Work-related musculoskeletal disorders and ergonomic risk assessment among radiologists and gastroenterologists using the workplace ergonomic risk assessment method

Background. Ergonomic risk factors in the workplace expose gastroenterologists and radiologists to Work-related Musculoskeletal Disorders (WRMSDs). This study aims to compare the frequency of musculoskeletal disorders and ergonomic risk factors in these two groups of physicians.

Materials and methods. This descriptive study was conducted on 360 physicians (radiologists and gastroenterologists) at the 5 University and teaching hospitals in Tehran. The prevalence of musculoskeletal symptoms was detected using the Nordic Musculoskeletal Questionnaire. The Workplace Ergonomic Risk Assessment (WERA) method was used to estimate and evaluate the ergonomic risk factors in each physician. Finally, the frequency of musculoskeletal disorders was compared between the two groups using statistical tests.

Results. The prevalence of shoulder (70% vs 36.66%; OR=4.03 (2.59–6.25); p<0.001) and hand pain (45% vs 30%; OR=2.78 (1.80–4.31); p<0.001) among radiologists was significantly higher than that among gastroenterologists. In contrast, gastroenterologists had a significantly higher prevalence of upper (65% vs 38.33%; OR=2.98 (1.94–4.58); p<0.001) and lower back pain (67.2% vs 49.44%; OR=2.55 (2.06–3.17); p<0.001) than radiologists. The mean WERA final score, the leg score, forceful score, contact stress, and task duration in radiologists were higher than that of gastroenterologists and the back score in gastroenterologists was higher than radiologists (p<0.05).

Limitations. In this study, the psychological factors affecting musculoskeletal disorders have not been investigated.

Conclusion. WRMSDs had a relatively high prevalence among radiologists (shoulder and hand pain) and gastroenterologists (upper and lower back). Due to the impact of ergonomic risk factors on these disorders in the workplace, ergonomic interventions should be implemented to reduce these risk factors in occupational settings.

Compliance with ethical standards. The study protocol was reviewed and approved by ethical committee of the Iran University of Medical Sciences and Health Services (code: IR.IUMS.FMD.REC.1398.060.)

Contributions:
Kabir-Mokamelkhah E. — research concept and design, analysis and interpretation, writing the text, editing the text;
Aghilinejad M. — research concept and design, writing the text;
Dehghan N. — data collection or processing, writing the text;
Sanati P. — data collection or processing, writing the text;
Hosseininejad M. — analysis and interpretation, writing the text, editing the text.

Acknowledgments. The study had no sponsorship.

Conflict of interest. The authors declare no conflicts of interest.

Received: October 12, 2023 / Accepted: December 28, 2023 / Published: January 31, 2023

1. Krishnan K.S., Raju G., Shawkataly O. Prevalence of work-related musculoskeletal disorders: Psychological and physical risk factors. Int. J. Environ. Res. Public Health. 2021; 18(17): 9361. https://doi.org/10.3390/ijerph18179361

2. Abledu J., Abledu G. Multiple logistic regression analysis of predictors of musculoskeletal disorders and disability among bank workers in Kumasi. Ghana J. Ergonomics. 2012; 2: 2. https://doi.org/10.4172/2165-7556.1000111

3. Farioli A., Mattioli S., Quaglieri A., Curti S., Violante F.S., Coggon D. Musculoskeletal pain in Europe: the role of personal, occupational, and social risk factors. Scand. J. Work Environ. Health. 2014; 40(1): 36–46. https://doi.org/10.5271/sjweh.3381

4. Shettar D., Sherkhane M.S. Assessment of risk factors for the development of musculoskeletal disorders among working women. Int. J. Community Med. Public Health. 2017; 4(3): 718–23. https://doi.org/10.18203/2394-6040.ijcmph20170746

5. Ozvurmaz S., Mandiracioglu A. Prevelans of upper extremity musculoskeletal complaints and its relationship with risk factors for bank employees working with computer. Ulutas Med. J. 2017; 3(2): 39–47. https://doi.org/10.5455/umj.20160922084115

