• Title/Summary/Keyword: Low-back pain

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Evaluation of the Degenerative Changes of the Distal Intervertebral Discs after Internal Fixation Surgery in Adolescent Idiopathic Scoliosis

  • Dehnokhalaji, Morteza;Golbakhsh, Mohammad Reza;Siavashi, Babak;Talebian, Parham;Javidmehr, Sina;Bozorgmanesh, Mohammadreza
    • Asian Spine Journal
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    • v.12 no.6
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    • pp.1060-1068
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    • 2018
  • Study Design: Retrospective study. Purpose: Lumbar intervertebral disc degeneration is an important cause of low back pain. Overview of Literature: Spinal fusion is often reported to have a good course for adolescent idiopathic scoliosis (AIS). However, many studies have reported that adjacent segment degeneration is accelerated after lumbar spinal fusion. Radiography is a simple method used to evaluate the orientation of the vertebral column. magnetic resonance imaging (MRI) is the method most often used to specifically evaluate intervertebral disc degeneration. The Pfirrmann classification is a well-known method used to evaluate degenerative lumbar disease. After spinal fusion, an increase in stress, excess mobility, increased intra-disc pressure, and posterior displacement of the axis of motion have been observed in the adjacent segments. Methods: we retrospectively secured and analyzed the data of 15 patients (four boys and 11 girls) with AIS who underwent a spinal fusion surgery. We studied the full-length view of the spine (anterior-posterior and lateral) from the X-ray and MRI obtained from all patients before surgery. Postoperatively, another full-length spine X-ray and lumbosacral MRI were obtained from all participants. Then, pelvic tilt, sacral slope, curve correction, and fused and free segments before and after surgery were calculated based on X-ray studies. MRI images were used to estimate the degree to which intervertebral discs were degenerated using Pfirrmann grading system. Pfirrmann grade before and after surgery were compared with Wilcoxon signed rank test. While analyzing the contribution of potential risk factors for the post-spinal fusion Pfirrmann grade of disc degeneration, we used generalized linear models with robust standard error estimates to account for intraclass correlation that may have been present between discs of the same patient. Results: The mean age of the participant was 14 years, and the mean curvature before and after surgery were 67.8 and 23.8, respectively (p<0.05). During the median follow-up of 5 years, the mean degree of the disc degeneration significantly increased in all patients after surgery (p<0.05) with a Pfirrmann grade of 1 and 2.8 in the L2-L3 before and after surgery, respectively. The corresponding figures at L3-L4, L4-L5, and L5-S1 levels were 1.28 and 2.43, 1.07 and 2.35, and 1 and 2.33, respectively. The lower was the number of free discs below the fusion level, the higher was the Pfirrmann grade of degeneration (p<0.001). Conversely, the higher was the number of the discs fused together, the higher was the Pfirrmann grade. Conclusions: we observed that the disc degeneration aggravated after spinal fusion for scoliosis. While the degree of degeneration as measured by Pfirrmann grade was directly correlated by the number of fused segments, it was negatively correlated with the number of discs that remained free below the lowermost level of the fusion.

Corni Fructus Inhibits Wrinkle Formation by Reduced Advanced glycation end product (AGEs) (산수유의 최종당화산물 억제로 인한 주름 개선효과)

