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El Boghdady M, Ewalds-Kvist BM. General surgeons' occupational musculoskeletal injuries: A systematic review. Surgeon 2024:S1479-666X(24)00048-9. [PMID: 38862375 DOI: 10.1016/j.surge.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Surgeons are expected to work long hours in operating theatres. A high prevalence of work-related musculoskeletal (WRMSK) injuries and pain in healthcare professions exists. We aimed to study WRMSK pain and injuries in general surgeons and study their risk in different surgical techniques comprising open, laparoscopic and robotic-assisted surgery. METHODS A systematic search was performed in compliance with The PRISMA checklist. Search was performed in PubMed and Cochrane library databases for 6 years to 2024. The search terms used were "disability and surgeon", "occupational injuries and surgeon", and "musculoskeletal pain and surgeons", in addition to MESH terms in PubMed database. Risk of bias was calculated among studies. RESULTS The search revealed 3648 citations from which a final list of 24 citations were included after application of inclusion and exclusion criteria. The citations comprised over 1900 surgeons including consultants and surgical trainees from different subspecialities. Incorporated citations consisted of 21 cross-sectional 3 observational studies. Most common pain sites, risks and preventative measure for MSK injuries were revealed. CONCLUSION There is high prevalence of WRMSK pain among general surgeons. Surgeons were primarily affected at physical body parts ranging from the neck, shoulders, upper back and lower back to upper extremity. Robotic-assisted surgery led to lower post-operative discomfort and decreased demanding muscle activity in upper extremities but enhanced static neck position resulting in subjective back stiffness compared with laparoscopic surgery.
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Affiliation(s)
- Michael El Boghdady
- Department of General Surgery, St Georges' University Hospitals NHS Foundation Trust, London, UK; University of Edinburgh, Edinburgh, UK.
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Cha JS, Athanasiadis DI, Asadi H, Stefanidis D, Nussbaum MA, Yu D. Evaluation of a passive arm-support exoskeleton for surgical team members: Results from live surgeries. JOURNAL OF SAFETY RESEARCH 2024; 89:322-330. [PMID: 38858056 DOI: 10.1016/j.jsr.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 08/16/2023] [Accepted: 02/05/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Musculoskeletal symptoms and injuries adversely impact the health of surgical team members and their performance in the operating room (OR). Though ergonomic risks in surgery are well-recognized, mitigating these risks is especially difficult. In this study, we aimed to assess the impacts of an exoskeleton when used by OR team members during live surgeries. METHODS A commercial passive arm-support exoskeleton was used. One surgical nurse, one attending surgeon, and five surgical trainees participated. Twenty-seven surgeries were completed, 12 with and 15 without the exoskeleton. Upper-body postures and muscle activation levels were measured during the surgeries using inertial measurement units and electromyography sensors, respectively. Postures, muscle activation levels, and self-report metrics were compared between the baseline and exoskeleton conditions using non-parametric tests. RESULTS Using the exoskeleton significantly decreased the percentage of time in demanding postures (>45° shoulder elevation) for the right shoulder by 7% and decreased peak muscle activation of the left trapezius, right deltoid, and right lumbar erector spinae muscles, by 7%, 8%, and 12%, respectively. No differences were found in perceived effort, and overall scores on usability ranged from "OK" to "excellent." CONCLUSIONS Arm-support exoskeletons have the potential to assist OR team members in reducing musculoskeletal pain and fatigue indicators. To further increase usability in the OR, however, better methods are needed to identify the surgical tasks for which an exoskeleton is effective.
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Affiliation(s)
| | | | - Hamed Asadi
- Purdue University, West Lafayette, IN, United States
| | | | | | - Denny Yu
- Purdue University, West Lafayette, IN, United States
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Wong SW, Parkes A, Crowe P. Ergonomic interventions to reduce upper limb musculoskeletal pain during robotic surgery: a narrative review. J Robot Surg 2024; 18:224. [PMID: 38801617 PMCID: PMC11130008 DOI: 10.1007/s11701-024-01992-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024]
Abstract
There is a high prevalence of upper limb musculoskeletal pain among robotic surgeons. Poor upper limb ergonomic positioning during robotic surgery occurs when the shoulders are abducted, and the elbows are lifted off the console armrest. The validated rapid upper limb assessment can quantify ergonomic efficacy. Surface electromyography and hand dynamometer assessment of strength are the most common methods to assess muscle fatigue. A literature review was performed to find evidence of ergonomic interventions which reduce upper limb musculoskeletal pain during robotic surgery. There is a paucity of studies which have reported on this topic. In other occupations, there is strong evidence for the use of resistance training to prevent upper extremity pain. Use of forearm compression sleeves, stretching, and massage may help reduce forearm fatigue. Microbreaks with targeted stretching, active ergonomic training, improved use of armrest, and optimal hand controller design have been shown to reduce upper limb musculoskeletal pain. Future studies should assess which interventions are beneficial in reducing surgeon upper limb pain during robotic surgery.
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Affiliation(s)
- Shing Wai Wong
- Randwick Campus, School of Clinical Medicine, The University of New South Wales, Sydney, NSW, Australia.
- Department of General Surgery, Prince of Wales Hospital, Sydney, NSW, Australia.
| | - Allan Parkes
- Randwick Campus, School of Clinical Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Philip Crowe
- Randwick Campus, School of Clinical Medicine, The University of New South Wales, Sydney, NSW, Australia
- Department of General Surgery, Prince of Wales Hospital, Sydney, NSW, Australia
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Norasi H, Kim J, Hallbeck MS, Cerri PE, Elli EF, Tollefson MK, Harold KL, Pathak RA, Pak R. Surgeons' dominant surgical modality: Impacts on wellbeing, burnout, and interventions for neuromusculoskeletal disorders. Am J Surg 2024:115769. [PMID: 38796376 DOI: 10.1016/j.amjsurg.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/10/2024] [Accepted: 05/17/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND This study investigated the impact of surgical modalities on surgeon wellbeing with a focus on burnout, job satisfaction, and interventions used to address neuromusculoskeletal disorders (NMSDs). METHODS An electronic survey was sent to surgeons across an academic integrated multihospital system. The survey consisted of 47 questions investigating different aspects of surgeons' wellbeing. RESULTS Out of 245 thoracic and abdominopelvic surgeons, 79 surgeons (32.2 %) responded, and 65 surgeons (82 %) were able to be categorized as having a dominant surgical modality. Compared to robotic surgeons, laparoscopic (p = 0.042) and open (p = 0.012) surgeons reported more frequent feelings of burnout. The number of surgeons who used any treatment/intervention to minimize the operative discomfort/pain was lower for robotic surgeons than the other three modalities (all p < 0.05). CONCLUSIONS NMSDs affect different aspects of surgeons' lives and occupations. Robotic surgery was associated with decreased feelings of burnout than the other modalities.
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Affiliation(s)
- Hamid Norasi
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA; Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Joseph Kim
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA; Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - M Susan Hallbeck
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA; Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA; Department of Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Petrine E Cerri
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA; Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Enrique F Elli
- Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Matthew K Tollefson
- Department of Surgery, Mayo Clinic, Rochester, MN, USA; Department of Urology, Mayo Clinic, Rochester, MN, USA
| | | | - Ram A Pathak
- Department of Urology, Mayo Clinic, Jacksonville, FL, USA
| | - Raymond Pak
- Department of Urology, Mayo Clinic, Jacksonville, FL, USA
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Jacovides CL, Guetter CR, Crandall M, McGuire K, Slama EM, Plotkin A, Kashyap MV, Lal G, Henry MC. Overcoming Barriers: Sex Disparity in Surgeon Ergonomics. J Am Coll Surg 2024; 238:971-979. [PMID: 38511681 DOI: 10.1097/xcs.0000000000001043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND Musculoskeletal discomfort is widely experienced by surgeons across multiple surgical specialties. Developing technologies and new minimally invasive techniques add further complexity and ergonomic stressors. These stressors differentially affect male and female surgeons, but little is known about the role these sex disparities play in surgical ergonomic stress. We reviewed existing literature to better understand how ergonomic stress varies between male and female surgeons. STUDY DESIGN A literature search was performed via PubMed including but not limited to the following topics: ergonomics, surgeons, female surgeons, women surgeons, pregnancy, and operating room. A review of available quantitative data was performed. RESULTS Female surgeons endure more pronounced ergonomic discomfort than their male counterparts, with added ergonomic stress associated with pregnancy. CONCLUSIONS A 4-fold method is proposed to overcome ergonomic barriers, including (1) improved education on prevention and treatment of ergonomic injury for active surgeons and trainees, (2) increased departmental and institutional support for ergonomic solutions for surgeons, (3) partnerships with industry to study innovative ergonomic solutions, and (4) additional research on the nature of surgical ergonomic challenges and the differential effects of surgical ergonomics on female surgeons.
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Affiliation(s)
- Christina L Jacovides
- From the Division of Trauma, Surgical Critical Care, and Acute Care Surgery, Department of Surgery, Temple University Hospital, Philadelphia, PA (Jacovides)
| | - Camila R Guetter
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Guetter)
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA (Guetter)
| | - Marie Crandall
- Department of Surgery, University of Florida College of Medicine Jacksonville, Jacksonville, FL (Crandall)
| | - Kandace McGuire
- Department of Surgery, Virginia Commonwealth University, Richmond, VA (McGuire)
| | - Eliza M Slama
- Sentara Northern Virginia Medical Center, Woodbridge, VA (Slama)
| | - Anastasia Plotkin
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Southern California, Los Angeles, CA (Plotkin)
| | - Meghana V Kashyap
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE (Kashyap)
| | - Geeta Lal
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA (Lal)
| | - Marion C Henry
- Division of Pediatric Surgery, Department of Surgery, University of Chicago, Chicago, IL (Henry)
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Pillado E, Li RD, Chia MC, Eng JS, DiLosa K, Grafmuller L, Conway A, Escobar GA, Shaw P, Sheahan MG, Bilimoria KY, Hu YY, Coleman DM. Reported pain at work is a risk factor for vascular surgery trainee burnout. J Vasc Surg 2024; 79:1217-1223. [PMID: 38215953 DOI: 10.1016/j.jvs.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/30/2023] [Accepted: 01/04/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND Work-related pain is a known risk factor for vascular surgeon burnout. It risks early attrition from our workforce and is a recognized threat to the specialty. Our study aimed to understand whether work-related pain similarly contributed to vascular surgery trainee well-being. METHODS A confidential, voluntary survey was administered after the 2022 Vascular Surgery In-Service Examination to trainees in all Accreditation Council for Graduate Medical Education-accredited vascular surgery programs. Burnout was measured by a modified, abbreviated Maslach Burnout Inventory; pain after a full day of work was measured using a 10-point Likert scale and then dichotomized as "no to mild pain" (0-2) vs "moderate to severe pain" (3-9). Univariable analyses and multivariable regression assessed associations of pain with well-being indicators (eg, burnout, thoughts of attrition, and thoughts of career change). Pain management strategies were included as additional covariables in our study. RESULTS We included 527 trainees who completed the survey (82.2% response rate); 38% reported moderate to severe pain after a full day of work, of whom 73.6% reported using ergonomic adjustments and 67.0% used over-the-counter medications. Significantly more women reported moderate to severe pain than men (44.3% vs 34.5%; P < .01). After adjusting for gender, training level, race/ethnicity, mistreatment, and dissatisfaction with operative autonomy, moderate-to-severe pain (odds ratio, 2.52; 95% confidence interval, 1.48-4.26) and using physiotherapy as pain management (odds ratio, 3.06; 95% confidence interval, 1.02-9.14) were risk factors for burnout. Moderate to severe pain was not a risk factor for thoughts of attrition or career change after adjustment. CONCLUSIONS Physical pain is prevalent among vascular surgery trainees and represents a risk factor for trainee burnout. Programs should consider mitigating this occupational hazard by offering ergonomic education and adjuncts, such as posture awareness and microbreaks during surgery, early and throughout training.
