\

RMA
PROHEALTH: Physiotherapy Rehabilitation and Research

Center for Musculoskeletal Conditions

Submitted by: Samson, John Gabriel R.

Submitted to: Arch. Leah P. Dela Rosa
 Chapter I

Introduction

1.0. Introduction

As a person ages comes with an increase of health-related complications experienced. These said

complications, may it be chronic, injury, disease and etc…, can have an apathetic effect on the

social, mental and physical aspects of the diseased. Musculoskeletal conditions have been a

prevalent factor in the consensus of disability. It contributes the most in the global percentage of

disability. According to the World Health Organization, musculoskeletal conditions are typically

characterized by pain often persistent and limitations in mobility, dexterity and functional ability

resulting a decrease on an individual’s ability to work and participate in social affairs associating

with the mental health of the recipient, and at a more broader concept, the overall performance of

the community. As listed by the International Classification of Diseases, musculoskeletal

conditions can vary from over 150 ailments that affects the locomotor functions; associated with

the muscles, bones, joints and associated tissues such as tendons and ligaments. (ICD, 2016)

These conditions can range from those that acute pain due to injury, such as fractures, sprains

and strains, to chronic conditions associated with ongoing pain and disability. (WHO, N.D)

Physical rehabilitation and its allied field of Physical Medicine promotes not only in restoring an

individual’s motor functions but also studies the root of these symptoms. This process

strengthening the core body of a person as well as to educate the mental state of each patient on

confronting different situations. (Eberhard, 2008) It is designed to restore function and quality

of life by means of therapeutic modalities, manual therapies, therapeutic exercises, and patient
education. When these therapies are chosen correctly, initiated at the right time, individualized to

the patient, and implemented in a way to ensure patient compliance, then they offer significant

potential benefit with usually minimal risk. (Wyss and Patel. 2007) Physical rehabilitation

concerns itself with providing physical healing methods for different kinds of injuries and

illnesses especially in the terms of musculoskeletal conditions.

1.1 Background of The Project

According to the World Health Organization, Musculoskeletal conditions are the leading

contributor to disability worldwide, with lumbar pain being the leading cause globally. Over a

billion people, or about 15% of the world’s population, are estimated to live with some form of

disability. In accord to the International Classification of Functioning, Disability and Health

refers disability to an impairment, activity limitation or participation restriction that is the result

of the interaction between health conditions and environmental and personal factors. Disability is

affected by factors of body structure of an individual, the activities an individual may participate,

the lifestyle of an individual and the environmental factors that affect these experiences (WHO

N.D)

For many developing countries such as the Philippines, manpower and resource are of outmost

importance as it greatly benefits the economy. Blue-collared worker especially those of

production has seen a higher chance of injury within the workplace due to the increased physical

labor compared to other professions. The economic performance of the Philippines of the year

2011 and 2013 has found a significant increase. Rising from 5.1% to 7.2%. This has resulted an

inflation in the demand for steel products having a consumption growth of 61% from year 2010

up to 2013 was. As based from the beforementioned data, the number of musculoskeletal

disorders experienced by the worker has significantly raised from 31,096 in year 2011 to 51,110

in year 2013, resulting to an increase of 39.16% in occupational disorders. (Philippine Statistics

Authority V.D.)
The rehabilitation industry in the Philippines, on-paper is an unmet need. In the Philippines,

rehabilitation services are limited. These services are particularly in Public Health Sectors or

Government funded Hospitals and in Level III Hospital mostly found in major cities. (PARM,

2017) With most specialists in the field are found in NCR. About 16 per thousand of the

country’s population had disability of the 92.1 million household population in the country, 1.44

million persons or 1.57 percent had disability, based on the 2010 Census of Population and

Housing (2010 CPH). Nationwide in 2011, there were 305,729 low-income households with

members having disabilities. The recorded figure of persons with disability (PWD) in the 2000

CPH was 935,551 individuals, which was 1.23 percent of the household population. (CPH,

2010)

1.2. Statement of The Problem

Hospitals nationwide, inclusion of those in NCR, do not have enough positions for

Physiotherapists and Occupational therapists, resulting for newly graduates to seek employment

oversees. Due to limited primary healthcare services in the Philippines gives an explanation as to

why rehabilitation is given low priority in comparison to other forms of medical services.

According to Olavides Soriano an estimate of eight million people with disabilities in the

Philippines have no or limited access to therapy outside of the private health care. The WHO

recognizing the importance of affordable rehabilitation as it ensures healthy lives and promotes

well-being of the individuals as such these services support them to remain independent,

participate in education, be economically active and live meaningful lives. To effectively

assimilate the possible benefits of investing in therapy and rehabilitation in the Philippines the

needs of people with disabilities must first be considered.

