Repercussions of neck pain on the quality of life of health professionals in Intensive Care Units

Abstract

Objective. To analyze the repercussions of neck pain on the quality of life of health professionals in intensive care units. Methods. Cross-sectional, descriptive and correlational study, carried out with 94 health professionals (21 nurses, 13 physical therapists and 60 nursing technicians) in Intensive Care Units of two medium-sized hospitals in a municipality in the far south of Brazil. An instrument containing variables of sociodemographic and work environment characterization was applied; the Neck Bournemouth Questionnaire (NBQ) and the WHOQOL-Bref were applied. Results. There was a predominance of female professionals (88.3%), white (78.8%), aged 30 to 39 years (34.1%), with family income between one and two minimum wages (31.9%) and weekly workload between 31 and 40 hours (67%), night shift (54.3%), time of professional experience of one to five years (38.3%) and one job (73.4%). Neck pain and disability showed significant negative correlations with quality of life. The relationship was weak with the physical (r: -0.218; p=0.035) and psychological (r: -0.280; p=0.006) domains, and moderate with social relationships (r: -0.419; p<0.001), environment (r: -0.280; p<0.001) and general quality of life (r: -0.280; p<0.001). Overall quality of life showed a moderate correlation with the feeling of anxiety (r: -0.431; p<0.001) and depression (r: -0.515; p<0.001) of professionals in the last week. Conclusion. Neck pain caused repercussions in the physical, psychological, social, environmental and general quality of life of health professionals in intensive care units.

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Vol. 42 No 3, September - December 2024
ISSNp: 0120-5307 • ISSNe: 2216-0280
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Original Article
Repercussions of
neck pain on the
quality of life of
health professionals
in Intensive Care
Units
Alberto de Oliveira Redü1,8
https://orcid.org/0000-0003-4774-3090
Daiani Modernel Xavier2,8
https://orcid.org/0000-0003-2376-6474
Marcela Amaral Daoud3,8
https://orcid.org/0000-0002-1725-4977
Giovana Calcagno Gomes4,8
https://orcid.org/0000-0002-2464-1537
Eliane Raquel Rieth Bennetti5,9
https://orcid.org/0000-0003-1626-5698
Franciele Gomes Soares6,8
https://orcid.org/0000-0003-4356-8416
Luciano Garcia Lourenção7,8
https://orcid.org/0000-0002-1240-4702
1 Physical therapist, Master. Email: betoredu@hotmail.com. Correspon-
ding author.
2 Nurse, Ph.D. Adjunct Professor. Email: daiamoder@gmail.com
3 Occupational Safety Engineer, Master.
Email: marceladaoud@yahoo.com.br
4 Nurse, Ph.D. Associate Professor. Email: giovanacalcagno@furg.br
5 Nurse, Ph.D. Adjunct Professor. Email: elianeraquelr@yahoo.com.br
6 Nurse. Email: francielesoares933@gmail.com
7 Nurse, Ph.D. Full Professor Email: lucianolourencao.enf@gmail.com
8 School of Nursing, Federal University of Rio Grande, Rio Grande, Rio
Grande do Sul, Brazil.
9 Department of Nursing, Federal University of Santa Maria. Santa Ma-
ria, Rio Grande do Sul, Brazil.
Conflicts of interest: No
Received: January 10, 2024.
Approved: August 26, 2024.
DOI: https://doi.org/10.17533/udea.iee.v42n3e06
https://creativecommons.org/licenses/by-nc-sa/4.0/deed.en
How to cite this article: Redü AO, Xavier DM, Daoud MA, Gomes GC, Ben-
netti, ERR, Soares, Lourenção LG. Repercussions of cervical pain on the
quality of life of health professionals in Intensive Care Units. Investigación
y Educación en Enfermería. 2024; 42(3):e06.

Invest Educ Enferm. 2024; 42(3): e06
Repercussions of neck pain on the quality of life of health professionals in Intensive Care Units
Repercussions of cervical pain on the quality of life of
health professionals in Intensive Care Units
Abstract
Objective. To analyze the repercussions of neck pain on the quality of life of health
professionals in intensive care units. Methods. Cross-sectional, descriptive and
correlational study, carried out with 94 health professionals (21 nurses, 13 physical
therapists and 60 nursing technicians) in Intensive Care Units of two medium-
sized hospitals in a municipality in the far south of Brazil. An instrument containing
variables of sociodemographic and work environment characterization was applied;
the Neck Bournemouth Questionnaire (NBQ) and the WHOQOL-Bref were applied.
Results. There was a predominance of female professionals (88.3%), white (78.8%),
aged 30 to 39 years (34.1%), with family income between one and two minimum
wages (31.9%) and weekly workload between 31 and 40 hours (67%), night shift
(54.3%), time of professional experience of one to ve years (38.3%) and one job
(73.4%). Neck pain and disability showed signicant negative correlations with
quality of life. The relationship was weak with the physical (r: -0.218; p=0.035) and
psychological (r: -0.280; p=0.006) domains, and moderate with social relationships
(r: -0.419; p<0.001), environment (r: -0.280; p<0.001) and general quality of life
(r: -0.280; p<0.001). Overall quality of life showed a moderate correlation with the
feeling of anxiety (r: -0.431; p<0.001) and depression (r: -0.515; p<0.001) of
professionals in the last week. Conclusion. Neck pain caused repercussions in the
physical, psychological, social, environmental and general quality of life of health
professionals in intensive care units.
Descriptors: neck pain; quality of life; health professionals; intensive care units;
occupational health.
Repercusiones del dolor cervical en la calidad de vida de
los profesionales sanitarios de las Unidades de Cuidados
Intensivos
Resumen
Objetivo. Analizar las repercusiones del dolor cervical en la calidad de vida de
los profesionales sanitarios de las unidades de cuidados intensivos. Métodos.
Estudio transversal, descriptivo y correlacional de 94 profesionales de la salud (21
enfermeros, 13 sioterapeutas y 60 técnicos de enfermería) de las unidades de
cuidados intensivos de dos hospitales de tamaño medio de un municipio del extremo
sur de Brasil. Se aplicó un instrumento que contenía variables sociodemográcas
y de caracterización del ambiente de trabajo; el Cuestionario Neck Bournemouth
(NBQ) y el WHOQOL-Bref. Resultados. Hubo predominio de profesionales del sexo
femenino (88.3%), raza blanca (78.8%), edad entre 30 y 39 años (34.1%), con
renta familiar entre uno y dos salarios mínimos (31.9%); una carga horaria semanal

