Risk factors for neck pain-induced disability among primary healthcare workers: A pilot study

Abstract

BACKGROUND:

Neck pain (NP) is associated with high disability rates among healthcare workers.

OBJECTIVE:

To determine the potential risk factors associated with disability due to NP among healthcare staff working in primary care settings.

METHODS:

This 30-day prospective cross-sectional study involved a survey of 63 healthcare personnel (55 women and 8 men aged 45.30±12.34 years) of two primary healthcare centers in Serbia, who completed a general questionnaire developed for this purpose along with the Neck Disability Index (NDI), whereby the potential predictors of NP-related disability were assessed using the statistical package SPSS ver. 24.

RESULTS:

Female healthcare workers achieved a higher score on the NDI scale (Me = 8.00, p < 0.05), as did older respondents (r = 0.260, p < 0.05), those with longer work experience (r = 0.323, p < 0.05), and those that wear prescription glasses (Me = 9.00, p < 0.01). Higher NDI scores were also achieved by respondents that suffered from neck pain at the time of the study (Me = 12.50, p < 0.001), especially if they relied on pain medication (Me = 13.00, p < 0.05), and topical analgesic creams (Me = 12.50, p < 0.05) for treating neck pain.

CONCLUSION:

Female sex, older age, greater work experience, current neck pain, use of pain-relieving medications and creams, and need for prescription glasses to correct vision increase the risk of disability due to pain in the cervical spine among healthcare workers.

Keywords

Neck pain workplace health personnel primary health care

1 Introduction

Neck pain (NP) is becoming increasingly prevalent, and is causing significant public health burden due to the resulting disability [1], given that it affects 30–50% of workforce worldwide [2]. In their study of pain prevalence among men and women across Europe, Todd and colleagues noted that back/neck pain (40%) was twice as common as arm/hand pain (22%) and foot/leg pain (21%) irrespective of sex [3]. Ample body of evidence indicates that musculoskeletal diseases, and NP in particular, most frequently affect personnel working in long-term care settings, computer users [4], dentistry students [5], general dentists and general pharmacists [6], and administrative workers in hospitals [7]. However, NP prevalence among health workers of all profiles, such as nursing staff, physical therapists, and occupational therapists and their assistants [8, 9], especially those employed in hospitals, is much greater relative to that noted for general population. Based on a systematic literature review conducted by Soylar and colleagues in 2018, the 12-month prevalence of musculoskeletal diseases among nurses varied between 33% and 88%, and the most frequently affected regions were lower back, shoulders, neck, knees, and wrists/hands. This finding is not surprising, given that musculoskeletal disorders are associated with cumulative trauma caused by repetitive movements [10] due to which significant number of doctors of various specialties also experience NP [11 –14].

Neck and/or shoulder pain is becoming increasingly prevalent and is thus an occupational health hazard to which all healthcare providers are exposed. However, this multifaceted issue requires further investigation, as its emergence and persistence are influenced by a variety of factors, including hospital level, workplace role, employment status (contract/temporary vs. permanent), workload, ergonomic factors (such as tasks necessitating prolonged neck bending or twisting) and computer-related factors (extensive computer use and inadequate keyboard position) [15]. Moreover, extant research shows that persistent pain in cervical spine can undermine motivation and productivity [16].

According to Rypicz and colleagues, clinical nurses are particularly prone to experience episodes of musculoskeletal pain owing to regular exposure to workplace-related risk factors that contribute to overload. It is thus crucial to determine the real causes of musculoskeletal pain and take appropriate preventive measures to improve the workplace ergonomics [17]. Yet, as extant studies on this topic primarily focus on NP among hospital staff, no information on its prevalence in primary healthcare settings presently exists.

This gap in literature has motivated the present study, the aim of which was to elucidate the risk factors contributing to the NP-related disability among primary healthcare personnel. We hypothesized that female sex and years of service would be the primary drivers of NP-related disability in this population and tested this assertion by analyzing the data obtained by administering a general study-specific questionnaire and Neck Disability Index (NDI) to a sample of health workers employed full-time in primary healthcare facilities.