In the Philippines, vocational rehabilitation falls under the National Occupational Safety and

Health of the Department of Labor and Employment and the National Council for the Welfare of

Disabled Persons. At present, vocational rehabilitation to address work-related injuries in the

Philippines are provided by institutions in private sectors. Community based in barangays

however fathoms only 2% of people with disability to have access to rehabilitation services.

According to Olavides Soriano, occupational rehabilitation in the Philippines does not

differentiate between people with general disabilities and occupational injuries; these services

therefore are addressed by mortality and sick leave rather than the enhancement of physical,

psychological and social aspects of daily life. An argument can be made that the examination of

the effectiveness of occupational rehabilitation in the Philippines could lead to the provision of a

systematic understanding, generation and mandatory reporting of data which would promote the

delivery of such services.

With musculoskeletal complications not only limited to physical injuries but also to other

spectrums of illnesses comes with a large amount of patients, in which the current health care

facilities cannot accommodate. According to the Philippine Statistics.

Authority (2013) in 2000 there were 935,551 disabled people which has increased to 1,443,000

in 2010. In terms of age distribution almost 60% are from the 15-64 age range, majority of whom

are at a working age. With these, there are many conditions where therapy and rehabilitation

could make a significant contribution to improving the lives of those affected; these include low

back pain, stroke, ischemic heart disease, diabetes, road Injuries, neck pain, falls, and other
1.3. Significance of The Study

As of date Physical rehabilitation has always been an unmet concern in the Philippines. The

proposed project will be beneficial to the local communities in the province especially towards

the professionals, may it be blue or white-collared jobs who experiences musculoskeletal

conditions that affects their lives. With Physical rehabilitation not being accessible towards the

public; available only in either in small clinics or Level 3 Hospitals; these conditions are usually

left untreated until to the point of the condition to worsen. (PARM, 2017) The project will help

these professionals to recuperate and treat these conditions in order to reduce the risk of on the

job injuries and to live their lives as normal as possible

With Physical rehabilitation being an in-demand course, lack of manpower can only be attributed

to lack of job opportunities. Majority of Physiotherapists from the Philippines migrate to the

other countries, usually 1st world or 2nd world, as rehabilitation is a much more mainstream

service in contrast to the developing countries, such as Philippines. (PARM, 2017) The proposed

project will not only adhere to the lack of manpower in specialized field of Rehab Medicine but

will also provide more job opportunities for the local professionals within the province.

Philippines is a country susceptible to natural disasters. With disasters having a direct correlation

to the number of risks and emergency of disabilities. (World Disaster Report 2007) The

proposed project will greatly benefit the province especially during trying times of a natural

disaster if one would ever occur.

According to Soya Mori, the amount of data in Philippines pertaining to disability is either

limited or too general. This contributes to the lack of response in the prevalent issue of disability

within the country. The proposed project will also include a separate facility where areas data on

disability within the province can be and analyzed for further use. These will help with the lack

of specific statistics in disability within the province. Facility-based survey will be a model for

the proposed project. These data can help not only the services of the center but also help

lawmakers in further understanding the need of the disabled within the specific area.

1.4. Project Goals and Objectives

The aim of the project is to educate and provide the unmet need for rehabilitation in the area and

to provide a facility that will both passively and actively improve the disability condition within

the province. Offering accessible service to the public and minimize the conventional negative

aspects of health facilities towards its patients. The goal is to fit the ideal mold of a

Rehabilitation Medicine facility in mainstreaming accessible services in rehabilitation to the

country.

Specifically, it aims to answer the following:

1. To establish a provincial paradigm in the provision of rehabilitation towards the public.

2. To create a Rehabilitation Center that will offer accessible services for the province’s locals

3. To improve the physical and social function of the disabled.

4. To improve data system in correlation to the disabilities within the province.

1.5. Scope and Limitations

1.5.1 Scope

The proposed project will follow the objectives of the proposed ordinance of the

Philippine Academy Rehabilitation Medicine for the country to have a Rehabilitation

Center for each city/town. The project will include a Rehabilitation center for both out-

patient and in- patient users as well as its amenities (not finalized). The center will try to

preserve the natural views and features of the area. Aside from the Rehabilitation center,

the project will provide a research facility to the further study (in the terms of gathering

and analyzing statistics) of the current state of disability within the province.

