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

Abstract

BACKGROUND:

Work-related musculoskeletal disorders (WMSDs) are among the most commonly reported occupational diseases worldwide. Healthcare workers, such as medical radiation staff, are susceptible to WMSDs.

OBJECTIVE:

To analyze the prevalence of work-related musculoskeletal disorders (WMSDs) and their influencing factors among professionals working in medical radiation institutions.

METHODS:

This study employed cluster random sampling and included 1669 medical radiation staff members from medical units and institutions in Guangdong Province, China. The modified Nordic Musculoskeletal Questionnaire was used to analyze musculoskeletal symptoms in nine body regions over the previous 12 months. The chi-square test was used to analyze the association between WMSDs and these factors. Logistic regression was used to identify potential influencing factors.

RESULTS:

This study collected 1669 complete and valid questionnaires. The overall self-reported prevalence of WMSDs among medical radiation staff was 15.3%. Multivariate logistic regression showed that gender, alcohol consumption, senior rank hospital, repetitive motions at work, overtime work, and prolonged maintenance of the same posture increased the risk of WMSDs (P < 0.05). Adjustable work chairs and comfortable workplace temperatures were protective factors against WMSDs (P < 0.05).

CONCLUSION:

Being female, alcohol consumption, higher hospital level, repetitive motions, working overtime, and maintaining a single posture contributed to the risk of neck, shoulder, and lower back WMSDs among medical radiation staff. Prevention and management strategies to facilitate reduction in adverse health effects on the occupational health of the medical radiation staff should be considered.

Keywords

Radiation exposure medical staff occupational health MSD musculoskeletal pain work-related musculoskeletal symtoms

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

2.1 Sample size calculation

The required sample size (n) for our objective was calculated by consulting a similar previous study, in which the prevalence (p) of WMSDs was 32.4% [23] among medical staff in China. Using a two-sided test, with level α= 0.05, allowable error d = 0.1×p, and 20% for possible non-response rate, the minimum required sample size for this study calculated using pass software was 1038.

2.2 Participants

This cross-sectional study enrolled medical radiologists from hospitals and clinics, including general hospitals, dental hospitals, and dental clinics in Guangdong Province. All participants were requested to complete a self-reported electronic questionnaire reflecting their physical pain and discomfort from October 2020 to December 2022.

The questionnaire was in the form of an online survey, and a QR code was generated using “Wenjuanxing,” China’s online questionnaire distribution platform. All participants provided an informed consent document prior to participating in the study. To avoid the possibility of ethical violation, all the personal identification has been encrypted to secure the privacy and confidentiality of the individuals. Thus, the study had been approved by the Medical Ethics Review Committee of Guangdong Province Hospital for Occupational Disease Preventionand Treatment.

Participants aged ≥18 years with at least 1 year of work experience were included in this study. The exclusion criteria were as follows: those who had a medical history of local injuries, surgical procedures, or infectious illnesses; those with conditions such as tumors, diabetes, hypertension, and rheumatism; or pregnant or had a history of pregnancy in the previous year. The study enlisted 2000 health workers, from whom 1669 questionnaires were deemed valid, resulting in a response rate of 83.5%. The study group comprised 727 oral imaging workers, 540 radiographers, 175 radiotherapists, 152 interventional radiologists, and 75 nuclear medicine workers.

This study recruited doctors, technicians, and nurses who were exposed to radiation during their work. Their positions ranged from dentists to diagnostic radiologists, radiotherapists, interventional radiologists, and nuclear medicine practitioners. Furthermore, their work primarily involved radiography, computed tomography, radiotherapy instruments, and patient positioning for radiological diagnosis and radiotherapy. In nuclear medicine, positron emission tomography and single-photon emission computed tomography are primarily used for venous puncture. Interventional radiology focuses on minimally invasive surgical treatments guided by radiography through skin or blood vessels.