6. Vinothini P., Halim I., Umar R., Too Y. A future framework for musculoskeletal disorders symptoms among computer office workers. Int. J. Physiother. 2018; 5(6): 167–77. https://doi.org/10.15621/ijphy/2018/v5i6/178053

7. Sulaiman S.K., Kamalanathan P., Ibrahim A.A., Nuhu J.M. Musculoskeletal disorders and associated disabilities among bank workers. Int. J. Res. Med. Sci. 2015; 3(5): 1153–8. https://doi.org/10.5455/2320-6012.ijrms20150523

8. Mekonnen T.H., Kekeba G.G., Azanaw J., Kabito G.G. Prevalence and healthcare seeking practice of work-related musculoskeletal disorders among informal sectors of hairdressers in Ethiopia, 2019: findings from a cross-sectional study. BMC Public Health. 2020; 20(1): 718. https://doi.org/10.1186/s12889-020-08888-y

9. Smith A.C., Wolf J.G., Xie G.Y., Smith M.D. Musculoskeletal pain in cardiac ultrasonographers: results of a random survey. J. Am. Soc. Echocardiogr. 1997; 10(4): 357–62. https://doi.org/10.1016/s0894-7317(97)70073-7

10. van Det M.J., Meijerink W.J., Hoff C., Totté E.R., Pierie J.P. Optimal ergonomics for laparoscopic surgery in minimally invasive surgery suites: a review and guidelines. Surg. Endosc. 2009; 23(6): 1279–85. https://doi.org/10.1007/s00464-008-0148-x

11. Knuttinen M.G., Zurcher K.S., Wallace A., Doe C., Naidu S.G., Money S.R., et al. Ergonomics in IR. J. Vasc. Interv. Radiol. 2021; 32(2): 235–41. https://doi.org/10.1016/j.jvir.2020.11.001

12. Morrison J.J., Jiao A., Robinson S., Jahangiri Y., Kaufman J.A. Prevalence of Musculoskeletal Symptoms in Interventional Radiologists. J. Vasc. Interv. Radiol. 2020; 31(8): 1308–14. https://doi.org/10.1016/j.jvir.2020.02.015

13. Orme N.M., Rihal C.S., Gulati R., Holmes D.R. Jr., Lennon R.J., Lewis B.R., et al. Occupational health hazards of working in the interventional laboratory: a multisite case control study of physicians and allied staff. J. Am. Coll. Cardiol. 2015; 65(8): 820–6. https://doi.org/10.1016/j.jacc.2014.11.056

14. Buschbacher R. Overuse syndromes among endoscopists. Endoscopy. 1994; 26(6): 539–44. https://doi.org/10.1055/s-2007-1009030

15. Liberman A.S., Shrier I., Gordon P.H. Injuries sustained by colorectal surgeons performing colonoscopy. Surg. Endosc. 2005; 19(12): 1606–9. https://doi.org/10.1007/s00464-005-0219-1

16. Ridtitid W., Coté G.A., Leung W., Buschbacher R., Lynch S., Fogel E.L., et al. Prevalence and risk factors for musculoskeletal injuries related to endoscopy. Gastrointest. Endosc. 2015; 81(2): 294–302.e4. https://doi.org/10.1016/j.gie.2014.06.036

17. Morais R., Vilas-Boas F., Pereira P., Lopes P., Simões C., Dantas E., et al. Prevalence, risk factors and global impact of musculoskeletal injuries among endoscopists: a nationwide European study. Endosc. Int. Open. 2020; 8(4): E470–80. https://doi.org/10.1055/a-1038-4343

18. Shergill A.K., Asundi K.R., Barr A., Shah J.N., Ryan J.C., McQuaid K.R., et al. Pinch force and forearm-muscle load during routine colonoscopy: a pilot study. Gastrointest. Endosc. 2009; 69(1): 142–6. https://doi.org/10.1016/j.gie.2008.09.030

