Self-reported musculoskeletal disorders of the distal upper extremities and the neck in German veterinarians: a cross-sectional study

Physical stress and musculoskeletal complaints of veterinarians - A narrative review

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.

A narrative review of the physiology and health effects of burnout associated with veterinarian-pertinent occupational stressors

Chronic workplace stress and burnout are serious problems in veterinary medicine. Although not classified as a medical condition, burnout can affect sleep patterns and contributes to chronic low grade systemic inflammation, autonomic imbalance, hormonal imbalances and immunodeficiencies, thereby increasing the risks of physical and psychological ill health in affected individuals. Cultural misconceptions in the profession often lead to perceptions of burnout as a personal failure, ideas that healthcare professionals are somehow at lower risk for suffering, and beliefs that affected individuals can or should somehow heal themselves. However, these concepts are antiquated, harmful and incorrect, preventing the design of appropriate solutions for this serious and growing challenge to the veterinary profession. Veterinarians must first correctly identify the nature of the problem and understand its causes and impacts before rational solutions can be implemented. In this first part of two companion reviews, burnout will be defined, pathophysiology discussed, and healthcare and veterinary-relevant occupational stressors that lead to burnout identified.

Health Promotion for Students of Veterinary Medicine: A Preliminary Study on Active Microbreaks and Ergonomics Education

Occupational hazards, such as psychosocial stressors, physical injuries from human-animal interactions, and physically demanding work tasks, are common in the veterinary profession, and musculoskeletal discomfort and pain (MDP) may already be present in veterinary undergraduates. This preliminary study investigates the effects of very short, active interventions, called microbreaks, in 36 veterinary students. At the start, participants had a high prevalence of MDP, especially in the neck and lower back. Within a 12-week observational period, 6 weeks of active intervention comprised teaching microbreaks (nine strengthening, stretching, and relaxation exercises; 30-90 s each) and a weekly veterinary-specific ergonomics education and discussion. After the intervention, participants reported fewer painful body regions and an increase in their self-efficacy in potentially painful, risky, or dangerous human-animal interactions. After the 12-week observational period, participants had increased self-efficacy in the maintenance of physical health and self-protection but decreased self-efficacy in healing injuries after veterinary human-animal interactions. Participants felt to have increased and decreased control over dangerous situations with dogs and horses, respectively, although self-efficacy in handling horses increased. Participants integrated microbreaks well into their undergraduate activities and rated the topic relevant to their (later) profession. This should encourage the inclusion of similar programs in undergraduate curricula.

The impact of endoscopic activity on musculoskeletal disorders of high-volume endoscopists in Germany

Physical stress is common in GI endoscopists, leading to musculoskeletal disorders. Considering the increasing complexity of interventional GI endoscopy with prolonged examination time, work-related musculoskeletal disorders have come into focus. However, data on work-related health stress in German endoscopists are elusive. The aim of this study was therefore to investigate the prevalence and consequences of work-related musculoskeletal disorders in German endoscopists. A 24-item questionnaire on endoscopy-associated musculoskeletal disorders and standardized pain assessment was developed by an interdisciplinary team of endoscopists and sports medics. The survey was distributed online by the leading German societies for gastroenterology and endoscopy. Overall, 151 German practicing endoscopists took part in the study. Regarding the average number of endoscopic procedures per week, the study collective consisted mainly of high-volume endoscopists. The survey showed that most participants suffered from general musculoskeletal disorders (82.8%) and from work-related musculoskeletal disorders (76.8%). The most affected body parts were the neck, low back, thumb, and shoulder. Temporary absence from work due to symptoms was reported by 9.9% of the respondents. Over 30% of participating endoscopists stated the need for analgesics or physiotherapy due to musculoskeletal disorders. Age, professional experience and work time were identified as relevant risk factors for musculoskeletal health issues. A high number of German endoscopists are affected by musculoskeletal disorders due to specific working postures and repetitive movements with a large impact on personal health. Further interventional studies are mandatory to improve the risk prevention of endoscopic activity.

Musculoskeletal discomfort in veterinary healthcare professions

BACKGROUND

Veterinarians appear to be at risk for work-related musculoskeletal discomfort (MSD), based on surveys conducted outside the US.

