An Objective Ergonomic Risk Assessment of Surgeons in Real Time While Performing Endoscopic Sinus Surgery.

There are increased reports of high prevalence of work related musculoskeletal symptoms in surgeons performing otolaryngology procedures. However, real time ergonomic risk assessment in the OR is difficult due to issues related to sterility, cooperation and acceptance from surgeons. Although such analyses can provide valid risk estimate and guide corrective actions, they are scarce. Hence, this study was undertaken to assess the postural ergonomic risk on RULA in otolaryngologists while performing Functional Endoscopic Sinus Surgery in OR, in real time. A cross sectional, observational multi-centric study was conducted in tertiary referral hospitals. Spinal, shoulder and elbow movements of 10 surgeons performing FESS were measured intraoperatively using orientation sensor-based, motion-analysis system (Noraxon myomotion). Postural ergonomic risk on RULA was computed using the motion analysis data. RULA is a method of quantifying the physical postural risk of the trunk and upper limb based on the postures adopted by an individual during work. 10 surgeons (9 males and 1 female) with the mean (± SD) age of 38 ± 7.5 years participated in the study. The motion analysis data results indicate that the surgeons often adopt awkward spinal and upper extremity postures during the surgery. All the surgeons scored higher than the acceptable RULA score (1 or 2) with the mean RULA scores being in the range of 6-7. The physical ergonomic risk in surgeons performing FESS is high (> 6 on RULA). There is a need for urgent ergonomic attention to the working environment of FESS surgeon.

Patient Perception after Traumatic Brachial Plexus Injury - A Qualitative Case Report.

STUDY DESIGN: This is a qualitative case study. INTRODUCTION: Considering individual patient's perception is an important aspect of rehabilitation according to International Classification of Functioning model (Geneva, 2002). PURPOSE OF STUDY: The report highlights the importance of patient education and considering individual's perception to achieve rehabilitation outcomes. METHOD: A written informed consent for case report was given by a 24-year-old male, a mass media graduate student diagnosed with global brachial plexus injury. Detailed evaluation by a senior therapist was conducted in a tertiary government hospital using the following tools: RESULT: Patient education and rehabilitation led to signs of clinical improvement at the end of 5 months. In spite of this clinical signs of recovery, patient showed lack of satisfaction in terms of his appearance and body image. DISCUSSION: As employment and social life determined our patient's satisfaction level, a negative impact was seen on functional recovery. CONCLUSION: Considering an individual's perception regarding the condition in terms of their contextual and personal factors is an important aspect of rehabilitation according to International Classification of Functioning model (Geneva, 2002).

A Survey of Work-Related Musculoskeletal Disorders Among Otolaryngologists.

There are increased reports of prevalence of work-related musculoskeletal disorders (WRMSDs) in surgeons performing minimal access surgeries. Due to the nature of the speciality, otolaryngologists spend their work days in performing markedly precise procedures in small workspaces i.e. the patients' ear, nose and throat. Due to this, they frequently adopt awkward neck, back and shoulder postures while using devices like otoscope, endoscope and microscope. The field of otolaryngology has barely received any attention with respect to ergonomic assessment. Thus, the aim of this study was to find out the prevalence of WRMSDs in otolaryngologists in Mumbai and Navi Mumbai. A pre-validated, structured questionnaire was distributed to 150 otolaryngologists. Seventy-three otolaryngologists responded to the questionnaire. The questionnaire comprised of demographic and workload data, report of musculoskeletal symptoms and otolaryngologists' interpretation of casual and preventive factors of symptoms at workplace. Response rate of the survey was 48.6%. The total prevalence of WRMSDs in the otolaryngologists was 87.67%. Majority of those surveyed reported that they suffered from musculoskeletal problems which they attributed to the ergonomic flaws encountered during surgery (60.27%) and OPD (69.86%) respectively. Pain and discomfort during surgery experienced by the surgeons were most frequently attributed to the awkward and sustained postures adopted during surgery. Effective time management, ergonomically apt postures, intermittent change of posture, using back rest and availing skilled assistance during OPD and surgery, were the self-assessed corrective measures suggested by the respondents. The otolaryngologists' job profile puts them at high risk for WRMSDs.