2.3 Study design and setting

This study employed a cross-sectional epidemiological survey method utilizing the electronic version of the modified Nordic Musculoskeletal Questionnaire and Dutch Musculoskeletal Questionnaire to survey the Chinese occupational population [24]; the reliability and validity of this method have been tested in various industries and regions [25, 26]. The questionnaire comprised four sections: (1) demographic data, including sex, age, body mass index (BMI, weight/height²), years of service, and education level; (2) health and lifestyle behaviors, including smoking and alcohol consumption habits, and exercise habits; (3) working conditions, including working hours, posture, and environment; and (4) musculoskeletal symptoms, including soreness, numbness, pain, and restricted movement experienced in nine body areas, namely neck, shoulders, upper back, lower back, elbows, wrists, hips, knees, and ankles over the previous 12 months. Our study identified WMSDs based on symptoms, such as soreness, numbness, pain, and restricted movement, persisting for >24 hours in the past year, that are not alleviated after rest. Pain or discomfort induced by trauma or other diseases are excluded. Furthermore, conditions such as tenosynovitis, bursitis, meniscal injury, and carpal tunnel syndrome were also categorized as WMSDs.

2.4 Data quality control

The data collectors and supervisors were trained before data collection. The method of data collection was explained to the participants in detail. The questionnaire was equipped with an automatic logic error correction function, and incomplete questionnaires could not be submitted. The questionnaires were reviewed and checked for accuracy and consistency. Repeated and non-inclusion standard questionnaires were eliminated accordingly.

2.5 Statistical analysis

Statistical analyses were performed using SPSS 24.0 software (SPSS Inc. Chicago, IL, USA). In the results section, quantitative variables following normal distribution were presented as mean±standard deviation (x±s). Qualitative data were statistically described using frequency and proportion (rate). The chi-square test was used to analyze the differences between classified data, and P < 0.05 was considered statistically significant. The multivariate analysis of WMSDs was performed using a binary logistic regression analysis model considering significant factors with a two-sided significance level of α= 0.05, and P < 0.05 was considered statistically significant.

3 Results

3.1 Demographics

The questionnaire was completed by 1669 medical radiation staff members (61.7% men and 38.3% women). The participants’ mean age was 37.14±9.67 years, and the mean job tenure was 12.56±9.55 years. The participants had an average weight, height, and BMI of 62.4±12.2 kg, 166.3±7.7 cm, and 22.5±3.7 kg/m², respectively. Tables 1 and 2 show the prevalence of WMSDs across various job positions and occupations in 1 year. The overall prevalence of WMSDs was 15.3% (256/1669). The prevalence rates of multiple site (involving two or more anatomical sites) [27] WMSDs were 6.5 and 5.9% across different job positions and occupations, respectively. Nurses had a higher prevalence of multi-site WMSDs than radiologists and technicians. However, no significant differences were observed between the three job positions (P > 0.05) (Table 1). The most frequent complaints of single-site WMSDs were in the neck (11.4%), shoulders (5.3%), and lower back (4.6%). The prevalence rates of WMSDs were higher in the nuclear medicine (18.7%) and radiotherapy (20%) groups. However, the differences were not statistically significant among the occupations (P > 0.05) (Table 2).

Table 1
Prevalence of work-related musculoskeletal disorders (WMSDs) in different body parts by occupation among medical radiation workers

Occupation N (%) Neck (%) Shoulder (%) Upper back (%) Low back (%) Elbow (%) Hand (%) Hip (%) Knee (%) Foot (%) ≥1 body parts (%) Multi-site (≥2 body parts) (%)

Radiologists 1061(63.6) 126(11.9) 64(6) 20(1.9) 43(4) 7(0.7) 13(1.2) 7(0.7) 10(0.9) 12(1.1) 170(16) 68(6.4)

Nurses 146(8.7) 10(6.8) 5(3.4) 2(1.4) 6(4.1) 2(1.4) 0 0 2(1.4) 0 13(8.9) 21(14.3)

Technicians 462(27.7) 55(11.9) 19(4.1) 8(1.7) 28(6) 2(0.4) 8(1.7) 3(0.6) 4(0.9) 2(0.4) 73(15.8) 9(1.9)

Total 1669 191(11.4) 88(5.3) 30(1.8) 77(4.6) 11(0.7) 21(1.3) 10(0.6) 16(1) 14(0.8) 256(15.3) 98(5.9)