2 Materials and methods

This prospective cross-sectional study included 63 health workers (aged 45.30±12.34 years; 55 women and 8 men) employed in primary healthcare facilities (31 were recruited from the Health Center Bač and 32 from the Health Center Bački Petrovac) in Serbia. The participants’ roles and responsibilities were typical of those in a primary healthcare institution, i.e., nurses, general practitioners, and doctors of other specialties, all of whom worked full time (eight hours per day). However, for the analysis purposes, the participants were segregated according to their educational attainment into doctors (those with a university degree at the minimum) and other health workers (those with educational attainment below university level), as shown in Table 1, while workplace responsibilities were grouped under sedentary tasks and physically demanding duties. The data for this study was gathered via a survey administered between April 1st and May 1st, 2021, following the approval by the Ethics Committees of both institutions (approval number 414/22 and 01-274/21, respectively). Participation was voluntary and anonymous, and all individuals that agreed to take part in the study signed the informed consent form. All respondents completed a general questionnaire designed specifically for the purpose of this investigation, along with the NDI [18]. NDI was chosen, as this self-report questionnaire is frequently used in both research and practice to determine how neck pain affects respondents’ daily life and to assess the resulting self-rated disability levels. The generic questionnaire probed into the participants’ gender, age, educational attainment, length of work experience, current neck pain status, pain duration, use of pain-relieving medication, use of topical analgesic creams, use of prescription glasses, as well as average daily use of mobile phone and computer.

Table 1
Basic demographic and lifestyle characteristics of study participants

Characteristic N = 63

Sex, n (%)

Male 8 (12.7%)

Female 55 (87.3%)

Age (years), Mean±SD 45.30±12.34

Work experience (years), Mean±SD 20.95±12.68

Educational attainment, n (%)

High school 34 (54.8%)

College 6 (9.7%)

University 22 (35.5%)

Time spent using computer (hours per day), Me (IQR) 6.00 (7.00)

Time spent using mobile phone (hours per day), Me (IQR) 2.00 (2.00)

Currently experiencing neck pain, n (%)

Yes 24 (38.1%)

No 39 (61.9%)

Neck pain duration, n (%)

<6 weeks 18 (54.5%)

6–12 weeks 3 (9.1%)

12+ weeks 12 (36.4%)

Taking pain-relieving medications n (%)

Yes 7 (11.9%)

No 52 (88.1%)

Applying analgesic topical creams n (%)

Yes 8 (13.8%)

No 50 (86.2%)

Wearing prescription glasses, n (%)

Yes 34 (56.7%)

No 26 (43.3%)

Characteristic	N = 63
Sex, n (%)
Male	8 (12.7%)
Female	55 (87.3%)
Age (years), Mean±SD	45.30±12.34
Work experience (years), Mean±SD	20.95±12.68
Educational attainment, n (%)
High school	34 (54.8%)
College	6 (9.7%)
University	22 (35.5%)
Time spent using computer (hours per day), Me (IQR)	6.00 (7.00)
Time spent using mobile phone (hours per day), Me (IQR)	2.00 (2.00)
Currently experiencing neck pain, n (%)
Yes	24 (38.1%)
No	39 (61.9%)
Neck pain duration, n (%)
<6 weeks	18 (54.5%)
6–12 weeks	3 (9.1%)
12+ weeks	12 (36.4%)
Taking pain-relieving medications n (%)
Yes	7 (11.9%)
No	52 (88.1%)
Applying analgesic topical creams n (%)
Yes	8 (13.8%)
No	50 (86.2%)
Wearing prescription glasses, n (%)
Yes	34 (56.7%)
No	26 (43.3%)

Abbreviations: Me (IQR) – Median (Interquartile Range).