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Affiliation(s)
- Eric Pillado
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES) Department of Surgery, Northwestern University, Chicago, IL
| | - Ruojia Debbie Li
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES) Department of Surgery, Northwestern University, Chicago, IL
| | - Matthew C Chia
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES) Department of Surgery, Northwestern University, Chicago, IL
| | - Joshua S Eng
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University, Indianapolis, IN
| | - Kathryn DiLosa
- Division of Vascular Surgery, Department of Surgery, University of California, Davis, Sacramento, CA
| | - Leanne Grafmuller
- Division of Vascular Surgery, Department of Surgery, University of Rochester, Rochester, NY
| | - Allan Conway
- Division of Vascular Surgery Lenox Hill Hospital, Department of Surgery, Northwell Health, New York, NY
| | - Guillermo A Escobar
- Division of Vascular Surgery, Department of Surgery, Emory University, Atlanta, GA
| | - Palma Shaw
- Division of Vascular Surgery, Upstate Medical University, Syracuse, NY
| | - Malachi G Sheahan
- Division of Vascular and Endovascular Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University, Indianapolis, IN
| | - Yue-Yung Hu
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University, Indianapolis, IN
| | - Dawn M Coleman
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC.
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Bhethanabotla RM, Ledgister K, Soriano IS, O'Sullivan P, Bigelow E, Knott PD, Park AM. Ergonomic Assessment of Septorhinoplasty Maneuvers During Simulated Pregnancy. OTO Open 2024; 8:e126. [PMID: 38577238 PMCID: PMC10988238 DOI: 10.1002/oto2.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 03/07/2024] [Indexed: 04/06/2024] Open
Abstract
Objective Women represent an increasing proportion of the otolaryngology workforce. Work-related musculoskeletal disorders (WRMSD) are a little-studied yet important impediment to career completion. Scant attention has been directed to study the impact of pregnancy on surgeon posture and ergonomics. We piloted the use of a pregnancy simulation suit (Empathy Belly) to assess the risk of ergonomic compromise when performing open septorhinoplasty. Study Design Surgical simulation. Setting Single session, training simulation lab at academic medical center. Methods Medical students and surgical residents performed the initial steps of a rhinoplasty procedure without and with a pregnancy simulation suit and were filmed with an artificial intelligence-based video analysis app from Kinetica Labs that calculates joint angles and categorizes the ergonomic risk factors. Still images from videos were taken and analyzed using validated posture-based analysis rubrics. Participants were asked to complete a qualitative questionnaire after the session. Results Twelve medical students and surgical residents participated in the study. Posture-based analysis indicated increased ergonomics risk factors among trainees when performing a rhinoplasty while wearing the pregnancy suit. Video analysis indicated trends of worsening back angle and shoulder postures. Trainees reported experiencing pain in the neck, suprapubic area, and lower back. They acknowledged the importance of ergonomics in otolaryngology and desired further education about workplace injury risk mitigation. Conclusion Pregnancy impacts the ergonomics of performing septorhinoplasty and further investigation is required into interventions to reduce risk of WRMSDs.
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Affiliation(s)
- Rohith M. Bhethanabotla
- Department of Otolaryngology–Head and Neck SurgeryUniversity of California‐San FranciscoSan FranciscoCaliforniaUSA
| | - Kaye Ledgister
- Department of Environment, Health, and SafetyUniversity of California‐San FranciscoSan FranciscoCaliforniaUSA
| | - Ian S. Soriano
- Department of SurgeryUniversity of California‐San FranciscoSan FranciscoCaliforniaUSA
| | - Patricia O'Sullivan
- Department of SurgeryUniversity of California‐San FranciscoSan FranciscoCaliforniaUSA
| | - Elaine Bigelow
- Department of Otolaryngology–Head and Neck SurgeryUniversity of California‐San FranciscoSan FranciscoCaliforniaUSA
| | - Philip Daniel Knott
- Department of Otolaryngology–Head and Neck SurgeryUniversity of California‐San FranciscoSan FranciscoCaliforniaUSA
| | - Andrea M. Park
- Department of Otolaryngology–Head and Neck SurgeryUniversity of California‐San FranciscoSan FranciscoCaliforniaUSA
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Bonsch R, Seibt R, Krämer B, Rieger MA, Steinhilber B, Luger T. Influence of Intraoperative Active and Passive Breaks in Simulated Minimally Invasive Procedures on Surgeons' Perceived Discomfort, Performance, and Workload. Life (Basel) 2024; 14:426. [PMID: 38672698 PMCID: PMC11051257 DOI: 10.3390/life14040426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
Laparoscopic surgeons are at high risk of experiencing musculoskeletal discomfort, which is considered the result of long-lasting static and awkward body postures. We primarily aimed to evaluate whether passive and active work breaks can reduce ratings of perceived discomfort among laparoscopic surgeons compared with no work breaks. We secondarily aimed to examine potential differences in performance and workload across work break conditions and requested the surgeons evaluate working with passive or active work breaks. Following a balanced, randomized cross-over design, laparoscopic surgeons performed three 90 min laparoscopic simulations without and with 2.5 min passive or active work breaks after 30 min work blocks on separate days. The simulation included the following tasks: a hot wire, peg transfer, pick-and-place, pick-and-tighten, pick-and-thread, and pull-and-stick tasks. Ratings of perceived discomfort (CR10 Borg Scale), performance per subtask, and perceived workload (NASA-TLX) were recorded, and the break interventions were evaluated (self-developed questionnaire). Statistical analyses were performed on the rating of perceived discomfort and a selection of the performance outcomes. Twenty-one participants (9F) were included, with a mean age of 36.6 years (SD 9.7) and an average experience in laparoscopies of 8.5 years (SD 5.6). Ratings of perceived musculoskeletal discomfort slightly increased over time from a mean level of 0.1 to 0.9 but did not statistically significantly differ between conditions (p = 0.439). Performance outcomes of the hot wire and peg transfer tasks did not statistically significantly differ between conditions. The overall evaluation by the participants was slightly in favor regarding the duration and content of active breaks and showed a 65% likelihood of implementing them on their own initiative in ≥90 min-lasting laparoscopic surgeries, compared with passive breaks. Both passive and active breaks did not statistically significantly influence ratings of perceived discomfort or perceived workload in a 90 min simulation of laparoscopic surgery, with an overall low mean level of perceived discomfort of 0.9 (SD 1.4). As work breaks do not lead to performance losses, rest breaks should be tested in real-life situations across a complete working shift, where perceived discomfort may differ from this laboratory situation. However, in this respect, it is crucial to investigate the acceptance and practicality of intraoperative work breaks in feasibility studies in advance of assessing their effectiveness in follow-up longitudinal trials.
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Affiliation(s)
- Rosina Bonsch
- Institute of Occupational and Social Medicine and Health Services Research, Eberhard Karls University and University Hospital Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany
- Clinic for Hand, Plastic, Reconstructive and Burn Surgery, BG Clinic Tübingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany
| | - Robert Seibt
- Institute of Occupational and Social Medicine and Health Services Research, Eberhard Karls University and University Hospital Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany
| | - Bernhard Krämer
- Department of Gynecology and Obstetrics, University Hospital Tübingen, Calwerstraße 7, 72076 Tübingen, Germany
| | - Monika A. Rieger
- Institute of Occupational and Social Medicine and Health Services Research, Eberhard Karls University and University Hospital Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany
| | - Benjamin Steinhilber
- Institute of Occupational and Social Medicine and Health Services Research, Eberhard Karls University and University Hospital Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany
| | - Tessy Luger
- Institute of Occupational and Social Medicine and Health Services Research, Eberhard Karls University and University Hospital Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany
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Gidumal S, Saade M, Schwam ZG, Govindan A, Mavrommatis M, Wong K, Perez ER, Wanna GB, Cosetti MK. Use of Soft Cervical Collar Improves Surgeon Ergonomics During Simulated Otologic Surgery. Otol Neurotol 2024; 45:266-272. [PMID: 38238911 DOI: 10.1097/mao.0000000000004097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
OBJECTIVE To determine whether surgeon use of a soft cervical collar during endoscopic and microscopic otologic surgery is feasible and impacts surgeon ergonomics as measured by inertial sensors. STUDY DESIGN Prospective crossover trial. SETTING US-based otolaryngology training program. PATIENTS Otolaryngology residents and fellows. INTERVENTIONS Therapeutic-use of a soft cervical collar during simulated otologic surgery. MAIN OUTCOME MEASURES Time spent in high-risk angles of neck and back flexion and extension; average angle of neck flexion, extension, rotation, and lateral bending; validated assessment of neck pain; average daily phone use. RESULTS Fifteen subjects met criteria for inclusion. Ten of 15 (67%) were male. Seven of 15 (47%) were postgraduate year 1-2. Seven of 15 (47%) reported a history of neck pain. None reported prior spinal steroid injections or surgery. Across all subjects, use of the soft cervical collar significantly reduced time spent in high-risk angles of neck flexion/extension during both endoscopic (56% vs. 35%, p < 0.05) and microscopic (60% vs. 32%, p < 0.05) otologic surgery. There was no effect on back flexion or extension. There was no difference in time spent in high-risk neck or back angles between endoscopic and microscopic surgery. Average angles of neck or back flexion, extension, lateral bending, and rotation were not significantly different for subgroups with more operative experience, increased phone use, perception of good posture, or history of neck pain. CONCLUSIONS Use of a soft cervical collar during simulated otologic surgery significantly reduced time spent in high-risk neck positions. These data support feasibility of soft collar use during otologic surgery and hold promise for reduction in the high rates of neck pain reported by neurotologists. PROFESSIONAL PRACTICE GAP AND EDUCATIONAL NEED Improving surgeon ergonomics for otologic surgery. LEARNING OBJECTIVE To identify a therapeutic intervention to mitigate neck pain in surgeons caused by assumption of high-risk cervical neck flexion and extension. DESIRED RESULT To demonstrate that use of a readily available soft cervical collar reduces risk of neck pain in otologic surgeons. LEVEL OF EVIDENCE II. INDICATE IRB OR IACUC Exempt.
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Affiliation(s)
- Sunder Gidumal
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
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Merrill AL, Haigh PI, Lal GI. Lessons from the American Association of Endocrine Surgeons (AAES) ergonomics panel: Operating is a pain in the neck … and other places. Am J Surg 2024:S0002-9610(24)00133-8. [PMID: 38423805 DOI: 10.1016/j.amjsurg.2024.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/04/2024] [Accepted: 02/22/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Andrea L Merrill
- Department of Surgery, Boston Medical Center, 830 Harrison Ave, FGH 5005, Boston, MA, 02118, USA.
| | - Philip I Haigh
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, 4760 Sunset Boulevard, Los Angeles, CA, 90027, USA.
| | - Geeta I Lal
- Department of Surgery, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
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11
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Kaldany A, Patel HV, Shaw NM, Jones CP, Breyer BN. Ergonomics in Urology: Current Landscape and Future Directions. Urology 2024; 184:235-243. [PMID: 38160765 DOI: 10.1016/j.urology.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
Optimal ergonomics are essential to improving clinical performance and longevity among urologists, as poor ergonomics can contribute to work-related injury and physician burnout. While a majority of urologists experience muscular injury throughout their career, women and trainees are disproportionately affected. These disparities are exacerbated by the lack of formal ergonomics education within urologic training programs. This review provides an overview of practical approaches to optimize ergonomics across working environments for urologists and trainees. We highlight intraoperative techniques and novel devices which have been shown to reduce work-related injury, and we identify knowledge gaps to guide future areas of ergonomic research.
