Profile of Work Related Musculoskeletal Disorders among Hospital Workers - A Survey

Introduction

Work related musculoskeletal disorders (WRMSDs) are subgroups of the occupational health hazards, and is one of the worldwide problems leading to sickness absenteeism, working errors, also leading to the financial loss for the firm or company due to worker’s disability, increase in compensation claims and health care costs.^1,2 WRMSDs usually occur when the worker is not suitable for the job or the physical capacity does not match the job demands.² Ideally workers should be allotted jobs depending upon the physical movement characteristics, ergonomics and mechanical design of work tasks. Due to the mismatch between the worker and the task, there can be fatigue, discomfort, pain, local swelling, numbness or tingling in the nerves, tendons, muscles, and supporting structures of the musculoskeletal system leading to severely disturbing conditions known as ‘Work Related Musculoskeletal Disorders’ (WRMSDs).³

The risk factors leading to musculoskeletal disorders involve single activity performed continuously over a long period of time resulting for months or years of exposure to higher levels of physical and psychosocial stressors at work.⁴ The major risk factors for WRMSDs in the workplace include heavy manual handling, repetitive and forceful action, vibration, awkward static postures that arise from badly designed work stations, tools, equipment working methods, poor work organization.⁵

Musculoskeletal disorders (MSDs) occur when mechanical load is higher than the load bearing capacity of components of musculoskeletal system. It can be divided into acute injury resulting from strong and instant loading leading to sudden failure and into chronic injury resulting from long term overload causing chronic pain and multiple minor injuries at various stages of healing.⁵ MSD is one of the main occupational health issues in India and estimations have indicated that MSDs contribute to approximately 40 percent of total expenditure towards the treatment of work-related illnesses.⁶

Occupations demanding heavy lifting, static loading and tool usage are ubiquitous in hospitals and the health care profession is well-known for its increased risk of developing WMSDs.⁷ Even in developed countries, it seems as if WMSDs are under-reported among health care professionals. It is poorly reported in under developed nations like India.⁸ Previous studies from India have reported the prevalence of pain in various body parts of a specific group of people working in hospitals, such as physicians, nurses and physical therapists, but the present study was an attempt to profile the pain in the most commonly reported pain sites, such as neck, shoulder, elbow, back, knee and ankle joints among various workers of the hospital such as nurses, security workers, laundry workers, dietary workers, and blue collar workers. Insufficient data on overall incidence of WRMSDs and the lack of inclusivity of all the hospital staff in the previous studies underpins the importance of this study. Hence this study was envisioned as a pilot project to obtain preliminary data on WRMSDs among hospital workers. This study was planned as a case study involving a single hospital.

Materials and Methods

This cross-sectional study incorporated a complete enumeration sampling strategy. All the workers of the selected hospital willing to participate in the study were recruited. Participants were excluded if they had any congenital deformities, any present musculoskeletal illness such as intervertebral disc prolapse, any current or recent fractures. The study protocol was reviewed and approved by the institutional ethical committee prior to the commencement of the study (JSSMC/ IEC/02/663/16). One of the tools to assess the burden of WRMSDs is Standardized Nordic Musculoskeletal Questionnaire (NMQ).⁹ It is an instrument which is fairly robust with reported sensitivity between 66%-92% and specificity between 71%-88%.⁹ Hence this questionnaire was used for the data collection.

Permission to translate the questionnaire into Kannada was obtained from the authors of NMQ questionnaire. Following this, the standard cross cultural adaptation method by Beton et al. was adopted for the translation and the final Kannada version of the questionnaire was developed.¹⁰

The administrative department of the hospital was approached and list of the workers was procured. After screening for eligibility, 1240 participants were recruited for the study.

After obtaining the informed consent, participants were interviewed using Nordic musculoskeletal questionnaire (Kannada version).

Data analysis

Descriptive statistics were used to profile work related musculoskeletal disorders among hospital workers using SPSS version 21. The data were presented as mean and standard deviation.

Results

Table 2 shows the prevalence of work related pain among various workers. Pain in ankle, knee, hip, low back, wrist, right shoulder and neck were present among all the employees. However, back, knee and ankle were the most prevalent pain sites among the participants. The magnitude of pain in lower limb and back was greater than upper limb and neck. Nurses, dietary workers and blue-collar workers reported pain in most of the body areas.

