Upper limb musculoskeletal disorders in healthcare personnel

The Risk Assessment of Patient Handling in Hospitals of Northeast of Iran

The study aim was to determine the risk of Manual patient handling (MPH) in Shahroud public hospitals, Iran. A cross-sectional study was performed in Imam Hossein (IHospital) and Bahar (BHospital) with 21 wards. MPH risk assessment was performed using MAPO (Movement and Assistance of Hospital Patient) index. The ratio of operator to disabled patient (NC/Op and PC/Op), lifting, minor aid, wheelchair, environmental, and training factor are evaluated to calculate MAPO index. Among studied wards 57%, 33.3%, and 9.5%, respectively, were in the high, moderate, and low risk exposure level. The maximum MAPO score were 16.7 in CCU of IHospital. Emergency ward of BHospital had the highest score of 9.8 and PC/OP ratio 17.5. The most risk factors were minor aid (90.5%), lifting factor (71.4%), and PC/OP (66.7%). Immediate ergonomic action is recommended.

Can Vitality and Mental Health Influence Upper Extremity Pain? A Prospective Cohort Study of 1185 Female Hospital Nurses

Musculoskeletal disorders of the upper extremity are among the most common occupational problems affecting nurses. The aim of this study was to analyze the prospective association between vitality and mental health and increased upper extremity pain intensity in female hospital nurses during a 1-year follow-up. A prospective cohort of 1185 female nurses from 19 hospitals in Denmark was conducted using baseline and 12-month follow-up questionnaires to identify potential associations between levels of vitality and mental health (SF-36 subscales) with pain intensity (0-10 scale) in the shoulder, elbow and hand/wrist regions. Associations were modeled using cumulative logistic regression. The fully adjusted model included the variables of age, baseline pain, body mass index, smoking status, years of occupation, leisure time physical activity level, number of daily patient transfers/handlings, as well as recognition and influence at work. The mean age was 48.3 (SD: 10.4) years. In the fully adjusted model, significant associations between low vitality levels and the odds of shoulder pain (OR = 1.96; 95%CI: 1.43-2.68) and hand/wrist pain (OR = 2.32; 95%CI: 1.58-3.42) were observed. Likewise, moderate levels of mental health was associated with increased odds of shoulder pain at follow-up (OR = 1.50; 95%CI: 1.16-1.93). These results provide an important incentive for nursing managers to assess vitality and mental health among hospital nurses and to consider this factor in prevention strategies to ensure good worker health and, by extension, high-quality care.

Biomechanical evaluation of midwifery tasks and its relationship with the prevalence of musculoskeletal disorders

Introduction

As an important occupational group in the healthcare system, midwives face various ergonomic risk factors such as musculoskeletal disorders (MSDs) risks. Moreover, an accurate job evaluation can help to design appropriate ergonomic interventions and more accurately estimate the probability of developing MSDs. Therefore, the present study aimed to investigate musculoskeletal discomforts and biomechanical stresses using the Three-Dimensional Static Strength Prediction Program (3DSSPP Ver. 7.1.3) to find the association of these factors with the prevalence of MSDs among midwives.

Materials and methods

A total of 91 midwives with at least two years of work experience participated in this cross-sectional descriptive study. All midwifery duties were analyzed using the hierarchical task analysis (HTA) method. Moreover, time analysis was performed for this job, and data were collected using the Nordic Musculoskeletal Questionnaire (NMQ) and body mapping. The 3DSSPP software was used to investigate the forces acting on the lumbar region, and finally, the association of individual characteristics and the forces exerted on the body with MSDs was investigated.

Results

According to the results, the highest level of pain and discomfort was related to the back and neck regions. The software analysis of the four major midwifery tasks showed that the highest biomechanical forces were exerted on the L5/S1 disc during lifting the mothers from bed (to help them sit or walk) and breastfeeding training. Accordingly, only in the task of lifting the mothers and helping them to sit or walk, the balance status was inappropriate and critical due to the improper distribution of forces. The analysis of the associations between variables showed that biomechanical forces, age, height, body mass index, and job tenure were among the risk factors affecting MSDs.

Conclusion

According to the results of this study, MSDs were highly prevalent, especially in the neck and back regions; this can be attributed to the nature of midwifery tasks. The software analysis results of the tasks showed that the biomechanical forces on the spine in each of the tasks can be affected by the weight of the mother, the height of the bed, static posture, and the bending/twisting of the whole body. Compression and shear forces were among the risk factors that can affect MSDs. To prevent MSDs in midwives, it is appropriate to improve the workstations.

Characterization of upper limb use in health care workers during regular shifts: A quantitative approach based on wrist-worn accelerometers

Despite the high prevalence of upper limb (UL) work-related musculoskeletal disorders (WRMSD) among health care workers (HCWs), little is known about their relationship with exposure to biomechanical risk factors. This study aimed to assess UL activity features under actual working conditions using two wrist-worn accelerometers. Accelerometric data were processed to obtain duration, intensity, and asymmetry of UL use in 32 HCWs during the execution of commonly performed tasks (e.g., patient hygiene, transfer, and meal distribution) within a regular shift. The results show that such tasks are characterized by significantly different patterns of UL use, in particular, higher intensities and larger asymmetries were observed respectively for patient hygiene and meal distribution. The proposed approach appears, thus, suitable to discriminate tasks characterized by different UL motion patterns. Future studies could benefit from the integration of such measures with self-reported workers' perception to elucidate the relationship between dynamic UL movements and WRMSD.

