A Study on Prevalence, Risk Factors and Prevention of Work-Related Muscular Disorder among Physiotherapists

Work-related musculoskeletal diseases (WMSDs) are widespread among healthcare professionals, particularly those who have direct patient interactions, such as surgeons (1), nurses (2) and therapists (3). (3). Musculoskeletal discomfort is a potential indication of WMSD, leading to lifelong impairment if left untreated (4). (4). Physiotherapists, who often specialize in fields such as disease prevention and post-trauma care, have a good grasp on how to avoid musculoskeletal injuries. Yet, they still face a significant risk of developing WMSD because to the nature of treatment itself, which includes things like doing the same activities repeatedly, standing in one place for extended amounts of time, and treating several patients in a day (5–7). Musculoskeletal discomfort is the leading cause of physiotherapy absenteeism, which has serious consequences for productivity and economic advantages, as reported in a recent online survey (8). Just as Nordin (9) and Obembe (10) revealed, physiotherapists could also become patients.[1] The prevalence of work-related musculoskeletal diseases (WRMDs) among physiotherapists (PTs) is as high as 91%, and the recurrence rate is 88%, as documented in prevalence research done by West therapists (PTs) interact directly with patients and engage in a variety of physically demanding tasks in the clinic setting. The increasing demand for PT services has resulted in a larger patient load, which in turn has raised the workload and the physical strain on PTs.[2] Musculoskeletal diseases (MSDs) are highly frequent among healthcare personnel. The frequency of MSDs across numerous healthcare professions was studied. Prevalence of above 80% has been recorded among physiotherapists, masseurs, nurses, midwives, dentists and surgeons. The high exposure to MSDs is directly tied to their profession, which involves different duties and a significant physical load. Several studies have emphasized the usage of repeated difficult postures that are typically immobile, notably among surgeons and physiotherapists. [3] Nurses and physical therapists have also been witnessed doing patient transfers or handling. It has been established that the need for precision in the dental and medical fields contributes to the development of MSDs. [4] While trying to figure out what causes MSDs to show up, it helps to know which parts of the body are most vulnerable. The lower back has been shown to be an especially vulnerable location in several research conducted on physiotherapists, nurses, and surgeons. The neck and the shoulder have also been mentioned as vulnerable regions for medical staff. There have also been more targeted assessments of MSD prevalence, such as studies of masseurs' thumbs. Multiple sclerosis (MS) in the medical field has been studied from several angles, including the risk factors and responses/treatments used to lessen symptoms. It was first described for physical therapists by Muaidi and Shanb, then for nurses by Tinubu et al., and finally for surgeons by Mohseni-Bandpei et al. [5]

MATERIALS AND METHOD

Many research, including those by Cromie JE et al. (2000), Bindu PH et al. (2014), Milhem et al. (2016), Ramanandi V et al. (2021), Karanikas N et al. (2021), etc., have examined the prevalence of WMSDs in the physiotherapy profession and found it to be rather high. Several research have highlighted the general risk factors and preventative techniques of WMSDs among physiotherapists. Nonetheless, the prevalence of WMSDs among physiotherapists may vary with their area of expertise, as each subfield serves a distinct function. The purpose of this research was to examine the present state of knowledge about the incidence, risk factors, and preventative measures for WMSDs among physiotherapists in different fields of practice. [6] Work-related musculoskeletal disorders, physical therapists, physiotherapists, prevalence, risk factors, physiotherapy were all searched for in Scopus, Web of Science, PEDro, EMBASE, MEDLINE, Google Scholar, and PubMed (NML) until January 2022 using a predefined strategy. The data from publications were not restricted in any way. All papers with potentially relevant titles and abstracts were read. All articles that were found were examined, including their cited sources. [7] Criteria for inclusion in the research included: (1) Studies written in English (2) Studies dealing with WMSDs in PTs (3) Study type randomized control trials only. [8] Articles that did not pertain to WMSDs in PTs, were originally published in languages other than English, or lacked access to the complete text were not considered. This narrative review draws conclusions after rationally analyzing articles and references. [9]

RESULT

Table 1 provides information on the research that have been done on the prevalence of WMSDS in different physiotherapy subspecialties. For the purpose of making evidence-based recommendations (1a), this review solely included randomized controlled trials.[10]

Anatomical sites impacted in Physiotherapists are shown in Table 2 by gender. Comparisons between the sexes show that women are more likely to have pain in their low back, neck, and shoulders than men are, but both sexes experience pain in their low back, neck, wrists, and hands. [11]