Invest Educ Enferm. 2024; 42(3): e06
Alberto de Oliveira Redü • Daiani Modernel Xavier • Marcela Amaral Daoud • Giovana Calcagno Gomes • Elia-
ne Raquel Rieth Bennetti • Franciele Gomes Soares •Luciano Garcia Lourenção
entre 31 y 40 horas (67%), turno nocturno (54.3%) y años de trabajo entre uno
y cinco años (38.3%) y tienen un solo empleo (73.4%). El dolor cervical y las
incapacidades laborales mostraron correlaciones negativas signicativas con la
calidad de vida: la relación fue débil con los dominios físico (r: -0.218; p=0.035)
y psicológico (r: -0.280; p=0.006), y moderada con las relaciones sociales (r:
-0.419; p<0.001), el entorno (r: -0.280; p<0.001) y la calidad de vida general
(r: -0.280; p<0.001). La calidad de vida global mostró una correlación moderada
con los sentimientos de ansiedad (r: -0.431; p<0.001) y depresión (r: -0.515;
p<0.001) de los profesionales en la última semana. Conclusión. El dolor cervical
repercute en la calidad de vida física, psicológica, social, ambiental y general de los
profesionales sanitarios de las unidades de cuidados intensivos.
Descriptores: dolor de cuello; calidad de vida; personal de salud; unidades de
cuidados intensivos; salud laboral.
Repercussões da dor cervical na qualidade de vida de
profissionais de saúde de Unidades de Terapia Intensiva
Resumo
Objetivo. Analisar as repercussões da dor cervical na qualidade de vida de
prossionais de saúde de unidades de terapia intensiva. Métodos. Estudo transversal,
descritivo e correlacional, realizado com 94 prossionais de saúde (21 enfermeiros,
13 sioterapeutas e 60 técnicos em enfermagem) em Unidades de Terapia Intensiva
de dois hospitais de médio porte de um município do extremo sul do Brasil. Foi
aplicado um instrumento contendo variáveis de caracterização sociodemográca e
do ambiente de trabalho; o Neck Bournemouth Questionnaire (NBQ) e o WHOQOL-
Bref. Resultados. Houve predomínio de prossionais do sexo feminino (88.3%),
brancos (78.8%), na faixa etária de 30 a 39 anos (34.1%), com renda familiar entre
um e dois salários-mínimos (31.9%) e carga horária de trabalho semanal entre 31 e
40 horas (67%), turno de trabalho noturno (54.3%), tempo de atuação prossional
de um a cinco anos (38.3%) e um emprego (73.4%). A dor cervical e incapacidade
mostraram correlações negativas signicativas com a qualidade de vida. A relação
foi fraca com os domínios físico (r: -0.218; p=0.035) e psicológico (r: -0.280;
p=0.006), e moderada com relações sociais (r: -0.419; p<0.001), meio ambiente
(r: -0.280; p<0.001) e qualidade de vida geral (r: -0.280; p<0.001). A qualidade
de vida geral apresentou correlação moderada com o sentimento de ansiedade (r:
-0.431; p<0.001) e de depressão (r: -0.515; p<0.001) dos prossionais, na
última semana. Conclusão. A dor cervical causou repercussões nos domínios físico,
psicológico, social, meio ambiente e na qualidade de vida geral dos prossionais de
saúde das unidades de terapia intensiva.
Descritores: dor cervical; qualidade de vida; prossionais de saúde; unidades de
terapia intensiva; saúde ocupacional.

Invest Educ Enferm. 2024; 42(3): e06
Repercussions of neck pain on the quality of life of health professionals in Intensive Care Units
Introduction
Neck pain is a multifactorial condition, which proves to be a public
health problem of modern society, especially of health professionals,
who deal with the pain of patients, often neglecting their own
pain. Although it is not the most prevalent disorder among the
population, it is usually in great demand and has a direct impact on work and
productivity, in addition to life outside the work environment.(1) According to
the Global Burden of Disease (GBD) study, neck pain was classied as the
third reason for years lived with disability among the young population, aged
between 20 and 24 years.(2) A review study showed that psychosocial factors
involving stress, anxiety, depression, kinesiophobia, low satisfaction and high
work overload can negatively inuence neck pain.(1) As it is a complex and
recurrent disorder, it has a strong tendency to chronicity, tending to generate
pain, limitation of activities of daily living, incapacity for work activities and
reduced Quality of Life (QoL).(3,4)
Quality of life can be dened as the individual’s perception of his position
in life, in the context of the culture and value system in which he lives, and
in relation to his goals, expectations, standards and concerns, and can be
evaluated in various ways.(5,6) Among the various QoL assessment instruments,
the abbreviated version of the WHOQOL-Bref has been widely used, as it is
easy to apply and addresses physical, psychological, social and environmental
aspects, as well as general quality of life.(5) The main causes of pain among
health professionals are occupational etiology, resulting from movements
of the upper limbs at inadequate angulations, excessive and compensatory
efforts.(1,7,8) Neck pain caused by musculoskeletal disorders related to the
work environment, such as repetitive movements and neck maintenance in
static postures, for long periods of time can interfere with the quality of life of
these professionals.(1)
It is common for health professionals in Intensive Care Units (ICU) to face
high physical and psychological work demands, resulting from the physical
deciencies of the work environment, the lack of Personal Protective Equipment
(PPE) and the lack of professionals qualied for the job.(9) Dealing with issues of
anxiety, depression and post-traumatic stress during the pandemic is a fact linked
to neck pain, in addition to being a factor that can trigger them.(1,10) In addition,
studies show that neck pain arising from the work process was potentiated
during the COVID-19 pandemic period, which contributed to the increase in
psychological disorders in the workplace.(1,9,10) Although there are studies on
neck pain, quality of life and work environment, the approach does not occur
in an integrated way, generating a gap in knowledge about the repercussions
of neck painful processes on quality of life and its relationship with the work
environment in health professionals of Intensive Care Units. In this context,
the research question arose: What is the relationship of neck pain in the

