The aim of this study was to determine the relationship between musculoskeletal complaints and working postures among pathology specialists working at the laboratories affiliated to the Mashhad University of Medical Sciences. The mean age of the subjects was 36.57 years. The results showed the majority of female sex (67.5%) in our study.
The highest incidence of MSDs among the subjects was in the neck (65%), wrist (57.5%) and upper back (50%). The MSDs were also observed in other areas of the lower back (5/47%), shoulder (40%), knee (30%), ankle (12.5%) and thigh (12.5%), respectively. This situation may be due to inappropriate design of workstations. Occupations in laboratory work, such as office jobs, often require a static position in the body due to their occupational status and sitting down on the chair over a long period of time, which has recently been reported as a major risk factor for the neck pain . Ortiz-Hernandez et al. also showed an increase in the risk of developing MSDs in computer-related staff . They introduced the use of the mouse, sitting so long, poor postures and psychological factors as risk factors in the increased prevalence of MSDs. Bergqvist U et al. reported the effective role of ergonomic factors, such as static postures, awkward hand postures, improper seat armchairs, repetitive movements, inappropriate placement of monitor and keyboard, in the prevalence of MSDs . Among the pathologists, the posture while working with a microscope, computer and other devices make a situation where they are forced to put their neck and waist in an inappropriate condition, and the awkward design of workstations is exacerbating this issue.
Falaki et al. conducted a descriptive cross-sectional study reported that the incidence of neck pain was higher than other body organs . Rahimi et al. carried out a descriptive cross-sectional study in Iran, on the WMSDs among pathologists . The highest prevalence of WMSDs within 12 months was reported in the neck (33.3%), followed by the shoulder and the elbow pain that was 21.6%. Maulik S et al. in India studied the working ergonomic assessments and the prevalence of musculoskeletal symptoms among the technicians in medical diagnostic laboratories . Overall incidence of MSDs experienced by technicians was 73.3% in the trunk, knees and ankles. There was also a significant difference between the mean scores before and after working shift in the neck, waist and knees.
Regarding the studies in other similar occupations, Nokhostin et al. examined musculoskeletal disorders and its complications among dentists . They showed that 67.5% of dentists suffered from physical disorders including neck (51.8%), wrist (92.9%) and elbows (11.11%) and shoulder (7.4%) discomforts. In a study of Rafeemanesh et al. the prevalence of MSDs in different parts of the body in dentists was obtained in the neck (75.9%), shoulders (58.6%), upper back (56.9%), lower back (48.3%) and wrists (44.8%) . In a study by Juul-Kristensen et al. on 1428 office workers, it was found that the MSDs are high in such occupations and are the highest in the neck, back and shoulders . Kristensen et al. also showed that the incidence of these discomforts in office personnel in the neck, waist and shoulder areas was higher than in other parts. In the studies of Szeto et al. on surgeons and Kumar et al. on dentists, the neck has had the highest MSDs [21-22]. The results of all these studies are in line with the findings of this study, indicating a high prevalence of MSDs in the neck and waist; a slight difference in the prevalence can be attributed to the nature of the work. In general, undoubtedly, the high prevalence of MSDs among the pathologists in the present study indicates the harmfulness of the working conditions and environment in this profession and their awkward physical postures during work.
The mean duration of occupation was 6.50±6.30 years and the mean weekly working hours was 45.15±12.84 hours in the subjects of this study. The interaction of long-term sitting position and the awkward workplace conditions may cause long-term static contraction of the muscles, hereby increasing pressure on the intervertebral discs, inducing muscle tension on the ligaments and muscles, reducing tissue flexibility and changing in the spine curvature. Therefore, the present study also found a high prevalence of MSDs in the upper back and the lower back areas. Meanwhile, the results of the statistical tests demonstrated a significant relationship between the mean duration of occupation of the subjects and the neck and lower back pain. There was also a significant relationship between the mean weekly working hours in the subjects and the discomfort in the thigh, upper back, wrists and ankles. In this case, the research has also shown that increasing daily work hours is associated with the prevalence of MSDs confirming the results of our study .