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Affiliation(s)
- Alain Kaldany
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
| | - Hiren V Patel
- Department of Urology, University of California, San Francisco, San Francisco, CA
| | - Nathan M Shaw
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC
| | - Charles P Jones
- Department of Urology, University of California, San Francisco, San Francisco, CA
| | - Benjamin N Breyer
- Department of Urology, University of California, San Francisco, San Francisco, CA
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12
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Gabrielson AT, Wei J. Assessment of musculoskeletal pain and surgical ergonomic parameters among members of the American Society of Pediatric Otolaryngology. Int J Pediatr Otorhinolaryngol 2024; 176:111765. [PMID: 37980843 DOI: 10.1016/j.ijporl.2023.111765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/13/2023] [Accepted: 10/18/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES To assess rates of self-reported work-related pain and knowledge of ergonomic principles among fellowship trained pediatric otolaryngologists within the American Society of Pediatric Otolaryngology (ASPO). We hypothesized that pediatric otolaryngologists experience rates of musculoskeletal pain and injury similar to what has been reported among adult otolaryngologists and other surgical subspecialties. METHODS An IRB-approved survey was distributed to members of ASPO through email listserv. Collected variables included surgeon demographic information, practice settings, surgical volume, procedure types, work-related musculoskeletal pain-related metrics, modifying factors, and knowledge/attitudes on surgical ergonomics. RESULTS A total of 685 ASPO members were approached via email, of which 435 opened the survey email and 118 attending pediatric otolaryngologists completed the survey (response rate 27%). In all, 78% of respondents reported current or prior pain and/or injury attributed to performing surgery, 20% higher than that reported in the previous ergonomics survey of ASPO members in 2012. The most affected areas were neck/cervical spine (63%), shoulders/arms (44%), lower back/lumbar spine (36%), and hands/wrist (31%). Half of the respondents were diagnosed with musculoskeletal condition(s) attributed to performing surgery. Two-thirds required treatment (62% pharmacologic only, 9% pharmacologic and surgical intervention) for their work-related pain. Leveraging intermittent pauses during surgical procedures to adjust body position was the most reported method of addressing pain in the operating room. Only 21% report ever having received ergonomic training during their training or career. CONCLUSION Musculoskeletal pain associated with performing pediatric otolaryngology procedures is highly prevalent and has not attenuated despite increased awareness of surgical ergonomics. Results from this study underscore the need to develop standardized surgical ergonomics curricula for pediatric otolaryngologists and trainees.
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Affiliation(s)
| | - Julie Wei
- University of Central Florida College of Medicine, Orlando, FL, USA.
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13
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Norasi H, Hallbeck MS, Elli EF, Tollefson MK, Harold KL, Pak R. Impact of preferred surgical modality on surgeon wellness: a survey of workload, physical pain/discomfort, and neuromusculoskeletal disorders. Surg Endosc 2023; 37:9244-9254. [PMID: 37872425 PMCID: PMC10709269 DOI: 10.1007/s00464-023-10485-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/17/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND We compared surgeons' workload, physical discomfort, and neuromusculoskeletal disorders (NMSDs) across four surgical modalities: endoscopic, laparoscopic, open, and robot-assisted (da Vinci Surgical Systems). METHODS An electronic survey was sent to the surgeons across an academic hospital system. The survey consisted of 47 questions including: (I) Demographics and anthropometrics; (II) The percentage of the procedural time that the surgeon spent on performing each surgical modality; (III) Physical and mental demand and physical discomfort; (IV) Neuromusculoskeletal symptoms including body part pain and NMSDs. RESULTS Seventy-nine out of 245 surgeons completed the survey (32.2%) and 65 surgeons (82.2%) had a dominant surgical modality: 10 endoscopic, 15 laparoscopic, 26 open, and 14 robotic surgeons. Physical demand was the highest for open surgery and the lowest for endoscopic and robotic surgeries, (all p < 0.05). Open and robotic surgeries required the highest levels of mental workload followed by laparoscopic and endoscopic surgeries, respectively (all p < 0.05 except for the difference between robotic and laparoscopic that was not significant). Body part discomfort or pain (immediately after surgery) were lower in the shoulder for robotic surgeons compared to laparoscopic and open surgeons and in left fingers for robotic surgeons compared to endoscopic surgeons (all p < 0.05). The prevalence of NMSD was significantly lower in robotic surgeons (7%) compared to the other surgical modalities (between 60 and 67%) (all p < 0.05). CONCLUSIONS The distribution of NMSDs, workload, and physical discomfort varied significantly based on preferred surgical approach. Although robotic surgeons had fewer overall complaints, improvement in ergonomics of surgery are still warranted.
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Affiliation(s)
- Hamid Norasi
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - M Susan Hallbeck
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA.
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA.
- Department of Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Enrique F Elli
- Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Matthew K Tollefson
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | | | - Raymond Pak
- Department of Urology, Mayo Clinic, Jacksonville, FL, USA
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Tetteh E, Wang T, Kim JY, Smith T, Norasi H, Van Straaten MG, Lal G, Chrouser KL, Shao JM, Hallbeck MS. Optimizing ergonomics during open, laparoscopic, and robotic-assisted surgery: A review of surgical ergonomics literature and development of educational illustrations. Am J Surg 2023:S0002-9610(23)00589-5. [PMID: 37981518 DOI: 10.1016/j.amjsurg.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND The surgical profession is plagued with a high prevalence of work-related musculoskeletal disorders. While numerous interventions have been tested over the years, surgical ergonomics education is still uncommon. METHODS The available literature on surgical ergonomics was reviewed, and with input from surgeons, recommendations from the review were used to create pictorial reminders for open, laparoscopic, and robot-assisted surgical modalities. These simple pictorial ergonomic recommendations were then assessed for practicality by residents and surgeons. RESULTS A review of the current literature on surgical ergonomics covered evidence-based ergonomic recommendations on equipment during open and laparoscopic surgery, as well as proper adjustment of the surgical robot for robot-assisted surgeries. Ergonomic operative postures for the three modalities were examined, illustrated, and assessed. CONCLUSIONS The resulting illustrations of ergonomic guidelines across surgical modalities may be employed in developing ergonomic education materials and improving the identification and mitigation of ergonomic risks in the operating room.
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Affiliation(s)
- Emmanuel Tetteh
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Tianke Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Joseph Y Kim
- Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Tianqi Smith
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Hamid Norasi
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | | | - Geeta Lal
- Department of Surgery, University of Iowa, Iowa City, USA
| | | | - Jenny M Shao
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - M Susan Hallbeck
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA; Department of Surgery, Mayo Clinic, Rochester, MN, USA.
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15
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Villarreal RT, Kim SY, Yu D. Worker and work-related factors influence on musculoskeletal symptoms among veterinary surgeons. ERGONOMICS 2023:1-16. [PMID: 37938127 DOI: 10.1080/00140139.2023.2280830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/03/2023] [Indexed: 11/09/2023]
Abstract
Worker and work-related musculoskeletal symptoms are prevalent among surgeons operating on human patients. Despite incidence rates for accidents among veterinarians and their staff being 2.9 times higher than that of general practitioners of human medicine, little is known about musculoskeletal symptoms among veterinary surgeons. In this study, 212 board-certified members of the American College of Veterinary Surgeons responded to a survey regarding various work-related activities and their experience with musculoskeletal symptoms in 10 different body regions. Across all body regions, reported pain increased from before to after a typical day of surgery (p <.01). Gender, weight, age, and years performing surgery were worker factors that were related to pain (p <.05), while number of procedures, practice focus, and proportion of minimally invasive surgery were work factors related to pain (p <.05). Our findings suggest that musculoskeletal symptoms are prevalent among veterinary surgeons and may help provide evidence for guidelines for minimising musculoskeletal injuries in veterinary surgery.Practitioner summary: Little is known about the risk factors for musculoskeletal symptoms (MSS) among veterinary surgeons. This cross-sectional survey of veterinary surgeons investigates worker and work factors related to MSS. We show that MSS are prevalent and identify key factors providing evidence that MSS are a concern in veterinary surgery.
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Affiliation(s)
| | - Sun Young Kim
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, USA
| | - Denny Yu
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
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16
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Nakabayashi M, Tsukada Y, Fukui H, Endo K. Analysis of Operator's Muscle Fatigue Using Time-Frequency Analysis During Suture Ligation Training. Curr Probl Surg 2023; 60:101381. [PMID: 37993241 DOI: 10.1016/j.cpsurg.2023.101381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Masataka Nakabayashi
- Mechanical Systems Engineering Course, Department of Fundamental Engineering, School of Engineering, Utsunomiya, Tochigi, Japan.
| | - Yuta Tsukada
- Graduate Program in Mechanical and Intelligent Engineering, Graduate School of Regional Development and Creativity, Utsunomiya University, Utsunomiya, Tochigi, Japan
| | - Hiroaki Fukui
- Net Learning Holdings Inc., 9F Nishi-Shinjuku Prime Square, Shinjuku-ku, Tokyo, Japan
| | - Kazuhiro Endo
- Department of Surgery, Medical Education & Training Core Center for Department of Advanced Medical Technology, Jichi Medical University, Shimotsuke, Tochigi, Japan
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17
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Pawa S, Kwon RS, Fishman DS, Thosani NC, Shergill A, Grover SC, Al-Haddad M, Amateau SK, Buxbaum JL, Calderwood AH, Chalhoub JM, Coelho-Prabhu N, Desai M, Elhanafi SE, Forbes N, Fujii-Lau LL, Kohli DR, Machicado JD, Marya NB, Ruan W, Sheth SG, Storm AC, Thiruvengadam NR, Qumseya BJ. American Society for Gastrointestinal Endoscopy guideline on the role of ergonomics for prevention of endoscopy-related injury: summary and recommendations. Gastrointest Endosc 2023; 98:482-491. [PMID: 37245720 DOI: 10.1016/j.gie.2023.05.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 05/30/2023]
Abstract
This clinical practice guideline from the American Society for Gastrointestinal Endoscopy provides an evidence-based approach to strategies to prevent endoscopy-related injury (ERI) in GI endoscopists. It is accompanied by the article subtitled "Methodology and Review of Evidence," which provides a detailed account of the methodology used for the evidence review. This document was developed using the Grading of Recommendations Assessment, Development and Evaluation framework. The guideline estimates the rates, sites, and predictors of ERI. Additionally, it addresses the role of ergonomics training, microbreaks and macrobreaks, monitor and table positions, antifatigue mats, and use of ancillary devices in decreasing the risk of ERI. We recommend formal ergonomics education and neutral posture during the performance of endoscopy, achieved through adjustable monitor and optimal procedure table position, to reduce the risk of ERI. We suggest taking microbreaks and scheduled macrobreaks and using antifatigue mats during procedures to prevent ERI. We suggest the use of ancillary devices in those with risk factors predisposing them to ERI.
