Association between chronic neck pain, disability, and Physical Activity among Healthcare Workers: A Cross-Sectional Study
DOI:
https://doi.org/10.62464/ijoprp.v4i8.126Keywords:
chronic neck pain, healthcare workers, Neck Disability Index (NDI), physical activity, occupational healthAbstract
BACKGROUND: Chronic neck pain is a prevalent musculoskeletal condition among healthcare workers, often contributing to absenteeism, reduced productivity, and career dissatisfaction. Despite their vulnerability due to high occupational demands, the relationship between neck pain, disability, and lifestyle factors such as physical activity remains insufficiently explored in this group. OBJECTIVE: This study aimed to investigate the association between chronic neck pain, disability, and physical activity levels among healthcare workers. METHODS: A cross-sectional survey was conducted among healthcare workers at Prince Sultan Military Medical City. Participants completed a structured questionnaire that included demographic and health data, the Numerical Pain Rating Scale (NPRS) for pain intensity, the Neck Disability Index (NDI) for disability, the extended Nordic Musculoskeletal Questionnaire, and the International Physical Activity Questionnaire (IPAQ). Descriptive statistics and Pearson correlation analyses were performed. RESULTS: Thirty healthcare workers (83% female) from multiple professions participated. The mean chronic neck pain score was 5.10 (SD = 1.81), and the mean NDI score was 20.25 (SD = 9.73). A high physical activity level was reported by 70% of participants. Significant correlations were observed: a moderate positive correlation between neck pain and disability (r = 0.64, p < 0.01) and a fair positive correlation between neck pain and physical activity (r = 0.45, p < 0.05). CONCLUSIONS: Chronic neck pain appears prevalent among healthcare workers and is moderately associated with disability. Interestingly, higher pain levels were also correlated with higher physical activity, warranting further investigation. Given the small sample size, findings should be interpreted cautiously. Larger, longitudinal studies are recommended to understand risk factors better and to guide preventive and occupational health strategies.
References
Al-Hazzaa, H. M. (2007). Health-enhancing physical activity among Saudi adults using the International Physical Activity Questionnaire (IPAQ). Public Health Nutrition, 10(1), 59–64. https://doi.org/10.1017/S1368980007184299 DOI: https://doi.org/10.1017/S1368980007184299
Al-Juhani, M. A.-M., Khandekar, R., Al-Harby, M., Al-Hassan, A., & Edward, D. (2015). Neck and upper back pain among eye care professionals. Occupational Medicine, 65(9), 753–757. https://doi.org/10.1093/occmed/kqv132 DOI: https://doi.org/10.1093/occmed/kqv132
Aljinović, J., Barun, B., Benzon, B., Marinović, I., Aljinović, A., & Poljičanin, A. (2023). Neck Disability Index detects higher neck-related disability levels among physiotherapists and family medicine specialists than among dentists. Healthcare (Basel), 11(4), 581. https://doi.org/10.3390/healthcare11040581 DOI: https://doi.org/10.3390/healthcare11040581
Almogbil, I. H., Alrashidi, L. R., Alhajlah, R. S., Alqasim, A. K., Alharbi, N. S., Alghamdi, M. A., … et al. (2023). Prevalence of shoulder and neck pain among healthcare workers in the Central Region of Saudi Arabia. Cureus, 15(7), e42286. https://doi.org/10.7759/cureus.42286 DOI: https://doi.org/10.7759/cureus.42286
Alqhtani, R. S., Ahmed, H., Alshahrani, A., Khan, A. R., & Khan, A. (2023). Effects of whole-body stretching exercise during lunch break for reducing musculoskeletal pain and physical exertion among healthcare professionals. Medicina (Kaunas), 59(5), 910. https://doi.org/10.3390/medicina59050910 DOI: https://doi.org/10.3390/medicina59050910
Alzahrani, H., Mackey, M., Stamatakis, E., Zadro, J. R., & Shirley, D. (2019). The association between physical activity and low back pain: A systematic review and meta-analysis of observational studies. Scientific Reports, 9(1), 8244. https://doi.org/10.1038/s41598-019-44664-8 DOI: https://doi.org/10.1038/s41598-019-44664-8
Alzayani, M. K., Salama, K. F., & Zafar, M. (2021). Work-related musculoskeletal disorders among dental staff in Armed Force Hospital in Dhahran, Saudi Arabia. International Journal of Preventive Medicine, 12, 119. https://doi.org/10.4103/ijpvm.IJPVM_136_20 DOI: https://doi.org/10.4103/ijpvm.IJPVM_136_20
Anderson, B., Lyon-Callo, S., Fussman, C., Imes, G., & Rafferty, A. P. (2011). Fast-food consumption and obesity among Michigan adults. Preventing Chronic Disease, 8(4), A71. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136980/
