Therapeutic Interventions for Prevention of Musculoskeletal Pain Among Orthopedic Surgeons.

Orthopedic surgery is a physically demanding specialty. The factors contributing to musculoskeletal injury among surgeons often stem from positioning the patient, using non-ergonomic instruments, maintaining static postures, and performing repetitive movements. This article focuses on exercise techniques intended to combat the most common problematic static postures held during procedures. Each exercise explained in this article is organized into "preop," "intraop," and "postop" components. Preop includes strengthening movements, intraop provides postural recommendations, and postop focuses on mobilization and recovery. This article aims for efficient body conditioning, targeting the muscular posterior chain and supporting elements. [Orthopedics. 2024;47(4):e214-e216.].

Ergonomic interventions to reduce upper limb musculoskeletal pain during robotic surgery: a narrative review.

There is a high prevalence of upper limb musculoskeletal pain among robotic surgeons. Poor upper limb ergonomic positioning during robotic surgery occurs when the shoulders are abducted, and the elbows are lifted off the console armrest. The validated rapid upper limb assessment can quantify ergonomic efficacy. Surface electromyography and hand dynamometer assessment of strength are the most common methods to assess muscle fatigue. A literature review was performed to find evidence of ergonomic interventions which reduce upper limb musculoskeletal pain during robotic surgery. There is a paucity of studies which have reported on this topic. In other occupations, there is strong evidence for the use of resistance training to prevent upper extremity pain. Use of forearm compression sleeves, stretching, and massage may help reduce forearm fatigue. Microbreaks with targeted stretching, active ergonomic training, improved use of armrest, and optimal hand controller design have been shown to reduce upper limb musculoskeletal pain. Future studies should assess which interventions are beneficial in reducing surgeon upper limb pain during robotic surgery.

Increasing physical activity in the vehicle with an interactive seating system in a male sample.

An interactive seating system (IASS) was compared to a state-of-the-art massage seating system (MS) regarding the potential of reducing health risks from prolonged sitting in the vehicle. The study investigated if the systems (1) increase heart rate, which is associated with reduced metabolic and cardiovascular risks; (2) activate muscles with the potential to reduce musculoskeletal pain; (3) influence seating comfort and discomfort. The systems were compared in a passenger scenario in a laboratory study (30 male subjects). Only the use of the IASS significantly elevated the heart rate. Muscle activity showed tendencies to increase in the lower back only while using the MS. In comparison, the IASS activated all six captured muscles. Significantly less discomfort was found for the IASS compared to the MS. In comparison to the MS, the IASS showed a substantially higher potential for reducing health risks from static sitting in the vehicle.Practitioner summary: This laboratory study compared the effects of a novel automotive interactive seating system with those of a state-of-the-art massage seating system. Muscle activity, heart rate and discomfort indicated that the IASS has a significantly higher potential to reduce health risks associated with static seating in a vehicle.Abbreviations: AB: air bladder; AC: active condition; ADSS: active dynamic seating system; CLBP: chronic lumbar back pain; ECG: electrocardiography; EMG: electromyography; IASS: interactive seating system; MS: massage seating system; PC: passive condition; PDSS: passive dynamic seating system; RMS: rootmean-square; TI: time interval.

Intraoperative stretching microbreaks reduce surgery-related musculoskeletal pain in otolaryngologists.

OBJECTIVE: The purpose of this study was to examine the role intraoperative otolaryngology stretching microbreak (OSMB) has on musculoskeletal (MSK) pain and discomfort in otolaryngologists. BACKGROUND: Otolaryngology procedures subject surgeons to significant amounts of pain and strain over their years of training. MSK pain is a serious concern for otolaryngologists' career longevity as well as their general wellbeing. METHODS: Participants from two different hospitals and one private practice were recruited to participate in this study. An initial ergonomic survey was obtained to assess baseline MSK pain, and its subjective impact on operative performance. The participants then completed three control days without OSMB exercises, followed by three intervention days with OSMB exercises which were completed at 20-40 minute intervals. Preoperative and postoperative pain rating surveys were completed before and after each procedure and at the end of the day to determine changes in pain and/or discomfort. RESULTS: Ten otolaryngologists (50 % men, 50 % women; mean age 35.6 years) participated in this study. Half of the participants indicated that they were concerned their pain would limit their ability to operate in the future. 70 % of participants indicated that they have not attempted to treat this pain and 60 % did not try any stretching exercises outside the operating room (OR) to mitigate their symptoms. Participants reported neck, upper back, and lower back to be the primary MSK discomfort. OSMB improved participants' pain scores in neck, shoulders, hands, and lower back pain (p < 0.05). CONCLUSION: MSK pain has shown to be a serious concern for the ability of otolaryngologists to continue performing surgery in the future. OSMB may be an effective strategy that can be implemented by otolaryngologists intraoperatively to improve MSK pain and overall well being.

A Global Survey of Ergonomics Practice Patterns and Rates of Musculoskeletal Pain Among Urologists Performing Retrograde Intrarenal Surgery.