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Affiliation(s)
- Swati Pawa
- Department of Gastroenterology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Richard S Kwon
- Division of Gastroenterology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Douglas S Fishman
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Nirav C Thosani
- Center for Interventional Gastroenterology at UTHealth, McGovern Medical School, Houston, Texas, USA
| | - Amandeep Shergill
- Division of Gastroenterology, Department of Medicine, University of San Francisco, San Francisco, California, USA
| | - Samir C Grover
- Division of Gastroenterology, Department of Medicine, Unity Health Toronto, St Michael's Hospital, Toronto, Ontario, Canada
| | - Mohammad Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Stuart K Amateau
- Division of Gastroenterology Hepatology and Nutrition, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - James L Buxbaum
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Audrey H Calderwood
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Jean M Chalhoub
- Department of Gastroenterology and Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, New York, USA
| | | | - Madhav Desai
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Sherif E Elhanafi
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Nauzer Forbes
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Divyanshoo R Kohli
- Pancreas and Liver Clinic, Providence Sacred Heart Medical Center, Spokane, Washington, USA
| | - Jorge D Machicado
- Division of Gastroenterology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Neil B Marya
- Division of Gastroenterology and Hepatology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
| | - Wenly Ruan
- Center for Interventional Gastroenterology at UTHealth, McGovern Medical School, Houston, Texas, USA
| | - Sunil G Sheth
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew C Storm
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nikhil R Thiruvengadam
- Division of Gastroenterology and Hepatology, Loma Linda University, Loma Linda, California, USA
| | - Bashar J Qumseya
- Department of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA
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18
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Pawa S, Kwon RS, Fishman DS, Thosani NC, Shergill A, Grover SC, Al-Haddad M, Amateau SK, Buxbaum JL, Calderwood AH, Chalhoub JM, Coelho-Prabhu N, Desai M, Elhanafi SE, Forbes N, Fujii-Lau LL, Kohli DR, Machicado JD, Marya NB, Ruan W, Sheth SG, Storm AC, Thiruvengadam NR, Wani S, Qumseya BJ. American Society for Gastrointestinal Endoscopy guideline on the role of ergonomics for prevention of endoscopy-related injury: methodology and review of evidence. Gastrointest Endosc 2023; 98:492-512.e1. [PMID: 37245721 DOI: 10.1016/j.gie.2023.05.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 05/30/2023]
Affiliation(s)
- Swati Pawa
- Department of Gastroenterology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Richard S Kwon
- Division of Gastroenterology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Douglas S Fishman
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Nirav C Thosani
- Center for Interventional Gastroenterology at UTHealth, McGovern Medical School, Houston, Texas, USA
| | - Amandeep Shergill
- Division of Gastroenterology, Department of Medicine, University of San Francisco, San Francisco, California, USA
| | - Samir C Grover
- Division of Gastroenterology, Department of Medicine, Unity Health Toronto, St Michael's Hospital, Toronto, Ontario, Canada
| | - Mohammad Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Stuart K Amateau
- Division of Gastroenterology Hepatology and Nutrition, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - James L Buxbaum
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Audrey H Calderwood
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Jean M Chalhoub
- Department of Gastroenterology and Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, New York, USA
| | | | - Madhav Desai
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Sherif E Elhanafi
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Nauzer Forbes
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Divyanshoo R Kohli
- Pancreas and Liver Clinic, Providence Sacred Heart Medical Center, Spokane, Washington, USA
| | - Jorge D Machicado
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Neil B Marya
- Division of Gastroenterology and Hepatology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
| | - Wenly Ruan
- Center for Interventional Gastroenterology at UTHealth, McGovern Medical School, Houston, Texas, USA
| | - Sunil G Sheth
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew C Storm
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nikhil R Thiruvengadam
- Division of Gastroenterology and Hepatology, Loma Linda University, Loma Linda, California, USA
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Bashar J Qumseya
- Department of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA
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Tahermanesh K, Maleki M, Rezaei Moghaddam F, Nejati P, Shahriyari R, Fazel Anvari-Yazdi A, Rahnama Moghadam A, Salehiniya H, Falahatinodeh P, Allahqoli L, Alkatout I. Effects of Corrective Exercises on Work-Related Musculoskeletal Disorders and Quality of Life in Surgical Residents: A Pilot, Quasi-Experimental Study. JOURNAL OF SURGICAL EDUCATION 2023; 80:1121-1128. [PMID: 37355402 DOI: 10.1016/j.jsurg.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 04/24/2023] [Accepted: 05/29/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE Work-related musculoskeletal disorders (WMSDs) are one of the most important reasons for absenteeism, high costs of health care and human injuries; the latter are very common in medical staff. The present study was designed to evaluate the effects of corrective exercises on quality of life and work-related musculoskeletal disorders in surgical residents. METHODS In a quasi-experimental study with a one-group pretest-posttest design, we assessed the eligibility of 135 surgical assistants. All recruited participants performed corrective exercises and were followed for 12 months. The primary outcome of the study was any change in the surgical residents' work-related musculoskeletal disorders, which was assessed using the Nordic Musculoskeletal Questionnaire (NMQ) and the Numerical Pain Rating Scale (NPRS) prior to, and 3, 6, and 12 months after intervention. The secondary outcome was any change in the surgical residents' quality of life (QOL) score, which was assessed at baseline, 6 and 12 months after the intervention using the World Health Organization Quality of Life - BREF (WHOQOL-BREF) questionnaire. RESULTS One hundred eligible surgical residents were enrolled, of whom 67 (67%) completed the study. At baseline the majority of the participants were female and >30 years of age. Fifty-five percent of them used analgesic drugs. The use of analgesic drugs per week fell by 14.7% from baseline to 12 months; the change was statistically significant (p = 0.042). The effect of corrective exercises on the intensity of pain in the shoulder (p = 0.002), hand/wrist (p = 0.001), upper back (p = 0.03), lower back (p = 0.02) and knee (p = 0.01) was significant. Corrective exercises also led to a significant rise in the quality-of-life score (p < 0.019). CONCLUSIONS This study demonstrated the effectiveness of corrective exercises in reducing work-related musculoskeletal disorders and improving quality of life among surgical residents.
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Affiliation(s)
- Kobra Tahermanesh
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Maleki
- School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.
| | | | - Parisa Nejati
- Department of Sports and Exercise Medicine, School of Medicine, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Roya Shahriyari
- Department of Obstetrics and Gynecology, Bank-e-Melli Iran Hospital, Tehran, Iran
| | - Abbas Fazel Anvari-Yazdi
- Division of Biomedical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, Canada
| | | | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | | | - Leila Allahqoli
- Midwifery department, Ministry of Health and Medical Education, Tehran, Iran.
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Alkosha HM, Mohammed MIR, Amen MM. Risk Assessment and Prevalence of Work-Related Musculoskeletal Disorders Among Cranial and Spinal Neurosurgeons. World Neurosurg 2023; 176:e151-e161. [PMID: 37178909 DOI: 10.1016/j.wneu.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To assess the risk and prevalence of work-related musculoskeletal disorders (WMSDs) in spine and cranial surgeons. METHODS A cross-sectional analytic study composed of a risk assessment and a questionnaire-based survey was conducted. The risk assessment for WMSDs was performed on young volunteer neurosurgeons using the Rapid Entire Body Assessment tool. The survey-based questionnaire was distributed using the Google Forms software among the relevant official WhatsApp groups of the Egyptian Society of Neurological Surgeons and the Egyptian Spine Association. RESULTS Thirteen volunteers with a median service of 8 years were assessed for the risk of WMSDs, showing moderate to very high risk of WMSDs, with a Risk Index >1 for all assessed postures. A total of 232 respondents completed the questionnaire, 74% of whom reported WMSD symptoms. Pain was experienced by most (96%), with neck pain being the most common (62.8%), followed by low back pain (56.0%), shoulder pain (44.5%), and wrist/finger pain (43.9%). Pain was experienced for 1-3 years by most respondents; however, most did not reduce their case volume, seek medical advice, or stop working when they experienced pain. The survey showed shortage in the literature studying ergonomics, calling for more ergonomic education and furnishing of working environment of neurosurgeons. CONCLUSIONS WMSDs are prevalent among neurosurgeons, affecting their ability to work. Ergonomics need further awareness, education, and interventions to reduce WMSDs, especially neck and low back pain, which proved to substantially interfere with work ability.
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Affiliation(s)
- Hazem M Alkosha
- Department of Neurosurgery, Mansoura University, Dakahlia, Egypt.
| | | | - Mohamed M Amen
- Department of Neurosurgery, Mansoura University, Dakahlia, Egypt
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21
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Lin E, Young R, Shields J, Smith K, Chao L. Growing pains: strategies for improving ergonomics in minimally invasive gynecologic surgery. Curr Opin Obstet Gynecol 2023; 35:361-367. [PMID: 37144567 DOI: 10.1097/gco.0000000000000875] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE OF REVIEW To evaluate factors contributing to the development of work-related musculoskeletal disorders (WMSDs) and review strategies for mitigating ergonomic strain in minimally invasive gynecologic surgery. RECENT FINDINGS Factors associated with increased ergonomic strain and the development of WMSDs include increasing patient body mass index (BMI), smaller surgeon hand size, noninclusive design of instruments and energy devices and improper positioning of surgical equipment. Each type of minimally invasive surgery (laparoscopic, robotic, vaginal) confers its own ergonomic risk to the surgeon. Recommendations have been published regarding optimal ergonomic surgeon and equipment positioning. Intraoperative breaks and stretching are effective in reducing surgeon discomfort. Formal training in ergonomics has not yet been widely implemented, but educational interventions have been effective in reducing surgeon discomfort and can improve surgeon recognition of suboptimal ergonomics. SUMMARY Considering the serious downstream effects of WMSDs on surgeons, it is imperative to implement strategies for WMSD prevention. Optimal positioning of the surgeons and operative equipment should be routine. Intraoperative breaks and stretching should be incorporated during procedures and between every case. Formal education in ergonomics should be provided to surgeons and trainees. Additionally, more inclusive instrument design by industry partners should be prioritized.
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Affiliation(s)
- Emily Lin
- Division of Gynecology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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22
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Norasi H, Wang T, Tetteh E, Smith T, Davila VJ, Erben Y, DeMartino RR, Hallbeck MS, Mendes BC. Intraoperative workload in elective open vascular and endovascular surgery: A study of procedural drivers. APPLIED ERGONOMICS 2023; 111:104049. [PMID: 37210778 DOI: 10.1016/j.apergo.2023.104049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 05/23/2023]
Abstract
This study investigated vascular surgeon workload and its association with specific procedural drivers over different procedure types. Thirteen attending vascular surgeons (two females) were emailed a survey over a 3-month period. Data from 253 surgical procedures (118 open, 85 endovascular, 18 hybrid, and 32 venous) revealed high physical and cognitive workload among vascular surgeons. Based on the statistically significant findings and similar non-significant trends in the data (significance level of 0.01), open and hybrid vascular procedures showed higher levels of physical and cognitive workload compared to venous cases, while endovascular procedures were relatively more moderate. Additionally, the workload subscales for five subcategories of open procedures (e.g., arteriovenous access) as well as three subcategories of endovascular procedures (e.g., aortic) were compared. The granularity of the intraoperative workload drivers across various vascular procedure types and adjunct equipment could be the key to create targeted ergonomic interventions to reduce workload during vascular surgeries.
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Affiliation(s)
- Hamid Norasi
- Mayo Clinic, Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, 205 3rd Avenue SW, Rochester, MN, 55905, USA; Mayo Clinic, Division of Health Care Delivery Research, 200 1st St. SW, Rochester, MN, 55905, USA.
| | - Tianke Wang
- Mayo Clinic, Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, 205 3rd Avenue SW, Rochester, MN, 55905, USA.
| | - Emmanuel Tetteh
- Mayo Clinic, Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, 205 3rd Avenue SW, Rochester, MN, 55905, USA; Mayo Clinic, Division of Health Care Delivery Research, 200 1st St. SW, Rochester, MN, 55905, USA.
| | - Tianqi Smith
- Mayo Clinic, Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, 205 3rd Avenue SW, Rochester, MN, 55905, USA.
| | - Victor J Davila
- Mayo Clinic, Division of Vascular Surgery, Department of Surgery, 5777 E. Mayo Blvd., Phoenix, AZ, 85054, USA.
| | - Young Erben
- Mayo Clinic, Division of Vascular Surgery, Department of Surgery, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - Randall R DeMartino
- Mayo Clinic, Division of Vascular Surgery, Department of Surgery, 200 1st St. SW, Rochester, MN, 55905, USA.
| | - M Susan Hallbeck
- Mayo Clinic, Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, 205 3rd Avenue SW, Rochester, MN, 55905, USA; Mayo Clinic, Division of Health Care Delivery Research, 200 1st St. SW, Rochester, MN, 55905, USA.
| | - Bernardo C Mendes
- Mayo Clinic, Division of Vascular Surgery, Department of Surgery, 200 1st St. SW, Rochester, MN, 55905, USA.
