Feasibility of a combined field and tele-rehabilitation exercise program for musculoskeletal pain in rural Iraqi female agrarian labourers
DOI:
https://doi.org/10.47197/retos.v76.117997Keywords:
Work-related musculoskeletal pain, Therapeutic exercise, Women's Health, IraqAbstract
Introduction: Chronic musculoskeletal pain significantly impacts the quality of life and physical productivity of women engaged in agrarian labour within rural settings. This study examined the efficacy of a hybrid rehabilitation approach specifically designed for this demographic in low-resource environments.
Objective: This study aimed to evaluate a hybrid rehabilitation program combining field-based activities and tele-exercises to manage pain and improve functional muscle strength among rural Iraqi women.
Methodology: A quasi-experimental pre-test–post-test cohort study was conducted among sixty-six women who had extensive histories of agrarian labour in the Hamdaniya District. The twelve-week intervention integrated home-based exercises delivered via mobile video applications with twice-weekly field sessions featuring culturally familiar games, while physical assessments utilized a handheld dynamometer and the Numeric Rating Scale-11.
Results: The data indicated that the majority of participants suffered from severe lower back and extremity pain at baseline. Following the intervention, significant improvements in muscle strength were recorded across all targeted regions, and pain levels transitioned from severe to either moderate or mild, with several cases reaching complete resolution.
Discussion: These findings aligned with previous studies suggesting that supervised exercise programs effectively mitigate chronic occupational pain. The results contrasted favourably with traditional clinical models by demonstrating that culturally adapted physical activity increases participant adherence and social engagement in rural communities.
Conclusions: The hybrid rehabilitation program successfully reduced chronic pain and enhanced the functional capacity of rural Iraqi women. The model presents a feasible, low-cost therapeutic strategy for improving musculoskeletal health in resource-limited settings.
References
Abdullah Fathe, M., Farhat, F., Karim, S. K., & Moalla, W. (2024). Feasibility Telerehabilitation at Home on Body Composition, Anthropometric Measures and Muscular Strength After Interruption 4–5 Years of Spinal Cord Injury: Serial Cases Study on Islamic State of Iraq and Syria War Survivors in Iraq. Telemedicine and E-Health, 30(8), 2181–2193. https://doi.org/10.1089/tmj.2024.0078
Abreu, F., Almeida, M., Rosa, M., & Technology, H. (2025). Breaking the backbone of productivity: work-related musculoskeletal pain among KSAU-HS employees and its impact on performance and rehabilitation strategies Dolor musculoesquelético laboral en empleados de KSAU-HS: impacto en el rendimiento y estrategias. Retos, 2025(70), 1209–1225. https://doi.org/10.47197/retos.v70.116889
Akbar, K. A., Try, P., Viwattanakulvanid, P., & Kallawicha, K. (2023). Work-Related Musculoskeletal Disorders Among Farmers in the Southeast Asia Region: A Systematic Review. Safety and Health at Work, 14(3), 243–249. https://doi.org/10.1016/j.shaw.2023.05.001
Alghadir, A. H., Anwer, S., Iqbal, A., & Iqbal, Z. A. (2018). Test-retest reliability, validity, and minimum detectable change of visual analog, numerical rating, and verbal rating scales for measurement of osteoarthritic knee pain. Journal of Pain Research, 11, 851–856. https://doi.org/10.2147/JPR.S158847
Allworth, I., Luscombe, G., Ferreira, P., & Mesa-Castrillon, C. (2025). Exploring participant satisfaction with an eHealth intervention for low back pain and knee osteoarthritis: Enhancing physiotherapy access in rural Australia. Musculoskeletal Science and Practice, 76(November 2024), 103252. https://doi.org/10.1016/j.msksp.2024.103252
Alonso Monteiro Bezerra, M., Hellwig, N., Da Rocha Castelar Pinheiro, G., & Souza Lopes, C. (2018). Prevalence of chronic musculoskeletal conditions and associated factors in Brazilian adults - National Health Survey. BMC Public Health, 18(1), 1–10. https://doi.org/10.1186/s12889-018-5192-4
