Work-Related Musculoskeletal Disorders Risk Assessment during Manual Lymphatic Drainage with Compressive Bands among Physiotherapists

Abstract

Background: Complete decongestive therapy is the standard treatment for lymphedema. Manual lymphatic drainage and short-stretch multilayer compression bandaging are two daily stages of complete decongestive therapy during which physiotherapists work with patients.

Objective: The aim of this study was to assess the risks of musculoskeletal disorders to which physiotherapists are exposed during these two phases.

Method: Five physiotherapists performed five 20 min manual lymphatic drainages, followed by the compression bandaging phase. From the video recordings, 8477 postures defined by 13 joint angles were grouped into clusters using hierarchical cluster analysis. The risk of musculoskeletal disorders in physiotherapists' postures was assessed using ergonomic tools.

Results: Seven clusters, called generic postures (GP), were identified and defined throughout the mean joint angle values and standard deviation. Four seated GPs were found for the drainage phase, and three standing GPs were identified for the bandaging phase. This phase corresponded to a quarter of the total duration. The GP's ergonomic scores ranged from 4.51 to 5.63 and from 5.08 to 7.12, respectively, for the Rapid Upper Limb Assessment (RULA) and Rapid Entire Body Assessment (REBA). GP1, GP3, and GP4 presented the highest ergonomic scores (RULA scores: 5.27 to 5.63; REBA scores: 6.25 to 7.12). The most affected areas were the neck (flexion > 20° for all GPs), trunk (flexion between 25 and 30° for GP2, and GP7 during the bandaging phase and GP4 during the drainage phase), and shoulder (flexion and abduction >20° for all GPs except GP5).

Conclusions: These results highlighted that the two complete decongestive therapy phases could be described as a combination of GP. Ergonomic assessment showed that compression bandaging as well as drainage phases expose physiotherapists to moderate musculoskeletal disorder risks that require "further investigation and change soon".

Keywords: REBA; RULA; ergonomic assessment; massage; occupational health; posture; risk.

Figure 1

Compression bandaging wrapped around the limb of a patient with lymphedema. On the left is an elastic compression band. On the right is compression device is composed of foam blocks encased between two non-woven bandages.

Figure 2

Ward’s minimum variance linkage dendrogram representing the seven-cluster solution of the hierarchical cluster analysis achieved from all measured postures during manual lymphatic drainage. The horizontal black line represents the cluster separation threshold. Each color represents a cluster of similar postures called “generic posture”.

Figure 3

Distribution of MSD risk by physiotherapist using RULA (left panel) and REBA (right panel) scores for the MLD phase, the CB phase, and the 2-CDT phases. The central histogram represents the relative proportion of MLD and CB phases. Mean RULA and REBA scores were computed from the scores obtained for all postures used by each physiotherapist (PT).

Figure 3

Distribution of MSD risk by physiotherapist using RULA (left panel) and REBA (right panel) scores for the MLD phase, the CB phase, and the 2-CDT phases. The central histogram represents the relative proportion of MLD and CB phases. Mean RULA and REBA scores were computed from the scores obtained for all postures used by each physiotherapist (PT).

Figure 3

Distribution of MSD risk by physiotherapist using RULA (left panel) and REBA (right panel) scores for the MLD phase, the CB phase, and the 2-CDT phases. The central histogram represents the relative proportion of MLD and CB phases. Mean RULA and REBA scores were computed from the scores obtained for all postures used by each physiotherapist (PT).