  • Lee, AhReum;Kim, SooHyun;Kim, SuJi;Kim, KyeongJo;Kwon, Ojun;Choi, JoonYoung;Roh, Seong-Soo
    • The Korea Journal of Herbology
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    • v.32 no.5
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    • pp.1-6
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    • 2017
  • Objectives : Corni Fructus (CF) is traditional herbal medicine used on polyuria, low back pain, and tinnitus. This study aimed to evaluate inhibits skin wrinkle formation effect of CF. Methods : To evaluate the produce inhibition effect of CF, SD-rats were distributed into four groups; normal rats (Nor), AGEs (advenced glycation end product)-induced rats (Con), AGEs-induced rats treated with 100mg/kg CF (CF). To induce AGEs, streptozotocin (50mg/kg) was administered intraperitoneally and after 3 days oral administrated 100mM methyl glyoxal for 3 weeks. Results : The oral administration of CF suppressed the reactive oxygen specis (ROS) in serum. The AGEs in skin tissues was significantly reduced through treatment of CF. Furthermore, the expressions of AGEs related proteins such as polyclonal anti-$N^e$-(carboxymethyl)lysine (CML), anti-$N^e$-(carboxyethyl)lysine (CEL), AGE receptors (RAGE) were decreased in CF treated group compared with the control group in skin tissues. Inflammation-related proteins such as Nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kB), monocyte chemoattractant protein-1 (MCP-1), interleukin-6 (IL-6) reduced in CF treatment group than control group. AGE-induced rats exhibited that the significant decreased collagen however, CF treatment (100mg/kg of body weight) up regulated collagen by improved the expression levels of skin fibril-related genes such as Matrix metalloproteinase (MMP-1). Conclusion : Taken together, our study suggests that CF regulates ROS to prevent accumulation of AGEs and inhibits skin wrinkles. Our finding indicate that CF may be an effective agent for inhibits AGEs formation, and improved skin wrinkle.

A Systematic Review of Mobile Health Applications Using Self-Acupressure (자가혈위지압을 활용한 모바일 의료 어플에 대한 체계적 문헌고찰)

  • Seokyung Park;Johyun Lee;Ga-Young Jung;Celine Jang;Sang-Ho Kim
    • Korean Journal of Acupuncture
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    • v.40 no.1
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    • pp.1-12
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    • 2023
  • Objectives : This study aims to provide information regarding the status and quality of mobile applications (MAs) using self-acupressure by performing a systematic review. Methods : We conducted comprehensive searching on five international databases and two app markets from inception to July 31, 2022 to identify MAs using self-acupressure. We analyzed the characteristics of each MA regarding the name of the MA, registered app markets, target symptoms, developers, the year and country of development, cost, target age, media function, and expertise. We assessed the quality of each MA using Mobile Application Rating Scale (MARS). Results : We identified a total of 30 MAs using self-acupressure (25 MAs from the app market and 6 MAs from clinical studies, with 1 MA in common). 17 out of 24 MAs from the app market provided self-acupressure regimens for various symptoms and the others provided regimens for specific symptoms such as memory, anxiety, depression, asthma, allergy, low back pain, and headache. 14 developers were reported. 23 MAs were developed after 2013. The largest number of MAs were developed in the United States. The target age group of 12 MAs was above the age of 3, and that of 11 MAs was above the age of 12. 14 MAs provided multimedia functions such as videos. 13 MAs provided information of expertise. From clinical studies, only 3 out of 6 MAs were accessible through the app market. 4 MAs were developed by the researchers of the study. In terms of MARS, the score of MAs from the app market was higher than that of MAs from clinical studies in both objective and subjective evaluation areas. Conclusions : This study summarizes the characteristics of MAs using self-acupressure. More MAs using self-acupressure should be developed and further clinical research for MA on each symptom and disease is warranted for the diversification of MA fields using self-acupressure.

Radiologic Features and Surgical Outcome of Juxtafacet Cyst Associated with Degenerative Lumbar Disease (퇴행성 요추 질환에서 발생한 후관절 근접 낭종의 방사선적 특징 및 수술의 결과)

  • Kim, Whoan Jeang;Chang, Shann Haw;Yang, Hwa Yeol;Kwon, Won Jo;Sung, Hwan Il;Park, Kyung Hoon;Choy, Won Sik
    • Journal of the Korean Orthopaedic Association
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    • v.52 no.1
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    • pp.65-72
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    • 2017
  • Purpose: The purpose of this study was to evaluate the radiologic features of juxtafacet cyst and determine the correlation between these features and clinical outcome. Materials and Methods: We analyzed a total of 23 patients. The degree of facet joint degeneration was classified using the Fujiwara method. The facet joint angles were measured with an magnetic resonance imaging to determine whether there was a difference between the cystic lesion that was occupied and the cystic lesion that was not occupied. Disc degeneration was measured by the Pfirrmann classification method. The clinical result was evaluated using the Oswestry disability index score and visual analogue scale. Results: The L4-5 level of juxtafacet cyst was mostly affected, as found in previous studies. Facet joint arthritis was more severe within the side with the cystic lesion. Significant correlation was found between disc degeneration and juxtafacet joint cyst. All patients underwent wide decompression and fusion. Clinical result was excellent. No patients had signs of recurrence during the follow-up periods. Conclusion: Juxtafacet cyst has a significant correlation with facet joint degeneration. Therefore, aggressive surgical treatment-not just simple cyst excision-should be considered as the treatment option for juxtafacet cyst associated with degenerative lumbar disease.

