|Year : 2021 | Volume
| Issue : 1 | Page : 3-7
Work-related musculoskeletal disorders among male health-care professionals in a private health care organization, India: Prevalence and associated risk factors
CM Shankar1, R Venkatesan2
1 Department of Exercise Physiology and Biomechanics, Tamil Nadu Physical Education and Sports University, Chennai, Tamil Nadu, India
2 Department of Exercise Physiology and Sports Nutrition, Tamil Nadu Physical Education and Sports University, Chennai, Tamil Nadu, India
|Date of Submission||24-Nov-2020|
|Date of Decision||01-May-2021|
|Date of Acceptance||27-May-2021|
|Date of Web Publication||31-Jul-2021|
Dr. C M Shankar
Department of Exercise Physiology and Biomechanics, Tamil Nadu Physical Education and Sports University, Chennai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Context: The prevalence of work-related musculoskeletal disorders (WMSDs) is significant in many professions including health care. WMSDs among health-care professionals in developing countries like India are overlooked.
Aims: This study aimed to assess the prevalence and risk factors of WMSD among health-care professionals.
Settings and Design: A descriptive survey study design done at a private health-care organization.
Materials and Methods: It was a descriptive survey study design involving 310 male health-care professionals working in a private health-care organization. Self-reported questionnaires included (i) Demographic information, (ii) Extended nordic musculoskeletal questionnaire, and (iii) Physical workload questionnaire.
Statistical Analysis Used: The values were expressed in mean, frequencies, and percentages.
Results: Of the 310 forms, 296 valid responses were considered for the analysis. The prevalence of WMSD was 46.28% with surgeons being most affected. The most frequent WMSD reported was low back pain (69.34%). Most frequently reported risk factor (52.55%) was “working in uncomfortable postures.”
Conclusion: A high prevalence rate of WMSDs was found among the health-care professionals. Ergonomics including specific exercises and physical fitness programs for the employees are the important measures to be taken to prevent/control the WMSD.
Keywords: Health-care professionals, Prevalence, Risk factors, Work-related musculoskeletal disorders
|How to cite this article:|
Shankar C M, Venkatesan R. Work-related musculoskeletal disorders among male health-care professionals in a private health care organization, India: Prevalence and associated risk factors. Indian J Phys Ther Res 2021;3:3-7
|How to cite this URL:|
Shankar C M, Venkatesan R. Work-related musculoskeletal disorders among male health-care professionals in a private health care organization, India: Prevalence and associated risk factors. Indian J Phys Ther Res [serial online] 2021 [cited 2021 Nov 28];3:3-7. Available from: https://www.ijptr.org/text.asp?2021/3/1/3/322918
| Introduction|| |
Musculoskeletal disorders (MSDs) include a wide variety of degenerative and inflammatory conditions that affect muscles, tendons, bones, joints, ligaments, and peripheral nerves. MSDs are one of the most common work-related health problems. Work-related MSDs (WMSDs) affect the back, neck, upper, and lower extremities., They are caused by occupational hazards which may contribute to ergonomic risks. Most WMSD develop in due course. In general, there is no single cause of MSD; there may be combination of various risk factors which includes physical, bio-mechanical, organizational, psychosocial, and individual factors. Physical and bio-mechanical factors are repetitive motions, forceful exertions, vibration, working in inappropriate postures, poor working conditions, etc. Organizational and psychosocial risk factors may include working long hours without sufficient breaks, working on shifts, high work demands, low autonomy, and low job satisfaction. These risk factors when combined with physical risks may lead to stress, fatigue, anxiety or other reactions, which consecutively raise the risk of MSD. Apart from these risks, individual risk factors such as past medical history, physical ability, lifestyle, and personal habits may also contribute to MSD.
The prevalence of WMSDs is significant in many professions including health care.,,,, Health-care workers are at risk of developing MSD with nurses being the most susceptible. According to reported data all over the world, nurses have a very high prevalence of MSD.,,, However, it was also reported that surgeons being the most susceptible, followed by nurses and physiotherapists. Health professionals are at risk of developing various MSD; one of main common MSD among health-care staffs is low back pain.,, Health problems of the workers may range from slight pain to more severe medical conditions requiring rest or medical treatment. The consequences of serious illness even lead to disability and the need to relinquish the work. There may be specific or nonspecific MSD. Specific MSD has apparent underlying cause and clear pathology. They include lumbo-sacral radiculopathy, carpal tunnel syndrome, and patellar tendonitis. In case of nonspecific MSD, pain is present without evidence of a clear and specific cause.
