|Year : 2020 | Volume
| Issue : 2 | Page : 185-193
Prevalence of musculoskeletal disorders and eye strain among the radiologists in Belagavi
Anand Heggannavar, Ashwin Patil, Fleur Lewis, Charlene Luis, Radhika Malu
Department of Orthopedic Manual Therapy, KAHER Institute of Physiotherapy and Research, Belgaum, Karnataka, India
|Date of Submission||02-Mar-2020|
|Date of Decision||19-May-2020|
|Date of Acceptance||17-Aug-2020|
|Date of Web Publication||18-Dec-2020|
Dr. Anand Heggannavar
KAHER Institute of Physiotherapy, Nehru Nagar, Belagavi - 590 010, Karnataka
Source of Support: None, Conflict of Interest: None
BACKGROUND: Radiologists face unique occupational health hazards among which musculoskeletal injuries, chronic eye strain, and others are yet to receive adequate attention. Mental strain due to demanding turnaround times and work pressures may lead to burnout. These combine to decrease overall work satisfaction and productivity.
AIMS: The aim of this study was to determine the prevalence of musculoskeletal disorders (MSDs) and eye strain among the radiologists in Belagavi.
SUBJECTS AND METHODS: This was an observational study where a self-administered questionnaire inclusive of the Nordic Musculoskeletal and Eye Strain Survey Questionnaire was provided to 47 radiologists. This questionnaire was given to most of the radiology centers in Belagavi specifically to radiographers who had at least more than 2 years of experience and daily work duration of more than 7 h.
STATISTICAL ANALYSIS USED: The statistical analysis was carried out using Statistical Package of the Social Science s Version 20.0.
RESULTS: The prevalence of neck pain among candidates was 74.4% followed upper back pain with rate of 65.9% and lower back pain with rate of 63.8%. The prevalence of shoulder pain was 57.4%. Wrist/hand pain was 55.3% while 29.7% complained of elbow pain. Twenty radiologists state that their symptoms have aggravated after introduction of picture archiving and communication system.
CONCLUSIONS: There was a prevalence of MSDs and eye strain seen among radiologists.
Keywords: Belagavi, eye strain, musculoskeletal disorders, radiologists
|How to cite this article:|
Heggannavar A, Patil A, Lewis F, Luis C, Malu R. Prevalence of musculoskeletal disorders and eye strain among the radiologists in Belagavi. BLDE Univ J Health Sci 2020;5:185-93
|How to cite this URL:|
Heggannavar A, Patil A, Lewis F, Luis C, Malu R. Prevalence of musculoskeletal disorders and eye strain among the radiologists in Belagavi. BLDE Univ J Health Sci [serial online] 2020 [cited 2021 Apr 14];5:185-93. Available from: https://www.bldeujournalhs.in/text.asp?2020/5/2/185/303958
” Musculoskeletal disorders” (MSDs) include a wide range of inflammatory and degenerative conditions affecting the muscles, tendons, ligaments, joints, peripheral nerves, and supporting blood vessels. Body regions most commonly involved in MSDs are the low back, neck, shoulder, forearm, and hand.
Work-related musculoskeletal disorders (WRMSDs) are the most common cause of discomfort, work-related disability, and physical disability among workers in most sectors all over the world. These MSDs are injuries to the human support system that can occur after a single event or cumulative trauma which negatively affect the activities of the worker.
The role of radiologists continues to evolve and broaden. Increasingly, radiologists not only interpret imaging examinations but also perform additional activities including consulting with referring clinicians and ancillary staff members, prioritizing and conducting interdisciplinary patient care, teaching sessions, and performing image guided procedures. Because of the advent of fully digitalized radiology departments centered on picture archiving and communication system (PACS) and digital imaging, many radiologists now spend their careers at computer work stations, thus making their lifestyle sedentary and increasing the risk of WRMSDs and repetitive strain injuries.
Radiographers, as part of the healthcare team, are at high risk of WRMSDs considering the nature of their activities which are associated with repetitive movement, static postures, muscular activation pattern, and also the use of physical force to lift, push, pull, or move equipment and patients. WRMSDs cause severe pains and discomfort that affect the attitude of radiographers toward work and also their output.