Haemodialysis nurses' occupational health and work-related musculoskeletal hand pain after work: A cluster analysis

AIM

To identify clusters based on haemodialysis nurses' self-rated work ability, work engagement and self-reported work hours and to compare the identified clusters regarding hand pain after work.

DESIGN

Cross-sectional survey.

METHODS

Data based on the Work Ability Index, Utrecht Work Engagement Scale and hand pain severity after work were collected through a web-based survey among 503 haemodialysis nurses working in Sweden and Denmark. A two-step cluster analysis was used to identify homogenous groups of cases within the dataset, followed by comparative analyses of the clusters.

RESULTS

Four distinct clusters were identified, illustrating differing profiles of haemodialysis nurses' work ability, work engagement and working hours. Nurses who worked part-time and reported moderate work ability and average work engagement had significantly higher ratings of hand pain after work.

CONCLUSIONS

Haemodialysis nurses are a heterogeneous group as regards work ability, work engagement and self-reported work hours. The four distinct clusters of nurses indicate a need for customized interventions for retaining each subgroup at work.

Rasch analysis of the Oxford shoulder score in a non-surgical occupational population

BACKGROUND: The Oxford shoulder score (OSS) questionnaire for measuring patient perception of shoulder disability, has not tested specifically in a non-surgical population and no study has assessed the OSS with modern psychometrics based on Rasch model (RM). OBJECTIVE: To assess the psychometric properties of the OSS using RM among health-care workers with shoulder disorders and to verify its interest in a non-surgical population. METHODS: In an occupational health department of a French hospital center, a retrospective review was performed of the medical records from June 2019 to October 2020. Responses to 110 questionnaires were examined from 55 subjects (97% of women). A polytomous Rasch model based on the Partial Credit Model was used. RESULTS: Overall fit was satisfactory, the reliability coefficient was high and an ascending order was observed with the 5 categories of the scale. Analysis of the residuals supports unidimensionality and the local independence assumption. Item performance remained stable across the subgroup examined (DIF measures). Scale to-sample targeting indicated a substantial floor effect, and the mildest impairments were not well discriminated. CONCLUSIONS: OSS presents good psychometric qualities. However, it does not clearly discriminate subjects presenting the lowest levels of impairment. Its use in a non-surgical population is questionable.

Aberrant Neuronal Activity in a Model of Work-Related Upper Limb Pain and Dysfunction

Work-related musculoskeletal disorders associated with intense repetitive tasks are highly prevalent. Painful symptoms associated with such disorders can be attributed to neuropathy. In this study, we characterized the neuronal discharge from the median nerve in rats trained to perform an operant repetitive task. After 3-weeks of the task, rats developed pain behaviors and a decline in grip strength. Ongoing activity developed in 17.7% of slowly conducting neurons at 3-weeks, similar to neuritis. At 12-weeks, an irregular high frequency neuronal discharge was prevalent in >88.4% of slow and fast conducting neurons. At this time point, 8.3% of slow and 21.2% of fast conducting neurons developed a bursting discharge, which, combined with a reduction in fast-conducting neurons with receptive fields (38.4%), is consistent with marked neuropathology. Taken together, we have shown that an operant repetitive task leads to an active and progressive neuropathy that is characterized by marked neuropathology following 12-weeks task that mainly affects fast conducting neurons. Such aberrant neuronal activity may underlie painful symptoms in patients with work-related musculoskeletal disorders. PERSPECTIVE: Aberrant neuronal activity, similar to that reported in this study, may contribute to upper limb pain and dysfunction in patients with work-related musculoskeletal disorders. In addition, profiles of instantaneous frequencies may provide an effective way of stratifying patients with painful neuropathies.

The Relationship Between the NSP and the Individual and Work Organizational Variables: A Cross-Sectional Study

Objectives

To investigate the characteristics of neck-shoulder pain (NSP) and explore the potentional relationship between the NSP and the individual and work organizational variables.

Methods

A cross-sectional study was performed in the tertiary general hospitals in Hunan Province, China between May 2019 and July 2019. A total of 2,030 healthcare workers were enrolled randomly in this study based on a three-stage stratified sampling method. The Neck Disability Index (NDI) was used to measure disability in subjects with neck pain. A self-administered questionnaire was used to assess the characteristics of individual and work organizational variables. The Mann-Whitney U test and the Kruskal-Wallis H test were applied to analyze the prevalence of pain intensity among groups. Multivariate linear regression analysis was performed to explore the potentional relationship between NSP and individual and work organizational variables using the NDI score as the dependent variable.

Results

2,008 of 2,030 healthcare workers filled out the survey questionnaires online. In the past 12 months, 1,489 participants (74.2%) complained of pain in the cervical-shoulder region. NDI score increased by 0.10 for each year of age, with healthcare workers working in Obstetrics and Gynecology, and the Operating Room less likely to have NSP than those working in other departments. In contrast, female healthcare workers with a history of pregnancy were more likely to have NSP. In terms of organizational factors, workers who received concern from their supervisor about their health, who had the choice to change their shift status to off duty when they were not feeling well, or who were informed about WMSDs were less likely to have NSP.