Invest Educ Enferm. 2024; 42(3): e06
Alberto de Oliveira Redü • Daiani Modernel Xavier • Marcela Amaral Daoud • Giovana Calcagno Gomes • Elia-
ne Raquel Rieth Bennetti • Franciele Gomes Soares •Luciano Garcia Lourenção
QoL of professionals working in intensive care
units? To answer it, the objective of the study was
established: to analyze the repercussions of neck
pain on the quality of life of health professionals
in intensive care units.
Methods
This is a cross-sectional, descriptive and
correlational study, from the macroproject “Work
process and health of clinical-occupational
workers in different socio-environmental contexts
and age groups”, developed between April and
August 2023, in Intensive Care Units of two
medium-sized hospitals in a municipality in the
far south of Brazil, being: (i) a university hospital,
which has an adult ICU composed of six beds
intended only for the care of patients in the
public health system, the Unied Health System
(SUS); (ii) a philanthropic hospital, which mostly
serves patients from the SUS, but provides care
for private patients and the supplementary health
network (medical insurance). This hospital has a
general ICU with seven intensive and three semi-
intensive beds, for SUS care; a Postoperative
Intensive Unit with nine beds, for the care of
patients in the postoperative period of cardiac
surgery and general cardiological care; and a
general ICU with ten beds, for the care of private
and afliated patients.
The study population consisted of nurses, physical
therapists or nursing technicians from therapy units
who had been working in health institutions for at
least two months, which is the average period of
adaptation of workers to organizational dynamics.
(11) Professionals who, even meeting the inclusion
criteria, were on vacation or on sick leave during
the data collection period were excluded from
the study. The population eligible for the study
consisted of 124 professionals: 29 nurses (10 from
the university hospital; 19 from the philanthropic
hospital), 73 nursing technicians (21 from the
university hospital; 52 from the philanthropic
hospital) and 22 physical therapists (7 from the
university hospital; 15 from the philanthropic
hospital). All eligible professionals were invited
to participate in the study and the sample was
constituted by convenience. However, to ensure
the representativeness of the professionals, the
sample size was calculated using StatCalc Epi
Info version 7.2. The 95% condence level and
the 5% margin of error were adopted, obtaining
the sample size of 94 professionals.
For data collection, carried out from April to August
2023, a self-administered instrument composed of
three parts was used, being: a) a sociodemographic
questionnaire and characteristics of the work
environment: built based on studies by the Reference
Center for Occupational Health of Bahia de Ilha
Grande.(12) This questionnaire was composed of
independent variables (professional category, sex,
age, skin color, family income, work shift, hours
worked, time of professional experience, number
of jobs and if you have ever suffered an accident at
work) and characteristics of the work environment
(professionals’ assessment of the volume of work;
and conditions of furniture, equipment and physical
space); b) the Neck Bournemouth Questionnaire
(NBQ), used to assess aspects related to the
level of pain and cervical disability. The version
validated in Brazil by Kamonseki et al.(13) has
seven questions, with answers on a numerical
scale ranging from zero (lowest intensity) to 10
(maximum intensity). The seven questions of the
instrument are distributed to score the level of
neck pain (NBQ1), how much pain impaired daily
activities (NBQ2), the impairment of recreational
and leisure activities (NBQ3), feelings of anxiety,
tension, irritability (NBQ4), feeling of sadness
and depression (NBQ5), worsening of neck pain
during activities in the last week (NBQ6) and
the way the participant managed pain properly
(NBQ7); and c) the WHOQOL-bref, validated
in Brazil by Fleck(14) and used to assess quality
of life. The instrument presents 26 questions,
with answers on a ve-point Likert scale, which
comprise ve domains: physical (covers pain and
discomfort, energy and fatigue, sleep and rest,
activities of daily life, dependence on medication
or treatments, work capacity); psychological (it