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Barrios EL, Polcz VE, Hensley SE, Sarosi GA, Mohr AM, Loftus TJ, Upchurch GR, Sumfest JM, Efron PA, Dunleavy K, Bible L, Terracina KP, Al-Mansour MR, Gravina N. A narrative review of ergonomic problems, principles, and potential solutions in surgical operations. Surgery 2023:S0039-6060(23)00177-0. [PMID: 37202309 DOI: 10.1016/j.surg.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Ergonomic development and awareness are critical to the long-term health and well-being of surgeons. Work-related musculoskeletal disorders affect an overwhelming majority of surgeons, and various operative modalities (open, laparoscopic, and robotic surgery) differentially affect the musculoskeletal system. Previous reviews have addressed various aspects of surgical ergonomic history or methods of ergonomic assessment, but the purpose of this study is to synthesize ergonomic analysis by surgical modality while discussing future directions of the field based on current perioperative interventions. METHODS pubmed was queried for "ergonomics," "work-related musculoskeletal disorders," and "surgery," which returned 124 results. From the 122 English-language papers, a further search was conducted via the articles' sources for relevant literature. RESULTS Ninety-nine sources were ultimately included. Work-related musculoskeletal disorders culminate in detrimental effects ranging from chronic pain and paresthesias to reduced operative time and consideration for early retirement. Underreporting symptoms and a lack of awareness of proper ergonomic principles substantially hinder the widespread utilization of ergonomic techniques in the operating room, reducing the quality of life and career longevity. Therapeutic interventions exist at some institutions but require further research and development for necessary widespread implementation. CONCLUSION Awareness of proper ergonomic principles and the detrimental effects of musculoskeletal disorders is the first step in protecting against this universal problem. Implementing ergonomic practices in the operating room is at a crossroads, and incorporating these principles into everyday life must be a priority for all surgeons.
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Affiliation(s)
- Evan L Barrios
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Valerie E Polcz
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Sara E Hensley
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - George A Sarosi
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Alicia M Mohr
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Tyler J Loftus
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Gilbert R Upchurch
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Jill M Sumfest
- Gatorcare Health Management Corporation, University of Florida, Gainesville, FL
| | - Philip A Efron
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Kim Dunleavy
- Department of Physical Therapy, University of Florida, Gainesville, FL
| | - Letitia Bible
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Krista P Terracina
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Mazen R Al-Mansour
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Nicole Gravina
- Department of Psychology, University of Florida, Gainesville, FL.
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AIUM Practice Principles for Work-Related Musculoskeletal Disorder. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1139-1157. [PMID: 36691912 DOI: 10.1002/jum.16124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 06/17/2023]
Abstract
The prevalence of Work-Related Musculoskeletal Disorders (WRMSDs) among ultrasound professionals has been significant. National and international efforts to create industry standards have focused primarily on injuries in sonographers. In addition, the Centers for Disease Control and Prevention (CDC) and National Institute for Occupational Safety & Health (NIOSH) have published documents related to this occupational exposure. There has also been significant attention on equipment utilization and design to help reduce the prevalence of WRMSDs. The American Institute of Ultrasound in Medicine (AIUM) developed the AIUM Practice Principles for Work-Related Musculoskeletal Disorder in collaboration with other organizations whose members use ultrasound [see Collaborating Societies and Representatives]. This document supports the "Industry Standards for the Prevention of Work-Related Musculoskeletal Disorders in Sonography" and aims to expand on these Standards to include safety practices for all health care professionals who utilize ultrasound. These professionals include members of the scientific community, a wide variety of medical professionals, and dental professionals. These ultrasound users and operators will collectively be referred to in this document as "operator(s)" except in those instances where data addressed those holding a specific job title, such as sonographer. In addition, this document will support guidance for quality improvement specific to preventing and reducing injury rates.
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Luger T, Bonsch R, Seibt R, Krämer B, Rieger MA, Steinhilber B. Intraoperative active and passive breaks during minimally invasive surgery influence upper extremity physical strain and physical stress response-A controlled, randomized cross-over, laboratory trial. Surg Endosc 2023:10.1007/s00464-023-10042-9. [PMID: 37084097 PMCID: PMC10120511 DOI: 10.1007/s00464-023-10042-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/25/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE Investigate the effect of passive, active or no intra-operative work breaks on static, median and peak muscular activity, muscular fatigue, upper body postures, heart rate, and heart rate variability. BACKGROUND Although laparoscopic surgery is preferred over open surgery for the benefit of the patient, it puts the surgeons at higher risk for developing musculoskeletal disorders especially due to the less dynamic and awkward working posture. The organizational intervention intraoperative work break is a workplace strategy that has previously demonstrated positive effects in small-scale intervention studies. METHODS Twenty-one surgeons were exposed to three 90-min conditions: no breaks, 2.5-min passive (standing rest) or active (targeted stretching and mobilization exercises) breaks after 30-min work blocks. Muscular activity and fatigue of back, shoulder and forearm muscles were assessed by surface electromyography; upper body posture, i.e., spinal curvature, by inclination sensors; and heart rate and variability (HRV) by electrocardiography. Generalized estimating equations were used for statistical analyses. This study (NCT03715816) was conducted from March 2019 to October 2020. RESULTS The HRV-metric SDNN tended to be higher, but not statistically significantly, in the intervention conditions compared to the control condition. No statistically significant effects of both interventions were detected for muscular activity, joint angles or heart rate. CONCLUSION Intraoperative work breaks, whether passive or active, may counteract shoulder muscular fatigue and increase heart rate variability. This tendency may play a role in a reduced risk for developing work-related musculoskeletal disorders and acute physical stress responses.
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Affiliation(s)
- Tessy Luger
- Institute of Occupational and Social Medicine and Health Services Research, Eberhard Karls University and University Hospital Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.
| | - Rosina Bonsch
- Institute of Occupational and Social Medicine and Health Services Research, Eberhard Karls University and University Hospital Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany
- Plastic, Reconstructive and Burn Surgery, Clinic for Hand, BG Clinic Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany
| | - Robert Seibt
- Institute of Occupational and Social Medicine and Health Services Research, Eberhard Karls University and University Hospital Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany
| | - Bernhard Krämer
- Department of Gynecology and Obstetrics, University Hospital Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Monika A Rieger
- Institute of Occupational and Social Medicine and Health Services Research, Eberhard Karls University and University Hospital Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany
| | - Benjamin Steinhilber
- Institute of Occupational and Social Medicine and Health Services Research, Eberhard Karls University and University Hospital Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany
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Haigh PI. Using the operating microscope to improve ergonomics for thyroidectomy. Am J Surg 2023; 225:803-804. [PMID: 36517276 DOI: 10.1016/j.amjsurg.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/06/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Philip I Haigh
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, 4760 Sunset Boulevard, Los Angeles, CA, USA, 90027.
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27
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Surgical Ergonomics and Preventing Work-Related Musculoskeletal Disorders. Obstet Gynecol 2023; 141:455-462. [PMID: 36735407 DOI: 10.1097/aog.0000000000005079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/03/2022] [Indexed: 02/04/2023]
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van de Wijdeven B, Visser B, Daams J, Kuijer PP. A first step towards a framework for interventions for individual working practice to prevent work-related musculoskeletal disorders: a scoping review. BMC Musculoskelet Disord 2023; 24:87. [PMID: 36726094 PMCID: PMC9890723 DOI: 10.1186/s12891-023-06155-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 01/10/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Work-related musculoskeletal disorders (WMSDs) are a key topic in occupational health. In the primary prevention of these disorders, interventions to minimize exposure to work-related physical risk factors are widely advocated. Besides interventions aimed at the work organisation and the workplace, interventions are also aimed at the behaviour of workers, the so-called individual working practice (IWP). At the moment, no conceptual framework for interventions for IWP exists. This study is a first step towards such a framework. METHODS A scoping review was carried out starting with a systematic search in Ovid Medline, Ovid Embase, Ovid APA PsycInfo, and Web of Science. Intervention studies aimed at reducing exposure to physical ergonomic risk factors involving the worker were included. The content of these interventions for IWP was extracted and coded in order to arrive at distinguishing and overarching categories of these interventions for IWP. RESULTS More than 12.000 papers were found and 110 intervention studies were included, describing 810 topics for IWP. Eventually eight overarching categories of interventions for IWP were distinguished: (1) Workplace adjustment, (2) Variation, (3) Exercising, (4) Use of aids, (5) Professional skills, (6) Professional manners, (7) Task content & task organisation and (8) Motoric skills. CONCLUSION Eight categories of interventions for IWP are described in the literature. These categories are a starting point for developing and evaluating effective interventions performed by workers to prevent WMSDs. In order to reach consensus on these categories, an international expert consultation is a necessary next step.
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Affiliation(s)
- Bert van de Wijdeven
- grid.7177.60000000084992262Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, K0-116 1105 AZ Amsterdam, The Netherlands
| | - Bart Visser
- grid.431204.00000 0001 0685 7679Centre of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Joost Daams
- grid.7177.60000000084992262Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, K0-116 1105 AZ Amsterdam, The Netherlands
| | - Paul P.F.M. Kuijer
- grid.7177.60000000084992262Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, K0-116 1105 AZ Amsterdam, The Netherlands
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Loh PY, Choi J, Lin Y. Impact of task variation and microbreaks on muscle fatigue at seated and standing postures. Work 2023; 76:1039-1045. [PMID: 37182852 DOI: 10.3233/wor-220528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Prolonged and sustained work posture among computer users is one of the main factors that contributes to musculoskeletal discomfort. Rest-break interventions such as task variation and microbreaks may help prevent muscle fatigue and work-related musculoskeletal disorder. OBJECTIVE We aimed to investigate the effects of task variation and microbreaks at seated and standing workstations on forearm muscle activity, namely extensor digitorum communis, extensor carpi ulnaris, flexor digitorum superficialis, and flexor carpi ulnaris; mouse operation force (vertical compression force); mouse operation parameters; and perceived body discomfort during mouse operation. METHODS Twelve healthy right-handed young adults were recruited (male: n = 7, 21.6±1.4 years; female: n = 5, 21.4±1.7 years). Participants performed three blocks of computer tasks (computer mouse operation and typing) in both seated and standing postures with each block lasting for 30 min. Surface electromyography (EMG) of the forearm muscles and operation force were monitored during computer mouse operation. Body discomfort rating was recorded at the end of each block. RESULTS With simulated task variation and microbreaks, work posture and work time showed no significant difference with EMG amplitude and mouse operation force. CONCLUSION Task variation and microbreaks could be of benefit to computer users by reducing muscle fatigue during long hours of computer work at both seated and standing workstations.
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Affiliation(s)
- Ping Yeap Loh
- Department of Life Design and Science, Faculty of Design, Kyushu University, Fukuoka, Japan
| | - Jeewon Choi
- Department of Industrial and Management Systems Engineering, Dong-A University, Busan, Korea
| | - Yu Lin
- Graduate School of Design, Kyushu University, Fukuoka, Japan
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O'Neill A, Baldwin D, Cortese S, Sinclair J. Impact of intrawork rest breaks on doctors' performance and well-being: systematic review. BMJ Open 2022; 12:e062469. [PMID: 36517098 PMCID: PMC9756173 DOI: 10.1136/bmjopen-2022-062469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To summarise evidence on intrawork breaks and their associated effect on doctors' well-being and/or performance at work. DESIGN Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement guidelines DATA SOURCES: Embase, PubMed, Web of Science (Core Collection) and PsychINFO were systematically searched on 6 June 2021. ELIGIBILITY CRITERIA No restrictions were placed on language, study design or date of publication. DATA EXTRACTION AND ANALYSIS Methodological quality was appraised using Cochrane's Risk of Bias (ROB-2), Cochrane's Risk of Bias in Non-randomised Studies (ROBINS-I), and the Johanna Briggs Institute (JBI) checklists for cross-sectional, cohort and qualitative studies. Quantitative synthesis was not undertaken due to substantial heterogeneity of design and outcomes. Results are presented narratively. RESULTS Database searches returned 10 557 results and searches of other sources returned two additional records. Thirty-two papers were included in the systematic review, comprised of 29 unique studies, participants and topics and 3 follow-up studies. A variety of well-being and performance outcome measures were used. Overall, findings indicate that intrawork breaks improved some measures of well-being and/or work performance. However, methodological quality was judged to be low with a high risk of bias in most included studies. DISCUSSION Using existing evidence, it is not possible to conclude with confidence whether intrawork breaks improve well-being and/or work performance in doctors. There is much inconsistency regarding how breaks are defined, measured and the outcomes used to assess effectiveness. Future research should seek to: (a) define and standardise the measurement of breaks, (b) use valid, reliable outcome measures to evaluate their impact on well-being and performance and (c) minimise the risk of bias in studies where possible. PROSPERO REGISTRATION NUMBER CRD42020156924; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=156924.