Conclusion

The prevalence of NSP within the previous year was high in this population. Individual factors including history of neck-shoulder diseases, age, and history of pregnancy and organizational factors including being adequately informed regarding WMSDs, concern from supervisors about workers' health, and the ability of workers to change their shift status to off duty when they were not feeling well were shown to induce significant effects to NSP.

A standardized protocol for the comprehensive assessment of dental hygiene work

BACKGROUND

Work-related musculoskeletal disorders are prevalent in dental hygienists. Although engineering controls and ergonomic training is available, it is unclear why this intransigent problem continues. One possible barrier is that a comprehensive, standardized protocol for evaluating dental hygiene work does not exist.

OBJECTIVE

This study aimed to generate a valid and reliable observational protocol for the assessment of dental hygiene work.

METHODS

An iterative process was used to establish and refine an ecologically valid video acquisition and observation protocol to assess key activities, tasks, and performance components of dental hygiene work.

RESULTS

Good inter-rater reliability was achieved across all variables when the final coding scheme was completed by three independent raters.

CONCLUSIONS

This work provides an exemplar of the process required to generate a comprehensive protocol for evaluating the work components of a particular job, and provides standardized nomenclature for use by scientists and practitioners interested in understanding and addressing the pervasive issue of work-related disorders in dental hygienists.

Can a metric combining arm elevation and trapezius muscle activity predict neck/shoulder pain? A prospective cohort study in construction and healthcare

OBJECTIVE

To determine whether a composite metric of arm elevation and trapezius activity (i.e. neck/shoulder load) is more strongly associated with the 2-year course of neck and shoulder pain intensity (NSPi) among construction and healthcare workers than each exposure separately.

METHODS

Dominant arm elevation and upper trapezius muscle activity were estimated in construction and healthcare employees (n = 118) at baseline, using accelerometry and normalized surface electromyography (%MVE), respectively. At baseline and every 6 months for 2 years, workers reported NSPi (score 0-3). Compositions of working time were determined for arm elevation (< 30°; 30-60°;  > 60°), trapezius activity (< 0.5%; 0.5-7.0%; > 7.0%MVE), and a composite metric "neck/shoulder load" (restitution, low, medium, and high load). Associations between each of these three compositions and the 2-year course of NSPi were determined using linear mixed models.

RESULTS

Associations between exposure compositions and the course of NSPi were all weak and in general uncertain. Time spent in 0.5-7.0%MVE showed the largest and most certain association with changes in NSPi during follow-up (β = - 0.13; p = 0.037; corresponding to a -0.01 change in NPSi every 6 months). Among pain-free workers at baseline, medium (β = - 0.23; p = 0.039) and high (β = 0.15; p = 0.031) neck/shoulder load contributed the most to explaining changes in NSPi.

CONCLUSION

The composite metric of neck/shoulder load did not show a stronger association with the course of NSPi than arm elevation or trapezius activity alone in the entire population, while some indications of a stronger association were found among those who were pain-free at baseline.

Blocking substance P signaling reduces musculotendinous and dermal fibrosis and sensorimotor declines in a rat model of overuse injury

Purpose/Aim: Substance P-NK-1R signaling has been implicated in fibrotic tendinopathies and myositis. Blocking this signaling with a neurokinin 1 receptor antagonist (NK1RA) has been proposed as a therapeutic target for their treatment.Materials and Methods: Using a rodent model of overuse injury, we pharmacologically blocked Substance P using a specific NK1RA with the hopes of reducing forelimb tendon, muscle and dermal fibrogenic changes and associated pain-related behaviors. Young adult rats learned to pull at high force levels across a 5-week period, before performing a high repetition high force (HRHF) task for 3 weeks (2 h/day, 3 days/week). HRHF rats were untreated or treated in task weeks 2 and 3 with the NK1RA, i.p. Control rats received vehicle or NK1RA treatments.Results: Grip strength declined in untreated HRHF rats, and mechanical sensitivity and temperature aversion increased compared to controls; these changes were improved by NK1RA treatment (L-732,138). NK1RA treatment also reduced HRHF-induced thickening in flexor digitorum epitendons, and HRHF-induced increases of TGFbeta1, CCN2/CTGF, and collagen type 1 in flexor digitorum muscles. In the forepaw upper dermis, task-induced increases in collagen deposition were reduced by NK1RA treatment.Conclusions: Our findings indicate that Substance P plays a role in the development of fibrogenic responses and subsequent discomfort in forelimb tissues involved in performing a high demand repetitive forceful task.

MAPO Method to Assess the Risk of Patient Manual Handling in Hospital Wards: A Validation Study

OBJECTIVE

To validate the effectiveness of MAPO method (Movement and Assistance of Hospital Patient) after the introduction of some changes to improve assessment objectivity.

BACKGROUND

The number of operators exposed to patient manual handling is increasing considerably. MAPO, proposed in 1999 as a useful tool to estimate the risk of patient manual handling, is a method characterized by analytical quickness. It has recently been improved to better match the 2012 ISO (International Organization for Standardization) technical report.

METHODS

A multicenter study was conducted between 2014 and 2016 involving 26 Italian hospitals in the Apulia Region. MAPO method was used to assess the risk of patient manual handling in 116 wards. A total of 1,998 exposed subjects were evaluated for the presence or absence of acute low back pain in the previous 12 months.