WMSDs have had marked impact on health-care industry due to increasing health costs and reduced productivity and poor quality of life of workers.,,,,, WMSDs have become a main cause of sickness absenteeism. Almost one-third of sickness absenteeism among health-care workers are related to MSD. WMSDs among health-care professionals in developing countries like India are overlooked and in developed countries they are under reported. In order to have a comprehensive picture of MSD, this study aimed to assess the prevalence and associated risk factors of WMSD among health-care professionals in a private tertiary hospital located in Hyderabad, India.
| Materials and Methods|| |
It was a descriptive survey study design. Convenient sampling method was used to conduct the study after obtaining approval from the “Department Research Committee” of the “Tamil Nadu Physical Education and Sports University,” Chennai. Informed consent was taken from health-care professionals working in a private health-care organization. We included male health-care professionals such as physiotherapists, nurses, laboratory technicians, radiology technicians, pharmacists and physicians (who do not perform surgery), and surgeons (who perform surgery along with other work) working for at least 1 year in respective field and who were below the age of 45 years. The participants having congenital deformities, traumatic conditions, and neurological conditions were excluded from the study.
The data were collected by face to face interview for 310 eligible participants who accepted to participate in the study. Questionnaire was administered in English that consisted of mainly three parts. Part-1 consisted of demographic information including body height, weight, and occupational history. Part-2 was the Extended Nordic Musculoskeletal Questionnaire (NMQ-E). It is composed of general questions about the complaint of having trouble in different regions of the body: neck, shoulders, upper/lower back, elbows, wrist/hand, hips, knees, and ankle/foot. The main advantage of NMQ-E over the original NMQ is that it generates an adequate data about pain and related problems in a single-page design. Part-3 consisted of Physical workload questionnaire. It was derived from the original Dutch musculoskeletal questionnaire (DMQ) constructed by Hildebrandt et al. The original DMQ consists of nine pages and approximately 25 questions per page, with a completion time of about 30 min. In view of saving time and easy administration, a precise and simple “Physical workload questionnaire” was developed by Bot et al. with fewer number of items and a less administration time, about 10 min. It identifies job risk factors based on working conditions and tasks that may contribute to the development of WMSD.
Descriptive statistics were used to analyze the data and the values were expressed in mean, frequencies and percentages. Graphpad Prism 8.4.3 (Graph Pad Software, San Diego, CA) was used to perform all analyses.
| Results|| |
Of the 310 forms, 14 were considered invalid because of few unanswered questions as the participants did not want to reveal the information. Hence, the valid responses were 296.
The respondents were between 24 and 44 years with a mean age of 34.55 years. Mean height was 1.68 m, mean weight was 69.27 Kg, and mean body mass index (BMI) was 24.24. Of the 296 valid responses, majority were pharmacists (19.6%) followed by physiotherapists (16.2%) [Table 1].
The prevalence of WMSD was 46.28% (137 out of 296). The most frequent WMSD reported was low back pain (69.34%) followed by neck pain (30.65). The least reported was pain in elbows [Table 2].
|Table 2: Prevalence of work-related musculoskeletal disorders stratified by region of pain (n=137)|
Click here to view
The prevalence was found to be high in surgeons (60%) followed by laboratory technicians (52.63%) and nurses (52.5%). Low prevalence was reported in physicians (27.27%) [Table 3].
|Table 3: Prevalence of work-related musculoskeletal disorders stratified by occupation|
Click here to view
WMSD were found to be associated with personal and job risk factors. Of the 137 respondents who reported WMSD, 60 (43.79%) respondents were >40 years of age and only 20 (14.59%) respondents were <30 years of age. WMSD were more prevalent (64.23%) in over-weight/obese respondents than those with normal BMI. Work experience was also found to be a major risk factor of WMSD. Of the 137 respondents who reported WMSD, 85 (62%) respondents had work experience >10 years and the respondents with work experience <5 years were only 21 (15.32%). Working in uncomfortable postures was reported by 52.55% of affected respondents. [Figure 1] shows the various job risk factors reported by the affected respondents.
