Risk Factors for Work-Related Musculoskeletal Disorders among Physiotherapists: A Literature Review

Megha V Jain; Rajitha Alva

doi:10.4103/ijptr.ijptr_3_22

REVIEW ARTICLE

Year : 2022 | Volume : 4 | Issue : 2 | Page : 92-96

Risk Factors for Work-Related Musculoskeletal Disorders among Physiotherapists: A Literature Review

Megha V Jain, Rajitha Alva
Department of Physiotherapy, Ramaiah Medical College, Bengaluru, Karnataka, India

Date of Submission	19-Jan-2022
Date of Decision	21-Jun-2022
Date of Acceptance	21-Jul-2022
Date of Web Publication	19-Jan-2023

Correspondence Address:
Ms. Rajitha Alva
Department of Physiotherapy, Ramaiah Medical College, Bengaluru, Karnataka
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijptr.ijptr_3_22

Abstract

The prevalence of work-related musculoskeletal disorders (WRMDs) among physiotherapists (PTs) is as high as 91%. These WRMDs directly impact their health, leading to acute and recurring injuries and chronic disabilities. Although the prevalence is high, the risk factors are not clearly understood. The objective of the review was to understand these risk factors for WRMDs among PTs. A comprehensive literature search was performed on PubMed, Google Scholar, and Cochrane databases. A search strategy was devised and articles were screened based on inclusion and exclusion criteria. Data were then extracted from the eligible studies and summarized. A total number of studies included were ten, of which seven were cross-sectional studies, two were a combination of focus group discussion and interview, and one was a nonexperimental cohort study. The literature review highlights the following risk factors: transferring and lifting patients, performing manual therapy techniques, working in static postures, responding to unanticipated movement by patients, repetitive tasks, bending, twisting, continuing to work even while injured, treating an excessive number of patients in a single day, inappropriate work scheduling, and so on. However, future studies must focus on a comprehensive assessment of WRMD's risk factors and developing reliable and valid PT-specific tools among PTs.

Keywords: Physiotherapists, Risk factors, Work-related musculoskeletal disorders

How to cite this article:
Jain MV, Alva R. Risk Factors for Work-Related Musculoskeletal Disorders among Physiotherapists: A Literature Review. Indian J Phys Ther Res 2022;4:92-6

How to cite this URL:
Jain MV, Alva R. Risk Factors for Work-Related Musculoskeletal Disorders among Physiotherapists: A Literature Review. Indian J Phys Ther Res [serial online] 2022 [cited 2023 Jun 6];4:92-6. Available from: https://www.ijptr.org/text.asp?2022/4/2/92/368055

Introduction

The prevalence of work-related musculoskeletal disorders (WRMDs) among physiotherapists (PTs) is as high as 91%, and the recurrence rate is 88%, as reported in a prevalence study conducted by West and Gardner.^[1] The job role of a PT is physically demanding in nature and this contributes to the high incidence of WRMDs among PTs.^[2] The work of a PT involves direct contact with their patients and repetitive and strenuous activities in the clinical area.^[3],[4] The growing need for physical therapy services has further increased the workload, leading to added physical stress on PTs.

These WRMDs directly impact the PTs' health, causing acute and recurring injuries. The most commonly affected body parts are the low back, neck, shoulders, wrist, and ankle.^[5],[6],[7] Studies suggest that increased work restriction and work absenteeism has a direct impact on productivity.^[8],[9],[10] This leads to chronic disabilities resulting in reduced quality of life. Evidence suggests that one in six physical therapists have to change their area of specialty or leave the profession due to WRMDs.^[11]

Although the prevalence of WRMDs among PTs is high, there is scarce literature about the contributing risk factors. However, extensive literature investigates the risk factors and highlights the preventive strategies for WRMDs among other health-care workers, especially among the nursing profession. Although there are certain similarities in the clinical environment, patient types, and some amount of overlap in patient handling among nurses and PTs, there is a difference in the nature of clinical tasks.^[12] Thus, giving rise to the need to investigate the risk factors specific to PTs.^[13] Some studies have investigated the job tasks that could contribute as risk factors; however, the assessments are inadequate to provide conclusive results.

PTs are exposed to multiple risk factors throughout their careers, yet there is insufficient literature on the risk factors causing WRMDs among them. Therefore, this literature review aims to collect and present all the available evidence on the risk factors for WRMDs among PTs.

Subjects and Methods

A comprehensive literature search was performed from 1996 to 2020. The search engines used were PubMed, Google Scholar, and Cochrane. The keywords used were “WRMDs,” “PTs,” and “risk factors.” Boolean concepts such as “AND” and “OR” were used to search all databases. MeSH terms were used for PubMed database search.

Articles were screened based on the predefined inclusion criteria such as WRMDs in practicing PTs, WRMDs caused by ergonomic disadvantage at work, articles assessing and discussing the risk factors, and articles in the English language. The exclusion criteria included articles that only stated the prevalence of WRMDs, articles on WRMDs in other health-care workers, and non-English literatures.