Figure 2 shows that the majority of physiotherapists (60%) encounter WRMD during the first five years of practice after graduating, whereas only 4.1% have WRMD after this timeframe. A similar reaction was seen in a study that divided participants by gender and examined when WRMD symptoms first appeared. (Table 3). [12]

Overwhelmingly (97%), respondents said they are familiar with ergonomics, and over 60% said they have had training on the topic. (Third Picture). [13] notable impact on WRMD are shown. Most participants (77%) cited prolonged static postures employed during treatment as a risk factor, [14] followed by the number of patients treated each day (68.2%), and finally, bending, twisting back in uncomfortable positions when treating patients (65.8%). [15]

7.271), p=0.007 from a chi-square test revealed statistically significant relationships between fitness sub-specialty and WRMD (Table 7)

According to Rugelj D, physiotherapists in primary care settings experience 73.7% more cases of low back pain than those working in hospitals. 15 Buddhdev & Kotecha found a 35% prevalence of LBP, Maheshwari et.al. found a 72.5% prevalence, and Malavizhi D et.al. found a 60% prevalence; these studies all focused on the low back. [17] Common risk factors for LBP include serving a high volume of patients in a single day, assuming uncomfortable postures such as bending or twisting the back, standing in one place for extended periods of time, moving or transporting heavy equipment or dependent patients, and not taking enough breaks. [18] Many factors contribute to WMSD, and certain risks cannot be controlled for (e.g., genetics). [19] Yet, we may lessen the likelihood of developing low back discomfort by avoiding potentially precipitating activities and behaviors. 18 Low back discomfort in healthy professionals may be reduced via careful patient handling, the use of patient transfer equipment (e.g., lifts), getting other personal support for lifting, adjusting the posture of the patient or therapist, and frequent practice of physical exercise. Manual therapy, manually resisted exercises and assisted stretches, adequate body mechanics, and other strategies like changing posture, adjusting bed height, using aids and 6,11 Physical therapists may lessen their strain by scheduling patients with varying degrees of physical difficulty and taking breaks in between sessions. [20] Full, normal spinal mobility is made possible by the strength and pliability of tissues around the spine and pelvis, which also prevents excessive stresses on the joints and lessens the likelihood of damage. Abdominal and back muscles that are sufficiently strong aid in stabilizing the spine, facilitating healthy spinal movement, and making it simpler to maintain upright posture. [21] To lift with the correct form and mechanics, you need strong hip and leg muscles. Hence, in order to keep the therapist physically healthy, abdominal and lower limb strengthening activities should be undertaken. Flexibility may be enhanced through stretching. Muscle fatigue, pain, and future WMSDs of the low back may all be avoided with frequent self-stretching exercises.[22]

Many studies show that the neck is the second most common site of injury for physiotherapists. Buddhdev & Kotecha reported a prevalence of 25% for neck pain and 15% for upper back pain, whereas Maheshwari et al. reported 72.5 and 28.6 percent, while Malavizhi D et al. reported 62.9 and 51.9%. [23] The shoulder, wrist/hand, and elbow were the additional upper limb joints affected. Physiotherapists often treat patients with neck and upper limb WRMDs such tension headaches, muscle strains, myalgia, carpal tunnel syndrome, de Quatrain’s disease, trigger finger, digital neuritis, arthritis of the carpometacarpal joint, etc. Mobilization and manipulation procedures, therapeutic massage techniques and other hands-on therapy, as well as repetitive performance of the same work, may all contribute to the development of WMSDs in the neck, upper back, and upper limbs. Treating a high patient volume per day has also been linked to increased risk of thumb and hand discomfort. Physiotherapists may help prevent injuries by using measures like work rotation and reducing the amount of time spent doing repetitive actions. [24] Physical therapists can reduce strain on their upper body and spine by, among other things, taking frequent breaks, scheduling less physically demanding patients immediately after more physically demanding ones, and making use of lightweight or ergonomically designed equipment that does not require an awkward, hunched over position while using it. Muscle tension and discomfort, as well as potential work-related musculoskeletal disorders (WMSDs) of the neck, upper back, and upper extremities, may be avoided with regular strength training and a variety of self-stretching activities.[25]

knee was 15%; according to Maheshwari et.al., it was 12.1%; and according to Malavizhi D et.al., it was 30.4%. [26] Because of the long periods spent kneeling and squatting, paediatric physiotherapists have a greater incidence of knee complaints. 2,13. If you have to work in a kneeling posture for more than an hour straight, your knees will start to hurt unless you take regular rests, sit on a mat or other soft, firm surface, and wear knee protectors. A physiotherapist's day often consists of a number of different tasks, including manual therapy, stretching and limb physiotherapy, and the use of electrotherapeutic modalities. The physiotherapist should sit in a more ergonomic posture, with their feet flat on the floor and their back straight, to reduce the risk of knee discomfort while treating the patient. [27] Therapists who must stand for extended periods of time to provide therapy should take on derived standing stances like walking and striding and constantly transfer their weight from one leg to the other.[28]