OBJECTIVE

This study provides new information about MSD prevalence in veterinarians and veterinary technicians in the US.

METHODS

Cross-sectional survey and observation.

RESULTS

A survey of 56 veterinarians and 38 veterinary technicians in Ohio found 12-month prevalence of MSD exceeded 60% in the neck, low back, and legs/feet. More than 85% of participants reported that work activities exacerbated discomfort in at least one region. Less than one-third of participants reported symptom-related lost work time. Personal and work-related burnout scores were higher for veterinary technicians, compared with veterinarians. Nine percent of observed work activities performed by veterinarians and 43% performed by veterinary technicians were rated high or very high risk.

CONCLUSIONS

High prevalence of MSD and low lost work time suggest many individuals are working in pain. Increased adoption of existing ergonomics solutions (equipment and process changes), in addition to further investigation of unmet needs, could improve working conditions and reduce musculoskeletal stress in veterinary health professions.

Electromyographic Analysis of Muscle Activation Patterns During Bovine Transrectal Palpation and the Development of the Bovine Pregnancy Diagnosis Improvement Exercise Program

The unusual and tiring physical activity of bovine transrectal palpation (TRP) requires a novel approach to improve students' TRP and pregnancy diagnosis (PD) skills. It has been shown that students who participated in an exercise program and students who had a grip strength (GS) of more than 30 kilograms performed better in bovine PDs. Participation in the exercise program increased students' sensitivity (ability to identify pregnant cows) but did not increase total arm muscle strength. To identify which muscles are used during TRPs and to improve the exercise program, an electromyographic (EMG) analysis was used to identify muscle activation patterns and muscle activity levels during bovine TRPs. Eight subject matter experts (SMEs) each palpated two live cows and one Breed'n Betsy^® rectal examination simulator while an EMG Triggered Stimulator recorded muscle activity. Muscle activation was higher for forearm muscles compared with all other examined muscle groups (p < .001); was higher during retraction of the uterus and palpation of left and right uterine horn, compared with palpation of cervix, uterine body, left ovary, and right ovary (p < .001); and showed an endurance pattern. Findings have been used to modify the previously developed exercise program in effort to improve students' TRP and PD skills. The Bovine PD Improvement Exercise Program is available to students through an online application (http://icarus.up.ac.za/vetmlp/) and aims to not only improve GS and TRP accuracy but also stamina and well-being while adding fun to busy study schedules.

Ergonomic assessment of veterinarians during performance of bovine reproductive examinations

OBJECTIVE

To identify and quantify potential ergonomic hazards associated with routine reproductive examinations of cattle.

SAMPLE

7 bovine veterinarians.

PROCEDURES

Each veterinarian was observed and videotaped during 2 bovine reproductive examination appointments. During each appointment, a force-matching protocol was used to estimate the entry force used by the veterinarian to insert an arm into a cow's rectum. Veterinarian posture and repetitive movements and the work environment were assessed and quantified during review of the video recordings. Descriptive data were generated.

RESULTS

Of the 14 appointments observed, 9 and 5 involved examination of beef and dairy cows, respectively. For all veterinarians, an arm inclination ≥ 60° was observed during most reproductive examinations. The number of examinations performed per hour ranged from 19.1 to 116.8. The estimated entry force ranged from 121 to 349 N. During all 9 appointments involving beef cows, the veterinarian participated in other tasks (eg, operating overhead levers, opening gates, or assisting with cattle handling) that represented ergonomic hazards.

CONCLUSIONS AND CLINICAL RELEVANCE

Results confirmed that reproductive examination of cattle exposes veterinarians to various ergonomic hazards involving awkward positions and repetitive and forceful exertions that can contribute to musculoskeletal discomfort and injury, particularly of the upper extremities (neck, shoulders, upper back, arms, elbows, wrists, and hands). Veterinarians frequently participated in other tasks during reproductive examination appointments that exposed them to additional ergonomic hazards. Risk mitigation strategies should prioritize minimizing exposure of veterinarians to tasks not directly associated with the reproductive examination procedure to decrease their overall ergonomic hazard burden.

