Einführung zu diesem Artikel:
Do we even lift, bros?Endosc Int Open 2022; 10(05): E570-E571
DOI: 10.1055/a-1797-1936
Introduction
Gastrointestinal endoscopic procedures (gastroscopy, colonoscopy, endoscopic retrograde
cholangiopancreatography [ERCP], and endoscopic ultrasonography [EUS]) are characterized
by a demanding physical interaction between the clinician and the endoscope, resembling
an endurance sport [1]. To perform a procedure, in fact, the endoscopist needs to press valves and switches,
rotate the wheels, hold the endoscope, and apply forces/torques on the insertion tube.
Moreover, the clinician is usually standing and continuously interacting with other
people (nurses, patient) as well as with other equipment (monitor, pedals, bed, etc.)
present in the operating room (OR). As a matter of fact, the OR set up, the handing
of the endoscope, and the tip control are ergonomically correlated one another [1]
[2]. Therefore, performing a gastrointestinal endoscopy is a complex activity and its
ergonomic optimization is beneficial for the health of the clinician and the success
of the intervention.
The shape and size of modern gastrointestinal endoscopes do not differ significantly
from those designed decades ago [3]
[4]. Despite the technological evolution of medical devices and the increased awareness
on safety in the working place, endoscopes are still designed to be “one-size-fits-all"
and based on anthropometrical data covering only a part of the user population, i. e.,
excluding most female users [5]. As a result, the clinicians work with a tool that may not allow them to perform
to the best of their capabilities, needing to adapt the position/movements to each
endoscope [6], which on the long term may result in work-related musculoskeletal injuries (MSIs).
This in turn might lead to modification of their practice. MSIs frequently result
in the inability to work, influencing the work and private life of the clinician but
also the productivity of the health care system [3]
[7]. Besides the handle design, other causes of MSI in gastrointestinal endoscopy include
the high applied forces, the position of the equipment in the OR, the repetitive movements,
and the prolonged standing time [3]
[8]
[9]
[10]
[11]
[12]
[13]
[14]
[15]
[16].
MSIs are frequent in gastrointestinal endoscopy: Previous studies show that MSIs range
from 37 % to 89 % among gastrointestinal endoscopists [8]
[9]
[10]
[11]
[12]
[14]
[15]
[17]
[18]
[19]
[20], and are experienced in many joints, from the lumbar area to neck and upper limbs’
joints [8]
[9]
[12]
[14]
[17]
[18]. The most reported MSIs are hand numbness, DeQuervain’s tenosynovitis, and carpal
tunnel syndrome [9]
[13]
[15]
[21]
[22].
Despite the increased awareness of the influence of gastrointestinal endoscopy on
MSIs, further research is necessary to better understand how to reduce the risk of
MSIs. To the best of our knowledge, an investigation about the correlation between
the anthropometrical characteristics and the occurrence and location of MSIs is missing.
Therefore, a survey was conducted among gastrointestinal endoscopists with the purpose
of investigating if certain anthropometrical characteristics correlate to MSIs. The
study also aimed at investigating if female endoscopists are more affected by MSIs,
if endoscopists with small hands are more affected by MSIs, and if tall endoscopists
are more prone to develop back pain.
Materials and methods
A world-wide online survey was conducted between March and June, 2021. Clinically
active endoscopists (doctors and nurses) participated anonymously, voluntarily and
without monetary compensation. The responders were identified in the authors’ network
and asked to forward the questionnaire to other colleagues. The questionnaire was
composed of 32 questions including endoscopist characteristics (as age, height, weight),
experience of MSI, treatment, and preventive measures such as ergonomic training.
Participants could select different MSIs and locations. The questions were based partially
on previous publications [19]
[20] and were reviewed in a final stage by one advanced gastrointestinal endoscopist
and one gastrointestinal nurse.
Descriptive statistics were used to analyse the data. The chi-squared test was used
using IBM SPSS Statistics (IBM Corp., Armonk, New York, United States) with a significance
level of P < 0.05.
Results
A total of 204 endoscopists responded to the survey (89 % doctors, 11 % nurses of
whom 59 % were actively using the endoscope for more than 10 hours/week) ([Table 1]). Of the respondents, 78 % were males and 81 % older than 35 years. The ethnic distribution
was 41 % Asian, 55 % White, and the rest distributed between Hispanic, mixed and Afro-American.
