This is the first study to report the prevalence of WRMD in a cohort of Irish surgeons. A 48% response rate to our study suggests a high level of engagement with this topic, with standard response rates to studies in this format typically 20–30% [10, 14]. We highlight high rates of WRMD of 75.5%, which is in keeping with internationally reported WRMD rates of 62–87% [11,12,13]. The most common WRMD symptom of neck pain noted in this cohort is reflective of the reported literature, with 72% of otolaryngologists describing neck/back pain in other studies . Surgeons performing minimally invasive surgery (MIS) compared to open procedures are known to be at increased risk of experiencing neck pain (odds ratio 2.77) .
The impact of WRMD in the Irish surgical workforce is highlighted in this study with 10.2% suggesting that they intend to reduce their workload or needed to take sick leave due to WRMD. Weekly symptoms were experienced by 26.5% of respondents. Previous meta-analysis highlighted that 12% of physicians with WRMD require a leave of absence, practice restriction, modification, or early retirement . Another study of neurosurgeons reported 14.2% considered a change of career due to WRMD . In our study, 8.7% of the consultant cohort reported planning earlier retirement due to symptoms of WRMD. The significant manpower impact and potential future workforce planning threat posed by WRMD are evident.
Consultants and NCHDs were affected equally by WRMD in our study, highlighting that WRMD also has significant effects for those at early stages in their careers. Of otolaryngology trainees in years 1–4 of training, 5 of 9 trainees experienced symptoms of WRMD. Basic procedures such as aural microsuction were reported as a common source of WRMD symptoms in this group, demonstrating early exposure to poor ergonomic practices. WRMD amongst otolaryngology trainees, including neck pain, has previously been reported to be as high as 82.3% in some cohorts . We highlight a potential for early ergonomic training to limit severe symptoms which result in later work absences or requirement for additional treatment. The precipitants of WRMD symptoms we report, including the use of a headlight, supervising a trainee, and prolonged fixed posture, add to previously reported data for plastic surgeons, which highlighted factors such as the use of surgical loupes in WRMD . Interventions to reduce the effects of these risk factors for WRMD are required. Incorporation of ergonomic principles into the surgical training curriculum could offer benefits.
Considerable interest was shown in our data for education in best ergonomic practices, with 85.7% in favour of further training. One trainee in our study added the response, “trainees, in particular those at early stages, should be advised, encouraged and allowed time to optimize set up in order to engender good habits from the outset of training. The perception that taking these moments slows down clinics or operating theatre should be discouraged.” The Health Service Executive (HSE) published a “Fast Fact” document in October 2020 regarding ergonomic principles to provide guidance to managers and employees . A guidance document for dentists in Ireland, a group similarly affected by WRMD related to fixed, standing positions, was published in 2016 . Strong legislative support and employer awareness of WRMD appear necessary to promote better practice.
Ergonomic principles and training can lead to improved outcomes. A randomised control trial of no ergonomic training versus a preventive program (followed by ergonomic teaching and specific exercises) showed a significant reduction of low back pain (66.2% vs 50.0%; p = 0.04) and analgesic consumption (30.9% vs 15.5%; p = 0.03) after 6 months . Thuy et al. reported 69.6% of otolaryngologists who applied ergonomic principles observed improved symptoms . Inexpensive interventions such as micropauses during surgery for 20 s have also been shown to reduce muscular fatigue . A study investigating the Ipswich Microbreak Technique (neck rotation, neck glide, and upper back stretch every 5–10 min for 30 s) showed a delay in subjective neck and shoulder pain and reduced objective surface electromyogram muscle activation during prolonged working under a microscope . Simple medication and physiotherapy were therapeutic measures commonly sought in our study cohort. Fifty-five percent of those requiring treatment for WRMD attended a physiotherapist. This is a similar to published literature with 83% of otolaryngologists seeking a physiotherapy review due to WRMD in Babar-Craig’s series .
This study provides the first data on WRMD in a cohort of Irish surgeons. The results highlight a significant prevalence of WRMD, demonstrate an impact on work practices/workforce planning, and demonstrate a willingness to engage with further training amongst surgeons. The study does, however, have a number of limitations. A survey of this nature is subject to responder bias, with an increased likelihood for those suffering from WRMD or interested in ergonomics training more likely to complete the questionnaire. The authors acknowledge that the methodology does not capture surgeons who have already left the specialty or retired, potentially due to severe WRMD. The total number of respondents is relatively small, despite an excellent response rate. Another limitation of this study is the lack of a comparative specialty, to highlight differences in prevalence of WRMD between medical subspeciality groups. Despite these limitations, we feel the study provides useful insights into WRMD in the Irish surgical workforce and provides a mandate for further study.