A Study of Teacher's Satisfaction Regarding Korean Medicine Doctor's Student Health and Wellness Program in 2016 - In Middle & High School of Seongnam City - (2016년도 한의 교의 프로그램의 교사들의 만족도에 관한 연구 - 성남시 중고등학교를 대상으로 -)

  • Sung, Hyun Kyung;Shin, Seon Mi;Go, Ho-Yeon;Ko, Jae-Un;Kim, Hyo-Sun;Choi, Suk-Hoon;Park, Jeong-Su
    • The Journal of Pediatrics of Korean Medicine
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    • v.32 no.1
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    • pp.83-91
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    • 2018
  • Objectives This study aims to build the baseline data for promoting school health care program by identifying satisfaction level and improvement point through the satisfaction survey after Korean medicine doctor's student health and wellness program in 2016. Methods An association of Korean medicine doctor in Seongnam city conducted Korean medicine doctor's student health and wellness program for 12 middle schools, 6 high schools and 1 special-need school in Seongnam city in 2016. The participating Korean medicine doctor visited each school for 8 times and conducted health consultations, health education classes and Korean medicine treatment for the school students and the school employees. Teachers and administrators from the participating schools answered the self-reported satisfaction questionnaires and the results were analyzed by SPSS 22.0. Results 35 people responded the program satisfaction questionnaires, the overall satisfaction average was $9.40{\pm}0.88$ (out of 10). In the course of the program, satisfaction average regarding the student's health check-ups was $9.05{\pm}0.88$, satisfaction average regarding the informatory brochures for the parents was $9.08{\pm}1.09$, satisfaction average regarding the participation enrollment process was $9.06{\pm}1.16$, and the satisfaction average regarding the questionnaire statistics and the result reports was $8.86{\pm}1.93$. The satisfaction average of the program was as follows: health consultation ($9.20{\pm}1.08$), treatment ($9.31{\pm}0.90$), and health education classes ($8.78{\pm}1.68$). Some of the good things about program were 'Telling students about their physical condition' (57.1%), 'Curing the sick student quickly' (48.6%), 'Providing students with useful information about the health' (48.6%), 'Teaching students how to manage their health and how to manage symptoms' (42.9%). Average satisfaction about sustainability and needs of the program was $9.15{\pm}0.91$, and the participant teachers wanted to learn more about how to manage internet addiction (22.9%), stress (45.7%), atopy (28.6%), neck pain (42.9%), allergic rhinitis (37.1%), and low back pain (34.3%) from the future wellness programs. Conclusions Student health care is one of the most important issue in national health policies. We have designed a bridge model that a local community, school, and doctors can work together to develop. After the implementation of the program, the results of the satisfaction survey showed a very high satisfaction level. This study can be the basis for further improvement of the bridge program as well as the expansion of the program in other settings.