Nine endoscopists worked in the United States, 117 in Europe (Italy, Germany, Spain,
Portugal, France, Belgium, Norway, Sweden, Denmark, Finland, UK); 64 in Asia (Singapore,
Malaysia, Japan, India, China, South Korea, Indonesia), and 13 in Oceania (Australia,
New Zealand) – one did not answer. Of the respondents, 88 % weighed at least 60 kg,
and 92 % were taller than 160 cm ([Table 1]). A total of 92 % were right-handed and 88 % had a surgical glove size between 6.5
and 8.0 ([Table 1]). More than half of the interviewees (53 %) reported a previous or present MSI related
to gastrointestinal endoscopy. Gender revealed to be a risk factor, with female clinicians
more prone to develop an MSI than the male counterparts (χ2 = 11.437, P = 0.001) ([Table 1]).
Table 1
Responders’ anthropometric and descriptive data vs. development of work-related injuries
(n [%]). Statistical differences were calculated within the groups and when found
(p < 0.05), data were reported in bold.
|
|
Injury experienced
|
|
|
|
|
|
Yes (n = 107)[1]
|
No (n = 97)[2]
|
Total (n = 204)[3]
|
|
|
Age (years)
|
< 25
|
0 [0.0 %]
|
0 [0.0 %]
|
0 [0.0 %]
|
χ2 = 4.264
P = 0.371
|
|
25–34
|
7 [36.8 %]
|
12 [63.2 %]
|
19 [9.3 %]
|
|
35–44
|
35 [50.7 %]
|
34 [49.3 %]
|
69 [33.8 %]
|
|
45–54
|
43 [57.3 %]
|
32 [42.7 %]
|
75 [36.8 %]
|
|
55–64
|
18 [50.0 %]
|
18 [50.0 %]
|
36 [17.6 %]
|
|
> 65
|
4 [80.0 %]
|
1 [20.0 %]
|
5 [2.5 %]
|
|
Gender
|
Female
|
33 [75.0 %]
|
11 [25.0 %]
|
44 [21.6 %]
|
χ2 = 11.437
P = 0.001
|
|
Male
|
74 [46.3 %]
|
86 [53.7 %]
|
160 [78.4 %]
|
|
Weight (kg)
|
< 50
|
3 [60.0 %]
|
2 [40.0 %]
|
5 [2.5 %]
|
χ2 = 6.136
P = 0.408
|
|
50–59
|
12 [63.2 %]
|
7 [36.8 %]
|
19 [9.3 %]
|
|
60–69
|
26 [53.1 %]
|
23 [46.9 %]
|
49 [24.0 %]
|
|
70–79
|
34 [54.8 %]
|
28 [45.2 %]
|
62 [30.4 %]
|
|
80–89
|
17 [38.6 %]
|
27 [61.4 %]
|
44 [21.6 %]
|
|
90–99
|
9 [52.9 %]
|
8 [47.1 %]
|
17 [8.3 %]
|
|
> 100
|
6 [75.0 %]
|
2 [25.0 %]
|
8 [3.9 %]
|
|
Height (cm)
|
< 150
|
0 [0.0 %]
|
0 [0.0 %]
|
0 [0.0 %]
|
χ2 = 1.618
P = 0.806
|
|
150–159
|
9 [56.3 %]
|
7 [43.7 %]
|
16 [7.8 %]
|
|
160–169
|
25 [59.5 %]
|
17 [41.5 %]
|
42 [20.6 %]
|
|
170–179
|
46 [51.1 %]
|
44 [48.9 %]
|
90 [44.1 %]
|
|
180–189
|
20 [46.5 %]
|
23 [53.5 %]
|
43 [21.1 %]
|
|
190–199
|
7 [53.8 %]
|
6 [46.2 %]
|
13 [6.4 %]
|
|
> 200
|
0 [0.0 %]
|
0 [0.0 %]
|
0 [0.0 %]
|
|
Right-handed
|
Yes
|
101 [53.7 %]
|
87 [46.3 %]
|
188 [92.2 %]
|
χ2 = 2.373
P = 0.123
|
|
No
|
6 [37.5 %]
|
10 [62.5 %]
|
16 [7.8 %]
|
|
Surgical glove size
|
5.5
|
2 [100.0 %]
|
0 [0.0 %]
|
2 [1.0 %]
|
χ2 = 10.030
P = 0.187
|
|
6.0
|
4 [50.0 %]
|
4 [50.0 %]
|
8 [3.9 %]
|
|
6.5
|
22 [52.4 %]
|
20 [47.6 %]
|
42 [20.6 %]
|
|
7.0
|
25 [69.4 %]
|
11 [30.6 %]
|
36 [17.6 %]
|
|
7.5
|
26 [40.6 %]
|
38 [59.4 %]
