Prevalence and risk factors of work-related musculoskeletal disorders among healthcare workers in medical radiation environments

1 Introduction

Work-related musculoskeletal disorders (WMSDs) are injuries to the body’s muscles, soft tissues, joints, and ligaments caused by occupational factors resulting in various debilitating conditions [1, 2]. Research suggests that WMSDs are major contributors to sick leave and reduced productivity, and they may lead to early retirement and reduced quality of life [3]. In addition, the socioeconomic impact of WMSDs is substantial, resulting in substantial consumption of healthcare resources, absenteeism from work, disability, and compensation payments [3, 4]. United States’ surgeons have a WMSD prevalence of 43%; Italian dentists have a prevalence of 84.6%; Nigerian have a prevalence of 88.8%; and Indian bus drivers have a prevalence of 55.8% [5–8]. The prevalence of WMSDs among workers is 20–90% in China, covering almost all industries, with some industries having a prevalence as high as 90% : 42.2% in the automobile manufacturing industry, 32.12% in the furniture manufacturing industry, 43.9% in the chemical manufacturing industry, 81.2% in power supply enterprises, and 94.3% in sonographers [9–13].

Healthcare workers frequently experience WMSDs due to their increasingly physically demanding job roles [14, 15]. Many surgeons (75.5%) experience physical pain due to occupational reasons such as forceful repetitive tasks or poor instrumentation design, and the lower back, neck, and shoulders were the most affected body regions [16]. Furthermore, 76% of dentists suffer from WMSDs [17], and clinical examinations have revealed a prevalence of 32.4% among nurses [18]. The use of radiation devices and nuclear technology in healthcare has increased, increasing the number of radiation staff in medical institutions and their workload. In the US, radiologists had an average workload of 14900 cases per full-time equivalent per year from 2006 to 2007, reflecting a 7% increase from 2002 to 2003 and a 34.0% increase from 1991 to 1992 [19]. As of 2018, China had 32000 hospitals and 36000 health clinics that provided radiological diagnosis and treatment, employing approximately 400000 medical radiation staff [20, 21]. Since these workers are exposed to ionizing radiation in their workplace, some must wear protective equipment, such as lead aprons and caps.

Additionally, they are susceptible to workplace musculoskeletal disorders owing to heavy workloads, high psychological stress, and sustained awkward postures. Physicians specializing in radiation exposure are at increased risk for WMSDs and lack awareness of applied ergonomics measurements, requiring prompt attention and action [22]. However, few studies have reported WMSDs in medical radiation workers. Thus, this study aimed to investigate and identify the association between WMSDs and their risk factors among medical radiation workers in medical units and institutions in Guangdong Province, China, to provide a reference for the prevention and control of WMSDs.

2 Methods

3 Results

Our study found that the prevalence of self-reported WMSDs among medical radiation workers was 15.3% and that musculoskeletal pain was more common among nuclear medicine workers and radiotherapists than among interventional radiologists. Herein, it was found that WMSDs commonly affected the neck, shoulders, and lower back of those working in radiological fields, which is consistent with a previous study highlighting that the neck, shoulders, and lower back were most affected by WMSDs in critical industries or occupations in China [28].

To our knowledge, this study assessed the prevalence and risk factors for WMSDs among medical radiation staff. Gender, unhealthy lifestyles, rank seniority hospital, and poor ergonomics were correlated with a higher risk of musculoskeletal pain, whereas a comfortable workplace was a protective factor against WMSDs. The overall prevalence of WMSDs was <78.5%, as reported in a study on musculoskeletal discomfort among radiologists and radiology trainees [29]. This discrepancy may be attributed to the relatively young age (mostly <40 years) and fewer years of service (mostly <10 years) of the study participants. Our results may have potentially underestimated the actual prevalence, as age and length of service were attributed to the risk of WMSDs [30].

Our findings suggest that the risk of shoulder WMSDs is higher in female than in male healthcare workers. One study showed a higher prevalence of multi-site musculoskeletal symptoms in female radiologists (72%) than in male radiologists (46.6%) [31]. This is consistent with the results of these studies [32–34]. Women may be more susceptible to awkward ergonomic issues owing to low muscle tension, strength, and hormonal factors, especially when they undertake the men’s workload [35]. Chronic alcohol consumption triggers a specific type of neuropathic pain [36], and previous studies have identified positive associations between alcohol consumption and neck, shoulder, and ankle pain [37]. Medical radiation staff at top-tier tertiary hospitals in China are at a higher risk of developing WMSDs in the lower back than those at lower-tier hospital levels. This may be due to the heavy workload, fast-paced work environment, and higher professional competency requirements of top-tier tertiary hospitals. Individuals with higher educational levels are more likely to develop neck WMSDs [38].

