Process evaluation of a randomised controlled trial - prevention of sickness absence through early identification and rehabilitation of at-risk patients with musculoskeletal disorders (PREVSAM).

BACKGROUND: Musculoskeletal disorders are commonly treated in primary healthcare and may, if not treated adequately, entail a risk for long-term disability and sickness absence. A team-based rehabilitation intervention (PREVention of Sickness Absence for Musculoskeletal disorders, PREVSAM) was evaluated in a randomised controlled trial. The purpose of this study was to evaluate the process of implementing the PREVSAM model in primary care rehabilitation. METHODS: This process evaluation was conducted alongside the trial, collecting quantitative and qualitative data to evaluate how the PREVSAM model was implemented, mechanisms of impact, and contextual factors. Acceptability, feasibility, appropriateness, adaptations, training and support, resources, recruitment, reach, retention, dose, fidelity, and readiness for change were investigated. Qualitative data were collected from healthcare professionals and patients. RESULTS: Eight of 22 invited rehabilitation clinics (36%) and 28 of 54 healthcare professionals (52%) were included in the PREVSAM trial and this process evaluation. Of 507 eligible patients, 261 (51%) were included. Of those, 134 were randomised to the intervention and 129 (96%) were retained. Twelve healthcare professionals and 15 patients participated in the qualitative evaluations. The model's essential components; individual assessments and structured, team-based rehabilitation with clear division of responsibilities agreed in a joint health plan; were generally delivered according to protocol. The optional components early access to psychological treatment and workplace contact were delivered to a lesser extent. Perceived acceptability, feasibility, and appropriateness of the PREVSAM model were moderate to high. Several contextual barriers, in the form of missing prerequisites, affected the implementation. Qualitative data showed that the model, with its holistic view, was appreciated by both healthcare professionals and patients. CONCLUSIONS: This process evaluation suggests that PREVSAM is acceptable, feasible and appropriate for patients with MSDs reporting psychological risk factors associated with increased risk for sickness absence. While essential components were implemented with fidelity for most patients, optional components were not. This variability reflects the complexity of the model, its mandatory and optional components, contextual barriers, and the person-centred approach meeting individual patient needs. As all model components were not delivered to all patients, the intervention may have been too similar to treatment as usual to detect differences on a group level. A limitation of the study is that half of the participating rehabilitation clinics withdrew prematurely.

Modeling the Impact of Ergonomic Interventions and Occupational Factors on Work-Related Musculoskeletal Disorders in the Neck of Office Workers with Machine Learning Methods.

BACKGROUND: Modeling with methods based on machine learning (ML) and artificial intelligence can help understand the complex relationships between ergonomic risk factors and employee health. The aim of this study was to use ML methods to estimate the effect of individual factors, ergonomic interventions, quality of work life (QWL), and productivity on work-related musculoskeletal disorders (WMSDs) in the neck area of office workers. Study Design: A quasi-randomized control trial. METHODS: To measure the impact of interventions, modeling with the ML method was performed on the data of a quasi-randomized control trial. The data included the information of 311 office workers (aged 32.04±5.34). Method neighborhood component analysis (NCA) was used to measure the effect of factors affecting WMSDs, and then support vector machines (SVMs) and decision tree algorithms were utilized to classify the decrease or increase of disorders. RESULTS: Three classified models were designed according to the follow-up times of the field study, with accuracies of 86.5%, 80.3%, and 69%, respectively. These models could estimate most influencer factors with acceptable sensitivity. The main factors included age, body mass index, interventions, QWL, some subscales, and several psychological factors. Models predicted that relative absenteeism and presenteeism were not related to the outputs. CONCLUSION: In this study, the focus was on disorders in the neck, and the obtained models revealed that individual and management interventions can be the main factors in reducing WMSDs in the neck. Modeling with ML methods can create a new understanding of the relationships between variables affecting WMSDs.

Facilitators and barriers to the adoption of active back-support exoskeletons in the construction industry.

