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Thielmann B, Pohl R, Böckelmann I. Physical stress and musculoskeletal complaints of veterinarians - A narrative review. APPLIED ERGONOMICS 2024; 115:104180. [PMID: 38008038 DOI: 10.1016/j.apergo.2023.104180] [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: 05/13/2023] [Revised: 11/02/2023] [Accepted: 11/12/2023] [Indexed: 11/28/2023]
Abstract
INTRODUCTION Veterinarians have high physical workloads. The aim of this narrative review is to evaluate the literature on typical physical workloads, such as lifting/carrying and forced position (during surgery) and predictors of injuries. The health complaints of veterinarians were also examined. METHODS Diverse databases were used. Prevalence rates of total workloads (also including surgery), health complaints, musculoskeletal discomfort, and predictors of injury, musculoskeletal disorders, and precaution awareness were examined. RESULTS Thirteen studies were included. The most prevalent injury was animal attacks (9%-84%). Working in large and mixed practice types were predictors of injuries or musculoskeletal disorders (e.g., shoulder, lower back, head/neck) compared to other types of practice. CONCLUSION The study findings presented here clearly show a high need for intervention to minimize and prevent occupational risks. Ergonomic working conditions and occupational safety training can reduce the risk of musculoskeletal disorders.
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Affiliation(s)
- Beatrice Thielmann
- Institute of Occupational Medicine, Medical Faculty, Otto-von-Guericke-University, Leipziger Str. 44, (Building 20), 39120, Magdeburg, Germany.
| | - Robert Pohl
- Institute of Occupational Medicine, Medical Faculty, Otto-von-Guericke-University, Leipziger Str. 44, (Building 20), 39120, Magdeburg, Germany
| | - Irina Böckelmann
- Institute of Occupational Medicine, Medical Faculty, Otto-von-Guericke-University, Leipziger Str. 44, (Building 20), 39120, Magdeburg, Germany
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Wong SW, Crowe P. Visualisation ergonomics and robotic surgery. J Robot Surg 2023; 17:1873-1878. [PMID: 37204648 PMCID: PMC10492791 DOI: 10.1007/s11701-023-01618-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/13/2023] [Indexed: 05/20/2023]
Abstract
Stereopsis may be an advantage of robotic surgery. Perceived robotic ergonomic advantages in visualisation include better exposure, three-dimensional vision, surgeon camera control, and line of sight screen location. Other ergonomic factors relating to visualisation include stereo-acuity, vergence-accommodation mismatch, visual-perception mismatch, visual-vestibular mismatch, visuospatial ability, visual fatigue, and visual feedback to compensate for lack of haptic feedback. Visual fatigue symptoms may be related to dry eye or accommodative/binocular vision stress. Digital eye strain can be measured by questionnaires and objective tests. Management options include treatment of dry eye, correction of refractive error, and management of accommodation and vergence anomalies. Experienced robotic surgeons can use visual cues like tissue deformation and surgical tool information as surrogates for haptic feedback.
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Affiliation(s)
- Shing Wai Wong
- Department of General Surgery, Prince of Wales Hospital, Sydney, NSW, Australia.
- Randwick Campus, School of Clinical Medicine, The University of New South Wales, Sydney, NSW, Australia.
