Prevalence of work-related musculoskeletal disorders among health care professionals: A systematic review

Abstract

BACKGROUND:

Work-related musculoskeletal disorders (WRMSDs) are one of the main causes of morbidity among healthcare professionals. It has various secondary consequences on productivity by diminishing the quantity and quality of work completed by the affected personnel, in addition to having a primary impact on the individual with pain and discomfort.

OBJECTIVE:

The study aims to determine the overall prevalence rate of WRMSD among dentists, physiotherapists, and surgeons and also identify the commonly affected regions of the body about specific health care professions among each of the three professions, as recorded by the cross-sectional studies performed in various countries and regions of the world.

METHODS:

RESULTS:

Out of the 42 articles that met the eligibility criteria, there were 39 cross-sectional studies, 2 pilot cross-sectional surveys and 1 prospective cohort study with one-year follow-up. All studies included in this review used various survey tools for recording the demographic details and measuring the prevalence of WRMSDs and other outcome factors.

CONCLUSION:

We conclude that all three health care professionals (dentists, physiotherapists and surgeons) are highly prone to develop WRMSDs with surgeons and dentists being more vulnerable when compared to physiotherapists. The lower back and neck are identified as the two most commonly affected regions among all three professionals.

Keywords

Health care professionals occupation related disorders body pain neck pain back pain occupational safety

1 Introduction

Musculoskeletal disorders (MSDs) are described by the National Institute for Occupational Safety and Health (NIOSH) as damage to the human body’s musculoskeletal system, particularly at the bones, spinal discs, tendons, joints, ligaments, cartilage, nerves, and blood vessels. Work-related musculoskeletal disorders (WRMSDs) are conditions in which the workplace environment and tasks performed at work contribute significantly to the condition. WRMSDs are considered one of the most serious occupational dangers among the working population, in addition to being one of the leading causes of short-term work impairment. WRMSDs have a significant impact on the health care system as a secondary consequence, decreasing productivity and quality of health care services [1].

According to the World Health Organisation (WHO) and NIOSH, WRMSD, also known as cumulative trauma disorder (CTD), repetitive strain injury (RSI), or repetitive motion injury (RMI) of the musculoskeletal system, are thought to be caused by a combination of factors, including the interaction of the work environment, psychosocial, organisational, and other cultural factors, as well as exposure to clinical conditions [2, 3].

WRMSDs may develop in health care professionals as a result of their repetitive movements, labor-intensive jobs, static work positions, manual handling procedures, and working quicker than is comfortable. Additionally, adopting awkward postures for extended periods of time at work appears to result in static muscular loading, which considerably increases the number of risk factors that can ultimately lead to the development of WRMSDs [4]. About 60% of MSDs are reported to be caused by unilateral musculoskeletal loading over a longer period of time, which is required by the healthcare industry [5]. Another theory about the origin of MSDs adopted a work posture that differs from the neutral position [6].

Dentists are reported to be more prone to WRMSDs than other medical professionals [7]. The numerous risk factors that dentists encounter while performing clinical work, such as continuous static postures in both sitting and standing, weird non-ergonomic positions, repetitive task performance above the anatomical and physiological limit, strained and precise wrist-hand movements, exposure to mechanical stress, forceful movements, and vibration, are frequently linked to the increased prevalence of WRMSDs in this population [5 –17].

Health difficulties brought on by MSDs in dentists might result in significant socioeconomic challenges, which can lower treatment quality, increase absenteeism, and raise the rate of leaving the field [18]. Dentists view proper ergonomic adjustments as a high-quality preventive measure for WRMSDs [19 –22].

Physiotherapy is a dynamic field that involves a variety of activities in settings ranging from private clinics or rehabilitation centers to academic institutions or public hospitals, subjecting physiotherapists to a demanding workload [23, 24]. As a result of their strenuous and physically demanding clinical practice, physiotherapists are also thought to be more prone to WRMSDs [25 –28]. Due to WRMSDs, about one-sixth of physiotherapists appear to switch workplaces or resign their positions. They have, however, also been observed to engage in self-protective behavior by receiving prompt treatment and altering lifestyles [29]. As a direct cause or risk factor, the intense physical job— which includes performing manual therapy procedures, transferring dependent patients, adopting overly strenuous and unconventional work postures, and regularly lifting, stooping, twisting, and turning— is associated with WRMSDs in physiotherapists [30 –35].

When compared to other health care providers, surgery is regarded as a profession that puts its practitioners at a higher risk of developing WRMSDs [36]. Besides the physically demanding job, surgeons also perform a lot of psychosocial work, including speaking with patients and their families, making difficult clinical decisions, and handling the consequences of those decisions [37].

The frequency and prevalence of MSDs are believed to be highest among orthopaedic surgeons, followed by general surgeons, and they are shown to be more exposed to multiple occupational risks than the other surgery specialists [38 –42]. The high prevalence of WRMSDs among surgeons is attributed to their physically and mentally demanding work, which includes performing time-consuming surgeries, intense concentration, repetitive movements, and fixed postures while using surgical tools, sustained abnormal positions, the pressure to perform error-free manoeuvres, extended hours of standing, high exposure to hazardous chemicals and radiations in operating rooms, and accurate and emergent decision making, insufficient sleep and rest further damages their health [39 –44].

Among health care professionals, WRMSD is one of the main causes of morbidity. It has various secondary consequences on productivity by diminishing the proportion and quality of work completed by the affected personnel, in addition to having a primary impact on the individual with pain and discomfort. The employment of health care workers involves several elements that put the musculoskeletal systems under tension, which causes the development of MSDs. These factors include extended work hours (40 to 90 hours per week), heavy lifting, and repetitive motions. The professionals may not be able to offer quality care and services as a result of their pain and suffering, and their ability to work for a longer period of time may also suffer. Therefore, the purpose of this study is to ascertain the overall prevalence rate of WRMSD among dentists, physiotherapists, and surgeons as well as to pinpoint the body parts that are most frequently affected by a particular health care profession among each of the three professions, according to cross-sectional studies carried out in numerous nations and regions of the world.

2 Methods

2.1 Quality assessment

To ensure an unbiased, transparent, and clear reporting of the systematic review, the preferred reporting items for systematic reviews and meta-analysis (PRISMA) checklist were used. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess the quality of each of the studies being included in the review (Fig. 1).

Fig. 1

PRISMA flowchart.

2.2 Search strategy

A systematic search strategy was framed following the PRISMA guidelines based on the present inclusion and exclusion criteria. A critical search of articles was conducted during June 2020 in CINAHL (DOAJ), PubMed, Google Scholar Scopus, PEDro databases, and SAGE journals. All databases were browsed for open access, English articles with no limitations on the year of publication. To obtain relevant articles, filters and Boolean operators “AND” & “NOT” were utilized. The search field was restricted to title and abstract alone while searching in PMC to obtain more specific articles. The search terms and search protocol used are listed in Table 1. Separate searches were carried out for each of the three professionals targeted (dentists, physiotherapists, and surgeons).