Objective ergonomic risk assessment of wrist and spine with motion analysis technique during simulated laparoscopic cholecystectomy in experienced and novice surgeons.

INTRODUCTION: There is a rise in prevalence of work-related musculoskeletal disorders in surgeons performing laparoscopic surgeries due to lack of ergonomic considerations to the minimal access surgical environment. The objective of this study was to assess the physical ergonomics in experienced and novice surgeons during a simulated laparoscopic cholecystectomy. METHODOLOGY: Thirty-two surgeons participated in this study and were distributed in two groups (experienced and novices) based on the inclusion criteria. Both groups were screened for the spinal and wrist movements on the orientation sensor-based, motion analysis device while performing a simulated laparoscopic cholecystectomy. Simultaneous video recording was used to estimate the other joint positions. The RULA (Rapid Upper Limb Assessment) ergonomic risk scores were estimated with the acquired data. RESULTS: We found that surgeons in both novice and experienced groups scored a high on the RULA. Limited awareness of the influence of monitor position on the postural risk caused surgeons to adopt non-neutral range cervical postures. The thoracolumbar spine is subjected to static postural demand. Awkward wrist postures were adopted during the surgery by both groups. There was no statistically significant difference in the RULA scores between the novice and experienced, but some differences in maximum joint excursions between them as detected on the motion analysis system. CONCLUSION: Both experienced and novice surgeons adopted poor spinal and wrist ergonomics during simulated cholecystectomy. We concluded that the physical ergonomic risk is medium as estimated by the RULA scoring method, during this minimally invasive surgical procedure, demanding implementation of change in the ergonomic practices.

Common musculoskeletal problem experienced by fishing industry workers.

INTRODUCTION: Work-related musculoskeletal disorders (WMSDs) are a common health problem throughout the world and a major cause of disability in the workplace. Awkward working posture is a main risk factor for developing WMSDs. Assessment of exposure level to WMSDs risks can be an appropriate base for planning and implementing interventional ergonomics program in the workplace. Fihing in India is a major industry in the coastal states employing over 14 million people. The job demand of fishermen make them vulnerable for various musculoskeletal problems This study was conducted among workers of fishing industry in Mumbai, India with the objective to determine WMSDs prevalence in fishing industry. MATERIALS AND METHODS: In this cross-sectional study, 110 randomly selected workers from fishing industry, India, Mumbai, Anonymous questionnaire was used to study prevalence of WMSDs.visual analogue scale used to assess intensity of pain. RESULTS: The results of NMQ revealed that WMSDs occurrence was high. The highest rates of WMSDs prevalence were reported in Low back(92.4%), Shoulder (64.8%) and Knee(31%) and Hand (25%). CONCLUSION: This study showed that maximum of the fishermen have musculoskeletal problem with the most common joint involved is low back and then followed by shoulder, knee, and hand. Ergonomic risk factor involved were found to be repeated pulling and throwing of the net as well as repeated bending forward action to lift heavy load and transfer that heavy load.

Effects of yoga on functional capacity and well being.