Invest Educ Enferm. 2024; 42(3): e06
Repercussions of neck pain on the quality of life of health professionals in Intensive Care Units
includes positive feelings, thinking, learning,
memory and concentration, self-esteem, body
image and appearance, negative feelings,
spirituality, religiosity and personal beliefs); social
relationships (it involves personal relationships,
social support and sexual activity); environment
(it considers physical safety and protection, home
environment, nancial resources, health and social
care, recreation/leisure, physical environment), in
addition to general quality of life (general QoL).(14)
To verify that the questionnaires did not present
possible misunderstandings, a pilot study was
carried out with eight professionals from one
of the work shifts. As there was no need for
semantic and structural reformulation, the
professionals who participated in the pilot study
were included in the nal sample. The application
of the research instruments was conducted by a
physical therapist with professional experience in
the ICU. Professionals were invited to participate
in the study through an informative text sent
in the ICU WhatsApp groups by the technical
managers of each unit. The professionals were
also approached in person by the researcher and
invited to ll out the study questionnaire. The
distribution of the questionnaires was carried
out by work shift, in each of the units. Three
attempts were made on different days, in order
to nd the professionals who, perhaps, had not
been approached. The professionals answered
the questions in the workplace. The mean
application time was approximately 30 minutes.
In case of unavailability due to complications
in the unit, the professionals were allowed to
answer the instruments at another time, outside
the work environment, with prior guidance from
the researcher and the return of the completed
instruments at the next visit of the researcher
to the unit. In addition, the researcher’s contact
was made available to clarify doubts. Four
professionals formally refused to participate in
the study.
The data obtained were tabulated in the
Statistical Package for the Social Science (SPSS),
version 28.0. The assessment of data normality
was performed using the Kolmogorov-Smirnov
test. To assess the level of pain and cervical
disability, the scores of all questions on the Neck
Bournemouth Questionnaire were summed,
resulting in a value from zero to 70, considering
that the higher the score obtained, the higher
the level of pain and cervical disability.(13)
To calculate the WHOQOL-bref results, the
scores for each domain were calculated,
considering: (i) physical domain: (Mediax6
(Q3+Q4+Q10+Q15+Q16+Q17+Q18))
x4; (ii) psychological domain: Mediax5
(Q5+Q6+Q7+Q11+Q19+Q26))x4; (iii) social
relations domain: (Mediax2 (Q20+Q21+Q22))
x4; (iv) environmental domain: (Mediax6
(Q8+Q9+Q12+Q13+Q14+Q23+Q24+Q25))
x4. Then, the obtained scores were converted to a
scale from 0 to 100 using the formula [(Mean - 4)
× 100/16]. The higher the scores, the better the
assessment of quality of life.(14)
For the descriptive analysis, central tendency
measurements (mean and median) and
dispersion measurements (standard deviation and
interquartile range) were performed, according to
data distribution. After describing the absolute
and relative frequencies, the means were
compared using analysis of variance (ANOVA).
To evaluate the correlation between the variables,
the Spearman Correlation test was applied. The
interpretation of the correlation was classied
as weak for r values up to 0.399, moderate for
values between 0.400 and 0.699, and strong
for values equal to or greater than 0.700.(10) All
analysis adopted a signicance level of 5%.
The study was approved by the Institution’s
Research Ethics Committee under Certicate
of Presentation of Ethical Appreciation number
63105722.2.0000.5324. Before data collection,
participants were informed about the purpose of
the study and signed the Informed Consent Form.

Invest Educ Enferm. 2024; 42(3): e06
Alberto de Oliveira Redü • Daiani Modernel Xavier • Marcela Amaral Daoud • Giovana Calcagno Gomes • Elia-
ne Raquel Rieth Bennetti • Franciele Gomes Soares •Luciano Garcia Lourenção
Results
The study included 94 health professionals, 28
(29.8%) from the university hospital and 66
(70.2%) from the philanthropic hospital. Among
the professionals assessed, 21 (22.4%) were
nurses, 60 (63.8%) nursing technicians and
13 (13.8%) physical therapists. As shown in
Table 1, there was a predominance of females
(88.3%), white skin color (78.8%), age group
from 30 to 39 years (34.1%), and family income
between one and two minimum wages (31.9%),
weekly workload between 31 and 40 hours
(67.0%), night shift (54.3%), time of professional
experience from one to ve years (38.3%) and
with only one job (73.4%).
Table 1. Sociodemographic and professional characteristics of health workers in
Intensive Care Units. Rio Grande, RS, 2023. (n=94)
Variables n%
Work institution
University Hospital 28 29.8
Philanthropic Hospital 66 70.2
Professional Category
Nurse 21 22.3
Nursing technician 60 63.8
Physical therapist 13 13.8
Sex
Male 11 11.7
Female 83 88.3
Skin color
White 74 78.8
Black and brown 20 21.2
Age group
20 to 29 years 25 26.6
30 to 39 years 32 34.1
40 to 50 years 31 33.0
Over 50 years 6 6.4
Monthly family income
1 to 2 minimum wages 30 31.9
2 to 3 minimum wages 22 23.4
3 and ≤ 5 minimum wages 23 24.5
5 and ≤ 20 minimum wages 20 20.2
Weekly workload
≥ 20 and ≤ 30 hours 18 19.1
≥ 31 and ≤ 40 hours 57 67.0
> 40 hours 13 13.8
Work Shift
Daytime 43 45.7
Nighttime 51 54.3

Invest Educ Enferm. 2024; 42(3): e06
Repercussions of neck pain on the quality of life of health professionals in Intensive Care Units
Variables n%
Time of experience in the profession
≤ 12 Months 9 9.6
One to ve years 36 38.3
Six to ten years year; 15 16.0
> 10 years 34 36.2
Number of Jobs
One 96 73.4
Two 21 22.3
Three 4 4.3
Has been through work accidents
Yes 33 35.1
No 61 64.9
*Minimum wage amount: R$1320.00 ≈ USD 264.05 (1 USD = R$4.9997)
Table 1. Sociodemographic and professional characteristics of health workers in
Intensive Care Units. Rio Grande, RS, 2023. (n=94) (Cont.)
Data on the work environment were described
through qualiers, in which 61.7% of the
professionals evaluated that there is a condition
of overload in relation to the volume of service.
The furniture of the work sector was considered
in unsatisfactory conditions (regular, bad or very
bad) by 61.7% of the professionals. Although the
percentage of professionals who consider work
sector equipment as excellent or good (48.9%), for
more than 50% of professionals, these equipment
have regular or poor conditions (Table 2).
Table 2. Characteristics of the work environment of health workers in Intensive Care
Units. Rio Grande, RS, 2023. (n=94)
Variables n%
How do you evaluate the volume of work?
Light 1 1.1
Moderate 35 37.2
There is an overload 49 52.1
Exhaustive 9 9.6
How do you evaluate the furniture in your work sector?
Excellent 2 2.1
Good 34 36.2
Regular 46 48.9
Bad 11 11.7
Very bad 1 1.1
How do you evaluate the equipment in your work sector?
Excellent 4 4.2
Good 42 44.7
Regular 42 44.7
Bad 1 1.1