Table 1
Search strategy

Database Filter used Key search terms Search field Results Selected articles

PubMed Open access Musculoskeletal disorders All fields 1894 46

English Dentists Title/ abstract

Human Surgeon MESH terms

Physiotherapists

Physical therapists

CINAHL (DOAJ) Open access Musculoskeletal disorders All fields 131 29

Dentists

Surgeon

Physiotherapists

Google Scholar Scopus (no filter) Prevalence All fields 733 26

Musculoskeletal disorders

Dentists

Surgeon

Physiotherapists

PEDro Open access Musculoskeletal disorders All fields 0 0

Dentists

Surgeon

Physiotherapists

SAGE Open access Musculoskeletal disorders Abstract 30 2

Dentists All fields

Surgeon

Physiotherapists

2.3 Data extraction

Two independent researchers searched five different databases, performing individual searches for each of the three professionals. The title, abstract, and full text of each article was assessed to analyze if they met the prefixed eligibility criteria. A third researcher performed a separate search of all identified records to ensure that no eligible articles were being missed. After a final check and inclusion in the review, the articles were scrutinized further to extract the following factors: study design, outcome measure, sample details, profession targeted, general prevalence, and regional prevalence measure.

2.4 Inclusion criteria

Open access and full-text articles; studies including only dentists, physiotherapists, and surgeons; studies including the assessment of the regional prevalence rate of MSDs; WRMSDs measuring across all body sites; studies dealing with only one profession; and English articles.

2.5 Exclusion criteria

Systematic reviews and meta-analyses, case reports, editorials, and letters to the editors; studies including students, non-clinical professionals, and/or other workers like assistants, in the prevalent measure of MSDs; studies including professionals other than dentists, physiotherapists, and surgeons; and studies which did not include the regional prevalence measure of all three major regions (upper limb, spine, and lower limb). One article was excluded as it was retracted from PubMed and another article was excluded as it included students in the selected sample [47]. The majority of the studies were excluded from the review as they did not include the measurements of WRMSDs among all three major body regions [45 , 48–59].

3 Results

Out of the 42 articles that met the eligibility criteria (Fig. 1), there were 39 cross-sectional studies, 2 pilot cross-sectional surveys, and 1 prospective cohort study with one year follow-up [33]. No relevant randomized control trials were found in the search strategy. All studies included in this review used various survey tools for recording the demographic details and measuring the prevalence of WRMSDs and other outcome factors.

The tools used for measuring WRMSDs are listed in Table 2 and the region specific prevalence are listed in Table 3. The most commonly used outcome measures for WRMSDs were the Standardized Nordic Questionnaire and its various modified versions. Two studies [25, 32] utilized a questionnaire developed by Holder et al. [35] and one study [21] used a survey tool based on Cromie et al. [29]. A modified version of the physical discomfort survey has been used in two studies [40, 41], while the other studies used self-designed questionnaires as the survey tool.

Table 2
Study characteristics

Authors Study design Location of study Sample details Outcome measures

1. Lin et al. [18] Cross-sectional study Taiwan, China N = 197, M = 146, F = 51 Nordic Questionnaire modified by the Taiwan Institute of Occupational Safety and Health

2. Phedy and Gatam [7] Cross-sectional study Bintaro, Indonesia N = 241, M = 35, F = 206 Nordic Musculoskeletal Questionnaire

3. Zahoor et al. [19] An observatio nal cross- sectional study Lahore, Pakistan N = 467, M = 221, F = 246 Orebro Musculoskeletal Pain Questionnaire and a self- developed questionnaire

4. Khan et al. [6] Cross-sectional study Karachi, Pakistan N = 50, M = 24, F = 26 Nordic Musculoskeletal Questionnaire

5. Aljanakh et al. [8] Cross-sectional study Saudi Arabia N = 680 A self-administrated questionnaire based on the Nordic Musculoskeletal Questionnaire

6. Garbin et al. [9] Cross-sectional study Brazil N = 201, M = 75, F = 129 The Nordic Questionnaire developed by Kuorinka et al. [49]

7. Sustova et al. [5] Cross-sectional study Czech Republic, Europe N = 581, M = 163, F = 418 Self-designed three-part questionnaire based on Kuorinka et al. [49]

8. Prudhvi et al. [10] Cross-sectional study Visakhapatn am, India N = 100, M = 70, F = 30 Self-administrated previously validated Nordic Musculoskeletal Questionnaire based on Kuorinka et al. [49]

9. Leggat et al. [11] Cross-sectional study Queensland, Australia N = 285 Self-reported MSD Questionnaire

10. Revankar et al. [12] Cross-sectional study Salem, India N = 150 Self-administered questionnaire based on the Nordic Questionnaire

11. K kumar et al. [13] Cross-sectional study India N = 536 Self-administrated questionnaire

12. Shames Ali et al. [14] Cross-sectional study Mansoura city, Egypt N = 195 Self-designed questionnaire

13. Veeresh et al. [15] Cross-sectional study Davangere, Karnataka, India N = 70, M = 44, F = 26 Self-designed structured questionnaire modified from the Standardized Nordic Questionnaire

14. Sahu et al. [2] Pilot cross-sectional survey Gurgaon, Delhi, India N = 167, M = 79, F = 88 Standardized Nordic Questionnaire

15. Tamo et al. [20] Cross-sectional study Guwahati, Assam, India N = 156, M = 99, F = 57 Self-designed questionnaire based on the Nordic Musculoskeletal Questionnaire

16. Rafeemanesh et al. [16] Cross-sectional study Mashhad, Iran N = 58, M = 49, F = 9 Nordic Musculoskeletal Questionnaire

17. Bhatam and Yasobant [3] Cross-sectional study Bhopal, India N = 93 Nordic Musculoskeletal Questionnaire

18. Shaik et al. [17] Pilot cross-sectional survey Mangalore N = 30 Dental Workstation Observation Checklist - Close-ended Questionnaire

19. Nokhostin and Zafarmand et al. [21] Cross-sectional survey Iran N = 600, M = 405, F = 195 Questionnaire based on Cromie et al. [29]

20. Sankar et al. [22] Cross-sectional study India N = 259, M = 212, F = 47 Modified Nordic Questionnaire

21. Cromie et al. [29] Cross-sectional study Victoria, Australia N = 536, M = 118, F = 418 Self-administered, purpose designed questionnaire, based on the Standardized Nordic Questionnaire

22. Maheshwari et al. [23] Cross-sectional study Haryana, India N = 100, M = 22, F = 78 Standardized Nordic Questionnaire

23. Yesim and Ozcan [59] Cross-sectional study Izmir, Turkey N = 120, M = 28, F = 92 A two part questionnaire based on Holder et al. [35]

24. Anyfantis and Biska [30] Cross-sectional study Greece N = 252, M = 132, F = 120 Self-administrated questionnaire with seven sections

25. Al-Eisa et al. [31] Cross-sectional study Egypt and Saudi arabia N = 162 Validated self-administered questionnaire

26. Alrowayeh et al. [26] Cross-sectional study Kuwait N = 212, F = 99, M = 113 Self-designed three-part survey; Part 3 based on Kuorinka et al. [49]

27. Marayta et al. [27] Quantitative non-experimental survey Palestine N = 60, M = 29, F = 31 Self- administrated two part questionnaire

