Prevalence,characteristics,contributing factors,work sector,and impact of work-related musculoskeletal disorders among otorhinolaryngology practitioners in Saudi Arabia: A cross-sectional study

Abstract

BACKGROUND:

Otorhinolaryngology practitioners are known to be susceptible to work-related musculoskeletal disorders (WMSDs), but the incidence of WMSDs in Saudi Arabia has not been documented.

OBJECTIVES:

This study aimed to establish the prevalence, characteristics, contributing factors, work sector, and impact of WMSDs among otorhinolaryngology practitioners in Saudi Arabia.

METHODS:

A cross-sectional survey was conducted on 104 otorhinolaryngology practitioners in Saudi Arabia using a six-component questionnaire. Descriptive statistics, prevalence, percentages, and chi-square tests were used for data analysis.

RESULTS:

The response rate was 65.3%. The reported 12-month incidence of WMSDs was 72.7%. The neck region (67.3%) was the most common site of disorders, followed by the shoulder (49%). The elbow and hip (10.5%) regions were the least commonly affected regions. WMSD prevalence was related to gender, with men more affected than women (neck, shoulders, low back); age, with younger otorhinolaryngology practitioners more affected than older ones (neck, shoulder); work sector, with greater prevalence in government than other sectors (neck); and sub-specialty, with general otolaryngology reporting the highest WMSD frequency, followed by otology and neurotology (neck, shoulder, low back, upper back, knees). Most otorhinolaryngology practitioners experienced two to four episodes of neck, shoulder, and low-back WMSDs. The most significant risk factor for WMSDs was sustained posture for long periods of time (61.5%). The most common strategy implemented against WMSDs was modifying the practitioner’s position during treatment (58.6%).

CONCLUSIONS:

WMSDs among otorhinolaryngology practitioners in Saudi Arabia are very common, with the neck and shoulders regions most often involved. Improved professional skills and an understanding of the principles of ergonomics can prevent the initial development of WMSDs in otorhinolaryngology practitioners.

Keywords

Ergonomics prevalence musculoskeletal workload otolaryngology Saudi Arabia

1 Introduction

Work-related musculoskeletal disorders (WMSDs) are among the leading health problems in otorhinolaryngology practitioners, who are at increased risk [1], but relatively few studies have addressed the prevalence of WMSDs in otorhinolaryngology practitioners. The lifetime incidence of WMSDs among otolaryngologists has been reported as 47.4% in the United Kingdom [2] and 87.6 % in India [3]. Research suggests that WMSDs experienced by otorhinolaryngology practitioners may be associated with various risk factors: common causes of musculoskeletal pain and discomfort are frequent engagement in poor postures, especially while performing surgeries in the operating theater [4]; the type of surgical chair used during practice [5]; static positioning [6]; operating room settings [7]; inadequate vision; constrained liberty of movement; prolonged sitting postures; and continuous use of devices [8]. These factors can adversely affect quality of life, leading to reduced output and related healthcare expenses for both employees and employers.

Most studies of musculoskeletal pain in otorhinolaryngology practitioners have found the neck to be the most commonly affected body area, followed by the upper back [3 , 9], while a few have found that the shoulders are more frequently affected than other regions [10, 11]. One study in the United Kingdom observed that 72% of otolaryngologists experienced either back pain or neck pain [12]; another study of pediatric otolaryngologists reported that 62% of respondents felt pain or discomfort related to their surgical practice [7].

Most studies have suggested that WMSDs can have serious consequences for the surgeon’s health, often requiring them to use sick leave and pursue medical and surgical interventions [3 , 13]. The National Institute of Occupational Safety and Health has introduced integral health and safety principles to help decrease WMSDs in otorhinolaryngology practitioners, such as avoiding static loads, reducing fixed working postures, avoiding awkward postures, taking systematic breaks, and completing online training on postural ergonomics [14].

Since these issues are extensive and particular to otorhinolaryngology, otorhinolaryngology practitioners in Saudi Arabia were expected to show the same problems, despite variations in practice settings. We believe recognizing the risk factors is essential to helping prevent WMSDs in otorhinolaryngology practitioners in the future. To our knowledge, no research has examined the occupational risks of otorhinolaryngology professionals’ practice in Saudi Arabia. Therefore, a better investigation of these specific work-related risk factors and the management strategies to prevent WMSDs is needed.

This study aimed to (1) investigate the prevalence of WMSDs and their association with the demographic factors, work settings, and professional characteristics of otorhinolaryngology practitioners working in Saudi Arabia; (2) analyze the work factors that otorhinolaryngology practitioners identified as contributing to WMSDs; and (3) evaluate the management strategies used by otorhinolaryngology practitioners to combat WMSDs. These outcomes could contribute to a better work style and the improvement of effective intervention strategies for preventing WMSDs in otorhinolaryngology practitioners.

2 Material and methods

2.1 Participants

Otorhinolaryngology practitioners working in the public and private sectors in various regions of Saudi Arabia participated in this cross-sectional study. Those with at least one year of work experience for at least one hour per day in their present work setting were included. Otorhinolaryngology practitioners who were elderly, retired, or non-practicing at the time of the study were excluded. The Ethical Committee of King Khalid University approved the study protocol [ECM#2020-1602].

2.2 Procedures

The researchers contacted otorhinolaryngology practitioners of the Saudi Society of Otorhinolaryngology and invited them to contribute voluntarily to the study in hospitals and medical centers. All participants received via email a letter describing the objective of the study along with the online questionnaire. The researchers explained the questionnaire to each participant and provided a contact number in case further explanation was required. Each participant consented to take part in the study by responding to the questionnaire. All participants required approximately 15–20 minutes to complete the questionnaire. One month after sending the questionnaire, the researchers emailed a reminder to all participants, inviting them to complete it if they had not yet. Incomplete questionnaires were excluded from the study.

2.3 Questionnaire

The questionnaire was primarily intended to collect data about self-reported musculoskeletal pain and work-related issues among the otorhinolaryngology practitioners. It was written in English and consisted of six sections. The first section of the questionnaire collected demographic characteristics. The next section included questions regarding the participant’s education, professional rank, professional experience, working hours, primary type of patients seen, working facilities, areas of specialty, longest duration of symptoms (in days), total number of episodes, nature and onset of symptoms, type of treatment received, any expert that had been consulted for their symptoms, work position, and exercise habits. This was followed by questions from the Nordic Musculoskeletal Questionnaire [15], which was used to evaluate the participant’s musculoskeletal symptoms (pain or discomfort) in nine anatomical regions with a body diagram: neck, shoulders, elbows, hands and wrists, upper back, low back, hips and thighs, knees, and ankles and feet. In the next component, the duration of WMSDs was evaluated by the question: “How long does the pain or discomfort typically last?” The participants were instructed to select one of the following: 24 hours or less, 24 hours to one week, one week to one month, one to six months, or more than six months. The rate of occurrence of WMSDs was evaluated by the following question: “How many instances have you had this pain or discomfort?” For each area of the body, participants were instructed to choose one of the following: once every six months or less, once every two to three months, once a month, once a week, or more than once a week. To evaluate the severity of pain, a visual analog scale ranging from 0 (no pain) to 10 (worst pain possible) was used for each body region. The next component of the questionnaire surveyed respondents about the presence of work factors that Otorhinolaryngologists recognize as contributing to WMSDs. The last component included management strategies used by otorhinolaryngology practitioners with WMSDs.