1.5.1 Limitations

Due to different reasons, the proponent will not be able to attain some information. The

following are the unavoidable limitations of this study:

 The proposed project will only provide a rehabilitation center in a specific city

 The proposed project will not by any means function as an all-in-one solution for

the demand of Physical rehabilitation

 It is a prevalent problem that limited data in Disabilities and its correlation of

rehabilitation is available

 The proposed project will mostly use technology and services commonly found

and supported in the Philippines. This does not include technologies or

innovations that can be deemed feasible by the researcher

 Chapter II

Review of Related Literature

2.1 Musculoskeletal Conditions

The World Health Organizations described musculoskeletal conditions, comprising of over than

150 diagnoses, as symptoms that affect the normal range of motion of an individual; these

conditions may involve the muscles, bones, joints and associated tissues such as tendons and

ligaments. As listed in the International Classification of Diseases Symptoms, these conditions

are typically characterized by pain and limitations in mobility, dexterity and functional ability,

often reducing people’s capacity to work and their ability to participate in social roles having

impacts on the mental wellbeing of the individual and at a broader level, the prosperity and

progress of communities.

In accord to WHO, the most common and disabling conditions of the musculoskeletal system are

osteoarthritis, back and neck pain, fractures correlated to bone fragility, injuries and systemic

inflammatory conditions. Through life-course conditions of the musculoskeletal system are

prevalent and commonly affects people those of adolescence to of older ages. The prevalence

and impact of these conditions are forecasted to rise as the global population ages and risk

factors for noncommunicable diseases increases, particularly affecting low and middle-income

settings. Musculoskeletal conditions occur commonly with other noncommunicable diseases in

multimorbidity health states. With these conditions affecting the regular locomotor movement of
an individual, it is justifiable that these conditions account for the greatest portion of dropped

productivity in the workplace. In 2011, according to the American Academy of Orthopedic

Surgeons, musculoskeletal conditions cost the United States about $13 billion or 1.4% of the

total Gross Domestic Product.

According to the Global Burden Disease 2017 study, musculoskeletal conditions were the

highest contributor to global disability, approximately accounting for 16% of all years lived with

disability. Lower back pain is found as the leading cause of disability since it was first measured

in 1990. While the prevalence of musculoskeletal conditions varies by age and diagnosis,

between 20%– 33% of people across the globe live with a painful musculoskeletal condition.

In accord to the GBD 2017, burden of disease profiles is shifting from communicable, neonatal,

maternal and nutritional health conditions to predominantly long-term noncommunicable

diseases, commonly including musculoskeletal conditions. To give a comparison,

noncommunicable diseases accounted for 61.4% of global disability-adjusted life years (DALYs)

in 2016, compared to 43.9% in 1990. The steepest trajectory of rise in the burden of such

diseases was observed in low-income settings. With this transition in health profiles, the global

population is now living longer with consequences of chronic disease and injuries, particularly

musculoskeletal conditions. This demographic shift underlines the importance of re-focusing the

emphasis of health care from curative to promotive, preventive and rehabilitative health care,

particularly in low- and middle- income settings. This is also relevant in high-income settings,

where over-medicalization and an

emphasis on a biomedical, rather than biopsychosocial approach to care, can lead to poor or

adverse health outcomes and unsustainable health care expenditure. According to Carvallo

Araulio, the opioid medicine epidemic for management of non-cancer pain, the majority of

which is of musculoskeletal etiology, is a notable example. Prioritizing community and primary

health- care services and a long-term care system will have the greatest impact on improving

functional ability into older age and containing health care expenditure.

The 2016 Global Burden of Disease (GBD) data for noncommunicable diseases identified the

profound burden of disease associated with musculoskeletal health. DALYs for musculoskeletal

conditions increased by 61.6% between 1990 and 2016, with an increase of 19.6% between 2006

and 2016. Osteoarthritis was observed to have a 104.9% rise in DALYs (or 8.8% when age-

standardized) from 1990 to 2016. Musculoskeletal conditions comprised the second highest

global volume of years lived with disability in 2016. Spinal pain remains the leading cause of

global disability since 1990. Notably, these GBD estimates likely underestimate the true burden

of musculoskeletal health conditions since important constructs such as career burden,

participation and financial implications are not considered.

According to Barnett K, Mercer, more than half of all older people experience multimorbidity of

noncommunicable diseases. Such multi-morbidities increase with age and are more common

among those in lower socioeconomic groups. This reinforces the need to address

noncommunicable diseases in a whole-person, integrated manner rather than with an approach

where individual conditions are managed in silos. Multimorbidity very commonly includes
musculoskeletal conditions, with musculoskeletal prevalence ranging from one-third to more

than one-half of all noncommunicable disease multimorbidity presentations. Importantly, the

presence of a musculoskeletal condition significantly depletes physical function, clusters with

mental health impairment and increases health-care costs. These data highlight that policies,

strategies and health programmed for noncommunicable diseases, as well as essential care

packages for universal health coverage (UHC), must include musculoskeletal health as an

integral component, particularly those programmes targeted in lower socioeconomic settings and

for older people.