28. Nordin et al. [28] Cross-sectional study Malaysia N = 81, F = 63, M = 18 Self-designed questionnaire based on Kuorinka et al. [49]

29. Khairy et al. [32] Cross-sectional study Egypt N = 501, M = 267, F = 234 Self-administrated questionnaire based on Holder et al. [35]

30. Malarvizhi et al. [24] Observational cross-sectional study India N = 141, M = 81, F = 60 Nordic Musculoskeletal Questionnaire

31. Campo et al. [33] Observational prospectiv cohort 1 year follow-up USA N = 881, F = 627, M = 254 Self-designed survey based on Blair and Kuorinka et al. [49]

32. Alnefaie et al. [39] Cross-sectional study Saudi Arabia N = 121 Self-administered cross-sectional survey

33. Vaghela et al. [37] Cross-sectional study Gujarat, India N = 43, M = 30, F = 13 Standardized Nordic Questionnaire

34. Alzahrani et al. [40] Cross-sectional study North America N = 402 Modified version of the physical discomfort survey

35. AlQahtani et al. [41] Cross-sectional study Canada N = 86, M = 73, F = 13 Modified version of the physical discomfort survey

36. Tirgar et al. [43] Cross-sectional study Babol, Iran N = 45, M = 37, F = 8 Nordic Standardized Musculoskeletal Disorder Questionnaire

37. Knudsen et al. [38] Cross-sectional study Iowa, USA N = 15 Nordic Musculoskeletal Questionnaire

38. Mehrifar et al. [45] Cross-sectional study Tehran, Iran N = 40 Nordic Musculoskeletal Questionnaire

39. Vaidya et al. [36] Cross-sectional study Kathmadu, Nepal N = 50, M = 40, F = 10 Dutch Musculoskeletal Questionnaire and Standard Nordic Musculoskeletal Questionnaire

40. Dabholkar et al. [46] Cross-sectional study New Mumbai, India N = 75, M = 55, F = 20 Self-formulated three part questionnaire

41. Aghilinejad et al. [44] Cross-sectional study Tehran, Iran N = 81 Nordic Musculoskeletal Questionnaire

42. Tan and Kwek [42] Cross-sectional study Singapore N = 80 Nordic Musculoskeletal Questionnaire

Authors	Study design	Location of study	Sample details	Outcome measures
1. Lin et al. [18]	Cross-sectional study	Taiwan, China	N = 197, M = 146, F = 51	Nordic Questionnaire modified by the Taiwan Institute of Occupational Safety and Health
2. Phedy and Gatam [7]	Cross-sectional study	Bintaro, Indonesia	N = 241, M = 35, F = 206	Nordic Musculoskeletal Questionnaire
3. Zahoor et al. [19]	An observatio nal cross- sectional study	Lahore, Pakistan	N = 467, M = 221, F = 246	Orebro Musculoskeletal Pain Questionnaire and a self- developed questionnaire
4. Khan et al. [6]	Cross-sectional study	Karachi, Pakistan	N = 50, M = 24, F = 26	Nordic Musculoskeletal Questionnaire
5. Aljanakh et al. [8]	Cross-sectional study	Saudi Arabia	N = 680	A self-administrated questionnaire based on the Nordic Musculoskeletal Questionnaire
6. Garbin et al. [9]	Cross-sectional study	Brazil	N = 201, M = 75, F = 129	The Nordic Questionnaire developed by Kuorinka et al. [49]
7. Sustova et al. [5]	Cross-sectional study	Czech Republic, Europe	N = 581, M = 163, F = 418	Self-designed three-part questionnaire based on Kuorinka et al. [49]
8. Prudhvi et al. [10]	Cross-sectional study	Visakhapatn am, India	N = 100, M = 70, F = 30	Self-administrated previously validated Nordic Musculoskeletal Questionnaire based on Kuorinka et al. [49]
9. Leggat et al. [11]	Cross-sectional study	Queensland, Australia	N = 285	Self-reported MSD Questionnaire
10. Revankar et al. [12]	Cross-sectional study	Salem, India	N = 150	Self-administered questionnaire based on the Nordic Questionnaire
11. K kumar et al. [13]	Cross-sectional study	India	N = 536	Self-administrated questionnaire
12. Shames Ali et al. [14]	Cross-sectional study	Mansoura city, Egypt	N = 195	Self-designed questionnaire
13. Veeresh et al. [15]	Cross-sectional study	Davangere, Karnataka, India	N = 70, M = 44, F = 26	Self-designed structured questionnaire modified from the Standardized Nordic Questionnaire
14. Sahu et al. [2]	Pilot cross-sectional survey	Gurgaon, Delhi, India	N = 167, M = 79, F = 88	Standardized Nordic Questionnaire
15. Tamo et al. [20]	Cross-sectional study	Guwahati, Assam, India	N = 156, M = 99, F = 57	Self-designed questionnaire based on the Nordic Musculoskeletal Questionnaire
16. Rafeemanesh et al. [16]	Cross-sectional study	Mashhad, Iran	N = 58, M = 49, F = 9	Nordic Musculoskeletal Questionnaire
17. Bhatam and Yasobant [3]	Cross-sectional study	Bhopal, India	N = 93	Nordic Musculoskeletal Questionnaire
18. Shaik et al. [17]	Pilot cross-sectional survey	Mangalore	N = 30	Dental Workstation Observation Checklist - Close-ended Questionnaire
19. Nokhostin and Zafarmand et al. [21]	Cross-sectional survey	Iran	N = 600, M = 405, F = 195	Questionnaire based on Cromie et al. [29]
20. Sankar et al. [22]	Cross-sectional study	India	N = 259, M = 212, F = 47	Modified Nordic Questionnaire
21. Cromie et al. [29]	Cross-sectional study	Victoria, Australia	N = 536, M = 118, F = 418	Self-administered, purpose designed questionnaire, based on the Standardized Nordic Questionnaire
22. Maheshwari et al. [23]	Cross-sectional study	Haryana, India	N = 100, M = 22, F = 78	Standardized Nordic Questionnaire
23. Yesim and Ozcan [59]	Cross-sectional study	Izmir, Turkey	N = 120, M = 28, F = 92	A two part questionnaire based on Holder et al. [35]
24. Anyfantis and Biska [30]	Cross-sectional study	Greece	N = 252, M = 132, F = 120	Self-administrated questionnaire with seven sections
25. Al-Eisa et al. [31]	Cross-sectional study	Egypt and Saudi arabia	N = 162	Validated self-administered questionnaire
26. Alrowayeh et al. [26]	Cross-sectional study	Kuwait	N = 212, F = 99, M = 113	Self-designed three-part survey; Part 3 based on Kuorinka et al. [49]
27. Marayta et al. [27]	Quantitative non-experimental survey	Palestine	N = 60, M = 29, F = 31	Self- administrated two part questionnaire
28. Nordin et al. [28]	Cross-sectional study	Malaysia	N = 81, F = 63, M = 18	Self-designed questionnaire based on Kuorinka et al. [49]
29. Khairy et al. [32]	Cross-sectional study	Egypt	N = 501, M = 267, F = 234	Self-administrated questionnaire based on Holder et al. [35]
30. Malarvizhi et al. [24]	Observational cross-sectional study	India	N = 141, M = 81, F = 60	Nordic Musculoskeletal Questionnaire
31. Campo et al. [33]	Observational prospectiv cohort 1 year follow-up	USA	N = 881, F = 627, M = 254	Self-designed survey based on Blair and Kuorinka et al. [49]
32. Alnefaie et al. [39]	Cross-sectional study	Saudi Arabia	N = 121	Self-administered cross-sectional survey
33. Vaghela et al. [37]	Cross-sectional study	Gujarat, India	N = 43, M = 30, F = 13	Standardized Nordic Questionnaire
34. Alzahrani et al. [40]	Cross-sectional study	North America	N = 402	Modified version of the physical discomfort survey
35. AlQahtani et al. [41]	Cross-sectional study	Canada	N = 86, M = 73, F = 13	Modified version of the physical discomfort survey
36. Tirgar et al. [43]	Cross-sectional study	Babol, Iran	N = 45, M = 37, F = 8	Nordic Standardized Musculoskeletal Disorder Questionnaire
37. Knudsen et al. [38]	Cross-sectional study	Iowa, USA	N = 15	Nordic Musculoskeletal Questionnaire
38. Mehrifar et al. [45]	Cross-sectional study	Tehran, Iran	N = 40	Nordic Musculoskeletal Questionnaire
39. Vaidya et al. [36]	Cross-sectional study	Kathmadu, Nepal	N = 50, M = 40, F = 10	Dutch Musculoskeletal Questionnaire and Standard Nordic Musculoskeletal Questionnaire
40. Dabholkar et al. [46]	Cross-sectional study	New Mumbai, India	N = 75, M = 55, F = 20	Self-formulated three part questionnaire
41. Aghilinejad et al. [44]	Cross-sectional study	Tehran, Iran	N = 81	Nordic Musculoskeletal Questionnaire
42. Tan and Kwek [42]	Cross-sectional study	Singapore	N = 80	Nordic Musculoskeletal Questionnaire

