How to cite:
Fadma Putri, I Putu Gede Adiatmika, I Made Krisna Dinata. (2021).
Improvement of Working Condition through a Participatory Ergonomics
Approach Decrease Low Back Pain Complaints and Increase the
Productivity of Tailors. Journal Eduvest. 1(10): 1152-1162
E-ISSN:
2775-3727
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Eduvest – Journal of Universal Studies
Volume 1 Number 10, October 2021
p- ISSN 2775-3735 e-ISSN 2775-3727
IMPROVEMENT OF WORKING CONDITION THROUGH A
PARTICIPATORY ERGONOMICS APPROACH DECREASE LOW BACK
PAIN COMPLAINTS AND INCREASE THE PRODUCTIVITY OF TAILORS
Fadma Putri, I Putu Gede Adiatmika, I Made Krisna Dinata
Udayana University
E-mail: [email protected], [email protected]
ARTICLE INFO ABSTRACT
Received:
September, 26
th
2021
Revised:
October, 16
th
2021
Approved:
October, 18
th
2021
Tailors work in a static position and bend over with a
relatively long duration of workPostural muscle load on
tailors results in the risk of complaints of low back pain
which affects the productivity of tailor. The aim is to know
the effect of improving working conditions through a
participatory ergonomics approach to reduce low back
pain complaints and increase tailor productivity.The
method uses of experimental research with treatment by
subject design, involving 9 samples selected by simple
random sampling. Period 1 sample is working with
conventional working conditions. Period 2 samples
worked with improving working conditions through a
participatory ergonomics approach. Washing out period
and adaptation are given between the two periods.
Complaints of low back pain were measured by the
Oswestry Disability Index, while productivity was based on
a comparison between the number of stitches/day and the
score for complaints of low back pain per working time.
The results showed that improving working conditions
through a participatory ergonomics approach had a
significant effect (p < 0.05). There was a decreasing in low
back pain by 11.87% from an average of 48.67±1.73 to
42.89±1.76 and an increasing in productivity of 42.10%
Fadma Putri, I Putu Gede Adiatmika, I Made Krisna Dinata
Improvement of Working Condition through a Participatory Ergonomics Approach
Decrease Low Back Pain Complaints and Increase the Productivity of Tailors 1153
from an average of 0.038±0.004 to 0.054±0.005.
KEYWORDS
Improvement of working condition, low back pain complaints,
participatory ergonomics, productivity
This work is licensed under a Creative Commons
Attribution-ShareAlike 4.0 International
INTRODUCTION
In this era, society’s interest in fashion is increasing, and the order consumer
needs the businessman to improve their development of the garment industry. The
development of the garment industry in one area gives a positive effect especially for
increasing the labor, therefore it will support the economy and have the benefit to the
public as well as to create a job. One of the garment industries that was productive is
Putra Karmila Garment in Gianyar City, Bali. The development of the industry needs to
require the owner to increase the quality of the product within managing it wiser. The
occupational health and safety of the tailor in the garment industry is the most important
to improve quality of the product.
The result of an observational study and interview with tailors at Putra Karmila
Garment were they could make 15-18 products a day, but there were any symptoms of
health problem that make their time off and decreased of daily production targets. This
condition affected to loss of their focus and it could be some mistake or problem with
their production. The health problem mostly they have is low back pain.
Low Back Pain (LBP), the symptoms felt by tailors at the Garment caused by
lack of mobility and lack of time management. The tailors always cut their time off to
break because of their target of production and they wanted to increase the production as
much as they can. Long work duration is another risk factor for their symptoms, they
worked 8 hours a day with a 1-hour break for 6 days per week. That means they have
seated static with slouch posture (not properly as the physiological body) for a long time.
While sitting slouch position, there were decreasing in the lordosis lumbar angle.
This condition made weakness of abdominal muscles and tightness of the postural
muscle, there is a stretch of posterior ligament and if the condition duration for a long
time affected to intradiscal pressure increased and constantly make a pain
(Tjahayuningtyas, 2019; Wirgunatha & Adiputra, 2019).