The clinical study on 44 cases of patient with Thoracolumbar Compression Fracture (흉(胸)·요추(腰椎) 압박골절(壓迫骨折) 환자(患者)에 대한 임상적(臨床的) 고찰(考察))

  • Lim, Jeoung-Eun;Kim, Kee-Hyun;Hwang, Hyeon-Seo
    • Journal of Acupuncture Research
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    • v.17 no.2
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    • pp.41-51
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    • 2000
  • Clinical observation was made on 44 cases of stable thoracolumbar compression fracture that were confirmed through simple x-ray and neurological examination. They were hospitalized and treated by acupuncture and moxibustion, bed rest, herb medicine and physical therapy. If necessary, patient was given an enema. The results obtained are as follows. 1. The patient distribution ratio, in regard to sex, was shown to be 1: 13.7 for males to females. In regard to age, it was shown that people in their 60's was the most predominant case, followed by people in their 70's, 80's, 50's and 40's, respectively. 2. In regard to contributing factors, it was observed that accidental falls were most frequent, followed by reasons unknown, repetitive lifting of heavy objects, overlaboring and bruise in that order. 3. In regard to duration of illness before treatment, it was found that treatment within 1 week was most predominant, followed by over 4 weeks, and 1-2 weeks, respectively. 4. With regard to the duration of hospitalization, hospitalization within 2 weeks was found to be most predominant, followed by 2-4 weeks. 5. In regard to the level of the affected vertebral body; The affected vertebral bodies distributed between T3 to L5 except for T7; T12 was found to be most predominant, followed in turn by L1 and L5. 6. In regard to the number of affected vertebral bodies, 2 was the most frequent followed by 1 and 3, in that order. The average of the number of affected vertebral bodies was observed to be 2.8 and single vertebral body compression fracture was shown to have no clinical and statistical difference as compared with multiple vertebral body compression fractures. 7. In regard to the grade of the seriousness of symptoms, it was found that Grade IV was most predominant, followed by Grade III. 8. With regard to signs at the first medical examination, low back pain was seen in the highest number, and followed in order by gait disturbance, flank pain, flexion-extension disturbance, disturbance of rotation to right or left, and bowel dysfunction. 9. Concerning the effect of treatment, good results were most predominantly seen, and 95.5% of total patients showed fair results. 10. The duration of admission treatment due to the grade of clinical symptoms was as follows; In the case of the Grade IV, it was observed that within 2 weeks was most predominant and for Grade III was 2-4 weeks. It was also found that the grade of clinical symptoms was not in proportion to the duration of admission treatment. 11. In regard to the result of treatment due to the grade of clinical symptoms; It was found that in the case of Grade IV, within 2 weeks was most predominant, and for Grade III, it was found to be 2-4 weeks. 12. Intestinal obstruction was shown in 50% of total patients; In the case of duration of constipation, more than 1 week was found to be most predominant, followed by 2 and 4 days respectively. 13. With regard to the treatment of intestinal obstruction, using acupuncture and moxibustion, herb - medicine and enema together were found to be most effective. 14. Intestinal obstruction was mostly seen in the case of Grade IV.

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Assessment of Osteoporosis Based on Changes in SNR and ADC Values on MR Diffusion Weighted Images (확산강조영상에서 신호대 잡음비, 현성 확산 계수 변화에 따른 골다공증 평가)

  • Cho, Jae-Hwan;Kim, Yeong-Soo
    • Progress in Medical Physics
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    • v.21 no.1
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    • pp.70-77
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    • 2010
  • This study tested how S/N (Signal to Noise Ratio) ratios and ADC (apparent diffusion coefficient) values vary with different T-scores in a group of patients with osteoporosis. Based on DEXA (Dual Energy X-ray Absorptiometry) T-scores for L1.L4 for two groups of subjects consisting of 30 healthy people without osteoporosis and 30 patients who came for treatment of waist (lumbar or low back) pain and were suspected to have osteoporosis as judged from the simple X-ray findings, this study classified every spine into two groups of osteoporosis and osteopenia. Signal intensity measurements were made in the four regions of L1 to L4 on diffusion-weighted MR images obtained using 1.5T MR scanner, while ADC measurements were obtained from ADC map images. As an approach for quantitative analysis, the comparison of the variances in S/N ratios and ADC values for varying T-scores in the selected regions of interest was carried out based on averaged T-scores, S/N ratios, and ADC values. Also, the variances in S/N ratios and ADC values for each of the groups of osteoporosis and osteopenia, which were classified into by T-scores, were compared. For qualitative analysis, a careful naked eye examination of signal intensity differences in the area of L4 was made on T1-weighted sagittal images for each of the healthy (normal), osteopenia, and osteoporosis groups. In the qualitative analysis, it was found that for both the osteopenia group and the osteoporosis group, as T-scores deceased, the S/N ratios on diffusion-weighted MR images also decreased, with the greatest decrease in the S/N ratio found in the osteoporosis group. Additionally, among the three groups, the lowest S/N ratio was found in the osteoporosis group. With respect to ADC map, it was found that for both the osteopenia group and the osteoporosis group, as T-scores deceased, the ADC values on diffusion-weighted MR images also decreased, with the greatest decrease in the ADC values found in the osteoporosis group. Additionally, among the three groups, the lowest ADC value was found in the osteoporosis group. On the other hand, in the qualitative analysis, the osteoporosis group showed the highest signal intensity. Additionally, among the three groups, the lowest signal intensity was found in the healthy (normal) group. It was found that as osteoporosis progressed, S/N ratio and ADC decreased, whereas signal intensity increased on T1-weighted images. Also, in diagnosing osteoporosis, MRI tests turned out to be (more) effective.

