Agriculture-related musculoskeletal disorders among farming populations in rural India: focus on vulnerable communities – protocol for a scoping review

Abstract

Introduction

Agriculture remains the primary source of livelihood for India’s rural population, particularly among vulnerable communities including tribal communities, marginal farmers and agricultural labourers. Musculoskeletal disorders (MSDs) represent a significant but under-researched occupational health burden in this population. This scoping review will systematically examine the existing research on musculoskeletal hazards in agriculture across rural India. This will help identify knowledge gaps and provide suggestions for establishing comprehensive occupational health strategies and primary healthcare interventions, particularly for high-risk groups at risk of poor health outcomes.

Methods and analysis

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) guidelines and the Arksey and O’Malley framework will be used to investigate MSDs in rural agricultural communities in India. The PEO (Population, Exposure, Outcome) framework will be used to decide which studies will be included. Relevant Medical Subject Headings terms and keywords will be used for comprehensive literature searches across multiple databases, including MEDLINE, Physiotherapy Evidence Database, Scopus, Web of Science and Cumulative Index to Nursing and Allied Health Literature as well as grey literature sources. Articles written in English and published between January 2010 and December 2026 on farming-related MSDs among adults (18 years and above) in the rural population of India will be included. For data extraction, the study characteristics, demographic features of the population, farming techniques employed, the occurrence and classification of MSDs, risk factors, interventions and the accessibility of healthcare services will be considered. Thereafter, the results will undergo narrative synthesis and thematic analysis to identify research gaps, regional disparities and the policy and practical implications of the research.

Ethics and dissemination

No primary data will be collected from human participants in this review, so no formal ethical approval is required. Findings will be disseminated through peer-reviewed publication, conference presentations and stakeholder briefings targeted at agricultural health policymakers, rural healthcare providers and public health educators in India.

Trial registration number

https://doi.org/10.17605/OSF.IO/9YZ6M.

WHAT IS ALREADY KNOWN ON THIS TOPIC.

WHAT THIS STUDY ADDS

• This protocol would comprehensively map agriculture-related WR-MSD evidence across rural India, explicitly focusing on vulnerable subgroups, including tribal communities, women farmers, elderly workers, small farmers, marginal farmers, farm labourers, across diverse farming systems and multiple states, thereby providing a national-level evidence synthesis that to the best of our knowledge is currently absent from the literature.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

• By identifying the types of research gaps as per Miles (2017), regional disparities, health disparities and the specific needs of high-risk farming communities, this review will inform evidence-based occupational health policy for the agricultural sector, guide the integration of WR-MSD screening and management into primary healthcare services in rural India, and establish priorities for future intervention and ergonomic research targeting farming populations.

Background

Agriculture is the backbone of India’s rural economy and the primary livelihood, employing a substantial portion of its workforce in one of the country’s oldest and most established industries, making India among the world’s largest agricultural nations. The agricultural sector is the most labour-intensive industry in Asia, with about 2 billion people working in this industry alone. Despite its economic centrality, occupational health among agricultural workers is severely under-researched and overlooked, creating a significant knowledge and practice gap that endangers workers’ health, efficiency and the sustainability of agricultural systems. India’s diverse farming landscapes expose workers to physically demanding manual labour conditions that place them at high risk of musculoskeletal disorders (MSDs). Yet, this burden receives far less attention than other occupational health priorities.¹

There is a significant tribal population in India, with the second-largest tribal population residing in Maharashtra, where they comprise roughly 9.35% of the state’s total population.² Agriculture is the primary livelihood for the majority of rural residents across this state, which administers health services through seven health circles across 35 districts, covering over 41 095 inhabited villages and 27 920 gram panchayats. This vast and heterogeneous geography, spanning tribal districts, rain-fed farmlands, irrigated plains and hilly terrains, means that work-related MSD (WR-MSD) risk profiles and healthcare access barriers are likely to vary substantially across subregions, reinforcing the need for a spatially sensitive evidence synthesis.³ The Census of India formally recognises workers in these sectors as cultivators or agricultural labourers, a distinction with direct implications for WR-MSD risk profiles and access to occupational health services, especially for older male agricultural workers who often continue physically demanding farming tasks well into their later years.⁴ Critically, the WR-MSD burden is not confined to Maharashtra alone; it is manifest across farming communities throughout India, varying by crop systems, mechanisation levels, climatic conditions and available health facilities in the area, indicating that the burden needs to be re-examined at the national level.

