints as the neck, shoulder, elbow, wrists, fingers, lower back and leg are involved. WMSDs can reduce working time, lower productivity and increase the health costs of industrial labor in both industrially developed and developing countries. The risk of MSDs increases when a body part is repeatedly used without any time for rest. These disorders are the main cause of disabilities and loss of productivity in the developed countries and are common among workers. Proper workstation design is essential especially in the industries that require manual operation by the operator. Neglecting ergonomic factors in the designation of the workstation causes damage to the musculoskeletal system of the individual workers.
In the assembly lines, most of the tasks involve repetitive and precise activities, so assembly workers in these occupations suffer from the resulting physical as well as psychological stresses, which ultimately lead to musculoskeletal disorders. Work-related musculoskeletal disorders among the assembly workers of an electronic component manufacturing industry showed that more than half of the participants reported pain in their shoulder, wrists and lower back. On other hand, in assembly workers, the risk of these disorders increases because the part of the body is used successively and without rest.
Although, hand pinch strength threshold is the best way to identify people at risk of limitation of motion, it is not yet fully known. Pinch strength assesses the function of hand. Measurement of pinch strength provides valuable information about the function and status of the upper limb and the neuromuscular system. Pinch strength can also be used as a measure of the amount of muscular damage or neurological impaired caused by trauma or surgery. In addition, pinch strength is a good indication of a person's overall physical condition. Assessment of pinch strength, compared to other tests, is simple, easy and of high reproducibility Pinch strength occurs when gripping with any of the fingers or a combination thereof, in concordance with the movement of the thumb whit no palm contact.
Kinesio tape is a thin porous cloth with acrylic gluey. This adhesive tape can be stretched up to 140% of its normal length, allowing the joint and muscle to move in their full range without limiting the movement of the joint and the muscle. The mechanism of Kinesio tape therapeutic effect on pain relief is still unclear. In 1998, Kase and his colleagues found that the localized blood flow increases below the area that was taped. Kinesio tape are used in muscle treatment in two ways: 1. For muscles that are elongated, or the muscles in acute phase or those that are involved in overwork activities, the brigade is pushed from the muscular end to the muscle's origin, with the aim of inhibiting muscle function.2 - For muscles that are in the chronic phase or weak muscles, the type is pulled from the muscle origin to the muscle end, which facilitates muscle function.
The current study investigates the simultaneous effect of Kinesio Taping and exercise on maximal key pinch force in Electronically Company.
 
 Methods: This research is a clinical trial study of women workers in the assembly unit of an electrical equipment manufacturing industry.
In one session the purpose and a complete overview of the study was fully explained to the 100 female workers employed in the assembly line of the manufacturing company. Selection criteria in this study were the lack of any 1) hand surgery in recent years, 2) osteoporosis, 3) hand fracture or disorder in a hand part and 4) malignant diseases or any known diseases that may affect the variables under study that were determined by the questionnaire and the interviews. Exclusion criteria also were 1) unwillingness to cooperate, 2) irregular participating in doing exercises 3) not completing the research tests and 4) having allergy to kinesio tape adhesives.
Out of the one hundred workers invited, 66 accepted to participate in the study.Six workers were also excluded from these 66 participants due to lacking eligibility criteria for entering the program. In addition, during the study, seven workers in the control group showed unwillingness to cooperate, four workers from the exercise group were absent in more than 50% of the exercise sessions and nine workers in the taping and exercise group had adhesive allergy or showed non-willingness to cooperate. Therefore, 40 workers (11 in the taping & exercise intervention group, 16 in the exercise intervention group and 13 in the control group) were the research participants.
 
The DASH (Disability of the Arm, Shoulder and Hand) questionnaire was used to measure the functional impairment of the upper extremity of the workers. The DASH self-assessment questionnaire contains 30 questions measuring performance and physical symptoms. This questionnaire was designed to describe the upper limb disabilities and disorders experienced by individuals as well as to monitor changes in the symptoms and functions over time. Each question has five alternatives to select: from "no difficulty" to "unable to perform activity" that are ranked in a scale of one to five points. Finally, the questionnaire score is calculated using the existing formulas. In 2008, Moussavi et al. translated the questionnaire into Persian and confirmed its validity and reliability.
To measure pinch strength of hand, the American Society of Hand Therapists (ASHT) protocol was used. According to its instruction, the participants sit on a chair in such a way that their arms are held tightly to their body without any rotation, and the wrists are in the position of 0-30 degrees of extension and 0-15 degrees of deflection to the ulnar. In this study, the pinch strength was measured three times for both hands, and the average of the three times of maximum effort of the individual to the dynamometer handle was recorded as the hand pinch strength per kg force. Reliability and validity of the Jamar dynamometer for measuring grip strength have been documented and it is described as a standard for measuring the hand strength.
The intervention was performed for eight consecutive weeks, twice a week. All sessions were supervised by the physiotherapist and were during work hours at the workplace. At the beginning of each session and after preparing for exercises, the participants performed four trained stretching and strengthening exercises with a 30-second rest between repetitions. The first exercise was the bending of the wrist. In the second exercise, while the palm was placed on the table, the other hand was put on it and the participant tried to raise his fingers from the table. In the third exercise, while the elbow was straight, the participant held the first hand fingers with the other hand and held the wrist once up and once down. In the last exercise, while the wrist was straight, the fingers were bent from the second clause and kept in the same mode. At the end of the exercises, and after putting the kinesio tape on the hands of the first intervention group, the participants returned to their workplace to continue working. It should be noted that when exercising, the participants should not use kinesio tape.
Data were analyzed by SPSS 20, paired T test and Pearson correlation coefficient and the P value was considered smaller than 0.05.
Results: The present study was conducted on 40 female assemblers working in the electrical industry. The mean and standard deviation of the quantitative data are observable in Table 1.
Table1. Mean and standard deviation of quantitative data in the subjects