2.4 Data analysis

SPSS software (version 21.0 for Windows; SPSS Inc., Chicago, USA) was used to conduct statistical analyses. Descriptive statistics were used to estimate the incidence of WMSDs and demographic characteristics of the sample. Incidence rates and cross-tabulations were used to associate the musculoskeletal disorders occurrence between various demographic factors and work sector, work history (experience, settings, sub-specialty, type of work shift, daily workload etc.). Chi-square tests were also used to evaluate these relationships. The significance level was set at a p-value of <0.05 for all analyses.

3 Results

3.1 Response rate

Questionnaires were returned by 115 (65.3%) of 176 qualified otorhinolaryngology practitioners invited to participate in the study. Of these, 11 questionnaires were not filled out completely and were therefore excluded from the analysis. Thus, data from 104 participants were used to assess incidence rates.

3.1 Participant characteristics

The characteristics of all participants are presented in Table 1. The 104 participants included 76 (73%) men, with a mean age of 46.1±10.7 years and body mass index (BMI) of 27.1±3.9 kg/m², and 28 (26.9%) women, with a mean age of 35.9±4.6 years and BMI of 23.6±4.4 kg/m². A majority (51.9%) of the otorhinolaryngology practitioners were working in government hospitals. Otology neurotology was the most frequent sub-specialty, followed by general otolaryngology, rhinology, and other specialties. Of the otorhinolaryngology practitioners, 77% worked less than 12 hours a day, and a majority (80.7%) were on a fixed work shift schedule (Table 1).

Table 1
Demographics and professional characteristics of the participants

Characteristics No. Percentage (%)

Gender

Male 76 73

Female 28 26.9

Age

20–30 6 5.7

31–40 45 43.2

41–50 24 23

>50 29 27.8

Marital status

Single 20 19.2

Married 84 80.7

Smoking

Yes 6 5.7

No 98 94.2

Working sector

Government sector 54 51.9

Private sector 14 13.4

Both government & private sectors 36 34.6

General health perceptions

Very bad 0 0

Moderate 4 3.8

Good 70 67.3

Very good 30 28.8

Frequency of exercise (minutes/week)

Never 18 17.3

0–15 12 11.5

16–30 18 17.3

31–45 20 19.2

>45 36 34.6

Type of work shift

Fixed 84 80.7

Rotational 20 19.2

Resting time in one shift (minutes)

<30 45 43.2

31–60 36 34.6

>60 23 22.1

Missed days from work in previous year

1–7 72 69.2

8–14 5 4.8

>14 27 25.9

Daily workload

Not much 4 3.8

Some what 11 10.5

Reasonable 62 59.6

Too much 27 25.9

Working posture

Mostly sitting 23 22.1

Mostly standing 12 11.5

Mixed between sitting & standing 69 66.3

Daily working time

<12 hours 81 77.8

>12 hours 23 22.1

Frequency of changes in working order

Weekly 23 22.1

Monthly 35 33.6

Yearly 46 44.2

Type of chair using in practice

Very low 5 4.8

Medium 87 83.6

High 12 11.5

Total years of experience

0 to 5 Years 11 10.5

6 to 10 Years 20 19.2

11 to 15 Years 31 29.8

16 to 20 Years 42 40.3

Sub specialty

General otolaryngology 20 19.2

Otology neurotology 43 41.3

Rhinology 18 17.3

Head neck surgery 14 13.4

Pediatric otolaryngology 5 4.8

Facial plastic surgery 4 3.8

Average number of operations(per week)

0–5 72 69.2

6–10 23 22.1

>10 9 8.6

Operating hours (per week)

0–5 15 14.4

6–10 52 49.5

>10 37 35.5

Characteristics	No.	Percentage (%)
Gender
Male	76	73
Female	28	26.9
Age
20–30	6	5.7
31–40	45	43.2
41–50	24	23
>50	29	27.8
Marital status
Single	20	19.2
Married	84	80.7
Smoking
Yes	6	5.7
No	98	94.2
Working sector
Government sector	54	51.9
Private sector	14	13.4
Both government & private sectors	36	34.6
General health perceptions
Very bad	0	0
Moderate	4	3.8
Good	70	67.3
Very good	30	28.8
Frequency of exercise (minutes/week)
Never	18	17.3
0–15	12	11.5
16–30	18	17.3
31–45	20	19.2
>45	36	34.6
Type of work shift
Fixed	84	80.7
Rotational	20	19.2
Resting time in one shift (minutes)
<30	45	43.2
31–60	36	34.6
>60	23	22.1
Missed days from work in previous year
1–7	72	69.2
8–14	5	4.8
>14	27	25.9
Daily workload
Not much	4	3.8
Some what	11	10.5
Reasonable	62	59.6
Too much	27	25.9
Working posture
Mostly sitting	23	22.1
Mostly standing	12	11.5
Mixed between sitting & standing	69	66.3
Daily working time
<12 hours	81	77.8
>12 hours	23	22.1
Frequency of changes in working order
Weekly	23	22.1
Monthly	35	33.6
Yearly	46	44.2
Type of chair using in practice
Very low	5	4.8
Medium	87	83.6
High	12	11.5
Total years of experience
0 to 5 Years	11	10.5
6 to 10 Years	20	19.2
11 to 15 Years	31	29.8
16 to 20 Years	42	40.3
Sub specialty
General otolaryngology	20	19.2
Otology neurotology	43	41.3
Rhinology	18	17.3
Head neck surgery	14	13.4
Pediatric otolaryngology	5	4.8
Facial plastic surgery	4	3.8
Average number of operations(per week)
0–5	72	69.2
6–10	23	22.1
>10	9	8.6
Operating hours (per week)
0–5	15	14.4
6–10	52	49.5
>10	37	35.5

3.2 Prevalence

Almost three-quarters (72.7%) of the otorhinolaryngology practitioners reported experiencing WMSDs in the 12 months prior to the study. The neck was the most common site of disorders (67.3%), while the hips and thighs (10.5%) were least affected. The prevalence of neck (67.3%), shoulder (49%), low-back (44.2%), wrist and hand (33.6%), upper-back (27.8%), knee (24%), ankle and foot (22.1%), and elbow and hip (10.5%) symptoms are presented in Table 2.

Table 2
Prevalence of WMSDs by body part among ENT practitioners in Saudi Arabia

Body areas (n) Percentage (%)

Neck (70) 67.3

Shoulder (51) 49

Low back (46) 44.2

Wrist (35) 33.6

Upper back (29) 27.8

Knees (25) 24

Ankle (23) 22.1

Elbow (11) 10.5

Hip (11) 10.5

Body areas (n)	Percentage (%)
Neck (70)	67.3
Shoulder (51)	49
Low back (46)	44.2
Wrist (35)	33.6
Upper back (29)	27.8
Knees (25)	24
Ankle (23)	22.1
Elbow (11)	10.5
Hip (11)	10.5

3.3 Association of WMSDs with demographic factors, work settings, exercise habits, and professional characteristics of otorhinolaryngology practitioners

The prevalence of work-related neck symptoms was significantly correlated with age, work sector, work shift, daily workload, working posture, daily working time, frequency of changes in working order, type of chair used during practice, total years of experience, average number of operations per week, and sub-specialty (p < 0.001). The prevalence of work-related shoulder symptoms was significantly correlated with age, frequency of exercise, type of hospital, rest time in a given shift, missed days of work, work sector, daily workload, daily working time, type of chair used during practice, average number of operations per week, outpatient consultation, and sub-specialty (p < 0.001). The prevalence of work-related elbow symptoms was significantly correlated with age, frequency of exercise, missed days of work, daily workload, working posture, frequency of changes in working order, type of chair used during practice, total years of experience, average number of operations per week, outpatient consultation, and sub-specialty (p < 0.001). The prevalence of work-related wrist symptoms was significantly correlated with age, frequency of exercise, work sector, rest time in a given shift, daily workload, daily working time, frequency of changes in working order, total years of experience, average number of operations per week, outpatient consultation, and sub-specialty (p < 0.001; Table 3).