WR-MSDs represent a broad group of disorders of muscles, tendons, ligaments, joints, peripheral nerves and the vascular system that arise or are aggravated by occupational exposures. WR-MSDs in agricultural contexts involve the whole musculoskeletal system and encompass low back pain (LBP), neck pain, shoulder disorders, knee osteoarthritis, upper extremity (carpal tunnel syndrome and tendinopathies) and lower limb disorders. These disorders are caused by a combination of biomechanical risk factors inherent to farming: prolonged awkward postures (bent-spine transplanting, squatting during weeding), repetitive forceful exertions, long-term stationary load during harvest and transport, and contact stress from hand tools. Among tribal female agricultural workers, particularly sal leaf platemakers, WR-MSDs have been reported to represent a considerable but unrecognised occupational burden.⁵ Lifting and carrying heavy loads, working with a bent spine for prolonged periods of time, repetitive work with hand tools, slipping on uneven surfaces and working with livestock are the factors that contribute to cumulative stress across various musculoskeletal areas. In severe or untreated cases, the exposures can progress to conditions such as lumbar disc herniation, degeneration of knee joints that need surgery and chronic upper limb disorders, which greatly affect the work capacity.⁶ The public health importance is further reflected by community health statistics of tribal districts like Gadchiroli: community surveys have revealed that LBP impacts most adult residents in the area, and the disease is a topical issue in local health assemblies, alongside malaria and maternal health concerns, which is a manifestation of the extent to which WR-MSDs are integrated into the daily burden of agricultural populations.⁷ The gendered dimension of this burden is particularly acute: women engaged in physically demanding jobs, including household chores, manual farming, consistently demonstrate a greater prevalence of musculoskeletal symptoms across all body regions compared with men and these symptoms are closely associated with reduced Physical Health-Related Quality of Life.⁸

The age-related musculoskeletal vulnerability complicates occupational exposure among agricultural workers. The cumulative mechanical stress on the lumbar spine in agriculture, particularly in repeatedly bent-over work postures, exposes workers to disc degeneration and nerve root compression. The actions of transplanting, weeding and harvesting root crops, such as kneeling and squatting, generate sustained compressive forces on the knee cartilage, leading to osteoarthritis and functional disability. Repetitive overhead work and forceful shoulder movements during farming tasks, such as during harvesting, lifting heavy loads on the head or shoulders, are among the predisposing factors for rotator cuff disorders and shoulder impingement. Agricultural workers with lumbar pathology have been reported to have poorer postural stability, which increases their risk of falling and subsequent disability.⁹ The absence of affordable healthcare, especially in underserved tribal communities, further increases joint aches and mobility problems among approximately a quarter of individuals over 60.^{10 11} Individuals who are above 60 in the rural tribal regions generally experience a lot of musculoskeletal problems and reduced bone mineral density that may cause pain, fractures and deformities that are costly to patients and healthcare systems.¹² In the case of older agricultural workers who, due to financial need, continue working in their old age beyond the age of retirement, these age-related vulnerabilities interact with occupational exposures, creating compounded health risks.

This occupational health burden needs to be addressed in a coordinated manner across the health system at various levels. Structured models of care (MoC) for musculoskeletal conditions, incorporating prevention, early investigation and management, have been shown to enhance outcomes and reduce the burden of disability in primary healthcare settings.¹³ The MoC approach seeks to meet community needs and to combine services using knowledge translation techniques and evidence-based policies.¹⁴ Rural evidence indicates that musculoskeletal health needs are often not addressed due to geographical remoteness, a shortage of specialists and insufficient awareness among primary care providers.^{15 16} Although the risks of agricultural labour are well known, little has been done to investigate the specific occupational health problems (WR-MSD) faced by various farming communities in India. Knowledge of WR-MSD prevalence, risk factors and outcomes across different geographical areas, agricultural systems and high-risk population groups is needed to inform evidence-based policies and interventions. Despite reports of musculoskeletal health issues in specific states or districts through individual studies, none of them has mapped this evidence nationally in India, analysed differences across farming systems and demographic subgroups, or identified the key research gaps that still need to be addressed. Since trends observed in one agricultural area may not generalise to other regions with different crops, farming methods, mechanisation levels or demographic profiles, there is no existing national-level synthesis and that represents a critical gap in the current evidence base that this scoping review aims to address.