INTRODUCTION: Active back-support exoskeletons are gaining more awareness as a solution to the prevalence of work-related musculoskeletal disorders in the construction industry. This study aims to understand the factors that influence the adoption of active back-support exoskeletons in the construction industry. METHOD: A literature review was conducted to gather relevant adoption factors related to exoskeleton implementation. Building on the TOE (Technology, Organization, and Environment) framework, two rounds of the survey via the Delphi technique were administered with 13 qualified industry professionals to determine the most important adoption factors using the relative importance index. Through semi-structured interviews, the professionals expressed their perspectives on the impact of active back-support exoskeletons on the construction industry. RESULTS: Important factors included 18 facilitators and 21 barriers. The impact of the exoskeletons in the construction industry was categorized into expected benefits, barriers, solutions, adjustment to technology, implementation, and applicable tasks. CONCLUSIONS: This study identified the factors to be considered in the adoption and implementation of active back-support exoskeletons in the construction industry from the perspective of stakeholders. The study also elucidates the impact of active exoskeletons on construction organizations and the broader environment. PRACTICAL APPLICATIONS: This study provides useful guidance to construction companies interested in adopting active back-support exoskeletons. Our results will also help manufacturers of active back-support exoskeletons to understand the functional requirements and adjustments required for utilization in the construction industry. Lastly, the study expands the application of the TOE framework to the adoption of active back-support exoskeletons in the construction industry.

Effects and Mechanisms of Polyunsaturated Fatty Acids on Age-Related Musculoskeletal Diseases: Sarcopenia, Osteoporosis, and Osteoarthritis-A Narrative Review.

Background: The process of the globally aging population has been accelerating, leading to an increasing social burden. As people age, the musculoskeletal system will gradually go through a series of degenerative and loss of function and eventually develop age-related musculoskeletal diseases, like sarcopenia, osteoporosis, and osteoarthritis. On the other hand, several studies have shown that polyunsaturated fatty acids (PUFAs) possess various important physiological functions on the health of muscles, bones, and joints. Objective: This narrative review paper provides a summary of the literature about the effects and mechanisms of PUFAs on age-related musculoskeletal diseases for the prevention and management of these diseases. Methods: Web of Science, PubMed, Science Direct, and Scopus databases have been searched to select the relevant literature on epidemiological, cellular, and animal experiments and clinical evidence in recent decades with keywords "polyunsaturated fatty acids", "PUFAs", "omega-3", "omega-6", "musculoskeletal diseases", "sarcopenia", "osteoporosis", "osteoarthritis", and so on. Results: PUFAs could prevent and treat age-related musculoskeletal diseases (sarcopenia, osteoporosis, and osteoarthritis) by reducing oxidative stress and inflammation and controlling the growth, differentiation, apoptosis, and autophagy of cells. This review paper provides comprehensive evidence of PUFAs on age-related musculoskeletal diseases, which will be helpful for exploitation into functional foods and drugs for their prevention and treatment. Conclusions: PUFAs could play an important role in the prevention and treatment of sarcopenia, osteoporosis, and osteoarthritis.

Preventing Surgeon Work-Related Musculoskeletal Disorders: A Pilot Study of the Comprehensive Operating Room Ergonomics (CORE) Program.