The NDI instrument consists of ten items, respectively pertaining to pain intensity, personal care, lifting, reading, headaches, concentration, work, driving, sleeping, and recreation, thereby assessing the functional status of individuals experiencing disabling neck pain. As each item is rated on a 6-point Likert scale, anchored at 0 (no activity limitation) and 5 (major activity limitation), the sum of all scores (ranging from 0 to 50) was used in the present study for determining the degree of disability as follows: 0–4 (no disability), 5–14 (mild disability), 15–24 (moderate disability), 25–34 (severe disability), and 35–50 (complete disability).

Only adults (aged 18 years and above) in permanent employment at one of the two participating healthcare institutions that signed the informed consent form were eligible for participation, while those to whom any of the following criteria applied were excluded: presence of cervical spine injury, whiplash-associated disorders, inflammatory autoimmune diseases, or polymyalgia rheumatica; prior cervical spine surgery; participation in physical therapy for neck pain in the preceding six months; regular corticosteroid use; and failure to sign the informed consent form.

2.1 Statistical methods

First, the distribution of numerical variables was examined using the Kolmogorov-Smirnov test. Non-parametric statistical methods were used for variables that statistically significantly deviated from normal distribution, while parametric tests were adopted for normally distributed variables. Cronbach’s α coefficient was calculated to test the reliability of the measurement scale. For normally distributed numerical data, arithmetic mean and standard deviation (M±SD) were reported, whereas the median (Me) and the interquartile range (IQR) were calculated in other cases. To test the significance of differences between studied parameters, the Mann-Whitney U test was performed, while associations were assessed via non-parametric Spearman’s rho and parametric Pearson correlation tests. The predictive power of independent variables was evaluated through univariate linear regression. All analyses were conducted using the statistical package SPSS ver. 24 with p < 0.05 signifying statistical significance.

3 Results

The study sample comprised 63 middle-aged healthcare workers (55 women and 8 men aged 45.30±12.34 years) with considerable work experience (20.95±12.68 years). Majority (54.8%) of the participants completed high school only, while 9.7% completed further medical training equivalent to a college diploma. These individuals occupied workplace positions that do not require university degree. On the other hand, all doctors (35.5% of the sample) completed undergraduate (primary care physicians) or postgraduate (specialists in relevant medical field) medical training. All healthcare staff, in addition to treating patients, are required to utilize computer and mobile phone on a daily basis to complete their duties. As they on average reported six and two hours of daily computer/mobile phone use, this factor was considered in relation to the reported NP. A significant percentage (38.1%) of respondents reported having neck pain, which in 54.5% of cases persisted for up to six weeks, and was treated with medication and topical analgesic creams by 11.9% and 13.8% of these individuals, respectively. Moreover, 34 respondents (56.7% of the sample) required prescription glasses (Table 1).

Neck Disability Index (NDI) was used to assess the extent of NP-induced disability. This instrument contains ten items, each requiring response on a 6-point Likert scale (anchored at 0 = “no activity limitation” and 5 = “major activity limitation”). The total score on the scale was calculated as the sum of scores pertaining to all items, thereby spanning the 0–50 range. As all respondents rated all items, there were no missing data, allowing the total score to be calculated for the full sample, yielding Me = 7 (IQR = 9.0). The analyses further revealed that 38.1% of respondents had no disability, 46% had mild disability, and 15.9% had moderate disability, confirming that complete disability due to NP was absent in this cohort. To examine the internal consistency of this instrument, Cronbach’s α coefficient was calculated, whereby 0.765 was obtained for the NDI total score and satisfactory reliability was achieved for all individual dimensions (ranging from 0.730 to 0.765, as shown in Table 2).

Table 2
Descriptive statistics of the NDI scores and cronbach’s α coefficient

NDI total score and items Me (IQR) Cronbach’s α

NDI total score 7 (9.0) 0.765

NDI total score by category n (%)

No disability 24 (38.1%)

Mild disability 29 (46.0%)

Moderate disability 10 (15.9%)

Severe disability 0 (0.0%)

Complete disability 0 (0.0%)