Barreto-andrade, J. A. (2025). Determining factors and diagnostic methods of musculoskeletal disorders related to the spine in administrative workers . Bibliographical review Autores Factores determinantes y métodos de diagnóstico de los trastornos musculoesqueléticos de la columna ver. Retos, 2025(63), 165–176. https://doi.org/10.47197/retos.v63.105501
Bashshur, R. L., Shannon, G. W., Smith, B. R., Alverson, D. C., Antoniotti, N., Barsan, W. G., Bashshur, N., Brown, E. M., Coye, M. J., Doarn, C. R., Ferguson, S., Grigsby, J., Krupinski, E. A., Kvedar, J. C., Linkous, J., Merrell, R. C., Nesbitt, T., Poropatich, R., Rheuban, K. S., … Yellowlees, P. (2014). The empirical foundations of telemedicine interventions for chronic disease management. Telemedicine and E-Health, 20(9), 769–800. https://doi.org/10.1089/tmj.2014.9981
Bradford, N. K., Caffery, L. J., & Smith, A. C. (2016). Correction: Telehealth services in rural and remote Australia: A systematic review of models of care and factors influencing success and sustainability [Rural and Remote Health, 16, (2016) 4268]. Rural and Remote Health, 16(4), 1–23. https://search.informit.org/doi/10.3316/informit.206937797420021
Fathe, M. A., Hasan, M. S., & Karash, S. J. (2022). The Effectiveness of a Rehabilitative Program on the Cervical and Lumbar Pain Relief for Rural Women. Annals of Applied Sport Science, 10(1), 1–8. https://doi.org/10.52547/aassjournal.985
Firman, A. (2025). Everyday agrarian labor as physical activity : gender , health , and community cohesion in rural Indonesia How to cite in APA Keywords Resumen Palabras clave. Retos, 2025(72), 1115–1132. https://doi.org/10.47197/retos.v72.117586
Ganesh, S., Chhabra, D., & Kumari, N. (2016). The effectiveness of rehabilitation on pain-free farming in agriculture workers with low back pain in India. Work, 55(2), 399–411. https://doi.org/10.3233/WOR-162403
González-Rocha, A., Mendez-Sanchez, L., Ortíz-Rodríguez, M. A., & Denova-Gutiérrez, E. (2022). Effect Of Exercise on Muscle Mass, Fat Mass, Bone Mass, Muscular Strength and Physical Performance in Community Dwelling Older Adults: Systematic Review and Meta-Analysis. Aging and Disease, 13(5), 1421–1435. https://doi.org/10.14336/AD.2022.0215
Hassan, M. G., Mohamed Ali, A. F., Samy, H., Hamdy, M., Abdelkarim Attia, A. S., El-Din, S. S., Mahmoud Ahmed, S. S., Mabrouk Bondok, S. M., Abdelaziz, S. S., Hassan, E. J., & Hassan, S. S. (2025). Telerehabilitation for carpal tunnel syndrome: a new treatment style with new possibilities: a randomized controlled trial. Retos, 72, 1141-1150. https://doi.org/10.47197/retos.v72.117333
Henriques, B., Abreu, F., Jesus, L., Almeida, M., Silva, C. G., & Rosa, M. (2025). Impact of a game-based intervention on chronic low back pain considering the interference of kinesiophobia in middle-aged and older adults. Retos, 72, 1209-1225. https://doi.org/10.47197/retos.v72.117762
Hjermstad, M. J., Fayers, P. M., Haugen, D. F., Caraceni, A., Hanks, G. W., Loge, J. H., Fainsinger, R., Aass, N., & Kaasa, S. (2011). Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: A systematic literature review. Journal of Pain and Symptom Management, 41(6), 1073–1093. https://doi.org/10.1016/j.jpainsymman.2010.08.016
Hogg, M. N., Kavanagh, A., Farrell, M. J., & Burke, A. L. J. (2021). Waiting in Pain II: An Updated Review of the Provision of Persistent Pain Services in Australia. Pain Medicine (United States), 22(6), 1367–1375. https://doi.org/10.1093/pm/pnaa374
Hulshof, C. T. J., Pega, F., Neupane, S., Colosio, C., Daams, J. G., Kc, P., Kuijer, P. P. F. M., Mandic-Rajcevic, S., Masci, F., van der Molen, H. F., Nygård, C. H., Oakman, J., Proper, K. I., & Frings-Dresen, M. H. W. (2021). The effect of occupational exposure to ergonomic risk factors on osteoarthritis of hip or knee and selected other musculoskeletal diseases: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and In. Environment International, 150, 106349. https://doi.org/10.1016/j.envint.2020.106349
Kichloo, A., Albosta, M., Dettloff, K., Wani, F., El-Amir, Z., Singh, J., Aljadah, M., Chakinala, R. C., Kanugula, A. K., Solanki, S., & Chugh, S. (2020). Telemedicine, the current COVID-19 pandemic and the future: a narrative review and perspectives moving forward in the USA. Family Medicine and Community Health, 8(3), 1–9. https://doi.org/10.1136/fmch-2020-000530
Lombard, C., Harrison, C., Kozica, S., Zoungas, S., Ranasinha, S., & Teede, H. (2016). Preventing Weight Gain in Women in Rural Communities: A Cluster Randomised Controlled Trial. PLoS Medicine, 13(1), 1–20. https://doi.org/10.1371/journal.pmed.1001941