Bakker, E. W. P., Verhagen, A. P., van Trijffel, E., Lucas, C., & Koes, B. W. (2009). Spinal mechanical load as a risk factor for low back pain: A systematic review of prospective cohort studies. Spine, 34(8), E281–E293. https://doi.org/10.1097/BRS.0b013e318195b257 DOI: https://doi.org/10.1097/BRS.0b013e318195b257
Brug, J., van der Ploeg, H. P., Loyen, A., Ahrens, W., Allais, O., Andersen, L. F., … et al. (2017). Determinants of diet and physical activity (DEDIPAC): A summary of findings. International Journal of Behavioral Nutrition and Physical Activity, 14(1), 150. https://doi.org/10.1186/s12966-017-0609-5 DOI: https://doi.org/10.1186/s12966-017-0609-5
Bull, F. C., Al-Ansari, S. S., Biddle, S., Borodulin, K., Buman, M. P., Cardon, G., … et al. (2020). World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine, 54(24), 1451–1462. https://doi.org/10.1136/bjsports-2020-102955 DOI: https://doi.org/10.1136/bjsports-2020-102955
Chiu, T. T., Lam, T. H., & Hedley, A. J. (2005). Correlation among physical impairments, pain, disability, and patient satisfaction in patients with chronic neck pain. Archives of Physical Medicine and Rehabilitation, 86(3), 534–540. https://doi.org/10.1016/j.apmr.2004.02.030 DOI: https://doi.org/10.1016/j.apmr.2004.02.030
Cohen, S. P., & Hooten, W. M. (2017). Advances in the diagnosis and management of neck pain. BMJ, 358, j3221. https://doi.org/10.1136/bmj.j3221 DOI: https://doi.org/10.1136/bmj.j3221
Côté, P., Wong, J. J., Sutton, D., Shearer, H. M., Mior, S., Randhawa, K., … et al. (2016). Management of neck pain and associated disorders: A clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. European Spine Journal, 25(7), 2000–2022. https://doi.org/10.1007/s00586-016-4467-7 DOI: https://doi.org/10.1007/s00586-016-4467-7
Dawson, A. P., Steele, E. J., Hodges, P. W., & Stewart, S. (2009). Development and test-retest reliability of an extended version of the Nordic Musculoskeletal Questionnaire (NMQ-E): A screening instrument for musculoskeletal pain. Journal of Pain, 10(5), 517–526. https://doi.org/10.1016/j.jpain.2008.11.008 DOI: https://doi.org/10.1016/j.jpain.2008.11.008
Dong, H., Zhang, Q., Liu, G., & Shao, T. (2020). Prevalence of neck/shoulder pain among public hospital workers in China and its associated factors: A cross-sectional study. Scientific Reports, 10(1), 12311. https://doi.org/10.1038/s41598-020-69382-4 DOI: https://doi.org/10.1038/s41598-020-69382-4
El Far, H. E., Albitar, E. A. E. F., Araby, E. M., Nabil, N., & Hassan, O. M. (2020). Patterns of work-related musculoskeletal disorders among health care workers. Egyptian Journal of Hospital Medicine, 81(7), 2325–2334. https://doi.org/10.21608/ejhm.2020.131251 DOI: https://doi.org/10.21608/ejhm.2020.131251
Gupta, N., Christiansen, C. S., Hanisch, C., Bay, H., Burr, H., & Holtermann, A. (2017). Is questionnaire-based sitting time inaccurate and can it be improved? A cross-sectional investigation using accelerometer-based sitting time. BMJ Open, 7(1), e013251. https://doi.org/10.1136/bmjopen-2016-013251 DOI: https://doi.org/10.1136/bmjopen-2016-013251
Halkai, K. R., Halkai, R. S., Sulgante, S., Sanadi, R. M., Ara, S. A., Zainab, H., … et al. (2022). Work-related musculoskeletal disorders among dentists and their prevention through ergonomic interventions—a systematic review. International Journal of Occupational Safety and Health, 12(2), 125–139. https://doi.org/10.3126/ijosh.v12i2.39195 DOI: https://doi.org/10.3126/ijosh.v12i2.39195
Hallman, D. M., Birk Jørgensen, M., & Holtermann, A. (2017). Objectively measured physical activity and 12-month trajectories of neck-shoulder pain in workers: A prospective study in DPHACTO. Scandinavian Journal of Public Health, 45(3), 288–298. https://doi.org/10.1177/1403494816688376 DOI: https://doi.org/10.1177/1403494816688376
Jacquier-Bret, J., & Gorce, P. (2023). Prevalence of body area work-related musculoskeletal disorders among healthcare professionals: A systematic review. International Journal of Environmental Research and Public Health, 20(1), 841. https://doi.org/10.3390/ijerph20010841 DOI: https://doi.org/10.3390/ijerph20010841
Johns, G. (2010). Presenteeism in the workplace: A review and research agenda. Journal of Organizational Behavior, 31(4), 519–542. https://doi.org/10.1002/job.630 DOI: https://doi.org/10.1002/job.630
Jun, D., Zoe, M., Johnston, V., & O’Leary, S. (2017). Physical risk factors for developing non-specific neck pain in office workers: A systematic review and meta-analysis. International Archives of Occupational and Environmental Health, 90(5), 373–410. https://doi.org/10.1007/s00420-017-1205-3 DOI: https://doi.org/10.1007/s00420-017-1205-3
Jull, G., Falla, D., Treleaven, J., & O’Leary, S. (2019). Management of neck pain disorders: A research-informed approach (1st ed.). Elsevier Health Sciences.
