Abstract
Background
Workplace-related musculoskeletal pain has been studied in various occupations, but it is rarely reported in the surgical literature.
Objective
The aim of this study was to examine work-related discomfort and injury among pediatric otolaryngologists and to assess their knowledge of workplace ergonomic principles.
Methods
We surveyed current North American members of the American Society of Pediatric Otolaryngology. Our main outcomes were whether the physician had ever experienced discomfort or physical symptoms that they attributed to their surgical practice.
Results
Response rate of 43.7% was attained, and 62.0% of respondents reported experiencing pain or discomfort that they attributed to their surgical practice. Women were significantly more likely to report experiencing pain or discomfort that they associated with their surgical practice ( P = .033). There were no significant differences found among length of time in practice, academic vs community setting, or number of surgeries completed by the surgeon. Some of the surgeons (31.0%) were aware of ergonomic principles, and of those who were aware, 83.9% had implemented ergonomic principles into their surgical practice.
Conclusion
Almost two thirds of surgeons who responded to the survey reported experiencing pain or discomfort that they attributed to their surgical practice. Only a minority of respondents were aware of ergonomic principles. These findings may confirm that most physicians believe that their physical health is affected by their operative environment. Increased knowledge of surgical ergonomics may lead to strategies that improve workplace health and safety.
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Introduction
Ergonomics is a relatively new scientific discipline concerned with the understanding of interactions among humans and other elements of a system. It is the profession that applies theory, principles, data, and methods to design to optimize human well-being and overall system performance . Ergonomic analyses are widely applied today in industry , the military , and sports training to help people achieve optimum performance while lowering the risk of error and injury.
Industrial ergonomics is applicable to surgical practice because it is well recognized that both static and dynamic postural stresses can lead to fatigue and disability . The National Institute of Occupational Safety and Health (NIOSH) recommendations for workstation design include the following: avoiding static loads, reducing fixed work postures, avoiding postures that include leaning to the front or to the side, holding a limb in a bent or extended position, and neck forward positions of more than 15° . Repetitive motion injuries have also been described as the most frequent and disabling injuries involving medical professionals . These principles prove difficult to comply with in an operating room setting, leaving surgeons at risk for work-related injury, pain, and discomfort complaints.
Generally, surgeons tend to adopt operative positions based on their training and personal preferences as opposed to ergonomically guided principles. Kant et al studied the posture of physicians and nurses while performing surgical procedures and found that both groups experienced substantial stress to the musculoskeletal system due primarily to the frequent and prolonged static head-bent and back-bent postures assumed. More recently, Park et al surveyed 317 surgeons who performed laparoscopic procedures and found 86.9% reported physical complaints or discomfort related to their practice.
Musculoskeletal disorders have been studied throughout various health care occupations. The higher incidence of occupational cervicobrachial disorders among dentists has prompted improved designs of dental operative equipment and dentist positioning . However, studies among surgeons, particularly otolaryngologists, are rare . One study in the United Kingdom found that 72% of otolaryngologists surveyed had either back pain or neck pain . There were no North American studies found in the literature that described the incidence of pain and discomfort associated with pediatric otolaryngology surgical practices. It is for this reason that we conducted an ergonomics survey study among the North American pediatric otolaryngologists, with the aim to investigate the prevalence of workplace-related discomfort and injury and to assess their knowledge of workplace ergonomics principles.
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Methods
North American members of the American Society of Pediatric Otolaryngology (ASPO) were contacted for this study. An e-mail list of the current ASPO members with an active surgical practice was included in the study. Physicians practicing pediatric otolaryngology but who were not ASPO members and ASPO members who did not have a surgical practice were excluded from the study.
Physicians were surveyed between June and November of 2010. The survey was delivered via their contact e-mail using an online survey system. To promote a higher response rate, 3 iterations of the same survey were sent out.
For the survey, the questionnaire used by Park et al to assess ergonomic knowledge and practice among general surgeons was partially adapted. The survey and some of the questions were altered to better represent a pediatric otolaryngology practice. The survey was pretested on medical postgraduate students, faculty physicians, occupational therapists, and ergonomists. Fig. 1 shows the survey used in this study.
The questions were grouped into 4 categories: (1) demographics, (2) surgical practice characteristics, (3) physical symptoms, and (4) ergonomics. Some questions required single answers, such as “Have you ever had any discomfort or physical symptoms that you would attribute to your surgical practice? Yes/No.” Other questions allowed selection of multiple applicable and open-ended answers.