Invest Educ Enferm. 2024; 42(3): e06
Alberto de Oliveira Redü • Daiani Modernel Xavier • Marcela Amaral Daoud • Giovana Calcagno Gomes • Elia-
ne Raquel Rieth Bennetti • Franciele Gomes Soares •Luciano Garcia Lourenção
The analysis of the Neck Bournemouth
Questionnaire (Table 3) showed that there was no
statistical difference in the mean scores obtained
by each professional category (p>0.05). It is
noteworthy, however, that the professionals
obtained higher scores in the questions referring
to the presence of anxiety (question 4) and neck
pain (question 1) in the last week.
Table 3. Scores for the questions of the Neck Bournemouth Questionnaire, according to
the professional category of workers in the Intensive Care Units. Rio Grande, RS, 2023.
(n=94)
Scores for the Neck Bournemouth Ques-
tionnaire
Nurses Nursing Technicians Physical therapists
p-value
Mean (95% CI) Mean (95% CI) Mean (95% CI)
1. What was your level of neck pain 5.3 (4.1 – 6.5) 4.3 (3.6 – 5.1) 3.6 (1.8 – 5.4) 0.198
2. How much did your neck pain impair
your daily activities (Homework, bathing,
putting on clothes, getting up, reading and
driving)
4.1 (2.8 – 3.8) 3.0 (2.3 – 3.8) 2.8 (0.9 – 4.7) 0.307
3. How much did your neck pain affect your
recreational, social and family activities? 3.6 (2.5 – 4.8) 2.7 (2.0 – 3.4) 2.1 (0.3 – 3.9) 0.232
4. Did you feel anxious (tense, nervous,
irritable, having difculty concentrating/
relaxing)?
6.3 (4.9 – 7.6) 6.1 (5.3 – 6.9) 4.8 (2.8 – 6.8) 0.317
5. Did you feel depressed (“down”, sad,
pessimistic, and unhappy)? 4.6 (3.0 – 6.1) 4.4 (3.5 – 5.3) 3.8 (1.8 – 5.7) 0.794
6. How much has your neck pain gotten
worse, (or could it have gotten worse) with
work both outside and at home?
4.5 (3.3 – 5.8) 3.4 (2.6 – 4.1) 3.2 (1.0 – 5.5) 0.283
7. How much have you been able to control
(reduce) your neck pain on your own? 3.9 (2.8 – 5.0) 3.1 (2.4 – 3.7) 1.3 (0.5 – 3.3) 0.079
The evaluation of the level of pain and cervical
disability, based on the analysis of the NBQ
score in percentiles, revealed that 27 (28.7%)
professionals had a score ≤ 14 points (1st
percentile); 43 (54.8%) had a score > 14 and
< 75 points (2nd percentile); and 24 (25.5%)
professionals had a score ≥ 75 points (3rd
percentile). The latter are the ones with the
highest level of pain and cervical disability,
being: 7 (29.2%) nurses, 14 (58.3%) nursing
technicians and 3 (12.5%) physical therapists.
Figure 1 shows the analysis of the overall NBQ
score, by professional category.

Invest Educ Enferm. 2024; 42(3): e06
Repercussions of neck pain on the quality of life of health professionals in Intensive Care Units
Figure 1. General score of the Neck Bournemouth Questionnaire, according to the
professional category of workers in the Intensive Care Units. Rio Grande, RS, 2023.
(n=94)

Invest Educ Enferm. 2024; 42(3): e06
Alberto de Oliveira Redü • Daiani Modernel Xavier • Marcela Amaral Daoud • Giovana Calcagno Gomes • Elia-
ne Raquel Rieth Bennetti • Franciele Gomes Soares •Luciano Garcia Lourenção
Regarding the evaluation of quality of life,
the professionals had a lower score in the
physical domain (55.2 points) and a higher
score in the social relationships domain
(68.1points). Nurses had a significantly
lower score than other professionals in the
physical domain and nursing technicians
had a significantly higher score than other
professionals for overall quality of life (Table 4).
Table 4. Mean WHOQOL-Bref scores of workers in Intensive Care Units. Rio Grande, RS,
2023. (n=94)
WHOQOL-bref
DOMAINS
Nurses Nursing Technicians Physical therapists Total
p-value
Mean (95% CI) Mean (95% CI) Mean (95% CI) Mean (95% CI)
Physical 50.9 (46.8 – 54.9) 57.3 (54.9 – 59.6) 52.7 (47.7 – 57.8) 55.2 (47.7 – 57.8) 0.010
Psychological 60.1 (56.4 – 63.8) 63.0 (59.9 – 66.0) 61.9 (54.7 – 69.0) 62.2 (59.9 – 64.5) 0.595
Social Relationships 63.9 (57.1 – 70.6) 68.8 (64.0 – 73.5) 71.8 (57.8 – 85.8) 68.1 (64.3 – 71.9) 0.435
Environment 52.5 (46.7 – 58.4) 61.2 (58.1 – 64.3) 58.9 (47.8 – 70.0) 58.9 (56.2 – 61.7) 0.039
Overall QoL 55.4 (52.6 – 58.2) 61.4 (59.0 – 63.9) 59.5 (52.3 – 66.6) 59.8 (57.9 – 61.8) 0.037
As shown in Table 5, there was a negative
and statistically significant correlation of
neck pain and disability with quality of
life. There was a weak correlation between
neck pain and disability and the physical
(r: -0.218; p=0.035) and psychological (r:
-0.280; p=0.006) domains of quality of
life; and moderate correlation of neck pain
and disability with the social relationships
(r: -0.419; p<0.001) and environment (r:
-0.280; p<0.001) and with overall quality
of life (r: -0.280; p<0.001) domains. It is
also noteworthy the moderate correlation
of general quality of life with the feeling of
anxiety (r: -0.431; p<0.001) and depression
(r: -0.515; p<0.001) of professionals during
the last week.