Kim, R., Wiest, C., Clark, K., Cook, C., & Horn, M. (2018). Identifying risk factors for first-episode neck pain: A systematic review. Musculoskeletal Science and Practice, 33, 77–83. https://doi.org/10.1016/j.msksp.2017.11.007 DOI: https://doi.org/10.1016/j.msksp.2017.11.007
Kjaer, P., Kongsted, A., Hartvigsen, J., Isenberg-Jørgensen, A., Schiøttz-Christensen, B., Søborg, B., … et al. (2017). National clinical guidelines for non-surgical treatment of patients with recent onset neck pain or cervical radiculopathy. European Spine Journal, 26(9), 2242–2257. https://doi.org/10.1007/s00586-017-5121-8 DOI: https://doi.org/10.1007/s00586-017-5121-8
Lagersted-Olsen, J., Korshøj, M., Skotte, J., Carneiro, I., Søgaard, K., & Holtermann, A. (2014). Comparison of objectively measured and self-reported time spent sitting. International Journal of Sports Medicine, 35(6), 534–540. https://doi.org/10.1055/s-0033-1358467 DOI: https://doi.org/10.1055/s-0033-1358467
Lin I, Wiles L, Waller R, Caneiro JP, Nagree Y, Straker L, et al. Patient-centred care: the cornerstone for high-value musculoskeletal pain management. Br J Sports Med. 2020; 54(21): 1240-2. http://doi.org/10.1136/bjsports-2019-101918?utm_source=chatgpt.com DOI: https://doi.org/10.1136/bjsports-2019-101918
Lindegård, A., Larsman, P., Hadzibajramovic, E., & Ahlborg, G. (2014). The influence of perceived stress and musculoskeletal pain on work performance and work ability in Swedish health care workers. International Archives of Occupational and Environmental Health, 87(4), 373–379. https://doi.org/10.1007/s00420-013-0875-8 DOI: https://doi.org/10.1007/s00420-013-0875-8
Liu, W., Tian, W., Wu, T., Luo, B., Yi, J., Li, W., … et al. (2014). Work-related injuries of rehabilitation therapists and measures for prevention. Frontiers in Public Health, 12, 1398948. https://doi.org/10.3389/fpubh.2024.1398948 DOI: https://doi.org/10.3389/fpubh.2024.1398948
Long, M. H., Bogossian, F. E., & Johnston, V. (2013). The prevalence of work-related neck, shoulder, and upper back musculoskeletal disorders among midwives, nurses, and physicians: A systematic review. Workplace Health & Safety, 61(5), 223–229. https://doi.org/10.1177/216507991306100506 DOI: https://doi.org/10.3928/21650799-20130426-38
Marchiori, D. M., & Henderson, C. N. (1996). A cross-sectional study correlating cervical radiographic degenerative findings to pain and disability. Spine, 21(23), 2747–2751. https://doi.org/10.1097/00007632-199612010-00007 DOI: https://doi.org/10.1097/00007632-199612010-00007
Milhem, M., Kalichman, L., Ezra, D., & Alperovitch-Najenson, D. (2016). Work-related musculoskeletal disorders among physical therapists: A comprehensive narrative review. International Journal of Occupational Medicine and Environmental Health, 29(5), 735–747. https://doi.org/10.13075/ijomeh.1896.00620 DOI: https://doi.org/10.13075/ijomeh.1896.00620
Mirmohammadi, S., Yazdani, J., Etemadinejad, S., & Asgarinejad, H. (2005). A cross-sectional study on work-related musculoskeletal disorders and associated risk factors among hospital health cares. Procedia Manufacturing, 3, 4528–4534. https://doi.org/10.1016/j.promfg.2015.07.468 DOI: https://doi.org/10.1016/j.promfg.2015.07.468