Table 3
Prevalence and association of WMSDs to demographic factors, work settings, and professional characteristics among ENT practitioners in Saudi Arabia (neck, shoulder, elbow, and wrist)

Total-104 Neck Shoulder Elbow Wrist

No. Yes% No No% p No. Right% No Left% No Both% No None% p No. Right% No None% p No. Right% No Left% No Both% No None% p

Male 56 69.1 25 30.9 0.30 6 7.4 9 11.1 23 28.4 43 53.1 0.88 11 13.6 70 86.4 0.05 27 33.3 1 1.2 3 3.7 50 61.7 0.13

Female 14 60.9 9 39.1 2 8.7 3 13.0 8 34.8 10 43.5 0 0 23 100 3 13 1 4.3 0 0 19 82.6

Age 70 67.3 34 32.7 0.00^* 8 7.7 12 11.5 31 29.8 53 51 0.00^* 11 10.6 93 89.4 0.00^* 30 28.8 2 1.9 3 2.9 69 66.3 0.00^*

Marital status

Single 9 64.3 5 35.7 0.50 3 21.4 3 21.4 6 42.9 2 14.3 0.01 0 0 14 100 0.18 2 14.3 1 7.1 0 0 11 78.6 0.23

Married 61 67.8 29 32.2 5 5.6 9 10 25 19.4 51 96.2 11 12.2 79 87.8 28 31.1 1 1.1 3 3.3 58 64.4

Frequency of exercise

Never 9 81.8 2 18.2 0.49 3 27.3 0 0 2 18.2 6 54.5 0.00^* 0 0 11 100 0.00 1 9.1 0 0 0 0 10 90.9 0.00^*

0–15 minutes 11 84.6 2 15.4 1 7.7 6 46.2 6 46.2 0 0 2 15.4 11 86.4 4 30.8 1 7.7 3 23.1 5 38.5

16–30 minutes 9 60 6 40 0 0 0 0 11 73.3 4 26.7 4 26.7 11 73.3 6 40 1 6.7 0 0 8 53.3

31–45 minutes 16 69.6 7 30.4 0 0 0 0 0 0 23 100 3 13 20 87 7 30.4 0 0 0 0 16 69.6

More than 45 minutes 22 59.5 15 40.5 2 5.4 6 16.2 12 32.4 17 45.9 0 0 35 100 12 32.4 0 0 0 0 25 67.6

Type of Hospital

Government 27 52.9 24 47.1 0.00^* 7 13.7 6 11.8 12 23.5 26 51 0.00^* 6 11.8 45 88.2 0.32 5 9.8 1 2.0 3 5.9 42 82.4 0.00^*

Private 10 62.5 6 37.5 0 0 6 37.5 4 25 6 37.5 3 18.8 13 81.2 5 31.2 0 0 0 0 11 68.8

Both 33 89.2 4 10.8 1 2.7 0 0 15 40.5 21 56.8 2 5.4 35 94.6 20 54.1 1 2.7 0 0 16 43.2

Type of work shift

Fixed 53 60.9 34 39.1 0.00^* 8 9.2 12 13.8 27 31 40 46 0.08 11 12.6 76 87.4 0.12 26 29.9 2 2.3 3 3.4 56 64.4 0.68

Rotation 17 100 0 0 0 0 0 0 4 23.5 13 76.5 0 0 17 100 4 23.5 0 0 0 0 13 76.5

Rest time in one shift

Less than 30 33 76.7 10 23.3 0.15 1 2.3 9 20.9 15 34.9 18 41.9 0.00^* 3 7.0 40 93 0.26 18 41.9 2 4.7 3 7.0 20 46.5 0.00^*

31 to 60 minutes 19 55.9 15 44.1 1 2.9 3 8.8 11 32.4 19 55.9 6 17.6 28 82.4 9 26.5 0 0 0 0 25 73.5

More than 30 18 66.7 9 33.3 6 22.2 0 0 5 18.5 16 59.3 2 7.4 25 92.6 3 11.1 0 0 0 0 24 88.9

Missed days in work

Up to 7 days 42 61.8 26 38.2 0.00^* 6 8.8 12 17.6 24 35.3 26 38.2 0.00^* 11 16.2 57 83.8 0.03 18 26.5 2 2.9 3 4.4 45 66.2 0.32

8 to 14 days 2 33.3 4 66.7 0 0 0 0 0 0 6 100 0 0 6 100 0 0 0 0 0 0 0 100

More than 14 days 26 86.7 4 13.3 2 6.7 0 0 7 23.3 21 70 0 0 30 100 12 40 0 0 0 0 18 60

Daily work load

Not much 3 50 3 50 0.00^* 0 0 3 50 3 50 0 0 0.00^* 0 0 6 100 0.32 0 0 0 0 3 50 3 50 0.00^*

Some what 7 70 3 30 3 30 3 30 0 0 4 40 0 0 10 100 5 50 0 0 0 0 5 50

Reasonable 34 56.7 26 43.3 5 8.3 3 5.0 12 20 40 66.7 9 15 51 85 9 15 2 3.3 0 0 49 81.7

Too much 26 92.9 2 7.1 0 0 3 10.7 16 57.1 ‘53 51 2 7.1 26 92.9 16 57.1 0 0 0 0 12 42.9

Working posture

Standing 16 64 9 36 0.03 1 4 0 0 9 36 15 60 0.09 0 0 25 100 0.03 7 28 1 4 0 0 17 68 0.75

Sitting 2 100 0 0 0 0 0 0 4 33.3 8 66.7 0 0 12 100 5 41.7 0 0 0 0 7 58.3

Both 42 62.7 25 37.3 7 10.4 12 17.9 18 26.9 30 44.8 11 16.4 56 83.6 18 26.9 1 1.5 3 4.5 45 67.2

Daily working time

Less than 12 hours 49 60.5 32 39.5 0.00^* 7 8.6 9 11.1 19 23.5 46 56.8 0.04 9 11.1 72 88.9 0.54 16 19.8 1 1.2 3 3.7 61 75.3 0.00^*

More than 12 hours 21 91.3 2 8.7 1 4.3 3 13 12 52.2 7 30.4 2 8.7 21 91.3 14 60.9 1 4.3 0 0 8 34.8

Frequency of changes in working order

Weekly 15 88.2 2 11.8 0.00^* 1 5.9 3 17.6 7 41.2 6 35.3 0.37 0 0 17 100 0.01 8 47.1 1 5.9 0 0 8 47.1 0.04

Monthly 16 43.2 21 56.8 2 5.4 6 16.2 12 32.4 17 45.9 8 21.6 29 78.4 6 16.2 0 0 3 8.1 28 75.7