N, Sample size; F, Female; M, Male.

Table 3

Profession and region specific prevalence rate

Authors	Profession targeted	Overall prevalence (%)	Region of body affected (%) (regional prevalence rate)
			Spine	Upper limbs	Lower limbs
1. Lin et al. [18]	Dentists	92.4	Neck - 71.6	Shoulder -75.1	Hip/thigh/buttock - 14.7
			Upper back - 45.2	Elbow - 27.4	Knee - 13.2
			Lower back - 66.5	Wrist/hand - 41.1	Ankle/foot - 13.2
2. Phedy and Gatam [7]	Dentists	63.5	Neck - 25.7	Shoulder - 24.9	Hip/thigh - 6.6
			Upper back - 22.4	Elbow - 3.3	Knee - 13.7
			Lower back - 20.7	Wrist/hand - 13.3	Ankle/foot - 17
3. Zahoor et al. [19]	Dentists	88	Lower back - 53	Shoulder - 33	Leg - 11
			Neck - 39	Arm - 7
4. Khan et al. [6]	Dentists	86	Neck - 96	Shoulder - 90	Hip/thigh - 44
				Upper extremity –	Knee - 34
				82	Ankle/foot - 20
5. Aljanakh et al. [8]	Dentists	77.9	Lower back - 73.5	Shoulder - 43.3	Hip/thigh - 13.2
			Neck - 66	Wrist/hand - 22.6	Knee - 11.3
			Upper back- 22.6	Elbow - 9.4	Ankle/foot - 9.4
6. Garbin et al. [9]	Dentists	81.4	Neck - 55.4	Shoulder - 52	Knee - 22.1
			Upper back - 50.5	Wrist/hand - 46.1	Ankle/foot - 15.7
			Lower back - 48.5	Elbow - 15.7	Hip/thigh - 15.2
7. Sustova et al. [5]	Dentists	96.9	Neck - 78.1	Shoulder - 52.2	Hip - 40.2
			Lower back - 75	Elbow - 28.3	Knee - 37.7
			Upper back - 49.7	Wrist - 38.8
				Fingers - 40.5
8. Prudhvi et al. [10]	Dentists	100	Neck – 56	Hand – 39	Ankle – 10
			Lower back - 32	Shoulder - 18	Knee - 8
			Upper back - 8	Elbow - 3	Hip/thigh - 6
9. Leggat et al. [11]	Dentists	87.2	Neck - 57.5	Shoulder - 53.3	Knee - 18.9
			Lower back - 53.7	Hand/wrist - 33.7	Hip/thigh - 12.6
			Upper back - 34.4	Elbow - 18	Ankle/foot - 11.6
10. Revankar et al. [12]	Dentists	84	Neck - 53.8	Shoulder - 26.3	Hip/thigh - 1.7
			Upper back - 13.7	Wrist/hand - 8.3
				Arm/forearm - 5
11. Kumar et al. [13]	Dentists	100	Neck - 75.74	Wrist/hand - 73.13	Hip/thigh - 29.85
			Lower back - 72.01	Shoulder/arm - 69.4	Knee/leg - 20.52
			Upper back - 18.65	Elbow/forearm - 7.46	Ankle/foot - 12.31
12. Shames	Dentists	(no detailts)	Lower back - 75.2	Shoulder - 58.2	Ankle/foot - 26.7
Ali et al. [14]			Neck - 73.9	Wrist/hand - 52.7	Knee - 25.5
			Upper back - 29.1	Elbow - 18.7	Hip/thigh - 11.5
13. Veeresh et al. [15]	Dental	34.71	Neck 71.42	Shoulder - 44.28	Ankle/foot - 20
	practitioners		Low back - 70	Hand/wrist - 42.85	Knee - 18.57
			Upper back - 28.57	Forearm - 24.28	Hip/thigh - 11.42
				Elbow - 15.71
14. Sahu et al. [2]	Dentists	81.06	Neck - 11.6	Wrist/hand - 3.55	Ankle/foot - 4.07
			Lower back - 10.38	Elbow - 2.4	Knee/leg - 2.89
			Upper back - 0.4	Shoulder/arm - 1.92	Hip/thigh - 2.89
15. Tamo et al. [20]	Dentists	70.51	Lower back - 48	Shoulder - 19	Ankle/foot - 12.8
			Neck - 24	Wrist/hand - 14	Hip/thigh - 11.5
			Upper back - 23	Elbow - 5	Knee - 6
16. Rafeema nesh et al. [16]	Dentists	(no details)	Neck - 75.9	Shoulder - 58.6	Knee 44.8
			Upper back - 56.9	Wrist - 44.8	Femur - 10.3
			Lower back - 48.3		Ankle - 6.9
17. Bhatam and Yasobant [3]	Dentists	92.47	Neck - 88.17	Wrist/hand - 54.8	Ankle/feet - 19.35
			Lower back - 86.02	Shoulder - 34.41	Knee - 2.15
			Upper back - 17.2	Elbow - 5.38
18. Shaik et al. [17]	Dental surgeons	(no details)	Back - 86.6	Wrist - 36.7	Ankle/foot - 53.3
			Neck - 73.3	Hand - 30	Knee - 46.7
				Elbow - 20	Hip/thigh - 33.3
				Shoulder - 20.6
19. Nokhostin and Zafarmand et al. [21]	Dentists	67.5	Neck - 51.87	Hand/wrist - 29.62	Waist - 11.11
				Shoulder - 7.4
20. Sankar et al. [22]	Orthodontists	41.69	Lower back - 39.38	Wrist - 39.38	Hip/thigh - 17.37
			Upper back - 30.11	Shoulder - 37.83	Knee - 13.51
			Neck - 25.48	Elbow - 32.43	Ankle/foot - 12.35
21. Cromie et al. [29]	Physical	82.8	Low back - 62.5	Thumbs - 33.6	Knee - 11.2
	therapists		Neck - 47.6	Shoulder - 22.9	Hip - 7.3
			Upper back - 41	Wrist/hand - 21.8	Ankle - 7.1
				Elbow - 13.2
22. Mahesh wari et al. [23]	Physiotherapists	91	Neck - 72.5	Shoulder - 20.9	Knee - 12.1
			Low back - 72.5	Wrist/hand - 17.6	Ankle/foot - 12.1
			Upper back - 28.6		Hip - 7.7
23. Yesim and Ozcan [59]	Physiotherapists	85	Lower back - 26	Wrist/hand - 18	Knee - 8
