Abstract
Purpose
Previous studies have suggested that musculoskeletal symptoms are common among practicing otolaryngologists. Early training can be the ideal time to foster knowledge of ergonomics and develop safe work habits, however, little data exists regarding musculoskeletal symptoms in residents. The purpose of this study was to identify and characterize musculoskeletal symptoms in a preliminary sample of otolaryngology residents.
Materials and methods
A cross-sectional survey incorporating the Nordic Musculoskeletal Questionnaire was sent to 30 Otolaryngology-Head and Neck Surgery residencies to examine musculoskeletal symptoms among residents. A two-sample test of proportions was performed to compare symptoms between male and female residents.
Results
In total, 141 respondents (response rate = 34.7%) completed the survey. Fifty-five percent of survey respondents were male and 45% were female. Musculoskeletal symptoms were most frequently reported in the neck (82.3%), followed by the lower back (56%), upper back (40.4%), and shoulders (40.4%). The most common symptoms were stiffness in the neck (71.6%), pain in the neck (61.7%), and pain in the lower back (48.2%). In total, 6.4% of residents missed work and 16.3% of residents stopped during an operation at some point due to their symptoms. Most residents (88.3%) believed their musculoskeletal symptoms were attributed to their surgical training. Female residents were significantly more likely to experience neck (p < 0.0001) and wrist/hand (p = 0.019) discomfort compared to male residents.
Conclusions
Musculoskeletal symptoms were common among residents, approaching rates similar to those previously identified in practicing otolaryngologists. Increased emphasis on surgical ergonomics is warranted to improve workplace safety and prevent future injury.
1
Introduction
Work-related musculoskeletal disorders (WMSDs) are defined as “musculoskeletal disorders to which the work environment and the performance of work contribute significantly” . In the medical community, surgeons are at a particularly high risk for developing WMSDs because many of the procedures they perform may require ergonomically challenging positions for extended periods of time .
In 2003, Babar-Craig and colleagues sent a questionnaire to 558 otolaryngology consultants in the United Kingdom inquiring about neck and back pain . Among the 325 respondents, 72% reported neck pain, back pain, or both. Over half of these otolaryngologists attributed their symptoms directly to their job as surgeons. More recently, Rimmer and colleagues distributed a survey to members of the European Rhinologic Society and found that nearly 80% of endoscopic surgeons experienced physical pain or discomfort . Together, these findings provided early insight into WMSDs among practicing otolaryngologists and raised their existence as a potential concern in the otolaryngology community.
Early training is an ideal time to foster knowledge and awareness of proper workplace ergonomics that can positively influence a surgeon’s future career . Unfortunately, no study to date has investigated musculoskeletal symptoms in otolaryngology residents. The purpose of this pilot study was to identify and evaluate the characteristics of musculoskeletal symptoms in otolaryngology residents.
2
Methods
This study received exemption by the Boston Medical Center institutional review board. In August 2016, a Web-based survey incorporating the Nordic Musculoskeletal Questionnaire (NMQ) was sent to 30 Otolaryngology-Head and Neck Surgery residencies in the United States. The NMQ is a reliable and previously validated questionnaire designed to assess musculoskeletal symptoms in the occupational health setting. A total of three contact attempts were made – one initial email and two reminders.
2.1
Survey design
The first portion of the survey inquired about demographic information including age, gender, ethnicity, height, weight, handedness, postgraduate year, and estimated operating hours per week. The second or symptomatic portion of the questionnaire inquired about musculoskeletal symptoms in nine anatomic regions according to the NMQ : (1) neck, (2) shoulders, (3) elbows, (4) wrists/hands, (5) upper back, (6) lower back, (7) hips/thighs, (8) knees, and (9) ankles/feet. The first question for each body region asked if residents experienced any musculoskeletal discomfort in that region within the past year. Survey logic was incorporated so that the survey skipped to the next body region if a resident answered “no symptoms”. If the resident did report symptoms, however, he or she was then presented with an additional set of questions regarding: severity of symptoms (mild, moderate, or severe), impact of symptoms on activities of daily living, description of the symptoms (pain, stiffness, weakness, numbness, or other), whether or not symptoms occurred within the past week, whether or not symptoms ever caused the resident to stop operating, whether or not symptoms ever caused the resident to miss work, and whether or not the resident believed his or her symptoms were directly caused by his or her work training as a surgeon.
2.2
Statistical analysis
A two-sample test of proportions (p < 0.05) was performed to determine if there was a difference in the proportion of male and female residents who experienced musculoskeletal symptoms. Male and female residents were further stratified into three height classes : (1) within one standard deviation of the average American adult height, (2) at least one standard deviation below the average height, and (3) at least one standard deviation above the average height. Freeman-Halton extension of Fischer’s exact test was utilized to determine if there was a significant difference (p < 0.05) in categorical symptomatic data between residents based on height.
