Effect of Ergonomic Physiotherapy on Work Related
Musculoskeletal Disorders
Abdulrhman Ahmed Alhusaini1*, Nauwaf Ali M
Almushaiqeh2, Othman Meshari Almeshari3, Saleh Abdullah
Almarshad4, Bandar Abdulmohsen Alsada5
1 Physiotherapist, PSMMC, Riyadh, KSA
aalhusaini@psmmc.med.sa
2 Physiotherapist, PSMMC, Riyadh, KSA
3 Physiotherapist, PSMMC, Riyadh, KSA
4 Physiotherapist, PSMMC, Riyadh, KSA
5 Physiotherapist, PSMMC, Riyadh, KSA
Abstract : Pain, functional
impairment, and decreased productivity are symptoms of work-related
musculoskeletal diseases (WMSDs), which affect both those with physically
demanding jobs and those with more sedentary work situations. Adjustments to
the workstation, exercises to strengthen the muscles, and education on proper
posture are all examples of ergonomic physiotherapy treatments. These therapies
aim to reduce the incidence of these disorders by treating the underlying
environmental and physiological reasons. This systematic review was conducted
with the intention of determining whether or not ergonomic treatments (PEIs)
administered by physiotherapists are effective in the prevention or management
of work-related stress injuries (WMSDs). Between the years 2009 and 2025, the
experiments were conducted using a randomization method. Six high-quality
studies have shown that PEIs increase both functional outcomes and pain in the
muscles and joints. PEIs also improve the results of functional tests. In
particular, this is the case when the PEIs combine specialized strengthening
exercises with modifications to the workstation. Due to limitations such as
small sample sizes, the lack of participant blinding, and variation in
intervention regimens, it is evident that more study of a high quality is
required despite the fact that these potentially positive effects have been
achieved.
Keywords:
Ergonomic physiotherapy, Work-related musculoskeletal Disorders, Workstation modification,
Strengthening exercises, Occupational health.
INTRODUCTION
Pain, discomfort, and
incapacity may be caused by musculoskeletal diseases (MSDs), which are medical
problems that affect soft tissues such as muscles, tendons, ligaments, nerves,
and more. Repetitive movements, bad postures, over-lifting, and unsuitable
ergonomic work environments are the main causes of MSDs, which impact many
different occupations. Musculoskeletal problems are becoming more common in sedentary
jobs as a result of poor ergonomic design and extended static postures [1,2].
Previously, these illnesses were associated with high-workload sectors
including manufacturing, construction, and healthcare. Back discomfort, carpal
tunnel syndrome, tendinitis, and neck strain are some of the MSDs that may
develop as a result of long-term exposure to certain occupational risk factors.
According to research,
these symptoms may be worsened by ergonomically unsound working practices,
which in turn lowers productivity and dissatisfaction on the job [3]. Different
industries have different rates of MSDs. Among the most impacted sectors in the
European Union, according to studies, are physically demanding occupations
(e.g., construction and healthcare), where between 30 and 80 percent of workers
report MSD-related problems. On the other hand, owing to inadequate workstation
design and extended sitting, more and more office workers are reporting MSDs,
especially in the lower back, neck, and shoulders. Direct expenditures, like
healthcare and rehabilitation, and indirect costs, like absenteeism and
decreased productivity, contribute to the substantial economic burden of MSDs.
Employers in the US alone lose almost USD 50 billion a year due to compensation
and lost productivity due to MSDs, which make up one-third of all workplace
injuries [4]. Employers and healthcare systems throughout the globe bear a
heavy financial burden due to the high prevalence of disability caused by
MSD-related accidents. Ergonomic treatments have grown in popularity as a means
to address this rising tide of worry by lowering the MSD risk factors and
enhancing workplace safety [5].
Tools and adjustments
to the workplace, such as sit-stand desks, ergonomic chairs, and adjustable
workstations, are examples of physical ergonomic interventions. Workflow
optimization for improved mental workload management, focus, and
decision-making is the goal of cognitive ergonomics. A lot of companies have
implemented training programs to teach their employees about proper lifting,
posture, and workplace ergonomics. It has been shown that training may raise
awareness, but it doesn't really change behavior in the long run unless it's
paired with ergonomic and physical treatments. Hence, a more all-encompassing method
of preventing MSDs may be to use multi-faceted ergonomic treatments that
include physical, cognitive, and training-based tactics [6,7].