|Figure 1: Self-reported job risk factors among respondents with work related musculoskeletal disorder (n = 137); The figure shows that “working in uncomfortable postures” is the most reported job risk factor (52.55%) followed by “standing for long periods of time” (38.68%). “Exerting maximum force” is the least reported job risk factor (14.59%)|
Click here to view
| Discussion|| |
The prevalence of WMSDs largely depends on nature of the work along with the working environment, organizational policies, cultural variations and evaluation tools used to collect data. WMSDs were found to be prevalent in all types of health care professionals assessed, irrespective of whether the doctors or supporting staff like nurses and technicians in our study. However, the prevalence was comparatively lesser than in other studies conducted in past. This may be because of the age criteria of our study. We included health care professionals who were below the age of 45 years because, degenerative joint diseases generally starts at 45 years., As the key objective of our survey was to explore the WMSDs which are developed only due to the risks and hazards in the working environment, the age group 45 years and above was excluded.
The overall prevalence of WMSDs was 46.28% which is lower than the prevalence reported in a study conducted by Emmanuel et al. that reported 68.7%. The reason may be that they included participants up to the age of 56 years. Previous research found that older age was significantly associated with MSD., We also found that the prevalence was higher in participants who were >40-year-old. These findings contradict with the results of a study conducted by Yasobant and Rajkumar. Another study which included both genders also reported higher prevalence of WMSD (65.4%). This higher prevalence was because of women who significantly complained more often of MSD than men. In contrast, prevalence was higher in males than in females in the above mentioned study. Though the overweight/obese respondents constitute only 40.53% (120 out of 296) of the total respondents, it was observed that they presented with higher prevalence of WMSD than that of respondents with normal BMI. It supports the study findings of Raithatha and Mishra.
Most reported WMSD in our study was low back pain. Of the total affected respondents, 69.34% reported to have pain in low back region. This is in agreement with results of the previous studies.,, Although there were methodological variations in the evaluation used in the studies and disproportion of the age and gender of the study participants, lower back was the highest reported region of pain. The most reported other complaint in our study was neck pain (30.65%) followed by knee pain (27.73%). This supports the study results of Jellad et al. In contrast, Choobineh et al. found a highest prevalence of knee complaint than any other MSD. However, few other studies reported a lowest prevalence of knee complaints., These differences again may be due to different characteristics of the study subjects.
Although various studies found that WMSDs were the highest in nurses than any other health care professionals,, we found that surgeons were the most affected category among all. The reason may be that the participants of our study were only male (including male nurses). On the other hand, the highest prevalence was reported in nurses in the studies which included both the genders. However, a recent systematic review and meta-analysis also found high prevalence of WMSD among surgeons along with interventionalists. Physicians were the least affected health-care professionals among all the others in the present study. A previous study also reported similar results. The rationale behind these findings may be that physicians typically do not have to work in uncomfortable postures. Moreover, they do not involve in tiring work.
It was found that the work experience was also a major risk factor of WMSD. A large proportion of respondents (62%) who reported WMSD had work experience >10 years. These results corroborate with the study findings of Tinubu et al. but contradict with the findings of Yasobant and Rajkumar. It was reported previously that repetitive movements, working in awkward positions and high forces are the main risk factors related to WMSD. However, several intrinsic and extrinsic factors are said to be involved in the aetiology of WMSD.,,, As per the finding of our study, working in uncomfortable postures, standing for long period of time, working in the same position for the long period of time were the most frequently reported risk factors for developing WMSD. Most of the surgeons, physiotherapists, and nurses in our study reported to be engaged in uncomfortable postures and standing for long period of time.
| Conclusion|| |
In conclusion, we found that the WMSDs were more prevalent among the health-care professionals with surgeons being the most affected category among all. The most frequently reported WMSD was low back pain. Among various professional risk factors, working in uncomfortable postures, standing for long period of time, working in the same position for long period of time were the frequently reported factor for developing WMSD.
It is recommended that training and education are to be provided to the workers to prevent the work related health problems and to recognize and report any signs and symptoms they may experience. Hazards prevention and control is an important strategy to be considered by the employers. Health promotion activities including ergonomics, specific exercises, and fitness programs for the employees are the important measures to be taken to prevent/control the WMSD.