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Affiliation(s)
- Aimee O'Neill
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - David Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- University Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Samuele Cortese
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
| | - Julia Sinclair
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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Cerier E, Hu A, Goldring A, Rho M, Kulkarni SA. Ergonomics Workshop Improves Musculoskeletal Symptoms in General Surgery Residents. J Surg Res 2022; 280:567-574. [PMID: 35787315 PMCID: PMC10084513 DOI: 10.1016/j.jss.2022.06.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/01/2022] [Accepted: 06/08/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Poor operative ergonomics can lead to muscle fatigue and injury. However, formal ergonomics education is uncommon in surgical residencies. Our study examines the prevalence of musculoskeletal (MSK) symptoms, baseline ergonomics knowledge, and the impact of an ergonomics workshop in general surgery residents. METHODS An anonymous voluntary presurvey and postsurvey was distributed to all general surgery residents at a single academic residency, assessing resident characteristics, MSK symptoms, and ergonomic knowledge before and after an ergonomics workshop. The workshop consisted of a lecture and a personalized posture coaching session with a physiatrist. RESULTS The presurvey received 33/35 (94%) responses. Of respondents, 100% reported some degree of MSK pain. Prevalence of muscle stiffness and fatigue decreased with increasing height. Females reported higher frequencies of MSK pain (P = 0.01) and more muscle fatigue than males (100% versus 73%, P = 0.03). All residents reported little to no ergonomics knowledge with 68% reporting that ergonomics was rarely discussed in the operating room. The postsurvey received 26/35 (74%) responses. Of respondents, 100% reported the workshop was an effective method of ergonomics education. MSK symptom severity improved in 82% of residents. Reports that ergonomics was rarely discussed in the operating room significantly decreased to 22.8% of residents (P < 0.01). CONCLUSIONS Surgical resident ergonomics knowledge is poor and MSK symptoms are common. Resident characteristics are associated with different MSK symptoms. Didactic teaching and personalized posture coaching improve ergonomics knowledge and reduce MSK symptom severity. Surgical residencies should consider implementing similar interventions to improve resident wellbeing.
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Affiliation(s)
- Emily Cerier
- Department of Surgery, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Andrew Hu
- Department of Surgery, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Annie Goldring
- Department of Physical Medicine and Rehabilitation, Section of Musculoskeletal Disease, Shirley Ryan Ability Lab, Chicago, Illinois
| | - Monica Rho
- Department of Physical Medicine and Rehabilitation, Section of Musculoskeletal Disease, Shirley Ryan Ability Lab, Chicago, Illinois
| | - Swati A Kulkarni
- Department of Surgery, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois.
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Fan X, Forsman M, Yang L, Lind CM, Kjellman M. Surgeons' physical workload in open surgery versus robot-assisted surgery and nonsurgical tasks. Surg Endosc 2022; 36:8178-8194. [PMID: 35589973 PMCID: PMC9613719 DOI: 10.1007/s00464-022-09256-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 04/08/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Musculoskeletal disorders (MSDs) are common among surgeons, and its prevalence varies among surgical modalities. There are conflicting results concerning the correlation between adverse work exposures and MSD prevalence in different surgical modalities. The progress of rationalization in health care may lead to job intensification for surgeons, but the literature is scarce regarding to what extent such intensification influences the physical workload in surgery. The objectives of this study were to quantify the physical workload in open surgery and compare it to that in (1) nonsurgical tasks and (2) two surgeon roles in robot-assisted surgery (RAS). METHODS The physical workload of 22 surgeons (12 performing open surgery and 10 RAS) was measured during surgical workdays, which includes trapezius muscle activity from electromyography, and posture and movement of the head, upper arms and trunk from inertial measurement units. The physical workload of surgeons in open surgery was compared to that in nonsurgical tasks, and to the chief and assistant surgeons in RAS, and to the corresponding proposed action levels. Mixed-effects models were used to analyze the differences. RESULTS Open surgery constituted more than half of a surgical workday. It was associated with more awkward postures of the head and trunk than nonsurgical tasks. It was also associated with higher trapezius muscle activity levels, less muscle rest time and a higher proportion of sustained low muscle activity than nonsurgical tasks and the two roles in RAS. The head inclination and trapezius activity in open surgery exceeded the proposed action levels. CONCLUSIONS The physical workload of surgeons in open surgery, which exceeded the proposed action levels, was higher than that in RAS and that in nonsurgical tasks. Demands of increased operation time may result in higher physical workload for open surgeons, which poses an increased risk of MSDs. Risk-reducing measures are, therefore, needed.
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Affiliation(s)
- Xuelong Fan
- IMM Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Mikael Forsman
- IMM Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
- Division of Ergonomics, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Hälsovägen 11C, 14157 Huddinge, Sweden
- Centre for Occupational and Environmental Medicine, Stockholm County Council, 113 65 Stockholm, Sweden
| | - Liyun Yang
- IMM Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Carl M. Lind
- IMM Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Magnus Kjellman
- Department of Molecular Medicine and Surgery, Department of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
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Kolz JM, Wagner SC, Vaccaro AR, Sebastian AS. Ergonomics in Spine Surgery. Clin Spine Surg 2022; 35:333-340. [PMID: 34321393 DOI: 10.1097/bsd.0000000000001238] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/23/2021] [Indexed: 11/26/2022]
Abstract
As physician burnout and wellness become increasingly recognized as vital themes for the medical community to address, the topic of chronic work-related conditions in surgeons must be further evaluated. While improving ergonomics and occupational health have been long emphasized in the executive and business worlds, particularly in relation to company morale and productivity, information within the surgical community remains relatively scarce. Chronic peripheral nerve compression syndromes, hand osteoarthritis, cervicalgia and back pain, as well as other repetitive musculoskeletal ailments affect many spinal surgeons. The use of ergonomic training programs, an operating microscope or exoscope, powered instruments for pedicle screw placement, pneumatic Kerrison punches and ultrasonic osteotomes, as well as utilizing multiple surgeons or microbreaks for larger cases comprise several methods by which spinal surgeons can potentially improve workspace health. As such, it is worthwhile exploring these areas to potentially improve operating room ergonomics and overall surgeon longevity.
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Affiliation(s)
- Joshua M Kolz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Scott C Wagner
- Walter Reed National Military Medical Center, Bethesda, MD
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Oyama H, Watanabe A, Togami H, Noro K. Effects of a chair for ophthalmic microsurgery on pressure distribution and pelvic tilt in surgeons. Work 2022; 73:S45-S55. [DOI: 10.3233/wor-211117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Ophthalmic surgeons experience high levels of physical strain in the neck, lower back, and buttocks. While ergonomic interventions may help to solve these problems, only a few studies have reported chair designs for ophthalmic microsurgery. OBJECTIVE: To design a chair that reduces the physical strain on surgeons and examine its effectiveness in improving posture and reducing seat pressure. METHODS: A prototype chair with a three-dimensional seat surface and a sliding adjustment mechanism for the backrest was designed to fit the surgeon’s body. A conventional chair (A) and the prototype chair (B) were compared during microsurgeries performed by five surgeons. Seat pressure was measured using a pressure-sensing device, and the pelvic tilt angle was measured using a gyroscope sensor. RESULTS: A paired t-test indicated significant differences between the chairs: average seat pressure was 70.4±12.7 mmHg for A and 40.5±3.8 mmHg for B (p = 0.008); the maximum seat pressure was 242.2±19.7 mmHg for A and 170.5±38.5 mmHg for B (p = 0.024); contact area was 906.1±114.5 cm2 for A and 1,255.9±60.1 cm2 for B (p < 0.001); and relative value of the pelvic tilt angle was –13.7°±3.7° for A and –7.1°±4.9° for B (p = 0.032). CONCLUSIONS: The prototype chair was associated with lower seat pressure and maintenance of a more neutral posture than the conventional chair, indicating that it may help to reduce physical strain in ophthalmic surgeons.
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Affiliation(s)
- Hideki Oyama
- National Institute of Occupational Safety and Health, Tokyo, Japan
- Department of Physical Medicine and Rehabilitation, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
| | - Akihisa Watanabe
- Department of Ophthalmology, University of Occupational and Environmental Health, Fukuoka, Japan
- Johseigaoka Eye Clinic, Fukuoka, Japan
| | - Hidenori Togami
- Physics Department, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Kageyu Noro
- Waseda University, Tokyo, Japan
- ErgoSeating Co., Ltd., Tokyo, Japan
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"Give me a break!" A systematic review and meta-analysis on the efficacy of micro-breaks for increasing well-being and performance. PLoS One 2022; 17:e0272460. [PMID: 36044424 PMCID: PMC9432722 DOI: 10.1371/journal.pone.0272460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 07/19/2022] [Indexed: 12/05/2022] Open
Abstract
Recovery activities during short breaks taken between work tasks are solutions for preventing the impairing effects of accumulated strain. No wonder then that a growing body of scientific literature from various perspectives emerged on this topic. The present meta-analysis is aimed at estimating the efficacy of micro-breaks in enhancing well-being (vigor and fatigue) and performance, as well as in which conditions and for whom are the micro-breaks most effective. We searched the existent literature on this topic and aggregated the existing data from experimental and quasi-experimental studies. The systematic search revealed 19 records, which resulted in 22 independent study samples (N = 2335). Random-effects meta-analyses shown statistically significant but small effects of micro-breaks in boosting vigor (d = .36, p < .001; k = 9, n = 913), reducing fatigue (d = .35, p < .001; k = 9, n = 803), and a non-significant effect on increasing overall performance (d = .16, p = .116; k = 15, n = 1132). Sub-groups analyses on performance types revealed significant effects only for tasks with less cognitive demands. A meta-regression showed that the longer the break, the greater the boost was on performance. Overall, the data support the role of micro-breaks for well-being, while for performance, recovering from highly depleting tasks may need more than 10-minute breaks. Therefore, future studies should focus on this issue.