Yoga has proven beneficial effects on various health domains including musculoskeletal conditions, cardiopulmonary conditions through the practice of asana and pranayamas as well as on mental health, as it is known to enhance the body-and mind coordination. There is paucity of data on the effect of yoga on functional capacity in literature using 6 min walk test. The present study aims to look at the effect of yoga on 6-min walked distance, rating of perceived exertion (RPE), recovery time following the walk and state of well being. This is a hospital-based longitudinal study where 30 physiotherapy students of the age group 18 - 22 years of either sex were enrolled. Subjects having musculoskeletal problems, cardio respiratory disease and those who were not willing to volunteer were excluded They received Yoga intervention in form of Yogic practices which included a combination of asanas, pranayamas and omkar chanting for 1 h for 30 sessions. A baseline 6-min walk test was conducted on subjects and the 6-min walked distance, rating of perceived exertion (RPE) on modified Borg's scale were recorded. The baseline state of well-being was noted using the Warwick- Edinburgh mental well-being scale and similar recording was done post intervention after 30 sessions. Of the 30 subjects, there were no drop outs as these were committed college students. Of them, 24 were females and 6 were males with a mean age of 21.5 years SD 2.38. Statistically significant improvements were observed in 6-min walk distance (P value = 0.000), RPE (P value < 0.000), recovery time (P value < 0.000) and sense of well being score (P value < 0.000). Yoga practices are beneficial in improving the functional capacity in young healthy adults. Yoga can very well be incorporated in medical practice for increasing the patient's functional capacity, for those who have limitations in performing aerobic training due to various health reasons. The improved state of well being motivates the patients to adhere to yogic practices.

Effect of different types of music on exercise performance in normal individuals.

While exercising, people seem to enjoy listening to music believing that it relaxes them or helps give the necessary rhythm for exercise. But is music really beneficial? In view of different people listening to different types of music, this study was intended to assess effect of different types of music on exercise performance. 30 healthy female college students in the age group of 18 to 25 years were made to walk on the treadmill 3 times at one week interval: without music (A), with slow music (B), with fast music (C). Duration of exercise and rate of perceived exertion were recorded at the end of each session. The results showed an increase in the duration of exercise in Group B and Group C as compared to Group A and the increase was more in Group C as compared to Group B. It was observed that level of RPE was the same at the end of every exercise session. The reason for increase in exercise duration with music could be because of various factors like dissociation, arousal, motivation, etc. It can be thus suggested that exercises can be performed for longer duration with music than without music and the effect is more with fast music than with slow music. Also with music, the same level of exertion is perceived though the walking duration is considerably increased.

Identification of awkward postures that cause discomfort to Liquid Petroleum Gas workers in Mumbai, India.

BACKGROUND: Awkward, extreme and repetitive postures have been associated with work related musculoskeletal discomfort and injury to the lower back. Liquid Petroleum Gas (LPG) workers in India; that is the delivery men carry heavy cylinders on their shoulders and back. The cylinders come in commercial and residential form which range in weight from 14.2kgs, 16.2kgs, 19.2kgs, 32kgs, 40 kgs etc. They have a tedious schedule of 8 h/day and mostly associated with loading and unloading of the cylinders. Their job demands a high intensity of strength and power. They are exposed to high level of physical demands and relatively lesser amount of rest which makes them vulnerable to various injuries over a period of time. MATERIALS AND METHODS: 100 LPG workers (delivery men) were interviewed using the Ovako work assessment system OWAS posture code and action category system developed by ISMAIL et al.[10] was used. A battery of questions with specific stress was constructed and validated in the Department of Physiotherapy, Padmashree Dr D.Y Patil University, Nerul, Navi Mumbai, India. RESULTS: This study presented an ergonomic assessment of LPG workers. The results show that the workers work in awkward postures. They transfer the cylinders in poor postures with high velocity and motion repetitiveness thus subjecting their spine to greater amounts of compressive forces. Regarding to work discomfort survey questionnaire, the postures cause ill effects on their various body segments. Among them 90% fall in category 4 while loading the cylinder, that is the load by those postures have a very harmful effect on musculoskeletal, system-corrective action for improvement required immediately. And while unloading 70% fall in category 3, which are postures that have harmful effect on musculoskeletal system. Corrective actions should be done as soon as possible. Majority of workers also complained of severe injury to back-34%, shoulder-20%, knee-20%, neck-16%, and toes-10%. CONCLUSION: These findings provide a prima facie evidence of higher occupational stresses among the LPG workers because of identified specific stressors prevalent in their jobs and explore the possible intervention strategies for its reduction.