Yearly 39 78 11 22 5 10 3 6 12 24 30 60 3 6 47 94 16 32 1 2 0 0 33 66

Type of chairs in practice

Low 11 100 0 0 0.00^* 0 0 0 0 2 18.2 9 81.8 0.01 0 0 11 100 0.00^* 4 36.4 0 0 0 0 7 63.6 0.67

Medium 59 67.8 28 32.2 8 9.2 9 10.3 29 33.3 41 47.1 8 9.2 79 90.8 26 29.9 2 2.3 3 3.4 56 64.4

Height 0 0 6 100 0 0 3 50 0 0 3 50 3 50 3 50 0 0 0 0 0 0 6 100

Total years of experience

0 to 5 Years 14 100 0 0 0.01 1 7.1 0 0 4 28.6 9 64.3 0.51 0 0 14 100 0.00^* 2 14.3 1 7.1 0 0 11 78.6 0.00^*

6 to 10 Years 17 73.9 6 26.1 2 8.7 3 13 11 47.8 7 30.4 0 0 23 100 9 31.9 0 0 3 13 11 47.8

11 to 15 Years 10 52.6 9 47.4 1 5.3 3 15.8 5 26.3 10 52.6 0 0 19 100 9 47.4 1 5.3 0 0 9 47.4

16 to 20 Years 29 60.4 19 39.6 4 8.3 6 12.5 11 22.9 27 56.2 11 22.9 37 77.1 10 20.8 0 0 0 0 38 79.2

Average number of operations 70 67.3 34 32.7 0.00^* 8 7.7 12 11.5 31 29.8 53 51 0.00^* 11 10.6 93 89.4 0.00^* 30 28.8 2 1.9 3 2.9 69 66.3 0.00^*

Operations per weeks 70 67.3 34 32.7 0.01 8 7.7 12 11.5 31 29.8 53 51 0.00^* 11 10.6 93 89.4 0.00^* 30 28.8 2 1.9 3 2.9 69 66.3 0.00^*

Outpatient consultation 70 67.3 34 32.7 0.00^* 8 7.7 12 11.5 31 29.8 53 51 0.00^* 11 10.6 93 89.4 0.00^* 30 28.8 2 1.9 3 2.9 69 66.3 0.00^*

Sub specialty

General otolaryngology 12 70.6 5 29.4 0.02 0 0 6 35.3 3 17.6 8 47.1 0.00^* 0 0 17 100 0.01 3 17.6 0 0 0 0 14 82.4 0.00^*

Otology neurotology 12 59.5 17 40.5 8 19 0 0 15 35.7 19 45.2 8 19 34 81 9 21.4 2 4.8 0 0 31 73.8

Rhinology 15 88.2 2 11.8 0 0 0 0 8 9 0 0 17 100 12 70.6 0 0 0 0 5 29.4

Head neck surgery 5 55.6 4 44.4 0 0 0 0 0 0 9 100 3 33.3 6 66.7 2 22.2 0 0 0 0 7 77.8

Pediatric otolaryngology 4 40 6 60 0 0 0 0 4 40 6 60 0 0 10 100 4 40 0 0 0 0 6 60

Facial plastic surgery 9 100 0 0 0 0 6 66.7 1 11.1 2 22.2 0 0 9 100 0 0 0 0 3 33.3 6 66.7