Purpose: Retrograde intrarenal surgery (RIRS) requires urologists to adopt an awkward body posture for long durations. Few urologists receive training in ergonomics despite the availability of ergonomic best practices utilized by other surgical specialties. We characterize ergonomic practice patterns and rates of musculoskeletal (MSK) pain among urologists performing RIRS. Methods: A web-based survey was distributed through the Endourological Society, the European Association of Urology, and social media. Surgeon anthropometrics and ergonomic factors were compared with ergonomic best practices. Pain was assessed with the Nordic Musculoskeletal Questionnaire (NMQ). Results: Overall, 519 of 526 participants completed the survey (99% completion rate). Ninety-three percent of urologists consider ergonomic factors when performing RIRS to reduce fatigue (68%), increase performance (64%), improve efficiency (59%), and reduce pain (49%). Only 16% received training in ergonomics. Residents/fellows had significantly lower confidence in ergonomic techniques compared with attending surgeons with any career length. Adherence to proper ergonomic positioning for modifiable factors was highly variable. On the NMQ, 12-month rates of RIRS-associated pain in ≥1 body part, pain limiting activities of daily living (ADLs), and pain requiring medical evaluation were 81%, 51%, and 29%, respectively. Annual case volume >150 cases (odds ratio [OR] 0.55 [0.35-0.87]) and higher adherence to proper ergonomic techniques (OR 0.67 [0.46-0.97]) were independently associated with lower odds of pain. Limitations include a predominantly male cohort, which hindered the ability to assess gender disparities in pain and ergonomic preferences. Conclusions: Adherence to ergonomic best practices during RIRS is variable and may explain high rates of MSK pain among urologists. These results underscore the importance of utilizing proper ergonomic techniques and may serve as a framework for establishing ergonomic guidelines for RIRS.

Systemic therapies for preventing or treating aromatase inhibitor-induced musculoskeletal symptoms in early breast cancer.

BACKGROUND: Adjuvant aromatase inhibitors (AI) improve survival compared to tamoxifen in postmenopausal women with hormone receptor-positive stage I to III breast cancer. In approximately half of these women, AI are associated with aromatase inhibitor-induced musculoskeletal symptoms (AIMSS), often described as symmetrical pain and soreness in the joints, musculoskeletal pain and joint stiffness. AIMSS may have significant and prolonged impact on women's quality of life. AIMSS reduces adherence to AI therapy in up to a half of women, potentially compromising breast cancer outcomes. Differing systemic therapies have been investigated for the prevention and treatment of AIMSS, but the effectiveness of these therapies remains unclear. OBJECTIVES: To assess the effects of systemic therapies on the prevention or management of AIMSS in women with stage I to III hormone receptor-positive breast cancer. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, WHO International Clinical Trials Registry Platform (ICTRP) and Clinicaltrials.gov registries to September 2020 and the Cochrane Breast Cancer Group (CBCG) Specialised Register to March 2021.  SELECTION CRITERIA: We included all randomised controlled trials that compared systemic therapies to a comparator arm. Systemic therapy interventions included all pharmacological therapies, dietary supplements, and complementary and alternative medicines (CAM). All comparator arms were allowed including placebo or standard of care (or both) with analgesia alone. Published and non-peer-reviewed studies were eligible. DATA COLLECTION AND ANALYSIS: Two review authors independently screened studies, extracted data, and assessed risk of bias and certainty of the evidence using the GRADE approach. Outcomes assessed were pain, stiffness, grip strength, safety data, discontinuation of AI, health-related quality of life (HRQoL), breast cancer-specific quality of life (BCS-QoL), incidence of AIMSS, breast cancer-specific survival (BCSS) and overall survival (OS). For continuous outcomes, we used vote-counting by reporting how many studies reported a clinically significant benefit within the confidence intervals (CI) of the mean difference (MD) between treatment arms, as determined by the minimal clinically importance difference (MCID) for that outcome scale. For dichotomous outcomes, we reported outcomes as a risk ratio (RR) with 95% CI. MAIN RESULTS: We included 17 studies with 2034 randomised participants. Four studies assessed systemic therapies for the prevention of AIMSS and 13 studies investigated treatment of AIMSS. Due to the variation in systemic therapy studies, including pharmacological, and CAM, or unavailable data, meta-analysis was limited, and only two trials were combined for meta-analysis. The certainty of evidence for all outcomes was either low or very low certainty. Prevention studies The evidence is very uncertain about the effect of systemic therapies on pain (from baseline to the end of the intervention; 2 studies, 183 women). The two studies, investigating vitamin D and omega-3 fatty acids, showed a treatment effect with 95% CIs that did not include an MCID for pain. Systemic therapies may have little to no effect on grip strength (RR 1.08, 95% CI 0.37 to 3.17; 1 study, 137 women) or on women continuing to take their AI (RR 0.16, 95% 0.01 to 2.99; 1 study, 147 women). The evidence suggests little to no effect on HRQoL and BCS-QoL from baseline to the end of intervention (the same single study; 44 women, both quality of life outcomes showed a treatment effect with 95% CIs that did include an MCID). The evidence is very uncertain for outcomes assessing incidence of AIMSS (RR 0.82, 95% CI 0.63 to 1.06; 2 studies, 240 women) and the safety of systemic therapies (4 studies, 344 women; very low-certainty evidence). One study had a US Food and Drug Administration alert issued for the intervention (cyclo-oxygenase-2 inhibitor) during the study, but there were no serious adverse events in this or any study. There were no data on stiffness, BCSS or OS. Treatment studies The evidence is very uncertain about the effect of systemic therapies on pain from baseline to the end of intervention in the treatment of AIMSS (10 studies, 1099 women). Four studies showed an MCID in pain scores which fell within the 95% CI of the measured effect (vitamin D, bionic tiger bone, Yi Shen Jian Gu granules, calcitonin). Six studies showed a treatment effect with 95% CI that did not include an MCID (vitamin D, testosterone, omega-3 fatty acids, duloxetine, emu oil, cat's claw).  The evidence was very uncertain for the outcomes of change in stiffness (4 studies, 295 women), HRQoL (3 studies, 208 women) and BCS-QoL (2 studies, 147 women) from baseline to the end of intervention. The evidence suggests systemic therapies may have little to no effect on grip strength (1 study, 107 women). The evidence is very uncertain about the safety of systemic therapies (10 studies, 1250 women). There were no grade four/five adverse events reported in any of the studies. The study of duloxetine reported more all-grade adverse events in this treatment group than comparator group. There were no data on the incidence of AIMSS, the number of women continuing to take AI, BCCS or OS from the treatment studies. AUTHORS' CONCLUSIONS: AIMSS are chronic and complex symptoms with a significant impact on women with early breast cancer taking AI. To date, evidence for safe and effective systemic therapies for prevention or treatment of AIMSS has been minimal. Although this review identified 17 studies with 2034 randomised participants, the review was challenging due to the heterogeneous systemic therapy interventions and study methodologies, and the unavailability of certain trial data. Meta-analysis was thus limited and findings of the review were inconclusive. Further research is recommended into systemic therapy for AIMSS, including high-quality adequately powered RCT, comprehensive descriptions of the intervention/placebo, and robust definitions of the condition and the outcomes being studied.

