不同精神压力与身体负荷对电脑工作相关颈痛的成因机制研究

Introduction/Background: Work related musculoskeletal disorders in neck have a significant impact on computer users in the modern society.The etiology of neck pain in computer workers is still not completely understood. High mental stress and physical workload are the main high-risk factors. In our previous study, we found those computer tasks with higher workload induced increased neck muscle activities seen in electromyography and engergy exertion. However, it's not easy to differentiate the effect of mental stress and physical workload and elaborate their interactive effect. Moreover, well-designed standardized computer task is lacking for laboratory study. Therefore, further research is needed to investigate the influence of mental and physical load on work related neck pain and explore their impact on the neurological network, by employing comparable computer tasks. Objective: The present study aims to explore the interactive effects of mental stress and physical workload during standardized computer tasks so as to understand the roles of physical and mental stress in work related neck pain on computer users. Methods: 160 participants will be recruited and allocated into the Pain-Free Group or the Neck Pain Group based on the inclusion criteria. All participants will perform four computer tasks in the standard computer workstation. The classic Stroop color word test will be ultilized for the four standardized tasks design. Physiological markers included electroencephalography (EEG), surface electromyography (sEMG), heart rate variability (HRV), and blood pressure (BP). In addition, psychosocial responses were recorded in terms of rating of perceived exertion (RPE), anxiety, and pain. Behavioral performance measures included response time, number of total trials, and accuracy of completed trials. Their responses during these tasks and the rest will be examined for within-group and between-group differences using ANOVA, t-test etc. Linear mixed model regression will be used to compare the influence of physical and mental workloads and their interactive effects on the key physiological and psychological markers. Expected outcome: Our pilot study indicated that the characteristics of standardized computer tasks were superior to previous studies. The protocol of recording the signal of EEG, sEMG, and HRV simultaneously when the participant was performing the tasks was also proved feasible. This study is an attempt to investigate the etiological factors of work related neck pain during the sedentary workstyle in the computer users and to develop a new conceptual model of causative mechanism of neck pain with regard to physiological, psychosocial, and behavioral parameters. Findings of the proposed study are expected to provide theoretical framework for clinical implication of neck pain rehabilitation.

工作相关的颈痛在使用电脑工作人群中的发病率很高，其主要危险因素为电脑工作中的精神压力和身体负荷。我们已经验证了高负荷的电脑工作可引起颈部肌肉的肌电活动增强和体能消耗增加，而如何设计标准化的电脑工作任务，及辨识精神压力和身体负荷这两方面的作用机制和神经网络联系尚不明确。本项目拟采用经典的Stroop颜色单词测试设计四项含有不同精神压力和身体负荷水平的标准化电脑工作任务，观察各项任务引致的生理学（脑电、肌电和心电信号）、社会心理学（自觉疲劳程度、焦虑水平、疼痛指数）以及行为表现（反应时间、正确率和输入单词量）等指标的变化。预试验结果提示标准化的电脑工作任务设计优于过往研究，有效整合脑电、肌电和心电等各系统信号同步采集的方案可行。有望揭示精神压力和身体负荷之间的交互效应，探讨对电脑工作时不同精神压力和身体负荷引致颈痛的机制并建立初步的成因模型，为颈痛的临床康复和预防提供理论框架。

本项目是基于立项计划中的要求，逐步完成了研究项目总体规划，实验材料准备、设备优化配置、实验手册制订，实验对象招募，根据不同阶段的任务要求，完成了实验对象的无颈痛组和颈痛组招募、信号采集及数据分析、建模和论文写作等工作。课题完成的过程中，先后撰写了7篇论文，并已分别投稿至相关专业期刊，其中已发表论文1篇，工作论文6篇（完成投稿1篇，正在审核或修订状态5篇）。另有8篇论文在国际、国内专业学术会议进行交流分享。课题组率先在国内举办颈椎病康复相关研究与科研培训班，举办了表面肌电信号采集与处理工作坊，推动了表面肌电测量评估方法与体系在颈痛科学研究的应用。.项目完成了颈痛组和无痛组的数据采集后，分析了脑电、肌电等各项生理指标、社会心理学和行为学指标，发现颈痛组及无颈痛组受试者在不同的4项任务时的双侧斜方肌、颈部竖脊肌的表面肌电活动均有显著性任务效应和组间效应。在不同的精神压力和身体负荷状态下的脑电（EEG）方面，结果发现θ波脑电无任务、分组的交互效应，但在任务的主效应具有统计学意义 (p < 0.001)。在不同的间歇时点，发现枕区的α波活动有明显的组间差异 (p < 0.001)。焦虑水平方面，基线状态，两组有显著性差异，颈痛组焦虑水平更高(p = 0.006)。完成高负荷Task 3任务后，颈痛组相比无痛组，有显著增加的焦虑分数(p = 0.008)。 行为学上的表现，其中无痛组普遍比颈痛组完成更多的打字试验数量。尤其在高负荷的Task 3中，两组的打字试验具有显著性差异 (p = 0.041)，颈痛组较无痛组完成的打字任务试验数量明显降低。根据上述数据完成相关、回归和LMM模型分析并初步形成了标准化坐位电脑工作的颈痛成因模型。.本研究通过进一步辨别不同精神压力和身体负荷对脑电反应的影响，并对颈痛时大脑相应区域的激活状态和响应机制的假说提供参考机制，揭示精神压力和身体负荷之间的交互效应。明确坐位对电脑工作时不同精神压力和身体负荷成因中的变化，有利于制订临床康复干预的针对性措施，提供有效的干预方案，有效预防和治疗对电脑工作引致的颈痛，减低因颈痛产生的高额医疗费用，减少因颈痛脱离工作岗位的时间。

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