The sustainable development goals (SDGs) and the Decade of Healthy Ageing 2020–2030 offer

a timely and favorable opportunity for increased global attention and action on musculoskeletal

health. To achieve the 2030 agenda for sustainable development and to promote and maintain

health across the life course, a renewed and sustained focus on improving musculoskeletal health

is needed at national and global levels. While the Bone and Joint Decade 2000–2010 catalyzed

awareness of the burden of musculoskeletal health conditions, important gaps in health system

improvements remain and a significant proportion of the global population continues to live with

disabling musculoskeletal conditions, irrespective of age, race and geography.

Three priorities for action to reduce the global disability burden exist. First, there are substantial

opportunities for global leadership to support policy responses which have so far been neglected.

For example, the 2008–2013 Action plan for the global strategy for the prevention and control of

noncommunicable diseases focused on mortality associated with cardiovascular disease, cancer,

diabetes and chronic respiratory disease, rather than on strategies to promote living with

improved
intrinsic capacity. While the nine global targets within the Global action plan for the prevention

and control of noncommunicable diseases 2013–2020 are relevant to the prevention and

management of musculoskeletal health conditions, musculoskeletal health is not identified as a

priority area for noncommunicable disease management and important occupational and

environmental targets are not considered. Musculoskeletal health was only included as a

noncommunicable disease target since 2016 in the Action plan for the prevention and control of

noncommunicable diseases in the WHO European Region. The World Health Organization and

its Member States can help reduce the global disability burden through an increased focus on

musculoskeletal health within system-reform initiatives for noncommunicable diseases and

healthy ageing policy agendas. There is a wealth of evidence for what works to improve

musculoskeletal health outcomes, yet translation into policy and practice remains limited.

Explicit advocacy for, and integration of, musculoskeletal health and persistent pain into existing

global and/or regional policy reform initiatives will be important to drive appropriate policy and

service implementation, particularly as part of action towards the SDGs.

Second, targets and monitoring for functional ability should be set as part of noncommunicable

diseases global health surveillance and as part of the health SDG performance targets. SDG 3

aims to ensure healthy lives and promote wellbeing for all at all ages, which implies support for

functional independence and participation. However, the specific target for noncommunicable

diseases remains focused on reducing premature mortality from such diseases by one-third by

2030. This target is critical because premature mortality from such diseases disproportionally

affects people in low- and middle-income countries, the poorest and most vulnerable; however,

targets to reduce disability related to noncommunicable diseases, as the major contributor to

global
DALYs, are absent. While musculoskeletal health conditions may be indirectly addressed as part

of the SDG on health, particularly in the context of preventive actions that influence

comorbidities such as obesity, current performance targets would not reflect changes in

musculoskeletal-related disability. Global targets should also be set to reflect maintenance of

mobility, participation and physical function as key components of functional ability and

performance.

Third, musculoskeletal health should be part of noncommunicable diseases national policy

reform. National system-level health policy and strategy responses to address musculoskeletal

health as a component of noncommunicable diseases care remain disproportionate with the

burden of disease. While health systems are now responding to the burden of noncommunicable

diseases, there has been an almost exclusive focus on cancer, diabetes, chronic respiratory

disease and cardiovascular disease and, more recently, mental health.

While these foci are important, inadequate prioritization of musculoskeletal health and persistent

pain as part of health reform initiatives targeting noncommunicable diseases does not align with

contemporary evidence for global health, limiting opportunities for development of appropriate

integrated policy responses, workforce capacity building initiatives and harnessing of capacity in

civil society. System reform leadership in some high-, middle- and low-income regions is

nonetheless encouraging. For example, the development of person-centered models of care for

musculoskeletal health and persistent pain that consider multimorbidity and care integration

across the health and social care systems are recognized to improve policy capacity, service

delivery and
cost–effectiveness. Implementation strategies have been developed for high-, middle- and low-

income settings.

A global framework to develop, implement and evaluate such models has also been

established. Further development and dissemination of effective models of care is needed to

inform promotive, preventive, rehabilitative and curative essential packages for UHC; innovative

service delivery options; and strategies to build workforce capacity and consumers’ capacity to

actively participate in care.

Service- and system-level responses addressing musculoskeletal health should also integrate the

responses to other noncommunicable diseases. This will have the greatest impact if organizations

that focus on noncommunicable diseases and injury work cooperatively to tackle the crosscutting

challenges of health system reform.

2.1.1 Musculoskeletal Conditions and Disorders in Asian Countries

According to Bitsiosis A., reported data all over the world showcases that nurses have a very

high prevalence of MSDs, to give context, in Europe, from 10% to 50% in France , 89% in

Portugal, and 85% in Macedonia; in the Americas, from 35.1% to 47% in USA and from 32.8%

to 57.1% in Brazil in Africa, 80.8% in Uganda; and in our Asia, 78.6% in China, 85% in Saudi

Arabia, and 88% in Iran. (Global Burden Disease 2010)

In Vietnam, although the occupational health sector is still underdeveloped, occupational

diseases and their prevention are increasingly concerned. Currently, the list of occupational

diseases covered by insurance has expanded to 34. However, MSDs are not included in this list.