Total-104	Neck	Shoulder	Elbow	Wrist
No.	Yes%	No	No%	p	No.	Right%	No	Left%	No	Both%	No	None%	p	No.	Right%	No	None%	p	No.	Right%	No	Left%	No	Both%	No	None%	p
Male	56	69.1	25	30.9	0.30	6	7.4	9	11.1	23	28.4	43	53.1	0.88	11	13.6	70	86.4	0.05	27	33.3	1	1.2	3	3.7	50	61.7	0.13
Female	14	60.9	9	39.1		2	8.7	3	13.0	8	34.8	10	43.5		0	0	23	100		3	13	1	4.3	0	0	19	82.6
Age	70	67.3	34	32.7	0.00^*	8	7.7	12	11.5	31	29.8	53	51	0.00^*	11	10.6	93	89.4	0.00^*	30	28.8	2	1.9	3	2.9	69	66.3	0.00^*
Marital status
Single	9	64.3	5	35.7	0.50	3	21.4	3	21.4	6	42.9	2	14.3	0.01	0	0	14	100	0.18	2	14.3	1	7.1	0	0	11	78.6	0.23
Married	61	67.8	29	32.2		5	5.6	9	10	25	19.4	51	96.2		11	12.2	79	87.8		28	31.1	1	1.1	3	3.3	58	64.4
Frequency of exercise
Never	9	81.8	2	18.2	0.49	3	27.3	0	0	2	18.2	6	54.5	0.00^*	0	0	11	100	0.00	1	9.1	0	0	0	0	10	90.9	0.00^*
0–15 minutes	11	84.6	2	15.4		1	7.7	6	46.2	6	46.2	0	0		2	15.4	11	86.4		4	30.8	1	7.7	3	23.1	5	38.5
16–30 minutes	9	60	6	40		0	0	0	0	11	73.3	4	26.7		4	26.7	11	73.3		6	40	1	6.7	0	0	8	53.3
31–45 minutes	16	69.6	7	30.4		0	0	0	0	0	0	23	100		3	13	20	87		7	30.4	0	0	0	0	16	69.6
More than 45 minutes	22	59.5	15	40.5		2	5.4	6	16.2	12	32.4	17	45.9		0	0	35	100		12	32.4	0	0	0	0	25	67.6
Type of Hospital
Government	27	52.9	24	47.1	0.00^*	7	13.7	6	11.8	12	23.5	26	51	0.00^*	6	11.8	45	88.2	0.32	5	9.8	1	2.0	3	5.9	42	82.4	0.00^*
Private	10	62.5	6	37.5		0	0	6	37.5	4	25	6	37.5		3	18.8	13	81.2		5	31.2	0	0	0	0	11	68.8
Both	33	89.2	4	10.8		1	2.7	0	0	15	40.5	21	56.8		2	5.4	35	94.6		20	54.1	1	2.7	0	0	16	43.2
Type of work shift
Fixed	53	60.9	34	39.1	0.00^*	8	9.2	12	13.8	27	31	40	46	0.08	11	12.6	76	87.4	0.12	26	29.9	2	2.3	3	3.4	56	64.4	0.68
Rotation	17	100	0	0		0	0	0	0	4	23.5	13	76.5		0	0	17	100		4	23.5	0	0	0	0	13	76.5
Rest time in one shift
Less than 30	33	76.7	10	23.3	0.15	1	2.3	9	20.9	15	34.9	18	41.9	0.00^*	3	7.0	40	93	0.26	18	41.9	2	4.7	3	7.0	20	46.5	0.00^*
31 to 60 minutes	19	55.9	15	44.1		1	2.9	3	8.8	11	32.4	19	55.9		6	17.6	28	82.4		9	26.5	0	0	0	0	25	73.5
More than 30	18	66.7	9	33.3		6	22.2	0	0	5	18.5	16	59.3		2	7.4	25	92.6		3	11.1	0	0	0	0	24	88.9
Missed days in work
Up to 7 days	42	61.8	26	38.2	0.00^*	6	8.8	12	17.6	24	35.3	26	38.2	0.00^*	11	16.2	57	83.8	0.03	18	26.5	2	2.9	3	4.4	45	66.2	0.32
8 to 14 days	2	33.3	4	66.7		0	0	0	0	0	0	6	100		0	0	6	100		0	0	0	0	0	0	0	100
More than 14 days	26	86.7	4	13.3		2	6.7	0	0	7	23.3	21	70		0	0	30	100		12	40	0	0	0	0	18	60
Daily work load
Not much	3	50	3	50	0.00^*	0	0	3	50	3	50	0	0	0.00^*	0	0	6	100	0.32	0	0	0	0	3	50	3	50	0.00^*
Some what	7	70	3	30		3	30	3	30	0	0	4	40		0	0	10	100		5	50	0	0	0	0	5	50
Reasonable	34	56.7	26	43.3		5	8.3	3	5.0	12	20	40	66.7		9	15	51	85		9	15	2	3.3	0	0	49	81.7
Too much	26	92.9	2	7.1		0	0	3	10.7	16	57.1	‘53	51		2	7.1	26	92.9		16	57.1	0	0	0	0	12	42.9
Working posture
Standing	16	64	9	36	0.03	1	4	0	0	9	36	15	60	0.09	0	0	25	100	0.03	7	28	1	4	0	0	17	68	0.75
Sitting	2	100	0	0		0	0	0	0	4	33.3	8	66.7		0	0	12	100		5	41.7	0	0	0	0	7	58.3
Both	42	62.7	25	37.3		7	10.4	12	17.9	18	26.9	30	44.8		11	16.4	56	83.6		18	26.9	1	1.5	3	4.5	45	67.2
Daily working time
Less than 12 hours	49	60.5	32	39.5	0.00^*	7	8.6	9	11.1	19	23.5	46	56.8	0.04	9	11.1	72	88.9	0.54	16	19.8	1	1.2	3	3.7	61	75.3	0.00^*
More than 12 hours	21	91.3	2	8.7		1	4.3	3	13	12	52.2	7	30.4		2	8.7	21	91.3		14	60.9	1	4.3	0	0	8	34.8
Frequency of changes in working order
Weekly	15	88.2	2	11.8	0.00^*	1	5.9	3	17.6	7	41.2	6	35.3	0.37	0	0	17	100	0.01	8	47.1	1	5.9	0	0	8	47.1	0.04
Monthly	16	43.2	21	56.8		2	5.4	6	16.2	12	32.4	17	45.9		8	21.6	29	78.4		6	16.2	0	0	3	8.1	28	75.7
Yearly	39	78	11	22		5	10	3	6	12	24	30	60		3	6	47	94		16	32	1	2	0	0	33	66
Type of chairs in practice
Low	11	100	0	0	0.00^*	0	0	0	0	2	18.2	9	81.8	0.01	0	0	11	100	0.00^*	4	36.4	0	0	0	0	7	63.6	0.67
Medium	59	67.8	28	32.2		8	9.2	9	10.3	29	33.3	41	47.1		8	9.2	79	90.8		26	29.9	2	2.3	3	3.4	56	64.4
Height	0	0	6	100		0	0	3	50	0	0	3	50		3	50	3	50		0	0	0	0	0	0	6	100
Total years of experience
0 to 5 Years	14	100	0	0	0.01	1	7.1	0	0	4	28.6	9	64.3	0.51	0	0	14	100	0.00^*	2	14.3	1	7.1	0	0	11	78.6	0.00^*
6 to 10 Years	17	73.9	6	26.1		2	8.7	3	13	11	47.8	7	30.4		0	0	23	100		9	31.9	0	0	3	13	11	47.8
11 to 15 Years	10	52.6	9	47.4		1	5.3	3	15.8	5	26.3	10	52.6		0	0	19	100		9	47.4	1	5.3	0	0	9	47.4
16 to 20 Years	29	60.4	19	39.6		4	8.3	6	12.5	11	22.9	27	56.2		11	22.9	37	77.1		10	20.8	0	0	0	0	38	79.2
Average number of operations	70	67.3	34	32.7	0.00^*	8	7.7	12	11.5	31	29.8	53	51	0.00^*	11	10.6	93	89.4	0.00^*	30	28.8	2	1.9	3	2.9	69	66.3	0.00^*
Operations per weeks	70	67.3	34	32.7	0.01	8	7.7	12	11.5	31	29.8	53	51	0.00^*	11	10.6	93	89.4	0.00^*	30	28.8	2	1.9	3	2.9	69	66.3	0.00^*
Outpatient consultation	70	67.3	34	32.7	0.00^*	8	7.7	12	11.5	31	29.8	53	51	0.00^*	11	10.6	93	89.4	0.00^*	30	28.8	2	1.9	3	2.9	69	66.3	0.00^*
Sub specialty
General otolaryngology	12	70.6	5	29.4	0.02	0	0	6	35.3	3	17.6	8	47.1	0.00^*	0	0	17	100	0.01	3	17.6	0	0	0	0	14	82.4	0.00^*
Otology neurotology	12	59.5	17	40.5		8	19	0	0	15	35.7	19	45.2		8	19	34	81		9	21.4	2	4.8	0	0	31	73.8
Rhinology	15	88.2	2	11.8		0	0	0	0	8		9			0	0	17	100		12	70.6	0	0	0	0	5	29.4
Head neck surgery	5	55.6	4	44.4		0	0	0	0	0	0	9	100		3	33.3	6	66.7		2	22.2	0	0	0	0	7	77.8
Pediatric otolaryngology	4	40	6	60		0	0	0	0	4	40	6	60		0	0	10	100		4	40	0	0	0	0	6	60
Facial plastic surgery	9	100	0	0		0	0	6	66.7	1	11.1	2	22.2		0	0	9	100		0	0	0	0	3	33.3	6	66.7

^*Significant difference: p < 0 : 05 level.

The prevalence of work-related upper-back symptoms was significantly correlated with gender, age, rest time in a given shift, missed days of work, working posture, type of chair used during practice, total years of experience, average number of operations per week, and outpatient consultation (p < 0.001). The prevalence of work-related low-back symptoms was considerably correlated with age, frequency of exercise, work sector, type of work shift, rest time in a given shift, daily workload, working posture, total years of experience, average number of operations per week, and outpatient consultation (p < 0.001; Table 4).

Table 4

Prevalence and association of WMSDs to demographic factors, work settings, and professional characteristics among ENT practitioners in Saudi Arabia (upper back, lower back, hip, knee, and ankle)