			Neck - 12	Shoulder - 14	Ankle/foot - 3
			Upper back - 9	Elbow - 8	Hip/thigh - 2
24. Anyfantis and Biska [30]	Physiotherapists	89	Lower back - 38	Shoulder - 12	Knee - 6
			Upper back - 19	Wrist - 9	Hip - 1
			Neck - 10	Fingers - 4
				Elbow - 1
25. Al-Eisa et al. [31]	Physiotherapists	Egypt - 63.9	Neck – 25	Shoulder - 15.3	Knee - 8.1
			Low back - 23.4	Wrist/hand - 14.5	Ankle/foot - 3.1
			Upper back - 6.5	Elbow - 3.1	Hip - 0.9
		Saudi - 74	Low back - 33	Wrist/hand - 5.1	Knee – 13
			Neck - 29	Shoulder - 4	Hip - 1.9
			Upper back - 12	Elbow - 0.9	Ankle/foot - 0.9
26. Alrowayeh et al. [26]	Physiotherapists	47.6	Lower back - 32	Shoulder - 13	Knee – 11
			Neck - 21	Hand/wrist - 11	Ankle/foot - 6
			Upper back - 19	Elbow - 4	Hip/thigh – 3
27. Marayta et al. [27]	Physiotherapists	70	Neck - 51.7	Shoulder – 15	Knee - 11.7
			Lower back - 40	Wrist/hand - 15	Hip/thigh - 6.7
			Upper thoracic - 5	Elbow - 1.7	Ankle/foot - 3.3
28. Nordin et al.[28]	Physiotherapists	71.6	Lower back - 51.7	Elbow - 8.6	(No details)
			Neck - 46.5	Hand/wrist - 12
			Thoracic - 44.8
29. Khairy et al. [32]	Physiotherapists	82.6	Lower back - 68.8	Shoulder - 40.8	Knee - 27.1
			Neck - 36.7	Wrist - 29	Ankle - 7
			Upper back - 30.2	Elbow - 8	Hip - 4.6
30. Malarvizhi et al. [24]	Physiotherapists	(no details)	Neck - 62.4	Shoulder - 28.4	Knee - 29.1
			Lower back - 61	Wrist/hand - 20.6	Ankle/foot - 20.6
			Upper back - 51.8	Elbow - 13.5	Hip - 12.8
31. Campo et al. [33]	Physical therapists	28	Lower back - 6.6	Shoulder - 3.2	Hip/thigh - 2.3
			Neck - 4.9	Elbow - 1.4	Knee - 2.1
			Upper back - 2.4	Hand/wrist - 5.3	Ankle/foot - 2.2
32. Alnefaie et al. [39]	All surgeons in tertiary care centre	80	Back - 71.1	Shoulder - 39.2	Leg – 33
				Hand - 33	Foot - 29.9
			Neck - 59.8	Arm - 14.4
33. Vaghela et al. [37]	Surgeons	83.7	Back - 52.5	Shoulder - 23.3	Knee - 6.98
				Elbow - 2.32	Ankle - 6.98
			Neck - 30.2	Wrist/hand - 2.32	Hip - 2.32
34.Alzahrani et al.[40]	Orthopedic pediatric surgeon	67	Lower back - 44	Shoulder- 23	Knee/leg - 11
			Neck - 24	Elbow - 18	Ankle/foot - 9
				Forearm/wrist/hand – 34	Hip/thigh - 7
35. AlQahtani et al. [41]	Orthopedic trauma surgeons	66.7	Lower back - 26.7	Wrist/forearm - 30.2	Ankle/foot – 14
				Elbow - 15.1	Knee - 9.3
				Shoulder - 12.8
36. Tirgar et al. [43]	Surgeons	95	Neck - 66.7	Wrist/hand – 51	Knee – 20
			Low back - 51.42	Shoulder - 40	Leg - 18
			Upper back 16	Elbow – 20
37. Knudsen et al. [38]	Resident orthopaedic surgeons	(no details)	Neck - 59.4	Shoulder - 34.4	Knee - 22.6
			Lower back - 54.8	Wrist/hand - 19.4	Ankle/foot - 22.6
			Upper back - 35.5	Elbow - 3.1	Hip/thigh - 9.7
38. Mehrifar et al. [45]	Surgeons	(no details)	Neck - 84.6	Wrist/hand - 40	Ankle/foot - 25
			Lower back - 56.8	Shoulder - 37.4	Knee - 18
			Upper back - 44.1	Elbow - 10	Hip/thigh - 20
39. Vaidya et al. [36]	Surgeons	70	Lower back - 60	Elbow - 34.28	Knee - 28.57
			Neck - 45.71	Shoulder - 31.42	Ankle/foot - 28.57
			Upper back - 25.71	Wrist/hand - 28.57	Hip/thigh - 20
40. Dabholkar et al. [46]	Surgeons	86	Lower back - 49.3	Wrist/hand - 25.3	Knee - 22.6
			Neck - 26.6	Shoulder - 14.6
				Elbow - 14.6
41. Aghilinejad et al. [44]	Surgeons	(no details)	Neck - 85	Shoulder/arm - 80.13	Thigh - 51.66
			Back - 80.36	Elbow/forearm - 74	Knee - 37.06
			Trunk - 64.2	Hand/wrist - 71.56	Leg/foot - 58.06
42. Tan and Kwek [42]	Orthopaedic surgeons and residents	87.5	Neck - 66.1	Hand/wrist - 42.9	Ankle/foot - 21.4
			Lower back - 35.8	Shoulder - 39.3	Knee - 16.2
			Upper back - 19.6	Elbow - 8.5	Hip/thigh - 5.3

3.1 Population targeted

Twenty of the 42 featured articles are geared towards dentists, 11 are about physiotherapists (ages 23–33), and 11 are about surgeons (ages 36–46). Articles from a wide range of nations, including Saudi Arabia, China, Indonesia, Pakistan, Brazil, Europe, India, Australia, Egypt, Iran, Turkey, Greece, Kuwait, Malaysia, USA, Canada, Nepal, and Singapore are included in this review. The majority of the articles discovered were about the Indian population. Twelve studies have been carried out in various Indian towns: five in Iran, three in Saudi Arabia, and threein Egypt.