|
64 [31.4 %]
|
|
8.0
|
19 [54.1 %]
|
18 [45.9 %]
|
37 [18.1 %]
|
|
8.5
|
4 [50.0 %]
|
4 [50.0 %]
|
8 [3.9 %]
|
|
9.0
|
4 [57.1 %]
|
3 [42.9 %]
|
7 [3.4 %]
|
|
Profession
|
Doctor
|
95 [52.2 %]
|
87 [47.8 %]
|
182 [89.2 %]
|
χ2 = 0.043
P = 0.835
|
|
Nurse
|
12 [54.5 %]
|
10 [45.5 %]
|
22 [10.8 %]
|
|
Use bifocal or progressive lenses
|
Yes
|
40 [48.8 %]
|
42 [51.2 %]
|
82 [40.2 %]
|
χ2 = –0.741
P = 0.389
|
|
No
|
67 [54.9 %]
|
57 [45.1 %]
|
122 [59.8 %]
|
1 The percentage is relative to the number of people in the relative group.
2 The percentage is relative to the overall number of responders.
3 Three clinicians did not reply to the question.
More than 85 % of the responders had at least five years of experience, and 73 % had
experience in ERCP ([Table 2]). A total of 40 % reported having less than a 10-minute break between two procedures
and the duration did not influence the probability of developing an MSI. Of the respondents,
47 % performed more than 25 procedures/week, and 55 % reported actively using the
endoscope for more than 15 hours/week ([Table 2]). Using the endoscope for more than 15 hours/week (χ2 = 4.178, P = 0.041) or performing more than 15 procedures/week (χ2 = 5.416, P = 0.020) were related to MSI.
Table 2
Responders’ work descriptive data vs. development of work-related injuries (n [%]).
Statistical differences were calculated within the groups and when found (P < 0.05), data were reported in bold.
|
|
Injury experienced
|
|
|
|
|
Yes (n = 107)[1]
|
No (n = 97)[1]
|
Total (n = 204)[2]
|
|
|
Years of practicing endoscopy
|
< 2[1]
|
3 [30.0 %]
|
7 [70.0 %]
|
10 [4.9 %]
|
χ2 = 5.469
P = 0.361
|
|
2–5
|
7 [36.8 %]
|
12 [63.2 %]
|
19 [9.3 %]
|
|
6–15
|
42 [58.3 %]
|
30 [41.7 %]
|
72 [35.3 %]
|
|
16–25
|
34 [50.7 %]
|
33 [49.3 %]
|
67 [32.8 %]
|
|
26–35
|
15 [57.7 %]
|
11 [42.3 %]
|
26 [12.7 %]
|
|
> 35
|
6 [60.0 %]
|
4 [40.0 %]
|
10 [4.9 %]
|
|
Experience in ERCP
|
Yes
|
79 [53.4 %]
|
69 [46.6 %]
|
148 [72.5 %]
|
χ2 = 0.186
P = 0.666
|
|
No
|
28 [50.0 %]
|
28 [50.0 %]
|
56 [27.5 %]
|
|
Average ERCP procedure duration (min)
|
< or = 10
|
0 [0.0 %]
|
1 [100.0 %]
|
1 [0.7 %]
|
χ2 = 5.203
P = 0.635
|
|
11–20
|
9 [60.0 %]
|
6 [40.0 %]
|
15 [10.1 %]
|
|
21–30
|
34 [54.0 %]
|
29 [46.0 %]
|
63 [42.6 %]
|
|
30–60
|
28 [50.0 %]
|
28 [50.0 %]
|
56 [37.8 %]
|
|
60–90
|
5 [71.4 %]
|
2 [28.6 %]
|
7 [4.7 %]
|
|
> 90
|
2 [100.0 %]
|
0 [0.0 %]
|
2 [1.4 %]
|
|
I am not sure
|
1 [25.0 %]
|
3 [75.0 %]
|
4 [2.7 %]
|
|
Average gastroscopic procedure duration (min)
|
< or = 5
|
14 [45.2 %]
|
17 [54.8 %]
|
31 [15.2 %]
|
χ2 = 4.701
P = 0.453
|
|
6–10
|
62 [58.5 %]
|
44 [41.5 %]
|
106 [52.0 %]
|
|
11–15
|
21 [48.8 %]
|
22 [51.2 %]
|
43 [21.1 %]
|
|
16–30
|
5 [33.3 %]
|
10 [66.7 %]
|
15 [7.4 %]