Computer technology, which has transformed the workplace, has also introduced an array of related health complaints, most of which involve the visual and musculoskeletal systems. Symptoms of eye strain are the most commonly reported complaints among computer users including radiologists. These symptoms comprise a complex of ocular and visual symptoms (such as itching, burning, dryness, blurred vision, or photophobia) that occur during or immediately after the workday.
With the introduction of PACS and extensive use of computers for administrative tasks, radiologists are likely to be susceptible to such computer-related symptoms. Although the type of lighting and the variety of tasks performed in the office workplace differ considerably from those in the environment in radiology interpreting rooms, eye strain is likely to occur by similar mechanisms. Therefore, radiologists need to focus on strategies to maximize productivity. Eye strain, which has a high prevalence among radiologists, can hinder productivity and diagnostic interpretation by causing “perceptual errors, performance errors, decrease in reaction time, fatigue, and even burnout.” 
Despite decades of ergonomics research, MSDs are still considered to be one of the biggest problems faced by the workers. Lack of attention to ergonomic design not only decreases efficiency and productivity but also harms the eye and causes back, neck, and shoulder pain. Therefore, the prevalence of MSDs and eye strain is an area of concern among radiologists. To provide us with a better understanding of work-related musculoskeletal changes that are seen in radiologists such as injuries and illness involving sprains/strains, joint inflammation, low back pain, and nerve compression syndromes, this helps in determining if the symptoms differ in location and severity among male and female radiologists. This study was undertaken to provide an insight regarding the prevalence of these conditions and broaden the scope for prevention and therapeutic interventions.
| Subjects and Methods|| |
Ethical clearance was obtained from the institution review committee. Prior permission was taken from the concerned authorities. Sampling method used was convenient sampling. All subjects were approached at various radiological centers of Belagavi city. All subjects were screened based on the inclusion and exclusion criteria before their enrolment into the study. Subjects who were working for 2 years and daily duration of at least 6–8 h were included in the study. Participants who have congenital deformity, history of recent injuries in the last 6 months, known neurological conditions affecting upper limb, lower limb, and back, and recent deliveries (less than a year) and radiologists working for <2 years or for <6 h per day were excluded from the study.
Nordic Musculoskeletal Questionnaire
This is a questionnaire used to screen MSDs in the ergonomic context and for occupational healthcare service. It focuses on nine areas of the body. It has two components: the generalized questionnaire focuses on which area of the body while the special questionnaire concentrates on the anatomical area in which symptoms are most common.
Eye Strain Survey Questionnaire
The survey included questions about demographic information, personal eye care, PACS versus film use, work habits, and workstation and interpreting environment design.
Written informed consent was obtained from all subjects. Brief demographic data were taken down, and additional questions regarding number of hours of work, years of working experience, site of work, and qualification were also noted. The subjects were asked to answer the Nordic Questionnaire and Eye Strain Survey Questionnaire; the scores were calculated following which the data were given for analysis.
Statistical analysis was done using? Statistical Package of the Social Science (SPSS) Windows version 20 (IBM Corp,. IBM Version 21, Armonk, NY, USA). All data were entered in Microsoft Windows Excel Sheet. Categorical data were compared using Chi-square test. Prevalence percentage was calculated for every variable.
| Results|| |
A total of 47 participants were included in the study, out of which 31 (65%) were male and 16 (35%) were female. The mean age of the participants was 36.96 ± 6.92 years. A majority of the population, i.e., 55.32%, fall within the age group of 31–40 years. 29.79% were above this age group while 14.89% fall below this age group. Thirty-six (76.60%) of the recruited participants were full-time consultants, while 11 (23.40%) came under the category of others that included 3rd-year postgraduates, junior and senior residents, and professors. 36.17% of the participants have been working for 1–5 years while 36.17% have been working for 6–10 years and 27.6% have been working for more than 11 years. The mean of the working duration is 8.45 ± 2.27. The mean of daily work duration was 8.04 ± 4.14 h with 28 (59.57%) participants working between 1 and 8 h and 19 (40.43%) participants working for more than 9 h [Table 1].