IMPORTANCE: Work-related musculoskeletal disorders (WMSDs) among surgeons are markedly increasing. Several proposed interventions to reduce WMSDs among surgeons have been studied, but few follow an occupational therapy-oriented approach addressing biomechanical, psychophysical, and psychosocial risk factors. OBJECTIVE: To design, implement, and assess the potential of the Comprehensive Operating Room Ergonomics (CORE) program for surgeons, a holistic evidence-based ergonomics and wellness intervention grounded in occupational therapy principles. DESIGN: Mixed-methods pilot study with the quantitative strand embedded in the qualitative strand. SETTING: University-affiliated hospital. PARTICIPANTS: Six laparoscopic surgeons. OUTCOMES AND MEASURES: CORE program outcomes were assessed using qualitative and quantitative data to indicate changes in posture, physical discomfort, sense of wellness, and operating room (OR) ergonomic performance. The Rapid Upper Limb Assessment (RULA) was used to quantify surgeons' WMSD risk level before and after intervention. RESULTS: There were 12 baseline observations (two for each participant), and two or three post-CORE implementation observations. A statistically significant difference, F(1, 6) = 8.57, p = .03, was found between pre- and post-occupational therapy intervention RULA scores. Thematic analysis of surgeon feedback, which was overwhelmingly positive, identified five themes: postural alignment, areas of commonly reported physical pain or discomfort, setup of the OR environment, surgical ergonomics training, and ergonomics in everyday life. CONCLUSIONS AND RELEVANCE: The CORE program effectively decreased ergonomic risk factors to optimize surgeons' occupational performance in the OR. This study demonstrates a potential solution to how occupational therapists can holistically support surgeons and health care providers who are at risk for WMSDs. Plain-Language Summary: By 2025, a surgeon shortage is expected, partly because of the increase in surgeons' work-related musculoskeletal disorders, which affect their health and job continuity. This pilot study shows that the Comprehensive Operating Room Ergonomics program effectively addresses these problems. The study also serves as a framework for occupational therapy professionals to work with health care providers on ergonomics, benefiting population health. Results suggest that this approach could enhance surgeons' work conditions, supporting the American Occupational Therapy Association's Vision 2025 to improve health and quality of life.

Start of the Season in a Seasonal Work Context: A Better Understanding of the Difficulties Experienced by Seasonal Workers in the Food Processing Industry for the Prevention of Work-Related Musculoskeletal Disorders.

The specific period of the start of a new working season and a return to work after the off-season seems to be a critical moment for the musculoskeletal health of seasonal workers. This study aims to identify the difficulties and working conditions encountered by seasonal workers in this particular period of the working season which may increase the risk of work-related musculoskeletal disorders (WMSDs). An in-depth ergonomic work activity study, combined with a multiple case study of eight seasonal workers from a meat processing facility, was conducted. Various interviews (n = 24) and observations of work activity, organization, and production (n = 96 h) were held at different moments (off-season, return to work at the start of the season, and during the season). Critical work situations exposing workers to WMSD risks emerged and highlighted a diversity of difficulties, such as accomplishing work activity involving strong physical strain and a significant and underestimated mental load, and having to rapidly develop new skills or re-learn working strategies after a long off-period. The study findings have implications for developing actions to prevent WMSDs that target working conditions and support a return to work for returning seasonal workers and a start of work for new seasonal workers, and to address work disability in this context.

Ergonomics in the operating room and surgical training: a survey on the Italian scenario.

Introduction: Surgical-related injuries are frequent, in fact the reported percentage of musculoskeletal disorders in surgeons is between 47% and 87%. These conditions are caused by long periods of standing, incorrect postures, repeated movements, little rest between operations, the lack of integrated operator rooms, the correct number and arrangement of monitors and the use of non-ergonomic instruments. This survey aims to assess the Italian overview both highlighting how prevalent surgical-related injury is in our surgeons and whether there is an operating room ergonomics education program in Italian surgical specialty schools. Methods: An anonymous questionnaire was designed through SurveyMonkey© web application. This survey was composed of 3 different sections concerning the general characteristics of the participants, their surgical background and any training performed, and any injuries or ailments related to the surgical activity. The survey was carried out in the period 1th of December 2022 and the 6th of February 2023. Results: At the close of our survey, 300 responses were collected. Among the participants, the two most represented specialties were Gynecology and Obstetrics (42.3%) and General Surgery (39.7%) and surgeons were mainly employed in the Northern regions of Italy (54.8%). Analyzing the participants' background, 61.7% of the respondents had laparoscopic training during their training and only 53.1% had a pelvic trainer during their residency. In accordance with 98.7% of the respondents, during surgery we have the feeling of being in an uncomfortable position that causes discomfort or muscle pain, and regarding the frequency of these discomforts, the majority of our study population experiences these problems monthly (46.2%), while in 29.6% it is experienced weekly, 12.1% annually and finally 12.1% daily. The surgical approach that is most correlated with these disorders is laparoscopy (62.7%) while the one that causes the least discomfort is robotic surgery (1.4%). These discomforts cause 43.9% of our population to take a break or do short exercises to reduce pain during surgery, and the body areas most affected are the back (61.6%), neck (40.6%) and shoulders (37.8%). Conclusion: Despite this, our survey allows us to highlight some now-known gaps present in the surgical training program of our schools and the lack of protection toward our surgeons during their long career.