Inconsistencies in
research design, intervention techniques, and outcome assessments have kept the
efficacy of ergonomic therapies controversial, despite their widespread
application. Ergonomic modifications have been shown to reduce the incidence of
MSDs in certain studies, whereas others have shown little or very little
long-term impact. A lack of consistent procedures, inadequate long-term
follow-ups, and insufficient comparison studies across diverse occupational
contexts are some of the significant deficiencies in the current research that
are emphasized by this heterogeneity.
OBJECTIVES
1.
To
assess how well ergonomic therapies administered by physiotherapy may reduce
musculoskeletal pain in individuals who work in physically demanding
environments.
2.
To
evaluate how ergonomic physiotherapy therapies affect workers with WMSDs in
terms of their functional results and productivity.
METHOD
In addition to ProQuest
Central, ScienceDirect, PubMed, and Taylor & Francis Online, EBSCOhost was
also used in the process of doing a comprehensive literature search. This was
done to ensure that all relevant information was located. There were keywords
such as "rehabilitation," "physical therapy," and
"physiotherapy" that appeared in the search results.
The search was focused
on medical specialists that provide ergonomic solutions. In order to ascertain
the results, search terms such as "work-related musculoskeletal
disorders" and "work-related injuries" were used. This was done
with the intention of focusing on musculoskeletal health issues among persons
who are employed. The search terms that were connected to interventions were
"ergonomics" and "ergonomic interventions," with the
primary emphasis being placed on physiotherapist-delivered therapies for the
prevention and management of work-related stress disorder (WMSD) in the
workplace.
Here are the criteria that were used for inclusion:
Using the PEDro scoring system, which measures internal validity, reporting
clarity, and statistical adequacy, each selected research was independently
screened and evaluated by two reviewers for methodological quality. This was
done in order to ensure that the studies were of sufficient quality. All of the
studies that had a score of six or above on the PEDro scale were deemed to have
a high level of methodological quality and were included in the end review.
The following types of information were gathered from each research:
participant characteristics, the kind of profession, specifics about ergonomic
interventions, outcome measures, the length of time that participants were
followed up, and study outcomes. The purpose of the research was to compile
data about the efficacy of ergonomic treatments that were administered by
physiotherapy in the prevention or management of work-related musculoskeletal
illnesses among people who were employed in physically demanding jobs.
RESULT
Table 1:
Summary Table
|
Study |
Interventions
Provided |
Functional
Outcome Measures |
Pain
Outcome Measures |
PEDro
Score |
|
Pillastrini
P et al. |
Spinal
stabilization and strengthening of core and hip musculature; Ergonomic
education |
Oswestry
Disability Index |
Visual
Analog Scale |
8/10 |
|
Welch A
et al. |
Assessing
workstation set-ups and modifications; Cervical and shoulder musculature
strengthening |
None |
Subjective
Pain Scale |
7/10 |
|
Munoz-Poblete
C et al. |
Theraband
stabilization program of the shoulder; Strengthening of upper extremity |
Disabilities
of the Arm, Shoulder and Hand |
Visual
Analog Scale |
7/10 |
|
Tsang
SMH et al. |
Assessing
workstation and modifications; Electromyography biofeedback; Re-education of
motor control; TENS and Ultrasound modalities |
Neck
Disability Index; Disabilities of the Arm, Shoulder and Hand |
Numeric
Pain Rating Scale |
6/10 |
|
Bultmann
et al. |
Assessing
workstation and modifications |
Oswestry
Disability Index |
Verbal
Pain Scale |
6/10 |
|
Figl-Hertlein
A et al. |
Assessing
workstation and modifications; Strengthening and individualized programs |
Short
Form-36 |
None |
5/10 |
Studies that were
conducted in the past that were systematic in nature explored the efficacy of
ergonomic therapies that were delivered by disciplines other than physical
therapy [8-11]. As a result of the comprehensive assessment that was carried
out, it was determined that PEI was successful in reducing pain and improving
functional capacities in physical therapy workers. Out of the six research,
four of them investigated how rearranging workstations might potentially
alleviate discomfort and improve function while working [12,13].
Workstation
Adjustment
The researchers Welch
and colleagues investigated how the pain that office workers experience in
their necks was changed by exercise as well as modifications to their
workstations. The participants, who totaled 763 in total, were randomly
allocated to either an intervention group or a control group at the beginning
of the experiment. The intervention group was selected at random, and they
participated in strength training, adaptations to their workstations, and
physical activity for a period of twelve weeks. Those who were assigned to the
control group were instructed on how to make constructive adjustments to their
way of life. For the purpose of this study, the Subjective Scale was used as
the outcome measure.
