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Musculoskeletal disorders represent a major problem in developing countries as they generate high economic costs and are recognized as a considerable cause of absenteeism and disability. The objective of this research was to describe the main risk factors associated with musculoskeletal disorders affecting nursing staff working at a Primary Care Hospital in Pachuca, Hidalgo, Mexico. Methodology. A quantitative study was conducted with a cross-sectional, observational design. Forty-nine nurses from the trauma service participated. Results. The most common gender was female (83.7%), while eight male nurses participated (16.3%). The mean age was 37 years, with a range of 25 to 53 years. Pain was observed to be the most common musculoskeletal symptom (87.5%). Similarly, the regions most affected by musculoskeletal injuries were the lower back (74.8%), followed by the neck (72.3%), and the upper back (64%). Conclusion. There is a high prevalence of MSDs in nursing staff, with pain being the most common symptom and with varying frequencies in relation to the affected region, the main ones being the lower back, neck and upper back.
Keywords: absenteeism from work; disability; muscle symptoms; musculoskeletal disorder; absenteeismfromwork; musclesymptoms; musculoskeletaldisorder
The International Labour Organization (ILO) reports thatmorethan2.3milliondeathsoccureachyeardue towork-relatedinjuriesorconditions. Furthermore, itisestimatedthatmorethan160millionpeoplesufferfromnon-fatalwork-relatedillnesseseachyear[1]. AccordingtotheMinistryofLaborandSocialWelfare, thenumberofwork-relatedillnessesinMexicoreached 12,622cases,withmusculoskeletaldisorders(MSDs) beingtheleadingwork-relatedillness,accountingfor 4,607cases, pushinghearinglossintosecondplace with1,873cases[2].MSDsaredegenerativesyndromes characterizedbypain,numbness,stiffness,swelling, fatigue,andirritationofthetissuesthatmakeupthe musculoskeletalsystem,suchasmuscles,bones,ligaments,andjoints[2][3][4]. Work-relatedMSDsare conditions affecting these bodily structures, exacerbatedbytheworkandworkingconditionsinwhich theemployeeoperates.Mostoftheseconditionsare caused by repetitive manual activities, lifting heavy loads,standingforprolongedperiods,andworkingin improperpostures,allofwhichoccuroverextended periodsoftime.[5][6][7][8][9].
Thesesyndromesnotonlyaffectworkers’healthbut canalsobeconsideredsocialandeconomicproblems, astheysignificantlyimpactqualityoflife;theyarethe leadingcauseoflong-termsickleave,representinga majoreconomicburdenonhealthcaresystemsandthe businesssector[6][8][10][11].Likewise,ithasbeen demonstratedthatworkabsenteeismduetoMSDsis associatedwithareducedlikelihoodofreturningto workandahighlikelihoodoftransferringtoanother job[12][13].InastudyconductedbySánchez(2019)titled“MusculoskeletalDisordersandWorkAbsenteeism AmongOperatingRoomNursesattheHipólitoUnanue elAgustinoNationalHospital,”asignificantassociation wasobservedbetweenmusculoskeletaldisordersand workabsenteeism[14].
Ithasbeenobservedthatworkersinvolvedinhealthcareandadministrativeactivitiesarethegroupmost frequentlyaffectedbymusculoskeletaldisorders[13] [15]. Similarly, variousstudieshaveconcludedthat nursingstaff,amonghealthscienceprofessionals,are atgreaterriskofdevelopingMSDs,astheprevalenceof theseconditionsinthispopulationexceeds80%,due totheuniqueconditionsoftheirworkenvironment[6] [8][12][13][16].Anotherstudyreportsthat86.1%of nursesexhibitedsometypeofmusculoskeletalsymptomandthattheprimarysymptomwaspain[17].On theotherhand,themostcommonphysicaldemands andarmmovements,painfulortiringpostures,and patienthandling[12][13][18].Theriskfactorsassociatedwiththeonsetofmusculoskeletaldisordersare welldefinedandcanbeclassifiedas:•Physicalfactors: Theseincludeallactivitiesrelatedtooverexertionand theuseofexcessiveforce.Cumulativeandrepetitive manualactivities—suchasmovingandliftingpatients andequipment,aswellasextremeflexion,extension, androtationmovements—havebeenidentifiedasthe primarycauseoftheseinjuries.Anotherimportantfactorisstandingforprolongedperiodsoftime.[13][18] [19].