	Upper back					Lower back					Hip					Knee					Ankle
Gender	No.	%	No.	%	p	No.	%	No.	%	p	No.	%	No.	%	p	No.	%	No.	%	p	No.	%	No.	%	p
Male	16	19.8	65	80.2	0.00^*	35	43.2	46	56.8	0.43	6	7.4	75	92.6	0.63	17	21	64	79	0.13	13	16	68	84	0.00^*
Female	13	56.5	10	43.5		11	47.8	12	52.2		5	21.7	18	78.3		8	34.8	15	65.2		10	43.5	13	56.5
Age	29	27.9	75	72.1	0.00^*	46	44.2	58	55.8	0.00^*	11	10.6	93	89.4	0.00^*	25	24	79	76	0.00^*	23	22.1	81	77.9	0.00^*
Marital status
Single	7	50	7	50	0.05	4	28.6	10	71.4	0.16	0	0	14	100	0.18	4	28.6	10	71.4	0.44	7	50	7	50	0.01
Married	22	24.4	68	75.6		42	46.7	48	53.3		11	12.2	79	87.8		21	23.3	69	76.7		16	17.8	74	82.2
Frequency of exercise
Never	2	18.2	9	81.8	0.14	5	45.5	6	54.5	0.00^*	5	45.5	6	54.5	0.00^*	2	18.2	9	81.8	0.49	5	45.5	6	54.5	0.00^*
0 to 15	6	46.2	7	53.8		12	92.3	1	7.7		2	15.4	11	84.6		3	23.1	10	76.9		3	23.1	10	76.9
16 to 30	6	40	9	60		6	40	9	60		0	0	15	100		4	26.7	11	73.3		2	13.3	13	86.7
31 to 45	4	17.4	19	82.6		3	13	20	87		4	17.4	19	82.6		4	17.4	19	82.6		0	0	23	100
More than 45	8	21.6	29	78.4		20	54.1	17	45.9		0	0	37	100		9	24.3	28	75.7		10	27	27	73
Type of Hospital
Government	14	27.5	37	72.5	0.24	22	43.1	29	56.9	0.00^*	4	7.8	47	92.2	0.66	11	21.6	40	78.4	0.39	15	29.4	36	70.6	0.20
Private	2	12.5	14	87.5		13	81.2	3	18.8		2	12.5	14	87.5		6	37.5	10	62.5		2	12.5	14	87.5
Both	13	35.1	24	64.9		11	29.7	26	70.3		5	13.5	32	86.5		8	21.6	29	78.4		6	16.2	31	83.8
Type of work shift
Fixed	26	29.9	61	70.1	0.23	34	39.1	53	60.9	0.00^*	3	3.4	84	96.6	0.00^*	23	26.4	64	73.6	0.16	18	20.7	69	79.3	0.30
Rotation	3	17.6	14	82.4		12	70.6	5	29.4		8	47.1	9	52.9		2	11.8	15	88.2		5	29.4	12	70.6
Resting time in one shift
Less than 30 minutes	13	30.2	30	69.8	0.00^*	20	46.5	23	53.5	0.00^*	4	9.3	39	90.7	0.03	10	23.3	33	76.7	0.02	13	30.2	30	69.8	0.00^*
31 to 60	14	41.2	20	58.8		20	58.8	14	41.2		7	20.6	27	79.4		13	38.2	21	61.8		10	29.4	24	70.6
More than 30 or 60	2	7.4	25	92.6		6	22.2	21	77.8		0	0	27	100		2	7.4	25	92.6		0	0	27	100
Missed days in work
Up to 7 days	21	30.9	47	69.1	0.00^*	33	48.5	35	51.5	0.47	1	1.5	67	67	0.00^*	17	25	51	75	0.00^*	17	25	51	75	0.34
8 to 14 days	6	100	0	0		2	33.3	4	66.7		0	0	6	100		4	66.7	2	33.3		0	0	6	100
More than 14 days	2	6.7	28	93.3		11	36.7	19	63.3		10	33.3	20	66.7		4	13.3	26	86.7		6	20	24	80
Daily workload
Not much	0	0	6	100	0.12	3	50	3	50	0.00^*	0	0	6	100	0.00^*	0	0	6	100	0.10	0	0	6	100	0.10
Some what	1	10	9	90		0	0	10	100		5	50	5	50		2	20	8	80		3	30	7	70
Reasonable	17	28.3	43	71.7		25	41.7	35	58.3		6	10	54	90		12	20	48	80		10	16.7	50	83.3
Too much	11	39.3	17	60.7		18	64.3	10	35.7		0	0	28	100		11	39.6	17	60.7		10	35.7	18	64.3
Working posture
Standing	11	44	14	56	0.00^*	4	16	21	84	0.00^*	3	12	22	88	0.44	4	16	21	84	0.55	2	8	23	92	0.00^*
Sitting	6	50	6	50		5	41.7	7	58.3		0	0	12	100		3	25	9	75		6	50	6	50
Both	12	17.9	55	82.1		37	55.2	30	44.8		8	11.9	59	88.1		18	26.9	49	73.1		15	22.4	52	77.6
Daily working time
Less than 12	20	24.7	61	75.3	0.13	35	43.2	36	56.8	0.43	7	8.6	74	91.4	0.20	14	17.3	67	82.7	0.00^*	12	14.8	69	85.2	0.00^*
More than 12 hours	9	39.1	14	60.9		11	47.8	12	52.2		4	17.4	19	82.6		11	47.8	12	52.2		11	47.8	12	52.2
Frequency of changes in working order
Weekly	6	35.3	11	64.7	0.70	5	29.4	12	70.6	0.21	4	23.5	13	76.5	0.00^*	7	41.2	10	58.8	0.00^*	6	35.3	11	64.7	0.23
Monthly	9	24.3	28	75.7		20	54.1	17	45.9		6	16.2	31	83.8		2	5.4	35	94.6		9	24.3	28	75.7
Yearly	14	28	36	72		21	42	29	58		1	2	49	98		16	32	34	68		8	16	42	84
Type of chairs in practice
Low	0	0	11	100	0.02	2	18.2	9	81.8	0.18	4	36.4	7	63.6	0.00^*	2	18.2	9	81.8	0.30	0	0	11	100	0.05
Medium	29	33.3	58	66.7		41	47.1	46	52.9		7	8	80	92		23	26.4	64	73.6		20	23	67	77
High	0	0	6	100		3	50	3	50		0	0	6	100		0	0	6	100		3	50	3	50
Total years of experience
0 to 5	3	21.4	11	78.6	0.00^*	10	71.4	4	28.6	0.00^*	6	42.9	8	57.1	0.00^*	2	14.3	12	85.7	0.02	6	42.9	8	57.1	0.00^*
6 to 10	11	47.8	12	52.2		10	43.5	13	56.5		0	0	23	100		11	47.8	12	52.2		12	52.2	11	47.8
11 to 15	9	47.4	10	52.6		3	15.8	16	84.2		3	15.8	16	84.2		4	21.1	15	78.9		3	15.8	16	84.2
16 to 20	6	12.5	42	87.5		23	47.9	25	52.1		2	4.2	46	95.8		8	16.7	40	83.3		2	4.2	46	95.8
Average number of operations	29	27.9	75	72.1	0.00^*	46	44.2	58	55.8	0.00^*	11	10.6	93	89.4	0.19	25	24	79	76	0.00^*	23	22.1	81	77.9	0.02
Operations per week	29	27.9	75	72.1	0.00^*	46	44.2	58	55.8	0.00^*	11	10.6	93	89.4	0.19	25	24	79	76	0.00^*	23	22.1	81	77.9	0.02
Outpatient consultation	29	27.9	75	72.1	0.00^*	46	44.2	58	55.8	0.00^*	11	10.6	93	89.4	0.19	25	24	79	76	0.00^*	23	22.1	81	77.9	0.02
Subspecialty
General otolaryngology	2	11.8	15	88.2	0.30	8	47.1	9	52.9	0.00^*	4	23.5	13	76.5	0.00^*	3	17.6	14	82.4	0.76	8	47.1	9	52.9	0.00^*
Otology neurotology	13	31	29	69		10	23.8	32	76.2		1	2.4	41	97.6		10	23.8	32	76.2		3	7.1	39	92.9
Rhinology	7	41.2	10	58.8		10	58.8	7	41.2		6	35.3	11	64.7		3	17.6	14	82.4		8	47.1	9	52.9
Head neck surgery	2	22.2	7	77.8		6	66.7	3	33.3		0	0	9	100		2	22.2	7	77.8		0	0	9	100
Pediatric otolaryngology	4	40	6	60		4	40	6	60		0	0	10	100		4	40	6	60		4	40	6	60
Facial plastic surgery	1	11.1	8	88.9		8	88.9	1	11.1		0	0	9	100		3	33.3	6	66.7		0	0	9	100

^*Significant difference: p < 0 : 05 level.