RESULTS

Only 12% of the investigated wards fell in the green exposure level (MAPO index = 0.1-1.5), 37% resulted in the average exposure level (MAPO index = 1.51-5) and the remaining 51% in the higher exposure level (MAPO index >5). The results confirmed a positive association between increasing levels of MAPO index and the number of episodes of acute low back pain (adjusted p trend = .001).

CONCLUSION

The improvements made over the past years led to a more objective assessment procedure. Despite the changes, the study confirmed the effectiveness of MAPO method to predict low back pain.

APPLICATION

MAPO method is an accurate risk assessment tool that identifies and evaluates workplace risks. The proper application of the method significantly improves working conditions.

Efficacy of Combination Therapies on Neck Pain and Muscle Tenderness in Male Patients with Upper Trapezius Active Myofascial Trigger Points

Myofascial pain syndrome, thought to be the main cause of neck pain and shoulder muscle tenderness in the working population, is characterized by myofascial trigger points (MTrPs). This study aimed to examine the immediate and short-term effect of the combination of two therapeutic techniques for improving neck pain and muscle tenderness in male patients with upper trapezius active MTrPs. This study was a pretest-posttest single-blinded randomized controlled trial. Sixty male subjects with mechanical neck pain due to upper trapezius active MTrPs were recruited and randomly allocated into group A, which received muscle energy technique (MET) and ischemic compression technique (ICT) along with conventional intervention; group B, which received all the interventions of group A except ICT; and group C, which received conventional treatment only. Baseline (Pr), immediate postintervention (Po), and 2-week follow-up (Fo) measurements were made for all variables. Pain intensity and pressure pain threshold (PPT) were assessed by a visual analog scale (VAS) and pressure threshold meter, respectively. All the three groups received their defined intervention plans only. Repeated-measures analysis of variance was used to perform intra- and intergroup analyses. Cohen's d test was used to assess the effect size of the applied interventions within the groups. The intergroup analysis revealed significant differences among groups A, B, and C in VAS and PPT at Po (VAS-Po: F = 13.88, p=0.0001; PPT-Po: F = 17.17, p=0.0001) and even after 2 weeks of follow-up (VAS-Fo: F = 222.35, p=0.0001; PPT-Fo: F = 147.70, p=0.0001). Cohen's d revealed a significant treatment effect size within all groups except group C (only significant for VAS-Po-VAS-Pr: mean difference = 1.33, p < 0.05, d = 1.09); however, it showed a maximum effect size in group A for its variables (VAS-Fo-VAS-Pr: mean difference = 5.27, p=0.01, d = 4.04; PPT-Fo-PPT-Pr: mean difference = 2.14, p < 0.01, d = 3.89). Combination therapies (MET plus ICT) showed immediate and short-term (2-week follow-up) improvements in neck pain and muscle tenderness in male patients with upper trapezius active MTrPs.

Associations between materials used and work-related musculoskeletal hand complaints among haemodialysis nurses

BACKGROUND

One in every two haemodialysis nurses has reported musculoskeletal complaints concerning their hands, which is twice that reported for hospital nurses in general. It is possible that there is an association between the materials used by haemodialysis nurses and the occurrence of hand complaints.

OBJECTIVES

To examine the association between the type of dialysis machine and disposables used with the occurrence of hand complaints among haemodialysis nurses. To compare occupational risks of developing work-related musculoskeletal disorders based on the materials used for haemodialysis.

DESIGN

Cross-sectional.

PARTICIPANTS

Two hundred and eighty-two nurses working in 27 haemodialysis centres in Sweden participated in a survey, and 19 nurses at five centres were observed during priming procedures.

MEASUREMENTS

Nurses supplied demographic data and answered the Nordic Musculoskeletal Questionnaire. Centre level data regarding machines and disposables used for haemodialysis during the past year were also collected.

RESULTS

There were no differences in the prevalence of hand complaints based on the type of haemodialysis machines, dialysers or tubing used. There were no differences found in physical exposure to the hands during priming, based on machine type used.

CONCLUSION

The results of this study could not reveal any association between disposable materials used and the occurrence of hand complaints among haemodialysis nurses. Additionally, there were no occupational risks detected based on the types of machines used. Hence, the results of the present study strongly indicate that a deeper ergonomic analysis of the work environment is needed to understand the prevalence of hand complaints among nurses working in haemodialysis settings.

Prevalence of musculoskeletal complaints among haemodialysis nurses - a comparison between Danish and Swedish samples

Objective. The repetitiveness of priming and dismantling disposables for haemodialysis treatments might be an important contributor to musculoskeletal complaints. The objective was therefore to compare the prevalence of musculoskeletal complaints among haemodialysis nurses in Denmark and Sweden. Methods. For this cross-sectional study, nurses were recruited from haemodialysis centres in Denmark (n = 194) and Sweden (n = 351). Prevalence of musculoskeletal complaints was evaluated using the Nordic musculoskeletal questionnaire. Results. The percentage of nurses reporting musculoskeletal complaints from at least one part of their body was 90.2% in the Danish sample and 88.9% in the Swedish sample. The anatomical locations with the most complaints were the neck, lower back and hands. Except for the proportion of complaints concerning the neck, there were no differences between the countries. Absenteeism from work was mostly due to complaints regarding the hands. Conclusion. The prevalence of musculoskeletal complaints seems to be higher among haemodialysis nurses than among nurses in general. Because complaints concerning the hands are common, and also related to absenteeism from work, it is of particular importance that manufacturers of dialysis equipment and nurse managers acknowledge these occupational health and safety hazards in their efforts to create a good work environment.