3.2 Prevalence measure

The overall prevalence rate of WRMSDs reported by the studies included in this review ranged from a percentage as high as 100% [13] to a percentage as low as 28% [33]. The mean overall prevalence rate (MOPR) of all three professionals was identified to be high with a measure of greater than 70%. Among dentists, physiotherapists, and surgeons the MOPR of surgeons and dentists was found to be the highest with a minute difference of 0.356%. The MOPR measures are shown in Fig. 2. Seven studies did not mention the overall prevalence measure of WRMSDs and so these studies were excluded from the calculation of MOPR.

Fig. 2

Overall prevalence measure of WRMSDs among dentists, surgeons, and physiotherapists.

3.3 Regions involved in injury

The most commonly involved body region in the WRMSDs among dentists was the neck with a mean prevalence rate (MPR) of 58.524%, followed by the lower back with an MPR of 56.425%. The neck was also found to be the region with the highest regional prevalence rate among all regions recorded from the studies included in this review, with a prevalence measure of 96% [6]. The hip/thigh and ankle/foot regions were the least affected among dentists with an MPR of 16.3% and 16.542% respectively. For the physiotherapists, the most commonly affected region was the lower back with an MPR of 42.953%, followed by the neck region with an MPRof 35.316%.

The highest recorded prevalence measure of the lower back in the review was 72.5% [23]. The least affected region among physiotherapists was hip/thigh with an MPR of 4.563%. Similar to dentists, the most commonly involved region in WRMSDs among surgeons was found to be the neck followed by the lower back with an MPR of 54.811% and 52.98% respectively. The hip/thigh region was found to be the least affected with an MPR of 16.568% among surgeons.

4 Discussion

In the study conducted by Khan et al. [6] among dentists, the body region with the highest prevalence of WRMSDs was found to be the neck with a measure of 96%, which was followed by the shoulder region with a prevalence rate of 90%. Similarly, in many studies done among dentists [7 , 18], the neck and shoulder in combination were identified to be the regions with the highest prevalence rate of WRMSDs in their studies.

However, in most studies [2 , 20] the neck and lowerback were identified to be the most commonly affected regions with the highest WRMSD prevalence measures.

The neck is the most often affected region in the dentist population, with a prevalence rate of WRMSDs that ranges from as low as 11.6% [2] to as high as 96% [6]. The lower back is next, with a range of 10.38% [2] to 86.02% [3]. Shaik et al. [17] found that the ankle/foot region had the highest prevalence of WRMSDs in the lower extremities, with a value of 53.3%, followed by the knee region with a measure of 46.7%.

According to a study by Hodacova et al. [5], the neck is reported as the region with the highest prevalence of WRMSDs; however, the prevalence rate of wrist is found to be 38.8% and that of fingers is found to be 40.5%, which therefore makes the wrist/hand complex to be the region with the highest prevalence of WRMSDs with a measure of 79.3%. Meisha et al. [50] reported that 70% of dentists in Jeddah had MSDs due to dental practice.

In a prospective cohort research with a one-year follow-up among a physiotherapy population, Campo et al. [33] revealed that 57.5% of the 8882 American physiotherapists had WRMSDs. According to the majority of the previous studies on WRMSDs among physiotherapists [25 , 47], the lower back is the area most frequently affected by WRMSDs and has the highest prevalence rate.

The lower back region has the highest mean regional prevalence rate of WRMSDs, measuring 42.953%, followed by the neck region, at 35.316%. From the included studies the highest recorded regional prevalence of WRMSDs is 72.5% for both neck and lower back regions [23], and the lowest measure recorded for lower back was 6.6% and neck was 4.9% [33].

The least affected region among physiotherapists is the hip/thigh region with a mean regional prevalence rate of 4.563%, a highest regional prevalence rate of 12.8% [24], and the lowest regional prevalence rate of 0.9% as reported by Al-Eisa et al. on Egyptian physiotherapists [31]. The prevalence of WRMSDs overall was reported to be 63.9% among Egyptian physiotherapists and 74% among Saudi physiotherapists in this study, which included two separate surveys among physiotherapists in Egypt and Saudi Arabia. Physical therapists in South Korea participated in a study by Bae et al. [48], who found a correlation between WRMSDs, job stress, and quality of life.

The exposure of surgeons was determined to be highly similar to that of the dentists in case of both susceptible regions and mean overall prevalence measures. The mean regional prevalence rate of WRMSDs among surgeons was highest in the neck region with 54.811%, followed by the lower back region with 52.98%. The overall prevalence rates among surgeons ranged from 66.7% [39] to 95% [40]. In some studies [36 , 46], the neck and lower back were identified to be the most commonly involved regions in WRMSDs. The highest recorded regional prevalence rate of the neck region from the studies included in this review among surgeons was 85% [45] and the lowestwas 24% [38].

The hip/thigh region was least affected, even among surgeons, with a mean regional prevalence rate of 16.568%, much like physiotherapists. The MOPR of WRMSDs among surgeons, which is leading with a measure of 79.487%, is followed by dentists with 79.131% and physiotherapists with 71.409%, as determined by the critical analysis of all studies included in this review. Within each of these professionals, the neck and lower back regions were identified as the most susceptible areas of the body with the highest prevalence of WRMSDs when compared to other regions.

In our review, the MPR of the neck region among dentists, physiotherapists, and surgeons was identified to be 58.524%, 35.316%, and 54.811%, respectively, and that in the lower back region, it was found to be 56.524%, 42.953%, and 52.98%, respectively [Figs. 3–5]. Seven studies did not report the overall prevalence measures [14 , 45], hence these studies were excluded from the MOPR calculations.

Fig. 3

Mean regional prevalence measure of WRMSDs among dentists.

Fig. 4

Mean regional prevalence measure of WRMSDs among physiotherapists.

Fig. 5

Mean regional prevalence measure of WRMSDs among surgeons.

5 Limitations and recomendations

Seven studies had to be disregarded because they failed to record the prevalence measure from all three significant sites listed in our review’s inclusion criteria [48 , 50–56]. A few components of the Quality Assessment Tool for Observational, Cohort, and Cross-sectional Research did not apply to the majority of the included studies since their study designs were cross-sectional. In the majority of the studies [6 , 44], the regional prevalence measure was integrated in a different fashion than what is shown in Figs. 3–5. Because of this, such studies had to be either eliminated from the computations of the mean prevalence measurements or examined in the nearby regions.

Future studies with well-designed research comparing various healthcare professions at their work-place, working environment, physical strain, mental stress, and various factors responsible for musculoskeletal problems using quantitative outcome measures should be studied in order to offer the best and most effective preventive measures, based on the limitations and the narrow scope of the existing work.