Moustou, I., Panagopoulou, E., Montgomery, A. J., & Benos, A. (2010). Burnout predicts health behaviors in ambulance workers. Open Occupational Health & Safety Journal, 2(1), 16–18. https://doi.org/10.2174/1876216601002010016 DOI: https://doi.org/10.1177/1757975911404770
Muaidi, Q. I., & Shanb, A. A. (2016). Prevalence causes and impact of work-related musculoskeletal disorders among physical therapists. Journal of Back and Musculoskeletal Rehabilitation, 29(4), 763–769. https://doi.org/10.3233/BMR-160687 DOI: https://doi.org/10.3233/BMR-160687
Oude Hengel, K. M., Visser, B., & Sluiter, J. K. (2011). The prevalence and incidence of musculoskeletal symptoms among hospital physicians: A systematic review. International Archives of Occupational and Environmental Health, 84(2), 115–119. https://doi.org/10.1007/s00420-010-0565-8 DOI: https://doi.org/10.1007/s00420-010-0565-8
Øiestad, B. E., Hilde, G., Tveter, A. T., Peat, G. G., Thomas, M. J., Dunn, K. M., & Grotle, M. (2020). Risk factors for episodes of back pain in emerging adults: A systematic review. European Journal of Pain, 24(1), 19–38. https://doi.org/10.1002/ejp.1474 DOI: https://doi.org/10.1002/ejp.1474
Pappa, E., Kontodimopoulos, N., & Niakas, D. (2005). Validating and norming of the Greek SF-36 Health Survey. Quality of Life Research, 14(5), 1433–1438. https://doi.org/10.1007/s11136-004-6014-y DOI: https://doi.org/10.1007/s11136-004-6014-y
Paksaichol, A., Janwantanakul, P., Purepong, N., Pensri, P., & van der Beek, A. J. (2012). Office workers' risk factors for the development of non-specific neck pain: A systematic review of prospective cohort studies. Occupational and Environmental Medicine, 69(9), 610–618. https://doi.org/10.1136/oemed-2011-100459 DOI: https://doi.org/10.1136/oemed-2011-100459
Pedersen, S. J., Kitic, C. M., Bird, M.-L., & Mainsbridge, C. P., Cooley, P. D. (2016). Is self-reporting workplace activity worthwhile? Validity and reliability of occupational sitting and physical activity questionnaire in desk-based workers. BMC Public Health, 16(1), 836. https://doi.org/10.1186/s12889-016-3537-4 DOI: https://doi.org/10.1186/s12889-016-3537-4
Perruchoud, C., Buchser, E., Johanek, L. M., Aminian, K., Paraschiv‐Ionescu, A., & Taylor, R. S. (2014). Assessment of physical activity of patients with chronic pain. Neuromodulation, 17(1), 42–47. https://doi.org/10.1111/ner.12036 DOI: https://doi.org/10.1111/ner.12036
Peterson, G., & Pihlström, N. (2021). Factors associated with neck and shoulder pain: A cross-sectional study among 16,000 adults in five county councils in Sweden. BMC Musculoskeletal Disorders, 22(1), 872. https://doi.org/10.1186/s12891-021-04753-0 DOI: https://doi.org/10.1186/s12891-021-04753-0
Portney, L., & Watkins, M. (2015). Foundations of clinical research: Applications to practice (3rd ed.). FA Davis Company.
Razali, N. M., & Wah, Y. B. (2011). Power comparisons of Shapiro-Wilk, Kolmogorov-Smirnov, Lilliefors and Anderson-Darling tests. Journal of Statistical Modeling and Analytics, 2(1), 21–33.