Risk factors associated with work-preventing musculoskeletal discomfort in the upper extremities of bovine practitioners

OBJECTIVE

To identify risk factors associated with work-preventing musculoskeletal discomfort (MSKD) in the upper extremities (defined as neck, shoulders, upper back, arms, elbows, wrists, and hands) of bovine practitioners.

SAMPLE

116 members of the Western Canadian Association of Bovine Practitioners.

PROCEDURES

Data from a previously described cross-sectional survey of western Canadian bovine practitioners underwent further analysis. The survey, developed to glean information about MSKD in bovine practitioners, was a modified standardized Nordic questionnaire that included questions regarding personal and work characteristics and incidence and location of MSKD during the preceding 12 months along with perceptions about most physically demanding tasks. Logistic regression was used to identify factors associated with work-preventing upper extremity MSKD.

RESULTS

18 of 116 (15.5%) respondents indicated they had experienced work-preventing upper extremity MSKD during the preceding 12 months. The final multivariable regression model indicated that practice type (mixed animal vs primarily [> 50%] bovine; OR, 3.20; 95% CI, 0.96 to 10.67), practitioner height (OR, 0.93; 95% CI, 0.87 to 0.99), and number of veterinarians in the practice (OR, 1.32; 95% CI, 1.05 to 1.66) were significantly associated with the odds of work-preventing upper extremity MSKD.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that reproductive examination of cattle was not a significant risk factor for upper extremity MSKD in bovine practitioners. Further research into the effects of biomechanical, organizational, and psychosocial workplace factors on the development of MSKD in bovine practitioners is necessary to help inform prevention strategies to foster career longevity in this increasingly diverse practitioner group.

Development of the Nurses' Occupational Stressor Scale

Although nurses work in stressful environments, stressors in such environments have yet to be clearly assessed. This study aimed to develop a Nurses’ Occupational Stressor Scale (NOSS) with high reliability and validity. Candidate questions for the NOSS were generated by expert consensus following focus group feedback, and were used to survey in 2013. A shorter version was then developed after examination for validity and reproducibility in 2014. The accuracy of the short version of the NOSS for predicting nurses’ stress levels was evaluated based on receiver operating characteristic curves to compare existing instruments for measuring stress outcomes, namely personal burnout, client-related burnout, job dissatisfaction, and intention to leave. Examination for validity and reproducibility yielded a shorter version of NOSS with only 21 items was considered sufficient for measuring stressors in nurses’ work environments. Nine subscales were included: (1) work demands, (2) work–family conflict, (3) insufficient support from coworkers or caregivers, (4) workplace violence and bullying, (5) organizational issues, (6) occupational hazards, (7) difficulty taking leave, (8) powerlessness, and (9) unmet basic physiological needs. The 21-item NOSS proved to have high concurrent and construct validity. The correlation coefficients of the subscales for test-retest reliability ranged from 0.71 to 0.83. The internal consistency (Cronbach’s α) coefficients ranged from 0.35 to 0.77. The NOSS exhibited accurate prediction of personal burnout, client-related burnout, job dissatisfaction, and intention to leave.

Musculoskeletal discomfort among Canadian bovine practitioners: Prevalence, impact on work, and perception of physically demanding tasks

Musculoskeletal discomfort (MSD) is prevalent in large animal veterinarians but little research has been conducted on prevalence of MSD and its impact among Canadian bovine veterinarians. This 2017 survey targeted practicing and retired members of the Western Canadian Association of Bovine Practitioners, and adapted the Nordic Musculoskeletal Questionnaire to quantify MSD prevalence. Open-ended questions were used to determine the impact of MSD on work and to determine what were perceived to be the most physically demanding tasks. The survey response rate was 51.4% (133/259). Prevalence of MSD was high, with 12-month and lifetime rates of 89.5% and 96.9%, respectively. Obstetrical procedures, rectal examinations, and bull semen collections were reported as the 3 most physically strenuous tasks. The high MSD prevalence rates observed in the shoulder, neck, and lower back call for research on direct ergonomic assessments and work practice interventions for bovine veterinarians.