Limitation of the study
The study was conducted at one private hospital that may affect generalizability of the results. The questionnaires used in the study are self-reported and thus there may be a chance of subjective bias.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Punnett L, Wegman DH. Work-related musculoskeletal disorders: The epidemiologic evidence and the debate. J Electromyogr Kinesiol 2004;14:13-23.
Bernard BP. Musculoskeletal disorders and workplace factors: A critical review of epidemiologic evidence for work-related disorders of the neck, upper extremities and low back. Natl Institute Occup Safety Health 1997:97-141.
Yip Y. A study of work stress, patient handling activities and the risk of low back pain among nurses in Hong Kong. J Adv Nurs 2001;36:794-804.
European Agency for Safety and Health at Work Fact Sheet. Available from: http://www.osha.europa.eu
. [Last assessed on 2020 Sep 30].
de Carvalho MV, Soriano EP, de França Caldas A Jr., Campello RI, de Miranda HF, Cavalcanti FI. Work-related musculoskeletal disorders among Brazilian dental students. J Dent Educ 2009;73:624-30.
Burton AK, Symonds TL, Zinzen E, Tillotson KM, Caboor D, Van Roy P, et al.
Is ergonomic intervention alone sufficient to limit musculoskeletal problems in nurses? Occup Med (Lond) 1997;47:25-32.
Choobineh A, Movahed M, Tabatabaie SH, Kumashiro M. Perceived demands and musculoskeletal disorders in operating room nurses of Shiraz city hospitals. Ind Health 2010;48:74-84.
Kromark K, Dulon M, Beck BB, Nienhaus A. Back disorders and lumbar load in nursing staff in geriatric care: A comparison of home-based care and nursing homes. J Occup Med Toxicol 2009;4:33.
Maumet S, De Gaudemaris R, Caroly S, Balducci F. Risk factors related to musculo skeletal disorders in health care workers. Elements to take into consideration of risk assessment procedures. Arch Mal Prof Environ 2005;66:236-43.
Ribeiro T, Serranheira F, Loureiro H. Work related musculoskeletal disorders in primary health care nurses. Appl Nurs Res 2017;33:72-7.
Bitsios A, Giofsidou A, Malliou P, Beneka A. “Musculoskeletal disorders and their burden on nursing staf,” Nosilefiki 2014;53:185-92.
Yan P, Li F, Zhang L, Yang Y, Huang A, Wang Y, et al.
Prevalence of work-related musculoskeletal disorders in the nurses working in hospitals of xinjiang uygur autonomous region. Pain Res Manag Jul 13; 2017.
Attar SM. Frequency and risk factors of musculoskeletal pain in nurses at a tertiary centre in Jeddah, Saudi Arabia: A cross sectional study. BMC Res Notes 2014;7:61.
Mbada CE, Obembe AO, Alade BS, Adedoyin RA, Johnson OE, Soremi OO. Work-related musculoskeletal disorders among health workers in a Nigerian teaching hospital. TAF Preventive Med Bull 2012;11:583-8.
Bork BE, Cook TM, Rosecrance JC, Engelhardt KA, Thomason ME, Wauford IJ, et al.
Work-related musculoskeletal disorders among physical therapists. Phys Ther 1996;76:827-35.
Cromie JE, Robertson VJ, Best MO. Work-related musculoskeletal disorders in physical therapists: Prevalence, severity, risks, and responses. Phys Ther 2000;80:336-51.
Engels JA, van der Gulden JW, Senden TF, van't Hof B. Work related risk factors for musculoskeletal complaints in the nursing profession: Results of a questionnaire survey. Occup Environ Med 1996;53:636-41.
Sluiter JK, Rest KM, Frings-Dresen MH. European criteria document for evaluation of the work-relatedness of upper extremity musculoskeletal disorders. Proc Hum Factors Ergon Soc Annu Meet 2000;44:5-445-8.
McDermott H, Haslam C, Clemes S, Williams C, Haslam R. Investigation of manual handling training practices in organisations and beliefs regarding effectiveness. Int J Ind Ergon 2012;42:206-11.
Garbin AJ, Soares GB, Arcieri RM, Garbin CA, Siqueira CE. Musculoskeletal disorders and perception of working conditions: A survey of Brazilian dentists in Sao Paulo. Int J Occup Environ Health 2017;30:367-77.