[K-taping (coloured sticking adhesive bands): myth or reality?] / K-taping (bandages adhésifs élastiques de couleur) : mythe ou réalité ?

The use of Kinesiotaping (KT) has become common in the treatment and prevention of musculoskeletal injuries. This article covers the ten main myths encountered on a daily basis, examining the evidence from recent data (systematic reviews and meta-analyses). With current available data, there is a relative evidence regarding some effect upon short-term pain relief, improved mobility, better joint stability, drainage of edema, and improve muscle function. Concerning the prevention of musculoskeletal injuries, it seems that the effectiveness of KT is still questionable. Overall, there are few publications with a high-level of evidence that can support all myths surrounding K-taping.

L'utilisation de kinésiotaping (KT) est devenue courante dans le traitement et la prévention des blessures musculosquelettiques. Cet article reprend les dix principaux mythes rencontrés au quotidien, en examinant les preuves à partir de données récentes (revues systématiques et méta-analyses) qui nous semblent, à ce jour, les plus pertinentes. Avec les données disponibles actuellement, il existe des preuves partielles d'un soulagement de la douleur à court terme, d'une amélioration de la mobilité, de la stabilité articulaire, de l'œdème et de la fonction musculaire. Concernant la prévention des lésions musculosquelettiques, il semble que l'efficacité du KT soit encore discutable. Dans l'ensemble, il y a peu de publications avec un haut niveau de preuves à ce sujet qui permettent d'étayer l'ensemble des mythes gravitant autour du KT.

Evaluating the categorisation of interventions in individual working practice aimed at preventing work-related musculoskeletal disorders: An international experts consultation.

In a previous scoping review, eight categories of interventions in individual work practice were defined. The aim of the present study is to evaluate the relevance and completeness of these eight categories and to increase the clarity of the nomenclature and definitions of each category. An international expert consultation has been carried out for this purpose. Thirty-eight experts from 13 countries participated. Data collection was conducted using a survey design comprising structured questions. Consensus was reached if 75% of the experts answered 'Strongly agree' or 'Agree' on a 5-point Likert scale. For the topic 'Relevance', there was consensus for six of the eight categories (range 78%-86%), the exceptions were the categories: 'Exercising' (72%) and 'Professional manners' (64%). With regard to the topic 'Nomenclature', consensus was reached for six categories and for the topic 'Definition' this was five categories. The present definitions have been improved based on the expert recommendations. With respect to the topic 'Completeness': although a limited number of suggestions were given, this did not lead to one or more categories being added to the existing eight categories. The final 'Nomenclature' for the categories is: 'Variation', 'Professional behaviour', 'Motoric skills', 'Vocational working techniques', 'Physical workplace', 'Physical training', 'Assistive devices and tools' and 'Task content and task organisation'. This expert consultation has provided a solid basis for endorsing the categorisation of interventions in IWP and is an important step in building a framework to develop and evaluate interventions in IWP.

Promoting safety of underground machinery operators through participatory ergonomics and fuzzy model analysis to foster sustainable mining practices.

One of the most vital parameters to achieve sustainability in any field is encompassing the Occupational Health and Safety (OHS) of the workers. In mining industry where heavy earth moving machineries are largely employed, ergonomic hazards turn out to be significant OHS hazards causing Musculoskeletal Disorders (MSDs) in the operators. Nevertheless, the Indian mining industry lacks a comprehensive technique of OHS risk assessment, especially for ergonomic hazards that cause MSDs. This research appraises ergonomic hazards and develops Fuzzy Musculoskeletal-disorders Index (FMI) model to evaluate ergonomic-related MSDs. Work process and work tool ergonomic risk factors were identified through literature review and directives recommended by experts. Work posture was evaluated using RULA. The data-collecting approach was implemented using participatory ergonomic and design science principles. The FMI results show average MSDs score of 3.69, indicating high to extremely high risk. Surface plots show that combined work tool and work process was the most sensitive factors to MSDs risk compared to other two combinations. A two-sample t-test validated the FMI. The findings should help safety experts and managers develop effective OHS management plans and programmes for the sustainability of Indian mining industry.