Many occupational disease prevention programs have been implemented in different work

environments, including the medical milieu. Contrariwise, there was only one recent and unique

study ever about MSDs among workers in the health sector in Vietnam in 2015 that showed a

prevalence of MSDs over the past twelve months among nurses at Vietnam hospital, the largest

provincial hospital in Haiphong in the northern coastal region of Vietnam, which was very high

(81%), and many related factors may have affected these disorders. This suggests that the

problem of MSDs among nurses in Vietnam can be very large. However, in order to have a

comprehensive picture of MSDs among nurses, this study is to assess the current status and risk

factors affecting MSDs among nurses at the district hospitals of Haiphong.

Numerous previously studies throughout the world have shown the very different prevalence of

MSDs on nurses over a 12-month period. This result was relatively similar to the other studies on

nursing such as 79.5% in Turkey, 76% in India 76.2% in long-term study from 2004 to 2010 in

3915 nurses in Taiwan, 70% in Poland, 78% in Nigeria, and 79.5% in China. However, this

result was lower than those observed in Uganda in 2013 among 755 nurses (80,8%), in Estonia

(84%), 89% in Portugal, in Macedonia (85%), and 80.8% in Uganda and, in our Asia, there were

Saudi Arabia (85%), Iran (88%), and Japan (85.5%).

The most common site affected in this study was the lower back (44.4%) and the neck (44.1%).

The results of some studies in Asia are comparable to this result; for example, in Pakistan in

2015, it was illustrated that around 49.7% of nurses faced MSDs in their lumbar, and 35.4% of

them complained about MSDs in their shoulders; another study in Iran and in Hong Kong saw

the same picture with 40% and 42%, respectively, of nurses reporting MSDs in their lumbar; and

one study in Nigeria (in Africa) showed that the rate of MSDs in lower back was 44.1%.

Although most studies have shown that lower back was the most common site, this prevalence

was still modest when compared to that from other studies in Asia: in Japan (lower back 71.3%),

in Iran (73.2% in 2010 and 65.3% in 2014), in China (64.83%), and in Saudi Arabia (65.7%);

and this was similar to other studies in Europe: in Portugal (60.9% in 2015 and 63.1% in 2017)

and in Slovenia (85.9%). Neck was also one of the most common sites of MSDs. Results in this

study are similar to those of some other studies such as 46.3% in Iran, 42.8% in China, and

48.94% in Malaysia.

2.1.2 Disabilities in The Philippines

Results of the National Disability Prevalence Survey (NDPS) showed that, in 2016, around 12

percent of the Filipinos age 15 and older experienced severe disability Almost one in every two

(47%) experienced moderate disability while 23 percent with mild disability. Almost one-fifth

(19%) experienced no disability. In this survey, the disability prevalence rate corresponds to the

percentage of persons with severe disability. Almost a third of population age 60 and older

experience severe disability the percentage of persons age less than 60 who experienced mild

disability is 23 percent to 25 percent. More than one in two persons (53% to 54%) age at least 40
experienced moderate disability. Almost one in every three persons (32%) with severe disability

belonged to the older population age group of 60 and older.

The Philippines ratified the United Nations Convention on the Rights of Persons with Disabilities

(CRPD) in 2008, and several laws and policies to promote the rights of people with disabilities

have been enacted. However, a study commissioned by Disability Rights Promotion International

(DRPI) and the National Federation of Organizations of people with disabilities in the

Philippines (Katipunan ng Maykapansanan sa Pilipinas, Inc., KAMPI) in 2008, found that a

number of the rights of people with disabilities were regularly violated. The study interviewed

people with disabilities from Metro Manila, and the Luzon, Mindanao, and Visayas island

groups. The authors highlighted that despite having several policies and laws to protect their

rights, people with disabilities often faced discrimination in educational and employment

settings, and experienced barriers to social participation and access to health and rehabilitation

services. The study recommended a set of immediate measures to eliminate barriers to

participation and for the economic empowerment of people with disabilities. However,

socioeconomic factors associated with disability and the level of access to services and

participation in the community compared to people without disability were not studied

Results of the National Disability Prevalence Survey (NDPS) showed that, in 2016, around 12

percent of the Filipinos age 15 and older experienced severe disability. Almost one in every two

(47%) experienced moderate disability while 23 percent with mild disability. Almost one-fifth

(19%) experienced no disability. In this survey, the disability prevalence rate corresponds to the
percentage of persons with severe disability. Almost a third of population age 60 and older

experience severe disability the percentage of persons age less than 60 who experienced mild

disability is 23 percent to 25 percent. More than one in two persons (53% to 54%) age at least 40

experienced moderate disability. Almost one in every three persons (32%) with severe disability

belonged to the older population age group of 60 and older.