X² 3.333 3.468 0.209 3.041 1.488 2.703 0.965 0.305 3.239 5.113 1.954

P 0.189 0.177 0.901 0.219 0.475 0.259 0.617 0.895 0.198 0.078 0.376

Occupation	N (%)	Neck (%)	Shoulder (%)	Upper back (%)	Low back (%)	Elbow (%)	Hand (%)	Hip (%)	Knee (%)	Foot (%)	≥1 body parts (%)	Multi-site (≥2 body parts) (%)
Radiologists	1061(63.6)	126(11.9)	64(6)	20(1.9)	43(4)	7(0.7)	13(1.2)	7(0.7)	10(0.9)	12(1.1)	170(16)	68(6.4)
Nurses	146(8.7)	10(6.8)	5(3.4)	2(1.4)	6(4.1)	2(1.4)	0	0	2(1.4)	0	13(8.9)	21(14.3)
Technicians	462(27.7)	55(11.9)	19(4.1)	8(1.7)	28(6)	2(0.4)	8(1.7)	3(0.6)	4(0.9)	2(0.4)	73(15.8)	9(1.9)
Total	1669	191(11.4)	88(5.3)	30(1.8)	77(4.6)	11(0.7)	21(1.3)	10(0.6)	16(1)	14(0.8)	256(15.3)	98(5.9)
X²		3.333	3.468	0.209	3.041	1.488	2.703	0.965	0.305	3.239	5.113	1.954
P		0.189	0.177	0.901	0.219	0.475	0.259	0.617	0.895	0.198	0.078	0.376

Table 2

Prevalence of WMSDs in different body parts by specialty among medical radiation workers

Specialty	N (%)	Neck (%)	Shoulder (%)	Upper back (%)	Low back (%)	Elbow (%)	Hand (%)	Hip (%)	Knee (%)	Foot (%)	≥1 body parts (%)	Multi-site (≥2 body parts) (%)
Oral imaging	727(43.6)	80(11)	42(5.8)	14(1.9)	26(3.6)	6(0.8)	8(1.1)	6(0.8)	7(1)	6(0.8)	101(13.9)	46(6.3)
Radiology Diagnosis	540(32.3)	59(10.9)	29(5.4)	9(1.7)	31(5.7)	2(0.4)	9(1.7)	3(0.6)	6(1.1)	3(0.6)	83(15.4)	39(7.2)
Radiotherapy	175(10.5)	24(13.7)	7(4)	4(2.3)	12(6.9)	2(1.1)	1(0.6)	0	2(1.1)	2(1.1)	35(20)	10(5.7)
Interventional Radiologist	152(9.1)	15(9.9)	7(4.6)	1(0.7)	5(3.3)	0	1(0.7)	0	0	2(1.3)	23(15.1)	7(4.6)
Nuclear medicine	75(4.5)	13(17.3)	3(4)	2(2.7)	3(4)	1(1.3)	2(2.7)	1(1.3)	1(1.3)	1(1.3)	14(18.7)	6(8)
Total	1669	191(11.4)	88(5.3)	30(1.8)	77(4.6)	11(0.7)	21(1.2)	10(0.6)	16(1)	14(0.8)	256(15.3)	108(6.5)
X²		4.111	1.327	1.796	6.008	3.149	3.174	3.291	1.777	1.353	4.744	1.858
P		0.391	0.857	0.773	0.199	0.533	0.529	0.51	0.777	0.852	0.315	0.762

3.2 Univariate analysis of risk factors for WMSDs in nine body regions

According to the univariate analysis, demographic characteristics, alcohol consumption, repetitive motions, and awkward postures significantly affected the prevalence of WMSDs across the neck, shoulder, lower back, and multiple sites (P < 0.05). In contrast, age, BMI, job tenure, physical exercise, hand-use preference, use of vibrating tools during work, and break duration did not show any statistically significant association with WMSD prevalence in these three body regions among medical radiation workers (P > 0.05). Gender, education level, alcohol consumption, daily working hours, awkward postures, prolonged maintenance of the same posture, repetitive motions, working overtime, using supporting tools during work, workplace temperature, noise, and lighting showed statistically significant differences in the prevalence of WMSDs associated with the neck, shoulders, and multiple sites (P < 0.05). The adjustable nature of work chairs was significantly associated with the prevalence of WMSDs related to the neck, lower back, and multiple sites (P < 0.05). Shoulder and multi-site WMSDs were significantly correlated with difficulty in tool use (P < 0.01). Hospital level, years of service, smoking habits, and the requirement to lift, push, pull, carry, or move items weighing >5 kg during work were significantly correlated with the prevalence of low back WMSDs (P < 0.05; Table 3).