The examination of work-related musculoskeletal discomforts and risk factors in veterinarians

This study aimed to determine the frequency of work-related musculoskeletal discomforts (WMSDs) observed in veterinarians and the risk factors that may bring about these. Two hundred and seven veterinarians working in three provinces in south west Turkey were included in the study. The demographic and occupational information on the participants was recorded. The Modified Nordic Musculoskeletal Questionnaire was used to evaluate the musculoskeletal problems of different body parts, which cause difficulties at work and result in staying away from work. 49.8 % of veterinarians mostly have problems with lower back, 41.1 % with back, and 39.1 % with neck. The frequency of WMSDs tends to increase with the progress of professional experience. Three work-related activities during which veterinarians experience most difficulties while at work are obstetric procedures (28 %), vaccination (25.6 %), and driving (23.2 %). It is statistically significant that arm problems are observed more in veterinarians working with large animal types (p<0.05). The high level of job related stress and low job satisfaction statistically significantly affect the formation of WMSDs (p<0.05). The study showed that a large number of veterinarians experienced work-related musculoskeletal pain and discomforts that could be caused by some physical and psychosocial risk factors. Therefore, it is recommended for veterinarians to receive education on ergonomics and exercise from the beginning of their professional lives to prevent WMSDs.

Work environment and occupational risk assessment for small animal Portuguese veterinary activities

The professional work of small animal veterinary staff encompasses a wide diversity of demanding tasks. This has prompted a number of studies covering physical, chemical, biological, ergonomic, or psychological hazards, as well as their health effects upon veterinary workers. However, such results were obtained from self-reported surveys (via paper or online). This study reports the identification of potential hazards and provides a risk assessment of 15 veterinary clinics based on data from walk-through surveys, interviews with workers, and quantification of indoor air quality parameters including concentration of volatile organic compounds (total, isoflurane, and glutaraldehyde). The risk arising from X-ray exposure was unacceptable in seven clinics; X-ray examination should be discontinued in the absence of isolated radiation rooms, poor safety practices, and lack of personal protective equipment. Ergonomic-related hazards and work practices should be revised as soon as possible, considering that improper postures, as well as moving and lifting heavy animals are major causes of musculoskeletal disorders. The risk levels were, in general, small or medium (acceptable) with regard to exposure to physical hazards (such as bites, scratches, cuts, and burns) and biological hazards. It was observed that the indoor air quality parameters including temperature, respirable particulate matter and total volatile organic compounds do not indicate a comfortable workplace environment, requiring clinics' attention to keep the safe environment. The veterinarians and nurses were exposed to isoflurane (above 2 ppm) during surgery if an extractor system for waste gas was used instead of a scavenging system. Finally, veterinary workers did not possess any type of training on occupational safety and health issues, even though they recognized its importance.

Investigating the Association Between Lower Extremity and Low Back Symptoms Among Saskatchewan Farmers Using the Standardized Nordic Questionnaire

STUDY DESIGN

Cross-sectional survey.

OBJECTIVE

The aim of this study was to investigate the association between self-reported low back symptoms and symptoms in the hip, knee, and ankle in a high-risk occupational group.

SUMMARY OF BACKGROUND DATA

Low back pain, with or without lower extremity referral, poses a major challenge to occupational productivity, especially in farming. Although low back symptoms can occur independent of lower extremity symptoms, anatomical positioning of nerves supplying the lower limbs means structural and physiological changes in the spine can lead to referred pain in the lower limbs, but the magnitude of the association between low back and lower extremity symptoms is unclear.

METHODS

Baseline postal questionnaire data from the Saskatchewan Farm Injury Cohort Study yielded surveys from 2653 adults from 1020 farms, who responded to Standardized Nordic Questionnaire (SNQ) items on "ache, pain, discomfort" in nine body parts during the last 12 months. Bivariate and multivariate regression modeling was performed with low back symptoms as the outcome and lower extremity symptoms as the independent variable.

RESULTS

After adjustment for age, sex, depression, and heavy lifting, low back symptom was significantly related with hip pain (odds ratio [OR] = 3.84, 95% confidence interval [CI] 3.04-4.84), knee pain (OR = 1.84, 95% CI 1.49-2.28), and ankle pain (OR = 1.79, 95% CI 1.40-2.29). Results showed a significant but decreasing relationship to low back symptoms as sites became more distal.

