The effectiveness of ergonomics interventions in reducing upper limb work-related musculoskeletal pain and dysfunction in sonographers, surgeons and dentists: a systematic review

Preventing Surgeon Work-Related Musculoskeletal Disorders: A Pilot Study of the Comprehensive Operating Room Ergonomics (CORE) Program

IMPORTANCE

Work-related musculoskeletal disorders (WMSDs) among surgeons are markedly increasing. Several proposed interventions to reduce WMSDs among surgeons have been studied, but few follow an occupational therapy-oriented approach addressing biomechanical, psychophysical, and psychosocial risk factors.

OBJECTIVE

To design, implement, and assess the potential of the Comprehensive Operating Room Ergonomics (CORE) program for surgeons, a holistic evidence-based ergonomics and wellness intervention grounded in occupational therapy principles.

DESIGN

Mixed-methods pilot study with the quantitative strand embedded in the qualitative strand.

SETTING

University-affiliated hospital.

PARTICIPANTS

Six laparoscopic surgeons.

OUTCOMES AND MEASURES

CORE program outcomes were assessed using qualitative and quantitative data to indicate changes in posture, physical discomfort, sense of wellness, and operating room (OR) ergonomic performance. The Rapid Upper Limb Assessment (RULA) was used to quantify surgeons' WMSD risk level before and after intervention.

RESULTS

There were 12 baseline observations (two for each participant), and two or three post-CORE implementation observations. A statistically significant difference, F(1, 6) = 8.57, p = .03, was found between pre- and post-occupational therapy intervention RULA scores. Thematic analysis of surgeon feedback, which was overwhelmingly positive, identified five themes: postural alignment, areas of commonly reported physical pain or discomfort, setup of the OR environment, surgical ergonomics training, and ergonomics in everyday life.

CONCLUSIONS AND RELEVANCE

The CORE program effectively decreased ergonomic risk factors to optimize surgeons' occupational performance in the OR. This study demonstrates a potential solution to how occupational therapists can holistically support surgeons and health care providers who are at risk for WMSDs. Plain-Language Summary: By 2025, a surgeon shortage is expected, partly because of the increase in surgeons' work-related musculoskeletal disorders, which affect their health and job continuity. This pilot study shows that the Comprehensive Operating Room Ergonomics program effectively addresses these problems. The study also serves as a framework for occupational therapy professionals to work with health care providers on ergonomics, benefiting population health. Results suggest that this approach could enhance surgeons' work conditions, supporting the American Occupational Therapy Association's Vision 2025 to improve health and quality of life.

Work-related musculoskeletal disorders in oral health professionals: an umbrella review protocol

OBJECTIVE

The objective of this review is to synthesize the evidence on the prevalence, incidence, risk factors, and preventive and management interventions for work-related musculoskeletal disorders (MSD) in oral health professionals.

INTRODUCTION

Oral health professionals face a considerable risk of developing work-related MSD due to the nature of their work. These disorders can lead to loss of employment, reduced job quality, increased occupational injuries, and early retirement. They can also lead to significant financial burdens for employers and society.

INCLUSION CRITERIA

This umbrella review will include systematic reviews and meta-analyses that have oral health professionals as a population group and address at least one of the following topics: the prevalence or incidence, risk factors, and the efficiency or effectiveness of interventions for the prevention or management of work-related MSD.

METHODS

A systematic search will be conducted across CINAHL Complete (EBSCOhost), Dentistry and Oral Sciences Source (EBSCOhost), MEDLINE (EBSCOhost), Cochrane Library (Ovid), Scopus, PsycINFO (Ovid), AMED Allied and Complementary Medicine (Ovid), Epistemonikos, Ergonomics Abstracts Online (EBSCOhost), and Google Scholar (first 200 articles). The search will be limited to articles published in English, with no restrictions on geographical location. Two independent reviewers will screen the titles and abstracts against the inclusion criteria. The reviews will be assessed using the JBI critical appraisal instrument for systematic reviews and research syntheses, and data will be extracted from each review using a modified version of the JBI data extraction tool. A narrative summary and tables will be used to describe the review characteristics and findings. Results will be presented in a table using visual indicators (traffic light system) to represent beneficial, neutral, and negative effects with each risk factor and intervention. The GRADE approach will be used to rate the overall quality and strength of the evidence.

REVIEW REGISTRATION

PROSPERO CRD42023388779.