19. Wareluk P., Jakubowski W. Evaluation of musculoskeletal symptoms among physicians performing ultrasound. J. Ultrason. 2017; 17(70): 154–9. https://doi.org/10.15557/JoU.2017.0023

20. Feng Q., Liu S., Yang L., Xie M., Zhang Q. The prevalence of and risk factors associated with musculoskeletal disorders among sonographers in Central China: A cross-sectional study. PLoS One. 2016; 11(10): e0163903. https://doi.org/10.1371/journal.pone.0163903

21. Baker J.P., Coffin C.T. The importance of an ergonomic workstation to practicing sonographers. J. Ultrasound. Med. 2013; 32(8): 1363–75. https://doi.org/10.7863/ultra.32.8.1363

22. Scholl C., Salisbury H. Barriers to performing ergonomic scanning techniques for sonographers. J. Diagn. Med. Sonogr. 2017; 33(5): 406–11. https://doi.org/10.1177/8756479317726768

23. Crawford J.O. The Nordic musculoskeletal questionnaire. Occup. Med. 2007; 57(4): 300–1. https://doi.org/10.1093/occmed/kqm036

24. Bergqvist U., Wolgast E., Nilsson B., Voss M. The influence of VDT work on musculoskeletal disorders. Ergonomics. 1995; 38(4): 754–62. https://doi.org/10.1080/00140139508925147

25. Porter J.M., Gyi D.E. The prevalence of musculoskeletal troubles among car drivers. Occup. Med. (Lond.). 2002; 52(1): 4–12. https://doi.org/10.1093/occmed/52.1.4

26. Macdonald F., Waclawski E. Upper limb disorders among coopers in the Scotch whisky industry. Occup. Med. (Lond.). 2006; 56(4): 232–6. https://doi.org/10.1093/occmed/kql002

27. Hagen K.B., Magnus P., Vetlesen K. Neck/shoulder and low-back disorders in the forestry industry: relationship to work tasks and perceived psychosocial job stress. Ergonomics. 1998; 41(10): 1510–8. https://doi.org/10.1080/001401398186243

28. Abd Rahman M.N., Abdul Rani M.R., Rohani J.M. WERA: an observational tool develop to investigate the physical risk factor associated with WMSDs. J. Hum. Ergol. (Tokyo). 2011; 40(1-2): 19–36.

29. Epstein S., Sparer E.H., Tran B.N., Ruan Q.Z., Dennerlein J.T., Singhal D., et al. Prevalence of work-related musculoskeletal disorders among surgeons and interventionalists: a systematic review and meta-analysis. JAMA Surg. 2018; 153(2): e174947. https://doi.org/10.1001/jamasurg.2017.4947

30. Rempel D.M., Harrison R.J., Barnhart S. Work-related cumulative trauma disorders of the upper extremity. JAMA. 1992; 267(6): 838–42.

31. Pedrosa M.C., Farraye F.A., Shergill A.K., Banerjee S., Desilets D., Diehl D.L., et al. Minimizing occupational hazards in endoscopy: personal protective equipment, radiation safety, and ergonomics. Gastrointest. Endosc. 2010; 72(2): 227–35. https://doi.org/10.1016/j.gie.2010.01.071

32. Villa E., Attar B., Trick W., Kotwal V. Endoscopy-related musculoskeletal injuries in gastroenterology fellows. Endosc. Int. Open. 2019; 7(6): E808–12. https://doi.org/10.1055/a-0811-5985

33. Kuwabara T., Urabe Y., Hiyama T., Tanaka S., Shimomura T., Oko S., et al. Prevalence and impact of musculoskeletal pain in Japanese gastrointestinal endoscopists: a controlled study. World J. Gastroenterol. 2011; 17(11): 1488–93. https://doi.org/10.3748/wjg.v17.i11.1488

34. Austin K., Schoenberger H., Sesto M., Gaumnitz E., Teo Broman A., Saha S. Musculoskeletal injuries are commonly reported among gastroenterology trainees: results of a national survey. Dig. Dis. Sci. 2019; 64(6): 1439–47. https://doi.org/10.1007/s10620-019-5463-7