A multi-criteria methodology for evaluating alternative ultrasound devices

Several surveys and clinical studies report high prevalence of work-related musculoskeletal disorders (WMSDs) among sonographers and sonologists. Better performing ultrasound devices can increase the number and quality of examinations, but also reduce the user comfort and increase the risk of WMSDs. This should lead the choice of the device to buy and use. To support hospitals or diagnostic centres in selecting the best ultrasound device, this study provides a structured methodology based on a multi-criteria approach, the Analytic Hierarchy Process. It has a Goal (to optimise workers' well-being and satisfy company production objectives) and 45 evaluation elements. It was applied in an Italian hospital comparing 3 alternatives: wireless, portable, and cart-based. The latter proved to be the best in satisfying the Goal, whereas a previous study obtained that the wireless device was preferable considering only the ergonomic point of view. The case study validated the applicability of the methodology. Practitioner summary: This paper provides the decision-makers of hospitals or diagnostic centres with a multi-criteria methodology to select the best ultrasound device capable of optimising workers' well-being and satisfying company production objectives. The methodology can also support manufacturers of ultrasound devices in improving their products. Abbreviations: AHP: analytic hierarchy process; AIUM: American Institute of Ultrasound in Medicine; BSI: British Standards Institution; CEN: European Committee for Standardisation; EU-OSHA: EU Agency for Occupational Safety and Health; ISO: International Organisation for Standardisation; MCMD: multiple criteria decision-making; NIOSH: US National Institute for Occupational Safety and Health; SDMS: society of diagnostic medical sonography; WHO: World Health OrganizationWMSD: work-related musculoskeletal disorder.

Upper Limb Work-Related Musculoskeletal Disorders in Operating Room Nurses: A Multicenter Cross-Sectional Study

This study aimed to evaluate the association between personal and job characteristics and the risk of upper limb work-related musculoskeletal disorders (WMSDs) among operating room nurses (ORNs). To this end, we collected data from 148 ORNs working at 8 Italian hospitals and measured any upper limb disabilities experienced in the previous year using the Italian version of the disabilities of the arm, shoulder and hand (DASH) questionnaire. The associations between personal and job characteristics and risk of upper limb WMSDs were estimated by unconditional logistic regression models. The prevalence of upper limb WMSDs was 45.9%. Multivariate analysis showed the "female gender" and "monthly hours spent working as a scrub nurse" to be directly associated with a higher DASH score (adjusted OR for gender = 5.37, 95% CI: 1.65-17.51, p < 0.01; adjusted OR for monthly hours as scrub nurse = 3.09, 95% CI: 1.33-7.19, p < 0.01). Overall, our findings indicate that a full-time job (>120 h/month) as a scrub nurse significantly increases the risk of developing upper limb WMSDs among female ORNs. Thus, to reduce such risk in this particularly sensitive population, we recommend urgent implementation of ergonomic interventions on surgical equipment alongside job rotation and medical surveillance programs.

Manual therapy prevents onset of nociceptor activity, sensorimotor dysfunction, and neural fibrosis induced by a volitional repetitive task

Painful and disabling musculoskeletal disorders remain prevalent. In rats trained to perform repetitive tasks leading to signs and dysfunction similar to those in humans, we tested whether manual therapy would prevent the development of the pathologies and symptoms. We collected behavioral, electrophysiological, and histological data from control rats, rats that trained for 5 weeks before performing a high-repetition high-force (HRHF) task for 3 weeks untreated, and trained rats that performed the task for 3 weeks while being treated 3x/week using modeled manual therapy (MMT) to the forearm (HRHF + MMT). The MMT included bilateral mobilization, skin rolling, and long axis stretching of the entire upper limb. High-repetition high-force rats showed decreased performance of the operant HRHF task and increased discomfort-related behaviors, starting after training. HRHF + MMT rats showed improved task performance and decreased discomfort-related behaviors compared with untreated HRHF rats. Subsets of rats were assayed for presence or absence of ongoing activity in C neurons and slow Aδ neurons in their median nerves. Neurons from HRHF rats had a heightened proportion of ongoing activity and altered conduction velocities compared with control and MMT-treated rats. Median nerve branches in HRHF rats contained increased numbers of CD68 macrophages and degraded myelin basic protein, and showed increased extraneural collagen deposition, compared with the other groups. We conclude that the performance of the task for 3 weeks leads to increased ongoing activity in nociceptors, in parallel with behavioral and histological signs of neuritis and nerve injury, and that these pathophysiologies are largely prevented by MMT.

Clinical outcomes following an initial experience with a novel powered vascular stapler in video-assisted thoracoscopic lobectomies: results of a Chinese multi-center study

Background

The development of minimally invasive surgical approaches has revolutionized surgical care and greatly improved surgical outcomes. This study aimed to evaluate the clinical effectiveness of a powered vascular stapler (PVS) during video-assisted thoracoscopic surgery (VATS) lobectomy.

Methods

This prospective, multi-center, post-market clinical study in China enrolled 50 patients with either a suspected or formal diagnosis of clinical stage IA to IIB non-small cell lung cancer (NSCLC) scheduled for VATS lobectomy. The clinical effectiveness of the PVS for successful pulmonary artery (PA)/pulmonary vein (PV) transection was evaluated. In addition, the surgeon's stress, device usability, and surgeon satisfaction were measured using multiple questionnaires.