| | - Philip Crowe
- Department of General Surgery, Prince of Wales Hospital, Sydney, NSW, Australia
- Randwick Campus, School of Clinical Medicine, The University of New South Wales, Sydney, NSW, Australia
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Acharya H, Patel P, Shetty GM, Shah M, Bamb H, Nene A. Prevalence and risk factors of neck pain in spine surgeons - Are we our own patients? J Clin Orthop Trauma 2022; 33:102012. [PMID: 36110511 PMCID: PMC9467889 DOI: 10.1016/j.jcot.2022.102012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 06/04/2022] [Accepted: 08/27/2022] [Indexed: 10/14/2022] Open
Abstract
Aim This survey of spine surgeons aimed to determine the prevalence of neck pain and identify the associated risk factors. The prevalence of neck pain has been reported in various medical sub-specialities including laparoscopy surgeons, dentists, plastic surgeons, ophthalmologist, urologist and orthopaedic surgeons. However, the literature is lacking on prevalence and risk factors for neck pain in spine surgeons. Methods A survey questionnaire containing demographic, Neck pain and work practice details was administered to 300 spine surgeons (members of an online group) via text message and e-mail. Results One hundred and eighty surgeons responded to the survey (response rate, 60%). Three spine surgeons had previous cervical spine surgeries. The 1-month prevalence rate of neck pain was 74.4% (134/180 surgeons). One hundred and eighteen surgeons (88%) reported only neck pain, 16 surgeons (11.9%) had neck pain with radicular arm pain. Only 20.5% of surgeons used a loupe, 18% of surgeons used a microscope, and 24% of surgeons used operating table height at umbilicus during surgery. There was no significant difference between the mean age (p = 0.65), work experience (p = 0.8), time spent in surgery (p = 0.7), and operating table height preference (p = 0.4) when symptomatic and asymptomatic groups were compared. However, a significantly greater percentage of surgeons had a sedentary lifestyle (p = 0.002) & used loupes as compared to microscopes (p = 0.04) in the symptomatic group. There was significant correlation between the surgeon's lifestyle & use of loupe and the incidence of neck pain. Conclusion Spine surgeons have a higher prevalence of neck pain than general populations and surgeons from other specialties. Considering the high prevalence of neck pain, general health, work, and ergonomic guidelines and recommendations must be formulated to help prevent and decrease the burden of neck pain among spine surgeons.
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Affiliation(s)
- Hriday Acharya
- Dept of Spine Surgery, Lilavati Hospital & Research Center, Mumbai, India
| | - Priyank Patel
- Dept of Spine Surgery, Lilavati Hospital & Research Center, Mumbai, India
| | - Gautam M. Shetty
- Knee and Orthopaedic Clinic, Mumbai Head of Clinical Research, AIMD Research, India
| | - Munjal Shah
- Dept of Spine Surgery, Lilavati Hospital & Research Center, Mumbai, India
| | - Harshal Bamb
- Dept of Spine Surgery, Lilavati Hospital & Research Center, Mumbai, India
| | - Abhay Nene
- Dept of Spine Surgery, Lilavati Hospital & Research Center, Mumbai, India
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Norasi H, Tetteh E, Sarker P, Mirka GA, Hallbeck MS. Exploring the relationship between neck flexion and neck problems in occupational populations: a systematic review of the literature. ERGONOMICS 2022; 65:587-603. [PMID: 34477048 DOI: 10.1080/00140139.2021.1976847] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
A systematic review was conducted to evaluate the relationship between occupational neck flexion angles and neck problems. The synthesised findings were used to answer three research questions: (1) Is there a positive/negative relationship between neck flexion and neck problems? (2) What is the appropriate angular threshold for neck flexion as a risk factor for neck problems? (3) What are the gaps in our current knowledge? A review of 21 papers revealed (1) a consistent positive correlation between neck flexion and neck problems, and (2) a neck flexion angle of 20° as the most evidence-based (not necessarily the best) cut-off angle separating high- and low-risk neck flexion postures. Future research should focus on the (1) continuous collection of three-dimensional neck postures through longitudinal studies to quantify cumulative exposures of neck postures, and (2) development of standard descriptions of 'neck problems' and 'neck flexion' to facilitate the development of a dose-response relationship. Practitioner summary: Practitioners depend on thresholds for evaluating neck postural exposure using work assessment tools; however, the scientific basis for this is unclear. This systematic review investigated the angular threshold for neck flexion and found 20° of neck flexion with the greatest evidence-based support as the threshold for high-risk neck postural exposure.
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Affiliation(s)
- Hamid Norasi
- 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
- Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Emmanuel Tetteh
- 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
- Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Pramiti Sarker
- 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
| | - Gary A Mirka
- 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
- Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - M Susan Hallbeck
- 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
- Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
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The relationship between visual impairments and activity of the neck/shoulder muscles among surgeons during simulated surgical tasks. Surg Endosc 2022; 36:5326-5338. [PMID: 34997342 DOI: 10.1007/s00464-021-08913-0] [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: 07/27/2021] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Minimally Invasive Surgery (MIS) has an impact on surgeons' musculoskeletal and visual systems. However, the relationship between visual symptoms and musculoskeletal problems is not well understood. AIM OF THE STUDY This study used surface electromyography (sEMG) to examine changes in fatigue of the neck/shoulder muscles among surgeons with visual impairments when performing simulated surgical tasks in 2D and 3D viewing modes. DESIGN Cross-sectional laboratory study. METHODS Changes in median frequency (MDF, an indicator of muscle fatigue) were examined in 17 experienced gynaecologists. Four simulated surgical laparoscopy tasks were performed in 2D and 3D viewing modes. The MDF of three neck/shoulder muscles (cervical erector spinae, [CES], upper trapezii [UT], and anterior deltoids [AD]) were examined bilaterally. Visual parameters (accommodation, convergence, and stereoacuity) were measured prior to commencement. RESULTS There was a downward shift of MDF from simple to more complex tasks for the right and left CES and AD muscles but not the UT, which was consistent for surgeons with mild accommodation/convergence impairment and/or good stereoacuity. There were significant differences in the level of muscle fatigue of the neck/shoulder muscles according to the severity of visual impairment, muscle side, task and surgical performance level. CONCLUSIONS The results show a relationship between the degree of visual impairments and muscle fatigue of the neck/shoulder muscles among MIS surgeons. These findings have important implications in understanding the concurrence of musculoskeletal problems and visual symptoms.