6 Conclusion

After critically analyzing all included studies, based on the overall and regional prevalence measures of WRMSDs, we conclude that all three health care professionals (dentists, physiotherapists, and surgeons) are highly prone to develop WRMSDs with surgeons and dentists being more vulnerable when compared to physiotherapists (Fig. 4). The lower back and neck are identified as the two most commonly affected regions among all three professionals. The mean regional prevalence rate of WRMSDs among the three professionals is found to be highest in the lower back, followed by the neck region. However, the neck is found to be the highest prevalent region among dentists as well as surgeons, while the lower back is found to be the highest prevalent region among physiotherapists. Regular physical exercises, frequent health check-ups, and necessary relaxation were also suggested to prevent WRMSDs.

Footnotes

Acknowledgments

The authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to the authors, editors and publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

Conflict of interest

The authors report no conflict of interest.

Funding

The authors received no specific funding for this work.

References

Yasobant

, Rajkumar

. Work-related musculoskeletal disorders among health care professionals: A cross-sectional assessment of risk factors in a tertiary hospital, India. Indian Journal of Occupational and Environmental Medicine. 2014;18(2):75.

Sahu

, Tandon

, Dhingra

, Chinmaya

, Prasad

, Bali

, Ghosh

. Prevalence of musculoskeletal disorders among dentists: A pilot cross-sectional survey. Journal of Indian Association of Public Health Dentistry. 2015;13(3):307.

Batham

, Yasobant

. A risk assessment study on work-related musculoskeletal disorders among dentists in Bhopal, India. Indian Journal of Dental Research. 2016;27(3):236.

Ganiyu

, Olabode

, Stanley

, Muhammad

. Patterns of occurrence of work- related musculoskeletal disorders and its correlation with ergonomic hazards among health care professionals. Nigerian Journal of Experimental and Clinical Biosciences. 2015;3(1):18.

Hodacova

, Sustova

, Cermakova

, Kapitan

, Smejkalova

. Self-reported risk factors related to the most frequent musculoskeletal complaints among Czech dentists. Industrial Health. 2014:2013–0141.

Khan

, Ahmad

, Merchant

. Prevalence of work related musculoskeletal disorders (MSD) among dentists. Int J Contemp Med Res. 2017;483:77–2393.

Phedy

, Gatam

. Prevalence and associated factors of musculoskeletal disorders among young dentists in Indonesia. Malaysian Orthopaedic Journal. 2016;10(2):1.

Aljanakh

, Shaikh

, Siddiqui

, Al-Mansour

, Hassan

. Prevalence of musculoskeletal disorders among dentists in the Ha’il Region of Saudi Arabia. Annals of Saudi Medicine. 2015;35(6):456–61.

Isper Garbin

, Soares

, Arcieri

, Saliba Garbin

, Siqueira

. Musculoskeletal disorders and perception of working conditions: A survey of Brazilian dentists in São Paulo. International Journal of Occupational Medicine and Environmental Health. 2017:367–77.

10.

Prudhvi

, Murthy

. Self-reported musculoskeletal pain among dentists in Visakhapatnam: A 12-month prevalence study. Indian Journal of Dental Research. 2016;27(4):348.

11.

Leggat

, Smith

. Musculoskeletal disorders self-reported by dentists in Queensland, Australia. Australian Dental Journal. 2006;51(4):324–7.

12.

Revankar

, Yadav Chakravarthy

, Selvan

, Ganapathy

, Prasad

. Musculoskeletal disorders and mental health-related issues as occupational hazards among dental practitioners in Salem city: A cross-sectional study. Journal of Pharmacy & Bioallied Sciences. 2017;9(Suppl 1):S228.

13.

Kumar

, Kumar

, Baliga

. Prevalence of work-related musculoskeletal complaints among dentists in India: a national cross-sectional survey. Indian Journal of Dental Research. 2013;24(4):428.

14.

Shames Ali

, Hegazy

, Khashaba Omar

. Ergonomic design of dental clinics and its relation to musculoskeletal disorders among group of Dentists. 2016; 62(2).

15.

Veeresh

, Yunus

, Deepta

. Prevalence of musculoskeletal pain in dental practitioners in Davangere, Karnataka: A cross-sectional survey. Journal of Indian Association of Public Health Dentistry. 2015;13(3):302.

16.

Rafeemanesh

, Jafari

, Kashani

, Rahimpour

. A study on job postures and musculoskeletal illnesses in dentists. International Journal of Occupational Medicine and Environmental Health. 2013;26(4):615–20.

17.

Shaik

, Rao

, Husain

, D’sa

. Work-related musculoskeletal disorders among dental surgeons: A pilot study. Contemporary Clinical Dentistry. 2011;2(4):308.

18.

Lin

, Liu

, Hsieh

, Hsiao

, Lai

, Chang

. Prevalence of and risk factors for musculoskeletal complaints among Taiwanese dentists. Journal of Dental Sciences. 2012;7(1):65–71.

19.

Zahoor

, Ehsan

, Rafique

, Tayyab

, Nafees

, Basit

, Jamil

. Prevalence of Musculoskeletal Disorders and Associated Risk Factors: A Survey Conducted among Dentists in Lahore. Pakistan Oral & Dental Journal. 2017;37(2):351–4.

20.

Tamo

, Kalita

, Bhuyan

. Evaluation of occupational musculoskeletal disorders and related risk factors among dentists working in North East India. Dentistry and Medical Research. 2015;3(2):43.

21.

Nokhostin

, Zafarmand

. “Musculoskeletal problem”: Its prevalence among Iranian dentists. Journal of International Society of Preventive & Community Dentistry. 2016;6(Suppl 1):S41.

22.

Sankar

, Reddy

, Vanaja

. The prevalence of work-related musculoskeletal disorders among Indian orthodontists. Journal of Indian Orthodontic Society. 2012;46(4_suppl1):264–8.

23.

Maheshwari

, Soni

, Parkash

. Work related musculoskeletal disorders: a survey of physiotherapists in tricity. International Journal of Physiotherapy. 2015;2(6):1091–6.

24.

Malarvizhi

, Kumar

, Sivakumar

. Prevalence of work-related musculoskeletal disorders among clinical and teaching physiotherapists-an observational study. International Journal of Physiotherapy. 2017;4(2):86–92.

25.

Mason

, Moore

, Edwards

, Derry

, McQuay

. Topical NSAIDs for chronic musculoskeletal pain: systematic review and meta-analysis.BMC Musculoskeletal Disorders. 2004;5(1):1–8.

26.

Alrowayeh

, Alshatti

, Aljadi

, Fares

, Alshamire

, Alwazan

. Prevalence, characteristics, and impacts of work-related musculoskeletal disorders: a survey among physical therapists in the State of Kuwait. BMC Musculoskeletal Disorders. 2010;11(1):1–1.

27.

Abu Hassan

. Status of work related musculoskeletal disorders (wrmds) in palestinian practicing physiotherapists. Asian Journal of Computer Science and Information Technology. 2018;9(5):8107–11.

28.