|
|
> 30
|
1 [50.0 %]
|
1 [50.0 %]
|
2 [1.0 %]
|
|
I am not sure
|
4 [57.1 %]
|
3 [42.9 %]
|
7 [3.4 %]
|
|
Average colonoscopic procedure duration (min)
|
< or = 5
|
2 [50.0 %]
|
2 [50.0 %]
|
4 [2.0 %]
|
χ2 = 7.622
P = 0.178
|
|
6–10
|
3 [23.1 %]
|
10 [76.9 %]
|
13 [6.4 %]
|
|
11–15
|
23 [48.9 %]
|
24 [51.1 %]
|
47 [23.0 %]
|
|
16–30
|
65 [59.1 %]
|
45 [40.9 %]
|
110 [53.9 %]
|
|
> 30
|
8 [53.3 %]
|
7 [46.7 %]
|
15 [7.4 %]
|
|
I am not sure
|
6 [40.0 %]
|
9 [60.0 %]
|
15 [7.4 %]
|
|
Average break duration between two procedures (min)
|
< or = 10
|
42 [51.2 %]
|
40 [48.8 %]
|
82 [40.2 %]
|
χ2 = 0.639
P = 0.887
|
|
11–20
|
49 [54.4 %]
|
41 [45.6 %]
|
90 [44.1 %]
|
|
21–30
|
15 [51.7 %]
|
14 [48.3 %]
|
29 [14.2 %]
|
|
> 30
|
1 [33.3 %]
|
2 [67.7 %]
|
3 [1.5 %]
|
|
Average number of procedures per week
|
< or = 5
|
4 [33.3 %]
|
8 [67.7 %]
|
12 [5.9 %]
|
χ2 = 6.834
P = 0.233
|
|
6–10
|
8 [33.3 %]
|
16 [67.7 %]
|
24 [11.8 %]
|
|
11–15
|
9 [50.0 %]
|
9 [50.0 %]
|
18 [8.8 %]
|
|
16–20
|
19 [57.6 %]
|
14 [42.4 %]
|
33 [16.2 %]
|
|
21–25
|
12 [54.5 %]
|
10 [45.5 %]
|
22 [10.8 %]
|
|
> 25
|
55 [57.9 %]
|
40 [42.1 %]
|
95 [46.6 %]
|
|
Hours per week of active endoscopic procedures (active means actively using the endoscope)
|
< or = 5
|
6 [33.3 %]
|
12 [67.7 %]
|
18 [8.8 %]
|
χ2 = 10.510
P = 0.062
|
|
6–10
|
15 [45.5 %]
|
18 [54.5 %]
|
33 [16.2 %]
|
|
11–15
|
20 [48.8 %]
|
21 [51.2 %]
|
41 [20.1 %]
|
|
16–20
|
28 [68.3 %]
|
13 [31.7 %]
|
41 [20.1 %]
|
|
21–25
|
8 [38.1 %]
|
13 [61.9 %]
|
21 [10.3 %]
|
|
> 25
|
30 [60.0 %]
|
20 [40.0 %]
|
50 [24.5 %]
|
ERCP, endoscopic retrograde cholangiopancreatography.
1 The percentage is relative to the number of people in the relative group.
2 The percentage is relative to the overall number of responders.
Among the responders, 7 % stated to perform a muscular warm up before starting a procedure.
74 % adjusted the monitor position, 9 % the height of the patient bed, and 83 % the
pedals’ position. Only 19 % reported to use a floor mat. 18 % reported having participated
in ergonomic training, while 49 % would be interested in participating in one ([Table 3]). The willingness to participate in ergonomic training was significantly higher
among those who have had MSI (χ2 = 8.234, P = 0.016) ([Table 3]). Of the respondents, 18 % did not perform any physical activity during the week,
while 33 % stated doing a leisure activity that involves the use of the fingers ([Table 3]). Among the physical activities, jogging/running was the most common (n = 77), followed
by walking (n = 67), cycling (n = 65), strength training (n = 47), yoga/pilates (n = 24),
swimming (n = 20), hiking (n = 15), skiing (n = 3), martial arts (n = 2), and other
activities (n = 13) ([Table 3]).