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Dairywala MI, Gupta S, Salna M, Nguyen TC. Surgeon Strength: Ergonomics and Strength Training in Cardiothoracic Surgery. Semin Thorac Cardiovasc Surg 2021; 34:1220-1229. [PMID: 34597795 DOI: 10.1053/j.semtcvs.2021.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 01/09/2023]
Abstract
With the high prevalence of musculoskeletal pain in surgeons and interventionalists, it is critical to analyze the impact of ergonomics on cardiothoracic surgeon health. Here, we review the existing literature and propose recommendations to improve physical preparedness for surgery both in and outside the operating room. For decades, cardiothoracic surgeons have suffered from musculoskeletal pain, most commonly in the neck, and back due to a lack of proper ergonomics during surgery. A lack of dedicated ergonomics curriculum during training may leave surgeons at a high predisposition for work-related musculoskeletal disorders. We searched PubMed, Google Scholar, and other sources for studies relevant to surgical ergonomics and prevalence of musculoskeletal disease among surgeons and interventionalists. Whenever possible, data from quantitative studies, and meta-analyses are presented. We also contacted experts and propose an exercise routine to improve physical preparedness for demands of surgery. To date, many studies have reported astonishingly high rates of work-related pain in surgeons with rates as high as 87% in minimally-invasive surgeons. Several optimizations regarding correct table height, monitor positioning, and loupe angles have been discussed. Lastly, implementation of ergonomics training at some programs have been effective at reducing the rates of musculoskeletal pain among surgeons. Surgical work-related stress injuries are more common than we think. Many factors including smaller incisions and technological advancements have led to this plight. Ultimately, work-related injuries are underreported and understudied and the field of surgical ergonomics remains open for investigative study.
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Affiliation(s)
- Mohammed I Dairywala
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Houston, Texas
| | - Saurabh Gupta
- Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Michael Salna
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Tom C Nguyen
- Division of Adult Cardiothoracic Surgery, Department of Surgery, UCSF Health, San Francisco, California.
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Alhusuny A, Cook M, Khalil A, Johnston V. Visual symptoms, Neck/shoulder problems and associated factors among surgeons performing Minimally Invasive Surgeries (MIS): A comprehensive survey. Int Arch Occup Environ Health 2021; 94:959-979. [PMID: 33515063 DOI: 10.1007/s00420-020-01642-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Minimally Invasive Surgery (MIS) is demanding on the musculoskeletal and visual systems. Prevalence, severity and association of neck/shoulder problems and visual symptoms were examined among MIS surgeons. The associations of workplace and individual factors with these symptoms independently and combined were also examined. METHODS MIS surgeons completed a comprehensive online survey inclusive of 52 questions about individual and workplace physical factors, neck/shoulder problems and visual symptoms. Binary logistic regression models were conducted to determine the associations of the neck/shoulder problems, visual symptoms and combined symptoms with workplace and individual factors. RESULTS 290 surgeons completed the survey. Neck/shoulder problems and visual symptoms were reported by 31.0% and 29.0%, respectively, 15.5% reported both problems. The prevalence and severity of neck/shoulder problems and visual symptoms were significantly associated (p < 0.001). Several workplace and individual factors were associated with these symptoms (p ≤ 0.05). CONCLUSIONS Several factors in the workplace environment (temperature, asymmetrical weight bearing and forward head movement) and individual (being female and wearing vision correction glasses) were significantly associated with neck/shoulder problems and visual symptoms. Evaluation of different strategies to minimise the strain on the neck/shoulder region and the visual system is required.