Effect of Tart Cherry on Aromatase Inhibitor-Induced Arthralgia (AIA) in Nonmetastatic Hormone-Positive Breast Cancer Patients: A Randomized Double-Blind Placebo-Controlled Trial.

BACKGROUND: Aromatase Inhibitor induced Arthralgia (AIA) can cause noncompliance leading to decreased breast-cancer survival. Effective interventions for AIA are limited. Tart cherry (TC) showed beneficial effect on musculoskeletal pain. 48 patients (Pts) randomized to TC versus placebo over 6 weeks, TC (23pts) had 34.7% mean pain decrease versus 1.4% in Placebo (25pts). TC can improve AIA in nonmetastatic breast-cancer patients. METHODS: Randomized, placebo-controlled, double-blind trial. Eligible patients with NMHPBC on AI for at least 4 weeks were randomized to TC concentrate [50 tart cherries] vs. placebo (P) [syrup] in 1:1 model. Patients instructed to consume 1 Oz of concentrate in 8 Oz water daily for 6 weeks, and document their pain intensity at baseline, weekly and at study completion in a diary using Visual Analog Scale (VAS), with 0 mm indicating no pain, and 100 mm indicating highest pain. RESULTS: Sixty patients were enrolled. Two patients did not complete the study due to diarrhea, and 10 patients were noncompliant. Forty-eight patients were included in the final analysis. TC group (23 pts) had 34.7% mean decrease in pain compared to 1.4% in P group (25 pts). This difference was statistically significant (Mann-Whitney U Test, P = .034). CONCLUSIONS: Tart cherry can significantly improve AIA in nonmetastatic breast cancer patient.

Surgeon Positioning During Awake Laryngeal Surgery: An Ergonomic Analysis.

OBJECTIVES: While it is acknowledged that otolaryngologists performing microlaryngeal surgery can develop musculoskeletal symptoms due to suboptimal body positioning relative to the patient, flexible laryngoscopy and awake laryngeal surgeries (ALSs) can also pose ergonomic risk. This prospective study measured the effects of posture during ergonomically good and bad positions during laryngoscopy using ergonomic analysis, skin-surface electromyography (EMG), and self-reported pain ratings. STUDY DESIGN: Prospective cohort study. METHODS: Eight participants trained in laryngoscopy assumed four ergonomically distinct standing positions (side/near, side/far, front/near, front/far) at three different heights (neutral-top of patient's head in line with examiner's shoulder, high-6 inches above neutral, and low-6 inches below neutral) in relation to a simulated patient. Participants' postures were analyzed using the validated Rapid Upper Limb Assessment (RULA, 1 [best] to 7 [worst]) tool for the 12 positions. Participants then simulated ALS for 10 minutes in a bad position (low-side-far) and a good position (neutral-front-near) with 12 EMG sensors positioned on the limbs and torso. RESULTS: The position with the worst RULA score was the side/near/high (7.0), and the best was the front/near/neutral (4.5). EMG measurements revealed significant differences between simulated surgery in the bad and good positions, with bad position eliciting an average of 206% greater EMG root-mean-squared magnitude across all sampled muscles compared to the good posture (paired t-test, df = 7, P < .01), consistent with self-reported fatigue/pain when positioned poorly. CONCLUSION: Quantitative and qualitative measurements demonstrate the impact of surgeon posture during simulated laryngoscopy and suggest ergonomically beneficial posture that should facilitate ALSs. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:2752-2758, 2021.