The overall prevalence of discomfort due to MSDs within the last 12 months was 97.8% while the interference rate within the past 12 months was 93.62% and the last 7 days was 91.41%. Out of the 47 subjects surveyed, 46 had positive findings (97.8%). The incidence of neck pain was the highest with 35 out of 46 subjects affected (76%), with an interference rate of 57.45% and 40.43% in the last 12 months and last 7 days, respectively. The incidence of upper back pain among the candidates was the second highest with 31 out of 46 participants affected (67%), followed by lower back pain where 30 out of 46 individuals were affected (65.2%). The incidence of shoulder pain was 57.45% followed by wrist and hand pain. The occurrence of elbow, knees, and hip/thigh pain was comparatively less, while none of the candidates suffered from ankle pain [Table 2].
In the age group of 31–40 years, 20 (76.9%) out of 26 radiologists had neck pain, 15 (57.6%) complained of shoulder pain, 10 (38.4%) experienced elbow pain in the last 12 months, 15 (57.6%) complained wrist/hand pain, while 14 (53.8%) had discomfort in the upper back and 10 (38.4%) had discomfort in the lower back during the past 12 months. Four (15.3%) participants complained of knee pain. Among the participants above 41 years of age, 11 (78.5%) out of 14 radiologists had neck pain, 9 (64.2%) complained of shoulder pain, 4 (28.5%) experienced elbow pain, 8 (57.1%) complained of wrist/hand pain, while 12 (85.7%) had discomfort in the upper back and 9 (64.2%) had discomfort in the lower back during the past 12 months. Three (21.4%) participants complained of knee pain. Among the participants below the age of 30, 4 (66.6%) out of 6 radiologists had neck pain, 3 (50.0%) complained of shoulder pain and wrist/hand pain, while 5 (83.3%) had discomfort in the upper back and 3 (50%) had discomfort in the lower back during the past 12 months while 1 (16.6%) participant complained of knee pain [Table 3].
Among the males, 23 (65.7%) had experienced neck pain in the past 12 months, 21 (77.7%) complained of shoulder pain, 11 (78.5%) complained of elbow pain, while 15 (57.6%) complained of wrist/hand pain, 22 (70.9%) had upper back pain, and 20 (66.6%) had lower back pain. There were 5 (62.5%) radiologists with knee pain. Among the females, 12 (34.2%) had experienced neck pain in the past 12 months, 6 (31.5%) complained of shoulder pain, 3 (21.4) complained of elbow pain, while 11 (42.3%) complained of wrist/hand pain, 9 (29.0%) had upper back pain, and 10 (33.3%) had lower back pain. There were 3 (37.5%) radiologists with knee pain while 1 (33.3%) participant had hip pain. In this study, the male population is comparatively more symptomatic than the female population [Table 4].
Among the consultants, 27 (57%) had neck pain in the last 12 months, while 22 (48%) complained of pain interfering with their working capacity, and 14 (30%) complained of pain in the last 7 days [Table 5].
Of the 46 participants with positive symptoms, 28 participants (61%) work for 1–8 h while 18 (39%) participants work for more than 9 h per day. Among the participants who work for 1–8 h, 22 (62.86%) participants had neck pain, 20 (74%) had shoulder pain, 10 (71.43) had elbow pain, 17 (65.38%) experienced wrist/hand pain, while 22 (70.9%) had upper back pain and 19 (63.3%) had lower back pain. Three (6%) participants had pain in the hips/thighs. Four (8%) subjects had knee pain [Table 6].
|Table 6: Prevalence of musculoskeletal disorders as per work duration in years|
Click here to view
There were 18 (39%) radiologists working for more than 9 h, of which 13 (28%) had neck pain, 7 (25.93%) had shoulder pain, 4 (28.57%) experienced elbow pain, and 9 (34.6%) complained of wrist and hand pain. Nine (29%) had upper back pain, while 11 (36%) had lower back pain, and 8 (17%) had knee pain [Table 7].
|Table 7: Prevalence of musculoskeletal disorders as per work duration in hours|
Click here to view
All the participants in the study complained of eye strain that led to fatigue, strain, irritation, difficulty in seeing clearly, and headache at the end of the day. Of the 47 candidates, 23 have been using corrective lenses. Twenty-four (52%) candidates claim to spend 26%–50% of time in a week working on techniques such as screening computed tomography (CT), diagnostic CT, sonography, and conventional radiography. Nineteen (41%) candidates spend 51%–75% of time in a week doing the same, while 4 (9%) candidates spend 76%–100% of their working hours on the same techniques. Eighteen (38%) out of the 47 candidates complained of symptoms such as itching or burning or irritated eyes, difficulty in seeing clearly (blurred or double vision), and headaches which occur often during work, while 21 (45%) candidates experienced the same symptoms at a lower frequency; out of these candidates, 35 (74%) radiologists experienced these symptoms only at the end of the day while 12 (26%) radiologists stated that the symptoms started path way through the day and persisted for the rest of the day. Out of the 47 radiologists included in the survey, 33 (70%) have worked with hard copy films in the past. 20 (60%) radiologists stated that their symptoms have aggravated after the use of PACS [Table 8].