Results

A total of 167 PAs/PVs were transected with 3 (1.8%) requiring intra-operative intervention. Fourteen of the 50 patients (28.0%) experienced at least one adverse event (AE), among whom 5 (10.0%) suffered from serious AEs. There were no postoperative hemorrhagic complications related to transection of the PA/PV with PVS. Surgeon satisfaction was surveyed by questionnaire after each of the 50 procedures resulting in a 96% reported satisfaction with device usability, specifically related to a low stress load and an increase in work efficiency.

Conclusions

For VATS lobectomy, the PVS demonstrated a positive surgical effectiveness and value in cognitive and physical distress reduction. Complications following VATS lobectomy to treat NSCLC were generally low and as expected. Intraoperative complications were few and there were no postoperative complications related to the transection of the PA and PV during VATS lobectomy. Favorable results were reported on the surgeon satisfaction questionnaire regarding usability and surgeon stress.

Operating hurts: a study of EAES surgeons

BACKGROUND

Work-related pain and discomfort experienced by surgeons is widely reported in the literature. A survey was, therefore, conducted to explore this issue among members of the European Association for Endoscopic Surgery (EAES).

METHODS

The survey was emailed to 2980 EAES members in 2017 enquiring about their working practice, musculoskeletal (MSK) pain and burnout.

RESULTS

A total of 569 (19%) surgeons responded, of whom 556 were practicing surgeons; 86% were consultants, 84% were male, and 94% were right-handed. Respondents operated on average 3.3 days/week with 27% of their procedures lasting longer than 3 h. The 386 endoscopists surveyed reported performing an average of 5.3 procedures/day with 83% performing endoscopy at least once per week. Over half of practicing surgeons (62%) reported their worst pain score was 3 or higher (10-point scale) in the past 7 working days, encompassing 71% of their open, 72% laparoscopic, 48% robot-assisted cases and 52% of their endoscopies. Of the 120 surgeons who had ever sought medical help for aches, pain or discomfort, 38% were currently in pain and 16% had considered leaving surgery due to their MSK pain, 26% had reported work-related pain to their employer, 26% had been on short-term disability during their career and 4% long-term disability due to MSK disorders. A significant proportion of the respondents (49%) felt their physical discomfort would influence the ability to perform or assist with surgical procedures in the future. These surgeons reported significantly lower satisfaction from their work (p = 0.024), higher burnout (p = 0.005) and significantly higher callousness toward people (p < 0.001) than those not fearing loss of career longevity.

CONCLUSION

The results show that MSK pain is prevalent amongst EAES members. Nearly half the respondents had career longevity fears from pain/discomfort which, in turn, correlated with more prevalent feelings of burnout. More emphasis should be placed on the aetiology, prevention and management of musculoskeletal pain in the surgical workforce.

Using motion capture technology to measure the effects of magnification loupes on dental operator posture: A pilot study

BACKGROUND

Motion analysis has great potential for quantitatively evaluating dental operator posture and the impact of interventions such as magnification loupes on posture and subsequent development of musculoskeletal disorders.

OBJECTIVE

This study sought to determine the feasibility of motion capture technology for measurement of dental operator posture and examine the impact that different styles of magnification loupes had on dental operator posture.

METHODS

Forward and lateral head flexion were measured for two different operators while completing a periodontal probing procedure. Each was measured while wearing magnification loupes (flip up-FL and through the lens-TTL) and basic safety lenses.

RESULTS

Operators both exhibited reduced forward flexion range of motion (ROM) when using loupes (TTL or FL) compared to a baseline lens (BL). In contrast to forward flexion, no consistent trends were observed for lateral flexion between subjects.

CONCLUSIONS

The researchers can report that it is possible to measure dental operator posture using motion capture technology. More study is needed to determine which type of magnification loupes (FL or TTL) are superior in improving dental operator posture. Some evidence was found supporting that the quality of operator posture may more likely be related to the use of magnification loupes, rather than the specific type of lenses worn.

Prevalence of work-related musculoskeletal and non-musculoskeletal injuries in health care workers: the implications for work disability management

To compare the prevalence of musculoskeletal and non-musculoskeletal injuries in a cohort of workers in Manitoba health care sector, who made injury claims between 2002 and 2012. A retrospective study, using secondary data from WCB Manitoba. Logistic regression was used to determine odds ratios for nature of work-related injuries among different groups of workers. Idiopathic work-related musculoskeletal disorders (WMSD) constituted 74.6% of all the injury claims. Injury risks varied between worker groups, and a significant difference was found within the female group, χ² = 13.4, p = 0.0094, but not among the males. Compared to the married, single workers were more likely to experience traumatic than idiopathic injuries (OR = 1.72, CI, 1.28, 2.29), and much higher risk of traumatic injuries than non-WMSD (OR = 1.93, CI, 1.31, 2.84). Work-related injury risks vary significantly across occupations and worker groups, with idiopathic injuries being higher in high physical tasks. Practitioner Summary: To compare musculoskeletal and non-musculoskeletal injuries among workers in health care sector, and explore the implications for work disability management. Retrospective study, using workers' compensation claims data. The risk of idiopathic work-related musculoskeletal disorders continue to be high compared to traumatic and non-musculoskeletal disorders, particularly in tasks that involved high physical activities.