35. Byun Y.H., Lee J.H., Park M.K., Song J.H., Min B.H., Chang D.K., et al. Procedure-related musculoskeletal symptoms in gastrointestinal endoscopists in Korea. World J. Gastroenterol. 2008; 14(27): 4359–64. https://doi.org/10.3748/wjg.14.4359

36. Hansel S.L., Crowell M.D., Pardi D.S., Bouras E.P., DiBaise J.K. Prevalence and impact of musculoskeletal injury among endoscopists: a controlled pilot study. J. Clin. Gastroenterol. 2009; 43(5): 399–404. https://doi.org/10.1097/MCG.0b013e31817b0124

37. Campbell E.V. 3rd., Muniraj T., Aslanian H.R., Laine L., Jamidar P. Musculoskeletal pain symptoms and injuries among endoscopists who perform ERCP. Dig. Dis. Sci. 2021; 66(1): 56–62. https://doi.org/10.1007/s10620-020-06163-z

38. Coffin C.T. Work-related musculoskeletal disorders in sonographers: a review of causes and types of injury and best practices for reducing injury risk. Rep. Medical Imaging. 2014; 7: 15–26. https://doi.org/10.2147/RMI.S34724

39. Evans K., Roll S., Baker J. Work-related musculoskeletal disorders (WRMSD) among registered diagnostic medical sonographers and vascular technologists: a representative sample. J. Diagn. Med. Sonogr. 2009; 25(6): 287–99. https://doi.org/10.1177/8756479309351748

40. AlMubarek N.A., Al-Otaibi S.T., Herzallah H.K. Musculoskeletal disorders among sonographers in secondary care hospitals in the city of Al-Ahsa, Saudi Arabia. Work. 2022; 71(4): 1105–11. https://doi.org/10.3233/WOR-205145

41. Pike I., Russo A., Berkowitz J., Baker J.P., Lessoway V.A. The prevalence of musculoskeleta disorders among diagnostic medical sonograhers. J. Diagn. Med. Sonogr. 1997; 13(5): 219–27. https://doi.org/10.1177/875647939701300501

42. Village J., Trask C. Ergonomic analysis of postural and muscular loads to diagnostic sonographers. Int. J. Ind. Ergon. 2007; 37(9-10): 781–9. https://doi.org/10.1016/j.ergon.2007.06.005

43. Parikh J.R., Bender C., Bluth E. Musculoskeletal injuries affecting radiologists according to the 2017 ACR human resources commission workforce survey. J. Am. Coll. Radiol. 2018; 15(5): 803–8. https://doi.org/10.1016/j.jacr.2018.01.033

44. Seidel R.L., Krupinski E.A. The agony of it all: musculoskeletal discomfort in the reading room. J. Am. Coll. Radiol. 2017; 14(12): 1620–5. https://doi.org/10.1016/j.jacr.2017.07.024

45. Jensen C., Finsen L., Søgaard K., Christensen H. Musculoskeletal symptoms and duration of computer and mouse use. Int. J. Ind. Ergon. 2002; 30(4–5): 265–75. https://doi.org/10.1016/S0169-8141(02)00130-0

46. Krupinski E.A., Berbaum K.S. Measurement of visual strain in radiologists. Acad. Radiol. 2009; 16(8): 947–50. https://doi.org/10.1016/j.acra.2009.02.008

47. Krupinski E.A., Berbaum K.S., Caldwell R.T., Schartz K.M., Kim J. Long radiology workdays reduce detection and accommodation accuracy. J. Am. Coll. Radiol. 2010; 7(9): 698–704. https://doi.org/10.1016/j.jacr.2010.03.004

48. Krupinski E.A., Berbaum K.S., Caldwell R.T., Schartz K.M., Madsen M.T., Kramer D.J. Do long radiology workdays affect nodule detection in dynamic CT interpretation? J. Am. Coll. Radiol. 2012; 9(3): 191–8. https://doi.org/10.1016/j.jacr.2011.11.013