Suspected Upper Gastrointestinal Bleeding by Interaction of Clozapine and Buspirone (상부위장관 출혈이 의심되는 클로자핀과 부스피론의 상호작용)

  • Sung, Yu-Mi;Kim, Soo-In;Yun, Kyu-Wol;Lim, Weon-Jeong
    • Korean Journal of Psychosomatic Medicine
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    • v.14 no.1
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    • pp.62-66
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    • 2006
  • Introduction: Unexpected serious and lethal drug interactions can be occurred by polypharmacy for treatment-resistant psychiatric disorders. We report a case who has suspected upper gastrointestinal bleeding after the combination of clozapine and buspirone. Case : A 69-year-old woman with DSM-IV schizophrenia who was admitted to our hospital had no previous medical problems. Findings on physical exam, laboratory values, EEG, and a magnetic reso-nance imaging scans were no abnormality, except for slightly low level of hemoglobin at admission. Because of aggravating anxiety symptom, a trial of buspirone was begun from 15mg, in addition to olanzapine 30mg. And then olanzapine was switched to clozapine due to her treatment-refractory his-tory and poor response on this admission. Moreover, At the admission 11 weeks later, after 4 weeks of starting buspirone and clozapine, she was placed on a regimen of clozapine 300mg and buspirone 60mg. At this point, she started to complaint nonspecific abdominal pain for 4 days and then hematemesis, melena and hypotension were developed suddenly with negative findings in gastroduodenoscopy. After stopping all medication, the suspected upper gastrointestinal bleeding was subsided. After the regimen was switched back to clozapine only, psychotic symptoms were improved without the recurrence of the adverse events. Conclusion : We concluded that the upper gastrointestinal bleeding in this case was attributed to the drug interaction with clozapine and buspirone, although the definite mechanism is not clear. The clini-cians should be very cautious to prescribe the combination of clozapine and buspirone due to a possible lethal adverse effect.

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Effects of a Critical Pathway of Posterolateral Fusion in Patients with Lumbar Spinal Stenosis (측후방융합술을 시행한 요추관협착증 환자의 Critical Pathway 적용효과)