The prevalence of work-related hip symptoms was significantly correlated with age, frequency of exercise, type of work shift, rest time in a given shift, missed days of work, daily workload, working posture, frequency of changes in working order, type of chair used during practice, total years of experience, and outpatient consultation (p < 0.001). The prevalence of work-related knee symptoms was significantly correlated with age, rest time in a given shift, missed days of work, daily working time, frequency of changes in working order, total years of experience, average number of operations per week, and outpatient consultation (p < 0.001). The prevalence of work-related ankle symptoms was significantly correlated with gender, age, frequency of exercise, rest time in a given shift, work posture, daily working time, total years of experience, average number of operations per week, and outpatient consultation (p < 0.001; Table 4).

3.4 Characteristics of WMSDs

Most otorhinolaryngology practitioners in Saudi Arabia reported that they had suffered from two to four episodes of WMSDs of the neck, shoulders, wrists and hands, upper back, low back, knees, and ankles and feet. Most neck, shoulder, wrist, and low-back episodes persisted for more than 28 days. Most upper-back, knee, and ankle episodes lasted 8–14 days, and most elbow and hip episodes lasted 1–7 days. Pain was an exceptionally common complaint, followed by spasms, stiffness, and other symptoms.

3.5 Work factors

Otorhinolaryngology practitioners with WMSDs were questioned to identify which factors contributed to their WMSDs. Significant responses were assessed as percentages of the overall answers for each factor. The most important work factors identified by otorhinolaryngology practitioners were sustained posture (61.5%), working in awkward positions (50.9%), instrument handling (35.5%), inadequate lighting in workspaces (29.8%), and inadequate assistance at work (26.9%). Irregular work schedule (6.7%), continuing work when injured (4.8%), and inadequate training in injury prevention (1.9%) were reported as the most insignificant factors (Table 5).

Table 5
Risk factors that ENT practitioners identified as contributors to WMSDs

Risk factors No. of respondents Percentage (%)

1 Sustained posture 64/104 61.5

2 Working in awkward position 53/104 50.9

3 Instrument handling 37/104 35.5

4 Inadequate lighting in workspace 31/104 29.8

5 Inadequate assistance at work 28/104 26.9

6 Repetitive movements 25/104 24

7 Inadequate breaks during work 21/104 20.1

8 Limited work space 18/104 17.3

9 OPD table height 15/104 14.4

10 Administrative workload 13/104 12.5

11 Bending/twisting for a long time 10/104 9.6

12 Irregular work schedule 7/104 6.7

13 Continuing work when injured 5/104 4.8

14 Inadequate training in injury prevention 2/104 1.9

	Risk factors	No. of respondents	Percentage (%)
1	Sustained posture	64/104	61.5
2	Working in awkward position	53/104	50.9
3	Instrument handling	37/104	35.5
4	Inadequate lighting in workspace	31/104	29.8
5	Inadequate assistance at work	28/104	26.9
6	Repetitive movements	25/104	24
7	Inadequate breaks during work	21/104	20.1
8	Limited work space	18/104	17.3
9	OPD table height	15/104	14.4
10	Administrative workload	13/104	12.5
11	Bending/twisting for a long time	10/104	9.6
12	Irregular work schedule	7/104	6.7
13	Continuing work when injured	5/104	4.8
14	Inadequate training in injury prevention	2/104	1.9

3.6 Management strategies

The most frequent management strategies adopted by otorhinolaryngology practitioners were modifying their position (58.6%) and taking periodic breaks to stretch and change position (41.3%). The least implemented strategies were adjusting administrative workload (9.6%) as well as warming up and stretching before beginning manual techniques (6.7%; Table 6).

Table 6
Handling strategies used by ENT practitioners to combat WMSDs

Strategies Percentages (%)

Almost Sometimes Never

Number (%) Number (%) Number (%)

1 I modify my position during treatment 61 (58.6) 31 (29.8) 12 (11.5)

2 I halt repeatedly so that I can stretch and alter my position 43 (41.3) 39 (37.5) 22 (21.1)

3 I will select techniques that will not increase my discomfort 32 (30.7) 29 (27.8) 43 (41.3)

4 I adjust the table height during work 25 (24) 51 (49) 28 (26.9)

5 I stop treatment if anything increases my discomfort 21 (20.1) 36 (34.6) 47 (45.1)

6 I get someone help to handle the patient during treatment 18 (17.3) 54 (51.9) 32 (30.7)

7 I adjust the administrative workload 14 (13.4) 48 (46.1) 42 (40.3)

8 I warm up and stretch before beginning the manual techniques 9 (8.6) 23 (22.1) 72 (69.2)

	Strategies	Percentages (%)
1	I modify my position during treatment	61	(58.6)	31	(29.8)	12	(11.5)
2	I halt repeatedly so that I can stretch and alter my position	43	(41.3)	39	(37.5)	22	(21.1)
3	I will select techniques that will not increase my discomfort	32	(30.7)	29	(27.8)	43	(41.3)
4	I adjust the table height during work	25	(24)	51	(49)	28	(26.9)
5	I stop treatment if anything increases my discomfort	21	(20.1)	36	(34.6)	47	(45.1)
6	I get someone help to handle the patient during treatment	18	(17.3)	54	(51.9)	32	(30.7)
7	I adjust the administrative workload	14	(13.4)	48	(46.1)	42	(40.3)
8	I warm up and stretch before beginning the manual techniques	9	(8.6)	23	(22.1)	72	(69.2)

4 Discussion

This study aimed to assess the incidence and characteristics of WMSDs, their contributing work factors, and the management strategies used to combat these disorders among otorhinolaryngology practitioners working in Saudi Arabia. The findings revealed that 81.7% of otorhinolaryngology practitioners were affected by WMSDs. Most otorhinolaryngology practitioners affected by WMSDs were 30–55 years old, with more male than female practitioners affected.

Participants described working in a sustained posture for a long time, working in awkward positions, and performing strenuous instrument handling. This finding is consistent with those described in previous studies [5 , 12]. The incidence rate was higher than that reported in the United Kingdom (47.4%) [2] but less than that reported in India (87.6%) [3]. Potential reasons for these discrepancies are variations in study populations, sample size, gender balance, and practices in different countries.

In the present study, the neck region was identified as the most frequent location of WMSDs among otorhinolaryngology practitioners in Saudi Arabia, with a 12-month incidence rate of 67.3%. This result is consistent with that described in previous studies [2 , 16]. This was followed by WMSDs of the shoulders, lower back, wrists, knees, ankles, and hips and elbows, in contrast with the findings of previous studies [6 , 11]. We believe the reason for the neck being the most affected body part is that most practitioners placed their head-mounted eyeglasses in an incorrect position, hyperextending the neck and causing ergonomically unfavorable outcomes. Our findings contribute further to the study of work situations and environments that may lead to the high prevalence of WMSDs in these anatomical areas among otorhinolaryngology practitioners in Saudi Arabia.