Evaluation of a passive arm-support exoskeleton for surgical team members: Results from live surgeries

BACKGROUND

Musculoskeletal symptoms and injuries adversely impact the health of surgical team members and their performance in the operating room (OR). Though ergonomic risks in surgery are well-recognized, mitigating these risks is especially difficult. In this study, we aimed to assess the impacts of an exoskeleton when used by OR team members during live surgeries.

METHODS

A commercial passive arm-support exoskeleton was used. One surgical nurse, one attending surgeon, and five surgical trainees participated. Twenty-seven surgeries were completed, 12 with and 15 without the exoskeleton. Upper-body postures and muscle activation levels were measured during the surgeries using inertial measurement units and electromyography sensors, respectively. Postures, muscle activation levels, and self-report metrics were compared between the baseline and exoskeleton conditions using non-parametric tests.

RESULTS

Using the exoskeleton significantly decreased the percentage of time in demanding postures (>45° shoulder elevation) for the right shoulder by 7% and decreased peak muscle activation of the left trapezius, right deltoid, and right lumbar erector spinae muscles, by 7%, 8%, and 12%, respectively. No differences were found in perceived effort, and overall scores on usability ranged from "OK" to "excellent."

CONCLUSIONS

Arm-support exoskeletons have the potential to assist OR team members in reducing musculoskeletal pain and fatigue indicators. To further increase usability in the OR, however, better methods are needed to identify the surgical tasks for which an exoskeleton is effective.

Ergonomic interventions to reduce upper limb musculoskeletal pain during robotic surgery: a narrative review

There is a high prevalence of upper limb musculoskeletal pain among robotic surgeons. Poor upper limb ergonomic positioning during robotic surgery occurs when the shoulders are abducted, and the elbows are lifted off the console armrest. The validated rapid upper limb assessment can quantify ergonomic efficacy. Surface electromyography and hand dynamometer assessment of strength are the most common methods to assess muscle fatigue. A literature review was performed to find evidence of ergonomic interventions which reduce upper limb musculoskeletal pain during robotic surgery. There is a paucity of studies which have reported on this topic. In other occupations, there is strong evidence for the use of resistance training to prevent upper extremity pain. Use of forearm compression sleeves, stretching, and massage may help reduce forearm fatigue. Microbreaks with targeted stretching, active ergonomic training, improved use of armrest, and optimal hand controller design have been shown to reduce upper limb musculoskeletal pain. Future studies should assess which interventions are beneficial in reducing surgeon upper limb pain during robotic surgery.

Acute Effects of a Warm-Up Intervention on Pain, Productivity, Physical Capacities and Psychological Perceptions Among Vineyard Workers: a Cluster Randomized Trial

PURPOSE

Agriculture is one of the sectors that are the most concerned by musculoskeletal disorders (MSDs). Workplace physical activity programs are one of the most promising solutions to prevent adverse consequences of MSDs such as pain or impairment in physical capacities. The aims of this study were twofold: (1) to investigate the acute effect of a warm-up session on pain, work performance, physical capacities and psychosocial perceptions among vineyard workers; (2) to determine the most beneficial warm-up modality for vineyard workers.

METHODS

A cluster randomized study was implemented among 92 French vineyard workers. A 15 min single session of warm-up was implemented among four groups corresponding to four different conditions: (1) hybrid warm-up intervention (HWU); (2) dynamic warm-up intervention (DWU); (3) stretching warm-up intervention (SWU); (4) no warm-up intervention (CONTROL).

RESULTS

DWU showed significant increased performance (p < 0.05), increased heart rate (p < 0.001), better readiness to work (p < 0.05) and lower workload (p < 0.05) than the CONTROL. HWU showed a better readiness to work (p < 0.01). SWU showed better work quality (p < 0.05). However, the three different warm-up protocols did significantly not differ from the CONTROL group in terms of perceived pain intensity, and physical capacities.

CONCLUSION

The present findings confirm some beneficial acute effects on performance, heart rate and psychological perceptions of a single warm-up session performed before pruning. The DWU seems to be the most beneficial warm-up modality.

TRIAL REGISTRATION

NCT05425693. Registered 06/16/2022 in www.

CLINICALTRIALS

gov .

Ergonomics of bronchoscopy: good advice or a pain in the neck?