Use of Patient Abdominal Compression Device Reduces Staff Musculoskeletal Pain Associated With Supporting Colonoscopy: Results From a Randomized Controlled Trial.

Work-related musculoskeletal disorders occur frequently among the endoscopy staff, and patient-handling duties involved with colonoscopy-applying manual pressure and repositioning patients-are particularly physically demanding. This study explored whether the use of a lower abdominal compression device (ColoWrap), previously shown to reduce the need for manual pressure and patient repositioning, would diminish the frequency of staff-reported musculoskeletal pain. A randomized, blinded, sham-controlled clinical trial was performed at the University of North Carolina Hospitals. Three hundred fifty patients had either ColoWrap or a sham device applied before colonoscopy. The primary outcome was the frequency of staff-reported musculoskeletal pain after assisting with colonoscopy. In the intention-to-treat analysis, which included procedures in which ColoWrap was removed, there was no statistical difference in the frequency of staff-reported pain in the control versus ColoWrap arm (4.6% vs. 3.4% of procedures, p = .59). However, when ColoWrap was used as directed (e.g., remained in place for the duration of the procedure), the frequency of staff-reported musculoskeletal pain was significantly reduced (4.6% vs. 0.7% of procedures, p = 0.04). Use of ColoWrap as directed was also found to be independently associated with reduced odds of staff-reported pain relative to the sham arm (OR = 0.12; 95% CI [0.02, 0.95]). When used as directed, ColoWrap reduced the frequency of musculoskeletal pain experienced related to assisting with colonoscopy and may reduce the risk of musculoskeletal disorders and injuries among the endoscopy staff.

Surgical ergonomics for urologists: a practical guide.

Poor ergonomics in the operating room can have detrimental effects on a surgeon's physical, psychological and economic well-being. This problem is of particular importance to urologists who are trained in nearly all operative approaches (open, laparoscopic, robotic-assisted, microscopic and endoscopic surgery), each with their own ergonomic considerations. The vast majority of urologists have experienced work-related musculoskeletal pain or injury at some point in their career, which can result in leaves of absence, medical and/or surgical treatment, burnout, changes of specialty and even early retirement. Surgical ergonomics in urology has been understudied and underemphasized. In this Review, we characterize the burden of musculoskeletal injury in urologists and focus on various ergonomic considerations relevant to the urology surgeon. Although the strength of evidence remains limited in this space, we highlight several practical recommendations stratified by operative approach that can be incorporated into practice without interrupting workflow whilst minimizing injury to the surgeon. These recommendations might also serve as the foundation for ergonomics training curricula in residency and continuing medical education programmes. With improved awareness of ergonomic principles and the sequelae of injury related to urological surgery, urologists can be more mindful of their operating room environment and identify ways of reducing their own symptoms and risk of injury.

The effectiveness of ergonomics interventions in reducing upper limb work-related musculoskeletal pain and dysfunction in sonographers, surgeons and dentists: a systematic review.

The aim of this systematic review was to summarise the effects of ergonomics interventions on work-related upper limb musculoskeletal pain and dysfunction, and on productivity in sonographers, surgeons and dentists. A total of 31 studies were included. All studies reported effects on upper limb pain. Nine studies reported effects on dysfunction and only two studies reported effects on productivity. Moderately strong evidence in reducing upper limb pain was found for instigation of microbreaks into long duration surgical procedures, and the use of wider, lighter handles in dental instruments. Moderate evidence was also found for use of prismatic glasses and favourable positioning in reducing upper limb pain. Weak, inconsistent or no evidence was found for all other ergonomics interventions in reducing upper limb pain and dysfunction and increasing productivity. The lack of high quality research, particularly in sonographers and in the outcome of productivity, should be addressed. Practitioner summary: This systematic review investigates the effectiveness of ergonomics interventions on upper limb pain, dysfunction and productivity in sonographers, dentists and surgeons. Instigation of microbreaks during long duration procedures and the use of wider, lighter instrument handles were most effective in reducing upper limb work-related pain. Abbreviations: ANOVA: analysis of variance; CLS: conventional laparoscopic surgery; DMAIC: define, measure, analyze, improve and control; GRADE: grading of recommendations, assessment, development and evaluations; HD: high definition; PRISMA: preferred reporting items for systematic reviews and meta-analyses; PROSPERO: The International Prospective Register of Systematic Reviews; RCT: randomised control trial; SILS: single incision laparoscopic surgery; VITOM: video telescopic operative microscope; WNSWLHD: Western New South Wales Local Health District; WMSD: work related musculoskeletal disorder.