The impact of regulatory workplace safety inspections on workers' compensation claim rates.

BACKGROUND: Studies on the impact of workplace safety inspections on work injuries have found mixed effectiveness. Most studies are from the United States, examining Occupational Health and Safety Administration (OSHA) regulatory inspections in manufacturing firms with more than 10 employees. This study examines whether regulatory inspections in Alberta, Canada, result in reductions in workers' compensation claims rates for inspected firms relative to comparable non-inspected firms. METHODS: Firm and claim-level data from the Workers' Compensation Board of Alberta were linked with regulatory enforcement data from the Government of Alberta for construction, manufacturing, and transportation firms with at least one full-time employee for 37 consecutive months. A matched difference-in-differences study design was used to estimate changes in lost-time claim rates for work-related injuries and musculoskeletal diseases of inspected and comparable non-inspected firms between the year pre-inspection and 2 years, post-inspection, controlling for firm-level characteristics. RESULTS: Inspections were not effective in reducing firm-level claim rates, with the exception of transportation firms with more than one inspection experiencing a 28% decrease in their claim rate in the second year post-inspection, relative to the change in non-inspected firms. In construction, inspected firms experienced a 12% increase in their claim rate in the first year post-inspection. No effect was observed in the manufacturing sector. CONCLUSIONS: Regulatory workplace safety inspections in Alberta generally do not result in greater reductions in firm-level claim rates in the construction, manufacturing, and transportation sectors. Inspections alone may not be sufficient to induce compliance or hazard management changes that lead to reductions in firm-level injuries.

Ergonomics appraisals in operating rooms.

This document presents the ergonomic assessments carried out by Spanish surgeons on the materials used within an operating room. With the objective of disseminating and raising awareness of the importance of ergonomics, this working group has compiled information from a previously conducted survey on musculoskeletal disorders associated with surgical work from the year 2022, obtaining feedback from 131 surgeons from 17 distinct specialties. A noteworthy 80.2 % of surveyed surgeons reported having experienced forced postures during surgery, and 96.9 % believe that their physical discomfort is a result of the posture adopted during operations. Such postures can result in the development of pathologies and may have a direct impact on work performance and even in extreme cases, it can lead to sick leave or early retirement. By providing their insights on electronic devices, surgical furniture, and instrumentation, surgeons can help identify areas for improvement in the practice of their profession.

Mechanisms and Intervention of Prebiotic Foods in Musculoskeletal Health.

The review focuses primarily on collating and analyzing the mechanistic research data that discusses the function of prebiotics to halt the frailty of musculoskeletal system. Musculoskeletal diseases (MSDs) are frequently reported to co-occur within their own categories of conditions, such as osteoarthritis, rheumatoid arthritis, gouty arthritis, and psoriatic arthritis owing to their overlapping pathogenesis. Consequently, the same drugs are often used to manage the complications of most types. A few recent studies have addressed the therapeutic functions of gut microbes toward those commonly shared MSD pathway targets. Improving microbial diversity and enriching their population in the gut would promote the regeneration and recovery of the musculoskeletal system. Prebiotics are usually nondigestible substrates that are selectively used or digested by the gut microbes conferring health promotion. The microbial fermentation of prebiotics generates numerous host-beneficial therapeutic molecules. This study inspects the presumptive functions of plant-derived prebiotics for the growth and restoration of intestinal microbiota and the consequent improvement of skeletal health. The review also highlights the discrete functions of prebiotics against inflammation, autoimmunity, infection, physiologic overloading mechanism, and aging-associated loss of metabolism in MSD.

A mixed methods approach to describe the efficacy of lift assist device use to reduce low back musculoskeletal disorder risk factors during three common patient extrication scenarios.