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Repercussions of neck pain on the quality of life of health professionals in Intensive Care Units
Table 5. Correlations between Neck Pain and Disability (NBQ) with WHOQOL-BREF
DOMAINS
NBQ Questions
WHOQOL-BREF DOMAINS
Physical Psycholo-
gical
Social
Relations-
hips
Environ-
ment Overall QoL
1. During the last week, what
was your level of neck pain
-0.220*a
(0.033)
-0.095a
(0.362)
-0.259*a
(0.012)
-0.222*a
(0.032)
-0.242*a
(0.019)
2. During the last week, how
much has your neck pain
hindered your daily activities
(Homework, bathing, putting
on clothes, get up, reading and
driving)
-0.167a
(0.107)
-0.244*a
(0.018)
-0.315**a
(0.002)
-0.363**a
(<0.001)
-0.351**a
(0.001)
3. During the last week, how
much did your neck pain affect
your recreational, social and
family activities?
-0.166a
(0.110)
-0.212*a
(0.040)
-0.343**a
(0.001)
-0.394**a
(<0.001)
-0.357**a
(<0.001)
4. During the last week, have
you felt anxious (tense, nervous,
irritable, having difculty concen-
trating/relaxing)?
-0.220*a
(0.033)
-0.346**a
(0.001)
-0.339**a
(0.001)
-0.380**a
(<0.001)
-0.431**b
(<0.001)
5. During the last week, have
you felt depressed (“down”, sad,
pessimistic, unhappy)?
-0.222*a
(0.031)
-0.449**b
(<0.001)
-0.464**b
(<0.001)
-0.432**b
(<0.001)
-0.515**b
(<0.001)
6. During the last week, how
much has your neck pain gotten
worse, (or could it have gotten
worse) with work both outside
and at home?
-0.152a
(0.144)
-0.197a
(0.057)
-0.346**a
(0.001)
-0.358**a
((<0.001)
-0.339**a
(0.001)
7. During the last week, how
much have you been able to
control (reduce) your neck pain on
your own?
-0.103a
(0.323)
0.003a
(0.980)
-0.269**a
(0.009)
-0.241*a
(0.019)
-0.197a
(0.057)
Total Score -0.218*a
(0.035)
-0.280**a
(0.006)
-0.419**b
(<0.001)
-0.420**b
(<0.001)
-0.431**b
(<0.001)
* p<0.05. **p<0.01. a Weak correlation; b Moderate correlation.

Invest Educ Enferm. 2024; 42(3): e06
Alberto de Oliveira Redü • Daiani Modernel Xavier • Marcela Amaral Daoud • Giovana Calcagno Gomes • Elia-
ne Raquel Rieth Bennetti • Franciele Gomes Soares •Luciano Garcia Lourenção
Discussion
The study made it possible to analyze the
work environment of health professionals in
Intensive Care Units, examining how neck pain
affects the quality of life of these workers. The
results showed that neck pain has the potential
to negatively impact the quality of life of the
health professionals studied. Musculoskeletal
pain, especially neck pain accompanied
by disability, usually originates in the work
environment and affects several aspects of
health. They negatively impact the physical
and mental health and overall quality of life of
health professionals.(4,15) Nevertheless, during
the pandemic period there was a mix of feelings
capable of enhancing existing pains, due to the
environment and work routine, or contributing
to the emergence of new pains.
Workers have a higher risk of developing neck pain
when facing high work demands.(7,16) As shown in
the present study, the greater the volume of work
felt by workers, the greater the perception of neck
pain. In this sense, it is important to highlight that
the units studied have different characteristics.
Some attend a high turnover of patients, which
can increase the physical wear of professionals.
Other units deal with patients with chronic
diseases, which generates additional physical and
psychological demands for workers. In addition,
some services focus on the conduct established
only by physicians, disregarding the contribution
of other professionals. The literature points to the
lack of support from colleagues and the limitation
in decision-making power as risk factors for the
onset of neck pain.(7,16)
Another point to be highlighted is the repercussion
that the volume of service perceived by workers
causes in activities of daily living, leisure, social
or family activities. The intensity of low back
pain is associated with worse prognosis for pain
relief and greater physical limitations for daily and
social activities.(17) Nevertheless, neck and lower
back pain can be inuenced by work strain caused
by work-life imbalance. The constant pressure to
follow conducts that disregard multidisciplinary
collaboration can generate tensions. When these
stresses are combined with low pay and the need
to work more than one job, professionals are
more vulnerable to musculoskeletal problems.
Therefore, strategies that reduce tensions in the
health team can be effective in preventing these
injuries.(1,17) A study with Primary Health Care
professionals indicated that neck pain affected
only the physical and psychological domains
of quality of life.(18) In contrast, our study of
intensive care unit professionals revealed that the
level of neck pain was associated not only with
the physical domain but also with the social,
environmental, and overall quality of life domains.
The association of higher levels of neck pain
with lower quality of life scores observed in our
study suggests a possible relationship between
the complexity of the work environment and the
occurrence of neck pain.
A study carried out in China showed that nursing
professionals presented, primarily, pain in the back
and lower limbs. In addition to estimating that
more than a third of professionals reported pain
reexes in their daily lives and sleep impairments.
(19) Similar results were found in the present study,
where health professionals who reported greater
impact of neck pain on daily activities showed a
strong association with the physical domain. This
domain includes the evaluation of factors such as
pain and discomfort, day-to-day activities, sleep
and rest.(14) Saudi health professionals presented
with high-intensity neck pain when compared to
symptoms of shoulder pain.(20) It is common for
cervical spine pain to have a negative impact
on the physical and mental health of workers.
In this sense, psychological factors, such as
anxiety, are responsible for worsening neck pain
crises, in addition to contributing to disability and
kinesiophobia. In addition, patients with neck
pain crises may experience periods of anxiety.
(1,21) In addition to anxiety, problems related to
depressive events also contribute to neck pain,
creating a bidirectional mechanism in which pain