Interventional radiology is a distinct specialty that requires radiologists to stand for long periods while wearing heavy personal protective equipment, performing technically intricate procedures, and adjusting their body positions to complete tasks. Interventional radiologists who must adopt awkward postures while using anti-X aprons are at a higher risk of developing WMSDs [39]. Studies have investigated work-related diseases, both cancer and musculoskeletal pain [40]. The prevalence of neck and lower back pain among interventional radiologists is approximately 20.1–24% [41]. Although our study found that 9.9 and 3.3% of interventional radiologists complained of neck and lower back pain, respectively, repetitive motion, inadequate recovery time, prolonged standing, axial loading on the spine, and awkward postures were specific risk factors associated with back pain among interventional radiologists [41]. Recently, computer workstations have become vital components of diagnostic radiology. Owing to their increased workload, most radiologists work long hours without breaks. Inadequate ergonomic practice may increase the risk of repetitive stress injuries as well as neck, shoulder, and lower back pain [42]. Diagnostic radiologists, radiotherapists, and nuclear medicine healthcare workers reported the presence of musculoskeletal disorders.

Repetitive motions during work contribute to the risk of WMSDs in the neck, shoulders, lower back, and at multiple sites. Interventional radiologists frequently use handheld devices during inspection procedures throughout their operations and assume a posture that involves lowering their heads and bending their necks forward while repetitively moving their hands and necks, resulting in the muscles and joints being subjected to excessive strain. This posture causes the workers’ wrists, shoulders, arms, and lower back to remain in contracted or overextended states, leading to excessive straining of the muscles and joints, thus increasing the risk of WMSDs. Additionally, repetitive execution of the same task can cause workers to experience monotony, fatigue, and weariness [43, 44]. Working overtime also increases the risk of neck, shoulder, and multi-site WMSDs. The term “overtime” denotes an additional workload that deprives the already stressed neck and shoulder areas of essential rest. This situation keeps the skeletal muscles in a state of prolonged fatigue without sufficient time to recuperate, ultimately leading to chronic injuries [45]. Stationary posture is recognized as a contributing factor to WMSDs. Dental imaging, interventional procedures, and similar tasks performed in the standing position require concentrated attention. Prolonged standing leads to tightening and fatigue of the lower back muscles and increased pressure on the lumbar discs. Frequently adopting a bending or twisting posture while standing for long periods, coupled with high concentration, is a predisposing factor for low back pain [46, 47]. Furthermore, maintaining a single position for prolonged periods leads to systemic or localized circulatory disorders, resulting in an insufficient blood supply to the areas surrounding the spinal cord. In such situations, the tissues, muscles, ligaments, and bones can experience different stress levels. Failure to provide timely intervention can result in the accumulation of issues over time, potentially resulting in WMSDs [48].

Adjustable work chairs have the potential to protect against neck and multi-site WMSDs. Computers are essential for diagnostic radiologists to analyze images; however, this inevitably involves prolonged sitting times. Prolonged sitting and computer working hours have been identified as risk factors for neck pain [49–51]. An adjustable work chair allows workers to adjust their height to a knee flexion angle of almost or slightly <90∘, which provides adequate spinal support, reduces spinal strain, and avoids ergonomic complaints. This position ensures good spinal support by minimizing spinal stress and preventing negative ergonomic effects. A comfortable workplace temperature is a protective factor against lower back WMSD. Low temperature is a recognized risk factor for lower back pain [52–55]. Working at suboptimal temperatures in the work environment can cause tension in the lower back muscles, resulting in lower back pain [56].

The risk factors for WMSDs, including occupational and individual factors, as well as a psychological load, are multifaceted and complex [39–41]. In general, medical staff face occupational stress, such as high workloads, swift work pace, and the need to treat critically ill patients. Occupational tension, burnout, and other adverse psychological effects can trigger or exacerbate WMSDs [57–59].

Poor ergonomics, unhealthy lifestyles, psychological factors, and working environments play significant roles in WMSD development. Despite these challenges, WMSDs remain unrecognized among medical radiation workers. Improving medical radiation workers’ knowledge of WMSDs and the early implementation of preventive measures are essential to alleviate these conditions significantly. To avoid WMSDs, employers should enhance employees’ ergonomic knowledge and increase their awareness of WMSDs. Additionally, implementing a rotational rest system for medical radiation workers to combat musculoskeletal fatigue, wearing lighter and more convenient protective clothing, and enhancing the workplace environment should be considered.

Our study has some limitations. This study relied on self-reported questionnaires that investigated musculoskeletal symptoms in the previous year, which might have been prone to recall bias. In addition, there might have been a bias in the selection of survey results due to the participants’ young age and limited tenure years in the field.

5 Conclusion

WMSDs commonly affect the neck, shoulders, and lower back of professionals working in radiologic fields. Being female, alcohol consumption, higher hospital levels, working overtime, repetitive motions, and prolonged maintenance of the same posture were potential risk factors, while adjustable work chairs and comfortable workplaces were protective factors for WMSDs among radiation staff. Therefore, there is an urgent need for preventive education in hospitals to provide radiation professionals with ergonomic knowledge. Future research should focus on interventions to improve awareness of ergonomics and provide appropriate measures for creating a healthy workplace to lessen the prevalence of WMSDs among radiation workers.

Ethical approval

Ethical approval for this study was obtained from the Medical Ethics Review Committee of Guangdong Province Hospital for Occupational Disease Prevention and Treatment (MEC 074).

Informed consent

Informed consent was obtained from all subjects involved in the study.

Competing interests

There is no conflict of interest to declare.