Among physiotherapists, several studies have shown that the correlation between age and WMSDs is strongest for those in their early twenties. Studies show that this is because newly certified therapists, in search of career direction, choose to work in therapeutic areas that are physically demanding and need higher work hours. It's possible that freshly licensed physiotherapists, as compared to their more seasoned counterparts, don't know as much about the many ways to deal with stress and anxiety that might help avoid WMSDs.[29]

As compared to male physiotherapists, the prevalence of WMSDS was shown to be considerably greater among female physiotherapists in a study by Nordin NAM et al. Female physiotherapists have been shown to be more prone to WMSDs than their male counterparts in a number of studies, which has been attributed to the fact that women tend to be shorter and physically weaker than men, which can put them at a disadvantage when performing care tasks like lifting and transferring patients.[30] Studies found that male physiotherapists, perhaps due to their increased use of mobilization & manipulation techniques, had more neck, wrist, hand, & thumb complaints than female physiotherapists.[31] Changes in spinal posture and a weakening of joint structures5 make the lower back a frequent target of pregnancy-related stress, which also affects women.

When it comes to getting patients back on their feet after an illness or accident, physiotherapists play a vital role in the healing process. The prevalence of WMSDs in various body parts may vary with a physiotherapist's area of expertise. As musculoskeletal physiotherapists have to conduct a lot of manual treatment and stand in one place for lengthy periods of time, they often have pain in their thumbs, necks, and lower backs. More patients relying on the neuro physiotherapist for transfer and lifting activities, as well as passive and supported mobility for ADL, increases the risk of low back WMSDs. Treating a high volume of patients each day and standing in awkward postures while bending and twisting both increase the risk of developing WRMD. Therefore, owing to the type and pattern of employment participation in Physiotherapy, removing these risk factors is unlikely. The literature review highlights the following risk factors: patient transfer and lifting, manual therapy techniques, static postures, responding to unexpected patient movement, repetitive tasks, bending, twisting, continuing to work even while injured, treating an excessive number of patients in a single day, inappropriate work scheduling, and so on. Nevertheless, further research is needed to determine the full scope of WRMD's risk factors and to create relevant and effective PT-specific tools for use with Pts.

1. Bindu PH and Thiruppathi A. Work related musculoskeletal discomfort among physiotherapists. International Journal of Physiotherapy. 2014;1(4):200-204. DOI: https://doi.org/10.15621/ijphy/2014/v1i4/54 558. 2. Dsouza S, Mathew A, Kumar DKU. Work related musculoskeletal disorders in physiotherapist; prevalence and associated factors: a review of literature. Int J Health Sci Res. 2016; 6(6):344-351 3. Buddhadev NP, Kotecha IS. Work-related musculoskeletal disorders: a survey of physiotherapists in Saurashtra region. National journal of medical research. 2012;2(2):178-181. 4. Adegoke BO, Akodu AK, Oyeyemi AL. Work-related musculoskeletal disorders among Nigerian physiotherapists. BMC musculoskeletal disorders. 2008 Dec;9(1):1- 9.