| Discussion|| |
This study was designed to determine the prevalence of MSDs and eye strain among radiologists in Belagavi. The participants of this study were explained the aim of the study and asked to fill out the Nordic Musculoskeletal Questionnaire and the Eye Strain Survey Questionnaire. The findings of this study showed that radiologists within the region of study are at high risk of WRMSDs as compared to their counterparts in other regions.
A study conducted in 2019 stated that the incidence of musculoskeletal injuries among Indian radiologists is much higher as compared to those reported in the Western literature. A comparison between their study and another 2017 study from the United States in Journal of the American College of Radiology proves that some injuries have almost double the incidence in Indian radiologists as compared to their Western colleagues.
The overall prevalence of WRMSDs as per our study was 97.87%. Most of the participants were males and within the age group of 31–40 years. A majority of the subjects were working as consultants and the daily working duration ranges from 1 to 8 h. Previous studies have shown that long working hours and high caseload were high risk factors for WRMSDs.
In this study, as per the Nordic Questionnaire, the neck region was the most affected. A majority of the subjects had experienced discomfort in the neck during the past 12 months. Out of this, some reported that the pain had interfered with their ability to work efficiently, while a few had experienced pain recently during the last 7 days. A majority of the radiologists complaining of neck pain belonged to the age group of 31–40 years and those who had been working for 6–10 years. These findings match the results of a study which stated that neck pain is more likely to interfere with radiologists that are older and have been practicing for a longer duration. This is attributed to improper monitor positioning, insufficient neck support from the chair, or even eye strain.
Back pain was the second most affected region as per this study where many radiologists complained of upper back pain as well as lower back pain within the past 12 months. According to a study titled WRMSDs among medical staff in a radiology department conducted in 2009, upper back pain was associated to work characteristics such as frequently rotating between different department sections on two floors, gathering and managing patient records, and frequent stair climbing. Lower back pain, on the other hand, in addition to prolonged periods spent typing and sitting, is also attributed to time spent performing angiographies which are very time-consuming. It is also associated with lifting heavy loads, twisting, and bending the trunk. Radiologists working in the CT scan department are known to have a higher incidence of low back pain.
The incidence of back pain among sedentary workers had been proved to be higher than that workers with free postures. Shoulder pain and wrist pain were the next most affected body parts, where subjects complained of discomfort in the past 12 months. However, a few of the candidates reported elbow pain.
A significant correlation was found between the prevalence of neck pain, low back pain, and shoulder pain – a condition known as transducer user syndrome. This is mainly seen in radiologists due to the overuse of the dominant arm, prolonged uncomfortable positions, and repetitive movements. A small percentage of the subjects reported knee pain/discomfort within the past 12 months, out of which a small minority complained of pain during the past 7 days. This is attributed to the static postures attained during prolonged hours of sitting at desk jobs.
The aim of this study was also to find out the prevalence of MSDs and eye strain among the radiologists of Belagavi. In this study, the screening scale that was filled by the participants to measure eye strain and fatigue was the Eye Strain Survey Questionnaire. The Eye Strain Survey Questionnaire was completed by the participants to measure eye strain and fatigue . The findings revealed that significant prevalence of symptoms ranging from dry eyes to fatigue, strain, irritation, difficulty in seeing clearly, and headache at the end of the day could be attributed to the regular use of visual display units (VDUs) at work.
A study published in January 28, 2014, stated that, in a general population, the prolonged use of VDUs is associated with ocular symptoms. Females, elderly computer users, and those who wear corrective lenses are at higher risk of developing symptoms of eye strain, which may affect up to 40% of workers who regularly using VDUs. Eye strain manifests as a complex of symptoms, including pain and a sensation of grittiness. It was caused by fatigue of the ciliary and extraocular muscles and an increased surface area of the cornea, owing to eye position and decreased blink rate. In the present study, the candidates complained of symptoms such as itching, burning, irritated eyes, and difficulty in seeing clearly (blurred or double vision) and headaches which occur often after work.