•Psychologicalfactors:ThereisasignificantrelationshipbetweenMSDsandthementalhealthofnursing staff.Roleconflicts,monotonouswork,dissatisfaction withassignedtasks,perceivedhighworkloads,limited socialsupport,lowpay(loweffort-rewardratio),and unfairworkenvironmentsareconsideredmajorcauses ofwork-relatedstress,whichisstronglylinkedtoMSDs [18][19][21].
• Sociodemographic factors: The incidence of musculoskeletalsymptomsincreasesgraduallywithage. AstudyconductedbyHeidenfoundthatyoungand middle-agednursesprimarilyexperiencedMSDsinthe shoulderandneckregions,whereasolderstaffwereprimarilyaffectedinthelumbarspine.Similarly,women weremoreaffectedthanmen(17.7%versus14.6%).A strongrelationshiphasbeendemonstratedbetween overweightstatusandMSDs,withtheriskincreasing whenthebodymassindex(BMI)is 30kg/m2.Onestudy reportedthatagroupofpatientstreatedbymedical staffforMSDshadanobesityrateof35%to55%.Similarly,itwasobservedthatnursespresentingwithmusculoskeletalsymptomsengagedinminimalphysical activity.[13][18][19][22].
•Factorsassociatedwithworkorganization:Theseincludeincreasedworkinghours(excessiveovertime), an excessively fast work pace, and a lack of human resources [23]. Likewise, it has been observed that theriskofdevelopingchronicmusculoskeletalpain islargelyrelatedtoexertionperceivedasstrenuous duringtheworkday[24].
•Environmentalfactors:Theseincludeinadequateor insufficientinfrastructure, whichhinderstheperformanceofworkactivitiesandisconsideredtoincrease thephysicalstrainonworkers[25].Accordingtodata fromthe7thNationalSurveyonWorkingConditions inSpain,themostcommoncomplaintsarethoracic andlumbarbackpain(50.3%),cervicalpain(neckand nape)(32%),andshoulderpain(26.6%)[26].According totheWHO,lowbackpain(painconfinedtothelumbarspinethatimpairsnormalmobility)istheleading causeofmedicalconsultationworldwide,affecting568 millionpeople.[26-27].
Toidentifyanddescribethemainriskfactorsassociatedwithmusculoskeletaldisordersaffectingnursing staffworkingatatertiarycarehospitalinPachuca,Hidalgo.
A quantitative study was conducted using a crosssectionalobservationaldesign.
Anon-randomconveniencesampleofnursingstaffwas selectedfromthosepracticingatatertiarycarehospitalinPachuca,Hidalgo.Atotalof49nursesparticipated inthestudy.
Participantswereselectedfromthenursingstaffofa tertiarycarehospitalinPachuca,basedonthefollowinginclusioncriteria:staffmembersintheorthopedic surgerydepartment,withatleast6monthsofservice andaged55oryounger.
Nursingstaffwithcongenitalmusculoskeletalinjuries, traumaticinjuriesresultingfromcaraccidentsorsports activities,systemicinflammatoryandautoimmunediseases,andthoseworkingpart-timeduetotheirvery lowriskofdevelopingMSDswereexcluded.
Nursing staff whose questionnaire is incomplete or whoseresponsesareinconsistentwillbeexcludedfrom thestudy,aswellasthosewhoweretransferredtoanotherhospitalduringthestudyperiodorwhoseparticipationwasinterrupted.
Datawerecollectedusingtwoquestionnaires,which weredistributedinpaperformtothenursingstaffto gathertheirresponses.
1. Datawerecollectedusingtwoquestionnaires, whichweredistributedinpaperformtothenursingstafftogathertheirresponses.Sociodemographicquestionnaire:Thisquestionnairewas used to collect general data such as age, sex, educationallevel,historyofmusculoskeletalinjuries,andinformationabouttheirworkingconditions(workinghours,shifts,lengthofservice, andstrenuousactivities).
2. StandardizedNordicQuestionnaire:ThisquestionnairewasdevelopedbyKuorinka[17]andassesseswork-relatedmusculoskeletalsymptoms andthemostcommoninjuriesamongemployees in a workplace. It consists of 21 items dividedintotwosections(musculoskeletalproblemsandlumbarspineproblems).
Forthedescriptiveanalysis,measuresofcentraltendencyanddispersionwillbeestimatedforquantitative variables,whilefrequenciesandproportionswillbe estimatedforqualitativevariables;thesewillbepresentedusingtables,barcharts,andhistogramsasappropriate.Ananalysisofthemeasurementinstrument wasconductedusingtheSPSS-IBMstatisticalsoftware package.