The duration of work is the other risk factor that would affect to work position.
Human-machine interaction in a sewing process needs to highlight because this is will
have an important impact and this condition based on the table and the chair. The tailors
at Putra Karmila Garment Industry used chairs (plastic material) height 41 cm, length 27
cm and width 27 cm. It was not appropriate with their anthropometry and the addition
they used the chair without backrest and hard seat cushion below made the tailors sew-in
a poor posture that will be affected to their physiological body. According to (Nag, Vyas,
& Nag, 2016), a hard seat cushion below the chair is affected to increase the postural
muscle load for postural control. The increased load of muscle have a big impact on
fatigue and make them uncomfortable.
LBP felt by tailors have been decreased by a poor and not ergonomically work
environment and caused an increase of the stress due to work, loss of motivation, and
high risk of a work accident that will affect low the productivities and their welfare.
(Dewi et al., 2018). The cold temperature affected metabolism and it will make the body
slower, lack of nutrition to soft tissue and make the necrosis of some muscle’s tissues
therefore the contractility is not efficient cause pain. (Tarwaka, 2014).
Eduvest – Journal of Universal Studies
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1154 http://eduvest.greenvest.co.id
A recent study in Putra Karmila Garment Industry showed six from thirteen
tailors have musculoskeletal problems, five of them have LBP and the other has upper
extremity pain. RULA (Rapid Upper Limb Assessment) was used to examine the problem
of working position and they have a score of 5 which means their work position needs
some intervention and changes. This problem has been concluded with the changes of
working position approached with participatory ergonomic.
Changes of work position approached by participatory ergonomic including
changing their chair, suggest of break time and core stability exercise before they work.
All of those conditions need agreement from the owner and agreement by the tailors to
make a good plan and solution for the problem. Ergonomic participatory gives them
responsibility for their body and their problem shake the good result at the end (Suhardi,
Citrawati, & Astuti, 2021). Using the ideal chair will decrease the load of hip muscle and
as well as on the postural muscles. Therefore, working position will relax and reduce LBP
complaints (O’Keeffe, Dankaerts, O’Sullivan, O’Sullivan, & O’Sullivan, 2013). Duration
of break 5 minutes at 10.00 and 15.00 WITA and gave them exercise core stability
before work aims to reduce off time work accumulation and activate deep muscle for
weight-bearing more efficient because the deep muscles and global muscle balance
contracted and synergy. Global muscle is a fatigue type muscle, while the deep muscle
activates and caused the global muscle to slowly contracted therefore nutrition and
oxygen at tissue enough and reduced of LBP complaints (Stuber, Bruno, Sajko, &
Hayden, 2014).
One research in 2013 showed changes of the chair with the backrest more
effective than using the chair without backrest and that affected LBP complaints
(O’Keeffe et al., 2013). A break from the work time has been reported to reduce stress
caused by work and that will reduce the musculoskeletal problems, stay focus and
increase productivity (Sutapa, Sudiarsa, & Susila, 2017). The other study about core
stability exercise in 2017, assess pain intensity in LBP using Visual Analog Scale (VAS)
in 414 patients, the program core stability exercise is more effective to reduce the
intensity of LBP complaints and increase functional capacity than the general exercise
(Coulombe, Games, Neil, & Eberman, 2017).
This study aims to improve the working condition through an ergonomic
participatory approach include of changes in the chair, suggest to increase of break and
intervention with core stability exercise to reduce of low back pain complaints, and
increasing the productivity from the tailors at Putra Karmila Garment Industry.
RESEARCH METHOD
This study is an experimental study which treatment by subject design and along
with time period. The research in Putra Karmila Garment Industry at Gianyar, Bali. The
intervention period started 1st February 2021 – 1st May 2021. There are nine samples
randomized using simple random sampling. LBP complaints were assessed by
Questionnaire Oswestry Disability Index that have 10 items and productivity of them was
measured by comparing their product (product or shirt in one day), LBP complaints score
per unit time that means 8 hours per day. Hypothesis test used SPSS (version 16.0) with
value of α = 0.05.
