A Multidisciplinary Focus Review of Musculoskeletal Disorders Among Operating Room Personnel

The compatibility of exoskeletons in perioperative environments and workflows: an analysis of surgical team members' perspectives and workflow simulation

Surgical team members in perioperative environments experience high physical demands. Interventions such as exoskeletons, external wearable devices that support users, have the potential to reduce these work-related physical demands. However, barriers such as workplace environment and task compatibility may limit exoskeleton implementation. This study gathered the perspectives of 33 surgical team members: 12 surgeons, four surgical residents, seven operating room (OR) nurses, seven surgical technicians (STs), two central processing technicians (CPTs), and one infection control nurse to understand their workplace compatibility. Team members were introduced to passive exoskeletons via demonstrations, after which surgical staff (OR nurses, STs, and CPTs) were led through a simulated workflow walkthrough where they completed tasks representative of their workday. Five themes emerged from the interviews (workflow, user needs, hindrances, motivation for intervention, and acceptance) with unique subthemes for each population. Overall, exoskeletons were largely compatible with the duties and workflow of surgical team members.

Comparison of self-management and spa therapy for upper-extremity musculoskeletal disorders: A randomized controlled trial

BACKGROUND

Musculoskeletal disorders (MSDs) are common in the workplace and are a public health issue. Persistent pain despite conservative treatment or surgery may lead to poor long-term outcomes.

OBJECTIVE

To compare the effect of a combined 6-day program of exercise, self-management workshops and spa therapy with self-management on functional capacity in personal and professional daily life at 3 months in people with musculoskeletal disorders.

METHODS

We conducted a prospective, randomized controlled trial. Participants were employed (any type of work) and aged between 18 and 65 years, with latent or symptomatic upper extremity MSDs, with or without a history of sick leave. They were randomized to participate in 6 days (2 h per day) of spa therapy, exercise, and self-management workshops immediately (intervention) or at 3 months (control). The control group performed self-management until 3 months. The primary outcome was the score on the self-reported Quick Disability of Arm-Shoulder-Hand (QuickDASH) at 3 months. The primary analysis was conducted using analysis of covariance with baseline QuickDASH score as the covariate.

RESULTS

In total, 150 participants were randomized (85 % women): 78 to the control group and 72 to the intervention group. At 3 months, the QuickDASH total and work scores did not differ between groups (effect-size [ES] = -0.15, 95 %CI, -0.38 to 0.09, p = 0.215, and ES = -0.11, 95 % CI, -0.35 to 0.12, p = 0.343). However, QuickDASH sport/performing arts score was significantly different between randomization groups at 3 months (ES =-0.25, 95 % CI, -0.48 to -0.02, p = 0.035).

CONCLUSIONS

This study provided no evidence in favor of a short-course, personalized self-management, intensive spa therapy intervention over self-management alone for the management of upper-extremity MSDs.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT02702466) retrospectively registered.

Effect of Assisted Surgery on Work-Related Musculoskeletal Disorder Prevalence by Body Area among Surgeons: Systematic Review and Meta-Analysis

Surgeons are highly exposed to work-related musculoskeletal disorders (WMSDs). The objective of this review was to summarize the WMSD prevalence by body area with and without assistive devices. The underlying question was whether there is an effect of assistive device use (robot, video, or other) during surgery on WMSD prevalence by body area among surgeons, regardless of their specialty. The systematic review was conducted according to the PRISMA guidelines. The Google Scholar, Pubmed/Medline, and ScienceDirect databases were scanned to identify relevant studies. The article selection, review, critical appraisal, and data extraction were performed by two authors independently. Among the 34,854 unique identified records, 77 studies were included. They were divided into two groups: 35 focused on robotic- and video-assisted surgery (RVAS) and 48 concerning surgery without video/robotic assistance (WAS) (6 studies evaluated the prevalence for both groups). WMSD prevalence was reported for 13 body areas: the neck, back, upper back, mid-back, lower back, shoulders, elbows, wrists, fingers, thumbs, hips, knees, and ankles. The results showed that WMSD prevalence was significantly higher (unpaired t-test, p < 0.05) for RVAS in the shoulders (WAS: 28.3% vs. RVAS: 41.9%), wrists (WAS: 20.9% vs. RVAS: 31.5%), and thumbs (WAS: 9.9% vs. RVAS: 21.8%). A meta-analysis was performed for 10 body areas (with 4 areas including more than 25 studies). No sufficient data were available for the mid-back, thumbs, or hips. A high heterogeneity (Cochran's Q test and I² statistic) was observed. A random-effects model revealed that the highest worldwide prevalence was in the neck (WAS: 41% and RVAS: 45.3%), back (WAS: 37.7% and RVAS: 49.9%), lower back (WAS: 40.0% and RVAS: 37.8%), and shoulders (WAS: 27.3% and RVAS: 41.4%). Future work could focus on work environment design, particularly the positioning and adjustment of equipment, and on postural analysis to reduce the appearance of WMSDs. Recommendations are proposed for future reviews and meta-analyses.