CONCLUSION

Hip and low back symptoms are highly associated, suggesting a common mechanism may be at work. Although there appears be increased risk of knee and ankle region symptoms among those with back pain, the SNQ is not designed to differentiate types of referred symptoms (i.e., numbness, tingling, shooting pain) and/or clinical diagnoses. Other tools, possibly corroborated with clinical examination findings, are likely necessary for a more thorough investigation of referred pain patterns in this high-risk occupational group.

LEVEL OF EVIDENCE

3.

Awareness and Knowledge of Ergonomics Among Medical Laboratory Scientists in Nigeria

Background:

Ergonomics awareness helps in its right application and contributes significantly to general wellbeing and safety of worker at workplace.

Aim:

This cross-sectional descriptive study aimed at assessing the level of awareness and knowledge of the science of ergonomics among Medical Laboratory Scientists in Benin City, Nigeria.

Subjects and Methods:

A total of 106 medical laboratory scientists comprising 64 and 42 in public and private laboratories, respectively, were recruited for this study using systematic random sampling technique. Data were obtained from the study participants using a questionnaire and subsequently analyzed with the statistical software INSTAT^®.

Results:

Out of 106 study participants, 27 (25.5%) were reported to have heard of the term ergonomics. Awareness was significantly associated with gender (male vs. female: 38.5% [15/39] vs. 17.9% [12/67]; odds ratio = 2.9; 95% confidence interval = 1.2, 7.1;P = 0.02). Awareness of ergonomics was not significantly affected by affiliation (P = 0.18), area of specialization (P = 0.78), post-qualification experience (P = 0.43), and educational qualification (P = 0.23) of the study participants. Irrespective of the affiliation of the participant, only 6 of 27 (22.2%) participants who were aware of ergonomics knew at least a benefit of right application of ergonomics in the laboratory. Knowledge of risk factors for the development of musculoskeletal disorders was reported by 8 of 27 (29.6%) persons who claimed to be aware of ergonomics.

Conclusions:

Awareness of ergonomics and knowledge of gains of its right application was poor among the study participants. Regular ergonomic education of medical laboratory scientists in Nigeria is advocated.

Musculoskeletal Symptoms and Risk of Burnout in Child Care Workers - A Cross-Sectional Study

Objectives

German child care workers' job satisfaction is influenced by the consequences of unfavourable underlying conditions. Child care workers tend to suffer from psychosocial stress, as they feel that their work is undervalued. The objective of the present study is to investigate how the psychosocial factors of the effort-reward imbalance (ERI) model influence musculoskeletal symptoms (MS) and the risk of burnout. To our knowledge this is the first study investigating the association between the factors of the ERI model and MS in child care workers.

Methods and Findings

Data from 199 child care workers were examined in a cross-sectional study. Psychosocial factors were recorded with the ERI questionnaire. MS was recorded with the Nordic Questionnaire and risk of burnout with the Personal Burnout scale of the Copenhagen Burnout Inventory. Multivariate analysis was performed using linear and logistic regression models. The response rate was 57%. In most of the sample (65%), an effort-reward imbalance was observed. 56% of the child care workers were at risk of burnout and 58% reported MS. Factors associated with risk of burnout were subjective noise exposure (OR: 4.4, 95%CI: 1.55–12.29) and overcommitment (OR: 3.4; 95%CI: 1.46–7.75). There were statistically significant associations between MS and overcommitment (low back pain—OR: 2.2, 95%CI: 1.04–4.51), low control (overall MS OR: 3.8; 95%CI: 1.68–3.37) and risk of burnout (overall MS OR: 2.3, 95%CI: 1.01–5.28). For ERI no statistically significant associations were found with reference to risk of burnout or MS.

Conclusion

Overcommitment in child care workers is related to MS and risk of burnout. There is also evidence that low control is associated with MS and subjective noise exposure with risk of burnout. Effort-reward imbalance is not related to either outcome. This occupational health risk assessment identifies changeable working factors in different types of facilities.