Moreover, the elderly agricultural labourers, women labourers, marginal farmers and tribal communities are particularly vulnerable groups that require special consideration due to the combination of their occupational exposures and barriers in accessing healthcare. The purpose of this scoping review is to: (1) identify and map the existing evidence on WR-MSDs in the farming populations in rural India; (2) define the types, prevalence and determinants of WR-MSDs under various farming systems, geographical areas and subpopulations at risk; (3) establish key gaps and limitations in the current literature; and (4) produce evidence that can be applied to formulate targeted occupational health interventions, healthcare policies and health professions education programmes relevant to India’s agricultural workforce. By examining data from multiple states and farming systems, this review will provide a national level evidence synthesis that can inform both state and federal level action to protect the musculoskeletal health of those who sustain India’s agricultural economy.

Methodology

Study design

A planned scoping review of the literature on MSDs related to agriculture among rural Indian farming populations is outlined in the protocol. The scoping review methodology is suitable for this review, as it enables the systematic representation of a broad research area, the identification of research gaps and the synthesis of different types of evidence without being limited by specific study designs. The review will follow Arksey and O’Malley’s¹⁷ five-stage methodological framework, which includes developing the research question, finding relevant studies, selecting studies, charting the data and gathering, summarising and reporting the results. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines will be followed when reporting.

Protocol registration

This scoping review protocol has been prospectively registered on the Open Science Framework (OSF) to enhance methodological transparency and prevent duplication of research effort. The OSF registration doi: https://doi.org/10.17605/OSF.IO/9YZ6M.

Research questions

‘What is the evidence regarding agriculture-related MSDs, their risk factors, and the healthcare needs among farming populations in rural India, and what gaps exist in current knowledge and practice?’ is the main research question.

The secondary research questions are:

1. What are the types, prevalence and anatomical distribution of MSDs reported among farming populations in various rural regions of India?

2. Which agricultural practices and occupational risk factors cause MSDs in different farming systems?

3. How does the burden of MSDs vary across different demographic subgroups, including gender, age, tribal status and categories of farming, such as cultivators versus labourers, by farm size?

4. What are the regional differences in the burden of MSD, risk factors and access to healthcare in the Indian states?

5. What preventive measures, interventions and healthcare services are in place or being researched to prevent agriculture-related MSDs?

6. What are the major gaps and methodological limitations in the existing literature?

7. What are the implications for occupational health policy, primary healthcare delivery and health professions education?

PEO framework for study selection

The Population–Exposure–Outcome (PEO) framework will guide the assessment of study eligibility (table 1).

Table 1. PEO framework for study eligibility.

Requirements	Components
P—Population	Farming populations in rural India (adult farmers (≥18 years), agricultural workers, cultivators, labourers, rural populations engaged in farming activities). Studies from any state/region in India. Special attention to vulnerable groups (tribal, women, elderly, marginal farmers).
E—Exposure	Agricultural work and farming practices; any farming activities (crop cultivation, animal husbandry, horticulture, plantation work); occupational exposures in agriculture; work-related physical demands; use of agricultural tools and equipment.
O—Outcomes	Musculoskeletal health and disorders; MSDs (any anatomical region); work-related MSDs; pain, discomfort, functional limitations; risk factors for MSDs; healthcare utilisation and needs; interventions and preventive strategies.

MSDs, musculoskeletal disorders.

Search strategy

Comprehensive searches will be conducted in the following databases: MEDLINE (via PubMed interface), PEDro (Physiotherapy Evidence Database), Scopus, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and Google Scholar (limited to first 200 results). Note: MEDLINE is the primary database; PubMed serves as the interface for accessing MEDLINE and is not counted as a separate database. The search strategy was developed in consultation with an academic librarian to ensure comprehensive and reproducible coverage. The strategy will combine three main concept blocks using Boolean operators:

Block 1—Population: (“farmer” OR “agricultural worker” OR “farm worker” OR “cultivator” OR “agricultural labour” OR “farm labour” OR “rural population” OR “tribal” OR “indigenous” OR “plantation worker”).