The effect of anti-fatigue floor mat on pain and fatigue levels of surgical team members: A crossover study

As ergonomics is important to maintain comfort, this study aimed to examine the effect of anti-fatigue floor mats on pain and fatigue levels of surgical team members. Thirty-eight members participated in this crossover-designed study with no-mat and with-mat conditions, separated by a one-week washout period. They stood on the 15 mm thick rubber anti-fatigue floor mat and on the standard antistatic polyvinyl chloride flooring surface during the surgical procedures. Subjective ratings of pain and fatigue levels were measured pre and after-surgery for each experimental condition using the Visual Analogue Scale and Fatigue-Visual Analogue Scale scales. The after-surgery pain and fatigue levels for the with-mat condition were significantly lower than the no mat condition (p < .05). Consequently, anti-fatigue floor mats are effective in decreasing pain and fatigue levels of surgical team members during surgical procedures. Using anti-fatigue mats may be a practical and easy way to prevent discomfort that is often experienced by surgical teams.

Effectiveness of a theory-based educational intervention on work-related musculoskeletal disorders preventive behaviors among assembly-line female workers: a study protocol for a randomized controlled trial

BACKGROUND

The use of preventive behaviors of musculoskeletal disorders (MSDs) requires proper training, which leads to correct decisions regarding maintaining postures at work and performing stretching exercises. Due to very repetitive work, applying manual force, improper postures, and static contractions of proximal muscles, assembly-line female workers suffer from musculoskeletal pains. It is assumed that structured and theory-based educational intervention using a learning-by-doing (LBD) approach may increase the preventive behaviors against MSDs and reduce the consequences of these disorders.

METHODS

This randomized controlled trial (RCT) will be conducted in three phases: phase 1: validation of the compiled questionnaire, phase 2: determining the social cognitive theory (SCT) constructs that predict the preventive behaviors of MSDs in assembly-line female workers, and phase 3: designing and implementing the educational theory. The educational intervention is based on the LBD approach, and the study population includes assembly-line female workers in electronic industries of Iran, who are randomly divided into two intervention and control groups. The intervention group received the educational intervention in the workplace and the control group does not receive any intervention. The theory-based educational intervention includes evidence-based information along with pictures, fact sheets, and published literature about a good posture at work and the need to perform proper stretching exercises. The educational intervention aims to improve the knowledge, skills, self-efficacy, and intention of assembly-line female workers to adopt preventive behaviors of MSDs.

DISCUSSION

The present study will evaluate the effects of maintaining a good posture at work and performing stretching exercises on the adherence to preventive behaviors of MSDs among assembly-line female workers. The developed intervention is easily implemented and evaluated in a short period of time based on the improved score of the rapid upper limb assessment (RULA) method and the mean score of adherence to stretching exercises and can be provided by a health, safety, and environment (HSE) expert.

TRIAL REGISTRATION

ClinicalTrials.gov IRCT20220825055792N1. Registered on 23 September 2022 with the IRCTID.

Global prevalence of musculoskeletal disorders among physiotherapists: a systematic review and meta-analysis

BACKGROUND

Musculoskeletal disorders (MSD) are one of the most important problems among physiotherapists worldwide. However, there is no meta-analysis of the MSD prevalence in all body areas among physiotherapists.

