Prevalence of Work-Related Musculoskeletal Disorders Among Surgeons and Interventionalists: A Systematic Review and Meta-analysis

Abstract

Importance: Physicians in procedural specialties are at high risk for work-related musculoskeletal disorders (MSDs). This has been called "an impending epidemic" in the context of the looming workforce shortage; however, prevalence estimates vary by study.

Objectives: To estimate the prevalence of work-related MSDs among at-risk physicians and to evaluate the scope of preventive efforts.

Data sources and study selection: Systematic search in MEDLINE (Ovid), Embase (Elsevier), Web of Science, PubMed (National Center for Biotechnology Information), and 2 clinical trial registries, without language restriction, for studies reporting on the prevalence and prevention of work-related MSDs among at-risk physicians published until December 2016. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines for meta-analyses and systematic reviews of observational studies were used. At-risk physicians were defined as surgeons and medical interventionalists. Studies reporting on specific disorders or pain assessed with validated instruments were included.

Data extraction and synthesis: Study characteristics; disease prevalence for the neck, shoulder, back, and upper extremity; and measures of resulting disability were recorded. Study estimates were pooled using random-effects meta-analytic models.

Main outcomes and measures: Career prevalence of injuries and 12-month prevalence of pain.

Results: Among 21 articles (5828 physicians [mean age, 46.0 years; 78.5% male; 12.8 years in practice; 14.4 hours performing procedures per week]) included in this systematic review and meta-analysis, pooled crude prevalence estimates of the most common work-related MSDs were degenerative cervical spine disease in 17% (457 of 2406 physicians) (95% CI, 12%-25%), rotator cuff pathology in 18% (300 of 1513 physicians) (95% CI, 13%-25%), degenerative lumbar spine disease in 19% (544 of 2449 physicians) (95% CI, 5%-16%), and carpal tunnel syndrome in 9% (256 of 2449 physicians) (95% CI, 5%-16%). From 1997 to 2015, the prevalence of degenerative cervical spine disease and degenerative lumbar spine disease increased by 18.3% and 27%, respectively. Pooled prevalence estimates for pain ranged from 35% to 60% and differed by assessment instrument. Of those with a work-related MSD, 12% (277 of 2319 physicians) (95% CI, 7%-18%) required a leave of absence, practice restriction or modification, or early retirement. Heterogeneity was considerable for all crude analyses (mean I2 = 93.5%) but was lower for sensitivity analyses (mean I2 = 72.3%). Interventions focused on products and behaviors. Twelve at-risk specialties described a gross lack of awareness and an unmet need for ergonomics education.

Conclusions and relevance: Prevalence estimates of work-related MSDs among at-risk physicians appear to be high. Further research is needed to develop and validate an evidence-based applied ergonomics program aimed at preventing these disorders in this population.

Figure 1.. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Flow Diagram of the Systematic Literature Search and Review Protocol

NCBI indicates National Center for Biotechnology Information; NIH, National Institutes of Health; PICO, population, injury, or context; and WHO, World Health Organization.
^a Nine articles presented data for multiple outcomes of interest and were added more than once for analysis.
^b See eTable 2 in the Supplement for study-level reasons for exclusion.

Figure 2.. Meta-analyses of the Career Prevalence of Work-Related Musculoskeletal Injuries Among At-Risk Physicians Stratified by Site of Injury

Included were 6 studies for degenerative cervical spine disease (A), 4 studies for rotator cuff pathology (B), 7 studies for degenerative lumbar spine disease (C), and 7 studies for carpal tunnel syndrome (D).

Figure 3.. Meta-analyses of the 12-Month Prevalence of Work-Related Neck Pain and Shoulder Pain Among At-Risk Physicians Stratified by Site of Pain and Assessment Instrument

Included were 8 studies for neck pain (A) and 7 studies for shoulder pain (B). MIS-E indicates minimally invasive surgery–endoscopy; MIS-R, minimally invasive surgery–robotic; NMQ, Nordic Musculoskeletal Questionnaire; Ob/Gyn, obstetrics and gynecology; and PDS, Physical Discomfort Survey.

Figure 4.. Meta-analyses of the 12-Month Prevalence of Work-Related Back Pain and Upper Extremity Pain Among At-Risk Physicians Stratified by Site of Pain and Assessment Instrument

Included were 11 studies for back pain (A) and 6 studies for upper extremity pain (B). MIS-E indicates minimally invasive surgery–endoscopy; MIS-R, minimally invasive surgery–robotic; NMQ, Nordic Musculoskeletal Questionnaire; Ob/Gyn, obstetrics and gynecology; and PDS, Physical Discomfort Survey.