Theresearchwasconductedinaccordancewiththe generalguidelinesandprinciplesoftheRegulations oftheGeneralHealthLawregardinghealthresearch, incompliancewithArticles13,14,16,17,and22,emphasizingtheprinciplesofrespectforhumandignity, autonomy,dataprotection,confidentiality,biosafety, andthewell-beingofparticipants.Afterprovidinginformationaboutthestudyandaddressinganyquestions, informedconsentwasobtainedfromtheparticipants.
Fiftyquestionnairesweredistributed,and49participantsagreedtotakepartinthestudy,resultinginaresponserateof98%.Themajorityofparticipantswere female, with 41 participants (83.7%); 8 male nurses (16.3%)alsoparticipated.Themeanagewas37years, rangingfrom25to53years.Regardingthehighestlevel ofeducation,57.8%ofthesamplehadatechnicaldegree in nursing, and 42.2% had a bachelor’s degree innursing.Theaveragelengthofservicewas5years, rangingfromaminimumof8monthstoamaximumof 18years.Analysisofthedatarevealedthat75.5%ofthe staffhadexperiencedMSDsinthepast12months.Pain wastheprimarysymptominupto87.5%ofstaffwith MSDs,beingmorefrequentamongwomen(78%)than among men (62.2%), and similar in intensity across allagegroups. Likewise, 74.8%reportedexperiencingpaininthelumbarspine,72.3%inthecervicalregion,64.6%inthethoracicspine,58.3%intheshoulder, 31.3%intheelbow,and10.1%inthewrist;conversely, 24.5%ofthesamplereportednosymptoms.(Figure1)
revealingthat100%wereexposedtoriskfactors,the mostcommonbeing:continuouspatientmobilization (83.6%),physicalactivitiesrequiringuncomfortablepositions(79.3%),andliftingheavyloads(56.7%).Thirtyfivepercentconsideredtheirassignedtasksunfair,as theworkloadwasexcessiveandtherewasinsufficient staff.Likewise,75%ofstaffwithmusculoskeletalsymptomsidentifiedtheirworkingconditionsasthecausal factor;however,23%wereunawareofthecause.Similarly,itwasobservedthat69.4%ofthesamplehad beenperformingthesamejobforyears,while30.6% had been working there for only a few months. Regardingtheirworkschedules,itwasfoundthat15.6% worked shifts of more than 16 consecutive hours at leasttwiceaweek,while52%workedmorethan48 hoursaweek. Theywereaskedwhether,inthepast 12months,theyhadexperiencedtotalorpartiallimitationsintheirwork,domestic,andrecreationalactivities.Theresultsshowedthat34.7%ofthesample reportedlimitationsinperformingworkactivities,particularlythoseinvolvingthemovementofpatientsand theliftingofheavymachineryorequipment;100%reportednoreductionintheirdomesticactivities;and 26.54%hadsuspendedsomeleisureactivity(sports), astheseactivitiesintensifiedtheirpain.(Figure2) Regardingworkabsenteeismduetomusculoskeletal symptoms,thestudyfoundthat33.3%ofnurseswere absentfromworkduetomusculoskeletaldisorders, reportingthatpainpreventedthemfromperforming theirdutiesnormally. 66.7%reportedhavingnodifficultyperformingtheirworkduetomusculoskeletal symptoms.96.5%ofparticipantsreportednothaving requiredhospitalizationformusculoskeletalinjuries inthepast12months,while3.5%reportedbeinghos-
takinganti-inflammatorydrugsoranalgesicsregularly, while32.7%reportednottakinganymedicationbecausethepainwastolerable;theremainderdidnot exhibitanymusculoskeletalsymptoms.