OBJECTIVES

The purpose was to investigate and estimate the worldwide prevalence of MSD among physiotherapists using a systematic review-, meta-analysis and meta-regression.

METHODS

The systematic review, meta-analysis and meta-regression were performed in 2022 using the PRISMA guidelines.

DATA SOURCES

The search was performed on PubMed/Medline, ScienceDirect, Google Scholar, Medeley and Science.gov databases.

STUDY APPRAISAL

The quality appraisal of the included articles was assessed using the critical appraisal tool for cross-sectional studies AXIS.

RESULTS

A total of 722 articles were found. After screening and comparison with the inclusion criteria, 26 studies were retained. Based on the random-effects model, the worldwide MSD prevalence in neck, upper back, mid back, lower back, shoulders, elbows, wrists/hands, thumb, hips/thighs, knees/legs, and ankles/feet was 26.4% (CI 95%: 21.0-31.9%), 17.7% (CI 95%: 13.2-22.2%), 14.9% (CI 95%: 7.7-22.1%), 40.1% (CI 95%: 32.2-48.0%), 20.8% (CI 95%: 16.5-25.1), 7.0% (CI 95%: 5.2-8.9), 18.1% (CI 95%: 14.7-21.5%), 35.4% (CI 95%: 23.0-47.8), 7.0% (CI 95%: 5.2-8.8), 13.0% (CI 95%: 10.3-15.8), and 5% (CI 95%: 4.0-6.9) respectively. The neck and shoulder prevalence of four continents were close to the world prevalence. No effect of continent was found on MSD prevalence. The heterogeneity of the results obtained in the meta-analysis and meta-regression was discussed.

CONCLUSIONS

Based on the random effects model, the results of the worldwide meta-analysis showed that lower back pain, thumb, neck and shoulder were the area most at risk for MSD and were therefore those to be monitored as a priority. Recommendations were proposed for future reviews and meta-analyses.

Construction of a Musculoskeletal Discomfort Scale for the Lower Limbs of Workers: An Analysis Using the Multigroup Item Response Theory

Musculoskeletal symptoms are a major occupational health problem in workers, and these can affect all professional occupations. Previous studies have proposed metrics capable of evaluating the musculoskeletal discomfort experienced by workers. However, no study has developed a metric that considers professional groups. Thus, this study aimed to develop a scale for musculoskeletal discomfort in the lower limbs to compare self-reported symptoms among education, health, and industry professionals. The sample included 159 teachers, 167 health professionals, and 401 industrial operators who relayed their symptoms using a diagram of the hips, thighs, knees, lower legs, and feet. Factor and multigroup item response theory analyses were used to construct a musculoskeletal discomfort scale consisting of seven levels and to assess and compare the identified symptoms. The results showed that the progressive evolution of discomfort differed for each profession, demonstrating that each context and work environment affects workers differently, which may explain the different patterns of symptom responses among professional groups.

Effect of a Developed Nursing Stretch Break Application on Work-Related Musculoskeletal Complications and Fatigue among Nurses: An Interventional Study

Objective

The present study aimed to develop Nursing Stretch Break (NSB) application to relieve work-related musculoskeletal complications and fatigue among hospital nurses.

Methods

This interventional study was conducted among 71 nurses (15 men and 56 women with a mean age of 33.32 ± 6.42) employed in Shiraz governmental hospitals, Southwest Iran, for four months. In this study, NSB was developed; it includes eight main menus for the user, including (1) Registration, (2) Stretches, (3) User panel, (4) Questions from the researcher, (5) About us, (6) Contact us, (7) Reports, and (8) Answers to questions. Data were collected pre and post-intervention via the Persian version of the Nordic Musculoskeletal Questionnaire (P-NMQ), the Persian version of the Multidimensional Assessment of Fatigue (P-MAF) Scale, the Persian version of the Numeric Rating Scale (P-NRS), and the Persian version of the Usefulness, Satisfaction, and Ease of use (P-USE) questionnaire.