Minimum data	Maximum  data	Mean± SD	Variable
23	50	33.67±6.8	Age (years)
48	88	65.05±8.64	Weight (kg)
147	178	162.37±6.72	Height (cm)
1	18	4.03±3.77	Experience (years)
50.15	85.32	24.74±3.40	BMI (kg / m2)
2.75	9.25	6.36±0.35	Right hand pinch strength
2.50	10.25	6.22±0.35	Left hand pinch strength

 
 
Descriptive statistics of the qualitative variables of the subjects are also presented in Table 2.
Table2. Descriptive statistics of qualitative variables of the subjects

Qualitative variables		Frequency (%)
marital status	Single	22.5
	Married	77.5
sports program	YES	20
	NO	80
The dominant hand	Right	82.5
	Left	17.5
History of hand pain	Right	35
	Left	30
	NO	35
Upper extremity disability score	without problem	7.5
	Mild problem	55
	Moderate problem	22.5
	Severe problem	12.5
	Powerless	2.5

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Paired t-test showed that there was a significant difference between mean left and right hand stability time and upper extremity disability after and before kineso typing and exercise and exercise alone; had a positive. On the other hand, kinesio therapy and exercise have reduced upper extremity disability. It should be noted that these are not observed in the control group.
Table3. The mean of left and right hand stability time and upper extremity disability score after and before intervention in the three study groups.

Variable	Number of people in each group	Groups		Mean± SD	P -value
Use of kineso typing and exercise	11	Right hand pinch strength time (s)	Before intervention	5.91±0.42	0.002
			After the intervention	7.37±0.35
		Left Hand pinch strength Time (s)	Before intervention	5.7±0.33	0.011
			After the intervention	6.72±0.36
		Upper extremity disability score (%)	Before intervention	38.71±27.19	≤0.001
			After the intervention	25.07±19.49
Use of exercise	16	Right hand pinch strength time (s)	Before intervention	6.53±0.33	≤0.001
			After the intervention	7.43±0.32
		Left Hand pinch strength Time (s)	Before intervention	6.43±0.43	0.011
			After the intervention	7.53±0.41
		Upper extremity disability score (%)	Before intervention	20.36±18.83	≤0.001
			After the intervention	10.96±11.73
control group	13	Right hand pinch strength time (s)	Before intervention	6.65±0.3	0.414
			After the intervention	6.78±0.34
		Left Hand pinch strength Time (s)	Before intervention	6.53±0.31	0.616
			After the intervention	6.44±0.3
		Upper extremity disability score (%)	Before intervention	12.14±14.50
					0.987	0.097
			After the intervention	13.63±16.16

 
In this study, as can be seen in Table 4, Pearson's correlation coefficient showed that among demographic variables, only age had a positive significant relationship with upper extremity disability score, and no significant relationship was found between other variables.
Table4. The relationship between demographic variables with right hand, left hand stability and upper extremity disability score

Variable		Upper extremity disability score	Left hand pinch	strength of right hand pinch
Age	r	0.546	-0.249	-0.421
	P- value	≤0.001	0.121	0.007
Weight	r	0.103	0.245	0.182
	P- value	0.528	0.128	0.261
Height	r	0.235	-0.016	0.148
	P- value	0.144	0.924	0.362
work experience	r	-0.1.9	0.042	-0.05
	P -value	0.503	0.795	0.757
BMI	r	0.234	0.230	0.074
	P- value	0.146	0.154	0.651

 
Conclusion:
 According to the results, it seems that doing at least 2 or 3 sessions per week during working hours and also using of Kinsio taping, lead to the increase in Key pinch force and decrease in the upper limb disability. Therefore, it is recommended that the exercise program be included in the personnel work program to improve performance. It is also recommended that further studies be conducted to investigate the use of kinesio types in different organs and their effects on improving the pain and performance of workers and employees as well as men.

Keywords: Kinesio Tape, Sport exercise, Key pinch, Assembly worker, DASH

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