Block 2—Exposure: (“agriculture” OR “farming” OR “crop cultivation” OR “rice cultivation” OR “cotton farming” OR “vegetable farming” OR “plantation” OR “animal husbandry” OR “agricultural practices” OR “farm work” OR “agricultural occupation”).

Block 3—Outcome: (“musculoskeletal disorder” OR “MSD” OR “WRMSD” OR “work-related musculoskeletal” OR “back pain” OR “low back pain” OR “neck pain” OR “shoulder pain” OR “knee pain” OR “joint pain” OR “arthritis” OR “musculoskeletal pain” OR “occupational health” OR “ergonomic” OR “musculoskeletal symptom”).

Block 4—Geography: (“India” OR “Indian” OR state names: “Maharashtra” OR “Madhya Pradesh” OR “Odisha” OR “Gujarat” OR “Rajasthan” OR “Karnataka” OR “Tamil Nadu” OR “Andhra Pradesh” OR “Telangana” OR “Punjab” OR “Haryana” OR “Uttar Pradesh” OR “Bihar” OR “West Bengal” OR “Assam” OR “Kerala” OR “Chhattisgarh” OR “Jharkhand”).

Grey literature and additional sources

Dissertation and thesis databases (Shodhganga); government reports (Ministry of Health and Family Welfare, Ministry of Agriculture, Indian Council of Medical Research); reports from WHO India, the International Labour Organization (ILO) India offices; conference proceedings (Indian Public Health Association, Indian Occupational Health Association); non-governmental organisation (NGO) reports (AgrAbility India, occupational health organisations); manual reference screening of included studies; citation tracking of key articles.

Choosing eligible studies

The PEO framework will be the basis for screening abstracts and titles (table 1). Additional qualifying requirements will guarantee that the material included in the studies is pertinent to the research issue.

Inclusion criteria

Studies must fulfil the following requirements to be included:

Population:

• Studies focused on adult populations aged 18 years and older working in farming or agricultural activities.

• Rural populations in India (any state or region).

• Any farming category: cultivators, agricultural labourers, plantation workers, animal husbandry workers.

• Studies focusing on general farming populations or specific subgroups, such as tribal, women and elderly populations.

Types of studies:

• Original research (cross-sectional, cohort, case–control, experimental, mixed methods).

• Systematic reviews and meta-analyses, narrative reviews and literature reviews.

• Intervention studies and programme evaluations.

• Qualitative studies examining experiences and perceptions.

• Grey literature with relevant data.

Exclusion criteria

Studies that have any of the following criteria will be excluded:

• Studies exclusively focusing on non-agricultural occupations.

• Studies on younger populations (<18 years) as the sole focus.

• Studies from countries other than India.

• Studies not reporting musculoskeletal health outcomes.

• Case reports and case series (n <10).

• Opinion pieces, editorials without original data, commentaries.

• Conference abstracts without full papers (unless containing substantial original data).

• Publications in languages other than English.

• Studies with insufficient methodological detail to extract relevant data.

Study selection process

The study selection process will follow PRISMA-ScR guidelines and involve multiple stages in the process:

Stage I: database search and deduplication

One reviewer (GK) will conduct searches across all databases between 1 and 2 months following the publication of the protocol. Results will be exported to EndNote 20 for deduplication. After removing duplicates, the records will then be imported into Rayyan QCRI (a web-based systematic review software) for screening.

Stage 2: title and abstract screening

Two reviewers (GK and IQ) will independently screen titles and abstracts against eligibility criteria. A pilot screening of 50 records will be conducted to ensure consistency. Inter-rater reliability will be calculated using Cohen’s kappa coefficient. Conflicts will be resolved through discussion; if unresolved, a third reviewer (AB) will be consulted. This stage will be conducted during Months 2–3 following the publication of the protocol.

Stage 3: full-text screening

Two reviewers will independently assess full-text articles for eligibility, and the reasons for exclusion will be documented. Inter-rater reliability will be calculated. This stage will be conducted during Months 3–4 following the publication of the protocol.

