Work-Related Musculoskeletal Disorders of Perioperative 2017. 8. 18.¢  Work-Related Musculoskeletal

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  • Work-Related Musculoskeletal Disorders of Perioperative

    Personnel in the Netherlands PAUL MEIJSEN, BED, MA; HANNEKE J. J. KNIBBE, MSC, RPT

    Editor’s note: In the Netherlands, person- nel working in the OR typically are not nurses. Personnel who want to work in the scrub, circulating, or first assistant roles undertake a three-year education program, after which they become operatieassistenten (singular: operatieassistent). This term has been used throughout the article to clarify that these OR personnel perform many of the duties that perioperative nurses perform in the United States, but they are not RNs.

    Approximately one-third of allcases of sick leave for healthcare workers are related to musculoskeletal disorders (MSDs) orig- inating in the neck, shoulders, and back. The causes of these disorders are mainly related to the high exposure to heavy physical loads involved in work in health care.1 The percentage of sick leave among hospital staff members in the Netherlands was 7.8% in 1999, and thus considerably higher than the mean for the working population as a whole (ie, 5.4%).2 This finding resulted in an agreement between the Dutch Ministry of Social Affairs and Employment; the Ministry of Health, Welfare, and Sport; and health care employers and unions to try to reduce the incidence of sick leave and the number of worker’s com- pensation claims in hospitals and create a safe and pleasant working environ- ment for hospital staff members.

    Earlier studies of perioperative per- sonnel have focused mainly on the caus- es of physical pain and measures for pre- vention.3-6 The purpose of this study was to gain insight into the nature and scope of MSDs. It is necessary to gather epi- demiological information on the nature and scope of MSDs to ascertain whether they are more prevalent in perioperative

    settings than in the general population. Based on this information, causes can be explored and preventive measures can be sought and implemented. This study also provides reference data that could be of use in testing the effectiveness of preven- tion policies.

    Two specific research questions and a third more general research question were asked. • What is the prevalence of MSDs

    among operatieassistenten in the Netherlands?

    • What percentage of sick leave can be attributed to MSDs among oper- atieassistenten in the Netherlands?

    • What causes and possible preventive measures do operatieassistenten themselves perceive with regard to MSDs? To answer the research questions, the

    APPROXIMATELY ONE-THIRD of all cases of sick leave for health care workers are related to muscu- loskeletal disorders (MSDs) originating in the neck, shoulders, and back.

    A CROSS-SECTIONAL MULTICENTER SURVEY based on the Nordic Questionnaire for Analysis of Musculoskeletal Symptoms investigated the nature and scope of MSDs among Dutch OR personnel.

    THE THREE-MONTH PREVALENCE RATES for MSDs in OR personnel were found to be high com- pared to MSDs in the general population and com- parable to rates in other strenuous professions in health care, industry, and construction. The causes of MSDs that participants mentioned were summarized into four main categories: prolonged standing, awk- ward postures, lifting and pushing; and climactic conditions. AORN J 86 (August 2007) 193-208. © AORN, Inc, 2007.


    © AORN, Inc, 2007 hAUGUST 2007, VOL 86, NO 2 • AORN JOURNAL •193

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    researchers chose to use a self-administered questionnaire to efficiently gather anonymous results that are generalizable at a national level.7

    DESIGN The study was a cross-sectional multicenter

    survey. Data were collected on a one-time basis in 16 operating departments in 16 hospi- tals, by means of a questionnaire consisting of closed and open-ended questions.

    INSTRUMENT The questions used in this study were based

    on the Nordic Questionnaire for Analysis of Musculoskeletal Symptoms.8 This question- naire has been tested by other authors and found to have good reliability and validity.8,9

    There is also abundant reference material available about the instrument.8,9 The same types of questions have been asked in ergo- nomic studies for more than 15 years. This form of questioning avoids diagnostic labeling and enables comparison of various groups irrespective of, for example, level of education or potential diagnoses. Another advantage of using the Nordic questionnaire is that the influences of possible bias within this ques- tionnaire are similar in other studies using the same questionnaire, so comparisons between groups can easily be made.