Results

The process of article selection is summarized using the PRISMA flow diagram [Figure 1].

Figure 1: Selection of articles

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[Table 1] represents the study details (title of the study, author, year of publishing, number of participants, outcome measures used, and results). [Table 2] represents the cumulative percentage of risk factors from the selected studies in the review.

Table 1: Study details

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Discussion

This literature review aimed at understanding the risk factors for WRMDs among PTs. Ten articles that met the inclusion criteria were selected. Out of ten studies, seven were cross-sectional studies, two were combined focus group discussions and survey/interview, and one was a nonexperimental cohort study.

The total number of participants in the selected studies was 3932.

The various risk factors identified in the present review are transferring and lifting patients, performing manual therapy techniques, continuing to work even while injured, working in static postures, repetitive tasks, bending, twisting, and treating an excessive number of patients in a single day, responding to unanticipated movement by patients, and inappropriate work scheduling (overtime, not enough rest breaks, irregular shifts, and length of workday). One of the key findings of the review was a specialty and the clinical setup that the PTs worked in played a significant role in developing WRMDs.^[11] Each area has its inherent risks due to the different techniques and treatments practiced, which contributed to a huge risk in practicing PTs.^[21]

As mentioned in [Table 2], the percentage of risk reported for lifting or transferring dependent patients is 32.1% which is the highest, followed by manual therapy techniques which are 27.4%. Working in the same positions for long periods (e.g., standing, bent over, sitting, and kneeling) is 25.3%; performing the same task over and over is 22.8%; unanticipated sudden movement or fall by the patient is 20.4%; bending or twisting your back in an awkward way is 20.1%; carrying, lifting, or moving heavy materials or equipment (e.g., lifting Continous passive machine (CPM) machine) is 10.9%.

Table 2: Risk distribution of various MRMDs among Physiotherapists

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Among the self-reported activities that caused the most injury and discomfort among PTs were patient handling, patient lifting, transferring, and repositioning. The cohort study done by Campo M et al.^[19] stated transferring patients around 6–10 times/day had a 2.4 times higher risk of developing WRMDs than those therapists who did not perform any transfers. A study done in 1999 by Holder NL et al.^[8] provides biomechanical evidence that manual handling of even lightweight and compliant patients can exceed tissue tolerances in the lumbar spine. This study concluded that patient handling is an extremely complex job and it is associated with multiple risks.

In various studies conducted in the USA, Australia, and Kuwait, PTs have claimed that their symptoms exacerbated or they had recurring injuries when they continued to work, while still being injured.^[14] In addition, the study suggested that there was a lack of time to officially report their injuries as the employees were busy with their work activities. This is suggestive of PTs having a high workload. Hence, it is critical to understand the various factors that cause WRMDs and consider preventive and safety measures at the workplace to continue clinical practice safely.

All the selected studies administered self-reported questionnaires to obtain the results. None of the selected studies have performed an objective analysis to understand the risk factors imposed on the PTs in their workplace. An objective evaluation would provide an in detail biomechanical and physiological level of reasoning for the high prevalence of WRMDs among PTs. Workplace objective analysis is the need of the hour among PTs.

None of the selected cross-sectional studies used a validated tool to assess the risk factors among the PTs. They used self-constructed questionnaires developed by Bork in 1996^[20] which were slightly altered by the investigators according to their needs. It is a necessity to develop a reliable and valid screening tool to assess the risk factors. This screening tool or outcome measure must focus on PT-specific activities. It can be used for the early detection of risk factors.

Understanding the risk factors in detail will help to provide better solutions and effective preventive measures to reduce WRMDs. It will improve productivity and reduce work absenteeism and work restriction. In addition, preventive measures will also reduce the number of PTs quitting the profession due to WRMDs. Furthermore, improving their quality of life by preventing repeated injuries and lifelong disabilities. Thus, the focus must be on primary prevention rather than secondary prevention of WRMDs among PTs.

The articles included in this review are of low methodological quality. This highlights the need to investigate the risk factors for WRMDs among PTs in a more comprehensive manner. Researchers could conduct well-designed randomized controlled trials, emphasizing an objective analysis of the various risk factors at the workplace of PTs. Future research should be directed toward developing a valid and reliable screening tool for the early detection of risk factors among PTs.

Conclusion

This literature review helps in understanding the various risk factors of WRMDs among PTs. The review suggests that the highest risk underlies for lifting and transferring dependent patients and performing manual therapy techniques. However, this review highlights that there is sparse evidence available to understand these risk factors and more comprehensive research needs to be done on the same. There is also a requirement for objective evaluation to assess these risk factors. Furthermore, there is a necessity to devise a PT-specific screening tool or outcome measure to assess the risk factors at the workplace.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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