Table 3
Responders’ ergonomic data and work-related injuries (n [%]). Statistical differences
were calculated within the groups and when found (P < 0.05), data were reported in bold.
|
|
Injury experienced
|
|
|
|
|
Yes (n = 107)[1]
|
No (n = 97)[1]
|
Total (n = 204)[2]
|
|
|
Warm up before the procedure (stretching, mobility exercises, etc.)
|
Yes
|
5 [33.3 %]
|
10 [67.7 %]
|
15 [7.4 %]
|
χ2 = 2.373
P = 0.123
|
|
No
|
102 [54.0 %]
|
87 [46.0 %]
|
189 [92.6 %]
|
|
Adaptation of the position of the monitor to the height
|
Yes
|
75 [50.0 %]
|
75 [50.0 %]
|
150 [73.5 %]
|
χ2 = 1.365
P = 0.243
|
|
No
|
32 [59.3 %]
|
22 [40.7 %]
|
54 [26.5 %]
|
|
Adaptation of the position of the bed of the patient to the height
|
Yes
|
7 [36.8 %]
|
12 [63.2 %]
|
19 [9.3 %]
|
χ2 = 2.955
P = 0.086
|
|
No
|
100 [54.1 %]
|
85 [45.9 %]
|
185 [90.7 %]
|
|
Use of floor mat
|
Yes
|
19 [50.0 %]
|
19 [50.0 %]
|
38 [18.6 %]
|
χ2 = 0.112
P = 0.737
|
|
No
|
88 [53.0 %]
|
78 [47.0 %]
|
166 [81.4 %]
|
|
Adaptation of the position of the foot pedals
|
Yes
|
88 [51.8 %]
|
82 [48.2 %]
|
170 [83.3 %]
|
χ2 = 0.193
P = 0.661
|
|
No
|
19 [55.9 %]
|
15 [44.1 %]
|
34 [16.7 %]
|
|
Ergonomic training
|
Yes
|
16 [44.4 %]
|
20 [55.6 %]
|
36 [17.6 %]
|
χ2 = 1.124
P = 0.289
|
|
No
|
91 [33.3 %]
|
77 [66.7 %]
|
168 [82.4 %]
|
|
Will to participate in an ergonomic training
|
Yes
|
60 [60.6 %]
|
39 [39.4 %]
|
99 [48.5 %]
|
χ2 = 8.234
P = 0.016
|
|
No
|
11 [32.4 %]
|
23 [67.6 %]
|
34 [16.7 %]
|
|
Maybe
|
36 [50.7 %]
|
35 [49.3 %]
|
71 [34.8 %]
|
|
Hours of physical activity per week
|
0
|
19 [52.8 %]
|
17 [47.2 %]
|
36 [17.6 %]
|
χ2 = 0.170
P = 0.997
|
|
1–2
|
29 [52.7 %]
|
26 [47.3 %]
|
55 [27.0 %]
|
|
3–5
|
35 [53.8 %]
|
30 [46.2 %]
|
65 [31.9 %]
|
|
6–9
|
16 [48.5 %]
|
17 [51.5 %]
|
33 [16.2 %]
|
|
> 10
|
8 [53.3 %]
|
7 [46.7 %]
|
15 [7.4 %]
|
|
Leisure activity involving the use of fingers (i. e. videogames, playing a musical
instrument)
|
Yes
|
31 [45.6 %]
|
37 [54.4 %]
|
68 [33.3 %]
|
χ2 = 1.926
P = 0.165
|
|
No
|
76 [55.9 %]
|
60 [44.1 %]
|
136 [66.7 %]
|
1 The percentage is relative to the number of people in the relative group.
2 The percentage is relative to the overall number of responders.
Of the respondents, 53 % reported having or having had an work-related MSI (75 % within
the female clinician group), located mainly in the neck (n = 49), shoulder and thumb
(n = 39, both), and wrist (n = 34) ([Fig. 1]). When in a limb, MSIs were located in 51 cases on the right side and in 48 on the
left. Over 30% of the clinicians faced an MSI that limited him/her from going to work
(days without working due to an injury: 1–2 days (16 % of the responders); 3–7 (6 %);
7–15 (4 %); 15–30 (1%); over 30 (5 %)). Muscle/tendon strain was the most common MSI
(n = 38), followed by tension neck syndrome (n = 21) and tendinitis (n = 20) ([Fig. 2]). In most cases (n = 51), the clinicians did not intervene to heal it. Analgesics
(n = 29) and anti-inflammatory medication (n = 28) were the most frequently used intervention,
followed by exercise (n = 20), rest (n = 16), and physiotherapy (n = 15) ([Fig. 3]).