We found a significantly greater frequency of shoulder (34.8%), upper-back (56.5%), low-back (47.8%), hip (21.7%), knee (34.8%), and ankle (43.5%) symptoms among female practitioners than among male practitioners (28.4%, 19.8%, 43.2%, 7.4%, 21%, and 16%, respectively). This outcome is in contrast with those described in previous studies [3, 9]. Gender is considered a possible risk factor for developing WMSDs in these regions because of variations in body weight, height, muscle strength, and body composition. These variations result in a disadvantage for female practitioners, particularly when working in awkward postures with prolonged instrument handling and when lacking adequate breaks during work, which place a further burden on the body.

The present study found that participants’ age was significantly (p < 0.001) associated with neck, shoulder, elbow, wrist, upper-back, low-back, hip, and knee complaints, which contrasts with previous studies [2, 6]. We believe this outcome was primarily due to regular work in extremely limited operative areas that require uncomfortable working postures [17]. We also found that otorhinolaryngology practitioners between 45 and 60 years of age had fewer WMSDs than younger practitioners, as they transition to less physically demanding work, predominantly administrative roles.

The incidence of neck, shoulder, wrist, low-back, and hip WMSDs was significantly (p < 0.001) correlated with work sector, in contrast with the findings of previous studies [3, 9]. A probable explanation for these outcomes is the work pattern of otorhinolaryngology practitioners in Saudi Arabia: otorhinolaryngology practitioners in the government sector tend to work with insufficient rest breaks in one shift, work 12 hours per day, have more operating hours per week, and perform the same tasks frequently. Rotating work between government and private hospitals would allow otorhinolaryngology practitioners to take regular breaks with less working time, which is an important practice for avoiding WMSDs. No correlation was observed between the prevalence of elbow WMSDs and any specific working area.

Our findings indicate that work in both standing and sitting postures increases the possibility of developing WMSDs, particularly those of the neck, elbows, upper back, low back, and ankles. This is in contrast with previous findings among the same operating populations [18, 19]. We assume that these associations could be a result of constant musculoskeletal system overload from using microscopes, head-set lights, and surgical eyeglasses, all of which have been highlighted as common causative factors for the development of WMSDs in otorhinolaryngology practitioners. Another possible explanation for neck pain could be the implementation of a forward head posture during otoscope ear assessment, which increases excessive load on the cervical spine [20, 21].

In the present study, the majority of the otorhinolaryngology practitioners acknowledged different risk factors as contributing to the prevalence of WMSDs. In increasing order of importance, they were sustained posture, working in an awkward position, instrument handling, inadequate lighting in workspaces, and inadequate assistance at work. This result is in contrast with those described in previous studies. [5, 7]. We believe that sustained posture and working in awkward positions were associated with the development of neck and low-back WMSDs, and instrument handling and inadequate lighting in workspaces were related to symptoms in the neck, shoulder, and low back. In outpatient departments particularly, otolaryngologists regularly engage in an awkward posture of lumbar spine flexion and rotation as they bend repeatedly further on their chair to evaluate patients and subsequently turn across to write patient notes. This further results in increasing intradiscal pressure and may affect spinal postural health [22].

However, given that otorhinolaryngology practitioners self-documented the influencing risk factors, the association may be due to bias and could reflect the factors the otorhinolaryngology practitioners expected to influence their WMSDs, rather than the factors actually producing their injuries. These conclusions should thus be regarded with caution until they are independently verified.

Lastly, the most frequently adopted management strategies the otorhinolaryngology practitioners used to combat WMSDs were changing their position, taking periodic breaks to stretch and alter their position, choosing the skills that would not aggravate their pain or discomfort, and adjusting table height during treatment. This study was the first of its kind in evaluating the strategies used by otorhinolaryngology practitioners to overcome WMSDs. Most otorhinolaryngology practitioners in our study paused treatment if anything increased their discomfort, sought assistance to manage the patient during treatment, and adjusted their administrative load. Only 6.7% of otorhinolaryngology practitioners used the option of warming up and stretching before beginning surgical techniques to safeguard themselves.

4.1 Limitations

The present study has some limitations. First, it was a cross-sectional study, so direct interpretation of the reasons for the results is not possible. Second, the study depended on self-reported data, so participants may have over- or understated their experiences. Third, the study did not assess the correlation between WMSDs and psychosocial factors.

5 Conclusion

The outcomes of this study show that the one-year incidence of WMSDs among otorhinolaryngology practitioners in Saudi Arabia was high. The most affected locations were the neck and shoulder, followed by the low back, wrist, upper back, knees, ankle, elbow, and hip regions. Most otorhinolaryngology practitioners experienced two to four periods of neck, shoulder, low-back, elbow, wrist, and knee WMSDs. Age, gender, work sector, resting time in a given shift, daily workload, area of specialty, and working position were significantly correlated with WMSDs, especially in the neck, shoulders, and low back. These findings highlight the need for developing training plans on ergonomics and well-organized interventions to limit WMSDs and improve working conditions for otorhinolaryngology practitioners in Saudi Arabia.

Conflict of interest

The author declares that no competing interests exist.

Data availability

All relevant data are provided in the paper.

Funding

This research was funded by a grant from the Deanship of Scientific Research, King Khalid University, Abha, Saudi Arabia (RGP 2/64/42).

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	Strategies	Percentages (%)
		Almost		Sometimes		Never
		Number	(%)	Number	(%)	Number	(%)
1	I modify my position during treatment	61	(58.6)	31	(29.8)	12	(11.5)
2	I halt repeatedly so that I can stretch and alter my position	43	(41.3)	39	(37.5)	22	(21.1)
3	I will select techniques that will not increase my discomfort	32	(30.7)	29	(27.8)	43	(41.3)
4	I adjust the table height during work	25	(24)	51	(49)	28	(26.9)
5	I stop treatment if anything increases my discomfort	21	(20.1)	36	(34.6)	47	(45.1)
6	I get someone help to handle the patient during treatment	18	(17.3)	54	(51.9)	32	(30.7)
7	I adjust the administrative workload	14	(13.4)	48	(46.1)	42	(40.3)
8	I warm up and stretch before beginning the manual techniques	9	(8.6)	23	(22.1)	72	(69.2)

Prevalence,characteristics,contributing factors,work sector,and impact of work-related musculoskeletal disorders among otorhinolaryngology practitioners in Saudi Arabia: A cross-sectional study

Abstract

BACKGROUND:

OBJECTIVES:

METHODS:

RESULTS:

CONCLUSIONS:

Keywords

1 Introduction

2 Material and methods

2.1 Participants

2.2 Procedures

2.3 Questionnaire

2.4 Data analysis

3 Results

3.1 Response rate

3.1 Participant characteristics

Table 2 Prevalence of WMSDs by body part among ENT practitioners in Saudi Arabia Body areas (n) Percentage (%) Neck (70) 67.3 Shoulder (51) 49 Low back (46) 44.2 Wrist (35) 33.6 Upper back (29) 27.8 Knees (25) 24 Ankle (23) 22.1 Elbow (11) 10.5 Hip (11) 10.5

3.5 Work factors

4.1 Limitations

5 Conclusion

Conflict of interest

Data availability

Funding

References

Table 2
Prevalence of WMSDs by body part among ENT practitioners in Saudi Arabia

Body areas (n) Percentage (%)

Neck (70) 67.3

Shoulder (51) 49

Low back (46) 44.2

Wrist (35) 33.6

Upper back (29) 27.8

Knees (25) 24

Ankle (23) 22.1

Elbow (11) 10.5

Hip (11) 10.5