2.1.2 Musculoskeletal Conditions and Disorders in The Philippines

According to the Philippine Statistic Authority the total cases of occupational diseases in

establishments reached 125,973 in 2015. This is comparatively lower by 26.7 percent than the

reported cases in 2013. Among industries, 13 out of the 18 major industries nationwide reported

varying levels of declines in the number of cases of occupational diseases in 2015. The biggest

decrease (81.3%) was recorded in mining and quarrying from 9,255 in 2013 down to 1,735 in

2015.

On the other hand, the number of occupational diseases grew the most in real estate activities

which increased by 189.6 percent from 240 cases in 2013 to 695 in 2013. The distribution of

occupational diseases across industries in 2015 showed that administrative and support service

activities (34.3% or 43,183) and manufacturing industry (31.1% or 39,143) jointly comprised

almost two thirds (65.4%) of the total cases of occupational diseases during the year. Meanwhile,

industries which posted least shares of occupational diseases included: water supply, sewerage,

waste management and remediation activities (0.4%); arts, entertainment and recreation (0.3%);
and repair of computers and personal and household goods, and other personal service activities

(0.3%).

Cases of Occupational Diseases PSA stated that call center activities posted the highest share of

occupational diseases under administrative and support services industry Noteworthy, call center

activities (voice) exceeded all other sub-sectors in the administrative and support services

industry on the number of cases of occupational diseases in 2015 at 31,270. This is equivalent to

almost one-fourth (24.8 percent) of the total cases which means that 1 out of every 4 cases of

total occupational diseases in the industry originated from this sub-sector.

Specifically, the six occupational diseases with the highest incidences in the call center activities

(voice) subsector were as follows: back pain (23.8% or 7,428); occupational lung disease (16.8%

or 5,266); occupational asthma (13.8% or 4,305); other work-related musculoskeletal diseases

(12.0% or 3,745); neck-shoulder pain (10.9% or 3,410); and essential hypertension. This may be

attributed on the nature of work in the sector mostly characterized by mental and emotional

stress brought about by frequent repetitive tasks coupled with prolonged sitting and lengthy

verbal communication with clients.

1 out of every 3 (32.8%) occupational diseases reported in 2015 were back pains. Back pain is

highest in industries involving manual labor such as in manufacturing (34.3% or 14,185 cases)

and those that require sitting for long periods of time like that in administrative and support

service activities (25.6% or 10,581 cases) majority of which involve call center activities. Cases

of Occupational Diseases by Type in Call Center Activities (Voice), Philippines: 2015 Cases of

Occupational Diseases Number Percent Share Call Center Activities (Voice) 31,270, Back Pain

7,428, Occupational Lung Disease 5,266, Occupational Asthma 4,305, Other Work-Related

Musculoskeletal Diseases 3,745, Neck-Shoulder Pain 3,410, Essential Hypertension 3,124 10.0

Other occupational diseases 3,992. Aside from back pains, also included in the top five

occupational diseases in 2015 were essential hypertension (11.5% or 14,539); neck and shoulder

pain (11.4% or 14,392); other work-related musculoskeletal diseases (7.7%)

2.2 Rehabilitation

Rehabilitation according S no. 624 in standardizing Physical Rehabilitation Centers is a branch

of medicine which deals with the prevention, diagnosis, treatment and rehabilitation of
neuromusculoskeletal, cardiovascular, pulmonary and other system disorders which produce

temporary or permanent disability in patients as well as the performance of different diagnostic

procedures, including, but not limited to, electromyography and other electro diagnostic

techniques. It also involves specialized medical care and training of patients with loss of function

so that one may regain their maximum potential, physically, psychologically, social and

vocationally with special attention to prevent unnecessary complications or deterioration and to

assist in physiologic adaptation to disability.

Rehabilitation measures target body functions and structures, activities and participation,

environmental factors, and personal factors. They contribute to a person achieving and

maintaining optimal functioning in interaction with their environment, using the following broad

outcomes: prevention of the loss of function slowing the rate of loss of function improvement or

restoration of function compensation for lost function maintenance of current function.

Rehabilitation outcomes are the benefits and changes in the functioning of an individual over

time that are attributable to a single measure or set of measures. Traditionally, rehabilitation

outcome measures have focused on the individual’s impairment level. More recently, outcomes

measurement has been extended to include individual activity and participation outcomes.

Measurements of activity and participation outcomes assess the individual’s performance across

a range of areas, including communication, mobility, self-care, education, work and employment,

and quality of life. Activity and participation outcomes may also be measured for programmes.