Stage 4: data extraction

One reviewer (GK) will extract data using a standardised form. A second reviewer (IQ) will verify 20% of extractions for accuracy. This stage will be conducted during Months 4–5 following the publication of the protocol.

The selection process will be documented in a PRISMA-ScR flow diagram showing records identified, screened, excluded (with reasons) and included.^{18 19} It is anticipated that the selection of research for the evaluation will be finished in 10 weeks.

Data extraction and charting

A standardised data charting form will be developed and piloted on 5–10 included studies (a preliminary draft is provided in the online supplemental appendix-S1). The form will capture.

Study characteristics: Author(s) and year, study design/methodology, study setting (state, district, rural/tribal area), study duration and funding source.

Population: Sample size, age range and mean age, gender distribution, population type (tribal/non-tribal, cultivators/labourers), farm size/agricultural category, socio-economic indicators.

Agricultural practices: Type of farming (crop type, animal husbandry, etc), specific agricultural tasks studied, work duration and intensity, mechanisation level, use of ergonomic interventions.

MSDs assessed: Type of MSDs (anatomical regions), assessment methods (self-report, clinical examination, diagnostic tools), prevalence/incidence rates, severity measures, duration of symptoms.

Risk factors: Individual factors (age, gender, body mass index, health status), occupational factors (posture, repetition, force, duration), environmental factors (climate, terrain), psychosocial factors.

Intervention management: Type of intervention (ergonomic, educational, clinical), intervention effectiveness, healthcare utilisation patterns, barriers to healthcare access.

Key findings: Main results (relevant to research questions), statistical significance, author conclusions and limitations noted by authors.

Implications: Recommendations for practice, policy implications and research gaps identified.

Data synthesis and analysis

Analytical approach: Data synthesis will employ a narrative approach with thematic analysis, complemented by descriptive statistics and visual mapping where appropriate:

Descriptive analysis: (1) Frequency counts of studies by year, state/region, study design, population type; (2) Summary tables of MSD prevalence by anatomical region and population subgroups; (3) Mapping of the geographical distribution of studies.

(1) Common themes on risk factors, vulnerable populations and healthcare challenges will be found through thematic analysis; (2) findings will be grouped by farming systems, regions and population characteristics; and (3) the efficacy of intervention strategies will be synthesised.

The following will be identified by gap analysis: (1) under-represented geographical regions; (2) understudied farming systems and populations; (3) methodological limitations, and future research needs.

Presentation of results

The results will be reported in the following formats: (1) PRISMA flow diagram on the selection process; (2) Descriptive tables summarising the characteristics of the study and main findings; (3) Geographical maps on the distribution of research across states in India; (4) Thematic synthesis narratives organised by research questions; (5) Evidence gap maps on areas for further research.

Quality assessment

Following standard scoping review methodology, formal quality assessment of individual studies will not be conducted. However, methodological characteristics relevant to interpretation (study design, sample size, assessment tools, response rates) will be extracted and reported descriptively. This descriptive reporting will be practically used in two specific ways: first, to highlight research gaps where particular study designs (eg, longitudinal, interventional) are absent or under-represented, thereby informing recommendations for future primary research; and second, to identify methodological weaknesses recurring across the literature (such as reliance on self-report without clinical validation, or small convenience samples) that may limit the strength of existing evidence and should be addressed in future studies. This approach enables mapping the full breadth of available evidence while acknowledging that evidence quality varies across studies.

Patient and public involvement

The protocol describes a scoping review of published research and does not include the collection of primary data with human subjects. Although it is not possible to involve patients and public in the traditional context of such a design, we acknowledge that, in the case of a community-oriented issue of this kind, the views of key stakeholders would be of great value, which aligns with Stage 6 (Consultation) of the Arksey and O’Malley framework. Based on this, we will introduce a specific stakeholder consultation step after the evidence mapping phase. This will entail contact with a purposive sample of rural healthcare providers (physicians working in primary health centres and physiotherapists working in rural areas), representatives of agricultural NGOs operating in rural India and community health workers (Accredited Social Health Activists (ASHA) workers) from tribal farming communities. Stakeholders will be asked to read and provide remarks on the initial evidence map, assist in finding grey literature sources not identified by database searches and suggest how to distribute evidence to ensure that findings are available and accessible to farming communities. This consultation will be carried out through formalised email or short, semistructured interviews and the results will be publicly reported in the final scoping review. The results will also be disseminated on platforms available to agricultural communities and to health professionals working in rural communities.