Fadma Putri, I Putu Gede Adiatmika, I Made Krisna Dinata
Improvement of Working Condition through a Participatory Ergonomics Approach
Decrease Low Back Pain Complaints and Increase the Productivity of Tailors 1155
RESULT AND DISCUSSION
Category of age the sample was middle age that was a productive category
(Primadi, 2020). The mean of work experience is 12 years that means sample if the
samples of this study have good experience and good skills. Besides affected skill, age
and work experience will affect LBP complaints. At 35 years old, there will be a decrease
in functional capacity and will continue along with the aging and increase the risk factor
to have LBP complaints (Nooryana, Adiatmika, & Purnawati, 2020; Tarwaka, 2014).
Workers that have work experiences more than 4 years will have result better than the
other but have a high risk of 11.71 times for having LBP syndrome (Riningrum &
Widowati, 2016; Shafira & Listiara, 2017). In addition, worker’s body mass index (BMI)
more than 27 kg/m
2
(obesity) had a higher risk to have musculoskeletal problems than
they with BMI normal and underweight especially on the lower extremity, hip, and
pelvic. Due to posture changes the lordosis of the lumbar caused weakness on abdomen
muscles, therefore make changes on the center of gravity of the body to anteriorly. The
effect of this condition is to increase the load of paravertebral muscles and if it happens in
a long period will have mechanical stress on the low back (Kaçuri, Murtezani, Rrecaj,
Martinaj, & Haxhiu, 2015).
Data of samples characteristic in Table 1 below.
Table 1. Data Characteristic Samples
Variabel
n
Mean±SD
Range
Age (Year)
9
48±2.55
42-50
Height (Cm)
9
158.78±2.73
154-163
Weight (Kg)
9
57.78±5.29
50-64
Body Mass Index (Kg/m
2
)
9
22.96±1.99
19.8-25.2
Work Duration (Year)
9
12±3.49
8-18
Normality test using Shapiro-Wilk test to show the distribution of data (α=0.05)
variable including work environment, LBP complaints pre and post, and the productivity
in Period 1 and Period 2. The result of the normality test is shown in Table 2 below.
Table 2. Normality Test Work Environment, Low Back Pain and Productivity
Variable
Period 1
Period 2
P value
P value
Temperature (°C)
0.804
0.167
Humidity (%)
0.660
0.505
Light Intensity (lux)
0.242
0.204
Noise (dBA)
0.049
0.198
Wind velocity (m/s)
0.089
0.101
Low Back Pain complaints (Pre)
0.364
0.208
Low Back Pain complaints (Post)
0.132
0.338
Productivity
0.000
0.000
Normality test of all variables distribute normally (p>0.05), except the noise data in
Period 1 and productivity data all period (p<0.05). Comparability test for the work
environment aims to show there are differences of condition on this research time period,
while the test for LBP complaints pre and post-study aims to observe the difference after
given the intervention of exercise and test for productivity data aims to prove there are an
improvement or a derivation mean of their production after the intervention period.
Comparability tests shown below in Table 3.