Invest Educ Enferm. 2024; 42(3): e06
Repercussions of neck pain on the quality of life of health professionals in Intensive Care Units
and disability reinforce each other.(1,21) Feelings
of sadness, pessimism, and unhappiness are
often associated with neck pain disorders,
which can lead to high morbidity.(1) However, to
diagnose a depressive disorder, it is necessary
for the individual to be evaluated by a mental
health professional. In addition, the excessive
volume of work and the lack of decision-making
power make the professional feel powerless,
which can result in negative consequences
outside the work environment.(18)
Some osteokinematic movements, when
performed excessively or sustained by long hours
of work, such as cervical exion and rotation,
are associated with psychosomatic symptoms,
such as anxiety, depression and Post Traumatic
Stress Disorder (PTSD).(20,22) As elucidated in our
study, the worsening of neck pain during work
was a reality found that, in turn, compromised
all domains of QoL. A meta-synthesis identied
that neck pain proves to be of multidimensional
phenomenology, affecting both the physical and
psychological domains, as well as the social one.
(23) In the present study, we observed an inverse
correlation between the ability to control or
reduce neck pain and quality of life, indicating
that health professionals who face more difculty
in controlling pain have greater losses in the
physical, social, general and environmental
domains. According to the literature, there are
different strategies for coping with neck pain, such
as psychotherapy, pharmacological treatments,
electrotherapy, dietary changes, mental health
resources, lifestyle adaptations and regular
practice of physical activity.(24)
A qualitative study conducted in Canada(24)
showed that chronic pain represents an important
factor of interference in all aspects of QoL, in
addition to highlighting the importance of a
clinical diagnosis, and not only strategies for
coping with it. In the case of Brazil, the low
remuneration received by professionals leaves
them hostage to drug treatments, which are often
ineffective because they do not treat the cause.
This situation leads to chronic pain, which can
culminate in incapacity for work. To face this
problem, strategies are needed that promote the
adequate sizing of professionals for the demands
of health units, the availability of equipment that
assists in the manual transport of cargo and the
implementation of public policies for valuing and
promoting the health of professionals in intensive
care units.(6,25)
It is concluded that neck pain has had
repercussions on several aspects of the lives of
health professionals working in intensive care
units, including the physical, psychological, social,
and environmental and quality of life domains.
The increase in pain and disability affects feelings
of anxiety and depression, further contributing to
the worsening of the quality of life and well-being
of these professionals.
As a limitation of the study, it is noteworthy
that the sample restricted to two hospital units
in a municipality in southern Brazil may not
capture the diversity of work environments and
conditions that inuence neck pain and quality
of life, resulting in a reduced view of the factors
involved and the dynamics of evolution of these
conditions. However, the results obtained are
able to support the implementation of prevention
and intervention strategies that can reduce the
incidence of neck pain and its consequences on
the quality of life of workers, such as ergonomics
and psychological support programs. In addition to
directing institutional managers and professionals
responsible for occupational health to make
changes in the work environment and in worker
support practices, aiming to improve the quality
of life and well-being of these employees.

