Musculoskeletal disorders in sign language interpreters: a systematic review protocol

Backgroud Full physical, mental and social well-being is presented by the World Health Organization (WHO) as a denition for health. The relationship between "health" and "work" is present in an area known as "worker health", this area aims to promote, protect, recover and rehabilitate workers' health. It is known that different musculoskeletal disorders affect employees from the most diverse occupational groups due to their working hours, with high cognitive and physical demands according to the specicity of each labor branch. The sign language interpreter is a professional who develops his activities by carrying out communication between users of two different languages, auditory-oral and visual-gestural, due to the high cognitive and physical demand of these professionals during simultaneous interpretation, there are risks of developing disorders musculoskeletal.

by the interpreter is outlined as a key point, since he is the link between the deaf and his "universe" that is mostly composed of listeners [10].
The sign language interpreter involves a high cognitive as well as physical demand due to simultaneous interpretation. Since these are movements with different speeds, repetitive and with uncomfortable positions, there are risks of developing musculoskeletal disorders, such as repetitive strain injuries (RSI) and work-related musculoskeletal disorders (WMSDS) [11].

Objectives
The objectives of this systematic review are: 1. Analyze the prevalence of musculoskeletal disorders in professional sign language interpreters.

Methods
This is a systematic review of studies examining musculoskeletal disorders in sign language interpreters.
The review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database [12] under registration number CRD42020178849. This protocol was structured according to the guidelines of the Preferred Report Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) [13] (see Additional le 1).
The guiding question of this study was: what is the prevalence of musculoskeletal disorders in sign language professionals due to their professional performance?

Eligibility criteria
The studies will be selected according to the criteria described below: Participants Studies with people of both sexes, with or without pathologies.

Study designs
Only observational studies that used generic or speci c tools to assess the prevalence of musculoskeletal disorders in sign language interpreters should be included. Qualitative studies will be excluded.

Interventions or exposure
Professionals who act as sign language interpreters. Exclusion of professionals from other functions.

Comparators
Not applicable.

Primary outcome
The main outcome to be considered is the prevalence of different musculoskeletal disorders described in the studies according to the instruments used.

Secondary outcomes
Secondary results will not be considered in this review.

Search methods
The terms that will be used in the search were consulted in the Health Sciences Descriptors (DeCS) [14] and Medical Subject Headings (MeSH) [15], Searches will be conducted in the following databases: Latin American and Caribbean Health Sciences Literature (LILACS) [16], Scienti c Electronic Library Online (SciELO) [17], ScienceDirect [18], Scopus Elsevier [19], United States National Library of Medicine (PubMED) [20], Web of Science [21]. The search for the articles will take place in the year 2020 and no date lters and database languages will be used.
The reference lists of the included articles will be analyzed to ensure studies that have not been found by searching the databases. For database searches, the following keywords or search terms will be used: "Cumulative Trauma Disorders" OR "Cumulative Trauma Disorder" OR "Disorder, Cumulative Trauma" OR "Disorder, Repetitive Motion" OR "Disorders, Cumulative Trauma" OR "Disorders, Repetitive Motion" OR "Injuries, Overuse" OR "Injuries, Repetition Strain" OR "Injuries, Repetitive Strain" OR "Injuries, Repetitive Stress" OR "Injury, Overuse" OR "Injury, Repetition Strain" OR "Injury, Repetitive Strain" OR "Injury, Repetitive Stress" OR "Motion Disorder, Repetitive" OR "Motion Disorders, Repetitive" OR "Overuse Injuries" OR "Overuse Injury" OR "Overuse Syndrome" OR "Overuse Syndromes" OR "Repetition Strain Injuries" OR "Repetition Strain Injury" OR "Repetitive Motion Disorder" OR "Repetitive Motion Disorders" OR "Repetitive Strain Injuries" OR "Repetitive Strain Injury" OR "Repetitive Stress Injuries" OR "Repetitive Stress Injury" OR "Strain Injuries, Repetition" OR "Strain Injuries, Repetitive" OR "Strain Injury, Repetition" OR "Strain Injury, Repetitive" OR "Stress Injuries, Repetitive" OR "Stress Injury, Repetitive" OR "Trauma Disorder, Cumulative" OR "Trauma Disorders, Cumulative" AND "sign language interpreter" OR "Interpreters" OR "Interpreter" OR "Sign Language Translator" OR "Translator". The data found in the search process will be organized in a Microsoft Excel spreadsheet.