Eduvest – Journal of Universal Studies
Volume 1 Number 10, October 2021
1156 http://eduvest.greenvest.co.id
Table 3 Comparability test on Work environment, Low Back Pain and Productivity
Variabel
Period 1
Period 2
P value
Mean±SD
Mean±SD
Temperature (°C)
28.58±0.74
29.00±0.45
0.185
a
Humidity (%)
72.33±1.40
72.66±1.63
0.102
a
Light Intensity (lux)
990.33±45.01
1003.58±9.21
0.481
a
Noise (dBA)
74.16±4.08
73.41±4.15
0.066
b
Wind Velocity (m/s)
0.15±0.111
0.15±0.006
0.750
a
Low Back Pain complaints
(Pre)
34.67±2.00
34.89±2.02
0.782
a
Low Back Pain complaints
(Post)
48.67±1.73
42.89±1.76
0.000
a
Productivity
0.037±0.004
0.054±0.005
0.007
b
a. Paired sample test
b. Wilcoxon’s test
In Table 3 showed that the temperature and humidity environment at Putra Karmila
Garment Industry has an ideal value for industrial activity. This condition was similar to a
study by (Lady & Wiyanto, 2019) that stated temperature in the industry environment
around 18°C-30°C and mean the humidity is 65%-95%. Lighting during work activities
in garment used sunlight that flows within the main door and air ventilation.
Transportation is one of noise for the industry because of the location of this industry in
center of the city. But this condition is categorized normally based on the standard of
occupational health and safety according to the Indonesian Ministry of Manpower’s
regulation Number 5 about Occupational health and safety in the work
industry (Menaker, 2018). In addition, wind velocity has mean and standard deviation
0.15±0.111 on Period 1 and on Period 2 is 0.15±0.006 which means ideal condition.
Pandiangan et al (2013) stated standard of wind velocity in industry work activity
range from 0.15-0.25 m/s. Comparability test of work environment along period showed
that was not significant statistically (p>0.05), and the conclusion is along period of this
study has similar work environment characteristic.
Before Period 2 started, the washing out period did aims to move out of the
residual effect, therefore preconditions along period have similar characteristics. The
result of data in Table 3 showed there were no significant statistically on LBP complaints
pre and post within p >0.05.
Samples of this study chosen by inclusion and exclusion criteria, they are having
not deformity on their body and not disabilities. LBP complaints in the sample are not
caused by trauma history on the spine, but its consequence of poor work position (not
ergonomic position). There was unaware of work position, unideal of facility, overtime
work duration, and lack of mobility from them. Mobility has an important part of the
human body and lack of mobility due to static position for a long time made isometric
contraction of postural muscles and caused of mechanical stress at muscle tissue. It will
increase the nociceptor stimulation on muscle tissue active, therefore there are increasing
of tightness muscle and will have local ischemic effect to decrease of nutrition and
oxygen absorption and the residual of metabolism (Sugijanto & Bimantoro, 2008).
Residual of metabolism called Lactate Acid that gives an imbalance of aerobic
energy within decreasing of oxygen capacity in tissue muscle and start the muscle activity
using Adenosine Triphosphates (ATP) and Creatine Phosphate (CP) in limited stock.
Maintaining the activity of muscle tissue energy supply will change to a carbohydrate
called glucose. Carbohydrates are converted to glucose, restore in the pancreas and
Fadma Putri, I Putu Gede Adiatmika, I Made Krisna Dinata
Improvement of Working Condition through a Participatory Ergonomics Approach
Decrease Low Back Pain Complaints and Increase the Productivity of Tailors 1157
muscles as glycogen is energy storage. Anaerobic Glycogen releases energy from
glycogen molecules resulted in ADP and Pi to ATP, this process will release energy for
the body and have lactate acid as the end part of the process anaerobic glycolysis which
pain physiological in muscle tissue (Hidayah, 2018).
In addition, static sitting position using the unideal chair (not required as
anthropometry) for long period caused neck compensation to forward head posture.
Forward head posture affected the postural body especially the cervical spine and neck
muscles. Isometric contraction of M. Extensor Cervical due to overuse flexion movement.
Imbalance muscles affected postural problems such as posterior pelvic tilt and increase
thorax’s kyphosis curve and reduce lordosis curve of the lumbar. If this condition persists,
degeneration will increase twice and the risk of injury in ligament caused pain (Talati,
Varadhrajulu, & Malwade, 2018). LBP complaints also affected the productivity of the
tailor on the day (Nooryana et al., 2020).
