Giagio S1, Squizzato F2
1University of Padova, Padova, Italy, 2University of Padova, Vascular and Endovascular Surgery Division, Padova, Italy
Background: Surgeons are exposed to an excessive physical and cognitive work load associated with a high risk for Work-Related Musculoskeletal Disorders (WRMSD).
Social, professional and personal life negative impact and career longevity shortening may occur as consequences.
In this scenario, ergonomic guidelines in the operating room (OR) have already been described, but their importance may be underestimated. Also, other preventive programs have been reported with good results, but only in the short term, and they required surgery interruption and adjunctive economic resources for specific equipment.
Purpose: To evaluate the efficacy of a global program to reduce WRMSDs prevalence and their complications among surgeons.
Methods: This is a multicenter randomized clinical trial (UMIN000028557) conducted from January to August 2015. Participants included were surgery consultants and residents of both gender from three Italian medical centers. Range of age was 25-70 years. In order to include only patients who suffered from disorders related to the job activity, patients with diagnosis of other medical conditions were excluded.
A blind cluster randomization was performed considering the surgical division and included surgeons were allocated to two groups. NPP group (No Preventive Program) regularly continued the daily working activity. PP group (Preventive Program) followed integrated ergonomic guidelines in the OR and a protocol of exercises planned and supervised by a Physical Therapist with experience in musculoskeletal disorders. The self-treatment specifically addressed the most affected areas, before and after the procedures, with no-resistance active exercises and static stretching.
The program was approved by the chief of Service of each division and a written informed consent was obtained for all participants.
WRMSDs assessment was based on an ad hoc questionnaire and 3 validated questionnaires: Nordic Musculoskeletal Questionnaire (NMQ), Numerical Rating Scale (NRS), and Short Form 36 Health Survey (SF-36). Follow-up was planned after 3 and 6 months.
The primary endpoints were to identify any difference, between the groups, in prevalence and severity of WRMSDs during 6 months.
The secondary endpoints were to identify any difference regarding quality of life, analgesic drugs assumption during the follow-up; a multiple logistic regression was performed to find baseline WRMSDs risk factors.
Results: 141 surgeons matched the inclusion criteria and were randomized in PP (n=65) and NPP (n=76) group. At the initial analysis, physical activity was the only modifiable independent risk factor for WRMSDs (OR, 2.44; P=.05). PP group showed a significant improvement in the item “General Health” (GH) regarding the quality of life at 3 (NPP: 70.5±15.2 vs PP: 75.9±14.1; P=0.04) and 6 months (70.6±13.4 vs 75.3±13.0; P=0.04). PP group had a significant reduction of low back pain (66.2% vs 50.0%; P=0.04) and analgesic drugs consumption (30.9% vs 15.5%; P=0.03) after 6 months.
Conclusion(s): This study demonstrated the effectiveness of a global program.
The association of simple specific self-treatment exercises and ergonomic education, in collaboration with a Physical Therapist, significantly improved quality of life after 3 months, and decreased low back pain and overall analgesic assumption after 6 months.
Implications: Considering the outcomes of this trial, it would be useful to promote ergonomic and physical education in surgeons.
Keywords: Work-related Musculoskeletal Disorders, Prevention, Physical Therapist
Funding acknowledgements: None
Social, professional and personal life negative impact and career longevity shortening may occur as consequences.
In this scenario, ergonomic guidelines in the operating room (OR) have already been described, but their importance may be underestimated. Also, other preventive programs have been reported with good results, but only in the short term, and they required surgery interruption and adjunctive economic resources for specific equipment.
Purpose: To evaluate the efficacy of a global program to reduce WRMSDs prevalence and their complications among surgeons.
Methods: This is a multicenter randomized clinical trial (UMIN000028557) conducted from January to August 2015. Participants included were surgery consultants and residents of both gender from three Italian medical centers. Range of age was 25-70 years. In order to include only patients who suffered from disorders related to the job activity, patients with diagnosis of other medical conditions were excluded.
A blind cluster randomization was performed considering the surgical division and included surgeons were allocated to two groups. NPP group (No Preventive Program) regularly continued the daily working activity. PP group (Preventive Program) followed integrated ergonomic guidelines in the OR and a protocol of exercises planned and supervised by a Physical Therapist with experience in musculoskeletal disorders. The self-treatment specifically addressed the most affected areas, before and after the procedures, with no-resistance active exercises and static stretching.
The program was approved by the chief of Service of each division and a written informed consent was obtained for all participants.
WRMSDs assessment was based on an ad hoc questionnaire and 3 validated questionnaires: Nordic Musculoskeletal Questionnaire (NMQ), Numerical Rating Scale (NRS), and Short Form 36 Health Survey (SF-36). Follow-up was planned after 3 and 6 months.
The primary endpoints were to identify any difference, between the groups, in prevalence and severity of WRMSDs during 6 months.
The secondary endpoints were to identify any difference regarding quality of life, analgesic drugs assumption during the follow-up; a multiple logistic regression was performed to find baseline WRMSDs risk factors.
Results: 141 surgeons matched the inclusion criteria and were randomized in PP (n=65) and NPP (n=76) group. At the initial analysis, physical activity was the only modifiable independent risk factor for WRMSDs (OR, 2.44; P=.05). PP group showed a significant improvement in the item “General Health” (GH) regarding the quality of life at 3 (NPP: 70.5±15.2 vs PP: 75.9±14.1; P=0.04) and 6 months (70.6±13.4 vs 75.3±13.0; P=0.04). PP group had a significant reduction of low back pain (66.2% vs 50.0%; P=0.04) and analgesic drugs consumption (30.9% vs 15.5%; P=0.03) after 6 months.
Conclusion(s): This study demonstrated the effectiveness of a global program.
The association of simple specific self-treatment exercises and ergonomic education, in collaboration with a Physical Therapist, significantly improved quality of life after 3 months, and decreased low back pain and overall analgesic assumption after 6 months.
Implications: Considering the outcomes of this trial, it would be useful to promote ergonomic and physical education in surgeons.
Keywords: Work-related Musculoskeletal Disorders, Prevention, Physical Therapist
Funding acknowledgements: None
Topic: Occupational health & ergonomics; Health promotion & wellbeing/healthy ageing
Ethics approval required: No
Institution: University of Padova
Ethics committee: University of Padova
Reason not required: The program was approved by the chief of Service of each division and a written informed consent was obtained for all participants. Ethic committee approval was waived for this study, since it included healthcare professional employees of the same Institution and not outpatients.
All authors, affiliations and abstracts have been published as submitted.