Distúrbios osteomusculares e ações para reduzir a ocorrência em trabalhadores de enfermagem / Musculoskeletal disorders and actions to reduce the occurrence in nursing staff / Trastornos musculoesqueléticos y acciones para reducir la ocurrencia en trabajadores de enfermería

Objetivo: identificar a presença de distúrbios osteomusculares relacionados ao trabalho nos trabalhadores de enfermagem de uma unidade de clínica médica e construir juntos aos trabalhadores propostas para reduzir a ocorrência dos distúrbios osteomusculares no ambiente de trabalho. Método: estudo transversal com 31 trabalhadores de enfermagem de uma clínica médica, que responderam uma ficha de dados sóciodemográfico e profissional e do Questionário Nórdico de Sintomas Osteomusculares. Resultados: os trabalhadores exercem suas atividades laborais com dores osteomusculares, sendo as regiões corpóreas mais prevalentes a lombar e a porção superior da coluna e ombros. Apesar disso, nem todos se afastam do trabalho ou procuram assistência terapêutica. As ações de redução dos distúrbios osteomusculares levantadas foram categorizadas em três dimensões: indivíduo, equipe e instituição. Conclusão: os trabalhadores apresentam distúrbios osteomusculares, principalmente, nas costas. As ações de redução de sua ocorrência perpassam pelo comportamento individual às mudanças estruturais e provisão de equipamentos de trabalho.

Objective: to identify the presence of work-related musculoskeletal disorders in nursing staff at an internal medicine unit and, jointly with the staff, to build proposals to reduce the occurrence of musculoskeletal disorders in the workplace. Method: in this cross-sectional study, 31 nursing staff of a medical clinic answered a socio-demographic and professional data sheet and the Nordic Musculoskeletal Questionnaire. Results: staff performed their work activities with musculoskeletal pain, the most prevalent body regions being: lower back and upper spine and shoulders. Nonetheless, not everyone would take time off work or seek therapeutic care. The actions suggested to reduce musculoskeletal disorders were categorized into three dimensions: individual, team and institutional. Conclusion: staff had musculoskeletal disorders, mainly in the back. Actions proposed to reduce pain ranged from individual behavior to structural changes and provision of work equipment.

Objetivo: identificar la presencia de trastornos musculoesqueléticos relacionados con el trabajo en el personal de enfermería en una unidad de medicina interna y, conjuntamente con el personal, elaborar propuestas para reducir la aparición de trastornos musculoesqueléticos en el lugar de trabajo. Método: en este estudio transversal, 31 miembros del personal de enfermería de una clínica médica respondieron una hoja de datos sociodemográficos y profesionales y el Cuestionario musculoesquelético nórdico. Resultados: el personal realizó sus actividades laborales con dolor musculoesquelético, siendo las regiones corporales más frecuentes: la parte baja de la espalda y la parte superior de la columna y los hombros. Sin embargo, no todos tomarían tiempo libre del trabajo o buscarían atención terapéutica. Las acciones sugeridas para reducir los trastornos musculoesqueléticos se clasificaron en tres dimensiones: individual, de equipo e institucional. Conclusión: el personal tenía trastornos musculoesqueléticos, principalmente en la espalda. Las acciones propuestas para reducir el dolor iban desde el comportamiento individual hasta los cambios estructurales y la provisión de equipos de trabajo.

Exercise therapies for preventing or treating aromatase inhibitor-induced musculoskeletal symptoms in early breast cancer.