2
Methods
This study received exemption by the Boston Medical Center institutional review board. In August 2016, a Web-based survey incorporating the Nordic Musculoskeletal Questionnaire (NMQ) was sent to 30 Otolaryngology-Head and Neck Surgery residencies in the United States. The NMQ is a reliable and previously validated questionnaire designed to assess musculoskeletal symptoms in the occupational health setting. A total of three contact attempts were made – one initial email and two reminders.
2.1
Survey design
The first portion of the survey inquired about demographic information including age, gender, ethnicity, height, weight, handedness, postgraduate year, and estimated operating hours per week. The second or symptomatic portion of the questionnaire inquired about musculoskeletal symptoms in nine anatomic regions according to the NMQ : (1) neck, (2) shoulders, (3) elbows, (4) wrists/hands, (5) upper back, (6) lower back, (7) hips/thighs, (8) knees, and (9) ankles/feet. The first question for each body region asked if residents experienced any musculoskeletal discomfort in that region within the past year. Survey logic was incorporated so that the survey skipped to the next body region if a resident answered “no symptoms”. If the resident did report symptoms, however, he or she was then presented with an additional set of questions regarding: severity of symptoms (mild, moderate, or severe), impact of symptoms on activities of daily living, description of the symptoms (pain, stiffness, weakness, numbness, or other), whether or not symptoms occurred within the past week, whether or not symptoms ever caused the resident to stop operating, whether or not symptoms ever caused the resident to miss work, and whether or not the resident believed his or her symptoms were directly caused by his or her work training as a surgeon.
2.2
Statistical analysis
A two-sample test of proportions (p < 0.05) was performed to determine if there was a difference in the proportion of male and female residents who experienced musculoskeletal symptoms. Male and female residents were further stratified into three height classes : (1) within one standard deviation of the average American adult height, (2) at least one standard deviation below the average height, and (3) at least one standard deviation above the average height. Freeman-Halton extension of Fischer’s exact test was utilized to determine if there was a significant difference (p < 0.05) in categorical symptomatic data between residents based on height.
3
Results
In total, 141 residents responded (response rate = 34.7%). Fifty five percent of survey respondents were male and 45% were female. The average age of survey respondents was 29.6 with a range from 26 to 38. By postgraduate year, 14.9% of residents were PGY-1, 18.4% were PGY-2, 18.4% were PGY-3, 24.8% were PGY-4, 18.4% were PGY-5, and 4.2% were greater than PGY-5. Sixty nine percent of residents were White, 16% were Asian, 6% were Hispanic, 4% were Black, 4% were Biracial, and 1% were listed as Other. One respondent withheld postgraduate year and three respondents withheld ethnicity. Ninety six percent of residents were right handed and 4% of residents were left handed. The average resident height was 1.74 m (5 ft 8 in.) and weight was 70.4 kg (average BMI = 23.1 kg/m 2 ). The average number of operating hours per week was 26.3.
The most common body region where residents reported symptoms was the neck (82.3%, [116/141]), followed by the lower back (56%, [79/141]), upper back (40.4%, [57/141]), and the shoulders (40.4%, [57/141]) ( Fig. 1 ). The most commonly reported symptoms were stiffness in the neck (71.6%, [101/141]) followed by pain in the neck (61.7%, [87/141]), pain in the lower back (48.2%, [68/141]), and stiffness in the lower back (46.8%, [66/141]). For each question, results were also calculated as the valid percentage of respondents, which excludes residents who skipped the question due to survey logic ( Table 1 ). Musculoskeletal symptoms had a direct impact on residency training: 76.6% (108/141) of residents experienced symptoms within the past week, 6.4% (9/141) of residents missed work at least once due to symptoms, and 16.3% of residents (23/141) were forced to stop operating at some point due to their musculoskeletal symptoms ( Table 2 ).
| Neck | Shoulders | Elbows | Wrists/hands | Upper back | Lower back | Hips/thighs | Knees | Ankles/feet | |
|---|---|---|---|---|---|---|---|---|---|
| Pain | 75.0% | 77.2% | 63.6% | 83.6% | 75.4% | 86.1% | 84.0% | 87.9% | 85.0% |
| Stiffness | 87.1% | 82.5% | 45.5% | 41.8% | 84.2% | 83.5% | 68.0% | 54.5% | 40.0% |
| Weakness | 4.0% | 17.5% | 27.3% | 34.5% | 7.0% | 19.0% | 20.0% | 30.3% | 10.0% |
| Numbness | 7.8% | 8.8% | 27.3% | 25.5% | 3.5% | 8.9% | 4.0% | 9.1% | 10.0% |
| Other | 1.7% | 1.8% | 18.2% | 5.5% | – | 2.5% | – | 3.0% | 7.5% |
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