Pain 0.0 (2.0) 0.732

Personal care 0.0 (0.0) 0.765

Lifting 0.0 (1.0) 0.750

Reading 1.0 (1.0) 0.742

Headaches 2.0 (2.0) 0.759

Concentration 0.0 (1.0) 0.739

Work 1.0 (1.0) 0.740

Driving 0.0 (1.0) 0.747

Sleeping 0.0 (1.0) 0.730

Recreation 0.0 (1.0) 0.741

NDI total score and items	Me (IQR)	Cronbach’s α
NDI total score	7 (9.0)	0.765
NDI total score by category n (%)
No disability	24 (38.1%)
Mild disability	29 (46.0%)
Moderate disability	10 (15.9%)
Severe disability	0 (0.0%)
Complete disability	0 (0.0%)
Pain	0.0 (2.0)	0.732
Personal care	0.0 (0.0)	0.765
Lifting	0.0 (1.0)	0.750
Reading	1.0 (1.0)	0.742
Headaches	2.0 (2.0)	0.759
Concentration	0.0 (1.0)	0.739
Work	1.0 (1.0)	0.740
Driving	0.0 (1.0)	0.747
Sleeping	0.0 (1.0)	0.730
Recreation	0.0 (1.0)	0.741

Abbreviations: NDI – Neck Disability Index; Me (IQR) – Median (Interquartile Range).

As can be seen from Table 3, women achieved a higher score on the NDI scale compared to men [Me = 8.00 (7.75) vs. Me = 3.00 (2.5); p < 0.05]. Likewise, greater level of NP-related disability was noted for older respondents (r = 0.260; p < 0.05) and those with longer work experience (r = 0.323; p < 0.05). As expected, higher NDI score was achieved by participants that suffered from NP at the time of the study [Me = 12.50 (8.25) vs. 4.00 (10.25); p < 0.001], and in particular by those that relied on pain-relieving medication [Me = 13.00 (10.50) vs. 5.50 (7.50); p < 0.05], and topical analgesic creams [Me = 12.50 (11.00) vs. 6.50 (6.00); p < 0.05] for pain relief, but also by healthcare workers that wore prescription glasses [Me = 9.00 (8.00) vs. 4.00 (10.50); p < 0.01]. On the other hand, no statistically significant differences in NP-related disability were noted when the sample was segregated by educational attainment, NP duration, and daily computer/mobile phone use.

Table 3

Sample characteristics and NDI total score

Characteristic	Me (IQR)	P value
Sex		0.017^a
Male	3.00 (2.5)
Female	8.00 (7.75)
Age (years)	0.260^e	0.041^d
Work experience (years)	0.323^e	0.011^d
Educational attainment, n (%)		0.079^a
High school	9.00 (8.25)
College	7.50 (14.25)
University	5.00 (8.00)
Currently experiencing neck pain n (%)		< 0.001^a
Yes	12.50 (8.25)
No	4.00 (10.25)
Neck pain duration, n (%)		0.403^a
<6 weeks	11.00 (6.25)
6–12 weeks	18.00 (8.00)
12+ weeks	10.50 (10.00)
Taking pain-relieving medications n (%)		0.013^a
Yes	13.00 (10.50)
No	5.50 (7.50)
Applying analgesic topical creams n (%)		0.025^a
Yes	12.50 (11.00)
No	6.50 (6.00)
Wearing prescription glasses n (%)		0.009^a
Yes	9.00 (8.00)
No	4.00 (10.50)
Time spent using computer (hours per day)	0.182^c	0.154^b
Time spent using mobile phone (hours per day)	0.004^c	0.976^b

Abbreviations: Me (IQR) – Median (Interquartile Range). ^aMann-Whitney U test, ^bSpearmans rho test, ^cSpearmans rho correlation coefficient, ^dPearson correlation test, ^ePearson correlation coefficient. P value – level of statistical significance.

Further analyses were performed to identify the main risk factors for the development of NP-related disability and the results are presented in Table 4. As can be seen from the tabulated findings, women had a higher NDI total score compared to men (Beta = –0.284; CI: –9.735 to –0.711; p < 0.05). Moreover, the extent of NP-related disability was found to increase with age (Beta = 0.260; CI: 0.006 to 0.257; p < 0.05) and work experience duration (Beta = 0.323; CI: 0.038 to 0.278; p < 0.05). As respondents who wore prescription glasses had a higher NDI total score, this factor emerged as a statistically significant predictor of NP-related disability (Beta = 0.315; CI: 0.819 to 7.031; p < 0.05).

