Kassapidaja selja funktsionaalne seisund ja terviseriskid

Inimest ümbritseval töökeskkonnal on tihti peale suurem mõju tema tervislikule seisundile, kui seda tunnetatakse. Pikka aega istuvas asendis töötamist nimetatakse sundasendiks. On selge, et sundasendis olemine pikka aega võib tekitada skeleti-lihassüsteemi vaevusi (SLV). Riskigruppi kuuluvad ka kassapidajad, kes terve tööpäeva on istuvas tööasendis. Uurimistöö eesmärgiks on välja selgitada kassapidajate skeleti-lihassüsteemi vaevuste levimus, selja funktsionaalne seisund ja terviseriskid. Uuringusse kaasati 156 naiskassapidajat (vastamismäär 77,2%) keskmise vanusega (±SD) 37,1 ± 14,5 aastat ja kehamassiindeksiga 25,3 ± 5,9 kg/m2 . Kõik uuringus osalenud olid naissoost. Töö eesmärgi saavutamiseks kasutati erinevaid ankeetküsitlusi – SLV-i standardiseeritud küsimustikku Nordic Questionnaire abil. Töövõime hindamiseks kasutati standardiseeritud küsimustikku, mille alusel arvutati töövõime indeks (work ability index, lüh. WAI). Üldankeedis on küsimused kassapidajate terviseriskide kohta ja organisatoorne info. Üldankeedis olevad küsimused aitasid määrata kassapidajate antropomeetrilised näitajad ning välja selgitada psühhosotsiaalsed ohutegureid. Laboruuringutes osales kokku 30 uuritavat: moodustati 15-liikmeline uuring- ja kontrollgrupp. Laboris teostati goniomeetria, müotonomeetria, selja dünamomeetria, stabiliomeetria, selja pantograafia, stabilomeetria, käe- ja sõrmede dünamomeetria, valude hindamine visuaal-analoog skaalal ning antropomeetrilised mõõtmised. Statistilise andmetöötluse jaoks kasutati programmi Microsoft Excel 2010. Viimase 6 kuu jooksul esines kassapidajatel SLV-i enam ajaseljas (63,2%), kaelas 51,6%, õlgades 43,2%,, põlvedes 40% ning vähem küünarliigeses ja randmes (vastavalt 23,9% ja 39,4%). Viimase 7 päeva jooksul esines neil vaevusi samuti kõige rohkem alaseljas (40%). Töövõimet hindas kokku 45 kassapidajat. Uuritavatest 48,9% hindab enda töövõimet „heaks“ ja uuritavate keskmine töövõime skoor  SD WAI alusel oli 37,8  4,9. Visuaalanaloog skaalal hindas uurimisgrupp kõige kõrgemalt alaselja valu, kus kassapidajate valu tugevuseks oli 52 mm ja kontrollgrupil 24 mm. Uurimis- ja kontrollgrupil mõõdetud seljalihaste isomeetrilist maksimaaljõu tulemustest selgus, et uurimisgrupi (574 N) maksimaaljõud on ligi 17% väiksem kui kontrollgrupil (730 N). Goniomeetria tulemustest selgus, et seljaosa liikuvusulatuse näitajad on kontrollgrupil suuremad kui uuritaval grupil, välja arvatud seljaosa rotatsioon vasakule, mille tulemused olid suuremad uurimisgrupil. Müotonomeetria tulemustest võib järeldada, et uurimisgrupil oli enamus juhtudel suurem pinge selgroosirgestajalihases ja trapetslihases. Seos on mõistetav, kuna uurimisgrupi naiskassapidajatel olid suuremad seljavalud. Lülisamba kõveruste hindamisel oli uurimisgrupi rinnaküfoosi nurk on 1,4˚ suurem kui kontrollgrupil. Keskmine nimmelordoosi nurk on aga mõõdetud suurem kontrollgrupil. Uurimis- ja kontrollgrupis esines kokku 86% uuritavatel skoliootiline deformatsioon paremale. Skeleti-lihassüsteemi vaevused on kassapidajate seas levinud terviseprobleem, kusjuures vaevused on enamlevinud alaselja, kaela, õlgade ja põlvede piirkonnas. Kontoritöötajatel tuleks skeleti-lihassüsteemi vaevuste vähendamiseks suurendada üldist liikumisaktiivsust, teha regulaarselt puhkepause arvutitööl ja vajadusel rakendada töökoha ergonoomikalist ümberkorraldamist.