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Leung KL, Segal RM, Bernstein JD, Orosco RK, Reid CM. Surgical ergonomics: Assessment of surgeon posture and impact of training device during otolaryngology procedures. Laryngoscope Investig Otolaryngol 2022; 7:1351-1359. [PMID: 36258864 PMCID: PMC9575056 DOI: 10.1002/lio2.901] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/15/2022] Open
Abstract
Objective To identify factors associated with cervical‐thoracic spine posture in otolaryngology surgeries and evaluate the efficacy of a commercially available posture‐training device in enhancing surgeon ergonomics. Methods Over 3 months, neck and spine posture from individuals performing otolaryngology surgeries was recorded using UpRight Go 2™. Average baseline posture was first recorded and biofeedback was later introduced to attempt to correct posture. The proportion of time spent in upright/neutral cervical‐thoracic spine posture was correlated with surgeon and procedure characteristics and compared to proportion of upright posture time after biofeedback intervention. Results The proportion of upright operating time was significantly different between procedure subtypes and surgical approaches with best performance in rhinology procedures and worst performance in head and neck surgeries (90% vs. 62%; both p < .001). Female gender, shorter stature, and use of sitting stools were associated with greater proportion of surgery spent upright (all p < .05). Loupes use was associated with less time in upright posture (p < .001). With biofeedback intervention, 8 of 10 subjects demonstrated an average of 5% improvement in operating upright, with most improvement found when performing laryngology procedures (7%) and least improvement in head and neck procedures (2%). Conclusions While surgeon posture varies across otolaryngology surgeries, sitting and minimizing the use of loupes may help promote a more ergonomic operating environment and improve surgeon posture. Although the efficacy of biofeedback intervention from a commercially available posture‐training device differs among otolaryngologists, exploration of alternative interventions and incorporation of an ergonomics curriculum is warranted to address postural issues experienced by many surgeons. Level of Evidence 3.
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Affiliation(s)
- Karen L. Leung
- School of Medicine UC San Diego San Diego California USA
| | | | - Jeffrey D. Bernstein
- Department of Otolaryngology ‐ Head & Neck Surgery, Department of Surgery UC San Diego Health San Diego California USA
| | - Ryan K. Orosco
- Department of Otolaryngology ‐ Head & Neck Surgery, Department of Surgery UC San Diego Health San Diego California USA
| | - Chris M. Reid
- Division of Plastic Surgery, Department of Surgery UC San Diego Health San Diego California USA
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Asadi H, Simons MC, Breur GJ, Yu D. Characterizing exposure to physical risk factors during veterinary surgery with wearable sensors: a pilot study. IISE Trans Occup Ergon Hum Factors 2022; 10:151-160. [PMID: 36008924 DOI: 10.1080/24725838.2022.2117252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Occupational ApplicationsVeterinarians provide comprehensive health services for animals, but despite exposure to similar occupational and safety hazards as medical physicians, physical risk factors for these doctors and healthcare teams have not been characterized. In this pilot study, we used wearable sensor technology and showed that veterinary surgeons commonly experience static and demanding postures while performing soft tissue and orthopedic surgeries. Observations showed that muscle activation was highest in the right trapezius. Job factors such as surgical role (attending vs. assisting) and surgical specialty (soft tissue vs. orthopedics) appeared to influence exposure to physical risk factors. These findings suggest a need to consider the unique demands of surgical specialties in order to address the key risk factors impacting injury risks among veterinarians. For example, static postures may be a priority for soft tissue surgeons, while tools that reduce force requirements are more pressing for orthopedic surgeons.Technical AbstractBackground: Although musculoskeletal fatigue, pain, and injuries are commonly reported among surgeons in veterinary medicine, few studies have objectively characterized the exposure to physical risk factors among veterinary surgeons.Purpose: This study aimed to characterize muscle activation and postures of the neck and shoulders during live veterinary surgeries in the soft tissue and orthopedic specialties.Methods: Forty-four ergonomic exposure assessments (exposures) were collected during 26 surgical procedures across five surgeons. Exposures were collected from both soft tissue (n = 23) and orthopedic (n = 21) specialties. Physical risk factors were characterized by: 1) directly measuring muscle activation and posture of the neck and shoulders, using surface electromyography and inertial measurement units, respectively; and 2) collecting self-reported workload, pain, and stiffness.Results: Across the 44 exposures, neck and back symptoms respectively worsened after the surgery in 27% and 14% of the exposures. Veterinary surgeons exhibited neck postures involving a mean of 17° flexion during the surgical procedures. Static postures were common, occurring during 53-80% of the procedures. Compared to soft tissue procedures (e.g., 13.2% MVC in the right trapezius), higher muscle activity was observed during orthopaedic procedures (e.g., 27.6% MVC in the right trapezius).Conclusions: This pilot study showed that physical risk factors (i.e., muscle activity and posture of the neck/shoulder) can be measured using wearable sensors during live veterinary surgeries. The observed risk factors were similar to those documented for medical physicians. Further studies are needed to bring awareness to opportunities for improving workplace ergonomics in veterinary medicine and surgery.
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Affiliation(s)
- Hamed Asadi
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
| | - Micha C Simons
- College of Veterinary Medicine, Purdue University, West Lafayette, IN, USA
| | - Gert J Breur
- College of Veterinary Medicine, Purdue University, West Lafayette, IN, USA
| | - Denny Yu
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
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Elzomor A, Tunkel A, Lee E, Jaamour F, Davidson L, Shaver TB, Niermeyer W, Benito D, Cole K, Zapanta P. Intraoperative stretching microbreaks reduce surgery-related musculoskeletal pain in otolaryngologists. Am J Otolaryngol 2022; 43:103594. [PMID: 36029617 DOI: 10.1016/j.amjoto.2022.103594] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/07/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the role intraoperative otolaryngology stretching microbreak (OSMB) has on musculoskeletal (MSK) pain and discomfort in otolaryngologists. BACKGROUND Otolaryngology procedures subject surgeons to significant amounts of pain and strain over their years of training. MSK pain is a serious concern for otolaryngologists' career longevity as well as their general wellbeing. METHODS Participants from two different hospitals and one private practice were recruited to participate in this study. An initial ergonomic survey was obtained to assess baseline MSK pain, and its subjective impact on operative performance. The participants then completed three control days without OSMB exercises, followed by three intervention days with OSMB exercises which were completed at 20-40 minute intervals. Preoperative and postoperative pain rating surveys were completed before and after each procedure and at the end of the day to determine changes in pain and/or discomfort. RESULTS Ten otolaryngologists (50 % men, 50 % women; mean age 35.6 years) participated in this study. Half of the participants indicated that they were concerned their pain would limit their ability to operate in the future. 70 % of participants indicated that they have not attempted to treat this pain and 60 % did not try any stretching exercises outside the operating room (OR) to mitigate their symptoms. Participants reported neck, upper back, and lower back to be the primary MSK discomfort. OSMB improved participants' pain scores in neck, shoulders, hands, and lower back pain (p < 0.05). CONCLUSION MSK pain has shown to be a serious concern for the ability of otolaryngologists to continue performing surgery in the future. OSMB may be an effective strategy that can be implemented by otolaryngologists intraoperatively to improve MSK pain and overall well being.
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Affiliation(s)
- Amir Elzomor
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| | - Alexandra Tunkel
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Esther Lee
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Farris Jaamour
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Lauren Davidson
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Timothy Brandon Shaver
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Weston Niermeyer
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Daniel Benito
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Keith Cole
- Department of Health, Human Function and Rehabilitation Sciences, The George Washington University School of Health Sciences, Washington, DC, USA
| | - Philip Zapanta
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Otolaryngology - Head and Neck Surgery, Sovah Health, Danville, VA, USA
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The Current State of Surgical Ergonomics. UROGYNECOLOGY (HAGERSTOWN, MD.) 2022; 28:461-465. [PMID: 36256963 DOI: 10.1097/spv.0000000000001229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Work-related musculoskeletal disorders are widespread among surgeons, causing significant disability and career modification. Gender plays a role, as female surgeons have a two-fold greater risk for discomfort during certain operations due to generally smaller hand sizes and height as compared to male surgeons. There is a lack of appropriate surgical instrumentation geared toward smaller hand sizes. Maintaining a neutral position while operating, frequent changes in position, and increased awareness can contribute to decreasing the detrimental impact on surgeons' bodies from performing operations.
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Hemmati P, Nguyen TC, Dearani JA. Ergonomics for Surgeons by Surgeons-Posture, Loupes, and Exercise. JAMA Surg 2022; 157:751-752. [PMID: 35704295 DOI: 10.1001/jamasurg.2022.0676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Pouya Hemmati
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Tom C Nguyen
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco Health
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
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Chan PH, Howard J, Eva N, Tse HH. A systematic review of at-work recovery and a framework for future research. JOURNAL OF VOCATIONAL BEHAVIOR 2022. [DOI: 10.1016/j.jvb.2022.103747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Segal RM, Zaldana-Flynn M, Dean R, Gosman AA, Reid CM. Reduction of Work-Related Musculoskeletal Disorders in Plastic Surgeons by Introduction of a Posture Training Device. Ann Plast Surg 2022; 88:S379-S384. [PMID: 37740471 DOI: 10.1097/sap.0000000000003136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
BACKGROUND Plastic surgeons have an increased risk for the development of musculoskeletal disorders because of frequent poor ergonomics of the operating room. This study characterizes selected plastic surgery procedures, with an attempt to identify high-risk procedures and procedural components as well as the impact of biofeedback on surgical ergonomics. METHODS A commercially available posture training device was used to initially record neck and spine positioning and later to send biofeedback to prompt surgeons to correct posture. Device data were correlated with in-person observations to characterize factors associated with more time spent in the slouched/nonneutral cervical and thoracic spine posture. RESULTS The proportion of time spent in the upright position during surgery was significantly different among male and female participants, level of training, participant height, in the sitting versus nonsitting positioning (P < 0.001), with loupes use, and if there was more than an 8-inch height difference between 2 participants (mean, 0.70 ± 0.285). Using the device intervention, all participants spent a larger proportion of operating time upright. Half of these improvements in posture were statistically significant. While in feedback mode, participants experienced shorter and more frequent periods of slouching/nonneutral posture. When comparing the same participant performing the same procedure with and without device biofeedback, 72.2% of participants spent more time in the upright/neutral posture during the surgery when the device was sending feedback. CONCLUSIONS Biofeedback devices used in the operating room can lead to improved surgical posture, which may translate to reduction of workplace injuries, and overall physician health. This study found that a commercially available posture training device and sitting stools in the operating room could significantly improve physician cervical and thoracic spine posture.
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Affiliation(s)
| | | | - Riley Dean
- Division of Plastic Surgery, Department of Surgery, UC San Diego, San Diego, CA
| | - Amanda A Gosman
- Division of Plastic Surgery, Department of Surgery, UC San Diego, San Diego, CA
| | - Chris M Reid
- Division of Plastic Surgery, Department of Surgery, UC San Diego, San Diego, CA
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Bello C, Filipovic MG, Andereggen L, Heidegger T, Urman RD, Luedi MM. Building a well-balanced culture in the perioperative setting. Best Pract Res Clin Anaesthesiol 2022; 36:247-256. [DOI: 10.1016/j.bpa.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 10/18/2022]
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Tetteh E, Hallbeck MS, Mirka GA. Effects of passive exoskeleton support on EMG measures of the neck, shoulder and trunk muscles while holding simulated surgical postures and performing a simulated surgical procedure. APPLIED ERGONOMICS 2022; 100:103646. [PMID: 34847371 DOI: 10.1016/j.apergo.2021.103646] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 06/13/2023]
Abstract
Exoskeletons have shown significant impact at reducing the biomechanical demand on muscles during repetitive lifting and overhead tasks in non-healthcare industries. However, the benefits of exoskeletons are yet to be realized in the operating room, particularly as work-related musculoskeletal disorders continue to be a concern for surgeons. This study quantified the effect of using neck, arm, and trunk exoskeletons on muscle activity while assuming typical postures held in the operating room. Fourteen participants were recruited to participate in this study. In this two-part experiment participants were asked to 1) hold a series of neck flexion, arm abduction and trunk flexion postures seen in surgical procedures, and 2) perform a simulated surgical task requiring five different trunk flexion posture levels. Participants were required to complete these tasks with and without passive exoskeleton(s). This study showed that even for postures held short time periods, exoskeletons are beneficial at reducing the demand on muscles; however, the reduction in muscle demand depends on body segment and postural angle, as intended with these passive exoskeletons. Furthermore, for the simulated surgical task with awkward trunk flexion postures (10-65°), the trunk exoskeletons showed a significant reduction in the rate of rise in back muscle sEMG (+1.365%MVC/min vs. +0.769%MVC/min for non-dominant lumbar extensor muscles, p = 0.0108; +1.377%MVC/min vs. +0.770%MVC/min for the dominant lumbar extensor muscles, p = 0.0196) over 25 min, consequently resulting in improved trunk subjective discomfort scores (7.34 vs. 4.30, p < 0.05), with no impact on the neck and shoulder biomechanical demand. The results from this study indicate that exoskeletons may be a potential intervention to reduce biomechanical loading during surgery.