Additionally, it was
given both before and after the intervention was carried out. The results were
not statistically significant; nevertheless, after a period of twelve weeks,
those who were part of the intervention group reported experiencing reduced
pain in their neck. In spite of the fact that the authors arrived at the
conclusion that increased physical activity and adjustments to the working
environment can decrease neck pain, further research is necessary before concluding
anything definitive. Motor control re-education, modalities, workstation
adjustments, and muscle activation and relaxation strategies were all evaluated
by Tsang et al. [14] for their efficacy in alleviating WRNSP. The total number
of participants was 101, and they were split into two groups: one group was
assigned to the control group (n = 50), while the other group was assigned to
the workplace transformation intervention (n = 51). The participants in the
intervention group received training on motor control as well as modifications
to their workstations that were suited to their specific responsibilities.
Those who were selected to be in the control group were given the opportunity
to choose their own off-site physical therapy practitioner.
When it came to pain,
some of the outcome measures were the NDI, the DASH, and the NPRS. At the
one-year follow-up, the study examined the groups and found that there were no
significant differences between them (p < 0.05). Additionally, the research
discovered that both groups had decreased pain. Patients with WRNSP who got
therapy on-site, on the other hand, demonstrated statistically significant
improvements in their overall recovery at the one-year follow-up. With the use
of complete on-site therapy, workers who are experiencing pain due to WRNSP may
be able to obtain relief from their condition, as stated by the authors. The
researchers Bultmann and colleagues [15]. examined the impact that
individualized alterations to workstations had on the amount of discomfort
experienced and the number of sick days taken due to low back pain while on the
job.
A total of 119
participants were randomly allocated to one of two groups: the control group,
which consisted of 51 individuals, and the intervention group, which included
68 individuals. An individual was regarded to be a participant if they
submitted a request for sick absence due to experiencing low back pain while
their work was being performed. Individualized work rehabilitation was provided
to the intervention group, which included adjustments to the workstation as
well as return-to-work programs. This was in contrast to the usual case
management therapy that was provided to the control group. In order to quantify
the outcomes, we used both the ODI and a pain rating scale that ranged from 0
to 10. Six and twelve months after the injury, respectively, these were given
to the treatment recipient. At six and twelve months, the intervention group
demonstrated a substantial increase in function and a decrease in discomfort
when compared to the control group, which had access to standard case
management.
In comparison to the group that served as the
control, the intervention group reported a lower number of sick days. The
authors believe that with the assistance of return-to-work programs and
adjustments to workstations, it may be able to reduce the amount of pain and
sick leave that is experienced by workers who have been injured. Figl-Hertlein
et al. [16] conducted a study on the influence of exercise and workstation
modification treatments on the general health of secondary school teachers in
Austria. The questionnaire that they used was called the Short-Form 36 (SF-36).
Within the framework of the cluster randomized pilot study, a convenience
sample was used. The total number of participants was 69, and they were divided
evenly between an intervention group (n = 26) and a control group (n = 43). Six
sessions of thirty minutes each were held with a physical therapist for the
intervention group over the course of a period of the five months. The
participants gained knowledge on ergonomics, how to alter their workstations,
and ways for managing stress while participating in these workshops.
One education session
on stress management was provided to the group that served as the control. With
regard to the SF-36 ratings, the data demonstrated that after five months of
the semester, the intervention group had an improvement (although one that was
not statistically significant), whilst the scores of the control group remained
unaltered. When it comes to avoiding health decline, the authors came to the
conclusion that secondary school teachers in Austria would benefit from direct
occupational health programs conducted by physical therapists rather than
relying only on instruction. For the purpose of enhancing their external
validity, ergonomic treatments that are administered via physical therapy in
the workplace need more research.
Education and
Strengthening
When compared to the
control groups, the intervention groups in two of the six studies used
strengthening programs when compared to the control groups. The fact that
ergonomic education was included in the control groups in each of the six
studies suggests that it is not sufficient to relieve pain and enhance function
for people who are employed in professions that require a high level of
physical exertion. Researchers Pillastrini et al. [17] conducted a cluster
randomized controlled trial with 71 nursery school teachers who were all
suffering from low back pain. All of the participants in the experiment were in
the same position. Participants were randomly allocated to either a control
group that got exercise instruction pamphlets (n = 35) or an intervention group
that received a program conducted by a physical therapist to strengthen their
hips, trunk, and spinal column (n = 36).