Table 3
Prevalence of WMSDs in neck, shoulder, low back and multi-site among medical radiation workers

Variable N (%) Neck Shoulder Low back Multi-site

n (%) X² P value n (%) X² P value n (%) X² P value n (%) X² P value

Gender 5.733 0.017^* 7.786 0.005^ 1.127 0.288 8.169 0.004^

Male 1049(62.9) 105(10) 43(4) 44(4.2) 54(5.1)

Female 620(37.1) 86(13.9) 45(7.3) 33(5.3) 54(8.7)

Hospital level 1.432 0.84 6.863 0.143 16.48 0.002^ 2.191 0.701

Gade 3A Hospital 212(12.7) 28(13.2) 14(6.6) 20(9.4) 15(0.7)

Grade 2A Hospital 295(17.7) 37(12.5) 13(4.4) 17(5.8) 21(7.1)

Grade 1 Hospital 395(23.7) 43(10.9) 17(4.3) 13(3.3) 25(6.3)

Dental specialist hospital 72(4.3) 8(11.1) 8(11.1) 4(5.6) 7(9.7)

Oral clinic 695(41.6) 75(10.8) 36(5.2) 23(3.3) 40(5.8)

Education level 12.574 0.000^^* 14.997 0.000^**^* 6.605 0.01^* 10.857 0.000^**

Junior college and below 993(59.5) 91(9.2) 35(3.5) 35(3.5) 48(4.8)

Bachelor’s degree or above 676(40.5) 100(14.8) 53(7.8) 42(6.2) 60(8.9)

Smoking 3.55 0.06 0.513 0.474 5.529 0.019^* 1.667 0.197

Often/always 171(10.2) 27(15.8) 11(6.4) 14(8.2) 15(8.8)

Never/fewer 1498(89.8) 164(10.9) 77(5.1) 63(4.2) 93(6.2)

Drinking 19.715 0.000^^^* 12.581 0.000^*** 18.06 0.000^^ 11.545 0.000^

Often/always 597(35.7) 96(16.6) 47(8.1) 45(7.8) 53(8.9)

Never/fewer 1072(64.2) 95(8.9) 41(3.8) 32(3) 55(5.1)

Daily working hours 4.467 0.035^* 10.692 0.001^** 19.684 0.000^*^** 5.857 0.016^*

≤8 h 1313(78.7) 139(10.6) 57(4.3) 45(3.4) 75(5.7)

>8 h 356(21.3) 52(14.6) 31(8.7) 32(9) 33(9.3)

Awkward postures 29.063 0.000^**^* 15.507 0.000^**^* 2.434 0.119 10.433 0.01^*

Often/always 172(10.3) 41(23.8) 20(11.6) 12(7) 21(12.2)

Never/fewer 1497(89.6) 150(10) 68(4.5) 65(4.3) 87(5.8)

Maintain the same posture 50.984 0.000^^^* 39.905 0.000^**^* 35.105 0.000^^^* 52.009 0.01^*

Often/always 338(20.3) 76(22.5) 41(12.1) 36(10.7) 51(15.1)

Never/fewer 1331(79.7) 115(8.6) 47(3.5) 41(3) 57(4.3)

Repetitive movements 82.274 0.000^**^* 72.101 0.000^* 32.599 0.000^^* 73.253 0.000^*

Often/always 526(31.5) 115(21.9) 64(12.2) 47(8.9) 74(14.7)

Never/fewer 1143(8.6) 76(6.6) 24(2) 30(2.6) 34(3.0)

Lifting or carrying weights 0.984 0.321 1.349 0.246 7.589 0.006^ 0.459 0.498

Often/always 58(3.5) 9(15.5) 5(8.6) 7(12) 5(8.6)

