Surgery is Physically Demanding and Associated with Multi-site Musculoskeletal Pain: a Cross-sectional Study
1Department of Sports Science and Clinical Biomechanics, University of Southern Denmark; 2Centre for Innovative Medical Technology, Odense University Hospital, Denmark; 3Occupational and Environmental Medicine, Odense University Hospital, Denmark; 4Clinical Institute, University of Southern Denmark; 5Department of Gynaecology and Obstetrics, Odense University Hospital, Denmark; 6Department of Gynaecology and Obstetrics, Karolinska University Hospital and the Karolinska Institute, Sweden
Background: A surgeon’s work involves well-known risk factors for developing musculoskeletal pain. Musculoskeletal pain and especially multi-site musculoskeletal pain could have an impact on the surgeon’s work life and ultimately shorten their surgical career. The objectives in the present study were to quantify the prevalence and intensity of musculoskeletal pain, and to identify surgeons’ characteristics associated with multi-site musculoskeletal pain.
Methods: Information on sociodemographic, work experience, work demands, current health status, levels of physical capacity, and presence and intensity of musculoskeletal pain were collected from an internet-based questionnaire in 284 surgeons. Descriptive statistics were used to report prevalence and intensity of musculoskeletal pain. A logistic regression model was conducted to assess the characteristics associated with multi-site musculoskeletal pain.
Results: Multi-site musculoskeletal pain was reported by 77% of the surgeons, 13% reported pain in one body site, whereas 10% reported no pain. Neck (63%) and lower back (60%) were the most prevalent pain locations. The reported median pain intensities ranged from 2 to 4. Multi-site musculoskeletal pain was significantly associated with being a female surgeon (OR:3.4; 95% CI:1.5-7.4), physical work demand (OR:1.5; 95% CI:1.2-1.7), work ability (OR:3.4; 95% CI:1.6-7.0), and feeling a sense of heaviness in the head/headache (OR:4.8; 95% CI:2.0-11.5). In addition, surgeons who experienced multi-site musculoskeletal pain reported that this negatively influenced their work (21%), leisure time activities (40%), and sleep (27%).
Conclusions: The observed high prevalence of multi-site musculoskeletal pain and high pain intensities adds new knowledge to the emerging literature on musculoskeletal pain in surgeons. Several characteristics, e.g. work ability, were significantly associated with multiple pain sites and this may be of concern for the future career of surgeons. In addition, multi-site musculoskeletal pain has a much greater impact on work, leisure time activities and sleep than pain occurring in one body site.
Standing Dentistry: An Old Practice That Needs Revival? A Scoping Review
McGill University, Canada
Introduction: Postures employed by dental professionals in practice have evolved over time. With the advent of new techniques in the mid-twentieth century, practice postures changed from predominantly standing to predominantly sitting positions. Nevertheless, current literature demonstrates a significant and ongoing prevalence of work-related musculoskeletal disorders (WMSD) among dental professionals. WMSD have been linked to significant loss work time, work disability, burnout, and early retirement among dental professionals. Similar trends have been noted among office workers whose work postures are comparable to those of dental professionals. Evidence supporting periods of standing for office workers is growing and, as a result, many workplaces are now providing sit-to-stand desks to encourage postural shifts throughout the workday. With dental professionals facing similar postural demands and similar rates of WMSD, it is timely to ask whether the dental profession should revisit abandoned standing practices. Objective: This scoping review aims to find whether research in the field of dentistry has determined which posture - seated, standing or alternating - is most effective in preventing WSMD in dental professionals. Methods: This scoping review follows the framework set out by Arksey and O’Malley (2005) and updated by Levac, Colquhoun and O’Brien (2010). A systematic search of four databases identified 2127 relevant studies after removing duplicates. At the title and abstract screening stage, 388 titles were included. The full text of these 388 titles are now being screened for inclusion. Once the final articles have been selected for inclusion, the data from these articles will be charted, collated, and summarized. Findings: Preliminary findings show that literature exploring ergonomics for dentistry professionals has been published since the 1940s by international experts. The results from this scoping review will contribute to the overall ergonomic literature on the prevention of WMSD in dental professionals by informing evidence-based postural practices for dentistry.
Social Stigma as a Barrier for Sustainable Employability of Employees with Mental Health or Substance Abuse Problems: A Focus Group Study in the Dutch Military.
1Tranzo, Scientific Center for Care and Wellfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands.; 2Military Mental Healthcare, Ministry of Defense, Utrecht, the Netherlands.; 3Strategic Military Healthcare Department, Ministry of Defense, Utrecht, the Netherlands.; 4Department of Culture studies, Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, the Netherlands.
Employees with Mental Health or Substance Abuse Problems (MH/SAP) have a higher risk for sick leave, unvoluntary early retirement, exiting the workforce via disability benefits, and unemployment. Whereas military personnel have an elevated risk for developing a variety of MH/SAP, research has shown that about 60% of those who experience such problems do not seek help, or discuss their MH/SAP with their supervisors. Across military studies, one of the most frequently reported barriers to seeking help and disclosing MH/SAP to supervisors, is concern about stigma: the fear of being treated differently in the work environment, and of damaging one’s career. The present study aims to evaluate the role of social stigma as a barrier to healthy decision making, and its effects on sustainable employability of military personnel with MH/SAP. Primary focus is on (1) the decision to seek treatment, and (2) the decision to discuss health problems with a supervisor, as both decisions can have a profound impact on sustainable employability.