Examples include the number of people who remain in or return to their home or community,

independent living rates, return- to-work rates, and hours spent in leisure and recreational

pursuits. Rehabilitation outcomes may

also be measured through changes in resource us, reducing the hours needed each week for

support and assistance services.

Rehabilitation is an allied medical profession which develops, coordinated and utilizes selected

knowledge and skill in planning, organizing, directing and evaluating the programs for the care

of individuals whose ability to function is impaired or threatened by disease or injury. Physical

Therapy is the art and science of treatment by means of therapeutic exercises, heat, cold, light,

water, manual manipulation, electricity and other physical agents. The goal of physical therapy is

to help the patient reach maximum potential.

Physiotherapy will help an individual to adapt a place in society while learning to live within

limits of his capabilities. Physical Therapy requires in depth knowledge on human growth and

development, human anatomy and physiology, neuroanatomy and neurophysiology,

biomechanics of motion, manifestations of disease and trauma, normal and abnormal

psychological responses to injury, sickness and disability, and the cultural socioeconomic

influences of the individual

2.2.1 Physical Rehabilitation in the Philippines

In the Philippines, rehabilitation services are limited, particularly in the public (government-

funded) health sector and are mainly found in major cities in Level 3 hospitals.6 Most specialists,

particularly physiatrists, practice in the National Capital Region

Rehabilitation, as defined for the scope of this paper, is a set of measures that assist individuals

with disabilities, both pre-existing and new, to achieve and maintain optimal body function in

interaction with their environment. Nationwide in 2011, there were 305 729 low-income

households with members having disabilities. Region 8, the area most affected by Typhoon

Haiyan, had 13 478 low-income households in which people with disabilities lived. Following

Typhoon Haiyan in November 2013, all six hospitals in Tacloban City, the capital of Leyte

province, that previously offered rehabilitation services were devastated. The entire physical

therapy unit of the Eastern Visayas Regional Medical Center (regional hospital) was flooded,

most of the therapeutic equipment was destroyed and medical records were water damaged.

Shops that sold assistive devices (standard orthopedic wheelchairs, crutches, walkers and canes)

were also damaged. Like the rest of the people of Tacloban City, hospital and health personnel

were also victims of the disaster. Immediately after Haiyan, all services, including rehabilitation

services for people with disabilities and injuries ceased at both in and out-patient facilities. Some

limited services resumed a few weeks after the disaster with the help of local and international

volunteers and the establishment of temporary facilities such as field hospitals.

2.3 Architectural Healing Space

According to Brian Schaller, the environment is concretely defined as “the place”, and the things

which occur there “take place”. The place is not so simple as the locality, but comprises of

concrete things which have physical substance, shape, texture, and color, and together join to

form the environment’s personality, or setting. It is this setting which allows certain spaces, with

similar or even matching purposes, to embody very diverse properties, in accord with the unique

cultural and
environmental situations of the place which they exist (Bachelard). Phenomenology is

considered as a “return to things”, maneuvering away from the abstractions of science and its

unbiased objectivity. Phenomenology engages the concept of partiality, making the thing and its

unique conversations with its place the pertinent topic and not the object itself. The man-made

constituents of the setting become the settlements of opposing scales, some large - like cities, and

some small

- like the house. The trails between these settlements and the many features which make the

cultural environment develop the secondary defining characteristics of the place. The difference

of natural and manmade offers one the principal stage in the phenomenological approach. The

second is to succeed inside and outside, or the connection of earth-sky. The third and final step is

to measure character, or how things are complete and occur as participants in their environment

(Palasmaa,).

The placebo effect is known as a “fake treatment” that does not hold any active substances itself.

It helps the body heal simply by the mind’s expectation that it will heal, and the brain then

releases endorphins. Placebos can ultimately reduce swelling and pain, minimizing stress, which

makes the body better able to receive medical treatments. Charles Jencks made full use of the

architectural placebo effect, and through his work shows the importance of environments of

healing. Architecture has the power to indirectly boost the immune system. He used this

philosophy to guide his design of the Maggie’s Centres, a series of retreat centres for people

dealing with cancer. There, people receive practical and social support for dealing with cancer in

an environment that supports their emotional needs. William James, an American philosopher

and psychologist, believed “the greatest revolution in our generation is the discovery that human

beings, by changing the inner attitudes of their minds, can change the outer aspects of their

lives.”
 Chapter III

Methodology

3.1 Introduction

This chapter will discuss the methodology utilized by the researcher in gathering data from

different modes and sources. It will give emphasis and detail on what and why were these modes

used for data gathering. This chapter will also cover in detail on how these data are gathered and

its relationship to the study.