Invest Educ Enferm. 2024; 42(3): e06
Alberto de Oliveira Redü • Daiani Modernel Xavier • Marcela Amaral Daoud • Giovana Calcagno Gomes • Elia-
ne Raquel Rieth Bennetti • Franciele Gomes Soares •Luciano Garcia Lourenção
References
1. Kazeminasab S, Nejadghaderi SA, Amiri P, Pourfathis H, Araj-Khodaei M, Sullman MJM, Kolahi AS, Sari S. Neck
pain: global epidemiology, trends and risk factors. BMC musculoskeletal disorders. 2022; 23(36):1-13.
2. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence,
prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a
systematic analysis for the Global Burden of Disease Study 2016. The Lancet. 2017; 390(10100):1211-1259.
3. Kondo Y, Ota R, Fujita H, Miki T, Watenabe Y, Takebayashi T. Quality of Japanese Online Information on Causes of
Neck Pain: A Biopsychosocial Analysis. The Cureus Journal of Medical Science. 2023; 15(7):1-7.
4. Mukhtar NB, Ibrahim AA, Mohammed J. Prevalence of neck pain and its associated factors in Africa: a systematic
review and meta-analysis protocol. BMJ Open. 2023; 13(9):e074219.
5. Fleck MPA, Leal OF, Louzada S, Xavier M, Chachamovich E, Vieira G, et al. Desenvolvimento da versão em
português do instrumento de avaliação de qualidade de vida da OMS (WHOQOL-100). Revista Brasileira de
Psiquiatria. 1999; 21(1):19-28.
6. Carvalho TM, Lourenção LG, Pinto MH, Viana RAPP, Moreira AMB da SG, Mello LP, et al. Quality of life and
work engagement among nursing staff at the start of the COVID-19 pandemic. Ciência & saúde coletiva. 2023;
28(10):2903-13.
7. Jahre H, Grotle M, Smedbraten K, Dunn KM, Oiestad BE. Risk factors for non-specic neck pain in young adults.
A systematic review. BMC musculoskeletal disorders. 2020; 21(366):1-12.
8. Lourenção LG, Silva FR, Gazetta CE, Cunha CLF, Sassaki NSGMS, Nascimento VF, Pompeo DF. Sintomas
osteomusculares em prossionais da Atenção Primária à Saúde. Revista de Epidemiologia e Controle de Infecção.
2024; 14(2):19039.
9. Han L, Wong FKY, She DLM, Li SY, Yang YF, Jiang MY, et al. Anxiety and Depression of Nurses in a Northwest
Province in China During the Period of Novel Coronavirus Pneumonia Outbreak. Journal of Nursing Scholarship.
2020; 52(5):564–573.
10. Lourenção LG, Penha JGM, Ximenes Neto FRG, Santos BMP dos, Pantoja VJ da C, Ribeiro JN, et al. Analysis of the
association between levels of compassion fatigue and work engagement with COVID-19 in nursing professionals.
Ciência & saúde coletiva. 2023; 28(10):2867–77.
11. Gajda J. Professional Adaptation of New Employees to the Organization. System Safety: Human - Technical Facility
– Environment. 2019; 1(1):929-38.
12. Centro de referência em saúde do trabalhador da Baía de Ilha Grande. Questionário geral sobre condições de
saúde do trabalhador. 2023 [cited 2023 Out 23]. Available from: https://www.angra.rj.gov.br/questionariosaude
?IndexSigla=SSA&vNomeLink=Question%E1rio%20sobre%20condi%E7%F5es%20de%20sa%FAde%20do%20
trabalhador
13. Kamonseki DH, Tavares-Preto LCJ, Peixoto BO, Rostelato-Ferreira S. Tradução e validação do Neck Bournemouth
Questionnaire para o português do Brasil. Revista Brasileira de Reumatologia. 2017; 57(2):141-148.
14. Fleck MPA. O instrumento de avaliação de qualidade de vida da organização mundial da saúde (WHOQOL):
características e perspectivas. Ciência & Saúde Coletiva. 2000; 5(1):33-38.
15. Sun W, Zhang T, Zhang H, Zhang R, Cai W. Prevalence of Work-Related Musculoskeletal Disorders among Nurses:
A Meta-Analysis. Iranian Journal of Public Health, 2023; 52(3):1-9.
16. Mutubaki EN, Beljon Y, Maas ET, Huygen FJPM, Ostelo RWJG, Van Tulder MW, et al. The longitudinal relationships
between pain severity and disability versus health-related quality of life and costs among chronic low back pain
patients. Quality of life research. 2020; 29(1):275-287.
17. Rassas I, Mahfoudh A, Khelil A, Amri C, Chaari N, Henchi A, et al. Strain-based work-to-family conict as a
predictor of lumbar and cervical pain in Tunisian nursing staff. International Journal of Occupational Safety and
Ergonomics. 2022; 28(2):856–862.
18. Cordioli Junior JR, Cordioli DFC, Gazetta CE, Silva AG, Lourenção LG. Quality of life and osteomuscular symptoms
in workers of primary health care. Revista Brasileira de Enfermagem. 2020; 73(5):e20190054.

Invest Educ Enferm. 2024; 42(3): e06
Repercussions of neck pain on the quality of life of health professionals in Intensive Care Units
19. Guan J, Wu D, Xie X, Duan L, Yuan D, Lin H, et al. Occupational factors causing pain among nurses in mainland
China. Medical Science Monitor Basic Research. 2019; 25(1):1071-1077.
20. Almogbil IH, Alrashidi LR, Alhajlah RS, Alqasim AK, Alharbi NS, Alghamdi MA, et al. Prevalence of Shoulder
and Neck Pain Among Healthcare Workers in the Central Region of Saudi Arabia. The Cureus Journal of Medical
Science. 2023; 15(7):1-10.
21. Manseld M, Taylor JL, Bannister K, Spahrs N, Jong ST, Smith T. The association between psychosocial factors and
mental health symptoms in cervical spine pain with or without radiculopathy on health outcomes: a systematic
review. BMC musculoskeletal disorders. 2023; 24(1):1-13.
22. Bucher T, Volken T, Pfeiffer F, Schaffert R. Musculoskeletal pain in health professionals at the end of their studies
and 1 year after entry into the profession: a multi-center longitudinal questionnaire study from Switzerland. BMC
musculoskeletal disorders. 2023; 24(1):1-11.
23. Maistrello LF, Zanconato L, Palese A, Geri T, Turolla A, Gianola S, Dell’isola A, Rossettini G. Perceptions and
Experiences of Individuals With Neck Pain: A Systematic Critical Review of Qualitative Studies With Meta-Summary
and Meta-Synthesis. The Journal of Physical Therapy Science. 2022; 102(8):1-23.
24. Bruce M, Lapatina E, Hodge J, Moffat K, Khan S, Pyle P, Kashuba S, Wasylak T, Santana MJ. Understanding the
chronic pain journey and coping strategies that patients use to manage their chronic pain: A qualitative, patient-led,
Canadian study. BMJ Open, 2023; 13(7):1-9.
25. Viegas SMF. Lâmpada que não se apaga: enfermagem em prol do reconhecimento social e valorização de seus
prossionais. HU Revista. 2021; 46:1-2.