    Hildebrandt9 concludes that there is suffi- cient correlation between pain experienced and the results of a standardized clinical exam- ination; Kuorinka et al8 describe this as well. The degree to which a person’s own report agrees with the opinion of the physiotherapist after examination varies from 87% to 100%. This means that the answers that 87% to 100% of the participants give on the Nordic ques- tionnaire match the physiotherapist’s findings on examination. These findings support the validity of the questionnaire. Kuorinka also studied response stability by asking a group of 25 nurses the same questions again two weeks later (ie, test-retest), and at least 96% of the answers were the same.

    A factor that can jeopardize the reliability of results is nonresponse. For example, a distort- ed view can be given if only people suffering from MSDs complete the questionnaire and

    people who do not have any pain do not do so. This is called selective response, and the Nordic questionnaire appears to be sensitive to it.10 To minimize the effects of this kind of selection, every effort was made to ensure that all the questionnaires that had been distrib- uted were completed and returned. A mini- mum response rate of 80% for questionnaires like the Nordic is desirable.10

    For an additional guarantee of reliability and validity, a small pilot study was conducted among operatieassistenten (N = 10). The ques- tionnaire was complemented with specific questions on the working situation of oper- atieassistenten. These questions were mainly intended to explore any topics that the main questionnaire might have missed. Experts in the subject matter were closely involved in the drafting of the questions. After the question- naire was completed, participants were asked to indicate the time it took them to complete the questionnaire, and short interviews were used to check that the questions, including the open-ended ones, were clear. The questionnaire was then adjusted on the basis of the feedback.

    SAMPLE There are 110 hospitals in the Netherlands.

    The aim of this study was to include 10% of these hospitals in order to generalize to a national level. An appeal was placed in the magazine Operationeel of the Landelijke Vereniging Van Operatieassistenten (LVO [Dutch Organization of Operatieassistenten]). Sixteen operatieassistenten with an interest in research and physical stress who were work- ing in 16 hospitals spread throughout the Netherlands responded that they were willing to participate in the research group, so 16 par- ticipating hospitals each had a delegate mem- ber on the research team. The group was assisted by a project leader, two human move- ment scientists, and an epidemiologist. A valu- able combination of science, research, and professional knowledge on the part of oper- atieassistenten was thus created.

    Ten meetings were organized with this team. During the meetings, the research proj- ect was prepared, processed, and discussed. The members of this research team were

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    involved in drafting, distributing, and collect- ing the questionnaires. They also made valu- able contributions to the processing and dis- cussion of the results. This organizational approach meant that it was possible to conduct a large-sample survey. Personal supervision by members of the research team ensured a good response, swift data collection, and objective instructions to the participants during the study. Full privacy protection was offered to all participants.

    SELECTION OF PARTICIPATING HOSPITALS. The selec- tion of the 16 participating hospitals had been a mix of convenience and chance, so the researchers discussed the participating hospi- tal sample and compared basic characteristics with the general national situation. They found the sample to be a good representation of Dutch hospitals. The researchers also were able to test the data from this study against data from a sample of operatieassistenten from a previously performed national survey for the operatieassistenten labor market in 2001.11 The distribution of small, medium, and large hos- pitals in this study is similar to the national distribution.

    SELECTION OF OPERATIEASSISTENT SAMPLE. The mem- bers of the research team were instructed to stimulate the response, but at the same time not to compromise the representative nature of the sample. The number of participants could vary from one hospital to another, with no minimum and maximum numbers set. In situations where it was not possible to include the whole ward in the study, the members of the research team received instructions to avoid unconscious selec- tion effects by selecting participants by the drawing of lots. Only qualified operatieassisten- ten or operatieassistenten in training (ie, stu- dents) were approached and asked to fill out the questionnaire.

    PRIVACY AND CONFIDENTIALITY. Together with the questionnaires, the participants received an information and instruction form i

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