Nordin

, Leonard

, Thye

. Work-related injuries among physiotherapists in public hospitals: a Southeast Asian picture. Clinics. 2011;66:373–8.

29.

Cromie

, Robertson

, Best

. Occupational injuries in PTs. Physical Therapy. 2000;80(5):529–30.

30.

Anyfantis

, Biska

. Musculoskeletal disorders among Greek physiotherapists: Traditional and emerging risk factors. Safety and Health at Work. 2018;9(3):314–8.

31.

Al-Eisa

, Buragadda

, Shaheen

, Ibrahim

, Melam

. Work related musculoskeletal disorders: causes, prevalence and response among egyptian and saudi physical therapists. Middle-East Journal of Scientific Research. 2012;12(4):523–9.

32.

Khairy

, Bekhet

, Sayed

, Elmetwally

, Elsayed

, Jahan

. Prevalence, profile, and response to work-related musculoskeletal disorders among Egyptian physiotherapists. Open Access Macedonian Journal of Medical Sciences. 2019;7(10):1692.

33.

Campo

, Weiser

, Koenig

, Nordin

. Work-related musculoskeletal disorders in physical therapists: a prospective cohort study with 1-year follow-up. Physical therapy. 2008;88(5):608–19.

34.

Iqbal

, Alghadir

. Prevalence of work-related musculoskeletal disorders among physical therapists. Medycyna Pracy. 2015;66(4):459–69.

35.

Holder

, Clark

, DiBlasio

, Hughes

, Scherpf

, Harding

, Shepard

. Cause, prevalence, and response to occupational musculoskeletal injuries reported by physical therapists and physical therapist assistants. Physical Therapy. 1999;79(7):642–52.

36.

Vaidya

, Sainju

, Joshi

. Work related musculoskeletal disorders among surgeons working in a tertiary care hospital in Kathmandu, Nepal. International Journal of Occupational Safety and Health. 2015;5(2):6–10.

37.

Vaghela

, Parekh

, Ganjiwale

, Mehta

. Work-Related musculoskeletal disorder among surgeons in Gujarat. Journal of Education and Health Promotion. 2019;8.

38.

Knudsen

, Ludewig

, Braman

. Musculoskeletal pain in resident orthopaedic surgeons: results of a novel survey. The Iowa Orthopaedic Journal. 2014;34:190.

39.

Alnefaie

, Alamri

, Hariri

, Alsaad

, Alsulami

, Abbas

, Alfozan

, Aljiffry

, Al-Abbadi

. Musculoskeletal symptoms among surgeons at a tertiary care center: a survey based study. Medical Archives. 2019;73(1):49.

40.

Alzahrani

, Alqahtani

, Tanzer

, Hamdy

. Musculoskeletal disorders among orthopedic pediatric surgeons: an overlooked entity. Journal of Children’s Orthopaedics. 2016;10(5):461–6.

41.

AlQahtani

, Alzahrani

, Harvey

. Prevalence of musculoskeletal disorders among orthopedic trauma surgeons: an OTA survey. Canadian Journal of Surgery. 2016;59(1):42.

42.

Tan

, Kwek

. Musculoskeletal occupational injuries in orthopaedic surgeons and residents. Malaysian Orthopaedic Journal. 2020;14(1):24.

43.

Tirgar A, Khallaghi S, Taghipour MO. A study on musculoskeletal disorders and personal and occupational risk factors among surgeons.

44.

Aghilinejad

, Ehsani

, Talebi

, Koohpayehzadeh

, Dehghan

. Ergonomic risk factors and musculoskeletal symptoms in surgeons with three types of surgery: Open, laparoscopic, and microsurgery. Medical Journal of the Islamic Republic of Iran. 2016;30:467.

45.

Mehrifar

, Mardanparvar

, Mohebian

. Musculoskeletal disorders among surgeons working in several hospitals of Tehran, Iran (2015). Journal of Occupational Health and Epidemiology. 2018;7(2):97–102.

46.

Dabholkar

, Yardi

, Dabholkar

, Khanvilkar

. Work related musculoskeletal disorders in surgeons performing minimal invasive procedures in Mumbai and Navi Mumbai India. Int J Health Sci Res. 2015;5(8):347–55.

47.

Adegoke

, Akodu

, Oyeyemi

. Work-related musculoskeletal disorders among Nigerian physiotherapists. BMC Musculoskeletal Disorders. 2008;9(1):1–9.

48.

Bae

, Lee

, Yoo

, Kim

, Lee

, Kim

, Ha

. Associations between work-related musculoskeletal pain, quality of life and presenteeism in physical therapists. Journal of Korean Society of Occupational and Environmental Hygiene. 2012;22(1):61–72.

49.

Arca

, Dönmezdil

, Durmaz

. The effect of the COVID-19 Pandemic on anxiety, depression, and musculoskeletal system complaints in healthcare workers. Work. 2021 May 12 (Preprint):1–8.

50.

Kurinka

, Jonsson

, Kilbom

. Vinter berg

, Biering-sorensen

, Anderon

and Jorgensen Standardized Nordic Questionnaires for the analysis of musculoskeletal symptoms. Applied Ergonomics. 1987;18(3):233–7.

51.

Meisha

, Alsharqawi

, Samarah

, Al-Ghamdi

. Prevalence of work-related musculoskeletal disorders and ergonomic practice among dentists in Jeddah, Saudi Arabia. Clinical, Cosmetic and Investigational Dentistry. 2019;11:171.

52.

Alexopoulos

, Stathi

, Charizani

. Prevalence of musculoskeletal disorders in dentists. BMC musculoskeletal disorders. 2004;5(1):1–8.

53.

Marshall

, Duncombe

, Robinson

, Kilbreath

. Musculoskeletal symptoms in new south wales dentists. Australian Dental Journal. 1997;42(4):240–6.

54.

Kayabinar

, Kayabinar

, Önal

, Zengin

, Köse

. The musculoskeletal problems and psychosocial status of teachers giving online education during the COVID-19 pandemic and preventive telerehabilitation for musculoskeletal problems. Work. 2021;1–1.

55.

Giberti

, Gallo

, Francini

, Signori

, Testa

. Musculoskeletal disorders among robotic surgeons: a questionnaire analysis. Archivio Italiano di Urologia e Andrologia. 2014;86(2):95–8.

56.

Omar

, Sultan

, El Sherif

, Abdallah

, Monga

. Ergonomics and musculoskeletal symptoms in surgeons performing endoscopic procedures for benign prostatic hyperplasia. Therapeutic advances in Urology. 2020;12:1756287220904806.

57.

Choi

, Brings

. Work-related musculoskeletal risks associated with nurses and nursing assistants handling overweight and obese patients: A literature review. Work. 2016;53(2):439–48.

58.

Kim-Fine

, Woolley

, Weaver

, Killian

, Gebhart

. Work-related musculoskeletal disorders among vaginal surgeons. International Urogynecology Journal. 2013;24(7):1191–200.

59.

Salik

Yesim

, Özcan

. Work-related musculoskeletal disorders: A survey of physical therapists in Izmir-Turkey. BMC Musculoskeletal Disorders. 2004;5(1):1–7.

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