The control group
received exercise instruction pamphlets. As a supplemental measure, the Visual
Analog Scale (VAS) was used, whilst the Roland Morris Disability Questionnaire
and the ODI were utilized as the primary end measures. All outcome variables
were filled out at the baseline assessment as well as the assessment that took
place two months after the intervention. On the Roland Morris Disability
Questionnaire, the ODI, and the VAS, members in the experimental group
demonstrated significant progress in comparison to those in the control group
after two months of treatment. After conducting their research, the authors
came to the realization that, in contrast to teaching alone, strengthening
therapies could be more effective in reducing low back pain among employees
working in nursery schools. Moreover, Munoz-Poblete and colleagues carried out
research on exercise programs with the purpose of lowering the incidence of
occupational injuries.
The 109 workers at the
plant who were randomly assigned to either the intervention group (n = 56) or
the control group (n = 53) were all engaged in repetitive actions involving the
upper extremities while they were doing their jobs. Participants in the program
were given a series of exercises that were aimed to stabilize the shoulder
joint. These exercises helped participants strengthen their shoulders as well
as the back of their upper limbs. Those who were assigned to the control group
were just instructed to do upper-extremity stretches. Among the outcome
measures that were used were the DASH and the VAS. The control group's scores
on the DASH and VAS were much lower than those of the intervention group, which
reported significantly higher ratings. According to the findings of the
authors, resistance training is an effective intervention that may successfully
minimize the risk of injuries to the upper extremities that industrial workers
face [18].
For the purpose of this
systematic review, each and every research that was included had a long list of
qualifications attached to it. In each of the six studies, however, it was not
feasible to blind the participants since it was not possible. In addition, the
sample sizes were quite small, which was an additional limitation that was
imposed. The inability to blind participants and the use of a small sample size
both contribute to a reduction in the research's capacity to generalize its
findings and its external validity. When doing future research, it may be
possible to improve both the generalizability and the external validity of the
findings by encouraging participants to be blinded and by utilizing larger
sample sizes.
DISCUSSION
According to the
findings of this research [19,20], physiotherapy-delivered ergonomic treatments
are an effective method for reducing the risk of working-related stress
disorders (WMSDs) in occupational settings. Alterations to the workstation,
such as modifying the height of the chair, the location of the monitor, and the
layout of the desk, were consistently associated with reductions in the amount
of pain experienced in the neck, shoulders, and lower back. To give you an
example, a research that was carried out by Welch and colleagues discovered
that office workers who coupled strengthening exercises with changes to their
workstations had reduced stiffness in their necks. However, the limited number
of participants in the research had an impact on the statistical significance
of the findings.
Similarly, Tsang et al.
found that after one year of follow-up, musculoskeletal pain was reduced and
general healing was enhanced with on-site therapies that included biofeedback,
motor control re-education, and modalities such as transcutaneous electrical
nerve stimulation (TENS) and ultrasound. These therapies were administered at
the patient's location. The findings of studies carried out by Pillastrini et
al. and Munoz-Poblete et al. shed light on the value of exercise-based
treatments in combination with education. These studies shown that
strengthening interventions that targeted the core, hip, and upper extremity
muscles improved function and decreased pain.
The investigations were
restricted in their ability to generalize owing to variables such as small
sample sizes, a lack of blinding persons, and variance in intervention
techniques and outcome measurements [21]. Despite the fact that there was
evidence of favorable benefits, the studies were considered to be limited in
their potential to generalize. In addition, the fact that education alone did
not result in improvements that were long-lasting brings into focus the need of
full ergonomic therapies that include exercise, modifications to workstations,
and ongoing training. When it comes to the prevention and treatment of
work-related stress disorders (WMSD), these findings demonstrate that ergonomic
physiotherapy is an essential component of the jigsaw when it comes to
workplace health management strategies.
CONCLUSION
Employees who are
suffering from musculoskeletal problems that are caused by their work may be
able to get ergonomic treatments from physiotherapists. This is a possibility.
It is possible that these therapies will alleviate the workers' discomfort and
improve their ability to do their jobs. In order to get the most reliable
results, the treatments that combine specific strengthening exercises with
posture training and adjustments to the workstation are the ones that are most
effective. On the other hand, generalizability is difficult to attain because
of the variable nature of the research design and the small number of samples
that were collected. In the future, there will be a need for randomized
controlled trials that are conducted on a bigger scale and make use of
standardized intervention approaches. It will be required to conduct these
research in order to bolster the evidence and provide more insight into
occupational health policies.
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