Never/fewer 1611(96.5) 182(11.3) 83(5.2) 70(4.3) 103(6.4)

Arms have support 7.034 0.008^ 2.194 0.139 2.754 0.097 8.188 0.004^

Often/always 185(11.1) 32(17.3) 14(7.6) 13(7) 21(11.4)

Never/fewer 1484(88.9) 159(10.7) 74(5) 64(4.3) 87(5.9)

Using assistive tools 6.711 0.01^* 13.548 0.000^^^* 0.146 0.702 8.6 0.003^

Often/always 194(11.6) 33(17) 21(10.8) 10(5.2) 22(11.3)

Never/fewer 1475(88.4) 158(10.7) 67(4.5) 67(4.5) 86(5.8)

Difficult to use tools 1.987 0.159 8.469 0.004^ 2.572 0.109 3.895 0.048^*

Often/always 170(10.2) 25(14.7) 17(10) 12(7) 17(10)

Never/fewer 1499(89.8) 166(11) 71(4.7) 65(4.3) 91(6.1)

Working overtime 22.7 0.000^**^* 15.602 0.000^^^* 8.913 0.003^ 14.623 0.000^*

Often/always 1340(80.3) 178(13.3) 85(6.3) 72(5.4) 102(7.6)

Never/fewer 329(19.7) 13(4) 3(0.9) 5(1.5) 6(1.8)

The working environment temperature is comfortable 10.217 0.001^ 6.888 0.009^ 15.917 0.000^**^* 10.26 0.001^**

Yes 1415(84.8) 147(10.4) 66(4.7) 53(3.7) 80(5.7)

No 254(15.2) 44(17.3) 22(8.7) 24(9.4) 28(11)

The working environment noise affects the work 5.203 0.023^* 9.199 0.002 0.006^** 0.937 5.199 0.023^*

Yes 90(5.4) 17(18.9) 11(12.2) 4(4.4) 11(12.2)

No 1579(94.6) 174(11) 77(4.9) 73(4.6) 97(6.1)

The working environment lighting is comfortable 11.499 0.001^ 12.39 0.000^^* 0.675 0.411 5.407 0.02^*

Yes 1400(83.9) 144(10.3) 62(4.4) 62(4.4) 82(5.9)

No 269(16.1) 47(17.5) 26(9.7) 15(5.6) 26(9.7)

Adjustable work chairs 6.976 0.031^* 2.64 0.267 6.664 0.036^* 8.826 0.012^*

No chairs 103(6.2) 16(15.5) 9(8.7) 7(6.8) 11(10.7)

Yes 1192(71.4) 121(10.2) 60(5) 45(3.8) 64(5.4)

No 374(22.4) 54(14.4) 19(5) 25(6.7) 33(8.8)

