Effect of chair types on work-related musculoskeletal discomfort during vaginal surgery.

BACKGROUND: Evidence supports that surgeons are at high risk for work-related musculoskeletal disorders. OBJECTIVE: The objective of the study was to compare the effect of different chairs on work-related musculoskeletal discomfort for surgeons during vaginal operations. STUDY DESIGN: This crossover study randomly assigned 4 surgeons to 4 chair types using a 4 × 4 Latin square model: a conventional round stool, a round stool with a backrest, a saddle chair with a backrest, and a Capisco chair. Subjective assessments of surgeon discomfort were performed with a validated body discomfort survey, and workload was assessed with the surgical task load index. The objective postural load was quantified with inertial measurement units of the modified rapid upper limb assessment limits. Subjective and objective assessments of chair comfort were performed with an 11 point scale and seat interface pressure-mapped distributions, respectively. The primary outcome was the difference in body discomfort scores between pre- and postsurgery measurements. Secondary outcomes were the differences in chair comfort scores, postural load, and seating interface pressure-mapped distribution. For each outcome, comparisons among the chair types were based on fitting a linear mixed model that handled the surgeon as a random effect and the chair type as a fixed effect. RESULTS: Data were collected for 48 vaginal procedures performed for pelvic organ prolapse. Mean (SD) duration of surgery was 122.3 (25.1) minutes. Surgeons reported body discomfort during 31 procedures (67.4%). Subjective increase in discomfort from the preoperative state was noted most commonly in the lower back (n = 14, 30.4%), followed by right shoulder (n = 12, 26.1%), upper back (n = 8, 17.4%), hips and buttocks (n = 7, 15.2%), left shoulder (n = 6, 13.0%), right or left thigh (n = 6, 13.0%), and neck (n = 6, 13.0%). Pre- and postsurgery body discomfort scores did not differ with respect to chair type. Chair discomfort scores for the round stool and the saddle chair were significantly higher than the round stool with backrest and the Capisco chair (P < .001). Although the average modified rapid upper limb assessment postural scores showed moderate to high musculoskeletal risk of neck and shoulder discomfort across the 4 surgeons; chair type did not affect postural scores. The saddle chair had significantly reduced dispersion of seated pressure vs the round stool with backrest (P ≤ .001), depicted by the number of cells with pressure values >5 mm Hg. An increased dispersion of pressure across the chair surface was associated with increased comfort (Spearman correlation, 0.40, P = .006). CONCLUSION: Musculoskeletal strain and associated discomfort for surgeons are very high during vaginal operations. Chair type can affect comfort, and chairs with more uniform distribution and fewer pressure points are more comfortable. However, the chair type used in surgery did not influence the musculoskeletal postural load findings.

Work-related musculoskeletal disorders among vaginal surgeons.

INTRODUCTION AND HYPOTHESIS: Work-related musculoskeletal disorders (MSDs) reportedly affect a large proportion of providers in obstetrics and gynecology. We hypothesize a high MSD prevalence rate among vaginal surgeons associated with surgeon- and work-related characteristics. METHODS: Surveys were distributed to members of the International Urogynecological Association and American Urogynecological Society. Exclusion criteria included inability to read English, no computer access, invalid or unavailable e-mail address, and missing >50% of responses. RESULTS: Among respondents, 86.7% (436/503) reported ever having work-related MSDs. On univariate analysis, surgeons involved in surgical teaching were significantly more likely to report work-related MSDs. Female surgeons had more frequent and more severe MSDs in the neck, dominant shoulder, and upper back. Older age and more years of work experience were associated with seeking medical attention. Right-hand dominance was associated with negative consequences on work behavior. CONCLUSIONS: A large proportion of vaginal surgeon respondents reported work-related MSDs.

Comparison of required operating forces between floor-based and overhead-mounted patient lifting devices.

This study investigated the differences in required push, pull and rotating forces for moving fully loaded, floor-based and overhead-mounted full body patient lifting devices with simulated patients of varying weight on a floor of optimal design (i.e. level vinyl tile over concrete). A single person operated the lifting devices for all of the tests. Eighteen male and female volunteer participants, ranging in weight from 51 to 146 kg, acted as patients during the lifting tests. For each test, the simulated patients were pushed and pulled for 3.7 linear metres and were rotated while sitting in the lift slings. Force measurements were acquired using two single axis dynamometers affixed to the lifting devices. Results revealed that, in general, operator input force and torque increased with patient weight category and floor-based lifts required greater force and torque compared to the overhead-mounted lift. Comparison of the required forces with published force limits reveals that the required push and pull force from the various patient lift systems, across all weight categories, were generally acceptable to 90% of the female population. The required forces for these patient transfer tasks, however, could exceed maximum acceptable force limits if the floor surfaces were less than ideal, such as floors composed of carpet, wood, or inclined surfaces. Additional research is needed to assess these conditions.