Fig. 1 Location of the musculoskeletal injury and distribution among female and male endoscopists
(n = 107).
Fig. 2 Kind of musculoskeletal injury reported by the respondents (n = 107).
Fig. 3 Kind of treatment for the injury reported by the respondents (n = 107).
Regarding the correlation between MSI location and anthropometric and descriptive
data, clinicians who reported an MSI located in the hip, knee and ankle had a statistically
significant higher body weight (all P < 0.05). Taller physicians reported a higher incidence of MSIs in the knee and ankle
(both P < 0.05). Physicians performing a leisure activity involving the use of the fingers
(e. g. videogames, playing a musical instrument) reported more MSIs located in the
thumb (P = 0.052). Having smaller hands (surgical glove size ≤ 6.5) did not relate to have
experienced an MSI located in the thumb or fingers.
Discussion
Recently, awareness of MSIs among gastrointestinal endoscopists has increased in response
to their impact on clinicians and subsequent effects on resources, cost, and quality
of the health care system [5]
[7]
[9]. In this study, 53 % of the interviewed endoscopists had experienced at least one
work-related MSI, in line with previous publications reporting an occurrence between
37 % and 89 % [8]
[9]
[10]
[11]
[12]
[14]
[15]
[17]
[18]
[19]
[20]. More than 30 % of those experiencing MSIs had such severe problems that they were
not be able to work.
In the present study, the only anthropometric or descriptive variable that statistically
led to MSI was gender: Female endoscopists were more prone to MSIs than males. An
explanation might be the biological lower force-generation of women compared to men
[23], also in gastrointestinal endoscopy [13]. Having a small surgical glove size and thus a smaller hand was not found to be
a risk factor for developing MSIs in the thumb or fingers, but despite that, users
with smaller hands need to adapt their position and movements to the endoscope [6]
[9]. In this regard, it is important to consider the role of movement adaptation to
external constraints, in this case to the handle design and size. Being the interaction
user-endoscope a repetitive movement, each clinician strategically applies a different
movement pattern to perform the task. Therefore, there is not a single optimal solution
to a specific task, but several [24]. As a result, only considering hand size as an injury risk factor is not sufficient,
since due to the movement adaptation, each user is overloading a particular joint
differently from other endoscopists [6].
Gastrointestinal endoscopy can be considered an extremely high-intensity endurance
activity [1], with long standing periods and a continuous application of forces and torques [9]
[12]
[17]
[18]
[25], especially in colonoscopy and ERCP. Performing a warmup (stretching or mobility
exercise) before a procedure has been demonstrated to be beneficial for gastrointestinal
endoscopists, as it is for athletes [1]. However, few responders (7 %) reported performing a warmup, and whether or not
warm-up was done did not correlate to MSIs. In line with previous publications [9]
[15]
[16], also the current survey found that the probability of experiencing an MSI is related
to the number of procedures or of hours of active use of the endoscope per week. Prolonged
standing periods in the workplace are generally considered a risk factor for back
pain and discomfort [26]. For this reason, taking breaks between procedures is beneficial, permitting a proper
recovery [4]
[9]. The importance of this practice seems to still be underestimated, as reported in
the current and previous studies [4]. 37 % of those younger than 35 years had experienced an MSI, showing that any endoscopists
exempt from MSIs and highlighting the importance of injury prevention and ergonomic
training even among younger fellows [1]. The ratio of doctors and nurses who experienced an MSI was comparable (52 % and
55 %, respectively), demonstrating that MSIs are not only frequent among doctors,
but also among the gastrointestinal nurses who assist and sometimes perform the procedures
as well [27].