Data was primarily taken from Journals and Books pertaining to the medical relationship of

Musculoskeletal Conditions and Physical Rehabilitation. Topics include but not exclusive to,

Healing Environment Design, Management of Medical Facilities, Relevance of Musculoskeletal

Conditions in the Philippines and the psychology and physiology of patients with MsC.

Interviews will be made to different professionals, ideally practitioners that makes of the facility

at hand. These include, Physical Therapists, Specialized Doctors, Physical Rehabilitation

Directors (Either Independent Organizations or Health Facilities) and those with experience in

designing Medical Facilities preferably of the specific Typology.

3.2 Research Design

Qualitative and quantitative data is gathered and utilized in forming the study. Numerical data

will be analyzed based on the quantitative data gathered from both statistical reports and

interviews.
Qualitative data on the other hand will pertain to the specific needs of users and how it can be

integrated towards the design. These data will be often taken from case studies, journals and

books.

This study utilized the descriptive method of research. This is to effectively draw conclusion from

the primary sources of data used in the study

3.2.1 Case Study

In this approach, comparative analysis will be drawn on similar structures of similar

context. The aim of this approach is to give insight on the hierarchy, zoning, user flow,

and other aspects that should be considered in design. The approach aims to give further

understanding on what requirements should be met on the study and how are these met.

3.3 Research Instrument

Different research instruments were used to gather the needed information of the study. These are

used to maintain the validity and effectivity of the data for current and future studies.

3.3.1 Interview

An interview will be conducted to specific professionals of relevance to the study. The data

gathered will help to further understand the set requirements to integrated in their

respective perspectives.
 3.3.2 Survey

A small sample size survey, at least 50 respondents, will be made towards patients. These

will involve the respondent’s financial and social implications, facility satisfaction,

complications experienced and etc…

3.3.3 Questionnaires

Questionnaires will contain questions based from suggestions and recommendations by

key officials in the different government agencies and both dependent and independent

organizations.

3.3.4 Archival Resources

Laws and ordinances pertaining to disability and medical practice will be considered in

the study. Statistics will be taken from government agencies, independent organizations

and major medical facilities.

3.4 Research Instrument

Qualitative data taken from surveys, interviews and questionnaires will be analyzed. The data taken

will be compared to the answers of the key informants from the interviews.
 CHAPTER 4

SITE SELECTION

4.1 Introduction

This chapter will involve the process of site selection of the given project. The section will

elaborate the given site selection criteria and provide justification and thorough investigation

towards the chosen site. The site selection will also be affected by the data taken from the

following: Philippine Statistics Authority, Philippine Orthopedic Center, and Philippine

Orthopedic Institute.

4.2. Site Criteria

The following are the criteria formulized in the site selection process. Each criterion will

accommodate a certain point system in qualifying the site.

4.1.1. General Criteria (55%)

4.1.1.1. Accessibility (15%)

Accessibility involves the modes of going in and out of the facility. The location

should be able to accommodate different modes of transportation keeping in mind

the given conditions of the users.

4.1.1.2. Location (10%)

As a medical facility the chosen location should avoid noisy areas and relatively

have an ambient atmosphere. Rural like locations which will give off different

feels a bustling urbanized area.

4.1.1.3. Safety and Security (5%)

The chosen area must be safe especially during service hours

4.1.1.4. Utilities (10%)

Access to basic services such as electricity, communication, and water connection

and sewer connection is essential of any medical Facility

4.1.1.5. Land Use Zoning (5%)

The location should follow the CLUP of the city’s planner.

4.1.1.6. Resistivity (10%)

As a medical facility where areas the nu, ber of users increase after major hazards.

The facility should be able to minimize damage from natural disasters such as

floods and earthquakes.

4.1.2 Specific Criteria (45%)

4.1.2.1. Availability of Site (10%)

Enough land must be available to accommodate the facilities of the project.

4.1.2.2. Marketability (10%)

The site should be widely accessible, easily located and available to the targeted

market of the project.

4.1.2.3. Expansion (5%)

The site should offer interest that will benefit the said project. The site must be

able to accommodate future expansions that are adjacent to the facility.

4.1.2.4. Orientation (10%)

The site must both have a good sun and wind orientation that can provide a

positive atmosphere towards the patients

4.1.2.3. Invigorating (10%)

The site should offer stimulants that can uplift or invigorate the users of the

facility. Beautiful scenery and natural recreational spaces may be incorporated in

the project
4.3. Scoring for Site Selection

Criteria Site 1 Site 2 Site 3

General Criteria

Accessibility (15%)

Location (10%)

Safety and Security (5%)

Utilities (10%)

Land use zoning (5%)

Resistivity (10%)

Specific Criteria

Availability of Site (10%)

Marketability (10%)

Expansion (5%)

Orientation (10%)

Invigorating (10%)
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