Variable	N (%)	Neck	Shoulder	Low back	Multi-site
Gender			5.733	0.017^*		7.786	0.005^**		1.127	0.288		8.169	0.004^**
Male	1049(62.9)	105(10)			43(4)			44(4.2)			54(5.1)
Female	620(37.1)	86(13.9)			45(7.3)			33(5.3)			54(8.7)
Hospital level			1.432	0.84		6.863	0.143		16.48	0.002^**		2.191	0.701
Gade 3A Hospital	212(12.7)	28(13.2)			14(6.6)			20(9.4)			15(0.7)
Grade 2A Hospital	295(17.7)	37(12.5)			13(4.4)			17(5.8)			21(7.1)
Grade 1 Hospital	395(23.7)	43(10.9)			17(4.3)			13(3.3)			25(6.3)
Dental specialist hospital	72(4.3)	8(11.1)			8(11.1)			4(5.6)			7(9.7)
Oral clinic	695(41.6)	75(10.8)			36(5.2)			23(3.3)			40(5.8)
Education level			12.574	0.000^*^		14.997	0.000^*^		6.605	0.01^*		10.857	0.000^**
Junior college and below	993(59.5)	91(9.2)			35(3.5)			35(3.5)			48(4.8)
Bachelor’s degree or above	676(40.5)	100(14.8)			53(7.8)			42(6.2)			60(8.9)
Smoking			3.55	0.06		0.513	0.474		5.529	0.019^*		1.667	0.197
Often/always	171(10.2)	27(15.8)			11(6.4)			14(8.2)			15(8.8)
Never/fewer	1498(89.8)	164(10.9)			77(5.1)			63(4.2)			93(6.2)
Drinking			19.715	0.000^^^*		12.581	0.000^***		18.06	0.000^^*		11.545	0.000^***
Often/always	597(35.7)	96(16.6)			47(8.1)			45(7.8)			53(8.9)
Never/fewer	1072(64.2)	95(8.9)			41(3.8)			32(3)			55(5.1)
Daily working hours			4.467	0.035^*		10.692	0.001^**		19.684	0.000^^*		5.857	0.016^*
≤8 h	1313(78.7)	139(10.6)			57(4.3)			45(3.4)			75(5.7)
>8 h	356(21.3)	52(14.6)			31(8.7)			32(9)			33(9.3)
Awkward postures			29.063	0.000^*^		15.507	0.000^*^		2.434	0.119		10.433	0.01^*
Often/always	172(10.3)	41(23.8)			20(11.6)			12(7)			21(12.2)
Never/fewer	1497(89.6)	150(10)			68(4.5)			65(4.3)			87(5.8)
Maintain the same posture			50.984	0.000^^^*		39.905	0.000^*^		35.105	0.000^^^*		52.009	0.01^*
Often/always	338(20.3)	76(22.5)			41(12.1)			36(10.7)			51(15.1)
Never/fewer	1331(79.7)	115(8.6)			47(3.5)			41(3)			57(4.3)
Repetitive movements			82.274	0.000^*^		72.101	0.000^***		32.599	0.000^*^		73.253	0.000^***
Often/always	526(31.5)	115(21.9)			64(12.2)			47(8.9)			74(14.7)
Never/fewer	1143(8.6)	76(6.6)			24(2)			30(2.6)			34(3.0)
Lifting or carrying weights			0.984	0.321		1.349	0.246		7.589	0.006^**		0.459	0.498
Often/always	58(3.5)	9(15.5)			5(8.6)			7(12)			5(8.6)
Never/fewer	1611(96.5)	182(11.3)			83(5.2)			70(4.3)			103(6.4)
Arms have support			7.034	0.008^**		2.194	0.139		2.754	0.097		8.188	0.004^**
Often/always	185(11.1)	32(17.3)			14(7.6)			13(7)			21(11.4)
Never/fewer	1484(88.9)	159(10.7)			74(5)			64(4.3)			87(5.9)
Using assistive tools			6.711	0.01^*		13.548	0.000^^^*		0.146	0.702		8.6	0.003^**
Often/always	194(11.6)	33(17)			21(10.8)			10(5.2)			22(11.3)
Never/fewer	1475(88.4)	158(10.7)			67(4.5)			67(4.5)			86(5.8)
Difficult to use tools			1.987	0.159		8.469	0.004^**		2.572	0.109		3.895	0.048^*
Often/always	170(10.2)	25(14.7)			17(10)			12(7)			17(10)
Never/fewer	1499(89.8)	166(11)			71(4.7)			65(4.3)			91(6.1)
Working overtime			22.7	0.000^*^		15.602	0.000^^^*		8.913	0.003^**		14.623	0.000^***
Often/always	1340(80.3)	178(13.3)			85(6.3)			72(5.4)			102(7.6)
Never/fewer	329(19.7)	13(4)			3(0.9)			5(1.5)			6(1.8)
The working environment temperature is comfortable			10.217	0.001^**		6.888	0.009^**		15.917	0.000^*^		10.26	0.001^**
Yes	1415(84.8)	147(10.4)			66(4.7)			53(3.7)			80(5.7)
No	254(15.2)	44(17.3)			22(8.7)			24(9.4)			28(11)
The working environment noise affects the work			5.203	0.023^*		9.199	0.002		0.006^**	0.937		5.199	0.023^*
Yes	90(5.4)	17(18.9)			11(12.2)			4(4.4)			11(12.2)
No	1579(94.6)	174(11)			77(4.9)			73(4.6)			97(6.1)
The working environment lighting is comfortable			11.499	0.001^**		12.39	0.000^*^		0.675	0.411		5.407	0.02^*
Yes	1400(83.9)	144(10.3)			62(4.4)			62(4.4)			82(5.9)
No	269(16.1)	47(17.5)			26(9.7)			15(5.6)			26(9.7)
Adjustable work chairs			6.976	0.031^*		2.64	0.267		6.664	0.036^*		8.826	0.012^*
No chairs	103(6.2)	16(15.5)			9(8.7)			7(6.8)			11(10.7)
Yes	1192(71.4)	121(10.2)			60(5)			45(3.8)			64(5.4)
No	374(22.4)	54(14.4)			19(5)			25(6.7)			33(8.8)

