Ergonomic Strategies and Workplace-Related Musculoskeletal Injury Amongst Endoscopists: A Systematic Review and Meta-Analysis

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Institutions: Washington University in St Louis, USA; Tower Health, USA; Saint Louis University, USA; The University of North Carolina at Chapel Hill, USA; Houston Methodist, USA. Disclosure compliance: I understand. Participant disclosure: Parth Desai: NO financial relationship with a commercial interest; Ameya Deshmukh: NO financial relationship with a commercial interest; Kelly Hathorn: NO financial relationship with a commercial interest; Ahmad Najdat Bazarbashi: NO financial relationship with a commercial interest; Thomas McCarty: NO financial relationship with a commercial interest. Background: Endoscopists are prone to occupational injury due to high procedural volumes, repetitive movements, and a lack of foundational ergonomic education. This may result in workload reduction, lower quality medical care, and increased disability. The aim of this study was to conduct a systematic review and meta-analysis to assess the use of ergonomic strategies and prevalence of musculoskeletal injury amongst endoscopists. Methods: A systematic review was conducted using individualized search strategies for PubMed, EMBASE, Web of Science, and Cochrane Library databases from inception through November 2022 in accordance with PRISMA and MOOSE guidelines. Demographics and outcome measures such as survey responses to ergonomic strategies and the prevalence of specific musculoskeletal injuries were included. This was a cumulative meta-analysis performed using pooled proportions with rates estimated using random effects models. Heterogeneity was assessed with I2 statistics and publication bias by funnel plot asymmetry. Further meta-regression analyses were performed comparing outcomes based on country of practice. Results: A total of 13 studies, all cross-sectional surveys, totaling 4057 patients were included in this meta-analysis. Mean age of respondents was 50.38 ±2.97 years. Males were 71.7% of respondents with a mean BMI of 25.60 ±0.85 kg/m2. The most common ergonomic strategies were the use of adjustable bed/table [54.11% (95% CI 27.49-78.57)] and eye-level/adjustable monitor height [58.00% (95% CI 40.66-73.57)]. Respondents reported infrequent use of stretching/warm up exercises [14.86% (95% CI 8.60-24.45)], routine breaks between cases [18.10% (95% CI 6.86-39.89)], orthopedic/support shoewear [12.06% (95% CI 6.72-20.71)], and anti-fatigue floor mats [15.71% (95% CI 8.96-26.07)]. General back injury was the most common reported injury [43.20% (95% CI 36.42-50.24)], followed by neck [20.62 (95% CI 14.76-28.05)], and thumb injury [19.65% (95% CI 14.67-25.82)]. Leave of absence was reported amongst 8.11% (95% CI 6.03-10.83) of endoscopists. Meta regression comparing outcomes from the United States versus other countries found no differences in pooled rate of neck injury (p=0.156), back injury (p=0.381), elbow injury (p=0.323) or leave of absence (p=0.468). However, the rate of shoulder injury and wrist injury was less common among United States endoscopists [OR: 0.31 (95% CI 0.12-0.84); p=0.021 and OR: 0.40 (95% CI 0.20-0.77); p=0.006, respectively]. Conclusion: Musculoskeletal injury is common among endoscopists, and may lead to significant health disability and economic burden. While use of adjustable equipment was reported in over half of respondents, other ergonomic strategies were not highly employed. Further studies are warranted to assess strategies such as ergonomics education in effort to lower endoscopy-related musculoskeletal injury. [Formula presented] Table 1: Demographics and Outcomes of Surveyed Endoscopists.

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Gastrointestinal Endoscopy




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