American Journal of Otolaryngology Head and Neck Medicine and Surgery

YAJOT-01794; No of Pages 5

American Journal of Otolaryngology�CHead and Neck Medicine and Surgery xxx (2017) xxx�Cxxx

Contents lists available at ScienceDirect

American Journal of Otolaryngology�CHead and Neck

Medicine and Surgery

journal homepage: locate/amjoto

Assessing work-related musculoskeletal symptoms among otolaryngology residents��

Kevin Wong ?, Kenneth M. Grundfast, Jessica R. Levi

Department of Otolaryngology�CHead and Neck Surgery, Boston Medical Center, 72 East Concord St, Boston, MA 02118, USA

a r t i c l e

i n f o

Article history:

Received 26 November 2016

Available online xxxx

Keywords:

Musculoskeletal symptoms

Occupational diseases

Otolaryngology

Residents

a b s t r a c t

Purpose: Previous studies have suggested that musculoskeletal symptoms are common among practicing otolaryngologists. Early training can be the ideal time to foster knowledge of ergonomics and develop safe work habits,

however, little data exists regarding musculoskeletal symptoms in residents. The purpose of this study was to

identify and characterize musculoskeletal symptoms in a preliminary sample of otolaryngology residents.

Materials and methods: A cross-sectional survey incorporating the Nordic Musculoskeletal Questionnaire was

sent to 30 Otolaryngology-Head and Neck Surgery residencies to examine musculoskeletal symptoms among

residents. A two-sample test of proportions was performed to compare symptoms between male and female

residents.

Results: In total, 141 respondents (response rate = 34.7%) completed the survey. Fifty-?ve percent of survey respondents were male and 45% were female. Musculoskeletal symptoms were most frequently reported in the

neck (82.3%), followed by the lower back (56%), upper back (40.4%), and shoulders (40.4%). The most common

symptoms were stiffness in the neck (71.6%), pain in the neck (61.7%), and pain in the lower back (48.2%). In

total, 6.4% of residents missed work and 16.3% of residents stopped during an operation at some point due to

their symptoms. Most residents (88.3%) believed their musculoskeletal symptoms were attributed to their surgical training. Female residents were signi?cantly more likely to experience neck (p b 0.0001) and wrist/hand

(p = 0.019) discomfort compared to male residents.

Conclusions: Musculoskeletal symptoms were common among residents, approaching rates similar to those previously identi?ed in practicing otolaryngologists. Increased emphasis on surgical ergonomics is warranted to improve workplace safety and prevent future injury.

? 2017 Published by Elsevier Inc.

1. Introduction

Work-related musculoskeletal disorders (WMSDs) are de?ned as

��musculoskeletal disorders to which the work environment and the

performance of work contribute signi?cantly�� [1]. In the medical community, surgeons are at a particularly high risk for developing WMSDs

because many of the procedures they perform may require ergonomically challenging positions for extended periods of time [2�C5].

In 2003, Babar-Craig and colleagues sent a questionnaire to 558 otolaryngology consultants in the United Kingdom inquiring about neck

and back pain [6]. Among the 325 respondents, 72% reported neck

pain, back pain, or both. Over half of these otolaryngologists attributed

their symptoms directly to their job as surgeons. More recently, Rimmer

and colleagues distributed a survey to members of the European

Rhinologic Society and found that nearly 80% of endoscopic surgeons

�� Funding source: This research did not receive any speci?c grant from funding agencies

in the public, commercial, or not-for-pro?t sectors.

? Corresponding author.

E-mail addresses: kevin.wong@ (K. Wong), kenneth.grundfast@

(K.M. Grundfast), jessica.levi@ (J.R. Levi).

experienced physical pain or discomfort [7]. Together, these ?ndings

provided early insight into WMSDs among practicing otolaryngologists

and raised their existence as a potential concern in the otolaryngology

community.

Early training is an ideal time to foster knowledge and awareness of

proper workplace ergonomics that can positively in?uence a surgeon's

future career [8,9]. Unfortunately, no study to date has investigated

musculoskeletal symptoms in otolaryngology residents. The purpose

of this pilot study was to identify and evaluate the characteristics of

musculoskeletal symptoms in otolaryngology residents.

2. Methods

This study received exemption by the Boston Medical Center institutional review board. In August 2016, a Web-based survey incorporating

the Nordic Musculoskeletal Questionnaire (NMQ) was sent to 30 Otolaryngology-Head and Neck Surgery residencies in the United States.

The NMQ is a reliable [10] and previously validated [11,12] questionnaire designed to assess musculoskeletal symptoms in the occupational

health setting. A total of three contact attempts were made �C one initial

email and two reminders.



0196-0709/? 2017 Published by Elsevier Inc.