There was a significant relationship between the mean age of subjects and neck, knee and ankle pain (P=0.02); the mean age was higher in people with discomfort in these areas. A significant association (P=0.00) was also observed between the age and the presence of MSDs in the study of Nokhostin et al. . The subjects in this study, only 1 (2.5%) had a history of smoking. Other demographic data indicated that the mean BMI of the physicians present in the study was 23.83±2.16 kg/m2. According to other examinations of the present study, the mean RULA grand scores was found to be 3 or 4 in 8 (20.0%), 5 or 6 in 27 (67.5%), and 7+ in 5 (12.5%). Further, the mean RULA A was 5.55±0.87, and the mean RULA B was 4.67±0.52. In addition, the mean RULA grand score was 5.25± 0.96. Accordingly, it can be claimed that a majority the pathology specialists present in our study are within ergonomic level (3 and over) resulting in high risk of MSDs. Meanwhile, the score of 6 and over in about 80% of cases indicates severe awkward posture of the body and thereby the abnormal ergonomics of the body in this occupation. In the study of Maulik et al. the final RULA score was obtained to be 6± 1.02, emphasizing poor workplace condition among medical laboratory technicians . Their study showed that the prevalence of MSDs is high among medical laboratory technicians, and intervention of administrative and engineering controls can dramatically attenuate ergonomic risks, consistent with the results of our study. Therefore, all physicians present in our study should prioritize corrective actions, which should be done as soon as possible.
The statistical test results showed a significant relationship between the mean RULA grand score and upper back (P=0.02) and shoulder (P=0.02) pain during the last 12 months and the mean RULA score was higher in individuals with upper back and shoulder pain. There was also a significant relationship between the mean RULA B and neck pain (P=0.02) and back pain (P=0.05). A significant relationship was also seen between the mean RULA A and upper back and wrist pain (P=0.003), indicating poor workstation design resulting in abnormal posture. Falaki et al. observed a significant relationship between awkward posture and pain in the body organs and finally showed high prevalence of MSDs in the medical laboratory personnel . The improper posture of these staff is of the main causes of these disorders and corrective ergonomic measures are needed to reconstruct the workstations in laboratories. In the study of Rafeemanesh et al. on dentists, the analysis of work using REBA showed that 89.6% of the organs in group A and 79.3% of the organs in group B had a score of 4 that shows an awkward posture in this occupation . Florian Rudalf Fritzsche et al. also emphasized the need for clinical care and ergonomic interventions in the workplace among the population of pathologists in Switzerland .
The Chi-square test results showed no significant relationship between gender, dominant hand, smoking and heart disease in the study subjects and discomforts in the neck, upper back, lower back, shoulder, thigh, knee, wrist and ankle.
Among the subjects, the highest prevalence of MSDs was observed in the neck, the wrists, and the upper back and the lower back. These results will help to improve the working conditions and corrective actions, paying attention to the risk factors of these areas. Some of the most important reasons for high RULA score among pathologists can be attributed to the poor design of the workstation, the awkward setting of the desk containing tools and gadgets, the impossibility of adjusting the seat height, non-compliance with ergonomic principles by the pathologist due to lack of proper training in this field, or huge workload. Therefore, understanding and observing ergonomic principles in the workplace like the lab will reduce these issues. Therefore, reducing working hours or increasing the rest time, conducting tests periodically, increasing accuracy in the correct positioning (such as allowing to adjust the height of the work desk, microscope, computer, and making available and standardizing other equipment) can be effective in the prevention of MSDs among the pathologists with high workloads.
Some of the limitations of this study were the small sample size and the lack of cooperation of some physicians (according to the self-report nature of the Nordic questionnaire). The psychological conditions in the workplace, occupational stress, and other external factors may also affect the outcomes of our project, which have not been addressed in this study.