Table 4

NDI predictors in the studied sample

Independent variables	Standardized coefficients beta	P value	95.0% confidence interval for B		Adjusted R squared
			Lower bound	Upper bound
Sex	–0.284	0.024	–9.735	–0.711	0.066
Age	0.260	0.041	0.006	0.257	0.052
Work experience	0.323	0.011	0.038	0.278	0.089
Education	–0.309	0.115	–3.650	–0.417	0.08
Neck pain duration	0.246	0.167	–0.694	3.839	0.03
Wearing prescription glasses	0.315	l0.014	0.819	7.031	0.084
Number of hours spent using computer during the day	0.151	0.237	–0.188	0.744	0.007
Number of hours spent using mobile phone during the day	–0.004	0.977	–0.614	0.596	0.016

Dependent variable: NDI Total Score. CI – confidence interval. P value – level of statistical significance.

4 Discussion

Neck pain, i.e., pain perceived to occur between the superior nuchal line and the spinous process of the first thoracic vertebra, is a serious public health concern [1, 19], especially in the healthcare sector [20]. As our investigation was conducted in the primary care setting, majority of the respondents (87.3%) were women, which is characteristic of the personnel employed in these facilities in Serbia and is in line with the sample composition reported by other authors [21, 22]. The average age and work experience in our cohort was 45.30±12.34 and 20.95±12.68 years, respectively, indicating that most participants were middle-aged and had decades of work experience, which likely contributed to NP. The findings yielded by the present study confirm the initial hypothesis that female gender and longer work tenure are the risk factors for greater disability due to pain in the cervical spine.

Although Kuo and colleagues conducted their research on a slightly younger sample, their finding that NP-induced disability severity increases with age concurs with our results [23]. Extant studies further suggest that sex can also influence NP development and prevalence, as confirmed by a number of systematic literature reviews. However, female sex is a weak predictor of NP risk, since the age of onset (as another influential factor) may differ between males and females, and aging is known to be the most important risk factor for developing most types of chronic pain. These findings are expected, given that the normal anatomy of the cervical spine changes as we get older, which can cause neck pain and long-term disability. For this reason, neck pain is more common in older adults, although it can occur at any age [24].

It is also worth noting that 64.5% of our sample was educated below the university degree level, which would influence the workplace role and the duties performed on a daily basis. In each country, the healthcare system is designed to best meet the population needs, which are reflected in the types and complexity of services provided, thereby affecting the personnel composition, as well as the level of formal education required to fill individual positions. In a study conducted by Keyaerts and colleagues involving 305 health workers from several hospitals in Belgium, 88% of the sample were women, 33.4% were nurses, and 30.9% were aged 45 years or older. Moreover, 31.3% of participants worked full time, and 46.9% of the sample was educated above the high school level. In terms of work experience, 34.5% and 30.3% of the respondents were in the current role for 0–4 years and 15+ years, respectively. The most prevalent form of pain during the preceding 12 months was located in the neck and shoulders (79.5%) and the lower back (72.4%), while 93.4% of the respondents complained of pain in at least one region of the body. The authors also found that the physical demands associated with the workplace role, autonomy at work and fear of movement were positively correlated with musculoskeletal diseases [22]. Dong et al. assessed pain prevalence by surveying 30,520 hospital workers and found that chronic neck and/or shoulder pain was associated with hospital level, employment status, workplace role, and workload [15].

Prescription glasses were used by 56.7% of primary healthcare workers that took part in our research, who on average spent six and two working hours using the computer and mobile phone, respectively, which is in accordance with the results (4.8±2.8) reported by Kuo et al. for daily computer use at workplace [23]. Dong and colleagues also found that having to bend and twist the neck forward for long periods of time, and spending a significant portion of workday using the computer (especially if sitting in incorrect position or using inappropriately positioned keyboard) increases the risk of neck pain [15]. These results concur with the growing body of evidence indicating that insufficient ergonomic adaptation of office furniture can be the cause of greater neck flexion and greater muscle activity in the shoulder region, which may result in pain in the cervical spine [25].