Please cite this article as: Wong K, et al, Assessing work-related musculoskeletal symptoms among otolaryngology residents, American Journal of

Otolaryngology�CHead and Neck Medicine and Surgery (2017),

2

K. Wong et al. / American Journal of Otolaryngology�CHead and Neck Medicine and Surgery xxx (2017) xxx�Cxxx

Fig. 1. Musculoskeletal symptoms. Prevalence of musculoskeletal symptoms by anatomic region.

2.1. Survey design

The ?rst portion of the survey inquired about demographic information including age, gender, ethnicity, height, weight, handedness, postgraduate year, and estimated operating hours per week. The second or

symptomatic portion of the questionnaire inquired about musculoskeletal symptoms in nine anatomic regions according to the NMQ [13]: (1)

neck, (2) shoulders, (3) elbows, (4) wrists/hands, (5) upper back, (6)

lower back, (7) hips/thighs, (8) knees, and (9) ankles/feet. The ?rst

question for each body region asked if residents experienced any musculoskeletal discomfort in that region within the past year. Survey

logic was incorporated so that the survey skipped to the next body region if a resident answered ��no symptoms��. If the resident did report

symptoms, however, he or she was then presented with an additional

set of questions regarding: severity of symptoms (mild, moderate, or severe), impact of symptoms on activities of daily living, description of the

symptoms (pain, stiffness, weakness, numbness, or other), whether or

not symptoms occurred within the past week, whether or not symptoms ever caused the resident to stop operating, whether or not symptoms ever caused the resident to miss work, and whether or not the

resident believed his or her symptoms were directly caused by his or

her work training as a surgeon.

2.2. Statistical analysis

A two-sample test of proportions (p b 0.05) was performed to determine if there was a difference in the proportion of male and female residents who experienced musculoskeletal symptoms. Male and female

residents were further strati?ed into three height classes [14]: (1) within one standard deviation of the average American adult height, (2) at

least one standard deviation below the average height, and (3) at least

one standard deviation above the average height. Freeman-Halton extension of Fischer's exact test was utilized to determine if there was a

signi?cant difference (p b 0.05) in categorical symptomatic data between residents based on height.

3. Results

In total, 141 residents responded (response rate = 34.7%). Fifty ?ve

percent of survey respondents were male and 45% were female. The average age of survey respondents was 29.6 with a range from 26 to 38. By

postgraduate year, 14.9% of residents were PGY-1, 18.4% were PGY-2,

18.4% were PGY-3, 24.8% were PGY-4, 18.4% were PGY-5, and 4.2%

were greater than PGY-5. Sixty nine percent of residents were White,

16% were Asian, 6% were Hispanic, 4% were Black, 4% were Biracial,

and 1% were listed as Other. One respondent withheld postgraduate

year and three respondents withheld ethnicity. Ninety six percent of

residents were right handed and 4% of residents were left handed. The

average resident height was 1.74 m (5 ft 8 in.) and weight was 70.4 kg

(average BMI = 23.1 kg/m2). The average number of operating hours

per week was 26.3.

The most common body region where residents reported symptoms

was the neck (82.3%, [116/141]), followed by the lower back (56%, [79/

141]), upper back (40.4%, [57/141]), and the shoulders (40.4%, [57/

141]) (Fig. 1). The most commonly reported symptoms were stiffness

in the neck (71.6%, [101/141]) followed by pain in the neck (61.7%,

[87/141]), pain in the lower back (48.2%, [68/141]), and stiffness in

the lower back (46.8%, [66/141]). For each question, results were also

calculated as the valid percentage of respondents, which excludes residents who skipped the question due to survey logic (Table 1). Musculoskeletal symptoms had a direct impact on residency training: 76.6%

(108/141) of residents experienced symptoms within the past week,

6.4% (9/141) of residents missed work at least once due to symptoms,

Table 1

Symptom characteristics.

Pain

Stiffness

Weakness

Numbness

Other

Neck

Shoulders

Elbows

Wrists/hands

Upper back

Lower back

Hips/thighs

Knees

Ankles/feet

75.0%

87.1%

4.0%

7.8%

1.7%

77.2%

82.5%

17.5%

8.8%

1.8%

63.6%

45.5%

27.3%

27.3%

18.2%

83.6%

41.8%

34.5%

25.5%

5.5%

75.4%

84.2%

7.0%

3.5%

�C

86.1%

83.5%

19.0%

8.9%

2.5%

84.0%

68.0%

20.0%

4.0%

�C

87.9%

54.5%

30.3%

9.1%

3.0%

85.0%

40.0%

10.0%

10.0%

7.5%

Percentage among those who reported symptoms.

Please cite this article as: Wong K, et al, Assessing work-related musculoskeletal symptoms among otolaryngology residents, American Journal of

Otolaryngology�CHead and Neck Medicine and Surgery (2017),

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