Table 3 showed that LBP complaints post on the second period have significant
difference statistically p<0,05 and there is the reduction of mean pre and post 48.67±1.73
to 42.89±1.76 or 11.87%. Mean of productivity along period showed significant
difference with the increase mean of data 0.016 or 42.10% (0.038±0.004 to 0.054±0.005).
This happened because of improving the work condition use the ergonomic
participatory approach, that all elements in the garment industry participated to have one
solution to improve their quality of life and as well as their business (Tappin, Vitalis, &
Bentley, 2016). A study by Susihono et al (2017) stated that the ergonomic participatory
approach has an impact on decrease the LBP complaints by 12.91%, meanwhile, the other
study from Guimaraes et al (2015) improvement of work condition used ergonomic
participatory improve productivity 46%. Otherwise, ergonomic intervention without an
ergonomic participatory approach increasing their productivity by 15.38% (Tunas, 2005).
The ergonomic participatory approach has a chance and one of a good program of work
condition, all elements in the entire industry participated actively from analyzing to
solved the problem. This condition will give the participant a responsibility to challenge
themselves. Ergonomic participation could be reliable and continuing for the work
situation more effective, efficient, safe and pleasant (Limerick, 2018). In addition, this
approach aims to not change extremely (Suhardi et al., 2021; Tappin et al., 2016).
Work condition improvement through an ergonomic participatory approach in this
study including changes in the chair, suggests break time, and intervention core stability
exercise. Change the chair by anthropometry measurement aims tailor to have better
sitting position and designed new chair along with their body. All data anthropometry can
see in Table 4 below
Table 4. Anthropometry
Anthropometry
Mean±SD
Percentage
5
50
95
Popliteal Height (Cm)
45.78±1.20
43.81
45.78
47.76
Popliteal Length-
Buttock (Cm)
48.11±1.05
46.38
48.11
49.84
Hip width (Cm)
47.22±1.72
44.40
47.22
50.04
Shoulder width (Cm)
45.56±1.24
42.74
45.56
48.38
Shoulder height (Cm)
58.00±1.22
55.99
58.00
60.01
Table 4 showed the design plan of chairs for samples and it based on their
proportion, required the smallest body (percentage 5%) from the height of popliteal to the
Eduvest – Journal of Universal Studies
Volume 1 Number 10, October 2021
1158 http://eduvest.greenvest.co.id
buttock, while the largest body dimension used (percentage 95%) of hip width, height,
and width of the shoulder. This design was recommended from a recent study by
(Carolina, Wibowo, & Rizqi, 2020; Suryatman & Ramdani, 2019). Changes on the
chair’s backrest were expected to facilitate posture samples, but that was not. According
to samples in this study, the backrest was uncomfortable to them. They prefer to have a
position nearest to the table to have focus when sewed, but their new chair has a height
more comfortable than their old chair. It has been measured with anthropometry and now
it had a cushion to make it more comfortable. That was stated in a study by (Yuliana,
Yamtana, & Husein, 2019) there were decreased of LBP complaints by 26.62% after
changes on a chair be more ergonomic. In addition, Manuaba (2003) showed work
station’s improvement and changes the equipment based on anthropometry will make the
work situation better and increasing productivity.
In this study, there was suggested to enhance the break time of samples at 10.00
WITA and 15.00 WITA and tell them to have a glass of water. This is a great solution for
them due to their lack of mobility and static sitting position for a long time. That will be
habitual to change their old habit and it had a benefit for their body too, the most
important that new habitual will make the new ergonomic situation in work. De Carvalho
(2015) stated walking is one of dynamic activity had rhythm, and their break time for
walking to drink is a good choice and it will minimize the effect of static position and
reduce postural load. Similar to a study by Ding et al (2020), active rest is changing
position and had stretched for 5 minutes give a better muscle performance 30-45 minutes
better than passive intervention. In addition, they showed there was minimized of some
mistakes in employees while writing or typing after took break time for 3 minutes every
20 minutes (Nakphet, Chaikumarn, & Janwantanakul, 2014).