6. Ramanandi V, Desai A. Prevalence and Risk Factors of work-related Musculoskeletal Disorders among Indian Physiotherapists: A Narrative Review of Literature. Archives of Occupational Health. 2021 Apr 10;5(2):961-8. 7. Mondal A, Mehedi MMH. Work Related Musculoskeletal Disorders among Physiotherapists in Dhaka City. Bone Muscle. 2019; 2:001- 004 8. Anyfantis ID, Biska A. Musculoskeletal disorders among Greek physiotherapists: Traditional and emerging risk factors. Safety and health at work. 2018 Sep 1;9(3):314-8. 9. Rugelj D. Low back pain and other workrelated musculoskeletal problems among physiotherapists. Applied ergonomics. 2003 Nov 1;34(6):635-9. 10. Kumar S. Theories of musculoskeletal injury causation. Ergonomics. 2001;44(1):1 11. Cromie JE, Robertson VJ, Best MO. Workrelated musculoskeletal disorders in physical therapists: prevalence, severity, risks, and responses. Physical therapy. 2000 Apr 1;80(4):336-51. 12. Milhem M, Kalichman L, Ezra D, Alperovitch-Najenson D. Work-related musculoskeletal disorders among physical therapists: A comprehensive narrative review. International journal of occupational medicine and environmental health. 2016 Jul 4;29(5):735-47 13. Rossettini, G., Rondoni, A., Schiavetti, I., Tezza, S., & Testa, M. Prevalence and risk factors of thumb pain in Italian manual therapists: An observational cross-sectional study. Work (Reading, Mass.). 2016;54(1):159–169. 14. Hazle, C. R., Jr, & Lee, M. Strategies to overcome size and mechanical disadvantages in manual therapy. The Journal of manual & manipulative therapy.2016;24(3):120–127. https://doi.org/10.1080/10669817.2015.111 9371 15. Woods A, & Woods CB. An exploration of the perspectives of elite Irish rowers on the role of the sports physiotherapist. Physical therapy in sport: official journal of the Association of Chartered Physiotherapists in Sports Medicine. 2012;13(1):16–21. https://doi.org/10.1016/j.ptsp.2011.02.004 https://sportsphysiotherapy.org.nz/w hat-is-sports-physiotherapy/ 17. Ashton H. Sports physiotherapy advancing in New Zealand. Br J Sports Med. 2015 Jul;49(14):903. 18. Ju YY, Cheng HY K, Hsieh YJ. et al. WorkRelated Musculoskeletal Disorders in Athletic Trainer. J Occup Rehabil. 2011; 21:190–198. 19. Atia DT, Abdelazeim FH, Radwan H. Impact of work-related musculoskeletal disorders on Egyptian pediatric physical therapists: one-year follow-up study. Trends in Applied Sciences Research. 2015 Mar 1;10(3):175. 20. Islam M. Common Work-Related Musculoskeletal Disorders Among the Paediatric Physiotherapists at CRP (Doctoral dissertation, Department of Physiotherapy, Bangladesh Health Professions Institute, CRP); Aug 2012 21. Happy SM. Common work-related musculoskeletal disorder among the physiotherapists of neurology unit at CRP (Doctoral dissertation, Bangladesh Health Professions Institute, Faculty of Medicine, the University of Dhaka, Bangladesh.) http://hdl.handle.net/123456789/398 2016- 08-16 22. Sunder S. Textbook of rehabilitation. Jaypee Brothers Medical Publishers; 2020 23. Burns PB, Rohrich RJ, Chung KC. The levels of evidence and their role in evidence-based medicine. Plastic and reconstructive surgery. 2011 Jul;128(1):305. 24. Cromie JE, Robertson VJ, Best MO. Workrelated musculoskeletal disorders in physical therapists: prevalence, severity, risks, and responses. Physical therapy. 2000 Apr 1;80(4):336-51. 25. Ramanandi VH, Desai AR. Association of working hours, job position, and BMI with work-related musculoskeletal disorders among the physiotherapists of Gujarat—an observational study. Bulletin of Faculty of Physical Therapy. 2021 Dec;26(1):1-6. 26. Ramanandi V, Desai A. Prevalence and Risk Factors of work-related Musculoskeletal Disorders among Indian Physiotherapists: A Narrative Review of Literature. Archives of

Musculoskeletal Disorders among Physiotherapists in Dhaka City. Bone Muscle. 2019;2:001- 004 28. Happy SM. Common work-related musculoskeletal disorder among the physiotherapists of neurology unit at CRP (Doctoral dissertation, Bangladesh Health Professions Institute, Faculty of Medicine, the University of Dhaka, Bangladesh.). http://hdl.handle.net/123456789/398 2016- 08-16 29. Milhem M, Kalichman L, Ezra D, Alperovitch-Najenson D. Work-related musculoskeletal disorders among physical therapists: A comprehensive narrative review. International journal of occupational medicine and environmental health. 2016 Jul 4;29(5):735-47. 30. Sharan Deepak, PS Ajeesh. Injury prevention in physiotherapists - a scientific review Work. 2012; 41:1855-1859 DOI: 10.3233/WOR-2012-0397-1855 IOS Press 31. Islam M. Common Work-Related Musculoskeletal Disorders Among the Paediatric Physiotherapists at CRP (Doctoral dissertation, Department of Physiotherapy, Bangladesh Health Professions Institute, CRP); Aug 2012

Physiotherapist, Physiotherapy Division Head, Home Health Care, Prince Sultan Medical Military City