BACKGROUND: Survival for stage I to III, hormone receptor-positive, breast cancer has substantially improved over time due to advances in screening, surgery and adjuvant therapy. However many adjuvant therapies have significant treatment-related toxicities, which worsen quality of life for breast cancer survivors. Postmenopausal women with hormone receptor-positive breast cancer are now prescribed aromatase inhibitors (AI) as standard, with longer durations of therapy, up to 10 years, being considered for certain women. AI treatment is associated with a high incidence of AI-induced musculoskeletal symptoms (AIMSS), often described as symmetrical pain and soreness in the joints, musculoskeletal pain and joint stiffness. AIMSS reduces compliance with AI therapy in up to one half of women undergoing adjuvant AI therapy, potentially compromising breast cancer outcomes. Exercise has been investigated for the prevention and treatment of AIMSS but the effect of this intervention remains unclear. OBJECTIVES: To assess the effects of exercise therapies on the prevention or management of aromatase inhibitor-induced musculoskeletal symptoms (AIMSS) in women with stage I to III hormone receptor-positive breast cancer. SEARCH METHODS: We searched Cochrane Breast Cancer's Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases up to 13 December 2018. We also searched two conference proceedings portals and two clinical trials registries for ongoing studies or unpublished trials, or both, in August 2019. We also reviewed reference lists of the included studies. SELECTION CRITERIA: We included randomised controlled trials that compared exercise versus a comparator arm. We did not impose any restriction on the comparator arm, which could include an alternative type of exercise, no exercise or a waiting list control. Both published and non-peer-reviewed studies were eligible. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data, assessed risk of bias and certainty of the evidence using the GRADE approach. The outcomes investigated were pain, joint stiffness, grip strength, health-related quality of life, cancer-specific quality of life, adherence to AI therapy, adverse events, incidence of AIMSS, breast cancer-specific survival and overall survival. For continuous outcomes that were assessed with the same instrument, we used the mean difference (MD); for those outcomes that used different instruments, we used the standardised mean difference (SMD) for the analysis. For dichotomous outcomes, we reported outcomes as an odds ratio (OR). MAIN RESULTS: We included seven studies with 400 randomised participants; one study assessed exercise for preventing AIMSS and six studies assessed treating AIMSS. For preventing AIMSS, the single study reported no difference in pain scores, grip strength or compliance to taking AI medication between groups. Data values were not provided in the study and no other outcomes were reported. For managing AIMSS, we found that the evidence for the effect of exercise therapies on overall change in worst pain scores was very uncertain (SMD -0.23, 95% confidence interval (CI) -0.78 to 0.32; 4 studies, 284 women; very low-certainty evidence). The evidence suggested that exercise therapies result in little to no difference in overall change in stiffness scores (Western Ontario McMasters Universities Osteoarthritis Index (WOMAC) stiffness score MD -0.76, 95% CI -1.67 to 0.15 and Visual Analogues Scale (VAS) stiffness score MD -0.42, 95% CI -2.10 to 1.26; 1 study, 53 women; low-certainty evidence). The evidence was very uncertain for the outcomes of overall change in grip strength (MD 0.30, 95% CI -0.55 to 1.15; 1 study, 83 women; very low-certainty evidence); overall change in health-related quality of life (subscales of SF-36 tool ranged from least benefit of MD 1.88, 95% CI -2.69 to 6.45 to most benefit of MD 9.70, 95% CI 1.67 to 17.73; 2 studies, 123 women, very low-certainty evidence); overall change in cancer-specific quality of life (MD 4.58, 95% CI -0.61 to 9.78; 2 studies, 136 women; very low-certainty evidence); and adherence to aromatase inhibitors (OR 2.43, 95% CI 0.41 to 14.63; 2 studies, 224 women; very low-certainty evidence). There were no adverse events identified across four studies in either arm (0 events reported; 4 studies; 331 participants; low-certainty evidence). There were no data reported on incidence of AIMSS, breast cancer-specific survival or overall survival. AUTHORS' CONCLUSIONS: Given the wide-ranging benefits of exercise for people affected by cancer, it was surprising that this review provided no clear evidence of benefit for exercise therapies in women with early breast cancer with AIMSS. This review only yielded seven eligible studies with 400 participants, which is likely to have underpowered the findings. The meta-analysis was challenging due to the considerable heterogeneity amongst the trials, with a wide range of exercise regimens and follow-up periods. Despite these inconclusive findings, exercise needs to be part of routine care for women with breast cancer due to its wide-ranging benefits. Future research in this area would be enhanced with further understanding of the mechanism of AIMSS, a single clear definition of the condition, and phase III randomised controlled trials that are adequately powered to test targeted exercise interventions on the key clinical outcomes in this condition.

Supporting Surgical Teams: Identifying Needs and Barriers for Exoskeleton Implementation in the Operating Room.

OBJECTIVE: The objective of this study was to identify potential needs and barriers related to using exoskeletons to decrease musculoskeletal (MS) symptoms for workers in the operating room (OR). BACKGROUND: MS symptoms and injuries adversely impact worker health and performance in surgical environments. Half of the surgical team members (e.g., surgeons, nurses, trainees) report MS symptoms during and after surgery. Although the ergonomic risks in surgery are well recognized, little has been done to develop and sustain effective interventions. METHOD: Surgical team members (n = 14) participated in focus groups, performed a 10-min simulated surgical task with a commercial upper-body exoskeleton, and then completed a usability questionnaire. Content analysis was conducted to determine relevant themes. RESULTS: Four themes were identified: (1) characteristics of individuals, (2) perceived benefits, (3) environmental/societal factors, and (4) intervention characteristics. Participants noted that exoskeletons would benefit workers who stand in prolonged, static postures (e.g., holding instruments for visualization) and indicated that they could foresee a long-term decrease in MS symptoms with the intervention. Specifically, raising awareness of exoskeletons for early-career workers and obtaining buy-in from team members may increase future adoption of this technology. Mean participant responses from the System Usability Scale was 81.3 out of 100 (SD = 8.1), which was in the acceptable range of usability. CONCLUSION: Adoption factors were identified to implement exoskeletons in the OR, such as the indicated need for exoskeletons and usability. Exoskeletons may be beneficial in the OR, but barriers such as maintenance and safety to adoption will need to be addressed. APPLICATION: Findings from this work identify facilitators and barriers for sustained implementation of exoskeletons by surgical teams.