  • Park, Hae-Ok
    • Journal of Korean Academy of Nursing Administration
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    • v.7 no.2
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    • pp.265-284
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    • 2001
  • The case management has been applied to improve the quality of care and the cost-effectiveness in the most health care institutions. In a way of case management, the critical pathway(CP) has been executed in many acute care settings, focused on the diagnoses with high cost, high volume, and high risk. This study was conducted to develop a case management program using CP as an intervention of patients with lumbar spinal stenosis for the surgery of posterolateral fusion, and to find out the effects of the critical pathway on the quality of nursing care, patient satisfaction as an outcome of care, length of stay and medical charge, and nurses' job satisfaction. At the same time, patients' functional states were checked with the Oswestry Low Back Pain Index, to show that the CP would not decrease the patients' function compared to the control group. The subjects were 25 control patients with a usual operation of lumbar fusion and 25 experimental patients with CP. They were all female, aged $50s{\sim}70s$, admitted in the Orthopedic surgery ward of a university hospital. Also nurses on the floor using CP were asked to respond to measurement tool of job satisfaction before and after the application of CP, and compared with other nurses on the different wards. Data were analyzed with t-test for continuous variables and chi-square for non-parametric variables in addition to the reliability test of the measurement tools. The results of this study were as followings: 1. Patients' functional states The differences in Oswestry scores of the experimental and control groups assessed at preoperation and at discharge were not statistically significant. The change in scores of the experimental group measured at preoperation and at discharge was larger than that of the control group, however the difference was not statistically significant. The results indicate that the CP did not decrease the patients' functional status. 2. The quality of nursing care The total of quality of nursing care given to the experimental group was better than that of the control group(P=.000). In addition, the experimental group showed better scores of quality of every item of care than the control group(P=.000 -.004). 3. Patient satisfaction Patients of the experimental group were not more satisfied with general care than the control group. But they were more satisfied with discharge care of 'explanation about medication, body posture, and brace application' and 'explanation about the adjustment of daily living and exercise during recovery'(P= .047, P=.028). 4. Nurses' job satisfaction Nurses working with the CP showed more job satisfaction than before the CP introduction(P=.048). But the control group of nurses on a different floor showed no change in job satisfaction at the same period of time. 5. Length of stay and medical charge The mean length of stay of the experimental group was shorter than that of the control group without statistical significance. The charge of medication and treatment of the experimental group were smaller than that of the control group(P=.011, P=.000). The results of the study support that the case management using critical pathway enables to improve the quality of care and job satisfaction, to reduce the medical charge, and consequently to increase satisfaction with care. However, the case management should be instituted focusing on the quality improvement of nursing and the client satisfaction, not just for the purpose of cost-effectiveness of health care facilities.

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The Effects of Musculoskeletal Disorder Prevention Exercise Program Considering Agricultural Work Posture (농작업 자세를 고려한 근골격계 질환 예방 운동프로그램의 효과)

  • Park, So-Yeon;Kim, Jin-Kyung
    • The Journal of Korean society of community based occupational therapy
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    • v.3 no.1
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    • pp.1-10
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    • 2013
  • Objective : This study investigates the impact of the musculoskeletal disorder prevention exercise program designed on the basis of agricultural work posture on the balance ability, Oswestry Disability level, and Psychosocial stress of participants from one rural village in Chungnam area. Method : The exercise program was provided to 21 farmers with musculoskeletal symptoms living in one village in Chungnam area. Such program was performed once a week, 90 minutes per session, for a total of twelve weeks from July 10 to October 11, 2008, and was constructed in a way to increase flexibility and muscular strength, taking agricultural work posture into account. The balance ability, Oswestry Disability Index, and Psychosocial Well-being Index scores were analyzed based on the data of 13 of the farmers who participated in the program for more than eight times and in all of the pre- and post-assessments. Result : Thirteen participants were all women who were 70.55(${\pm}6.78$) years old on average. Most of them were engaged in general dry-filed farming. The parts where they mainly felt the pain were low back(69.2%) and knees(61.5%), and 46.2% responded 'not healthy' to the question on the overall health status. The static balance ability when standing on the right foot significantly increased from the average 9.27(${\pm}5.53$) seconds before intervention to 14.22(${\pm}5.47$) seconds after intervention(p<.05). The Oswestry Disability Index showed a significant change, decreasing from the average 19.84(${\pm}6.89$) seconds to 14.38(${\pm}7.58$) seconds(p<.05). However, there was no change in the Psychosocial Well-being Index. Conclusion : This exercise program that has been conducted for the female farmers who are mainly engaged in the dry-filed farming has contributed to the improvement of their static ability and reduction of their Oswestry Disability Index scores. It is expected that the studies on the effects of the differentiated exercise programs depending on work characteristics will make progress in the future.

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