Chronic Pain, Physical Therapy, Rehabilitation, Rural Health
Conditions
Keywords
Muscle imbalance, Chronic musculoskeletal pain, Back pain
Brief summary
This study evaluates a 12-week Combined Rehabilitation Program (CRP) designed to reduce musculoskeletal pain and improve physical function among rural women in northern Iraq. The program integrates home-based therapeutic exercises with simple, culturally appropriate games. Sixty-six women from the Hamdaniya district, all with nearly two decades of experience in agricultural labor and chronic musculoskeletal pain in the back, neck, and limbs, participated voluntarily. The intervention includes two supervised group sessions per week at a local sports field and remote home-based sessions guided via pre-recorded videos shared through WhatsApp. Each session lasts 45 to 60 minutes and incorporates rest periods. The program is designed to strengthen weakened muscles, improve daily function, and promote social engagement among participants. Rural women engaged in long-term agricultural labor are at increased risk of chronic musculoskeletal pain, particularly in the back, neck, and limbs. What is already known on this subject: * Rural women engaged in long-term agricultural labor are at increased risk of chronic musculoskeletal pain, particularly in the back, neck, and limbs. * Home-based therapeutic exercises are widely used to manage pain and improve physical function. * Community-based rehabilitation programs can support better health outcomes in underserved populations. What this study adds: * Introduces a culturally adapted Combined Rehabilitation Program (CRP) that blends home-based exercises with traditional games in a rural Iraqi context. * Explores the feasibility of delivering rehabilitation through low-cost mobile technology in resource-limited environments. * Provides a community-based model for accessible, flexible rehabilitation tailored to the needs of rural women.
Detailed description
This study aims to evaluate the effectiveness of a Combined Rehabilitation Program (CRP) designed to reduce musculoskeletal pain and enhance physical function among rural women in northern Iraq. The CRP integrates home-based therapeutic exercises with culturally relevant physical games and is tailored to the specific needs and social context of the participants. The study includes 66 women, aged around 46 years, with 18-23 years of experience in agricultural work. All participants reported ongoing muscle and joint pain in the upper and lower limbs, back, and neck, which affects their ability to carry out daily activities. Due to family and work constraints, a flexible intervention was developed that combines in-person and remote elements to ensure accessibility and adherence. The 12-week program consists of two supervised group sessions per week held at a local field, along with home-based sessions delivered through pre-recorded videos shared via mobile applications. Each session lasts 45-60 minutes and includes walking, stretching, strengthening exercises, and simple games targeting muscle groups commonly affected by physical labor. Rest periods are integrated into each session to promote safety and participation. Participants are assessed before and after the intervention for muscle strength, flexibility, body composition, and pain levels using standardized tools. The study design emphasizes a community-based and technology-supported approach to rehabilitation, addressing the unique challenges faced by women in rural areas with limited access to conventional services.
Interventions
BEHAVIORALCombined Exercise
Participants engaged in a hybrid exercise program that included: In-field sessions held twice weekly at a local sports facility (45-60 minutes per session, including rest). Remote sessions delivered via pre-recorded videos through WhatsApp, with ongoing monitoring and feedback. Exercises included walking, jogging, full-body stretching, and strength training targeting the trunk, limbs, and weak muscle groups (shoulders, back, knees). The program aimed to reduce joint and muscle pain, improve strength and flexibility, and support daily functional activities. Pre- and post-intervention assessments included muscle strength (via hand dynamometer), flexibility tests, BMI, and self-reported pain using the NRS-11 scale.
Sponsors
University of Mosul
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Intervention model description
Design: Quasi-Experimental, One-Group Pretest-Posttest Design
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 57 Years
Healthy volunteers
No
Inclusion criteria
* Women have experienced Musculoskeletal pain in one or more one of fourth areas of study variables which are : the upper and lower extremities, neck, and lower back.
Exclusion criteria
* Women who suffer from other functional diseases not related to Musculoskeletal pain.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in musculoskeletal pain level in the lower back, neck, upper extremities, and lower extremities. | Baseline and Week 12 | Pain levels will be self-reported using the Numeric Rating Scale (NRS-11), a validated 11-point scale ranging from 0 (no pain) to 10 (worst possible pain). Participants will report pain in four body regions: lower back, neck, upper extremities, and lower extremities. The method of assessment was Numeric Rating Scale (NRS-11), administered in-person and via teleconsultation. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in flexibility. | Baseline and Week 12 | Flexibility of major joints and muscle groups (especially lower extremities) will be assessed using standard range-of-motion and stretch tests. The method of assessment was manual flexibility tests (sit-and-reach, joint range assessments) |
| Change in muscle strength in upper and lower extremities and trunk. | Baseline and Week 12 | Muscle strength will be measured using a handheld dynamometer (MicroFET2). Assessments will include trunk flexors/extensors, thigh flexors/extensors, and upper limb muscles (shoulder, elbow, wrist).The method of assessment was Handheld Dynamometer (MicroFET2). |
Other
| Measure | Time frame | Description |
|---|---|---|
| Change in Body Weight | Baseline and Week 12 | Body weight will be measured using a calibrated digital scale to assess changes over the course of the 12-week intervention. The method of assessment was standard anthropometric measurement tools. The unit of measure: Kilograms per square meter (kg/m²) |
| Change in body mass index (BMI). | Baseline and Week 12 | BMI will be calculated using measured weight and height, according to the formula: weight (kg) / \[height (m)\]². This will assess changes in body composition over the course of the 12-week intervention. The method of assessment: was standard anthropometric measurement tools. |
Countries
Iraq
Outcome results
None listed