ThereisahighprevalenceofMSDsamongnursingstaff intheTraumatologyDepartmentoftheFirst-LevelHospitalinPachuca,reachingashighas75.5%.AfterevaluatingstaffatsixhospitalsaffiliatedwithaTurkishuniversity, itwasobservedthatthehighestprevalence of MSDs was among nursing staff, at 77.1In another studyontheprevalenceofMSDsamongprofessionals inrehabilitationandphysicaltherapyservices,itwas foundthat83.2%ofnurseshadexperiencedmusculoskeletalsymptomsinthepast12monthsand91.8% atsomepointintheirlives[30]. Fajardoetal. (2015) foundthat79.5%ofnursesworkingintheintensive careunitsoftwohospitalsinBogotápresentedwith musculoskeletalsymptoms[31].AmongnursesatSultanAbdulHalimHospitalinMalaysia,ahighprevalence ofMSDs(97.3%)wasfound,withpainastheprimary symptom[32]. Thisisverysimilartotheresultsobtainedinthisstudy,wherepainwasthepredominant symptomin87.5Musculoskeletaldisorders(MSDs)are mostprevalentintheupperandlowerback,thecervical region, and the shoulders. [11][13][14][34]. In a study conducted at a hospital in the Kingdom of SaudiArabia,63.9%ofnursingstaffreportedexperiencingdiscomfortinthelowerbackregioninthepast12 months,makingitthemostaffectedregion,followed by the shoulders (50%) and the upper back (48.9%) [16].TheobservedprevalenceoflumbarMSDsinthis studywas74.8%,whichissimilar,asitisthemostaffectedregion;however,thecervicalregionrankssecondwith72.3%,andtheshoulders,althoughwitha similarprevalenceof58.3%,werenotamongthemost affectedareas. Yangetal. (2021)notethatlowback painisthemostfrequentlyobservedMSD(80.1%),followedbyneckpain(78.1%)andshoulderpain(70.4%); they also found that young nurses were more likely tosufferfromMSDsthanmalestaff[33].Activitiesrelatedtopatientcare(liftingandtransferring)arethe most significant factor in the development of MSDs [31][34][35];othercontributingfactorsincluderepetitivemovements,maintaininguncomfortablepostures forlongperiodsoftime,andfactorsrelatedtowork organization[14][16][20][36]. 83.6%ofthenursing staffwhoparticipatedinthisstudyidentifiedpatient mobilizationasthemaincausalfactorfortheirmusculoskeletalsymptoms.Regardingsociodemographic factorsrelatedtoMSDs,womenhaveshownahigher riskofdevelopingthesesyndromes[1][11].Inastudy conductedtoassesstheprevalenceandriskfactorsfor lowbackpainamongnursingstaffinspecializedhospitalsinNigeriaandEthiopia,itwasreportedthatlow backpainwasmorecommonamongfemalenurses (67.5%) than among male nurses (32.5%) [36]. This studyfoundthatwomenweremoreaffected;however, thedifferencebetweenthetwosexeswas15.8%,soit cannotbeconsideredapredictorofMSDs.
Thisstudysoughttoconductacomprehensivereview oftheavailableliteratureinordertoprovideathoroughinvestigation,withtheaimofservingasauseful referenceforfuturestudiesinvolvingsimilarpopulations.
Somelimitationsidentifiedinthisstudyincludethe factthattheresultswerenotreportedbyagegroup, norweretheyanalyzedinrelationtoBodyMassIndex (BMI)ortheinfluenceofpsychosocialfactors.Therefore,itwasnotpossibletodeterminetheprevalenceof TMEbyriskfactors.Likewise,thecostofmedications ormedicalconsultationsforthemanagementofMSDs wasnotanalyzed,norwastheimpactonthefinances ofnursingstafforonhealthsystems.Finally,theprevalenceofMSDsintheupperandlowerextremitieswas notinvestigated;rather,thestudywaslimitedtomusculoskeletalsymptomsinspecificregionsoftheneck, chest,andlumbarregion.
Itwasdeterminedthatthereisahighprevalenceof musculoskeletaldisorders(MSDs)amongnursingstaff, withpainbeingthemostcommonsymptomandvaryinginfrequencydependingontheaffectedregion;the lowerback,neck,andupperbackwereidentifiedasthe mostcommonlyaffectedareas.Itwasalsoobserved thattheseinjuriesareassociatedwithlimitationsin workactivitiesandabsenteeism.Regardingthecausal factorsforthedevelopmentofmusculoskeletalsymptoms, patientmobilizationwasidentifiedastheprimaryfactor,followedbyadoptinguncomfortableposturesandliftingheavyloads.Itisthereforeconcluded thatperformingactivitiesrequiringoverexertionand longworkshiftscontributetotheonsetofMSDs. On theotherhand,itwasobservedthatMSDsarenota causeofhospitalization,suggestingthatmusculoskeletalpainordiscomfortconstitutesminorinjuriesthat donotrequirespecialcare. However,thereisahigh prevalenceofanti-inflammatoryoranalgesicuse,so it should be analyzed in detail whether MSDs affect patients’qualityoflife.Finally,itisrecommendedto implementpatientmobilizationusingproperbodymechanics,asimproperhandlingandmobilizationofpatientswithinthehospitalsettingisamajorcontributing factortomusculoskeletalinjuries.
ConflictofInterestStatement. Theauthorsdeclare thatthereisnoconflictofinterestregardingthepublicationofthisarticle.
Artificialintelligence. Theauthorsdeclarethatno artificialintelligencetoolswereusedinanypartofthis article.