A total of eight focus groups will be held in January 2019, each consisting of 6-10 participants. Four focus groups with military personnel with MH/SAP, two with military personnel without MH/SAP, and two with military professionals who provide mental healthcare to workers with MH/SAP. Views on and experiences with decision making regarding seeking help for MH/SAP and disclosing MH/SAP to supervisors will be discussed, including the role stigma plays in these decisions. Additionally, the differences in views and experiences between these groups will be discussed in the results.
Results & Conclusion.
The role of stigma as a barrier for sustainable employability is highly under-researched, although interest in this topic is rapidly increasing. At the conference, results and conclusions will be presented.
The Impact Of Arm Position On Musculoskeletal Trouble In The Neck And Upper Extremities In Symphony Orchestra Musicians
1Physical Activity and Health at Work, Department of Sports Science and Clinical Biomechanics, University of Soutern Denmark, Denmark; 2Center for Musician's Health, Odense University Hospital
Background: Symphony orchestra musicians are at risk of developing musculoskeletal trouble in the neck and upper extremities due to their work involving many hours in awkward positions with static loads and repetitive movements. Few studies have evaluated the arm position as a risk factor, and results were ambiguous.
Purpose: To investigate the impact of arm position on musculoskeletal trouble in the neck and upper extremities in symphony orchestra musicians.
Method: A secondary analysis of data from a Danish cross-sectional study. Two-hundred-and-eleven musicians from six professional symphony orchestras were divided into two exposure groups: neutral and elevated arm position (NA/EA) during play. Neutral arm position included musicians playing oboe, clarinet, bassoon, French horn, tuba, cello, double bass, percussion, kettledrum or others. Elevated arm position included musicians playing violin, viola, flute, trumpet, trombone or harp. Eight body regions were evaluated for differences in musculoskeletal trouble, measured as self-reported trouble (10-point Numerical Rating Scale) and pressure pain assessed for seven body regions (yes/no).
Results: The EA group reported significantly more trouble in the upper back (p = 0.02) and left shoulder (p = 0,05) and had more pressure pain in the left shoulder (p = 0.05). There were more female musicians in the EA group compared to the NA group (p = 0.001). Musculoskeletal trouble was most frequently located in the neck and shoulders in the whole population (n = 211).
Conclusion: This secondary analysis found that, playing with an evaluated arm position resulted in more musculoskeletal trouble in the upper extremities compared to a neutral arm. Identifying risk factors associated with working in a symphony orchestra may be important for developing preventive measures to relieve musculoskeletal trouble.
Gender Differences In Return To Work Interventions Offered To Employees On Long-term Sick Leave?
1Research Unit for General Practice, NORCE, Norwegian Research Centre, Bergen, Norway; 2Institute of Global Health and Primary Health Care, University of Bergen; 3NORCE, Norwegian Research Centre, Bergen, Norway; 4Norwegian National Advisory Unit on Occupational Rehabilitation, Rauland, Norway
Increased awareness about gender norms in patient provider relations may counteract gender bias in treatment decisions and subsequent inequity in health care. The majority of sick leave certificates in Norway are issued to workers for unspecific musculoskeletal disorders (MSD) and common mental disorders. These disorders have low ranking among professionals and may in combination with the patient’s gender, influence the interventions offered to promote return to work (RTW). We aim to examine if gender and type of disorder (operationalized through diagnoses) influence the interventions GPs offer workers with MSD and common mental disorders to promote RTW.
Material and methods
The study population was 937 employees (57% women) completing an independent medical evaluation (IME) by an experienced GP after 6-7 months on sick leave. Data were based on the IME physicians’ assessments. We provide descriptive statistics and Odds Ratios (95% CI) for the likelihood of receiving sufficient rehabilitation measures from the treating GPs across six patient groups (women/MSD, men/MSD, women/mental, men/mental, women/other diagnoses, men/other diagnoses).
The study populations mean age was 47 y. (SD=11.04), 46% had sick leave diagnoses related to MSD, 25% to mental and 28% to all other diagnoses. Routine non-manual work was significantly more prevalent among women and higher income among men (p<0.001). Preliminary analyses showed that men/mental diagnoses had significantly lower chance of receiving sufficient interventions compared with women/MSD (OR=2.3, 95% CI=1.33-3.91). The estimates were robust for relevant adjustments.
Analysing reports from independent medical evaluations, men with mental diagnoses did not receive sufficient interventions aiming at RTW compared with women with musculoskeletal diagnoses. There is reason to believe that these men are not offered interventions that are suitable for their situation, and may be at risk of marginalisation in work life.
Women´s Experiences Of The Situation Of Being In The Sick Leave Process
University of Göteborg, Sweden
Background: Being on sick leave is a risky situation, with loss of meaningful activities, exclusion from the labour market and losing the worker role. Although the benefits of the person’s involvement in the RTW process have been emphasized, an increase in sickness absence and longer sick leave periods is still seen, especially among women. More studies are needed to more deeply understand the person’s own view of the situation.
Aims/Objectives: The aim was to explore the experiences of being on sick leave among a group of women.
Materials and methods: An explorative, qualitative design was used. The analysis, using content analysis, was based on individual, semi-structured interviews with 13 women.
Results: The analysis revealed three categories, describing the women’s experiences of the situation of being on sick leave: being regarded as an object, being supported and being engaged. The categories emerged as either barriers or enablers during the sick leave process.
Conclusion and significance: The results acknowledge the sick leave process as better understood through multiple dimensions, working at both the individual, organizational and societal levels. Using occupation based models underlining the importance of the interaction between person, occupation (work activity) and the environment may contribute to elucidating the complexity in supporting options for return to work.