Results

NSB application usability testing showed that the mean scores of P-USE subscales were high. The prevalence of work-related musculoskeletal symptoms (WMSs) in the last 7 days in nurses' body parts, except the elbows and knees, was significantly lower after the intervention than before. In addition, the intensity of work-related musculoskeletal pain/discomfort in all body parts, except the knees, was significant relief after the intervention compared to before. The results demonstrated that the difference in the mean score of the total fatigue and its subscales, except "degree of interference with activities of daily living," was significant after the intervention compared to before.

Conclusions

NSB could be a low-cost and feasible ergonomic solution to improve the nurses' musculoskeletal health.

Why multi-tier surgical instrument table matters? An ergonomic analysis from mento-physical demand perspectives

Using traditional back tables (BT) in operating rooms (OR) can lead to high physical/cognitive demand on nurses due to repetitive manual material handling activities. A multi-tier table (MTT) has been developed to relieve such stressors by providing extra working surfaces to avoid stacking the instrument trays and facilitate access to surgical tools. In this study, sixteen participants performed lifting/lowering and instrument findings tasks on each table, where kinematics, kinetics, subjective, and performance-related measures were recorded. Results indicated that MTT required lesser shoulder flexion (p-value<0.001), ∼14% lower shoulder loads (0.012), task completion time (<0.001), and cognitive/physical workloads (<0.004). Although peak low-back demands were ∼15% higher using MTT, the number of lifts to complete the same task was 60% lower, leading to lower cumulative demand on the low-back musculature. Utilizing MTT in OR could reduce demand and increase nurses' efficiency, leading to reduced risk of WMSDs and the total time of surgery.

Compassion satisfaction, compassion fatigue, burnout, working environments, and musculoskeletal disorders among nurses

PURPOSE

It was aimed to determine the perceptions of nurses' working environment and professional quality of life and to compare nurses with and without musculoskeletal discomfort.

DESIGN AND METHODS

It is a descriptive and comparative study. The data were collected from 333 nurses working at different units.

FINDINGS

Those, who did not have discomfort in their body parts, had a higher mean score in the Practice Environment Scale of the Nursing Work Index; whereas, those having discomfort in all parts of the body had a higher mean score in the Professional Quality of Life Scale (p < 0.05; p < 0.01; p < 0.001).

PRACTICE IMPLICATIONS

Attempts to reduce nurses' musculoskeletal discomfort can positively increase perceptions of the working environment and professional quality of life.

Prevalence and Clinical Characteristics of Low Back Pain among Operating Room Personnel: A Cross-Sectional Study in South of Iran

Background

Low back pain is one of the most common musculoskeletal disorders and the most common cause of activity restriction in people younger than 45 years. Nurses have a high incidence and prevalence of low back pain in terms of physical and emotional factors among healthcare workers. This study aimed to evaluate the prevalence and clinical characteristics of low back pain.

Methods

This cross-sectional study was performed on 385 operating room personnel of the hospitals affiliated with Shiraz (the largest city in southern Iran) University of Medical Sciences. The data were collected via a research-made developed questionnaire. The questionnaire consisted of two parts, including the demographic information and prevalence and dimensions of low back pain.

Results

The results showed that the prevalence of low back pain was 74% among operating room personnel. There was a significant relationship among low back pain, education level, and marital status (p < 0.05).

Conclusion

Hospital managers should reduce the prevalence of this disorder among operating room staff by teaching preventative patient handling techniques via training courses.

Prevalence and factors associated with work-related musculoskeletal disorder among health care providers working in the operation room

Background

Work-related musculoskeletal disorder is a major and frequently underappreciated problem on people, countries, healthcare services, and society as a whole. Not only have detrimental health impacts, but it had considerable damage on healthcare services and costs.

Objective

The aim of this study was to determine the prevalence and factors associated with work-related musculoskeletal diseases among health care providers working in the operating room of University of Gondar comprehensive specialized hospital and Tibebe Ghion comprehensive specialized hospital, North West Ethiopia, 2021.