It is also noteworthy that 38.1% of our respondents felt neck pain at the time of completing the survey, which had persisted for up to six weeks in 54.5% of these cases. These figures are comparable to those reported by Rypicz et al. who surveyed 136 nurses working in the anesthesiology, intensive care, and surgical hospital departments, as only 8% of their sample did not have musculoskeletal pain, while 67%, 59%, and 66% complained of pain in the lower back, upper back, and neck, respectively [17].

Based on their self-reports, 11.9% and 13.8% of our respondents relied on pain-relieving medication and topical analgesic creams, respectively, for alleviating NP, concurring with the results obtained in other studies. Available data indicate that, although majority of acute NP episodes resolve spontaneously, more than a third of individuals experiencing NP still have low-grade symptoms or relapse within the subsequent 12 months, whereby symptom persistence is attributed to genetic and psychosocial risk factors.

Almost half of individuals that suffer from chronic neck pain have a combination of neuropathic and nociceptive symptoms or predominantly exhibit neuropathic symptoms. According to Cohen and Hooten, although muscle relaxants and non-steroidal anti-inflammatory drugs are usually effective in relieving acute neck pain, their use in clinical practice is typically guided by the results yielded by studies focusing on other chronic pain conditions [26]. Therefore, Verhagen advocated for a greater reliance on non-pharmacological remedies, such as manual therapy, exercise, and education (ideally a combination of all three strategies), which tend to be favored by most patients with neck pain. However, evidence supporting the effectiveness of most such interventions is weak, as effect sizes tend to be small for making any definitive causal inferences [27].

Our analyses revealed that the NDI total score for all respondents was Me = 7, whereby 38.1% the sample had no disability, 46% had mild disability, and 15.9% had moderate disability, which is comparable to the MDI = 5.21±1.47, as well as the percentages related to absence of disability, mild, moderate, and severe disability (8.4%, 23.2%, 59.2%, and 9.2%, respectively) reported by Khadim et al. in 2018 [28]. In their study, Kuo et al. administered the NDI and the Oswestry Disability Index (ODI) to 139 nurses and reported the 7.6±4.8 and 3.4±5.1 average values for the two instruments. They also noted that 98.6% of respondents suffered from mild or moderate neck disability, and in the remaining 1.4% of the sample neck disability was severe. These authors further observed that longer job tenure (15–20 years) was a predictor of more severe neck disability, as 37% of subjects in this group suffered from moderate or severe neck disability [23]. Our findings also indicate that NP-related disability increases with age, with the highest incidence of moderate disability recorded in the 40–49 age group.

In our cohort, presence of neck pain at the time of taking the survey, use of pain-relieving medication or topical analgesic creams, and the need for prescription glasses were correlated with higher NDI scores. Du et al. recently reported that the total workload, especially among nurses, is associated with a higher risk of low back pain, neck pain, shoulder pain, and back pain [21]. Soylar and Özer attributed these findings to the accumulated trauma and repetitive movements involved in the daily duties of nurses, such as lifting, transferring, and repositioning patients, as well as prolonged standing and incorrect body posture [10]. A study conducted by Bozic et al. among 512 nurses in Serbia showed that 93.95% of participants reported experiencing discomfort or pain in the lower back in the preceding 12 months [29].

Suboptimal vision that necessitates use of prescription glasses is another statistically significant predictor of NP-related disability, as it is associated with higher NDI scores [30]. Based on their analysis of the relationship between accommodative visual dysfunctions and cervical complaints, Sanchez-Gonzalez et al. noted that visual impairments that warrant the use of prescription glasses are related to low performance index, decreased range of motion, as well as greater neck pain [31]. However, little is presently known about the link between anxiety and work-related musculoskeletal disorders (WRMSDs) in the nursing population. We found that nurses exhibiting anxiety symptoms were more likely to suffer from WRMSDs, especially in the neck and shoulders, compared to those that did not report such symptoms [32].