Selection of studies
Two independent reviewers will conduct the search following three phases. After each phase, the authors will check the included and excluded studies and in case of disagreement the authors will analyze and decide on the studies' eligibility for review.
In phase 1, the titles of the articles identi ed by the research will be selected according to the following criteria: Is the study with sign language interpreters? (Yes, it is not clear or not)

Is it a study of musculoskeletal disorders? (Yes, it is not clear or not)
In phase 2, the abstracts of the studies selected in phase 1 will be read and selected according to the following criteria:

Is the study with sign language interpreters? (Yes, it is not clear or not)
Is it a study of musculoskeletal disorders? (Yes, it is not clear or not)

Is it an observational study? (Yes, it is not clear or not)
Does the study use any instrument for the analysis of musculoskeletal disorders? (Yes, it is not clear or not) In phase 3, the studies will be read in full and a table will be drawn up with the following information:

Assessment of study risk bias
Immediately after lling in the information related to phase 3, the authors will present the reasons for exclusion from the studies and thus register in text for later consultation. None of the authors of this review will be blind to the titles of the journals or authors or institutions of study. A study owchart will be made containing measures, such as identi cation, screening, eligibility and inclusion of items with quantities, and an explanation of the reason for exclusion.
Additional information from the authors of the included studies will be requested to resolve questions about study eligibility.

Data extraction and management
Using a detailed step-by-step, reviewers will be able to extract studies from the databases independently following the same "path" and organize them in Excel software spreadsheets. The summarized data will include the name of the authors of the studies, title of the journal, date of publication; country of origin of the studies; the assessment tools for musculoskeletal disorders of the participants; socioeconomic pro le of sign language interpreters; methodology; details of intervention and results. In case of possible differences found in the assessment tools for musculoskeletal disorders, they will be analyzed by grouping equal or similar parts of the instruments. The reviewers will resolve any differences. In case of lack of information, the reviewers will contact the authors of the studies that were included in this review via email.

Quality assessment
The evaluation of the methodological quality of the articles will be carried out with instruments from the Joanna Briggs Institute (JBI) [22], according to the design of the selected study.
The classi cation of the studies will be identi ed as: "low risk of bias" when more than 80% of the established criteria are reached; "Medium risk of bias" when the criteria ful lled are between 50% to 80% and "high risk of bias" when less than 50% of the criteria are reached according to the instrument used.

Evidence synthesis
A systematic narrative synthesis will be provided with information presented in the selected studies using tables to summarize and explain the characteristics and results of the included studies (authors; country; title; year of publication; objective; sample; instrument; result).

Dissemination
The results of this review will be submitted in a journal of the same theme, and from the peer review the results will be reported according to the items in the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) [23]. A ow chart will be used to show the selection of articles with the reasons for exclusion. The characteristics of the study and the results will be presented in summary tables. The current protocol follows the rules of PRISMA-P [13].
The results will also be disseminated to the research community and key stakeholders through presentations at relevant academic and non-academic meetings and through social media.

Discussion
We hope that this study will contribute to the discussion and creation of public policies as an insertion of protective means in the work environments of professional sign language interpreters for the prevention of IHR and WMSDS. Discuss the importance of having a speci c time for continuous interpretation and subsequent rest, or having more than one professional acting with alternate substitution for physical and mental recovery and avoiding musculoskeletal disorders. and provided comments on the manuscript drafts and agreed with the nal version sent. DRM critically reviewed and provided comments on the draft manuscript and agreed with the nal version submitted. All authors read, provided feedback and approved the nal manuscript.