Work related musculoskeletal stress among residents of internal medicine on cardiological wards in their daily working practice - a kinematic and ergonomic analysis.

Abstract

Backround: Earlier, interventional and sonography techniques have been analyzed in detail for the field of internal medicine concerning workplace ergonomics. Here, work related musculoskeletal disorders (WRMSDs) have been reported with a prevalence of about 76%. The aim of this study is to provide a comprehensive kinematic and ergonomic analysis of an average working day of a resident physician in internal medicine on a cardiological ward.

Methods: The kinematic data of 17 resident physicians (9f/8m) of internal medicine, working in 3 different cardiological wards in a hospital of maximum care was collected on an average workday using the CUELA measurement system. A detailed, computer-based task analysis was conducted concurrently with the kinematic assessment. By synchronizing the data obtained from both measurements, postural patterns were chronologically aligned and contextualized with the corresponding task performance. The main categories were (1) Office work, (2) Ward rounds, (3) Tasks performed directly with the patient (i.e. patient examination, blood withdrawal) and (4) Other. The main categories were divided into several sub-categories for further differentiation. For the data analysis, characteristic values of joint angle distributions (percentiles P05, P25, P50, P75, and P95) for the head, neck, and torso during predefined tasks were examined and evaluated in accordance with ergonomic standards. In addition, the Owako Working Posture Analysing System was applied (OWAS).

Results: A total duration of 129.2 working hours were recorded. Resident physicians of internal medicine on a cardiological ward spend a large part of their work day in office type work situations (57%) with 36% dedicated to computer work, followed by 18% for ward rounds and 16% for directly patient related activities. The office type work situations showed high sedentary rates with increased ergonomic risk for postures of the cervical and thoracolumbar spine (moderate to unfavorable postures for back curvature in almost all percentiles and office activities, reclination of the neck during (-8°- -16° in P05 and P25) for 'use of computer'. Several aspects of patient related activities displayed high percentages of forward bending (predominately moderate and unfavorable postures for back curvature, sagittal trunk and neck inclination) and in P25-P95 for 'blood withdrawal' and 'patient examination'.

Conclusion: An important office type work setting is predominant in the daily routine of resident physicians of internal medicine working on cardiological wards and have been detected as important predictor to cause musculoskeletal stress. Resident physicians of internal medicine on cardiological wards have a high occurrence of ergonomically unfavorable situations, particularly during patient related activities and sedentary work using visual display units. This study highlights the need for ergonomic interventions particularly in respect to adjustable, individualized workstations and equipment.