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Affiliation(s)
- Emmanuel Tetteh
- Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, IA, USA; Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA; Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA.
| | - M Susan Hallbeck
- Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, IA, USA; Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA; Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Gary A Mirka
- Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, IA, USA; Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
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The burden of performing minimal access surgery: ergonomics survey results from 462 surgeons across Germany, the UK and the USA. J Robot Surg 2022; 16:1347-1354. [PMID: 35107707 PMCID: PMC9606063 DOI: 10.1007/s11701-021-01358-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/21/2021] [Indexed: 11/05/2022]
Abstract
This international study aimed to understand, from the perspective of surgeons, their experience of performing minimal access surgery (MAS), to explore causes of discomfort while operating and the impact of poor ergonomics on surgeon welfare and career longevity across different specialties and techniques. A quantitative online survey was conducted in Germany, the UK and the USA from March to April 2019. The survey comprised 17 questions across four categories: demographics, intraoperative discomfort, effects on performance and anticipated consequences. In total, 462 surgeons completed the survey. Overall, 402 (87.0%) surgeons reported experiencing discomfort while operating at least ‘sometimes’. The peak professional performance age was perceived to be 45–49 years by 30.7% of surgeons, 50–54 by 26.4% and older than 55 by 10.1%. 86 (18.6%) surgeons felt it likely they would consider early retirement, of whom 83 were experiencing discomfort. Our findings highlight the continued unmet needs of surgeons performing MAS, with the overwhelming majority experiencing discomfort, frequently in the back, neck and shoulders, and many likely to consider early retirement consequently. Innovative solutions are needed to alleviate this physical burden and, in turn, prevent economic and societal impacts on healthcare systems resulting from MAS limiting surgeon longevity.
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Symer MM, Keller DS. Human factors in pelvic surgery. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:2346-2351. [PMID: 35012835 DOI: 10.1016/j.ejso.2021.12.468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/15/2021] [Accepted: 12/29/2021] [Indexed: 01/18/2023]
Abstract
In the pelvis, anatomic complexity and difficulty in visualization and access make surgery a formidable task. Surgeons are prone to work-related musculoskeletal injuries from the frequently poor design and flow of their work environment. This is exacerbated by the strain of surgery in the pelvis. These injuries can result in alterations to a surgeons practice, inadvertent patient injury, and even early retirement. Human factors examines the relationships between the surgeon, their instruments and their environment. By bridging physiology, psychology, and ergonomics, human factors allows a better understanding of some of the challenges posed by pelvic surgery. The operative approach involved (open, laparoscopic, robotic, or perineal) plays an important role in the relevant human factors. Improved understanding of ergonomics can mitigate these risks to surgeons. Other human factors approaches such as standardization, use of checklists, and employing resiliency efforts can all improve patient safety in the operating theatre.
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Affiliation(s)
- Matthew M Symer
- Division of Colorectal Surgery, NewYork/Presbyterian-Weill Cornell Medicine, New York, NY, USA.
| | - Deborah S Keller
- Division of Colorectal Surgery, Department of Surgery, University of California at Davis, Sacramento, CA, USA.
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Tsao L, Kim S, Ma L, Nussbaum MA. An exploratory study comparing three work/rest schedules during simulated repetitive precision work. ERGONOMICS 2021; 64:1579-1594. [PMID: 34224340 DOI: 10.1080/00140139.2021.1950844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/23/2021] [Indexed: 06/13/2023]
Abstract
The pattern of work and rest can influence both physical fatigue and task performance in manual operations. However, there is relatively limited evidence regarding the influences of specific work/rest schedules in tasks requiring high repetitiveness and precision demands, along with relatively low exertion levels. Eighteen participants completed an exploratory study that simulated such tasks, to compare the effects of three distinct work/rest schedules (i.e. short frequent [short] and long infrequent breaks [long], and a self-selected schedule) on muscle fatigue, task performance (in terms of accuracy and speed), and preference. Schedules with long or self-selected breaks generally induced less muscle fatigue, compared with the short break condition. Participants preferred the self-selected condition the most and the long-break condition the least. The different schedules tested did not influence task performance. A self-selected schedule may be beneficial for repetitive precision task, to achieve a balance across muscle fatigue, task performance, and individual preference. Practitioner summary: Influences of three work/rest schedules (i.e. short and long breaks, and a self-selected schedule) on fatigue, performance, and preference were explored during repetitive precision tasks. Schedules with long or self-selected breaks induced less muscle fatigue and none of the three schedules influenced performance. A self-selected schedule was the most preferred.
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Affiliation(s)
- Liuxing Tsao
- Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA, USA
- Department of Industrial Engineering, Tsinghua University, Beijing, China
- Teaching Center for Writing and Communication, School of Humanities, Tsinghua University, Beijing, China
| | - Sunwook Kim
- Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA, USA
| | - Liang Ma
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Maury A Nussbaum
- Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA, USA
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McQuivey KS, Christopher ZK, Deckey DG, Mi L, Bingham JS, Spangehl MJ. Surgical Ergonomics and Musculoskeletal Pain in Arthroplasty Surgeons. J Arthroplasty 2021; 36:3781-3787.e7. [PMID: 34303581 DOI: 10.1016/j.arth.2021.06.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/04/2021] [Accepted: 06/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND One occupational hazard inherent to total joint replacement surgeons is procedural-related musculoskeletal pain (MSP). The purpose of this study is to identify the prevalence of work-related MSP among arthroplasty surgeons and analyze associated behaviors, attitudes, and beliefs toward surgical ergonomics. METHODS A survey was sent to members of the American Association of Hip and Knee Surgeons. The survey included 3 main sections: demographics, symptoms by body part, and attitudes/beliefs/behaviors regarding surgical ergonomics. Pain was reported using the Numeric Rating Scale (0 = no pain, 10 = maximum pain), and well-being was assessed using the Maslach Burnout Inventory. RESULTS In total, 586 surgeons completed the survey: 96.1% male and 3.9% female. Most surgeons (96.5%) experience procedural-related MSP. Collectively, surgeons reported an average pain score of 3.7/10 (standard deviation ±1.95). Significant levels of MSP (≥5/10) were most common in the lower back (34.2%), hands (24.8%), and the neck (21.2%). There was a positive association among higher MSP and burnout (P < .001), callousness toward others (P = .005), and decreased overall happiness (P < .001). MSP was also found to have a significant impact on surgeon behavior including the degree of irritability (P < .001), alcohol intake (P < .001), and poor sleep patterns (P < .001). CONCLUSION The prevalence of MSP among arthroplasty surgeons is extremely high. This study demonstrates that MSP has a significant impact on career attitudes, lifestyle, and overall surgeon well-being. This study may also contribute to future work to prevent cumulative chronic ailments, disability, and lost productivity of arthroplasty surgeons through promotion of improved ergonomics and risk-reduction strategies. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Kade S McQuivey
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | | | - David G Deckey
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Lanyu Mi
- Division of Biomedical Statistics and Informations, Mayo Clinic Arizona, Scottsdale, AZ
| | - Joshua S Bingham
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Mark J Spangehl
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ
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Sarwal G, Tobias G, Taylor DC, Misskey JD, Hsiang YN. Survey of Canadian vascular surgeons and trainees finds work-related musculoskeletal pain and discomfort is common. J Vasc Surg 2021; 75:1431-1436. [PMID: 34718100 DOI: 10.1016/j.jvs.2021.09.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 09/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Occupational injuries and disability are a source of surgeon morbidity. The purpose of this study was to assess the physical toll of working in operating rooms by Canadian vascular surgeons. OBJECTIVE To assess work-place musculoskeletal (MSK) complaints and challenges faced by Canadian vascular surgeons and trainees and its implications on surgical practice and occupational longevity. METHODS An online survey was distributed to resident and surgeon members of the Canadian Society of Vascular Surgery. The survey collected data on demographics, operative volume, and work-related MSK symptoms. RESULTS The survey was distributed to 188 surgeons and trainees. After three e-mailings, 109 surveys were returned (58% response rate). Of the responders, 87% were male, 51% were 45 years or older, and 56% had been in practice for ten or more years. Workplace MSK symptoms was reported by 83% of the responders. The most common locations were the low back (78%), neck (74%), and shoulder (30%). Most responders (83%) believed that these symptoms were related to their operative environment. Almost half (48%) sought medical care. As a result of these MSK symptoms, 25% experience chronic pain with 8% reporting time off work as a consequence. Another 11% reported an impact on their operative performance with 14% considering early retirement. A lack of operating room system changes to prevent workplace injury and disability was noted by 85% of the responders although only 3% reported their disability to their department. CONCLUSION Occupational MSK symptoms and disability is common amongst Canadian vascular surgeons. Further research is needed to create programs to improve surgeon morbidity.
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Affiliation(s)
- Gautamn Sarwal
- Division of Vascular Surgery, University of British Columbia, Vancouver, B.C
| | - Gabriel Tobias
- Division of Vascular Surgery, University of British Columbia, Vancouver, B.C
| | - David C Taylor
- Division of Vascular Surgery, University of British Columbia, Vancouver, B.C
| | - Jonathan D Misskey
- Division of Vascular Surgery, University of British Columbia, Vancouver, B.C
| | - York N Hsiang
- Division of Vascular Surgery, University of British Columbia, Vancouver, B.C..
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Asadi H, Monfared S, Athanasiadis DI, Stefanidis D, Yu D. Continuous, integrated sensors for predicting fatigue during non-repetitive work: demonstration of technique in the operating room. ERGONOMICS 2021; 64:1160-1173. [PMID: 33974511 DOI: 10.1080/00140139.2021.1909753] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/21/2021] [Indexed: 06/12/2023]
Abstract
Surface electromyography (sEMG) can monitor muscle activity and potentially predict fatigue in the workplace. However, objectively measuring fatigue is challenging in complex work with unpredictable work cycles where sEMG may be influenced by the dynamically changing posture demands. This study proposes a multi-modal approach integrating sEMG with motion sensors and demonstrates the approach in the live surgical work environment. Seventy-two exposures from twelve participants were collected, including self-reported musculoskeletal discomfort, sEMG, and postures. Posture sensors were used to identify time windows where the surgeon was static and in non-demanding positions, and mean power frequencies (MPF) were then calculated during those time windows. In 57 out of 72 exposures (80%), participants experienced an increase in musculoskeletal discomfort. Integrated (multi-modality) measurements showed better performance than single-modality (sEMG) measurements in detecting decreases in MPF, a predictor of fatigue. Based on self-reported musculoskeletal discomfort, sensor-based thresholds for identifying fatigue are proposed for the trapezius and deltoid muscle groups. Practitioner summary Work-related fatigue is one of the intermediate risk factors to musculoskeletal disorders. This article presents an objective integrated approach to identify musculoskeletal fatigue using wearable sensors. The presented approach could be implemented by ergonomists to identify musculoskeletal fatigue more accurately and in a variety of workplaces. Abbreviations: sEMG: surface electromyography; IMU: inertia measurement unit; MPF: mean power frequency; ACGIH: American Conference of Governmental Industrial Hygienists; SAGES: Society of American Gastrointestinal and Endoscopic Surgeons; LD: left deltoid; LT: left trapezius; RD: right deltoid; RT: right trapezius.
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Affiliation(s)
- Hamed Asadi
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
| | - Sara Monfared
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Denny Yu
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
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