Suboptimal and poor positioning of the equipment in the OR has been demonstrated to
be a risk factor for the health of endoscopists [4]
[16]
[18]
[28]
[29]. Adjusting the height and position of the screen and bed, for instance, can reduce
neck, shoulder, spine, and arm pain. But in the present study, no significant correlation
was found between adjusting the height of the screen or of the bed, the position of
the pedals, or the use of a floor mat and reported MSIs. There was, however, a non-significant
trend indicating that endoscopists adjusting the position of the equipment in the
OR had fewer MSIs. Therefore, as previously recommended [5]
[9]
[19], an “ergonomic time-out” is suggested to prepare the OR and to ensure the correct
equipment positioning. Surprisingly, despite such practice could be considered “common
sense,” only 74 % and 83 % of the clinicians reported adjusting the height of the
monitor and the position of the pedals, respectively, 19 % use a floor mat, and 9 %
adjusted the height of the bed/cart.
The importance of the ergonomic time-out could be highlighted during endoscopy-specific
ergonomic training. Only a small portion of the endoscopists have received such training
(18 %), despite its potential benefits in reducing MSIs [9]
[30]
[31]. In the study, no correlation between participating in an ergonomic training and
occurrence of work-related MSIs was found, differently from what previously reported
[19]. The importance of ergonomic training is nonetheless recognized by endoscopists
who had experienced MSIs, and these reported to be willing to participate in such
training (P = 0.016).
In the present study, no statistical correlation was found between performing physical
activity for more than two hours/week and the occurrence of MSIs. Having an active
lifestyle reduces the risk of MSIs among dentists [32], who, as gastrointestinal endoscopists stand for extended periods watching monitors
and operating with instruments. This suggests that having an active lifestyle might
reduce MSIs, also among endoscopists [1].
In line with previous studies [8]
[9]
[10]
[14]
[15]
[18]
[20]
[33], neck, upper and lower back, shoulder, wrist, and thumb were the primary locations
of MSIs. Women were more likely than men to have neck (52 % vs. 43 %) and thumb pain
(49 % vs. 31 %), while male clinicians more frequently reported lower back pain (37 %
vs. 15 %) [9]. When located in a limb, MSIs have been reported to be distributed relatively equally
between the left and right side (n = 48; 51, respectively). MSIs located on the lower
limb are rare and have been previously associated with frequent pressing of the electrocautery
and rinsing foot pedals [20]. In the current investigation, weight and height of the endoscopists were associated
with a higher risk of experiencing MSIs in the hip, knee, and ankle. Therefore, as
proposed in studies on injury prevention in the workplace, a sitting position during
procedures could be suggested to reduce the weight on the limbs [34], though this may be impractical when for instance torquing the colonoscope. The
use of bifocal lenses was not a risk factor for developing neck pain, though previous
studies have suggested it [35]. DeQuervain’s syndrome was not as frequently reported as in other studies [18]
[33], while the high frequency of muscle and tendon strain is related to the fact that
this injury can be in several different joints. Regarding treatment of MSIs, besides
not taking any remedy, most of the doctors utilized pain and anti-inflammatory medications,
which is in line with previous findings [15]
[20].
A limitation of the study is that the survey did not require the endoscopists to indicate
specifically the side of the MSI. Previous publications have shown that, due to the
use of the elevator in ERCP, the thumb is the most affected joint of the left side
[33], while the wrist and shoulder are most affected on the right side due to the relatively
high forces and torque movements [3]
[12]
[18]
[19]. In addition, endoscopists were not asked whether they were using a lead apron.
Therefore, its influence on the development of MSIs (especially located in the neck
and back, due to its weight) could not be investigated directly. However, because
the lead apron is mandatory protective equipment, especially in ERCP, it can be considered
that at least 73 % of those interviewed use it while performing ERCP. In the current
study, no statistical significance was found between practice of ERCP and development
of MSIs, confirming findings from a previous study [19] but differing from another [17].
Conclusions
The high frequency of MSIs among gastrointestinal endoscopists supports the need to
increase awareness about the importance that ergonomics plays in injury prevention.
The present study shows that considerations about ergonomics should be implemented
in different fields of gastrointestinal endoscopy. As a recommendation, the following
aspects should be considered to reduce injury prevention:
-
Promoting ergonomic training specific to gastrointestinal endoscopy
-
Reconsidering the position of the doctor during procedures, suggesting the possibility
of doctors sitting to reduce the load on joints if possible
-
Providing only adjustable, movable beds and screens in the OR, and adjusting these
during the ergonomics time-out.