Rossi, C., Giustino, V., Patti, A., Figlioli, F., Amato, A., Vicari, D. S. S., Bianco, A. (2025). The role of physical activity in workplace well-being: Impacts on stress, productivity, and health: A narrative review. Sport Sciences for Health, 21, 1–15. DOI: https://doi.org/10.1007/s11332-025-01460-4
Sakzewski, L., & Naser-ud-Din, S. (2015). Work-related musculoskeletal disorders in Australian dentists and orthodontists: Risk assessment and prevention. Work, 52(3), 559–579. https://doi.org/10.3233/WOR-152122 DOI: https://doi.org/10.3233/WOR-152122
Saridi, M., Filippopoulou, T., Tzitzikos, G., Sarafis, P., Souliotis, K., & Karakatsani, D. (2019). Correlating physical activity and quality of life of healthcare workers. BMC Research Notes, 12(1), 208. https://doi.org/10.1186/s13104-019-4240-1 DOI: https://doi.org/10.1186/s13104-019-4240-1
Shaheen, A. A. M., Omar, M. T. A., & Vernon, H. (2013). Cross-cultural adaptation, reliability, and validity of the Arabic version of the Neck Disability Index in patients with neck pain. Spine, 38(10), E609–E615. https://doi.org/10.1097/BRS.0b013e31828b2d09 DOI: https://doi.org/10.1097/BRS.0b013e31828b2d09
Shiri, R., & Falah-Hassani, K. (2017). Does leisure time physical activity protect against low back pain? Systematic review and meta-analysis of 36 prospective cohort studies. British Journal of Sports Medicine, 51(19), 1410–1418. https://doi.org/10.1136/bjsports-2016-097352 DOI: https://doi.org/10.1136/bjsports-2016-097352
Sitthipornvorakul, E., Janwantanakul, P., Purepong, N., Pensri, P., & van der Beek, A. J. (2011). The association between physical activity and neck and low back pain: A systematic review. European Spine Journal, 20(5), 677–689. https://doi.org/10.1007/s00586-010-1630-4 DOI: https://doi.org/10.1007/s00586-010-1630-4
Stein, A. D., Shakour, S. K., & Zuidema, R. A. (2000). Financial incentives, participation in employer-sponsored health promotion, and changes in employee health and productivity: HealthPlus Health Quotient Program. Journal of Occupational and Environmental Medicine, 42(12), 1148–1155. https://doi.org/10.1097/00043764-200012000-00005 DOI: https://doi.org/10.1097/00043764-200012000-00005
Suganthirababu, P., Parveen, A., Mohan Krishna, P., Sivaram, B., Kumaresan, A., Srinivasan, V., … et al. (2023). Prevalence of work-related musculoskeletal disorders among health care professionals: A systematic review. Work, 74(2), 455–467. https://doi.org/10.3233/WOR-211041 DOI: https://doi.org/10.3233/WOR-211041
Tinubu, B. M., Mbada, C. E., Oyeyemi, A. L., & Fabunmi, A. A. (2010). Work-related musculoskeletal disorders among nurses in Ibadan, South-west Nigeria: A cross-sectional survey. BMC Musculoskeletal Disorders, 11, 12. https://doi.org/10.1186/1471-2474-11-12 DOI: https://doi.org/10.1186/1471-2474-11-12
Triantafyllou, D. (2010). Quality of life and health status of hospital staff in Greece (Doctoral thesis).
Vänni, K., Neupane, S., & Nygård, C.-H. (2017). An effort to assess the relation between productivity loss costs and presenteeism at work. International Journal of Occupational Safety and Ergonomics, 23(1), 33–43. https://doi.org/10.1080/10803548.2016.1197578 DOI: https://doi.org/10.1080/10803548.2016.1197578
Vernon, H., & Mior, S. (1991). The Neck Disability Index: A study of reliability and validity. Journal of Manipulative and Physiological Therapeutics, 14(7), 409–415. PMID: 1834753
Von der Lippe, E., Krause, L., Porst, M., Wengler, A., Leddin, J., Müller, A., … et al. (2021). Prevalence of back and neck pain in Germany. Results from the BURDEN 2020 Burden of Disease Study. Journal of Health Monitoring, 6(Suppl 3), 2–14. https://doi.org/10.25646/7855
Wlodyka-Demaille, S., Poiraudeau, S., Catanzariti, J.-F., Rannou, F., Fermanian, J., & Revel, M. (2004). The ability to change of three questionnaires for neck pain. Joint Bone Spine, 71(4), 317–326. https://doi.org/10.1016/j.jbspin.2003.04.004 DOI: https://doi.org/10.1016/j.jbspin.2003.04.004
Yasobant, S., & Rajkumar, P. (2014). Work-related musculoskeletal disorders among health care professionals: A cross-sectional assessment of risk factors in a tertiary hospital, India. Indian Journal of Occupational and Environmental Medicine, 18(2), 75–81. https://doi.org/10.4103/0019-5278.146896 DOI: https://doi.org/10.4103/0019-5278.146896
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