Perturbações músculo-esqueléticas em adolescentes: estudo da prevalência e dos fatores determinantes / Trastornos musculoesqueléticos en adolescentes: estudio de prevalencia y factores determinantes / Musculoskeletal disorders in adolescents: a study on prevalence and determining factors

Resumo Objetivo Identificar a prevalência das perturbações músculo-esqueléticas em adolescentes e analisar a sua relação com variáveis sociodemográficas, antropométricas e contextuais. Métodos Conceptualizou-se um estudo observacional, transversal, descritivo/relacional de cariz quantitativo, que envolveu 632 adolescentes de seis agrupamentos de escolas das zonas centro e norte de Portugal, com média de idades de 13,36 anos. O protocolo de colheita de dados integrava questões de cariz sociodemográfico, antropométrico, contextual e ainda o "Questionário Nórdico Músculo-Esquelético" para avaliar as perturbações músculo-esqueléticas. Resultados Os dados mostraram que 47,4% dos adolescentes referem perturbação músculo-esqueléticas nos últimos 3 meses, localizando-se estas aos níveis dos ombros (27,8%), região dorsal (25,3%), coxa/anca (26,1%), pescoço (23,4%), zona lombar (22,8%) e joelhos (19,6%). Verificou-se ainda, que as perturbações músculo-esqueléticas são mais prevalentes nos adolescentes do género feminino, naqueles que gastam mais tempo por dia a ver televisão e ainda nos que se deslocam para a escola a pé ou de bicicleta. Conclusão A prevalência das perturbações músculo-esqueléticas nos adolescentes é elevada, tem origem multicausal, tornando-se imperativa a implementação de intervenções de prevenção e readaptação promotoras de um funcionamento músculo-esquelético otimizado.

Resumen Objetivos Identificar la prevalencia de trastornos musculoesqueléticos en adolescentes y analizar su relación con variables sociodemográficas, antropométricas y contextuales. Métodos Se conceptualizó un estudio observacional, transversal, descriptivo/relacional de aspecto cuantitativo, que incluyó 632 adolescentes de seis agrupamientos de escuelas de la zona centro y norte de Portugal, con promedio de edad de 13,36 años. El protocolo de recolección de datos incluyó cuestiones de aspecto sociodemográfico, antropométrico, contextual e, inclusive, el "Cuestionario Nórdico Musculoesquelético" para evaluar los trastornos musculoesqueléticos. Resultados Los datos mostraron que el 47,4% de los adolescentes señalan trastornos musculoesqueléticos en los últimos 3 meses, localizados en el nivel de los hombros (27,8%), región dorsal (25,3%), muslo/cadera (26,1%), cuello (23,4%), zona lumbar (22,8%) y rodillas (19,6%). Además, se verificó que los trastornos musculoesqueléticos tienen mayor prevalencia en adolescentes de género femenino, en los que pasan más tiempo por día viendo televisión y en los que van a la escuela caminando o en bicicleta. Conclusión La prevalencia de los trastornos musculoesqueléticos en adolescentes es elevada, tiene origen multicausal, por lo que se torna imperativa la implementación de intervenciones de prevención y readaptación que promuevan un funcionamiento musculoesquelético optimizado.

Abstract Objective To identify the prevalence of musculoskeletal disorders in adolescents, and to analyze this prevalence relationship with sociodemographic, anthropometric and contextual variables. Methods An observational, cross-sectional, descriptive/relational study with quantitative approach was conceptualized, involving 632 adolescents with mean age of 13.36 from six school groups from Central and North Portugal. Data collection protocol included questions of sociodemographic, anthropometric and contextual nature, and also the "Nordic Musculoskeletal Questionnaire" to assess musculoskeletal disorders. Results Data showed that 47.4% of adolescents mentioned musculoskeletal disorders within the last 3 months, located in the shoulders (27.8%), dorsal region (25.3%), thigh/hips (26.1%), neck (23.4%), lumbar region (22.8%), and knees (19.6%). We found that musculoskeletal disorders are more prevalent in female adolescents, and among those who spend longer time watching television per day, and also those who go to school by foot or bicycle. Conclusion The prevalence of musculoskeletal disorders in adolescents is high and has multicausal origin, turning imperative the implementation of preventive and readapted actions to promote a better musculoskeletal function.

Rib osteosynthesis is a safe and effective treatment and leads to a significant reduction of trauma associated pain.

PURPOSE: The usefulness of chest wall stabilization after blunt chest wall trauma with unstable rib fractures has recently been intensely discussed. Thereby, the surgical approach seems to influence outcome, mortality and the long-term complication rate including chronic chest pain, thoracic deformity and quality of life. Here, we present the outcome after surgical stabilization of unstable rib fractures using intramedullary splints and plate osteosynthesis. METHODS: n = 50 patients were enrolled in this trial. Surgical stabilization was performed using intramedullary splints and/or plate osteosynthesis. Video-assisted thoracoscopy was performed in all patients for the inspection of the thoracic cavity and to exactly localize the fractured ribs. The pre- and postoperative pain course was documented using the visual analog scale. RESULTS: A total of n = 50 patients (10 females, mean age 63 years) were included into the analysis. All patients presented with traumatic serial rib fractures with a mean of 3 fractured ribs (range 2-8 ribs) and an unstable thorax wall. Rib osteosynthesis was performed using intramedullary splints (n = 17 patients), locking plates (n = 17 patients), or a combined use of both procedures (n = 16 patients). Mean operating time was 80 min (31-161 min). No major complications were seen intra- and postoperatively. Mean hospital stay was 8 ± 2 days (2-21 days). In all patients, excellent chest wall stability was achieved. Moreover, a significant reduction of pain was observed (2.6 ± 0.3 postoperatively vs. 8 ± 1.15 preoperatively, p < 0.0001) already during the hospital stay. CONCLUSIONS: Rib osteosynthesis is a safe and effective treatment option for patients with unstable rib fractures after blunt chest wall trauma. It leads to a significant reduction of the trauma-associated pain caused by the rib fractures and supports a quick recovery of the patients.