Musculoskeletal Disorders Among Greek Physiotherapists: Traditional and Emerging Risk Factors

Background

Musculoskeletal disorders (MSDs) in the health industry are quite common, however, there have only been a few studies regarding physiotherapists, while in Greece, there is an apparent lack of research and data. The aim of this study is to investigate MSDs experienced by physiotherapists in Greece, their causes and specific measures, and good practices followed. Additional emerging risk factors will be examined.

Methods

A questionnaire of MSDs followed by individual and workplace characteristics was completed by 252 physiotherapists. It covered the major workplace categories such as public hospitals, private rehabilitation centers, and private practices.

Results

Analysis indicated that 89% of the respondents had experienced a work-related MSD; 32.2% of those injuries occurred within the first 5 years of working. The most lumbered physiotherapists were those working as private practitioners and almost half of the injured respondents chose to work while injured. The most common measure taken to tackle work related MSDs was found to be physical therapy sessions. Job satisfaction and psychosocial issues were also identified as side-effects of the economic slowdown.

Conclusion

Physiotherapists in Greece were found to suffer from MSDs; workplace musculoskeletal injuries were quite common but under-reported. The body parts most affected were the lower back, the upper back, the shoulders, and the neck. There was a strong correlation between the workplace setting and the number of MSDs. A well-defined occupational safety and health management system and strict administration steering were found to reduce MSDs. The economic slowdown experienced in Greece during the execution of this study placed additional pressure on physiotherapists.

Carpal tunnel syndrome among laboratory technicians in relation to personal and ergonomic factors at work

OBJECTIVES

Work-related carpal tunnel syndrome (CTS) has been reported in different occupations, including laboratory technicians, so this study was carried out to determine the prevalence and the associated personal and ergonomic factors for CTS among laboratory technicians.

METHODS

A cross-sectional study was conducted among 279 laboratory technicians at King Fahd Hospital, Saudi Arabia, who filled in a self-administered questionnaire, including questions regarding their demographic criteria, occupational history, job tasks, workplace tools, ergonomic factors at work, and symptoms suggestive of CTS. Physical examinations and electrodiagnostic studies were carried out for those who had symptoms suggestive of CTS to confirm the diagnosis. Univariate and multivariate analysis were performed for both personal and physical factors in association with confirmed CTS among laboratory technicians.

RESULTS

The prevalence of CTS among the laboratory technicians was 9.7% (27/279). The following were the statistically significant risk factors for CTS among them: gender (all cases of CTS were female, P=0.00), arm/hand exertion (OR: 7.96; 95% CI: 1.84-34.33), pipetting (OR: 7.27; 95% CI: 3.15-16.78), repetitive tasks (OR: 4.60; 95% CI: 1.39-15.70), using unadjustable chairs or desks (OR: 3.35; 95% CI: 1.23-9.15), and working with a biosafety cabinet (OR: 2.49; 95% CI: 1.11-5.59). CTS cases had significant longer work duration (17.9 ± 5.6 years) than CTS non-case (11.5 ± 7.4 yeas) with low OR (1.108).

CONCLUSION

This study demonstrates some personal and ergonomic factors associated with CTS among the laboratory technicians, including female gender, arm/hand exertion, pipetting, repetitive tasks, working with a biosafety cabinet, and an unadjusted workstation.

The biomechanical overload of the upper limb: a neglected occupational hazard in animal facility operators

Data on biomechanical overload of the upper limb in animal facility operators are currently scanty. We decided to study this risk in a university animal facility. Eleven different tasks performed by operators were identified. For each of them, the biomechanical overload of the upper limb was evaluated by applying 4 different methods frequently used, hypothesising a task duration of 4 and 8 h. Then two 'typical' real working days of the examined facility were reconstructed, and the risk for operators was calculated using the OCRA Index, Checklist and Mini-Checklist. Considering the specific tasks, the results show some difference among methods, but the overall results show an acceptable/slight risk of biomechanical overload of the upper limb in animal facility operators during typical working days. Practitioner Summary: Upper limb biomechanical overload (UL-BO) is a neglected risk in animal facilities. In a university facility, 11 different tasks were identified, and 2 typical working days were analysed. Even if some task at increased risk may exist, during typical working days,  the overall results show that the risk of UL-BO in operators can be considered usually acceptable or, at worst, slight.

Exploring musculoskeletal injuries in the podiatry profession: an international cross sectional study

Background

Workplace injury is an international costly burden. Health care workers are an essential component to managing musculoskeletal disorders, however in doing this, they may increase their own susceptibility. While there is substantial evidence about work-related musculoskeletal disorders across the health workforce, understanding risk factors in specific occupational groups, such as podiatry, is limited.

The primary aim of this study was to determine the prevalence and intensity of work related low back pain in podiatrists.

Methods

This was an international cross-sectional survey targeting podiatrists in Australia, New Zealand and the United Kingdom. The survey had two components; general demographic variables and variables relating to general musculoskeletal pain in general or podiatry work-related musculoskeletal pain. Multivariable regression analyses were used to identify factors associated with musculoskeletal stiffness and pain and low back pain intensity. Thematic analysis was used to group comments podiatrists made about their musculoskeletal health.