Discussion

The total number of hospital workers included in the study was 1463, with 223 people being excluded due to sickness absenteeism, or job termination. As a result, this study included 1240 employees. This was a questionnaire based research that represented the WRMSDs of the hospital employees. Over a 12-month period, we found that nurses with a mean age of 27.92 years reported most pain in their ankles (44.5%), followed by low back (40.5%), and upper back (32.5%). The existing studies are in contrast with the findings of the present study. A study conducted in Maharashtra's rural hospitals found a high prevalence of LBP, shoulder, neck, and knee pain.¹¹ Another study from Japan also showed low back pain to be more prevalent among the workers at a rural Japanese hospital.¹² Another study also found low back pain (84%), ankles/feet (74%), and shoulders (74%) as the most prevalent MSDs among nurses.¹³ During the working hours, nurses spend majority of their time standing and shifting patients, and these results suggest manual patient handling, transferring, or moving as significant predictors of musculoskeletal disorders and low back pain among nurses. Low back pain has been identified as a major source of pain among nurses in previous studies, but the present study identified low back pain as second most prevalent next to ankle pain. This difference could be attributed to differences in the workplace or jobs.

Security guards reported pain most commonly in lower limbs, neck and back as their work demands standing and walking during most of their working hours. Among laundry workers, most common pain site was ankle, followed by knee, and right elbow. This could be due to the fact that maximum amount of their work involves lifting clothes, loading the machines and drying. Dietary department workers’ maximum hours are spent in arranging the plates and delivering the food to the patients and they reported pain in most of the sites considered for this study. Blue-collar workers reported pain in every pain site considered for this study. This could be due attributed to the real-life situation as they spend maximum number of hours walking to deliver samples, transferring patients, cleaning, and bending.

We could not find studies conducted among laundry, dietary, blue collar workers and security staff in hospitals. Working in the same position for long periods, lifting or transferring patients and treating an excessive number of patients in one day were the most perceived job risk factors precipitating WRMSDs among the workers in this study. Furthermore, many patient-related manual handling activities, hospital linen cleaning, taking food to patient bedside, standing for long hours need to be undertaken in less than ideal spaces, incorrect postures, over exceeding physical labour and in suboptimal time frames. Such situations often incur great biomechanical strain, which may eventually lead to the development of MSDs.¹⁴

Throughout this study, the term WRMSDs was used since most of the ailments occurred due to high load static exertions and static postures sustained for prolonged durations. The Nordic musculoskeletal questionnaire was used in this study as it had been applied among a wide range of hospital workers to evaluate musculoskeletal problems, including nurses, security guards, laundry men, dietary department, and blue collar workers.

The reliability of the Nordic musculoskeletal questionnaire as a screening tool was proved by earlier studies using a test-retest methodology.⁹ Other studies also indicated that Nordic musculoskeletal questionnaire tool is repeatable, sensitive and can be used for screening and surveillance purposes.

This study involved large sample size and the Nordic musculoskeletal questionnaire was translated to regional language Kannada. It involved homogenous population with similar policies, physical components and biopsychosocial factors. These are the strength of this study.

Limitation of this study was that the findings do not exclude the possible impact of psychosocial job stressors on the musculoskeletal symptoms. The work specific symptoms were not analyzed.

Conclusion

This study profiled the work related musculoskeletal disorders where hip, knee and ankle, followed by upper back and lower back were found to be the most affected areas among hospital workers. About 84.35% workers reported pain in hip, knee and ankle, followed by 76.53% workers reporting pain in upper back and lower back, 36.85% in neck and shoulder, 10.80% in wrist, 5.4% in elbow.

Source of support

Nil

Conflict of interest

There is no conflict of interest to declare for this research project. All authors have no financial or personal relationships that may have inappropriately influenced the writing or interpretation of the study's results.

Acknowledgment

The authors would like to express their sincere appreciation to all the participants who provided information for the survey. Their participation was crucial in completing the study, and the authors are grateful for the time and effort they took to complete the survey questionnaire.