Information collected included physicians’ sociodemographic characteristics (age, sex); practice characteristics (academic or community practice, years in practice, fellowship training); number of different procedures completed each year (minor microscopy cases [eg, myringotomy tube placement], major microscopy cases [eg, mastoidectomy], minor endoscopy cases [eg, bronchoscopy], major endoscopy cases [eg, airway reconstruction]; physical symptoms (whether they ever had any physical discomfort that they attributed to their surgical practice, types of physical symptoms); therapy (had they ever had any therapy for their symptoms, did the therapy improve symptoms); knowledge of surgical ergonomics, including where they obtained their knowledge of ergonomics; application of ergonomic principles to practice; and interest in more information on surgical ergonomics.
Survey data were analyzed using the Statistical Package for the Social Sciences, version 11.5 (SPSS, Chicago, IL). Frequencies were used to describe the characteristics of the sample as a whole. χ 2 and t tests were used to identify differences between physicians who had physical discomfort and those who did not, and between physicians who were aware of surgical ergonomic principles and those who were not aware. Level of significance was set at P < .05. Frequencies were used to analyze responses from categorized open-ended questions.
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Methods
North American members of the American Society of Pediatric Otolaryngology (ASPO) were contacted for this study. An e-mail list of the current ASPO members with an active surgical practice was included in the study. Physicians practicing pediatric otolaryngology but who were not ASPO members and ASPO members who did not have a surgical practice were excluded from the study.
Physicians were surveyed between June and November of 2010. The survey was delivered via their contact e-mail using an online survey system. To promote a higher response rate, 3 iterations of the same survey were sent out.
For the survey, the questionnaire used by Park et al to assess ergonomic knowledge and practice among general surgeons was partially adapted. The survey and some of the questions were altered to better represent a pediatric otolaryngology practice. The survey was pretested on medical postgraduate students, faculty physicians, occupational therapists, and ergonomists. Fig. 1 shows the survey used in this study.
The questions were grouped into 4 categories: (1) demographics, (2) surgical practice characteristics, (3) physical symptoms, and (4) ergonomics. Some questions required single answers, such as “Have you ever had any discomfort or physical symptoms that you would attribute to your surgical practice? Yes/No.” Other questions allowed selection of multiple applicable and open-ended answers.
Information collected included physicians’ sociodemographic characteristics (age, sex); practice characteristics (academic or community practice, years in practice, fellowship training); number of different procedures completed each year (minor microscopy cases [eg, myringotomy tube placement], major microscopy cases [eg, mastoidectomy], minor endoscopy cases [eg, bronchoscopy], major endoscopy cases [eg, airway reconstruction]; physical symptoms (whether they ever had any physical discomfort that they attributed to their surgical practice, types of physical symptoms); therapy (had they ever had any therapy for their symptoms, did the therapy improve symptoms); knowledge of surgical ergonomics, including where they obtained their knowledge of ergonomics; application of ergonomic principles to practice; and interest in more information on surgical ergonomics.
Survey data were analyzed using the Statistical Package for the Social Sciences, version 11.5 (SPSS, Chicago, IL). Frequencies were used to describe the characteristics of the sample as a whole. χ 2 and t tests were used to identify differences between physicians who had physical discomfort and those who did not, and between physicians who were aware of surgical ergonomic principles and those who were not aware. Level of significance was set at P < .05. Frequencies were used to analyze responses from categorized open-ended questions.
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Results
Among the 253 ASPO members residing in North America, 24 no longer had a surgical practice and, thus, were excluded from the study. Of the remaining 229 pediatric otolaryngologists, 100 responded to the survey for a response rate of 43.7%.
To assess the representativeness of our sample, we compared the sex, age, and location of practice of respondents with those of physicians on the list provided by the ASPO. We found no significant differences between the respondents and the nonrespondents.
Table 1 presents the baseline characteristics of the participants and their type of practice. There were more men than women, and the average number of years in practice was 21. The mean age of respondents was 52 years. Most responders practiced in an academic setting (74.0%) and had completed a fellowship in pediatric otolaryngology (90.0%). Physicians completed a large number of minor microscopy and minor endoscopy cases, with an average of 334 and 135 cases/y, respectively. The number of major microscopy and endoscopy cases were 33 and 31 cases/y, respectively.