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Affiliation(s)
- Ameer Alhusuny
- School of Health and Rehabilitation Sciences, The University of Queensland, Level 3, Therapies Annexe Building 84, Brisbane, St Lucia, QLD, 4068, Australia.
| | - Margaret Cook
- School of Earth and Environmental Sciences, Faculty of Science, The University of Queensland, Brisbane, Australia
| | - Akram Khalil
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Venerina Johnston
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
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Impact of accommodation, convergence and stereoacuity on perceived symptoms and surgical performance among surgeons. Surg Endosc 2020; 35:6660-6670. [PMID: 33258031 DOI: 10.1007/s00464-020-08167-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 11/15/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Minimally invasive surgery (MIS) is not without impact on surgeons' neck/shoulder/head and eyes. However, the mechanisms for concurrent symptoms are not clear. This study aims to examine the effect of visual impairments on physical symptoms and surgical performance among surgeons performing simulated surgical tasks using two-dimensional (2D) and three-dimensional (3D) viewing modes. METHODS Gynaecologists with experience in laparoscopy performed four simulated surgical tasks in the 2D and 3D viewing modes. Visual parameters (accommodation, convergence and stereoacuity) were measured prior to commencement. Objective performance measures were derived from the laparoscopic tasks, and surgeons also self-reported their mental and physical workload using the NASA-TLX. In addition, perceived symptoms were measured using Visual Analogue Scales, the Simulator Sickness Questionnaire and the Computer Vision Syndrome Questionnaire. RESULTS Seventeen healthy gynaecologists participated in this study. There were significant relationships between visual impairments and both the perceived symptoms and surgical performance scores of MIS surgeons. Surgeons with a higher number of accommodation/convergence dysfunctions and/or poorer stereoacuity tended to have poorer objective performance scores on simulated surgical tasks in both viewing modes. NASA-TLX scores indicated that surgeons with poorer stereoacuity also perceived themselves to have been less successful at accomplishing tasks. However, these surgeons also reported less intense physical symptoms and simulator sickness. CONCLUSIONS Surgeons' performance for the simulated surgical tasks correlated with visual functions, and it also impacted on the symptoms experienced. Regular screening of surgeons' vision and vision therapy may be required to decrease physical symptoms and improve surgical performance.
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Alhusuny A, Cook M, Khalil A, Thomas L, Johnston V. Characteristics of headaches among surgeons and associated factors: A cross-sectional study. Surgeon 2020; 19:e79-e87. [PMID: 32873512 DOI: 10.1016/j.surge.2020.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/19/2020] [Accepted: 07/31/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Surgeons performing Minimally Invasive Surgery (MIS) report significant neck/shoulder problems and visual symptoms. Headache is another commonly reported symptom but publications about the characteristics and associated risk factors are limited. PURPOSE OF THE STUDY To determine the characteristics of headache among MIS surgeons and the associations of headache with neck/shoulder problems, visual symptoms and other associated factors. DESIGN A cross-sectional study. METHODS A comprehensive online survey was sent to MIS surgeons inclusive of 63 questions about individual and workplace physical factors, characteristics of headache, neck/shoulder problems and visual symptoms. Binary logistic regression models were conducted to determine the associations of the prevalence and severity of headache with risk factors. THE MAIN FINDINGS Headaches in the last 7 days were reported by 36% of surgeons, with 37% of these of moderate to severe intensity. Frequent intense headaches were often preceded by neck pain. Surgeons with headache were eight times more likely to also experience visual symptoms and four times more likely to experience neck/shoulder problems. Several factors (frequently adopting forward head movement, surgical specialty, sex and age) were significantly associated with headaches (p ≤ 0.05). CONCLUSIONS This study revealed headaches were present in one-third of MIS surgeons. During surgery, surgeons report adopting non-neutral neck/shoulder/head positions, which may explain headaches, neck/shoulder problems and visual symptoms. Evidence based strategies to assist surgeons better manage these symptoms are warranted.
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Affiliation(s)
- Ameer Alhusuny
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
| | - Margaret Cook
- School of Earth and Environmental Sciences, Faculty of Science, The University of Queensland, Brisbane, Australia
| | - Akram Khalil
- Faculty of Medicine, The University of Queensland, Brisbane, Australia; Department of Gynaecology, Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Lucy Thomas
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Venerina Johnston
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
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