Musculoskeletal discomfort (MSD) (pain, fatigue) and health complaints are common within cashiers, who work in sitting position. Continuous sitting while working is a common source of MSD. The most frequent areas are the low back, neck, shoulder and knees according to the literature. Working environment has a bigger influence on a person´s health than people are used to acknowledge. Working for a long time in a sitting position is called a forced position. It is clear that staying in a forced position for a long time can cause pain in the musculoskeletal system. Cashiers who work for an entire workday in a sitting position are most surely in the risk group. The aim of this research was to found out prevalence of MSD and health risks amongst female cashiers, and assess the functional condition of the back. One hundred and fifty-six female cashiers participated in the research. The responding rate was 77,2%, average age (±SD) 37,1 ± 14,5 years and the body mass index 25,3 ± 5,9 kg/m2.. All participants were female. All subjects worked in sitting position almost whole 8-hours workday. They filled the standardized Nordic Questionnaire, and informative form concerning bio-demographic variables. Work ability was assessed by standardized questionnaire (Finnish Institute of Occupational Health), where calculated work ability index (WAI). In the general questionnaire were questions about the participants health risks and organisational information. These questions helped to admeasure the anthropometrical indicators and psychosocial risk factors. Thirty people participated in the laboratorial research. Fifteen people were conducted as the research group and another fifteen as the control group. To assess back functional state, was carried out laboratory measurements. Maximal isometric voluntary contraction (MVC) force of back extensor muscles, and of hand and finger was measured by dynamometer. The neck and back active range of movement (aROM) was measured by goniometer. The spinal curvature in the sagittal plane was recorded using pantography method. Also was used stabilometry, myotonometry and visual-analog scale. Anthropometrical measurements were also taken in the lab. The program Microsoft Excel 2010 was used for data processing. In the last six months the most frequent complaints in the skeleto-muscular system were in low back (63,2%), in neck (51,6%), in shoulders (43,2%), in knees (40%) and less in elbow joint (23,9%) and in wrist (39,4%). In the last seven days the most frequent complaints were also in the lower back (40%). Altogether forty-five cashiers assessed their work ability. From the participants 48.9% would assess their work ability as ‘good’ and the average (±SD) score on the WAI was 37,8  4,9. Assessing the pain on the visual-analogy scale the research group assessed the low back pain to be the strongest: the cashiers rated it on a 100 mm scale to be 52 mm and the assessment group rated it to be 24 mm. The measuring of the maximum isometric strength of the back muscles in the research and assessment group concluded that the research group’s maximum strength (574 N) is 17% less than measured in the assessment group (730 N). Goniometric measures conclude that the movement range of the back area within the assessment group were higher that the research group, except for the rotation of the back area to the left – the research group had higher measures than the assessment group. From the mythonometric measures one could conclude that the research group had the highest tension in musculus erector spinae and musculus trapezius. The correlation is understandable as the cashiers in the research group rated the lower back pains as the most frequent. The assessment of the spinal curvature concluded that the research group’s thoracal kyphosis angle was 1,4˚ bigger than of the assessment group. The average angle of lumbar lordosis was measured higher within the assessment group. In the research and the assessment group 86% of participants had scoliotic deformation to the right. It is advised to take frequent and regular brakes when working on the computer and conduct an ergonomic workplace assessment or rearrangement of the workplace if necessary.