This mixed-method study evaluated the efficacy of lift assist device use (Binder®, Eagle®, Maxi Air®) relative to manual lifting/care-as-usual in reducing low back muscle activity and perceived exertion during simulated patient extrication tasks. User feedback was recorded to identify factors that might influence use. Twenty paramedics performed a floor to stretcher lift, lateral transfer, and confined space extrication care-as-usual and with lift assist devices. Use of a lift assist reduced low back muscle activity during floor to stretcher and confined space tasks by 34-47%. Paramedics perceived exertion decreased from 'somewhat hard' to 'light' or 'very light' when using an assistive device. Paramedics noted that ease of use, patient comfort, task time, patient acuity, among other considerations would influence use decisions. Lift assist devices were efficacious at reducing low back muscle activity and perceived exertion during floor to stretcher and patient extrication tasks.

Safety and Optimizing Ergonomics for Cardiothoracic Surgeons.

Cardiothoracic surgery, demanding in nature, often results in surgeons suffering from musculoskeletal injuries, causing chronic pain and leading to premature retirement. A significant majority report experiencing pain, exacerbated by minimally invasive techniques such as video-assisted thoracoscopic surgery. Despite this, many surgeons delay seeking medical assistance. To mitigate these risks, preventative strategies such as strength exercises, stretching during operations, and taking brief breaks are crucial. However, the surgical community faces a shortage of institutional support and comprehensive ergonomic education. Advancements in technology, including artificial intelligence and virtual reality, could offer future solutions.

How does the consecutive use of intraoral scanners affect musculoskeletal health? A preliminary clinical study.

BACKGROUND: Minimizing muscle strain and reducing the risk of musculoskeletal disorders associated with intraoral scanner (IOS) usage require ergonomic awareness, device selection, and workplace adjustments in dental practice. This preliminary clinical study aimed to simulate intraoral scanning tasks using wired and wireless IOSs and assess muscle activation and fatigue for both types. MATERIALS AND METHODS: Fourteen participants performed intraoral scanning tasks using wired and wireless IOSs (i700; MEDIT), with weights of 280 g and 328 g, respectively. The same computer system and software conditions were maintained for both groups (N = 14 per IOS group). Electrodes were placed on arm, neck, and shoulder muscles, and maximal voluntary contraction (MVC) was measured. Surface electromyography (EMG) was performed during the simulation, and EMG values were normalized using MVC. The root mean square EMG (%MVC) and muscle fatigue (%) values were calculated. Statistical comparisons were performed using the Mann-Whitney U and Friedman tests, with the Bonferroni adjustment for multiple comparisons (α = 0.05). RESULTS: Arm (flexor digitorum superficialis) and neck muscles (left sternocleidomastoid and left splenius capitis) showed significantly higher EMG values with wireless IOS (P < 0.05). The neck (left sternocleidomastoid and right levator scapulae) and shoulder muscles (right trapezius descendens) demonstrated significantly higher muscle fatigue with wireless IOS (P < 0.05). CONCLUSIONS: The consecutive use of heavier wireless IOS may increase the risk of muscle activation and fatigue in certain muscles, which may have clinical implications for dentists in terms of ergonomics and musculoskeletal health.

Ergonomic considerations for unique surgeon populations.

PURPOSE OF REVIEW: Surgeons are rapidly diversifying as a population, introducing new ergonomic challenges. This review describes the challenges that are experienced by special populations of surgeons including small-handed surgeons, pregnant surgeons, and trainees, and evidence-based solutions to overcome them. RECENT FINDINGS: Small-handed and female surgeons report more musculoskeletal complaints compared with their male counterparts. Pregnant surgeons frequently report development or worsening of musculoskeletal disorders such as carpal tunnel syndrome and low back pain. Trainees also report high rates of musculoskeletal complaints with minimal autonomy to alter their environment. Limited objective data exists regarding the ideal instruments currently available for special populations. Several small, randomized studies have proposed exercise regimens targeting the upper extremities and pregnancy-related pain syndromes with improvements in symptoms. Various methods of ergonomic education have been studied in trainees with improvements in operating room posture and performance. SUMMARY: Limited objective data is available to recommend specific surgical instruments for high-risk surgeon populations. Beneficial exercise regimens have been described for musculoskeletal disorders commonly plaguing surgeons but have yet to be studied explicitly in small-handed or pregnant surgeons and trainees.