It is thus noteworthy that, among healthcare workers, the prevalence of psychological and physical distress (including anxiety, depression, and fatigue), as well as musculoskeletal disorders, increased during the COVID-19 pandemic due to excessive workload. Specifically, in their survey, Arca and colleagues found that 73.4% of the participants had anxiety, 83.5% suffered from depression, and 94.9% experienced musculoskeletal pain. Moreover, 73.4% of the sample complained of NP in the preceding 12 months, and 61.4% indicated that they had experienced upper back pain in the last week. These alarming statistics highlight the need to provide psychological support and exercise training to healthcare workers [33].

When interpreting the results reported here, it is important to consider the limitations of our study, especially the small number of respondents (who were recruited from only two primary care facilities, and most of whom were women) and the short study period. Likewise, other potential causes of neck pain were not taken into account, and the impact of changes in body, head, and neck posture during the COVID-19 pandemic as a result of mandatory use of additional protective equipment (special glasses, visors, masks) was not considered. Although majority of participants were middle-aged women, the influence of menopause on the emergence of musculoskeletal issues, especially cervical spine pain, was not examined even though it is a known predisposing factor. Finally, preponderance of nociceptive and/or neuropathic pain was not captured in our analyses, which also failed to delineate daily work-related computer/phone use from that for other purposes.

It is thus necessary to address these shortcomings in future investigations in order to obtain a more comprehensive picture of the risk factors and consequences of neck pain among primary healthcare workers, especially in pandemic conditions.

Each type of work caries specific risks to personnel safety, whereby accidents can occur due to failures to follow prescribed protocols. In this context, deep learning algorithms are increasingly being adopted as a substitute for human supervision, as this increases the likelihood of compliance with site-specific safety regulations. While such systems are not presently in use in the Serbian healthcare system, the core premises behind their application are highly relevant, especially rules related to the adoption of protective postures and movements, as well as use of good ergonomic practices, in order to minimize the risk of incapacity due to cervical spine pain [34].

5 Conclusion

Female health workers employed in primary healthcare settings report higher levels of neck pain compared to their male counterparts. Moreover, older health workers, those with longer tenure, individuals that already suffer from neck pain, or use pain-relieving medications or analgesic creams to relieve neck pain, and those requiring prescription glasses tend to report greater NP-related disability. Yet, there is paucity or research exploring the influence of working conditions in primary healthcare institutions on the health workers’ wellbeing, even though they clearly require a workplace environment that is conducive for productivity and delivery of high-quality care without compromising their physical and mental health. Thus, initiatives such as early screening, improvements in working conditions, ergonomic education, and elimination and/or reduction of potential risk factors are urgently needed in order to prevent the development of neck pain in this population.

Based on these findings, we recommend greater focus on the timely detection of risk factors—hospital level, workplace role, employment status (contract/temporary vs. permanent), weekly workload, ergonomic factors (work duties that necessitate twisting and bending the neck forward for long periods) and computer-related factors (e.g., extended daily use of computer, inappropriate keyboard position)—that may precipitate neck pain [15], along with improvements in the workplace conditions, including provision of exercise programs during breaks, as well as ergonomic education, as a means of reducing neck pain prevalence among healthcare workers. Psychological stress should also be examined in this population, given that these problems are typically analyzed in the context of office work, focusing on the ergonomic body positions and the workplace ergonomics. The findings yielded by these studies indicate that provision of specific exercises for the neck would reduce absenteeism, and similar conclusions are likely to apply to health workers [35].

Ethical approval

The study was approved by the Ethics Committee of Health Center Bač (approval number 414/22) and the Ethics Committee of Health Center Bački Petrovac (approval number 01-274/21).

Informed consent

All individuals who agreed to take part in the study signed the informed consent form. The authors have no acknowledgments.

Footnotes

Acknowledgments

The authors have no acknowledgments.

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

The authors report no funding.

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