Mesa-Castrillon, C. I., Beckenkamp, P. R., Ferreira, M., Simic, M., Davis, P. R., Michell, A., Pappas, E., Luscombe, G., Noronha, M. De, & Ferreira, P. (2024). Global prevalence of musculoskeletal pain in rural and urban populations. A systematic review with meta-analysis. Musculoskeletal pain in rural and urban populations. Australian Journal of Rural Health, May, 864–876. https://doi.org/10.1111/ajr.13161
Mesa-Castrillon, C. I., Simic, M., Ferreira, M. L., Bennell, K. L., Luscombe, G. M., Gater, K., Beckenkamp, P. R., Michell, A., Bauman, A., de Luca, K., Bunker, S., Clavisi, O., & Ferreira, P. H. (2024). Effectiveness of an eHealth-Delivered Program to Empower People With Musculoskeletal Pain in Rural Australia: A Randomized Controlled Trial. Arthritis Care and Research, 76(4), 570–581. https://doi.org/10.1002/acr.25272
Mesa-Castrillon, C. I., Simic, M., Ferreira, M. L., Hatswell, K., Luscombe, G., de Gregorio, A. M., Davis, P. R., Bauman, A., Bunker, S., Clavisi, O., Knox, G., Bennell, K. L., & Ferreira, P. H. (2021). EHealth to empower patients with musculoskeletal pain in rural Australia (EMPoweR) a randomised clinical trial: study protocol. BMC Musculoskeletal Disorders, 22(1), 1–11. https://doi.org/10.1186/s12891-020-03866-2
Osborne, A., Blake, C., McNamara, J., Meredith, D., Phelan, J., & Cunningham, C. (2010). Musculoskeletal disorders among Irish farmers. Occupational Medicine, 60(8), 598–603. https://doi.org/10.1093/occmed/kqq146
Rockwell, K. L., & Gilroy, A. S. (2020). Incorporating telemedicine as part of COVID-19 outbreak response systems. American Journal of Managed Care, 26(4), 147–148. https://doi.org/10.37765/ajmc.2020.42784
Scriven, H., Doherty, D. P., & Ward, E. C. (2019). Evaluation of a Multisite Telehealth Group Model for Persistent Pain Management for Rural/Remote Participants. Rural and Remote Health, 19(1). https://doi.org/10.22605/RRH4710
Song, S., Graham-Engeland, J. E., & Kim, J. (2024). Associations Between Psychological Stress and Hand Pain Among Rural and Urban Adults: Findings From the KoGES Community Cohort Study. Journal of Pain, 25(2), 362–375. https://doi.org/10.1016/j.jpain.2023.08.016
Versteegh, T. H., Beaudet, D., Greenbaum, M., Hellyer, L., Tritton, A., & Walton, D. (2015). Evaluating the reliability of a novel neck-strength assessment protocol for healthy adults using self-generated resistance with a hand-held dynamometer. Physiotherapy Canada, 67(1), 58–64. https://doi.org/10.3138/ptc.2013-66
Walker-Bone, K., & Palmer, K. T. (2002). Musculoskeletal disorders in farmers and farm workers. Occupational Medicine, 52(8), 441–450. https://doi.org/10.1093/occmed/52.8.441
Widyaningsih, S. W., Yusuf, I., Prasetyo, Z. K., & Istiyono, E. (2021). The development of the hots test of physics based on modern test theory: Question modeling through e-learning of moodle lms. In-ternational Journal of Instruction, 14(4), 51–68. https://doi.org/10.29333/iji.2021.1444a
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Munib Abdullah Fathe, Amal Machfer, Stevan Karash, Mohamed Amine Bouzid, Wassim Moalla, Hamdi Chtourou
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and ensure the magazine the right to be the first publication of the work as licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgment of authorship of the work and the initial publication in this magazine.
- Authors can establish separate additional agreements for non-exclusive distribution of the version of the work published in the journal (eg, to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Is allowed and authors are encouraged to disseminate their work electronically (eg, in institutional repositories or on their own website) prior to and during the submission process, as it can lead to productive exchanges, as well as to a subpoena more Early and more of published work (See The Effect of Open Access) (in English).
This journal provides immediate open access to its content (BOAI, http://legacy.earlham.edu/~peters/fos/boaifaq.htm#openaccess) on the principle that making research freely available to the public supports a greater global exchange of knowledge. The authors may download the papers from the journal website, or will be provided with the PDF version of the article via e-mail.