Otherwise, improvement work conditions through the ergonomic participatory
approach combine with core stability exercise. It started before samples of this study
worked. Dose of the exercise is 3 times a week for 6 weeks period study. Core stability
exercise is given by researcher before they started activity at garment supposed by the
owner. Woods et al (2017) in their study used to exercise in the morning before all their
samples activity did aims to prepare and increase their muscle capacity for decreased risk
of injury. The temperature of the body increased during exercise caused vasocontraction
of vessels and hemoglobin binding oxygen more than usually, increased oxygen in blood
plasm at muscle tissues. Exercise before activity in the morning had the benefit to boost
the metabolism process and reduce of viscosity to have muscle contraction effective.
Core Stability exercise targeted core muscle including traverses abdominis,
Multifidus, paraspinal muscle, abdominal muscle, diaphragm, and pelvic floor muscle
aims to increase neuromuscular control, endurance, the strength of muscle central, and
stability of spine (Kisner & Colby, 2016). Core stability exercise activated deep muscle to
load and movement body more efficiently due to the integration and balance of deep
muscle and global muscles (Berbudi, Adiputra, & Sugijanto, 2014). A recent study that
used core stability exercise showed a decrease in LBP complaints and increased
endurance of abdominal muscles and pelvic floor muscles in patients who had chronic
low back pain (Ebrahimi, Blaouchi, Eslami, & Shahrokhi, 2014). Core stability exercises
is more effective than conventional exercise to reduce symptoms of nonspecific low back
pain (Akhtar, Karimi, & Gilani, 2017). Another research used Mc Kenzie Exercise that
had similar principal and program with core stability exercise showed effectiveness in
increase the productivity of Kendang Tambur Carver (Hamzah et al., 2018).
A better result from the study by Meisatama et al (2018) there was work condition
improvement with the other characteristic of labor in a static position with reducing LBP
complaints about 37%. Their characteristic sample on work duration ±24 hours per week,
Fadma Putri, I Putu Gede Adiatmika, I Made Krisna Dinata
Improvement of Working Condition through a Participatory Ergonomics Approach
Decrease Low Back Pain Complaints and Increase the Productivity of Tailors 1159
meanwhile in this study is 48 hours per week. This condition affected increased muscle
contraction and ligament strength. Sitting position for 5-8 hours in a day had 8.6 times
risk to have symptoms low back pain than if had sat in 1-4 hours in a day (Wijayanti,
Oktafany, Ramadhian, Saftarina, & Cania, 2019) differences in this study will affect
differences in LBP complaints.
Improvement of work conditions used the ergonomic participatory approach had
many benefits on the economic side. According to Hendrick (2001), the economy had
better when the ergonomic system was within. This statement agreed by some research on
increasing of salary tailors, they gained 25% more. Period 1 in this study showed
production samples reach 16 pieces shirt in a day and after the intervention increased to
20 pieces of the shirt in a day. This is accumulated to their fee of Rp5.000,00 per piece,
which means in Period 1 they got Rp2.400.000,00, and that increased in Period 2 to
Rp3.000.000,00. Changes on the chair are an effort from the Owner and it is worth for
accumulation of their profit because of productivity. The chair's worth and the economic
usage of it is 4 months, but it will depend on the material of chairs and suggested to use
wooden material because of good material and sturdier than plastic material which
fragile. In this study, work condition improvement used an ergonomic participatory
approach with changes the chair, increasing break time and intervention core stability
exercise showed the effectiveness in reducing the LBP complaints and increased of
productivity tailors in the garment industry.
CONCLUSION
Based on result and discussion, improvement of work condition through ergonomic
participatory approach significantly affected decrease the low back pain complaints (p <
0.05) and result decrease of 11.87% and there are 42.10% increase of their productivity.
Besides having an effect on decrease complaints of low back pain and increase
productivity. Improving working conditions through ergonomic participatory approach as
well as increase tailor's income.
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