Note: ^*P < 0.05, ^**P < 0.01, ^***P < 0.001.

3.3 Logistic regression analysis of the risk factors for WMSDs

In multivariate logistic regression analysis, WMSDs occurring in the neck, shoulders, lower back, and multiple sites (1 = yes, 0 = no) were considered dependent variables. Significant variables in the univariate chi-square test for risk factors were independent variables. We placed the classification variables into the classification covariables in SPSS to obtain the most significant risk factors. Repetitive movements at work were a risk factor for neck, shoulder, lower back, and multi-site WMSDs: (odds ratio [OR] (95% confidence intervals [CI]) = 2.762 (1.842–4.144), P = 0.000), (OR [95% CI] = 4.236 [2.351–7.63], P = 0.000), (OR [95% CI] = 2.059 [1.119–3.787], P = 0.02), and (OR [95% CI] = 3.498 [2.046–5.98], P = 0.000). Working overtime was a risk factor for neck, shoulder, and multi-site WMSDs: (OR [95% CI] = 2.63 [1.446–4.785], P = 0.002), (OR [95% CI] = 4.08 [1.252–13.3], P = 0.02), and (OR [95% CI] = 2.869 [1.212–6.793], P = 0.017). Being female was a risk factor for shoulder WMSDs (OR [95% CI] = 2.196 [1.346–3.584], P = 0.002). Alcohol consumption was a risk factor for neck, lower back, and multi-site WMSDs: (OR [95% CI] = 1.943 [1.385–2.725], P = 0.000), (OR [95% CI] = 2.025 [1.254–3.269], P = 0.003), and (OR [95% CI] = 1.997 [1.288–3.095], P = 0.002). Rank seniority hospital and prolonged maintenance of the same posture were identified as risk factors for lower-back WMSDs: (OR [95% CI] = 2.26 [1.121–4.559], P = 0.023) and (OR [95% CI] = 1.876 [1.021–3.448], P = 0.043). In contrast, a lower education level was identified as a protective factor against neck and shoulder WMSDs: (OR [95% CI] = 0.686 [0.496–0.948], P = 0.023) and (OR [95% CI] = 0.559 [0.349–0.897], P = 0.016). Being male was a protective factor against neck and multi-site WMSDs: (OR [95% CI] = 0.586 [0.402–0.803], P = 0.001) and (OR [95% CI] = 0.437 [0.279–0.685], P = 0.000). The use of adjustable work chairs has emerged as a protective factor against neck and multi-site WMSDs: (OR [95% CI] = 0.59 [0.404–0.859], P = 0.006) and (OR [95% CI] = 0.508 [0.314–0.822], P = 0.006). Having a comfortable workplace was a protective factor against lower-back WMSDs: (OR [95% CI] = 0.393 [0.223–0.691], P = 0.001] (Table 4).

Table 4
Multivariate logistic regression analysis of risk factors associated with WMSDs among medical radiation workers

Body parts Variable B Standard error Wald P value OR (95% CI)

Neck Male –0.566 0.177 10.218 0.001^** 0.586 (0.402–0.803)

Junior college and below –0.377 0.165 5.207 0.023^* 0.686 (0.496–0.948)

Drinking 0.664 0.173 14.82 0.000^**^* 1.943 (1.385–2.725)

Repetitive movements 1.016 0.207 24.12 0.000^**^* 2.762 (1.842–4.144)

Working overtime 0.967 0.305 10.037 0.002^ 2.63 (1.446–4.785)