A study done to determine the prevalence of and factors contributing to eye strain among radiologist an internet-based survey was sent to 2700 radiologists who randomly selected from the membership database of the Radiological Society of North America. The questions included were information about their viewing habits, methods, work habits, and workstation design. Common eye strain symptoms were evaluated. The findings of this study and our present study showed the same results where the number of working hours had the strongest influence on eye strain, followed by age. Eye strain decreased when the respondents were taking breaks at least for every hour. The use of corrective lenses, type of correction, and frequency of eye examination did not correlate with eye strain symptoms. The limitations of the present study are (1) gender distribution was unequal with less number of female participants in this study and (2) this study has lesser participants as the population of radiologists in Belagavi is less.
| Conclusions|| |
WRMSDs were commonly seen in majority of radiologists of Belagavi. Neck pain, upper back pain, lower back pain, and shoulder pain were frequently reported by the radiologists of Belagavi. Lower extremity involvement was least. Males reported more problems as compared to the females. Consultants reported the most of the WRMSDs. Work-year experience-wise, there was equal prevalence of WRMSD in all categories, and work-hour wise, the prevalence was 65% who worked for 1–8 h and 35% who worked for more than 9 h. Maximum radiologists experienced eye strain on a regular basis which worsened after the use of PACS, concluding that there is an increase of symptoms after the introduction of PACS.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Punnett L, Wegman DH. Work related musculoskeletal disorders: The epidemiological evidence and the debate. J Electrom Kinesiol 2004;14:13-23.
Al-Eisa E, Buragadda S, Shaheen AA, Ibrahim A, Melam GR. Work related musculoskeletal disorders: Causes, prevalence and response among Egyptian and Saudi physical therapists. Middle East J Sci Res 2012;12:523-9.
Okeji MC, Agwunna KK, Onwuzu SW, Nnaemeka JO. Patterns of work-related musculoskeletal disorders among practicing sonographers in Enugu State, Nigeria. World J Med Sci 2015;12:387-91.
Seguí Mdel M, Cabrero-García J, Crespo A, Verdú J, Ronda E. A reliable and valid questionnaire was developed to measure computer vision syndrome at the workplace. J Clin Epidemiol 2015;68:662-73.
Stec N, Arje D, Moody AR, Krupinski EA, Tyrrell PN. A systematic review of fatigue in radiology: Is it a problem? AJR Am J Roentgenol 2018;210:799-806.
Waite S, Scott J, Gale B, Fuchs T, Kolla S, Reede D. Interpretive error in radiology. AJR Am J Roentgenol 2017;208:739-49.
Crawford JO. The Nordic musculoskeletal questionnaire. Occup Med 2007;57:300-1.
Rajabi-Vardanjani H, Habibi E, Pourabdian S, Dehghan H, Maracy MR. Designing and validation a visual fatigue questionnaire for video display terminals operators. Int J Prev Med 2014;5:841-8.
Kawthalkar AS, Sequeira RA, Arya S, Baheti AD. Non-radiation occupational hazards and health issues faced by radiologists-A cross-sectional study of Indian radiologists. Indian J Radiol Imaging 2019;29:61-6.
] [Full text]
Parikh JR, Bender C, Bluth E. Musculoskeletal injuries affecting radiologists according to the 2017 ACR Human Resources Commission Workforce Survey. J Am Coll Radiol 2018;15:803-8.
Ugwu AC, Egwu OA, Nwobi IC, Oluware NF. Occupational stress among radiographers: The impact of sonography responsibility. Int J Med Update 2009;4:3-6.
Burnett DR, Campbell-Kyureghyan NH. Quantification of scan-specific ergonomic risk-factors in medical sonography. Intern J Indust Ergonomics 2010;40:306-14.
Halpenny D, O'Driscoll D, Torreggiani WC. Ocular health among radiologists in the age of PACS: Is it time for our profession to open its eyes to this issue in light of existing European legislation? Br J Radiol 2012;85:e1309-11.
Vertinsky T, Forster B. Prevalence of eye strain among radiologists: Influence of viewing variables on symptoms. AJR Am J Roentgenol 2005;184:681-6.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]