Results

There were 948 survey responses (5% of Australian, New Zealand and United Kingdom registered podiatrists). There were 719 (76%) podiatrists reporting musculoskeletal pain as a result of their work practices throughout their career. The majority of injuries reported were in the first five years of practice (n = 320, 45%). The body area reported as being the location of the most significant injury was the low back (203 of 705 responses, 29%). Being female (p < 0.001) and working in private practice (p = 0.003) was associated with musculoskeletal pain or stiffness in the past 12 months. There were no variables associated with pain or stiffness in the past four weeks. Being female was the only variable associated with higher pain (p = 0.018). There were four main themes to workplace musculoskeletal pain: 1. Organisational and procedural responses to injury, 2. Giving up work, taking time off, reducing hours, 3. Maintaining good musculoskeletal health and 4. Environmental change.

Conclusions

The postures that podiatrists hold while treating patients appear to impact on musculoskeletal pain and stiffness. Recently graduated and female podiatrists are at higher risk of injury. There is a need for the profession to consider how they move and take care of their own musculoskeletal health.

Electronic supplementary material

The online version of this article (doi:10.1186/s13047-016-0185-y) contains supplementary material, which is available to authorized users.

Anxiety and depression predict musculoskeletal disorders in health care workers

Incidence of musculoskeletal disorders (MSDs) is high among health care workers (HCWs). To determine whether MSDs are associated with preexisting anxiety and/or depression, a case-control study was carried out in female HCWs (56 cases/55 controls). Cases were HCWs with a first-time clinical diagnosis of MSD within the previous 2 years. Occupation, workplace, work shift, direct patient assistance, and anxiety/depression scores (Goldberg scale) were assessed. Increased risk of incident MSDs (multivariate logistic regression) was found in workers with preexisting anxiety/depression compared to those without (OR 5.01; 95% CI 2.20-12.05; p < .01). Other significant risk factors were direct patient assistance (OR 2.59; 95% CI 1.03-6.92; p = .04) and morning work shift (OR 2.47; 95% CI 0.99-6.48; p = .05). Preexisting anxiety/depression was associated with incident MSDs in HCWs, adjusting for occupational exposure risk factors.

Impact of Work Organizational Factors on Carpal Tunnel Syndrome and Epicondylitis

OBJECTIVE

The aim of this study was to identify relationships between work organizational variables (job rotation, overtime work, having a second job, and work pacing) (These work organizational variables and their relationships with biomechanical and psychosocial exposures were studied previously and published in a separate paper.) and health outcome measures [carpal tunnel syndrome (CTS), lateral and medial epicondylitis (LEPI/MEPI)].

METHODS

Using a pooled baseline cohort of 1834 subjects, the relationships were studied using logistic regression models.

RESULTS

Varied degrees of associations between the work organizational and outcomes variables were found. Job rotation was significantly associated with being a CTS case [odds ratio (OR) = 1.23, 95% confidence interval (95% CI): 1.00 to 1.50]. Overtime work was significantly associated with lower LEPI prevalence (OR = 0.48, 95% CI: 0.28 to 0.84). No statistically significant associations were found between having a second job and different work pacing and any of the three health outcome measures.

CONCLUSIONS

Work organizational variables were only partially associated with the studied health outcomes.

Relationships between job organisational factors, biomechanical and psychosocial exposures

The relationships between work organisational, biomechanical and psychosocial factors were studied using cross-sectional data from a pooled dataset of 1834 participants. The work organisational factors included: job rotation, overtime work, having second jobs and work pace. Task and job level biomechanical variables were obtained through sub-task data collected in the field or analysed in the laboratory. Psychosocial variables were collected based on responses to 10 questions. The results showed that job rotations had significant effects on all biomechanical and most psychosocial measures. Those with job rotations generally had higher job biomechanical stressors, and lower job satisfaction. Overtime work was associated with higher job biomechanical stressors, and possibly self-reported physical exhaustion. Those having second jobs reported getting along with co-workers well. Work pace had significant influences on all biomechanical stressors, but its impact on job biomechanical stressors and psychosocial effects are complicated.

PRACTITIONER SUMMARY

The findings are based on a large number of subjects collected by three research teams in diverse US workplaces. Job rotation practices used in many workplaces may not be effective in reducing job biomechanical stressors for work-related musculoskeletal disorders. Overtime work is also associated with higher biomechanical stressors.

Comparisons of musculoskeletal disorders among ten different medical professions in Taiwan: a nationwide, population-based study

Objective

Medical personnel are at risk of musculoskeletal disorders but little is known whether the risk of musculoskeletal disorders were different among various medical professions. Therefore, this study compared the risk of musculoskeletal disorders among personnel of 10 different medical professions in Taiwan using a nationwide health claims database.

Methods

Data from the 2000–2010 Taiwan National Health Insurance Research Database were used to identify personnel of 10 different medical professions. Diagnoses based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) were used to identify eight different musculoskeletal disorders that occurred after the license issuance date. Cox proportional hazards model was used to compare the risk of eight musculoskeletal disorders among the 10 different medical professions using dentists as the reference category.

Results

A total of 7,820 medical personnel were included in the analysis. Using dentists as the reference category, physical therapists showed a significantly higher risk of all eight musculoskeletal disorders (ranging from 1.59 [p = 0.032] in sprains and strains of other and unspecified parts of back to 2.93 [p < 0.001] in spondylosis and allied disorders).

Conclusions

Compared with dentists, a profession that already known to suffer from high rates of work-related musculoskeletal disorders, physical therapists, registered nurses, and doctors of Chinese medicine showed an even higher risk of musculoskeletal disorders.