Adjustable work chairs –0.528 0.192 7.561 0.006^ 0.59 (0.404–0.859)

Shoulder Female 0.787 0.25 9.909 0.002^** 2.196 (1.346–3.584)

Junior college and below –0.581 0.241 5.808 0.016^* 0.559 (0.349–0.897)

Drinking 0.706 0.244 8.335 0.003^ 2.025 (1.254–3.269)

Repetitive movements 1.444 0.3 23.101 0.000^^* 4.236 (2.351–7.63)

Working overtime 1.406 0.603 5.439 0.02^* 4.08 (1.252–13.3)

Waist Grade 3A Hospital 0.816 0.358 5.191 0.023^* 2.26 (1.121–4.559)

Drinking 0.741 0.26 8.127 0.003^** 2.097 (1.26–3.49)

Maintain the same posture for a long time 0.629 0.311 4.103 0.043^* 1.876 (1.021–3.448)

Repetitive movements 0.722 0.311 5.391 0.02^* 2.059 (1.119–3.787)

Temperature is comfortable –0.934 0.288 10.509 0.001^ 0.393 (0.223–0.691)

Multi-site Male –0.83 0.229 13.072 0.000^^* 0.437 (0.279–0.685)

Drinking 0.692 0.224 9.566 0.002^ 1.997 (1.288–3.095)

Repetitive movements 1.252 0.274 20.949 0.000^^* 3.498 (2.046–5.98)

Working overtime 1.054 0.44 5.747 0.017^* 2.869 (1.212–6.793)

Adjustable work chairs –0.661 0.245 7.621 0.006^** 0.508 (0.314–0.822)

Body parts	Variable	B	Standard error	Wald	P value	OR (95% CI)
Neck	Male	–0.566	0.177	10.218	0.001^**	0.586 (0.402–0.803)
	Junior college and below	–0.377	0.165	5.207	0.023^*	0.686 (0.496–0.948)
	Drinking	0.664	0.173	14.82	0.000^*^	1.943 (1.385–2.725)
	Repetitive movements	1.016	0.207	24.12	0.000^*^	2.762 (1.842–4.144)
	Working overtime	0.967	0.305	10.037	0.002^**	2.63 (1.446–4.785)
	Adjustable work chairs	–0.528	0.192	7.561	0.006^**	0.59 (0.404–0.859)
Shoulder	Female	0.787	0.25	9.909	0.002^**	2.196 (1.346–3.584)
	Junior college and below	–0.581	0.241	5.808	0.016^*	0.559 (0.349–0.897)
	Drinking	0.706	0.244	8.335	0.003^**	2.025 (1.254–3.269)
	Repetitive movements	1.444	0.3	23.101	0.000^*^	4.236 (2.351–7.63)
	Working overtime	1.406	0.603	5.439	0.02^*	4.08 (1.252–13.3)
Waist	Grade 3A Hospital	0.816	0.358	5.191	0.023^*	2.26 (1.121–4.559)
	Drinking	0.741	0.26	8.127	0.003^**	2.097 (1.26–3.49)
	Maintain the same posture for a long time	0.629	0.311	4.103	0.043^*	1.876 (1.021–3.448)
	Repetitive movements	0.722	0.311	5.391	0.02^*	2.059 (1.119–3.787)
	Temperature is comfortable	–0.934	0.288	10.509	0.001^**	0.393 (0.223–0.691)
Multi-site	Male	–0.83	0.229	13.072	0.000^*^	0.437 (0.279–0.685)
	Drinking	0.692	0.224	9.566	0.002^**	1.997 (1.288–3.095)
	Repetitive movements	1.252	0.274	20.949	0.000^*^	3.498 (2.046–5.98)
	Working overtime	1.054	0.44	5.747	0.017^*	2.869 (1.212–6.793)
	Adjustable work chairs	–0.661	0.245	7.621	0.006^**	0.508 (0.314–0.822)

Note: ^*P < 0.05, ^**P < 0.01, ^***P < 0.001.

4 Discussion

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.

Footnotes

Acknowledgments

The authors thank all participants who participated in the study.

Funding

This work was supported by the National Natural Science Foundation of China [81602804] and the National Key R&D Program of China [2022YFC2503203].

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