Work-related musculoskeletal complaints and ergonomic risk factors among Egyptian anesthesiologists: a cross-sectional study

Anesthesiologists are particularly susceptible to WMSDs which is considered an impending epidemic given the imminent workforce shortage and increasing economic burden. However, the reported prevalence and risk factors differ between studies [16, 22]. Our study findings suggest a high prevalence of WMDs amongst Egyptian anesthesiologists (71.6%), with 51.2% reporting lower back pain in the past 12 months, 57.1% was severe enough to seek medical care or sick leave, and 100% having MSDs complaint at least once a week. The number of awkward postures during work was the strongest predictor of WMSDs, where the odds of MSDs complaints in the past 12 months was about four times higher among anesthesiologists experiencing three or more awkward postures compared to those experiencing a single awkward posture. Other predictors of WMSDs in our sample were increasing age, lack of regular physical exercise, and insufficient rest between procedures.

Earlier studies showed a high variability in the estimated 12-month prevalence of WMSDs among anesthesiologists. In our study, the estimated 12-month prevalence of WMSDs among anesthesiologists is 71.6%, which is comparable to the reported worldwide values that ranged from 34 to 98.4% [15, 16, 22]. Among the Arab countries, our finding is lower than the estimated prevalence of low back pain among anesthesiologists (82.4%) in Saudi Arabia [19]. Albayadi et al., a recent study in Egypt, reported that all anesthesiologists had at least one MSDs complaint in the past 12 months [18]. Though, the actual incidence of WMSDs may be significantly higher due to underreporting [23]. The underreporting of WMSDs among healthcare workers is multifactorial. It involves intentional concealment due to the fear of job loss, the avoidance of filing workers’ compensation claims, and the inadequate benefits provided by workers’ compensation, which creates an economic incentive for underreporting work-related injuries. Instead, healthcare workers may opt for seeking care and wage replacement through health insurance and paid personal time. Beyond intentional concealment, other reasons include the failure to correctly diagnose or recognize a disorder as work-related, a physician’s preference to self-manage the condition or rely on over-the-counter medications, employers suppressing reporting through administrative systems, and the compilation of inaccurate injury logs to avoid safety inspections [24].

In our study, the lower back was the most frequently reported body region for WMSDs among anesthesiologists in the past 12 months. This finding is comparable to a recent Turkish study by Tolu and Basaran [16], and a systematic review by Tavakkol et al. [25] The later reported that low back was the most prevalent MSDs among operating room personnel with a pooled global estimate of 61.5%, and individual studies ranging from 5.5 to 84.0%. Moreover, WMSDs of the lower back was the most frequent complaint among our study participants in the past 7 days, which is in line with findings from Tolu and Basaran [16]. Increased prevalence of lower back complaints might be attributed to the extreme rotational movements of the spine and overreaching for objects in key anesthetic procedures such as spinal anesthesia [23]. Though, Leifer et al. [15] reported that the nature of many anesthesia-related tasks poses greater risk of poor posture for the neck and upper limbs.

WMSDs are the leading cause of disability, absenteeism, and reduced productivity among healthcare workers. A 2018 meta-analysis by Epstein et al. [22] reported that 12% of physicians required a leave of absence, work restriction or modification, or ended up early retirement. However, our study showed that over half of participants required sick leave or medical care due to their WMSDs. This finding is comparable to other earlier studies with a percentage ranged from 43.9 − 65.9% [16, 18].

The etiology of WMSDs is multifactorial and has been best explained by the biopsychosocial model of health, founded by Waddell in 1987 [13, 26, 27], WMSDs are influenced by individual factors such as sex, comorbidities, job design, workplace environment, overwork, fatigue, and stress levels of employees [12, 27]. In addition, anesthesiologists are subject to ‘double burden’ which mandates balancing simultaneously the demands of multiple paid work with unpaid domestic-family work [12]. Our study findings suggest that anesthesiologists are facing challenging work schedules and workloads, with 79.1% working for extended hours (≥ 40 h per week), predominantly night shifts, and about two thirds were overloaded with numerous lengthy procedures per week with insufficient rest. However, the rest time between procedures was the only significant predictor for WMSDs where insufficient rest time is associated with 2.25 times greater odds of WMSDs compared to sufficient rest time. These findings are in line with Tolu and Basaran study [16] which reported 2.62 greater odds of WMSDs with insufficient rest time. Lack of association with gender, extended work hours, night shifts, and excess lengthy procedures contradicts many earlier studies [16, 28‐30].

Anesthesiologists have a high risk for WMSDs due to sustained repetitive or forceful movements, static and awkward postures, and challenges with instrument design [10, 15, 17, 31]. The present study identified prolonged standing, repetitive head movement, head low position or tilting as the most frequent awkward postures among anesthesiologists. Besides, the increasing number of experienced awkward postures significantly predicts WMSDs where having at least three awkward postures is associated with 3.5 times greater odds of WMSDs compared to a single awkward posture. This observation is consistent with earlier studies demonstrating the ergonomic risk factors for WMSDs [16, 28, 32].

Although the literature suggest that young less experienced anesthesiologists are more likely to adopt awkward postures during procedures, [15] our study findings showed that older (≥ 45 years) anesthesiologists had significantly 3.22 times greater likelihood for WMSDs compared to younger participants. This finding can be attributed to the age-related changes in individual biomechanical tolerance to strength and loads, and the cumulative nature of ergonomic-related MSDs [12, 33]. Besides, regular exercise is recommended to alleviate fatigue resulting from working for extended hours and increased workloads among anesthesiologists [34]. Our findings support this recommendation since regular physical exercise among study participants was significantly associated with a 75% reduction in the odds of WMSDs compared to lack of exercise.

Several limitations should be considered while interpreting our study findings. Selection and misclassification bias are the major limitations of this study. Although the response rate of our study was acceptable, the convenience sampling using electronically accessible candidates increases the likelihood of selection bias. The use of a self-report instrument may increase the likelihood of participants responding if they had symptoms. However, the NMQ is a validated tool for WMSDs screening. Furthermore, the double-burden [12] is common in developing countries which may increase the liability for misclassification bias. The cross-sectional design of this study hinders causal inference due to the absence of information on the temporal relationship between the outcome and exposure. Finally, the study did not assess psychosocial factors as a significant factor contributing to WMSD according to the biopsychosocial model.