Interventional pulmonologists require a unique set of skills including precise motor abilities and physical endurance, but surprisingly the application of ergonomic principles in the field of bronchoscopy remains limited. This is particularly intriguing when considering the significant impact that poor ergonomics can have on diagnostic aptitude, income potential and overall health. It is therefore imperative to provide comprehensive education to physicians regarding the significance of ergonomics in their work, especially considering the introduction of advanced diagnostic and therapeutic procedures. By implementing simple yet effective measures (e.g. maintaining neutral positions of the wrist, neck and shoulder; adjusting the height of tables and monitors; incorporating scheduled breaks; and engaging in regular exercises), the risk of injuries can be substantially reduced. Moreover, objective tools are readily available to assess ergonomic postures and estimate the likelihood of work-related musculoskeletal injuries. This review aims to evaluate the current literature on the impact of procedure-related musculoskeletal pain on practising pulmonologists and identify modifiable factors for future research.

Patterns of musculoskeletal disorders in health care providers and their association with ergonomic risks

Objectives. Musculoskeletal disorders (MSDs) have a high prevalence among allied health care providers because of the demanding nature of their work and lack of practicing proper ergonomics. The aim of this study focused on patterns of work-related musculoskeletal disorders (WMSDs) affecting different health care providers working in a different unit of a tertiary care hospital. Methods. This cross-sectional study collected data from 2000 allied health care providers working at various departments of Civil Hospital and Dow University Hospital of Karachi (DUHS), via self-administered questionnaire, based on Occupational Safety and Health Administration (OSHA) guidelines. Results. Our findings revealed that 92.9% of individuals had MSDs as a result of poor ergonomics, with 93% reporting that the disease interferes with their normal job routine. Conclusions. Medical technologists are the most affected group among allied health care workers. Lack of knowledge and improper ergonomic culture results in such a high prevalence rate in allied health care workers in Pakistan.

Work productivity and activity impairment in disorders of gut-brain interaction: Data from the Rome Foundation Global Epidemiology Study

BACKGROUND

Disorders of Gut-Brain Interaction (DGBI) are highly prevalent worldwide, but their effect on work productivity has not gained much attention.

AIMS AND METHODS

We aimed to compare work productivity and activity impairment (WPAI) in persons with and without DGBI in a large population-based cohort and identify factors independently associated with WPAI in subjects with DGBI. Data were collected from Germany, Israel, Italy, Japan, the Netherlands, Poland, Spain and Sweden via Internet surveys as part of the Rome Foundation Global Epidemiology Study. Apart from the Rome IV diagnostic questionnaire, questionnaires evaluating WPAI related to general health (WPAI:GH), psychological distress (PHQ-4), somatic symptom severity (PHQ-15) and other factors were assessed.

RESULTS

Of the 16,820 subjects, 7111 met the criteria for DGBI according to the Rome IV diagnostic questionnaire. Subjects with DGBI were younger (median (interquartile range) age 43 (31-58) vs. 47 (33-62)) and more often female (59.0% vs. 43.7%) compared to subjects without DGBI. Subjects with DGBI had higher absenteeism, presenteeism (poor work productivity due to illness), overall work impairment and activity impairment (p < 0.001) compared with subjects without. For subjects with DGBI affecting more than one anatomical region, WPAI was incrementally higher for each additional region. There were significant differences in WPAI for subjects with DGBI in different countries. Subjects from Sweden had the highest overall work impairment and from Poland the lowest. Using multiple linear regression, male sex, fatigue, psychological distress, somatic symptom severity and number of anatomical regions were independently associated with overall work impairment (p < 0.05 for all).

CONCLUSION

In the general population, people with DGBI have substantial WPAI compared with those without DGBI. The reasons for these findings should be explored further, but having multiple DGBI, psychological distress, fatigue and somatic symptom severity seem to contribute to this impairment associated with DGBI.