Discussion

By systematically reviewing the literature on a range of states and agricultural systems, this scoping review aims to generate a comprehensive national evidence map of WR-MSDs in relation to agriculture in rural India. This national scope is intended to enable identification of common patterns and regional variations, to distinguish populations and geographical areas potentially bearing a greater burden of WR-MSDs, and to build a baseline for comparing future research and targeted intervention studies, unlike current studies, which usually concentrate on a specific region or population. It should be noted, however, that the exact nature and extent of the findings cannot be predetermined, as the review has not yet been conducted. The value of a scoping review lies precisely in its capacity to identify problems and challenges, map existing knowledge, uncover gaps in the literature and provide recommendations for future research and public health policy. The review can highlight health disparities among agricultural populations and identify the needs of high-risk groups, with a focus on vulnerable communities, including tribal populations, women farmers, elderly workers and marginalised farmers. Findings may inform the design of WR-MSD-specific interventions and support equity-oriented policymaking aligned with social justice and occupational health equity. The results may have implications for health professions education programmes across disciplines such as public health, physiotherapy, occupational therapy and community health work. Potential applications include providing training on occupation-specific MSD assessment for rural medical officers, creating ergonomic training modules applicable to farming settings and facilitating the incorporation of agricultural occupational health instruction into pertinent curricula. The systematic gap analysis of the review can inform the priority areas of future research interventions, populations to be targeted by research (such as youth workers working in the agricultural sector, which are not included in the current review because of age limits, but are one of the key future research priorities²⁰), geographical regions and agricultural systems that should be the focus of future research and the methodological enhancements that need to be done in future primary studies. This work may contribute to the Sustainable Development Goals, especially SDG 3 (Good Health and Well-Being), SDG 8 (Decent Work and Economic Growth) and SDG 10 (Reduced Inequalities), by helping to lessen the burden of WR-MSDs in the agricultural sector, drawing attention to vulnerable populations facing health disparities and providing an evidence base for occupational health action.

Limitations

There are several limitations to this scoping review. The eligibility criterion of English-language publications is a kind of language bias. Since the geographical focus is rural India, there could be pertinent government reports, institutional research and community-level research in Assamese, Bengali, Bodo, Dogri, Gujarati, Hindi, Kannada, Kashmiri, Konkani, Maithili, Malayalam, Manipuri, Marathi, Nepali, Odia, Punjabi, Sanskrit, Santali, Sindhi, Tamil, Telugu and Urdu and in other regional languages that this review will not capture. Although this limitation is partially offset by the addition of Shodhganga (an Indian thesis database) and Indian government reports to our grey literature plan, the possible lack of local knowledge resulting from the exclusion of regionally important literature not in English remains a weakness. Second, any literature review is subject to publication bias: studies with statistically significant or positive results are more likely to be published, whereas those with null results may remain unpublished. Partially, this will be addressed by including some grey literature such as theses, government reports and NGO publications. Third, heterogeneity in methods across studies, such as different case definitions of MSDs, the use of various assessment instruments (self-report vs clinical examination) and a range of study designs, can reduce the direct comparability of findings. This will be covered through the detailed extraction and transparent reporting of methodological features, a narrative synthesis to recognise heterogeneity and a clear discussion of how methodological variation can impact the interpretation of findings. Fourth, young populations (<18 years old) will be excluded, thereby failing to capture child and adolescent agricultural workers, who represent a distinct and important subgroup in India. This is one of the key and distinct research needs that we have identified. Fifth, the expectation of cross-sectional research designs in the literature will limit the possibility of making causal inferences about the relationship between agricultural exposures and MSD outcomes. Finally, self-reported MSD data, as is typical in this area, can be biased by recall and social desirability. Following standard scoping review methodology, no formal quality assessment will be conducted; nevertheless, methodological characteristics will be reported descriptively to provide context for interpretation and enable transparent mapping of the evidence.

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.