Using wearable technology for Posture Regulation to Improve Surgical Ergonomics in the paediatric operating room: the UPRISE trial: a pilot study.

BACKGROUND: The rising prevalence of work-related musculoskeletal disorders has numerous physical, financial, and mental repercussions for surgeons. This study aims to establish whether the use of a wearable posture device can improve the operating time spent in suboptimal, high-risk postures. METHODS: Surgeons were recruited in Phase 1 of this prospective randomised study and baseline postural data was obtained. In Phase 2, participants were randomised to receive either a traditional educational workshop or intraoperative vibrations from the device to correct postural lapses. During minor elective day cases, intraoperative postural data was collected and stratified by forward flexion angle, into five risk categories (negligible to very high). Participants' experience with the sensor was also assessed. RESULTS: A total of 100 surgical procedures (Phase 1: n = 50; Phase 2: n = 50) were performed by eight surgeons of varying seniority. Exposure to the educational intervention increased time spent in suboptimal posture (Phase 1 vs. Phase 2); 47.5% vs. 67.8%, p = 0.05. However, the vibrational intervention significantly reduced this time; 50.0% vs. 20.7%, p = 0.005. Procedure type didn't influence posture although, laparoscopic interventions spent most time in negligible-risk postures; 47.7% vs. 49.3%, compared to open procedures. Surgical consultants spent less time in suboptimal posture compared to fellow/registrars; 30.3% vs. 72.6% (Phase 1) and 33.8% vs. 65.3% (Phase 2). CONCLUSION: Vibrational intervention from the device significantly decreased the time spent in suboptimal, high-risk postures. As procedure type wasn't correlated with postural changes, surgeon-specific factors in regulating posture are paramount. Finally, surgeon experience was positively correlated with improved surgical ergonomics.

ERGONOMIC PRACTICE IN DENTAL CLINICS AND MUSCULOSKELETAL DISORDERS AMONG DENTISTS IN GEORGIA.

The dental profession is associated with occupational health problems. The working environment of a dentist is associated with ergonomic risk factors that can significantly reduce the dentist's working ability and even cause the termination of his/her professional activity. Numerous studies have been conducted in different countries (Sweden, Denmark, Germany, Poland, Australia, etc.) to assess the prevalence of musculoskeletal disorders in dentists, though no studies related to the principles of ergonomics in dentistry have been carried out in Georgia. The study aimed to assess the ergonomics of the working environment of dentists in Tbilisi (capital city of Georgia) clinics and to identify the prevalence of musculoskeletal disorders among them. An observational descriptive study was conducted in April-July 2023 in Tbilisi. A special questionnaire of 40 questions was designed based on international experience. The survey was conducted by random sampling in selected dental clinics. Dentists were asked to fill out the questionnaire during their free time between patient appointments. Those who agreed to participate were provided with electronic versions of the questionnaire. Five hundred dentists were invited to participate in the survey, of whom 314 (62.8%) agreed to fill out the questionnaire. A total of 291 fully completed questionnaires were used for the descriptive statistical analysis. Our study shows that in Tbilisi clinics dentists work on average for 5-6 days (48.8% - 6 days, 37.1% - 5 days) or 40-48 hours a week. A majority of respondents said their workplace met the requirements of ergonomics (it had a good lighting, the chair had a back, instruments could be easily reached), yet most of them rarely lean on the backrest, never or rarely use the hand rest method, and never or rarely do light physical exercise during breaks. The survey shows that 53.6% of dentists most frequently suffer from pain in the back, followed by pain in the neck (50.9%), shoulders (47.9%) and lower back (47.1%). Most of them said they had to work less because of the pain. Introduction of the principles of ergonomics in dental profession is vital for preventing occupational musculoskeletal disorders. It is important to provide continuing professional development programs and information booklets for dentists and thematic online webinars for the management of dental clinics in Georgia.