Tinubu BM, Mabada CE, Oyeymi AL, Fabunmi AA. Workrelated musculoskeletal disorders among nurses in Ibadan, SouthWest Nigeria: A cross-sectional survey. BMC Musculoskelet Disord 2010;11:12-20.
Ellapen TJ, Narsigan S, van Herdeen HJ, Pillay K, Rugbeer N. Impact of poor dental ergonomical practice. SADJ 2011;66:272, 274-7.
Alexopoulos EC, Stathi IC, Charizani F. Prevalence of musculoskeletal disorders in dentists. BMC Musculoskelet Disord 2004;5:16.
Salik Y, Ozcan A. Workrelated musculoskeletal disorders: A survey of physical therapists in IzmirTurkey. BMC Musculoskelet Disord 2004;5:27.
Dawson AP, Steele EJ, Hodges PW, Stewart S. Development and test-retest reliability of an extended version of the Nordic Musculoskeletal Questionnaire (NMQ-E): A screening instrument for musculoskeletal pain. J Pain 2009;10:517-26.
Hildebrandt VH, Bongers PM, van Dijk FJ, Kemper HC, Dul J. Dutch musculoskeletal questionnaire: Description and basic qualities. Ergonomics 2001;44:1038-55.
Bot SD, Terwee CB, van der Windt DA, Feleus A, Bierma-Zeinstra SM, Knol DL, et al.
Internal consistency and validity of a new physical workload questionnaire. Occup Environ Med 2004;61:980-6.
Badley EM, Wang PP. Arthritis and the aging population: Projections of arthritis prevalence in Canada 1991 to 2031. J Rheumatol 1998;25:138-44.
Palepu V, Kodigudla M, Goel VK. Biomechanics of disc degeneration. Adv Orthop Jan 1; 2012.
Emmanuel C, Obembe AO, Bamidele S. WorkRelated musculoskeletal disorders among health workers in a nigerian teaching hospital. TAF Prev Med Bull 2012;11:583-8.
Long MH, Johnston V, Bogossian F. Work-related upper quadrant musculoskeletal disorders in midwives, nurses and physicians: A systematic review of risk factors and functional consequences. Appl Ergon 2012;43:455-67.
Yasobant S, Rajkumar P. Work-related musculoskeletal disorders among health care professionals: A cross-sectional assessment of risk factors in a tertiary hospital, India. Indian J Occup Environ Med 2014;18:75-81.
] [Full text]
Jellad A, Lajili H, Boudokhane S, Migaou H, Maatallah S, Salah Frih ZB. Musculoskeletal disorders among Tunisian hospital staff: Prevalence and risk factors. The Egypt Rheumatol 2013;35:59-63.
Raithatha AS, Mishra DG. Musculoskeletal Disorders and Perceived Work Demands among Female Nurses at a Tertiary Care Hospital in India. International Journal of Chronic Diseases. 2016 Jul 14; 2016.
Daraiseh NM, Cronin SN, Davis LS, Shell RL, Karwowski W. Low back symptoms among hospital nurses, associations to individual factors and pain in multiple body regions. Int J Ind Ergon 2010;40:19-24.
Genevay S, Cedraschi C, Courvoisier DS, Perneger TV, Grandjean R, Griesser AC, et al.
Work related characteristics of back and neck pain among employees of a Swiss University Hospital. Joint Bone Spine 2011;78:392-7.
Epstein S, Sparer EH, Tran BN, Ruan QZ, Dennerlein JT, Singhal D, et al.
Prevalence of work-related musculoskeletal disorders among surgeons and interventionalists: A systematic review and meta-analysis. JAMA Surg 2018;153:e174947.
Silverstein BA, Fine LJ, Armstrong TJ. Occupational factors and carpal tunnel syndrome. Am J Ind Med 1987;11:343-58.
Alexopoulos EC, Burdorf A, Kalokerinou A. Risk factors for musculoskeletal disorders among nursing personnel in Greek hospitals. Int Arch Occup Environ Health 2003;76:289-94.
Smedley J, Egger P, Cooper C, Coggon D. Manual handling activities and risk of low back pain in nurses. Occup Environ Med 1995;52:160-3.
[Table 1], [Table 2], [Table 3]