An investigation of musculoskeletal disorders in healthcare professionals
The aims of the work within this thesis were to i) establish the prevalence of musculoskeletal disorders among hospital based nurses and physiotherapists and to establish both perceived and possible causes for these disorders, ii) obtain clinical diagnoses and prognoses of nurses and physiotherapy staff attending an Occupational Health Department, iii) to establish which occupational tasks have the greatest potential to cause musculoskeletal disorders and iv) to investigate the effects of simulated nursing tasks and a modified porters' work-rest schedule on spinal shrinkage. In the epidemiological study the annual prevalence of all musculoskeletal disorders was estimated for nurses and physiotherapists in combination as 49%. The point prevalence was 20.7%. The anatomical area most affected was the lower back, buttocks, upper leg area. In total, musculoskeletal disorders accounted for 19% of all absences from work from all respondents within the previous year. Of those staff attending the Occupational Health Department, the main anatomical area affected by musculoskeletal disorders was, again, the back. Whilst a clinical diagnosis could be given to some patients, others were categorised as having 'low-back pain' indicating the often idiopathic nature of the symptoms. Time off work was often extensive and some staff members were retired from their profession as a direct result of their disorder. Patient handling was cited as the major perceived cause of the musculoskeletal disorders experienced. This variable was not significantly associated with the presence of musculoskeletal disorders in a logistic regression analysis. It is likely that all aspects of nursing and physiotherapy require some degree of manual handling and the category as a whole is too broad to enable an association with the presence or absence of a musculoskeletal disorder to be identified. Factors found to be associated with the presence of a musculoskeletal disorder or back pain were the specialty in which the individual worked, the age of the individual, whether physiotherapists' work regularly required the maintenance of stooped postures, the percentage time the individuals spent on their feet during a shift and the psychological variables of work pressure, happiness at work and job aspirations/motivations. The direction of causality for these variables was not established. An ergonomic risk assessment indicated that the tasks with the highest risk potential were manual handling tasks and those involving a static hold/standing of a patient. Manual handling had a high risk score, mainly because of the awkward, non-optimum postures staff were forced to adopt to perform the task. Tasks requiring static flexions scored highly because they were often performed alone and the flexion was maintained for some time. The task's score was also related to other external factors. The final set of studies considered the influence of nurses' and porters' tasks on spinal shrinkage. During a 4-hour simulation of nursing tasks, spinal shrinkage was significantly less with a 20-min seated break than with a 20-min standing break. Ensuring nurses take a 20-min seated break during each shift has the potential to reduce the prevalence of back-pain. A modified work-rest schedule for hospital porters did not have any effect on spinal shrinkage during a 4-hour simulation of occupational activities. The high prevalence of back pain among this group can not be reduced by adopting the modified work-rest schedule. A model detailing the causal factors for musculoskeletal disorders and low-back pain in nurses and physiotherapists has been proposed based on current findings within this thesis. This ergonomic model requires validation in future work.