Method

Institution-based cross-sectional study was conducted on 394 healthcare providers. Purposive sampling was used to select the study participants. Data were collected through a self-administer questionnaire using the standard Nordic Musculoskeletal Questionnaire. Descriptive statistics and bivariate logistic regression were done to identify factors associated with work-related musculoskeletal disorders. Variables with P-value≤ 0.05 with 95% confidence interval in a multivariate model were taken as statistically significant. Finally, AOR with 95% confidence interval at a P-value<0.05 was reported.

Result

The prevalence of work-related musculoskeletal disorder among study participants was 64.2% with 95% CI: (59.4, 69.0). In multivariate logistic regression analysis; working overtime [AOR:1.74; 95% CI (1.05, 2.86)], previous history of MSD [AOR:6.85; 95%CI:(1.91, 22.7)], being diploma holder [AOR:5.27; 95% CI (1.12, 24.68)], being 1st degree holder [AOR:2.65; 95% CI (1.11, 6.28)], absence of assistance during procedures [AOR:1.73; 95% CI (1.02, 2.85)], and working in night shifts [AOR:1.72; 95% CI (1.08, 2.74)] were significantly associated with work related musculoskeletal disease among health care providers working in operation room.

Conclusion

A high proportion of hospital care providers working in the operation room reported MSD at different body parts. Lower back pain was the most often complained. Working overtime, not having assistance during procedures, educational status (diploma and 1st degree holder), and working at night shifts were statistically significant associated with musculoskeletal disorders.

The association among health behaviors, shift work and chronic morbidity: A cross-sectional study on nurses working in full-time positions

Background: Nurses are known to work in conditions of stress and physical overload. Health behaviors are modifiable factors that may reduce the adverse effects of work on general health. The present study examined health-related behaviors and their association with current night shift work and chronic morbidity among female nurses.

Design and Method: Four hundred seventy-two female nurses (M ± SD = 44.28±7.14 years) self-reported their health habits, physical activity, body mass index (BMI), and chronic disorders that required current treatment. Instruments used in the study consisted of an author-developed questionnaire and the Health Behavior Inventory (HBI). Reported diagnoses were classified as cardio-vascular, gastro-intestinal, malignant neoplastic, endocrine, or other.

Results: The most common reported disorders were cardiovascular disorders (5.7% of nurses) followed by other (7.6%), endocrine (7.4%), gastro-intestinal (6.4%), and malignancy (0.2%). On average, health-related behaviors on the HBI were average (83.49 ± 14.33). Overweight and/or obesity (i.e., BMI ≥25 kg/m²) were reported by 41.5% of nurses, 24.2% were current smokers, and 36% reported no recreational physical activity. The remaining 64% of nurses who performed physical activity did not report activity levels that met World Health Organization recommendations. Physical activity and HBI scores (total and subscales; i.e., positive attitude, preventive behaviors, proper dietary habits, health-related practices) were not associated with current night shift work or morbidity.

Conclusion: Health-promoting programs are needed to support weight control and promote health-related behaviors among nurses. Future research should identify potential barriers to healthy lifestyle recommendations in the workplace.

Musculoskeletal System Disorders among Surgical Nurses Related to Health Industry in Northwestern Turkey: A Cross-sectional Study

Introduction. Nurses may encounter musculoskeletal disorders (MSDs) and pain episodes stemming from regular exposure to health industry risk factors.Aim. To determine prevalence of MSDs and its associated factors among Turkish surgical nurses.Methods. A cross-sectional design which used a self-administered questionnaire surveys was employed with 169 surgical nurses. The survey included an individual data questionnaire, and Nordic Musculoskeletal Questionnaire- Extended (NMQ-E).Results. 88.8 %of the surgical nurses had musculoskeletal system disorders, and most experienced these problems were related health industry. The interventions causing physical strain in the participants were identified as constant standing up, patient care, carrying heavy loads, sudden movements, patient transfer, and pulling-pushing practices. It was found that the nurses used coping methods including walking, exercising, receiving physiotherapist support, pilates and yoga. The most frequently encountered problems were in the back region. A significant relationship was found between musculoskeletal system problems and the clinic of work, years of work, age, and gender (p < 0.05).Conclusions. Nurses experience musculoskeletal problems related to health industry. It is crucial to determine the real causes of musculoskeletal problems and take appropriate preventive measures to improve workplace ergonomics.