Confiabilidade intra e interexaminador do questionário Perfil do Estilo de Vida Individual (PEVI) em indivíduos com dor musculoesquelética / Confiabilidad intra e interevaluador del cuestionario Perfil de Estilo de Vida Individual (PEVI) en sujetos con dolor musculoesquelética / Intra- and inter-rater reliability of the Individual Lifestyle Profile (ILP) questionnaire for individuals with musculoskeletal pain

RESUMO O objetivo do estudo foi testar todas as propriedades de confiabilidade do Perfil do Estilo de Vida Individual (PEVI) em pacientes com dor musculoesquelética. Participaram desse estudo 105 pacientes com dor musculoesquelética, recrutados de um serviço público de fisioterapia de nível secundário. O PEVI foi aplicado pelo Examinador 1 na avaliação inicial e pelo Examinador 2 após uma hora. Após três a sete dias da avaliação inicial, o Examinador 1 reaplicou o PEVI. O PEVI e seus componentes apresentaram consistência interna de 0,27 a 0,61 e valores de confiabilidade intra e interexaminador de moderado a excelente (CCI=0,68 a 0,90) e de moderado a quase perfeito (K=0,59 a 0,83). A porcentagem de concordância foi de 61% a 98%, o EPM do PEVI foi de 4,1 pontos e a MMD foi de 5,7 pontos. Concluímos que o PEVI é um instrumento confiável para avaliar o estilo de vida de pacientes com dor musculoesquelética.

RESUMEN El objetivo del estudio fue poner a prueba todas las propiedades de confiabilidad del Perfil de Estilo de Vida Individual (PEVI) en pacientes con dolor musculoesquelético. Participaron en este estudio 105 pacientes con dolor musculoesquelético, provenientes de servicios públicos de fisioterapia de nivel secundario. El evaluador 1 aplicó el PEVI en la evaluación inicial, y el evaluador 2 lo aplicó después de una hora. Después de 3 a 7 días de evaluación inicial, el evaluador 1 reaplicó el PEVI. La consistencia interna del PEVI y sus componentes fue de 0,27 a 0,61; y los valores de confiabilidad intra e interevaluador fueron de moderada a excelente (CCI=0,68 a 0,9), y de moderada a casi perfecta (K=0,59 a 0,83). El porcentaje de concordancia fue de entre un 61% y un 98%, el EPM del PEVI fue de 4,1 puntos, y el CMD fue de 5,7 puntos. Se concluye que el PEVI es un instrumento confiable para evaluar los estilos de vida de pacientes con dolor musculoesquelético.

ABSTRACT The aim of this study was to test all the reliability properties of the Individual Lifestyle Profile (ILP) in patients with musculoskeletal pain. A total of 105 patients with musculoskeletal pain participated in this study after being recruited from a public secondary physical therapy care. ILP was applied by Rater 1 at the initial assessment and by Rater 2 after one hour. After three to seven days of the initial assessment, Rater 1 reapplied ILP. ILP and its components showed internal consistency from 0.27 to 0.61 and intra- and inter-rater reliability values from moderate to excellent (ICC=0.68 to 0.90) and from moderate to almost perfect (K=0.59 to 0.83). Percent agreement was 61% to 98%, the SEM of ILP was 4.1 points and the MDC was 5.7 points. We conclude that ILP is a reliable instrument to assess the lifestyle of patients with musculoskeletal pain.

The Impact of Ergonomics on Recruitment to Surgical Fields: A Multi-Institutional Survey Study.

BACKGROUND: Awareness of ergonomics in surgery is growing, but whether musculoskeletal (MSK) injuries in surgery influence trainee career choices remains unknown. This study aimed to characterize medical students' MSK pain during surgical rotations and determine whether ergonomics influence student interest in surgical fields. METHODS: An online survey was administered to medical students in North Carolina. Students were asked about specialty interest, MSK pain on surgical rotations, and deterrents from surgical fields. Students were exposed to literature about ergonomics in surgery then queried again about relative specialty interest (medical versus surgical). Differences in specialty interest before and after the exposure were compared using a Wilcoxon signed-rank test. RESULTS: Of 243 participants, 44.0% were interested in pursuing a surgical specialty. Overall, 75.3% reported MSK pain during their surgical rotation, with the average daily pain score highest during surgery rotations compared to all other clinical rotations. The worst pain was reported in the feet and low back while "standing in the operating room" (81.2%) or "retracting" (59.4%). Among students initially interested in surgery but whose interest changed to a medical specialty during medical school, "physical demands of the field" was a common deterrent (36.4%). After exposure to literature regarding the incidence of MSK injuries in surgery, student interest in surgical fields on a 10-point scale significantly decreased (average -0.5 points; P < 0.01). CONCLUSIONS: High incidence of MSK injury among surgeons may be one factor deterring medical students from surgical careers. Ergonomic interventions may be important both to improve surgeon longevity and maintain the surgical workforce.