A New Approach to Quantifying Muscular Fatigue Using Wearable EMG Sensors during Surgery: An Ergonomic Case Study

(1) Background: Surgeons are exposed to musculoskeletal loads that are comparable to those of industrial workers. These stresses are harmful for the joints and muscles and can lead to musculoskeletal disorders (MSD) and working incapacity for surgeons. In this paper, we propose a novel ergonomic and visualization approach to assess muscular fatigue during surgical procedures. (2) Methods: The activity of eight muscles from the shoulder girdle and the cervical/lumbar spines were evaluated using position and electromyographic wearable sensors while a surgeon performed an arthroscopic rotator-cuff surgery on a patient. The time and frequency-domain variables of the root-mean-square amplitude and mean power frequency, respectively, were calculated from an electromyographic signal. (3) Results: The entire surgical procedure lasted 73 min and was divided into 10 sub-phases associated with specific level of muscular activity and fatigue. Most of the muscles showed activity above 60%, while the middle trapezius muscles were almost constantly activated (>20%) throughout the surgical procedure. (4) Conclusion: Wearable sensors can be used during surgical procedure to assess fatigue. Periods of low-to-high activity and fatigue can be evaluated and visualized during surgery. Micro-breaks throughout surgical procedures are suggested to avoid fatigue and to prevent the risk of developing MSD.

Robotic and Microrobotic Tools for Dental Therapy

Robotic and microrobotic tools such as dental operating microscopes and dental endoscopes are being used extensively in dental therapy, which have a significant impact on dental therapy and education. Herein, this paper reviews the state of the art of robotic and microrobotic tools for dental therapy. This article starts with a brief introduction of current robotic and microrobotic tools for dental therapy and then displays their applications in various dental problems; strengths and weaknesses are also surveyed. Lastly, the conclusion and outlook are discussed, referring to the emerging dental clinic problems and demands. This review is expected to provide guidelines for the therapeutic application of robotic and microrobotic tools and to promote the development of robots in dentistry.

Tattoo artists and dental workers have similar musculoskeletal pain patterns

BACKGROUND

Tattoo artists are an understudied population with regards to musculoskeletal (MSK) pain.

AIMS

To explore the characteristics of MSK pain among Israeli tattoo artists and determine whether they are similar to those of dental workers.

METHODS

An online survey including demographics and the Hebrew version of the Extended Nordic Musculoskeletal Questionnaire was disseminated via Israeli social media groups. We directly compared tattoo artists, dental workers and office workers as a reference group.

RESULTS

Altogether, 114 tattoo artists, 161 dental workers and 296 office workers responded. The most prevalent pain sites were lower back (56%), neck (47%) and hand (36%) among office workers; neck (67%), lower back (62%) and upper back (42%) among the dental workers; and lower back (72%), neck (66%) and hand (55%) among tattoo artists. Contrast analysis suggested office workers were less likely to report pain in the previous 12 months compared with dental workers and tattoo artists (adjusted odds ratios [95% confidence intervals]: ORs [95% CIs] for upper limb pain: 1.13 [1.01-1.28], neck pain: 1.3 [1.15-1.47], upper back pain: 1.27 [1.12-1.43] and low back pain: 1.15 [1.02-1.3]). No significant differences were observed between dental workers and tattoo artists (upper limb pain: 1.18 [0.9-1.54], neck pain: 1.06 [0.81-1.4], upper back pain: 1.22 [0.94-1.58] and low back pain: 1.24 [0.95-1.64]).

CONCLUSIONS

Tattoo artists and dental workers have similar MSK pain characteristics and are different from those of office workers. These characteristics are seemingly a direct result of the physical demands associated with their line of work.

Musculoskeletal Disorder Symptoms in Saudi Allied Dental Professionals: Is there an Underestimation of Related Occupational Risk Factors?

This study aims to examine the prevalence of musculoskeletal disorder (MSD) symptoms in allied dental professionals (ADPs) in Saudi Arabia and risk factors for MSDs. The study also explores ADPs' opinions and attitudes about the effect of MSD symptoms on the quality of life and potential mitigatory measures. This is a prospective cross-sectional study. Participants were 355 licensed dental staff (average age 33.6 ± 8.1 years, 69% women) working as assistants, lab technicians, radiology technicians, or sterilization technicians with at least six months' work experience. The self-administrated questionnaire comprised socio-demographics, work-related factors, and items from the Nordic Musculoskeletal Questionnaire. Multivariate and univariate logistic regressions were conducted to investigate risk factors for MSD symptoms. Overall, 93% of ADPs complained of MSD symptoms in at least one body site in the past 12 months. Factors related to work conditions (e.g., 'keeping an uncomfortable posture for long periods of time', 'lifting heavy objects') and years of experience were proven to be significant risk factor for developing MSDs. The cohort of ADPs showed a high MSD symptoms prevalence. Efforts are imperative in addressing the risk factors of ergonomics and the workplace environment, and more rigorous studies are needed to further investigate risk factors.